Pregnancy Information

Vaginal Bleeding

Mild spotting and cramping can be normal within the first three months (12 weeks) of pregnancy. It is common to have a small amount of spotting/bleeding after a vaginal exam in the office. If you experience any vaginal bleeding with the following conditions, call the office immediately for an evaluation, or if after hours, call the physician on call or go to the Emergency Room.

• Saturating a pad in an hour
• Severe cramping or pain with bleeding
• Have an Rh-negative blood type
• Passing large clots

Vaginal Discharge

It is normal to have an increase in vaginal discharge during pregnancy, but this should be white to yellow-white, have no strong odor and no itching or burning. It is also common for urine to leak or gush from the bladder, and this may mimic leaking of the amniotic fluid. Please call the office if you have any concerns.

Braxton-Hicks Contractions

During your last three months (after 28 weeks), you may feel the uterus contract or tighten more frequently and stronger than it did before. This is normal. These contractions last about 20-30 seconds each, are usually irregular and not painful. Although you may or may not feel these “Braxton-Hicks” contractions, they often occur when you are changing positions or stretch. These contractions should resolve by changing your activity level and pushing fluids. You may experience Braxton-Hicks contractions earlier than 28 weeks when you have had more than one pregnancy.

Intercourse

Intercourse is safe during pregnancy. You may have some vaginal spotting afterwards. This is normal and should resolve within 24 hours. Contractions or cramping immediately after intercourse is also normal and should clear up within a couple of hours.

Travel

The primary problem travel poses is dealing with unanticipated obstetric complications that occur while out of town. The most common obstetric emergencies occur in the 1st and 3rd trimesters. Therefore, the best time to travel would be in the 2nd trimester. Most US airlines allow travel up to 36 weeks.

Travel is not recommended at any time during pregnancy for women who have medical or obstetric complications. Any questions regarding travel can be clarified with your physician at your next appointment.

When traveling long distances, we recommend that you get up and allow time to walk around at least every 1-2 hours. This will improve circulation and help avoid blood clots. Make sure you take frequent bathroom breaks as needed to avoid bladder infections. We also suggest taking a copy of your medical records with you when traveling towards the end of your pregnancy and keep our office number handy for questions.

Exercise

Exercise in moderation is encouraged during pregnancy. It will help with weight gain, labor and recovery, and decrease aches and pains throughout pregnancy. If you have not been exercising regularly before pregnancy, start slowly and for a short amount of time. Often, you won’t feel like exercising much until the second trimester (after 12 weeks) of your pregnancy.

• In general, avoid any activities that would pose any increased risk of accidental falls (especially from heights), injury or trauma to your belly or back.
• Stay well hydrated and don’t get over-heated.
• Low-impact activities such as walking, elliptical use and swimming are ideal for pregnancy. Monitor your pulase rate  to make sure it is not consistently above 140.

Painting

It is recommended the room you are painting in is well ventilated. If you develop a headache, dizziness or nausea, leave the area. Do not get on a ladder.

Hair Coloring / Permanents

All hair treatments are permitted as long as they are done in a well-ventilated area. If coloring your hair yourself, wear gloves. Manicures and pedicures are fine.

Tanning Beds and Self-Tanners

Tanning beds are NOT recommended during pregnancy. Check with your physician on self-tanners.

Hot Tubs / Saunas

AVOID hot tubs and saunas during pregnancy. They can raise the internal body temperature and can be harmful to the baby. A warm bath is permitted.

Tattoos and Piercings

During your pregnancy, it is recommended you not obtain any additional or new tattoos or piercings.

**If you have any questions or have a medical problem during our regular office hours, please call the office so that we will be able to review your chart and medical history while discussing your problem with you. Continuity of care is important.**

We recommend and encourage breastfeeding your baby after delivery. Even a short amount of breastfeeding can be helpful to both mom and infant.

Studies have found that breastfeeding is associated with great benefits for kids: a reduction in the risk of ear infections, gastroenteritis (stomach infections), severe lower respiratory tract infections, skin allergies, asthma, obesity, type 1 and 2 diabetes, childhood leukemia and SIDS (sudden infant death syndrome).

Studies also show benefits from moms including reduced risk of type 2 diabetes, breast and ovarian cancer. In addition, stopping breastfeeding early or no breastfeeding is associated with an increased risk of postpartum depression.

We recognize that breastfeeding can be difficult and initially painful, and it’s not for every mom and baby. The labor and delivery nurses will help you with initial instructions, and the postpartum nurses will continue to help you with the guidance of lactation specialists.

In addition, there are breastfeeding support groups through St Luke’s Health System, HCA Healthcare, and continued availability of the lactation specialists after you are discharged home.

Nausea

• Unisom Sleep Tabs (Doxylamine succinate) 25mg 1/2 tablet (3 times daily) and Vitamin B6 25mg (3 times daily)

Headache/Body Aches

• Tylenol (acetaminophen) (regular or extra strength)

Diarrhea

• 1st Trimester—Clear liquids for 24 hours (“BRAT” diet)
• After 1st Trimester—Imodium for no more than 2 days

Hemorrhoids

• Preparation H, Anusol HC cream, suppositories
• Tucks Pads
• Go to ER with severe pain

Sleep Aid

• Unisom Sleep Tabs, (doxylamine succinate)

Dentist

• X-ray with lead apron, Penicillin, Erythromycin, Lidocaine/Novocaine
• No Laughing Gas (Nitrous oxide) – requires close fetal monitoring

Massages

• Approved at any time during pregnancy

Vaginal Yeast Infection

• Any 7-day over the counter vaginal cream

Lice

• Nix topical treatment

Constipation

• Metamucil, Milk of Magnesia, Miralax, Colace, Senokot (short term only)

Upset Stomach/Heartburn/Gas

• Zantac, Nexium, Mylanta, Tums, Pepcid, Prevacid, Gas-X

Cough/Cold/Sore Throat/Sinus

• Plain Robitussin, plain Mucinex, Tylenol for pain, Throat lozenges, salt water gargle, nasal saline mist, Vicks Vapor-Rub ** Avoid any decongestant

Allergies

• Benadryl, Plain Claritin, Zyrtec, & Allegra (without “D” avoid any decongestant), Flonase, saline nasal rinse

Rashes

• Hydrocortisone cream, Benadryl cream, Calamine lotion, Oatmeal bath

Commonly Prescribed Medication in Pregnancy and Breastfeeding

Amoxicillin, Keflex, Z-pack (azithromycin), Albuterol Inhalers, Macrobid (nitrofurantoin), Flagyl, Oxycodone, Norco (hydrocodone)

Generally Avoid

Decongestant (Sudafed/phenylephrine), NSAIDs (Ibuprofen/Aleve), Pepto Bismol

During the last three months of pregnancy, you may feel the uterus contract more frequently and stronger than it did before. These contractions are usually irregular and very normal.

When you do begin labor, the contractions will generally come in intervals anywhere from 5 to 15 minutes apart, and may last from 45-60 seconds each. Your abdomen will become firm during the contractions and the force of the contraction may cause some vaginal pressure. The symptoms of labor may start out relatively mild and include low back and/or pelvic pain and cramping similar to menstrual cramps, but occurring on a REGULAR and PERSISTENT basis.

As the cervix begins to soften (efface) and open (dilate), you may notice a pink or red blood-tinged mucus. This is normal and is called bloody show.

Generally, the bag of water (amniotic fluid) which surrounds the fetus does not break until you are well along in labor. However, 15% of the time, it can break early in labor or even before labor begins, allowing clear, watery fluid to leak or gush out.

PLEASE CALL YOUR DOCTOR IF YOU EXPERIENCE ANY OF THE FOLLOWING:

• You have continued clear vaginal fluid leaking, or a gush of fluid vaginally
• You have bleeding more than spotting and other than the mucous plug
• You notice a significant decrease in fetal movement
• Regular, strong contractions every 5 minutes, lasting 45-60 seconds each continually for 1 hour

For questions, you can call us during office hours at 816-282-7809 or 816-942-3339.

For emergencies after hours, one of our physicians may be reached through our 24 hour answering service by calling the same main office phone numbers.

Because you do not expect it, you may begin labor early without realizing you are in labor. The symptoms may be relatively mild, and include a new-onset of regular, reoccurring lower back pain or pelvic pain, diarrhea, tightening across the belly, or cramping similar to menstrual cramping.

Please call the office at (816) 282-7809 or (816) 942-3339 for:

• Regular menstrual-like cramping lasting more than an hour
• Increased pelvic pressure
• Regular tightening (contractions) of the low abdomen/belly, contractions greater than 4 per hour.
• New onset of middle or low back pain, especially if associated with cramping
• Pink or blood-tinged mucous (if not after an exam) or bright red bleeding
• Continued leaking or a gush of clear, thin, watery fluid (may be the amniotic fluid or “bag of waters” breaking)

1st Appointment– This appointment will be scheduled with a nurse. A detailed health history (personal and family) and routine labwork will be obtained. You will be provided with educational materials. Your partner is welcome to come to any of your visits. When you check out, you will be scheduled for your next appointment with your physician.

2nd Appointment – This appointment will be scheduled with your physician. This appointment will include a breast exam, pelvic exam, cultures for chlamydia and gonorrhea and a pap smear if indicated.

Approximate Routine Appointment Schedule is as follows:

• OB visit every 4 weeks until you are 28 weeks gestation, then
• OB visit every 2-3 weeks until you are 35 weeks, then
• OB weekly until delivery.

**Your physician will determine if more frequent visits are necessary.

Routine Testing

18-20 weeks: Routine screening ultrasound will be performed in our office, or another local facility, depending on your insurance.

24-28 weeks: Gestational diabetes screen and hemoglobin will be performed to rule out diabetes and anemia.

28 weeks: Rhogam injection will be given if you have a negative Rh blood type.

35-37 weeks: Group B Strep (a bacteria that can be present in the vagina) screen will performed.

Optional Testing Offered

Nuchal Cord Translucency (First Trimester Screening): This test is a screening for early detection of Down Syndrome and Trisomy 18. It must be scheduled with a perinatologist between 11.2 to 13.6 weeks of your pregnancy. If you are interested in this test, please mention it to your nurse or doctor as soon as possible.

Penta AFP Screening: This is an alternative screen for Down Syndrome, Trisomy 18 and Trisomy 13. It also screens for Spina Bifida. This is a blood test and can be drawn in our office at 15 to 22 weeks of your pregnancy.

Cystic Fibrosis Screening: Cystic Fibrosis is a highly fatal and inherited lung disease. This blood test can be drawn in our office and can determine if you are a carrier. It can be drawn at any time during your pregnancy or before pregnancy occurs.

Fetal Surveillance: Testing can be performed as recommended by your physician and may include genetic counseling, amniocentesis, Level II ultrasound, NST (Non-Stress test) and BPP (Biophysical Profile).

Reminder: We will still have you see your PCP for any problems not related to pregnancy.

**You may also refer to www.acog.org for more pregnancy questions and general information.

Please drink at least 32 ounces of liquid starting at least 1 hour prior to your scheduled appointment. Thank you.

ACTIVITY

For two weeks, do not do anymore than you have been doing in the hospital. Avoid stairs and do not do any heavy lifting or cleaning. Don’t drive your car for two (2) weeks. The most important thing to remember is do not become over-fatigued. You may increase your activity gradually after the first 2 weeks.

BATHING

Keep your incision clean and dry. You may take baths, showers, and wash your hair. No tampons, douching, swimming or intercourse for 4-6 weeks.

DISCOMFORT

You may take sitz baths at home for any pelvic discomfort. The water level should be about 6-8 inches to cover your bottom. You will be sent home with pain pills if needed.

BREASTS

• NURSING – maintain good breast care and support. Avoid chocolate, caffeine, cabbage and highly seasoned foods. Your pediatrician will be able to give you a more complete list. Call the office if you have an increase in temperature, or if breasts become red or painful.
• NON-NURSING – wear a good supporting bra. If breasts become engorged, apply ice packs. You may need a pain pill. This discomfort may last 3-5 days, and you might have a slight elevation of temperature.

CONSTIPATION

Colace® for stool softener or Peri-Colace® for laxative.

EXERCISES

Wait two weeks to start any exercising and start slowly.

INCISION

If your incision becomes tender, red, or drains apply moist heat packs. Call the office if it looks infected or you see no improvement. Abdominal distention is to be expected for several weeks. Don’t worry, it will go away.

Call the office as soon as possible for an appointment in two weeks. If you still have staples make an appointment within 5 to 7 days from delivery date for removal. Please let us know if you have a temperature elevation, an increase in bleeding, or if you have any questions.

This condition consists of variable degrees of nausea, with or without vomiting, most likely occurring during the first 12-14 weeks of pregnancy (first trimester). These symptoms may be very mild in some, and almost disabling in others. Often, it is the first sign that someone is pregnant. Most women experience some symptoms of morning sickness between the two extremes.

This condition is probably associated with the drastic hormonal changes that must take place to permit normal growth of the new pregnancy. Progesterone is a hormone which causes relaxation of smooth muscles (over which you have no control) found in the blood vessels and walls of the intestinal tract. Progesterone and other hormones slow the emptying of the stomach and movement of the intestines (therefore, also causing constipation). They may also have a direct action on the center in the brain that controls nausea and vomiting.

What you can do:

Stay as active as your strength and sense of well-being allows. Take regular rest periods, but do not just stay in bed because of nausea.

Keeping fluids down is the most important thing. Sometimes Gatorade® or watered-down juice sits better than plain water, but try to drink 6-8 big glasses of fluids per day. You don’t need to drink it all at once, and often it is easier to drink 1/2 cup every 15-20 minutes. Wait a bit after drinking before trying to eat something.

Often, keeping something in your stomach helps with the nausea. Eat frequently during the day – as often as every 1-2 hours. Avoid large meals. Make your frequent snacks consist of high-protein foods such as celery spread with peanut butter, nuts, cheese and crackers, yogurt, granola bars, plain turkey or chicken.

Avoid junk foods, which may be high in fat and salt, but low in nutrition and not last long for energy.

Keep crackers by your bedside for early morning or late night snacks.

Avoid cooking if nauseated. Avoid exposure to strong smells. Some people find food/drinks with ginger, citrus or mint are helpful.

Over-the-counter medications to try:

• Vitamin B6 – 50 mg three times a day
• Unisom® (try a half-tablet during the day)
• Dramamine®
• Motion sickness wrist bands
• Tums®

***If you are not able to hold anything down for 1-2 days (including fluids), please call the office or go to the Emergency Room for evaluation and treatment. Sometimes, IV fluids and medicines are needed for treatment. There are also many prescription medications that we can use to help with nausea and vomiting during early pregnancy.***

Travel is not recommended at any time during pregnancy for women who have medical or obstetric complications. Any questions regarding travel can be clarified with your physician at your next appointment.

When traveling long distances, we recommend that you get up and allow time to walk around at least every 1-2 hours. This will improve circulation and help avoid blood clots. Make sure you take frequent bathroom breaks as needed to avoid bladder infections. We also suggest taking a copy of your medical records with you when traveling towards the end of your pregnancy and keep our office number handy for questions.

Frequently asked questions:

• Does our baby have diabetes: “NO” The mother has diabetes. You may or may not have diabetes with subsequent pregnancies. Ninety-nine percent (99%) of all women with gestational diabetes return to normal after the pregnancy.
• If I were diabetic, wouldn’t I have symptoms? Probably not. This is the reason that a screening test is done on all obstetrical patients.

Gestational diabetes screening needs to be done at your next appointment. Please follow these directions:

• Refrigerate the Glucola; do not put ice cubes into the drink.
• The day of the test, eat your regular meals, avoiding simple sugars, such as cakes, cookies, jams, jellies, syrups, etc.
• One hour before your appointment, drink (within 10 minutes) the 10oz. bottle of Glucola that has been given to you. NOTE what time it is that you FINISH drinking the Glucola.
• Do not eat or drink anything else until after your blood sample has been drawn in our office.
• Please arrive 10 minutes early for your appointment. Upon arrival, please inform the receptionist that you are to have a blood sugar test performed. This test needs to be done one hour after you finish drinking the Glucola, so, if that time arrives, and you have not been called to the lab, please inform the receptionist.

Please Note: If you are scheduled for an ultrasound the same day as your glucose screening test, you must drink your Glucola 1 hour and 15 minutes before your Ultrasound appointment and arrive 15 minutes before your appointment to have your blood drawn.

If you have any questions, please call our office.