• WHAT IS INCLUDED IN YOUR OBSTETRIC CARE?
• MEDICATIONS IN PREGNANCY
• PRENATAL CHILDBIRTH EDUCATION
• GENERAL PREGNANCY INFORMATION
• WHAT WILL HAPPEN AT THE HOSPITAL BEFORE DELIVERY?

WHAT IS INCLUDED IN YOUR OBSTETRIC CARE

Your obstetric care will consist of an initial visit, followed by return visits at appropriate intervals, depending upon the stage of your pregnancy and the presence or absence of risk factors or complications.   There will be a history and physical examination performed during the initial visit.   For uncomplicated pregnancies, subsequent visits will consist of evaluating uterine size and fetal growth, listening to the baby’s heart beat, blood pressure and urine checks, and an opportunity for you to ask questions and express any concerns you might have.    Prenatal blood work will be drawn during one of your early visits and redrawn occasionally during your pregnancy.  When you are within a few weeks of your due date, a pelvic exam will be performed weekly to assess the status of the cervix and the position of the baby.   

We will see you every four weeks in the early months of your pregnancy, then every 2-3 weeks beginning around seven months.  The last month you will be seen approximately once a week.  You may occasionally see our nurse practitioner for routine checks, if your pregnancy is proceeding normally.   

MEDICATIONS IN PREGNANCY

Pregnant women are susceptible to the same types of colds and viral infections as other women, although the symptoms may be a little more severe.  Fortunately, most viruses do not cause any adverse effects on the baby.  Medications do not make the illness resolve faster, but can help to keep you more comfortable.   It is best to first try comfort measures such as rest, fluids, warm baths and showers, and pain relievers like acetaminophen (Tylenol).  No medication can be guaranteed as “absolutely safe” during pregnancy, but there has now been extensive experience with certain over-the-counter medications that are felt to be safe if your symptoms are severe.  In general, herbal supplements have not been studied in pregnancy and should be avoided.  

The following medications may be taken according to directions on the product labeling: 

• Allergies  -  see meds for congestion.  Also loratidine (Claritin or Claritin-D).
• Congestion  -  Sudafed, Actifed, Chlortrimeton, Tylenol Cold, Afrin Nasal Spray, saline nasal spray
• Constipation  -  docusate (Colace) stool softener, any fiber product, milk of magnesia.  Increase fluids, exercise, and natural fiber in your diet.
• Cough  -  any cough syrup with guaifenesin or dextromethorphan
• Fever  -  acetaminophen regular (Tylenol) or extra strength.  Be sure to keep your temperature below 101 degrees and drink plenty of fluids.  Call the office if you are unable to do this.
• Headaches  -  acetaminophen regular (Tylenol) or extra strength.   NO ibuprofen, Advil, Motrin, or Aleve unless you’ve checked with your doctor.
• Heartburn  -  any antacid tablet or liquid such as Tums, Rolaids, Maalox, Mylanta.  Pepcid or Zantac if severe symptoms persist.
• Hemorrhoids  -  Anusol, Preparation-H, Tucks, Corticaine
• Nausea from pregnancy  -  Unisom, vitaminB6 25-50mg three times a day
• Nausea, vomiting and diarrhea from stomach flu  -  Kaopectate, Imodium AD.  Drink small, frequent amounts of clear liquids such as water, soda, tea, clear broth and clear fruit juices.  Avoid dairy products for several days.
• Rash/itching  -   Benadryl 25-50mg every 4-6 hours.  Calamine or Aveeno products, 1% hydrocortisone cream.
• Sore throat  -  throat lozenges, zinc lozenges, Chloraseptic spray
• Vaginal yeast infection    any over the  counter product

It is important to continue treatment for certain illnesses like asthma, diabetes, high blood pressure, thyroid disease, mental illness and seizures while you are pregnant.  However, sometimes it is best to change your prescription medication and it may not be safe to abruptly stop a medication.  Therefore, it is important that your doctor knows about any meds you are taking as soon as you know you are pregnant. 

Medications commonly prescribed by other physicians that are safe to take during pregnancy include antibiotics such as amoxicillin, penicillin, erythromycin, Zithromax, and Keflex.   Dental x-rays should be done only if necessary and the abdomen must be covered with a lead apron.  Do not use nitrous oxide or take tetracycline. 

We recommend that you attend one of the childbirth education classes available through Penrose Community Hospital.  These classes are very helpful in preparing you for the changes that you will experience in your body and in providing you with strategies for coping with the rigors of labor.  This excellent resource provides in-depth information concerning nutrition, diet, body changes, exercise, labor, delivery, and postpartum care.  The hospital also offers excellent classes on breastfeeding, infant care, and prematurity prevention.  You will be given a class schedule at your first prenatal visit.  This is an outstanding source of information and will augment topics discussed at your routine prenatal visits.

Weight Gain and Nutrition

For the woman whose weight is normal prior to pregnancy, a gain of 25 – 35 pounds appears to be associated with the most favorable outcome.  Generally, this can be accomplished by an increase of 300 calories a day.  In most women, this can be achieved by eating according to appetite – three meals a day adequate in low-fat milk, milk products, fruit, vegetables, meats or other protein foods and whole-grain breads and cereals.  For snacks, choose foods such as fruits or vegetables that will help provide you with your daily nutritional needs.  Avoid snacks such as candies, pastries, and chips that are high in calories but low in nutrition.  If you are underweight or overweight, we’ll give you specific recommendations for weight gain in pregnancy at your prenatal visit. 

Fish:  The U.S. Food and Drug Administration and the U.S. Environmental Protection Agency as well as the March of Dimes have the following recommendations for all women who are or might become pregnant, who are nursing, and for young children.  Limit a variety of fish and shellfish intake to no more than 12 ounces per week and AVOID shark, swordfish, king mackerel and tilefish COMPLETELY.  Nearly all fish and shellfish contain trace amounts of mercury, but those large fish listed above have the highest amounts.  For more information go to:  www.cfsan.fda.gov/seafood1.html.  We will give you more details about food safety in pregnancy at your first prenatal visit. 

Prenatal Vitamins

Prenatal vitamins are specially-formulated multivitamins for the expectant mother.  This special formulation ensures that pregnant women don’t get too much of certain vitamins (such as Vitamin A) that can be toxic to the developing baby in large amounts.  Prenatal vitamins also contain folic acid in a dosage thst has been shown to reduce the risk of neural tube defects, which are serious birth defects of the brain and spinal cord. 

Prenatal vitamins typically contain about 200 mg of calcium, only one-sixth the recommended amount of calcium for pregnancy.  Unless you consume a lot of dairy, you might want to consider adding a calcium supplement to make up the difference.  TUMS, Caltrate, Citrocal, and Viactive are examples of calcium supplements you might try.  Avoid oyster-shell and coral calcium while pregnant as there are concerns about heavy metal contamination in these forms. 

You may choose to use an over-the-counter prenatal vitamin, or your doctor can write you a prescription for a name-brand vitamin if you prefer.  If you’re having problems with nausea and/or vomiting and you think your prenatal vitamins are making it worse, your doctor can suggest some alternatives.   

Smoking

Mothers who smoke during their pregnancies frequently have smaller infants than nonsmokers.  These smaller infants tend to have an increased incidence of health problems, learning disorders, and newborn deaths.  For these reasons, smoking is not recommended during pregnancy.  It has been known to be responsible for spontaneous abortions, SIDS (crib) deaths and childhood respiratory illnesses. 

Alcohol

A pregnant woman who consumes large amounts of alcohol risks having a child with birth defects.  The effects of limited or moderate drinking are unknown.   It is probably best to avoid alcohol completely while pregnant. 

Exercise

It is not necessary for the pregnant woman to avoid exercise as long as she does not become overly fatigued or exceed a pulse rate of 140.   If you are in good physical condition and used to being active, there is no reason that being pregnant should keep you from participating in the activities you enjoy.  Use common sense and avoid activities that carry a risk of bodily injury.  Walking and swimming are excellent means of exercise for pregnant women.  Hot tubs and saunas should be avoided.   

Travel

Provided there are no complications with your pregnancy you may continue to travel until 36 weeks.  It is advised that you stretch each hour on long trips, to decrease the risk of blood clots. 

High Altitudes

Due to the decreased oxygen level at high altitude it is recommended that you avoid spending prolonged periods at altitudes over 10,000 feet.  Also no vigorous activity above 8,000 feet. 

Exposure to Fumes

Painting is safe provided the room is well-ventilated.  Should a headache or nausea occur, just leave the area.  Hair coloring and permanents are also OK.

COMMON PROBLEMS

Below are listed some common problems encountered during pregnancy and what you can do about them. 

The development or aggravation of hemorrhoids is a common occurrence during pregnancy.  Generally, pain and swelling can be relieved by topical anesthetics such as Tucks, and warm soaks or sitz baths. 

Many pregnant women notice an increase in their vaginal discharge.  Generally, this is a normal bodily response to the increased hormone levels during pregnancy.  Unless there is an accompanying irritation or foul odor, the increased discharge is not likely to be due to an infection.  If you do have either of these symptoms with the discharge please contact the office.  Douching is not recommended during pregnancy. 

In general, intercourse during a normal pregnancy is not harmful.  If, however, you should develop problems with preterm labor, or bleeding complications, you will be asked to practice abstinence. 

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OTHER PROBLEMS

If you have any problems not mentioned above, please contact the office and arrange for an appointment.  If you have any of the following problems, contact us immediately, day or night. 

Þ    Vaginal bleeding

Þ    A sudden and dramatic increase in swelling of the face and hands

Þ    Severe, continuous headaches not relieved with Tylenol and rest

Þ    Severe abdominal pain

Þ    Chills and fever

Þ    Leakage of amniotic fluid

Þ    Contractions greater than 6 per hour, if you are more than 4 weeks from your due date

Every pregnancy is different and therefore, each woman’s labor and delivery must be managed on an individual basis.  Our philosophy is that pregnancy and delivery are natural physiologic processes.  We do not routinely use IV’s, but you will have an IV if you choose to have an epidural or if your labor is complicated by dehydration, toxemia or bleeding.  We will support you in your efforts if you desire “natural childbirth” without the use of pain medicine.  For those who desire pain relief, excellent options are available to lessen the discomfort of labor and delivery.   

Fetal heart rate monitoring is used throughout labor to ensure the baby’s well-being.  For uncomplicated labors, an intermittent fetal monitoring protocol is available, so that women can be up and about as they feel able.  For labors that are induced or complicated, or for patients who choose to have an epidural, continuous fetal monitoring is employed to keep a close eye on the baby’s condition. 

An episiotomy is an incision made at the lowermost portion of the vaginal opening to provide more room for the delivery of the baby.  Episiotomies are no longer performed routinely, but rather only if needed to hasten the delivery of a baby that is stressed or if a woman is unable to overcome the resistance of these tissues with her own pushing efforts.  Not having an episiotomy does not mean you won’t need any stitches, as often natural lacerations occur during the birthing process that require suturing.   All suture material used will dissolve gradually on its own as the area heals.