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Your Guide to Pregnancy

Office Info

Mon-Thursday 8:30-5:00pm 

Friday 8:30-1:30pm 

We are closed Sat and Sunday 

5605 W Eugie Ave Ste 102 

Glendale Az 85304 

Phone: 602-298-8977

Fax: 602-298-1782

 

Appointment Schedule 

 

Your First Visit/Confirmation of Your Pregnancy

When you come to the office for your first visit, we ask that you bring your ID and insurance card. During this visit, you will have a physical exam including a pap smear if needed. An ultrasound may be done or ordered.

 

After Your First Visit

Between 8 and 28 weeks, we would like you to schedule a visit every four weeks. Around 30 weeks, your visits will increase to every two weeks, then once a week from 36 weeks until delivery. We will request to see you more frequently if you are high risk. During each visit, you will have your weight, blood pressure, and fetal heartbeat checked. Several additional tests are done at scheduled times throughout your pregnancy.

 

Postpartum Visit

It is very important to follow up with our office in the postpartum period. Instructions will be given when you leave the hospital regarding when you should follow up, but it is usually between 6 weeks after delivery. Health concerns during your pregnancy, your healing process, any emotional concerns, and birth control needs will be addressed during your visit(s).

 

 

Routine Testing 

Early Pregnancy Testing

Early in pregnancy, several tests are recommended to evaluate your health and look for certain risk factors that can affect your baby. These tests include blood type, checking for anemia, immunity to Rubella, HIV, Hepatitis B, Syphilis, and possibly others based on your health history

 

The Rh Factor

We will test your blood for the Rh factor. If your blood type is Rh negative, then you may be at risk for Rh disease, which affects about 10% of people. Rh disease is a pregnancy complication in which your immune system attacks the baby’s blood and can result in a life threatening situation for the baby. Fortunately, it can be prevented with a shot called Rhogam which is given at 28 weeks or anytime if vaginal bleeding occurs. If you are Rh negative, contact our office immediately if you develop bleeding or trauma to your belly.

 

Gestational Diabetes Screening

This screening is performed between 26-29 weeks. You will be given a sugar drink and instructions for how/when to drink it. One hour after you finish the sugar drink, your blood will be drawn. You do not need to fast.

 

Group B Strep (GBS)

GBS is a bacteria that some adults carry, and it usually does not cause problems for the mom or the developing baby. But at the time of birth, the baby can become infected.To help prevent GBS infection, women are tested for GBS late in pregnancy, between weeks 35 and 37. A swab is used to take a sample from the woman’s vagina and rectum. This procedure is quick and is not painful. If results of the test are positive, showing that GBS is present, you will receive treatment with antibiotics during labor to help prevent GBS from being passed to your baby. GBS test results from previous pregnancies cannot be used during the pregnancy. You still need to be tested during each pregnancy.However, if you have an older child who had GBS infection after birth, let us know because you will be given the antibiotics and treated as if you are a carrier with each future pregnancy.

 

Ultrasounds

We recommend one ultrasound early in pregnancy to confirm your due date and one between 18–22 weeks to evaluate the baby’s anatomy. Additional ultrasounds will be performed based on the medical need. Insurance will only cover additional ultrasounds if there is a medical need.

 

Common Symptoms of Pregnancy 

 

Nausea/Vomiting

Feeling nauseous during the first three months of pregnancy is very common. For some women, it can last longer, while others may not experience it at all. Try to eat 5-6 smaller meals a day in order to keep your stomach full at all times. Try bland foods like plain crackers, toast, dry breakfast cereal as well as carbonated drinks like ginger ale or 7-Up. Ginger is a natural treatment for nausea. Peppermint can also be used. Some over-the-counter medications are also safe. If the symptoms become severe or you are unable to keep fluids down without vomiting for more than 12 hours, contact the office. Vitamin B6 25-50 mg four times per day is very helpful for many women, and is safe to take in pregnancy. Sea-Bands are safe and may help reduce nausea.

 

Discharge

Discharge is an increase in vaginal discharge that is white and milky is common in pregnancy. If the discharge is watery or has a foul odor, call the office.

 

Spotting

Spotting may be a warning sign of a miscarriage but can also occur after an examination or sex. Call the office with any bleeding and we can give you further instruction on what to look for or do.

 

Constipation

Constipation is a common complaint which can be related to hormone changes, low fluid intake, increased iron or lack of fiber in your diet. Try to include whole grains, fresh fruit, vegetables and plenty of water. There are also safe over-the-counter medications. If you develop hemorrhoids, try sitz baths three to four times per day for 10-15 minutes each time. If the pain persists, contact the office.

 

Cramping

Experiencing infrequent cramps and contractions is normal. When cramps occur, empty your bladder, drink 1-2 glasses of water and try to rest. If you are less than 36 weeks pregnant and having more than six contractions in an hour after trying these measures, contact the office.

 

Leg Cramps

Cramping in your legs or feet can also be common. Eating bananas, drinking more lowfat/nonfat milk and consuming more calcium-rich foods like dark green vegetables, nuts, grains and beans may help. To relieve the cramp, try to stretch your leg with your foot flexed toward your body. A warm, moist towel or heat pad wrapped on the muscle may also help. You may also take Magnesium 500mg prior to bed to help prevent cramps.

 

Dizziness

You may feel lightheaded or dizzy at any time during your pregnancy. Try lying down on your left side and drink 1-2 glasses of water. If symptoms persist, contact the office.

 

Swelling

Because of the increased production of blood and body fluids, normal swelling, also called edema, can be experienced in the hands, face, legs, ankles and feet. Elevate your feet, wear comfortable shoes, drink plenty of fluids and limit sodium. Supportive stockings can also help. If the swelling comes on rapidly, or is accompanied by headache or visual changes, contact us immediately.

 

Heartburn

You may experience heartburn throughout the pregnancy, especially during the latter part of your pregnancy when your baby is larger. Try to eat 5-6 smaller meals a day and avoid laying down immediately after eating. Some over-the-counter medications are also safe for use.

 

Aches and Pains

As your baby grows, backaches are common. You may also feel stretching and pulling pains in the abdomen or pelvic area. These are due to pressure from your baby’s head, weight increase and the normal loosening of joints. Practice good posture and try to rest with your feet elevated. You may also treat with heat and warm Epsom salt baths; avoid hot baths.



Your Baby’s Growth 


Week 4

Your baby’s body now has three distinct layers from which all of his organs will develop.


Week 8

Your baby’s time fingers and toes start to develop.


Week 12

Your baby’s facial features continue to become more defined, particularly his nose and chin.


Week 16

Your baby’s skeletal system and nervous systems start to coordinate movement.


Week 20

Your baby’s skin thickens and develops layers under the vernix.


Week 24

Your baby’s movements can reveal to your doctor more about your baby’s development.


Week 28

Your baby is starting to take 20- to 30-minute naps.


Week 32

Your baby’s movements could start to change.


Week 36

Although your baby’s bones are hardening, his skull remains soft and flexible for birth.


Week 40

A surge of hormones in your baby’s body could play a part in initiating labor.



Safe Medications 


Acne

  • Benzoyl Peroxide
  • Clindamycin
  • Topical Erythromycin
  • Salicylic Acid
  • Avoid: Accutane, Retin-A, Tetracycline, Minocycline


Antibiotics

  • Ceclor
  • Cephalosporins
  • E-mycins
  • Keflex
  • Macrobid/Macrodantin
  • Penicillin
  • Zithromax
  • Avoid: Cipro, Tetracycline, Minocycline, Levaquin


Colds/Allergies

  • Benadryl, Claritin, Zyrtec
  • Chlor-Trimeton, Dimetapp
  • Drixoral-Non-Drowsy
  • Mucinex (guaifenesin)
  • Sudafed**/Sudafed-12 Hour**
  • Sudafed PE Pseudoephedrine**
  • Tylenol Cold & Sinus**
  • Vicks Vapor RubNasal Rinse
  • **AVOID if problems With Blood Pressure

 

Constipation

  • Colace, Miralax, Senokot
  • Dulcolax Suppository
  • Fibercon, Metamucil, Perdiem

 

Cough

  • Actifed, Sudafed
  • Cough Drops
  • Phenergan w/Codeine if prescribed
  • Robitussin (plain & DM)

 

Crab/Lice

  • RID
  • Avoid: Kwell

 

Gas

  • Gas-X
  • Mylicon
  • Phazyme

 

Headaches

  • Cold Compress
  • Tylenol (regular or extra strength)
  • Acetaminophen

 

Heartburn

  • (Avoid lying down for at least 1 hour after meals)
  • Aciphex, Maalox, Mylanta, Pepcid,
  • Milk of Magnesia
  • Pepcid Complete
  • Prevacid, Prilosec, Rolaids
  • Tums (limit 4/day)
  • Nexium

 

Hemorrhoids

  • Anusol/Anusol H.C.
  • (RX: Analapram 2.5%)
  • Hydrocortisone OTC
  • Preparation H, Tucks
  • Vaseline lotion applied to tissue

 

Herpes

  • Acyclovir
  • Famvir
  • Valtrex

 

Leg Cramps

  • Benadryl
  • Magnesium

 

Nasal Spray

  • Saline Nasal Spray

 

Nausea

  • Vitamin B6 25-50mg 4 times daily
  • Unisom 1/4 or 1/2 tablet at bedtime
  • Vitamin B6 and Unisom at bedtime
  • Dramamine, Emetrol
  • Ginger Root 250mg 4 times daily
  • High complex carbs @ bedtime
  • Sea Bands – Acupressure

 

Pain

  • Tylenol (frequent use may cause ADHD or asthma)

 

Prenatal Vitamins

  • Any over the counter prenatal vitamins.
  • DHA – is an optional addition to your prenatal vitamin and can be obtained in a separate pill. DHA can be found in fish oil, some plant based vitamins and Expecta DHA.

 

Rash

  • Benadryl
  • 1% Hydrocortisone Cream

 

Sleep Aids

  • Benadryl
  • Chamomile Tea
  • Unisom
  • Warm milk-add vanilla/sugar for flavor

 

Throat

  • Cepacol
  • Cepastat
  • Salt Water Gargle w/ warm water
  • Throat Lozenges
  • Butterscotch or Lemon drops

 

Tooth Pain

  • Orajel

 

Yeast Infection

  • Gyne-lotrimin, Monistat-3
  • Terazol-3



Nutrition and Pregnancy 

 

Recommendations for Weight Gain During Pregnancy

Overweight and obese women are at an increased risk of several pregnancy problems. These problems include gestational diabetes, high blood pressure, pre-eclampsia,preterm birth, and cesarean delivery. Babies of overweight and obese women also are at greater risk of certain problems such as birth defects, macrosomia with possible birth injury, and childhood obesity. On the other hand, underweight women are at increased risks for having small babies or preterm births.


Recommendations for weight gain during a singleton pregnancy are as follows:

  • Underweight women (BMI less than 20): 28-40 lbs
  • Normal weight women (BMI 20-25): 25-35 lbs
  • Overweight women (BMI 26-29): 15-25 lbs
  • Obese women (BMI >30): 11-20 lbs

 

Healthy Diet

The first step toward healthy eating is to look at your daily diet. Having healthy snacks that you eat during the day is a good way to get the nutrients and extra calories that you need. Pregnant women need to eat an additional 100-300 calories per day, which is equivalent to a small snack such as half of a peanut butter and jelly sandwich and a glass of low fat milk.

 

Key Nutrients During Pregnancy

NUTRIENT

REASON FOR IMPORTANCE

SOURCES

Calcium (1000mg)

Helps build strong bones and teeth

Milk, Cheese, Yogurt, Sardines

Iron (27 mg)

Helps create the red blood cells that deliver oxygen to the baby and also prevents fatigue

Lean Red Meat, Dried Beans and Peas, Iron-Fortified Cereals

Vitamin A (770 mcg)

Forms healthy skin, helps eyesight, helps with bone growth

Carrots, Dark Leafy Greens, Sweet Potatoes

Vitamin C (85 mg)

Promotes healthy gums, teeth, and bones. Helps your body absorb iron

Oranges, Melon and Strawberries

Vitamin B6

Helps form red blood cells, helps body use protein, fat and carbohydrates

Beef, Liver, Pork, Ham, Whole Grain Cereals, Bananas

Vitamin B12 (2.6 mcg)

Maintains nervous system, needed to form red blood cells

Liver, Meat, Fish, Poultry, Milk (only found in animal foods, vegetarians should take a supplement)

Folate (600 mcg)

Needed to produce blood and protein, helps some enzymes

Green Leafy Vegetables, Liver, Orange Juice, Legumes and Nuts

Vitamin D3 (1000-2000 IU)

Works with calcium to help your baby’s bones and teeth develop; essential for healthy skin and eyesight

Milk fortified with vitamin D,fatty fish such as salmon; exposure to sunlight also converts a chemical in the skin to vitamin D

 

 

Foods To Avoid In Pregnancy 


Raw meat
– Avoid uncooked seafood and undercooked beef or poultry due to risk of bacterial contamination, toxoplasmosis and salmonella.


Fish with mercury
– Avoid fish with high levels of mercury including shark, swordfish, king mackerel and tilefish. For other fish, limit consumption to two servings per week.


Smoked seafood
– Refrigerated, smoked seafood should be avoided due to risks of listeria contamination.


Raw shellfish
– including clams, oysters, and mussels can cause bacterial infections. Cooked shrimp is safe.


Raw eggs
– Raw eggs or any foods containing raw eggs can be contaminated with salmonella. This includes some homemade caesar dressings, mayonnaise, and homemade ice cream. Cook eggs thoroughly, until the yolk is firm.


Soft cheeses
– imported soft cheeses may contain listeria. Soft cheeses made with pasteurized milk are safe.


Unpasteurized milk
– May contain listeria which can lead to miscarriage.


Pate
– Refrigerated pate or meat spreads should be avoided due to risks of listeria.Caffeine – Limit caffeine intake to the equivalent of 1½ cups of coffee a day or less (or 200mg of caffeine). More than 200mg of caffeine may increase certain risks for pregnancy complications, but the effects are unknown.


Unwashed vegetables
– Wash all vegetables well to avoid exposure to toxoplasmosis which may contaminate the soil where vegetables are grown.Avoid spilling fluids from raw meat and hotdog packages on other foods, utensils, and food preparation surfaces. In addition, wash hands after handling hot dogs, luncheon meats, delicatessen meats, and raw meat (such as, chicken, turkey or seafood or their juices.)


Deli meat/hot dogs
– heat to steaming to kill Listeria bacteria.

 

Special Concerns


Vegetarian Diet

Be sure you are getting enough protein. You will probably need to take supplements, especially iron, B12 and vitamin D.


Lactose Intolerance

During pregnancy, symptoms of lactose intolerance often improve. If you are still having problems after eating or drinking dairy products, talk with us. We may prescribe calcium supplements if you cannot get enough calcium from other foods. Remember, calcium can also be found in cheese, yogurt, sardines, certain types of salmon, spinach, and fortified orange juice.


Artificial Sweeteners

These are OK to use but we would recommend limiting it to 1-2 servings per day. If you have diabetes, the artificial sweeteners are better than sugar to help control your blood sugars.

 

Common Questions 


When will I feel my baby move?

  • Sometime between 16-25 weeks of pregnancy, mothers will begin to feel movement. Initially, movements will be infrequent and may feel like butterfly flutters. As your baby grows, you will feel movement more often. It is recommended to start counting fetal movements beginning at 28 weeks. Once a day, rest on the bed or couch and place your hands on your abdomen. Begin counting movements. You can stop counting when you feel 10 movements. If you reach 2 hours and have not felt 10 movements you should call the office. A good time to do this is 20-30 minutes after breakfast and dinner. If you are concerned about movement, eat or drink something with sugar or caffeine, lie on your side and press your hands on your belly. If you have concerns about feeling baby movements or notice a decrease in movements, contact the office.


Why am I so tired? What is the best sleep position?

  • It’s normal to feel more tired. You may also notice you need more sleep than usual. Try to get at least 8-10 hours per night. Listen to your body.Try to sleep on your side to allow for maximum blood flow to baby. Lying on your back can cause your blood pressure to drop. You may also find it helpful to put a pillow behind your back and between your knees to improve comfort. As your pregnancy progresses, use more pillows and frequent position changes to stay comfortable.


Can I use a Jacuzzi?

  • Using a Jacuzzi or whirlpool bath is not recommended during the first trimester and should be limited to 15 minutes or less in the second and third trimester with the water temperature not exceeding normal body temperature which is 98.6 degrees.


Can I travel?

  • Traveling is safe during pregnancy for uncomplicated pregnancies. After 32 weeks, we recommend staying close to home. When you do travel, be sure to take breaks to stand up/walk around at least every two hours. If traveling by vehicle, wear a seat belt, positioning it under your abdomen as your baby grows. If you are involved in a car accident, please call the office immediately. You may need to be monitored.

 

Zika Virus is passed to humans by bites from mosquitoes infected with the virus, or by sexual contact with someone infected with the virus. Zika infections have been associated with certain birth defects. It is advised to avoid travel to areas of the world that have Zika infections. To help prevent mosquito bites, use a repellent that contains Deet or Oil of Lemon Eucalyptus.

For more information, visit the Centers for Disease Control website for Zika at www.cdc.gov/zika. If you plan to travel while pregnant, please discuss plans before you travel for specific recommendations

 

Can I care for my pets? 

  • If you have cats, please let us know. Avoid changing the litter box or use gloves to change it. Toxoplasmosis is a rare infection that you can get from cat feces.


What do I need to do about dental care?

  • Your teeth and gums may experience sensitivity throughout the pregnancy. Inform the dentist of your pregnancy and shield your abdomen if x-rays are necessary. Contact our office with any questions about dental care. Many dentists require a letter from your OB office prior to providing care. Please request this letter prior to your dental visit if possible.


Can I go to the salon for treatments?

  • Hair coloring and nail care should always be done in large, well-ventilated areas. If possible, avoid treatments in the first trimester


Can I have sex?

- You can have sex unless you are having complications or sex becomes too uncomfortable. There are times when exercise and sex should be avoided. This includes vaginal bleeding, leaking amniotic fluid, preterm labor, chest pain, regular uterine contractions, decreased fetal movement, growth restricted baby, headache, dizziness or general weakness.

 

Exercise 

Exercise is a key part of staying healthy. Everyone needs daily physical activity — including pregnant women who are healthy and do not have limitations. Regular exercise during pregnancy benefits both you and your baby!

 

Benefits of Exercise

  • Reduces back pain
  • Eases constipation
  • May decrease your risk of gestational diabetes, preeclampsia, and cesarean delivery
  • Promotes healthy weight gain during pregnancy
  • Improves your overall general fitness and strengthens your heart and blood vessels

 

Before You Start

If you are healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Physical activity does not increase your chances of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with us during your prenatal visits.Pregnant women should get at least30 minutes of moderate-intensity exercise every day. Moderate-intensity means you are moving enough to raise your heart rate and start sweating. You still can talk normally, but you cannot sing. Examples include brisk walking and gardening (raking, weeding, or digging). If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes each week until you can stay active for 30 minutes a day.

 

Warning Signs

Stop exercising and call your obstetrician or other member of your health care team if you have any of these signs or symptoms:

  • Bleeding from the vagina
  • Feeling dizzy or faint
  • Shortness of breath before starting exercise
  • Chest pain
  • Headache
  • Muscle weakness
  • Calf pain or swelling
  • Regular, painful contractions of the uterus
  • Fluid leaking from the vagina

 

Safe Exercises During Pregnancy

  • Walking—Brisk walking gives a total body workout and is easy on the joints and muscles.•Swimming and water workouts—Water workouts use many of the body’s muscles. The water supports your weight so you avoid injury and muscle strain. If you find brisk walking difficult because of low back pain, water exercise is a good way to stay active.

  • Stationary bicycling—Because your growing belly can affect your balance and make you more prone to falls, riding a standard bicycle during pregnancy can be risky. Cycling on a stationary bike is a better choice. Spinning classes offered at local gyms give a good aerobic workout set to music.

  • Modified yoga and modified Pilates—Yoga reduces stress, improves flexibility, and encourages stretching and focused breathing. There are even prenatal yoga and Pilates classes designed for pregnant women. These classes often teach modified poses that accommodate a pregnant woman’s shifting balance. You also should avoid poses that require you to be still or lie on your back for long periods.

 

Exercises to Avoid

Some types of exercise involve positions and movements that may be uncomfortable or harmful. While pregnant, do not do any activity that puts you at increased risk of injury, such as the following:•Contact sports and sports that put you at risk of getting hit in the abdomen, including ice hockey, boxing, soccer, and basketball

  • Activities that may result in a fall, such as downhill snow skiing, water skiing, surfing, off-road cycling, gymnastics, and horseback riding
  • “Hot yoga” or “hot Pilates,” which may cause you to become overheated
  • Scuba diving

Kegel Exercises

In the coming months, your growing uterus will put more pressure on your bladder. Even if your bladder is empty, it may feel like it is full. The weight of your uterus on your bladder may even cause you to leak a little urine when you sneeze or laugh. Doing Kegel exercises can help improve bladder control. Here is how they are done:

  • Squeeze the muscles that you use to stop the flow of urine.
  • Hold for 3 seconds then relax for 3 seconds.
  • Do 10 contractions three times a day.
  • Increase your hold by 1 second each week. Work your way up to 10-second holds.

Breathe normally. Do not hold your breath as you do these exercises. You can do Kegel exercises anywhere—while working, driving in your car, or watching television—but do not do them when urinating.



Alcohol and Smoking 

There is no safe amount of alcohol so we recommend avoiding all alcohol during pregnancy. Drinking alcohol can cause birth defects, mental retardation and abnormal brain development.If you smoke, so does your baby. This is a very important fact of pregnancy. Here are some known complications from smoking during pregnancy:

  • Low birth weight baby: Low birth weight can be caused by prematurity (birth less than 37 weeks), poor growth, or a combination of both. Prematurity is increased in pregnant smokers and is the number one cause of neonatal death and chronic illness in babies. Problems such as cerebral palsy, life-long lung, kidney, or other organ problems, mental retardation and learning disabilities are much more common in premature and low birth weight babies.

  • Placenta previa: Low-lying placenta that covers part or all of the opening to the uterus. Placenta previa blocks the exit of the baby from the uterus causing the mother to bleed.

  • Placental abruption: The placenta tears away from the uterus causing the mother to bleed.•Preterm premature rupture of membranes: The water breaks before 37 weeks of pregnancy, which is associated with an increase of preterm and low birth weight births.

  • Stillbirth: The fetus has died in the uterus.

 

Ways to Quit Smoking

No matter what your approach to quitting, a conversation with us can make the difference between success and failure. Quitting cold turkey is a great way. If you want to try a quitting aid such as a nicotine patch, gum, or the medication Zyban or Wellbutrin, we can help you choose a method right for you.

The March of Dimes recommends women stop smoking prior to becoming pregnant and remain smoke-free throughout pregnancy and once the baby is born. The more a pregnant woman smokes the greater the risk to her baby. However, if a woman stops smoking by the end of her first trimester (first three months), she is no more likely to have a low birth weight baby than a woman who never smoked. Even if a woman is not able to stop smokingduring her first or second trimester, stopping during the third trimester (the last three months) can improve her baby’s growth.

The effects smoking has on your baby continue when you take him/her home. Children exposed to smoke in the home have higher levels of lung problems such as asthma, pneumonia, or bronchitis. They also suffer from more ear infections than children not exposed to smoke. Even more troubling is the increased incidence of Sudden Infant Death Syndrome (SIDS) found in children exposed to smoking in the home. A child exposed to smoking in the home during the first few years of life are at an increased risk of developing asthma.

Great Start (1-866-66-START) is a national pregnancy specific smoker’s quit line operated by the American Legacy Foundation.

 

When To Go to the Hospital 

If you experience any of the following, please go to the hospital immediately as these are considered emergency:

  • Continuous leaking of fluid(water broken)
  • Abdominal trauma or car accident
  • Heavy bleeding
  • Fever greater than 101º
  • Decreased fetal movement
  • Urinary tract infection
  • Headache with vision changes
  • Painful contractions greater than 5 times an hour if less than 36 weeks


If you experience any of the following, please go to the hospital immediately as these are considered emergency:Please use this chart to determine how you should treat certain illnesses or symptoms throughout your pregnancy. If in doubt, go to the hospital.

 

ILLNESS

CALL THE OFFICE IF:

GO TO HOSPITAL IMMEDIATELY IF:

HOME TREATMENT:

Bleeding/Cramping

  • Some bleeding/spotting may occur after an internal exam
  • Bleeding is less than a period with mild cramping; common in 1st trimester
  • Your blood type is Rh Negative and you have not received Rhogam
  • Bleeding is heavy (using a pad every 2 hours)
  • 2nd & 3rd trimester cramping or painless heavy bleeding
  • Cramping is equal or worse than menstrual cramps
  • Rest
  • Avoid heavy lifting (more than 20 pounds)

Vomiting

  • Common in 1st trimester
  • Unable to keep down liquids and solids for more than a 24 hour period
  • Weight loss of more than 3-5 pounds
  • Signs of dehydration occur (e.g. dry mouth, fatigue/lethargy, poor skin turgor)
  • Abdominal pain accompanied with vomiting
  • Vitamin B6 25 mg three times a day
  • Separate liquids from solids (e.g. dry cereal followed by a glass of milk 1 hour later)
  • Plain popcorn
  • Rest
  • Avoid hot sun

Decreased fetal (baby) movements after 28 weeks

  • Baby moves less than 4 times in a 30 minutes period while you are resting, during a normally active period of baby
  • No fetal movement
  • Rest
  • Drink juice or soft drink
  • Eat a small snack

Labor

  • Contractions stronger than Braxton-Hicks (mild, irregular contractions), but may not be regular
  • If less than 36 weeks, call if contractions are every 15 minutes
  • Contractions are every 5 minutes apart for 1 hour
  • Water breaks; small leak or as a gush
  • Bleeding is more than a period
  • Pain or contractions won’t go away
  • Rest (you’ll need energy for real labor)
  • Increase fluids to 8-12 glasses daily
  • Dehydration can cause contractions, especially in the summer

Urinary urgency and/or pain with urination

  • Frequency is common in early and late pregnancy
  • Pain with urination
  • Feeling of urgency to void with little urine produced
  • Temperature of 101ºF or higher
  • Pain in upper back
  • Contractions occur
  • Blood in urine
  • Urinate at regular intervals
  • Increase fluid intake to 8-12 glasses daily

Swelling

  • Recent, noticeable increase in feet and ankles
  • Swelling of face and hands
  • Swelling accompanied with headache or upper abdominal pain
  • Swelling in one leg more than the other
  • Elevated blood pressure if using home monitoring
  • Lie on left side and elevate legs
  • Avoid salty foods (e.g. ham, pizza, chili)

Cold and flu

  • Temperature of 101ºF or higher
  • Green or yellow mucus develops
  • Persistent cough for more than 5 days
  • Breathing is difficult or wheezing occurs
  • Tylenol, Actifed, Sudafed, and any Robitussin
  • Increase fluids
  • Rest
  • Use vaporizer
  • Ibuprofen ok in 2nd trimester only

Rupture of membranes

 
  • Water breaks; small leak or as a gush
 

 

 

Discuss Your Pain Management Plan

If you have preferences for your baby’s birth, please share these with your provider. If desired, there are several options to provide pain relief while you are in labor. We are supportive of whatever you choose.

  • Morphine – This narcotic is given through injection or IV and helps take the edge off strong contractions. It can make you sleepy if given early in labor. We avoid giving this near delivery time.

  • Epidural – This safe and popular option is administered by an anesthetist and requires a fine, thin catheter or tube to be placed in your back during active labor. Medicine slowly drips through the tubing to provide pain relief throughout labor. It is removed after delivery.

  • Local – Many patients deliver without pain medication. Sometimes we need to give a small injection of numbing medicine for stitches called lidocaine.

 

Research Cord Blood Banking

Your baby’s blood is a valuable source of cells that could be used by your baby or another family member to treat some life-threatening diseases. It can easily and safely be obtained immediately after delivery. Parents can choose to have their baby’s blood saved; however the decision must be made before birth. Insurance does not generally cover this. If interested, you can order a kit and bring it with you to delivery. Ask your provider for information.

Obtain and Install a Car Seat

You must have a car seat installed in your vehicle before taking baby home. By law, children must be in a federally approved, properly installed, crash-tested car seat for every trip in the car beginning with the trip home from the hospital.


Learn More About Breastfeeding

Human milk is perfectly designed nutrition for babies. Babies who are breastfed get fewer infections and are hospitalized less. Mothers that breastfeed burn 500 calories a day which can help lose extra weight and reduce a woman’s risk of developing breast cancer. After delivery, the nurses and a lactation specialist are there to help you learn the art of breastfeeding.

Packing for the Hospital

  • Identification card and insurance card
  • Comfortable lounge clothes or pajamas if you want an alternative to the hospital gown
  • Small pack of Depends or other adult undergarments to wear after delivery
  • Toiletries such as toothbrush, toothpaste, shampoo, pads of your choice
  • Pacifier if you desire your baby to use one. The hospital does not provide pacifiers.
  • Clothes to wear home for you and your baby•Camera with extra batteries or chargers as needed
  • Car seat
  • Breast pump if you plan to pump soon following birth
  • Heating pad, if desired

 

When Will I Know I’m in Labor?

The chart below will help determine if you are in labor. If you have signs of true labor or if your water breaks, you may go to labor and delivery directly, day or night.

 

TRUE LABOR

FALSE LABOR

Contractions are regular, get closer together and last 40 to 60 seconds.

Contractions are irregular, do not get closer together and last 20 to 40 seconds.

Contractions continue despite movement.

Contractions may stop when you walk or rest or may change with change of position.

Pain/discomfort usually felt in back and moves around to front.

Pain/discomfort often felt in abdomen.

Contractions steadily increase in strength.

Contractions usually are weak and do not get much stronger.

Cervix dilates.

Cervix does not dilate.

Bloody show may be present.

Usually no bloody show is present.



Postpartum Instructions 

  1. You will make a follow-up appointment between 1-4 weeks after discharge from the hospital. We will discuss when you need to follow up on day of discharge and will depend on your specific needs in the postpartum period.
  2. Refrain from using tampons until after your postpartum check-up.
  3. Douching is never safe. Please do not use douche.
  4. No driving for 1-2 weeks following a cesarean section.
  5. Continue your prenatal vitamins daily and eat a well balanced diet.
  6. If breastfeeding increase your fluid intake to 10-12 glasses of water per day. With any signs of a breast infection (fever, flu-like symptoms, pain or redness in the breast) call the office for further instructions.
  7. If not breastfeeding, continue to wear a good supportive bra, bind if necessary, use ice packs, take Tylenol® for discomfort, and call the office if the problem persists or worsens.
  8. Tub bathing is encouraged one to two times daily after a vaginal delivery and two weeks after a cesarean. You may also use a handheld shower head to spray your bottom one to two times daily.
  9. Vaginal bleeding may continue for 6-8 weeks while the uterus is involuting back to prepregnancy state. You may have spotting and/or menstrual-like flow. Increased activity increases the flow. If bleeding or cramping increases to greater than a period, take two Advil and get off your feet. If bleeding is persistently heavy, call the office for further instructions.
  10. Avoid lifting anything heavier than your baby until after your postpartum check-up.
  11. Exercise – Avoid sit-ups, jumping jacks and aerobics until after your baby is 6 weeks old. You may do simple abdominal tightening exercises, kegal exercises, and walking.
  12. Constipation is very common. Drink 6-8 glasses of liquids every day. Citrucel, Metamucil, and stool softeners (Colace) may be used. Include food like bran cereal, fresh fruits and vegetables in your diet. Stool softeners are recommended while taking narcotics.
  13. Hemorrhoids usually are more symptomatic after delivery. If they are a problem for you, we can prescribe medication to relieve symptoms.
  14. Postpartum blues – Sadness, crying and blues are normal responses to hormonal changes in your body after the baby is born. Please let us know if you need additional assistance or if you are concerned that the blues have turned into depression.
  15. Abstain from intercourse for six weeks or longer if you are still having pain. Remember that you can become pregnant within the first few weeks after delivery. Consider your birth control needs and discuss this at a visit or before discharge.
  16. You may climb stairs 2-3 times a day in the first 2 weeks. Too much activity delays episiotomy and incisional healing.
  17. Please call the office if you have a fever of 101º F or greater, swelling, tenderness or redness in the lower leg.
  18. If you had a Cesarean delivery, keep your incision clean with soap and water. Bandage with gauze only if instructed. Call the office if the incision is swollen, red or has any unusual drainage. Remove any steristrips after 10 days. Avoid pulling on surgical glue as this can damage the skin.
  19. It is very important to rest as much as you can during the first few weeks after delivery. Your physical and emotional wellbeing is integrally tied to you having rest and support. Plan for help with other children, cooking, and cleaning for the first 2 weeks. Stock your freezer and pantry in the last few weeks of pregnancy. Limit visitors in the hospital and at home so you are able to rest.

 

Postpartum Depression 

40-80% of women experience mood changes after their delivery. This most commonly starts 2-3 days after delivery and usually goes away by 2 weeks. It is important to eat properly, get adequate sleep and reduce stress during this time to help with the symptoms. Sometimes the symptoms require treatment especially if mom is not bonding or enjoying her baby; unable to care for herself or the baby; feeling excessive sadness, depression or anxiety. Please schedule an appointment if you feel a problem is occurring. We are known for our compassionate care and have effective treatments for postpartum depression.


Reading List and Resources 

The childbearing year is one of the most transformative times in a woman’s life. We strongly encourage you to use the following as resources to help you along this journey.

The Healthy Pregnancy Book by Dr. William Sears

Pregnancy, Childbirth and the Newborn: The Complete Guide by Penny Simpkin

The Birth Book by Dr. William Sears

Breastfeeding: Keep It Simple” by Amy Spangler

The Baby Book by Dr. William Sears

ChildbirthConnection.org – National Partnership for Women and Families

KellyMom.com – Pregnancy, Breastfeeding and Parenting information

Postpartum.net – Postpartum Support International.

National Domestic Violence Hotline: 800-799-7233

 

Questions 

If you have additional questions, or need information on another topic, please take note and ask the nurse or doctor at your next appointment. We ask that when you call the office at 602-298-8977 or if you have an emergency and need to speak to the doctor on call that you please have a pharmacy number available so that prescriptions can be called in if necessary. It is also important that we speak to you directly if at all possible.

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