- Attend regular prenatal care visits
- Be INFORMED; educate yourself and ask questions. Get information from us, the ACOG book we provided for you and LIMIT Internet searches for information from non-accredited sources
- BE PROACTIVE—select a pediatrician and sign up for educational classes by 24 weeks if needed. Start taking classes around 30 weeks. We really encourage you to take classes with our office if this is your first pregnancy. BE PREPARED!!
- Check with insurance for maternity benefits. At your 10 week appt, you will meet with business office to set up payment plan
- Check with insurance company for benefits for breast pump if planning on breastfeeding. We will give you the order in the last month of pregnancy
- Contact your Human Resource Representative with your employer for maternity leave benefits. If you have paperwork that needs to be filled out, PLEASE bring these into the office several weeks in advance.
- REMEMBER that every pregnancy that you have is different and you may experience different complaints with each one
- Decrease stress levels and enjoy your pregnancy
Common Pregnancy Concerns
- First, fetal movements are usually felt between 18-22 weeks. Once you feel movement, try to feel for movement once a day until 28 weeks. At 28 weeks, we want you to feel at least 6 movements in 1 hour twice in one day (not every hour). Best time to do kick counts is after eating or drinking.
- Immunizations-Recommended by ACOG & CDC
- TDap (Tetanus, Diphtheria & Pertussis (Whooping Cough) Booster in the last trimester
- Seasonal Influenza
- Encourage family members or those who will be near the baby to be up to date
- You can get your hair styled and colored. FYI: It may not turn out the same as it usually does!!!
- You can paint if you want to, just make sure it is well ventilated so you don’t get lightheaded, a headache and nauseated
- You may go to a Chiropractor & Physical Therapy while pregnant
- You can have a Prenatal Massage-there is NO true research that massage causes miscarriage
- Use sunscreen while in the sun as your skin is more sensitive and can burn easily
- You can use bug spray with DEET to prevent bug bites
- Household cleaning products are safe to use while pregnant. If you are worried, use gloves.
- There are NO studies regarding self-tanners, spray tanning or using tanning beds; use at your discretion
- Refrain from laser hair removal, tattoos and piercings during pregnancy
- Activities such as: horseback riding, biking, skiing, water slides, boating, ATV, rollercoasters-CAUTION as we cannot tell you that it is 100%. If you could injure yourself when not pregnant, you could injure yourself & potentially your baby, while pregnant!!
- Hot tubs & saunas increase your core body temperature; it is not that you cannot do it, it is the amount of time spent doing it that can possibly cause harm (less than 10 minutes) Should not allow your core body temp to get to 102 or greater (this is when harm may occur).
- Group Beta Strep (GBS) is a bacteria that we screen for on every patient between 35-37 weeks. A swab is used to collect discharge from the perineal area. If it is positive you will be treated with IV antibiotics during Labor
- FMLA paperwork-please turn these in to us as soon as possible. They will be placed in a folder for us to work on when able. We cannot fill out the same day as turned in to us.
- FYI: If you have your Lipids (Cholesterol, etc) drawn during pregnancy, there is a good chance it will come back elevated
Common Pregnancy Complaints
- Changes in the body are common during pregnancy due to hormonal changes-please refer to the ACOG book that was provided for you for more detailed information
- Increase in vaginal discharge is NORMAL. It is from the hormonal changes that increase the blood flow to the vagina. The color can range from clear to white to yellowish. ONLY concerned if you may be experiencing irritation/itching with the discharge or a foul odor or pain with intercourse
- You may experience even more discharge, even mucous, if you have had intercourse, vaginal exam in the office
- “I’ve lost my mucus plug” This will occur in the last month of pregnancy and is a NORMAL change. It does NOT mean anything is wrong or that you are going into labor. You may or may not notice this occurrence-DO NOT CALL ABOUT THIS, IT IS NORMAL
- Leaky bladder—weight from the growing uterus puts pressure on bladder and you may have urine released for no reason, during coughing, sneezing, or exercising
- Leaking breasts—the hormones of pregnancy cause the breasts to enlarge and become swollen. It is not uncommon for them to leak discharge/colostrum from the nipple at any time during the pregnancy. It does not mean anything is wrong.
- Bloody noses & bleeding gums are common due to the hormonal changes that effect the nasal cavity and gum lines
- Nasal Congestion/Stuffiness due to swelling of the tissue in the nasal cavity
- Varicose veins are common and cannot be entirely prevented. You can minimize, by wearing compression stockings or maternity hose. They may cause some minimal discomfort after being on your feet. Pain, redness, swelling, warmth to area may be of concern.
- Lightheadedness, dizziness, feeling that you could “pass out” can occur due to blood volume changes, low blood sugar, blood pressure changes, dehydration or a virus. If this occurs, hydrate and eat something high in protein and rest. If prolonged and doesn’t get better you need to contact us during office hours
- Shortness of breath with activity, such as climbing the stairs is common due to vascular & respiratory changes and may increase as the baby grows and the uterus pushes up into the diaphragm. If you experience shortness of breath or difficulty breathing after trying to rest this may be a concern that would require an Emergency room visit
- Heart rate will increase by 20%-you may feel your heart beating faster in your chest at times
- Leg cramps—HYDRATION during day to prevent, leg stretches, Calcium (TUMS), Potassium (bananas, avocados), Magnesium
- Restless Leg Syndrome (RLS)-massage legs, keep moving, stretch leg muscles, hydration, warm bath, rotate ankles, reduce caffeine, may use Benadryl for relaxation/rest
- Sciatic Nerve Pain-pain in lower back/buttocks that may send shooting pains down into leg—stretch area (we can show you), ice, Tylenol, Bengay cream, Icy Hot, ThermaCare patches
- Back pain can be normal. Change positions often, stretch, stand, sit, move around, massage, ice, low heat, Tylenol, warm bath, Icy Hot, Bengay, ThermaCare patches. May be concerning if no relief at all from doing these things
- Round Ligament Pain-sharp pain in the abdomen or hip area, usually on one side, but can be on both. The pain will be sharp and then subside and go away. May notice it with activity, when going from sitting to standing, etc.
- Swelling may occur during your pregnancy if you are dehydrated, eat foods high in sodium, summer heat. Swelling should get better or even go away after resting at night. If you are concerned, weigh yourself every morning after urinating, wearing the same thing—if more than 3 lbs weight gain from one morning to the next morning, call the office during business hours
- STRETCH MARKS are from the hormonal changes in the body. They cannot be prevented!!! Using cream and lotion is only moisturizing the skin to prevent the “itching” as the skin stretches. Be careful using anything other than hypo-allergenic cream and lotion as they may irritate the skin and cause a rash and itching.
- Skin pigment changes are common-dark patches on the face, dark line on the abdomen, spider veins, skin tags-these cannot be prevented.
- Acne is common due to hormonal changes. The majority of over the counter facial cleansers, astringents, & toners are fine to use.
- Skin irritation is common and you may have an occasional rash/irritation-you may use hydrocortisone cream, etc. SEE APPROVED MEDICATIONS in PREGNANCY
- PUPPS rash is a rash associated with pregnancy that usually starts on the abdomen and can spread throughout the entire body. You may have little red bumps on the skin and it is very itchy. DO the APPROVED MEDICATIONS and if no relief, inform us during business hours
- Bowel changes are common due to hormone changes. You may have constipation or even looser stools. Heartburn, gas and hemorrhoids are common. SEE APPROVED MEDICATIONS IN PREGNANCY
- Hemorrhoids (external & internal) are common and you may notice some bleeding with stools
- Emotional changes—you may have some periods of irritability or even sadness or anxiety. If it is prolonged and causing problems on a daily basis, please talk with us.
- POSTPARTUM CONCERNS: small clotting from the vagina is common. We would be concerned if you are having large clots the size of lemons or larger with heavy bleeding where you saturate an overnight pad every hour x 3 hours. Extreme foul odor from the vagina, increase in pain, and fever.
- Plugged milk duct verses Mastitis (breast infection). They are very similar as you may have breast pain and feel a lump. The lump may be swollen, red and warm to touch. The difference between them is that you will run a temperature of 101 or greater if it has become Mastitis. If you have a plugged milk duct, you need to massage the area towards the nipple while applying moist heat during feeding or pumping. You can massage castor oil into area as well. For comfort measures between feedings, you may use Motrin, Ice and frozen cabbage leaves. If you start to run a fever of 101 or greater, contact us during business hours.
- Baby blues is common due to hormonal changes and sleep deprivation. You may have periods of sadness and crying. You may not even know why you are doing this. If it is prolonged, worsens, having panic attacks or feelings of harming yourself or other-you need to contact us.
- Keep all incisions clean and dry as much as possible to aid in HEALING. Change pad or dressings often, shower with soap daily if able
- PAIN-you will have some discomforts: uterine cramping, breast engorgement, discomfort from incision or episiotomy, muscle discomfort from pushing, back discomfort from epidural/spinal, and mild headache. These should be minimal and tolerable with Motrin/Ibuprofen, pain pills from hospital for a short time. If it is not tolerable, you will need to inform us during office hours.
Pregnancy Diet & Vitamins
- Take a Prenatal Vitamin with folic acid daily
- You will need a prescription Fluoride supplement if you drink well water or your city water is not supplemented
- You can take Vitamin D, Omega-3’s as they are considered safe, but there is limited research on the true positive effects during pregnancy
- Herbal products & teas are NOT studied in pregnancy and therefore you should refrain from use
- Artificial sweeteners are fine in moderation; refrain from sweet & low
- Eat healthy well balanced meals
- High in protein
- Low fat, low sodium, low cholesterol
- Food sources high in calcium & iron
- Eat small frequent meals with protein and low carbohydrates to prevent low blood sugars
- Low blood sugar may make you feel dizzy, sweaty, nauseated, feel like you may pass out
- DON’T eat undercooked or raw meats (ex. pink/red beef, raw fish-sushi)
- DON’T eat fish high in Mercury-Shark, King Mackerel, Tilefish, Swordfish
- You CAN eat other fish 1-3 times a week; Canned Light Tuna, Tilapia, Salmon, Shrimp, Cod, Catfish, & Albacore White Tuna (limit to 6oz/week)
- You can eat cheeses that are pasteurized, no raw eggs, Deli Sandwich meat is fine to eat
- Drink WATER; minimum of 64oz water a day -HYDRATION IS ONE OF THE MOST IMPORTANT THINGS YOU CAN DO DURING PREGNANCY!!!!!
- Helps prevents contractions, leg cramps, headaches, constipation, swelling
- Limit caffeine; you may have 1-3 cups/day
- Get 8 hours of sleep/rest a night
- After 20 weeks, try to sleep on your sides as much as you can. If you wake on your back, don’t worry, just roll back to your side. You need to sleep, so find a position that is comfortable
- STOP SMOKING-nothing “good” comes from smoking…it is harmful to you and your baby!!!!!
- Electronic Cigs: there is NO safety data using these in pregnancy
- Don’t drink alcohol or do illicit drugs
- Weight gain 25-35lbs
- Be ACTIVE and keep moving, it is good for the entire body (unless we tell you not to)
- Walking, swimming, yoga are less strenuous on joints/ligaments
- You may continue doing activities that you previously have done, as long as you feel fine
- Should try to keep your heartrate less than 140 bpm
- No abdominal crunches
- Good hand washing to prevent infections
- Good dental hygiene—go to regular dentist appointments
- You may experience bleeding gums with brushing/flossing
- Dental work with numbing medicine is safe, x-rays are fine if the abdomen is shielded-try to refrain from the first trimester tough
- Don’t change cat litter-due to risks of Toxoplasmosis
- If you are having a normal healthy pregnancy you may travel by car or air until 35 weeks. After 35 weeks, we encourage you to stay home.
- When traveling, continue to hydrate, move around every 1-2 hours, and use restroom regularly.
- You can work until you have your baby, unless you have a condition that prevents it (we will tell you)
- You can have intercourse while pregnant unless we tell you that you cannot. If you do, you may experience some light spotting for up to 48 hours, so don’t be alarmed (even if it hasn’t happened before)
Colds, Sinus Congestion, Sore Throat, Cough & Bronchitis
REMEMBER THAT MOST OF THESE ARE CAUSED BY VIRUSES AND TAKING ANTIBIOTICS WILL NOT HELP
If you are experiencing any of these symptoms please follow the instructions below:
- As with any medications during pregnancy, it is encouraged to use them minimally and PREFERABLY NOT AT ALL. NOTHING IS BEST!!!!
- If at any time you start running a temperature of 101 or greater, you may use Tylenol as needed. Having a temperature is your body’s way of fighting off the virus
- Rest as much as possible
- Maintain good hydration
- Wash hands frequently, cough in the crook of the elbow instead of your hands to prevents spreading the virus
- DO NOT worry about your baby, they are not usually effected by these symptoms
- Colored (green or yellow) discharge from blowing your nose or coughing does NOT mean you have an infection. This is “old” drainage that has turned colors.
- There is documentation that mild to moderate sinus symptoms (colored nasal discharge, pain in the cheeks, face, tooth pain) does NOT need antibiotics unless it has lasted over a week in duration or symptoms worsen during that time period
- Use a humidifier to keep nasal passages moist
- Use hot steam inhalation to moisten the nasal passages: ex. Hot shower, inhale hot steam (boil water on stove, remove, cover your head and the pot to inhale), heat water in a cup and inhale the steam
- Drink HOT fluids to help loosen up secretions
- Saline nasal spray , Flonase, Nasocort are acceptable
- You may use cough drops, throat lozenges, VICKs, Tylenol for discomfort, headaches, running a temp
- Swallow a teaspoon or honey every 4-6 hours for a sore throat—this helps with the swelling and coats the throat, it will also cut down on coughing
- If you are coughing at night, you can use VICKS to the feet (this really works), and Robitussin or Nova-histine and honey.
- CALL YOUR PRIMARY CARE DOCTOR’S OFFICE IF:
- Symptoms do not improve after 7-10 days or worsen during that time period
- If you are running a temp of 101.5 or greater despite using 2 tablets of extra strength Tylenol
- If you have been exposed by a family member with diagnosed Influenza or Strep Throat
- ONLY take antibiotics if there is a documented bacterial infection: blood test or chest x-ray
Nausea, Vomiting, Diarrhea & Other Gastrointestinal Symptoms
- May be caused by a VIRUS, pregnancy hormones OR something you ate
- If this is caused by a VIRUS, it will have to run its course as with all types of viruses; this may take 24-48 hours
- The stomach and bowels are easily irritated by certain foods, such as dairy products and fatty, greasy items. These may cause some gastrointestinal upset, such as abdominal pains, bloating, nausea, gas, diarrhea
- The hormones produced by the pregnancy may cause nausea, vomiting and bowel changes as well
If you are experiencing any of these symptoms please follow the instructions below:
- As with any medications during pregnancy, it is encouraged to use them minimally
- If at any time you start running a temperature of 101 or greater, you may use Tylenol as needed
- Rest as much as possible
- DO NOT worry about your baby, they are not usually effected by these symptomsNAUSEA:
- BEST to eat bland foods & liquids: toast, applesauce, bananas, rice, water, gingerale (very soothing to the stomach) chicken noodle soup
- Refrain from fatty, greasy foods, dairy products
- You may take Bonine (Meclizine) for nausea if needed
- Vitamin B6 (25-50mg) and ½ tablet of Unasom three times a day may help with nauseaVOMITING:
- MOST IMPOTANT THING: If you are unable to keep ANY fluids (not worried about food) in a 24 hours time period you may become dehydrated. This would be concerning and you need to inform the clinic during business hours. If the clinic is closed you need to go the hospital, do not call the doctor on call
- If you start vomiting: STOP trying to eat and drink for approximately 4 hours. After the 4 hours, you may start to sip on fluids, ice chips, Gatorade, etc. Note: Gingerale is very soothing to the stomachDIARRHEA:
- Refrain from all dairy products
- If it lasts longer than 48 hours, you may use IMMODIUM AD (over the counter medication)
- If your stools are watery and last longer than a week you will need to contact your primary care doctor for evaluation
Many employers have their own policies when it comes to maternity leave. Please consult with your Human Resources representative during your pregnancy to discover what you may be entitled to receive. Many employers will give you specific paperwork that needs to be filled out by the Women’s Clinic of Lincoln OB office regarding your time off.
PLEASE BRING THIS PAPERWORK TO OUR OFFICE SEVERAL WEEKS PRIOR TO YOU NEEDING IT RETURNED. We are unable to fill it out the same day as many of the forms have several pages.
The basic “maternity leave” for a vaginal delivery is 6 weeks and 8 weeks for a cesarean delivery. How this time is paid is dependent on each employer’s policies. FMLA (Family Medical Leave Act) allows certain employees to take additional “unpaid” time to lengthen their “maternity leave.” You will need to discuss with your HR department on specific details for your leave and to determine if you may qualify for FMLA if you choose.
We will fill out your paperwork and scan a copy into your chart. Depending on the how the paperwork is to be returned, we will fax, mail or hand deliver it to you at one of your prenatal care visits.
If you have any questions, please discuss with one of the nurses or nurse practitioners.
Optional Screening Tests During Pregnancy
Genetic testing is a screening test that can be done to determine the chance that your baby has a genetic condition.
Mothers at Higher Risk for chromosomal abnormalities:
- Advanced Maternal Age: a mother that will deliver her baby when she is 35 years or older
- History of a pregnancy or child born with chromosomal abnormalities
- Abnormal ultrasound findings
The Women’s Clinic offers genetic screening tests. These tests are OPTIONAL and the costs associated with it are NOT included in your pregnancy care contract with our office.
First Trimester Screening—High Risk Pregnancies
Second Trimester Screening—Low Risk Pregnancies
- QUAD Screen (AFP is part of this test)
- AFP-Alpha Fetoprotein—screening for neural tube defects (both High and Low Risk Pregnancies)
If you choose to do Harmony or Panorama:
- FIRST-You will be required to contact the company to find out if they are in network with your insurance company
- If your insurance IS in Network you will be given a CPT code to give to your insurance company to find out your out of pocket expense. This all depends on your deductible, etc. This is your responsibility prior to testing. ASK–“What is my out of pocket expense?” DO NOT ASK THEM IF IT IS “COVERED”
- If your insurance IS NOT in Network with the company, they will inform you of your out of pocket expense.
- You must do this several days in advance of your appointment in which is when the testing will be performed, otherwise the testing will be delayed.
- This testing is very expensive and insurance may not cover any of the cost. Again, we do NOT do any of the billing for these tests.
If you choose to do Second Trimester Screening—Quad Screen or AFP alone:
- You may call your insurance, but we have not received any claims that this is not being covered at this time.
- You will be responsible for any out of pocket expenses, which includes: Co-pay, deductible and co-insurance. You are responsible to know this information or call your insurance to be informed.
Turn to next page for further information on each test.