Patient Education

Pregnancy

Preparing for a Healthy Pregnancy

Vitamins

Folic acid, (or folate) is considered the vital vitamin with regards to pregnancy. Taking a supplement with 0.4 mg to 0.8 mg (400 mcg to 800 mcg) of folic acid before becoming pregnant reduces the chance of having a baby with certain birth defects. If you have a family history of neural tube defects, have had a previous infant with a neural tube defect, or are on medicines to prevent seizures, take a daily supplement containing 4 mg (4000 mcg) of folic acid. You also need other vitamins and minerals, such as calcium, for your health and that of your baby, so a daily multivitamin in addition to the folic acid is a good choice.

Medications

Before trying to conceive, talk to your doctor about any medicines or dietary supplements you are taking. You and your doctor may decide that it's best to stop taking the medicine, to take a different medicine, or to keep taking it.

Lifestyle changes

These lifestyle changes will help to insure that you have a healthy pregnancy and baby:

Quit smoking
Cut down on caffeinated drinks
Stop drinking alcoholic beverages
Stop any use of illegal drugs
Get plenty of exercise
Cut out junk food and eat a healthy diet

Fertility calculator

To figure out when the most likely time for you to get pregnant, see

http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn9893/interactive-tool-when-are-you-most-fertile.aspx#tx4401

Later Childbearing

For women having children after the age of 35, please see the following link

http://www.acog.org/~/media/For%20Patients/faq060.pdf

Pregnancy and Diabetes

Please see the following link: http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/uz2107/pregnancy-and-diabetes-planning-for-pregnancy.aspx#uz2108

Pregnancy and Anti-Depressants

There is information for women planning pregnancy who are taking anti-depressants at :

http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/zx1763/depression-should-i-take-antidepressants-while-im-pregnant.aspx#zx3744

Seizure Disorders and Pregnancy :

http://www.acog.org/~/media/For%20Patients/faq129.pdf

Due Date Calculator

http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn9888/interactive-tool-what-is-your-due-date.aspx#te7955

Prenatal Care

Your First (New OB) visit :

A complete health history will be obtained, including personal and family history
Your physical examination will include a pelvic exam and Pap smear and gonorrhea/chlamydia screening
Prenatal blood testing is drawn which includes: blood type and Rh factor; complete blood count; antibody screening; syphilis, rubella, hepatitis B, and HIV testing. A urine sample will also be sent for a culture. Additional information at
http://www.acog.org/~/media/For%20Patients/faq133.pdf

Subsequent (Return OB) visits

Your weight, blood pressure, and urine tests for sugar and protein will be checked.
Abdominal exam to measure the growth of the uterus and estimate the size and position of your baby.
Fetal heart rate will be listened to.
We suggest you keep a list of questions/concerns and bring them with you to your appointment for discussion with your OB provider.
Cervical checks begin at approximately 35-36 wks, unless otherwise indicated due to bleeding, contractions, or other complications.
At around 10‐13 weeks, several optional tests are offered: Cystic Fibrosis, and 1st Serum
Integrated screen. Please see Prenatal Testing section below for further information.
At around 15‐20 weeks, optional tests are offered: 2nd Serum Integrated screen, Alpha fetaprotein (AFP) or quad screen. Please see Prenatal Testing section below for further information.
At 20-21 weeks, an anatomic ultrasound to rule out any fetal abnormalities and check the sex of baby is offered.
At 28 weeks, a one hour glucose blood test is done to screen for gestational diabetes, and blood test to check for anemia is performed. If mom has Rh negative blood type, there will also be a blood test for Rh antibodies. See Rhogam for Rh negative blood type under Complications of Pregnancy, below.
At 36 weeks, a Group B Streptococcus vaginal culture is done to test for carrier status prior to delivery. If your test is positive, you will be treated with antibiotics when you are in labor as a preventative measure for your baby. See Group B Strep under Complications of Pregnancy, below.

Appointment Frequency

Every 4 weeks until the 32nd week of pregnancy
After 32 weeks, every 2 weeks until the 36th week of pregnancy
Weekly visits after 36 weeks of pregnancy
Postpartum visit 6 weeks following delivery (C-section deliveries may need a 2 week incision check)

Fetal development

You can track the growth of your baby throughout pregnancy at the following link. http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn10283/interactive-tool-from-embryo-to-baby-in-9-months.aspx#tn10284

Common Symptoms of Pregnancy

Abdominal Pain

Menstrual-like cramping is common in early pregnancy, as is a bloated sensation. Persistent or worsening cramping can be an indication of a urinary tract infection, so you should contact the nurse at the office to discuss your concerns with her. Later on in your pregnancy, the muscles that support the growing uterus are being stretched and pulled and you may feel this as a dull ache or sharp pain on one side of your abdomen. This is commonly referred to as “round ligament pain.” Tylenol, a heating pad, changing positions, and rest can provide relief.

Backaches

Late in pregnancy, the weight of the growing baby distorting your normal balance and pulling on your back muscles can cause back pain. Good posture, low-heeled shoes, rest, back massage and a heating pad will help. Exercises to stretch and strengthen your back may help, or you may try a maternity support belt. Sitting in a chair with good back support is important and sleeping on your side with pillows between your knees and below your abdomen for support is also helpful. Avoid lifting heavy objects and when doing any lifting, be sure to bend at the knees, not your back. If you’re experiencing unrelieved lower back pain along with lower abdominal pain or consistent mid back pain (kidney pain), please contact our nurse.

Braxton-Hicks Contractions

“False labor” contractions are intermittent, irregular uterine contractions which occur periodically toward the end of pregnancy. They may or may not be painful but will fade with rest or a warm bath. If the contractions become regular, every 3-5 minutes, lasting 60 seconds each, or if they persist, please call us (if after hours, please call our office to page the on call doctor). If past 34 weeks, please head over to Labor and Delivery for evaluation.

Breast Tenderness

Breast tenderness is common and may last the entire pregnancy. A bra with good support helps. Some women will have a clear, milky discharge from their nipples and may need to use nursing pads to protect their clothing.

Constipation

Pregnancy alone can slow digestion and cause constipation. Prenatal vitamins also contain iron which may be constipating. To help, you should drink plenty of water, and eat high fiber foods such as whole grains, fruits, and fresh vegetables. Adding a fiber supplement to your diet may help as well. Regular exercise also aids your digestion. You may also consider using a stool softener such as Colace, which is available over the counter.

Emotional Changes

Hormonal changes, the adjustment to pregnancy, and anticipation of caring for a new baby can cause normal emotional ups and downs. Communicate your feelings with supportive friends and family, and please be sure to discuss this with your OB provider and/or nurse if you are concerned about how you are feeling.

Dizziness/Feeling Faint

It is not unusual to feel lightheaded in pregnancy. This may be caused by changing positions suddenly, being dehydrated, having low blood pressure or low blood sugar, being anemic, or being in a room that is too warm. If you feel dizzy, you should rest or lay down right away. To prevent feeling this way, be sure to drink fluids throughout the day, eat small frequent meals with higher protein, and change positions slowly. Do not hesitate to call us if the dizziness persists, or if you have chest pain or shortness of breath that occur at the same time.

Fatigue

Fatigue is a common complaint during early and late pregnancy. Increased rest and fluids are advised. Paradoxically, mild exercise often helps to combat the fatigue by releasing endorphins. Remember to take your prenatal vitamins and iron, if needed. If you find that you are experiencing constant fatigue, please contact our nurse to come in for a blood pressure and iron check.

Frequent Urination

More frequent urination usually occurs early in pregnancy when the uterus is expanding and may push against the bladder. It should improve in mid-pregnancy, but recurs in late pregnancy, as the growing uterus and baby leave little room for a full bladder. Limiting fluids in the evening may decrease the number of times you need to get up during the night. Burning or pain with urination, consistent lower abdominal, or lower back pain may indicate a bladder infection. Please call if you have any of these symptoms.

Headaches

Headaches are quite common in all stages of pregnancy (particularly if you have a history of headaches). Rest, stress reduction, and Tylenol with a caffeinated drink may help. If headaches are prolonged or accompanied by blurred vision, swelling, upper abdominal pain, please call us. DO NOT take aspirin, anti-inflammatories (ibuprofen, Advil, Nuprin) or naproxen (Naprosyn). If your headache persists, please contact our nurse for further recommendations.

Heart burn

Burning, acidic feeling in the mid to lower chest is oftentimes experienced during pregnancy due to slower digestion and regurgitation. Sitting upright, elevating the head of the bed and “over the head” stretching exercises may provide relief. Do not lie down for 2 hours after eating. Mild antacids used in small quantities may also provide relief (Tums, Rolaids, and liquid antacids such as Mylanta and Maalox are fine). If these mild antacids don’t provide relief, you may try over-the-counter Pepcid AC, Tagamet, or Zantac.

Hemorrhoids

Hemorrhoids are dilated veins that protrude from the rectum and can therefore be quite irritable. You may experience itching or burning around the anus or have a spot of bright, red blood on the toilet tissue after a bowel movement. Avoiding constipation (see above) and straining with bowel movements is important in the prevention of hemorrhoids. Sitz baths are helpful to treat hemorrhoids, and TUCKS pads, and Anusol or Preparation H may decrease itching/burning. Ask about prescription medications available if symptoms are not improving.

Hip Pain/Pubic Bone Pain

Pelvic bone pain can occur late in pregnancy. The hormones of pregnancy loosen the ligaments supporting these areas in expectation of delivery. This loosening allows the pelvis to accommodate the passage of the baby’s head/body in labor. The downside is that it creates pain in the hip and/or pelvic bone region. Prolonged standing or walking tends to worsen ligament pain. Be gentle to yourself—rest, warm baths, and applying heat can be of great help.

Leg Cramps

Leg cramps tend to occur in mid-pregnancy due to poor circulation. These often occur at night. To relieve the cramp, flex your toes vigorously towards your knees. To lessen the cramps, you may try the following: Maternity support hose can help achy legs. Be sure that your ted hose aren’t too tight, therefore creating further decreased circulation. Balance rest and mild exercise during the day. You may try gentle massage, stretching your legs, or taking a calcium supplement. Bananas and oranges may also help provide electrolytes such as potassium that can decrease the cramps. If a specific area of tenderness or any redness develops behind the knee or in the calf, please contact our office immediately.

Lightening or “Dropping”

Lightening is a change in the baby’s position. Your abdomen appears lower and may experience more pelvic pressure and frequent urination instead of heartburn, shortness of breath, or rib discomfort as before. It usually means that the baby has “engaged” into the pelvis which is normal as a preparation for delivery.

Morning Sickness:

The most common ailment of pregnancy is morning sickness-- which is nausea, and sometimes vomiting. It usually occurs within 2-5 weeks of conception and in most cases, clears up by 12-16 weeks (fourth month of pregnancy). Even though it’s referred to as morning sickness, it can happen any time of the day. Morning sickness cannot be cured and probably to some degree, you will be nauseated-- but this nausea should be manageable. The following link has suggestions for dealing with the morning sickness. https://intermountainhealthcare.org/ext/Dcmnt?ncid=51061848

In addition to these remedies, we suggest

Try over-the-counter vitamins/medications: Taking vitamin B6 25 mg 2-3x/day with Unisom 25 mg once a day may help lessen the nausea and vomiting.
Ask for help! Please remember to ask for help from your partner, family, friends, or neighbors. Morning sickness is very real and different for every woman, so you shouldn’t wait until you are desperate to seek help.
If remedies do not help: Please contact our nurses if these remedies are not helping. If you’re unable to keep fluids down for 24 hours and/or exhibiting signs of dehydration (severe nausea and/or vomiting, fatigue, dry mouth, decreased urine output), please contact our nurses for further recommendations/treatments (prescriptions, IV hydration, etc.)

Mucus Plug

The mucus plug is an accumulation of secretions that form within the cervical canal (opening to the uterus). This mucus accumulates early in pregnancy and serves as a protective barrier against infection. As you near the late part of your pregnancy, your cervix will begin to thin out and dilate. As it changes, you may lose your mucus plug and have a gooey, mucous-like discharge. It is not uncommon for this mucus to be mixed with brown, pink, or red streaks of blood. Some women may lose the plug at around 36 weeks but many women are not even aware when they pass it. Loss of the mucus plug indicates that labor is approaching within the next few weeks, but has no other real significance. You may continue normal activity after losing your mucous plug (exercise, intercourse, bathing, etc.). If you happen to notice any consistent, watery discharge (like wetting your underpants), please go to labor and delivery for evaluation of possible rupture of membranes.

Nasal Congestion/NoseBleeds/Bleeding Gums

Nasal congestion can be bothersome to some and may make you think of an on-coming cold. Usually it is due to increased blood supply in the nasal membranes and does not make one feel ill. Due to the mucus membranes having more blood supply, nosebleeds may also occur. Saline nasal spray or Vaseline applied at bedtime to the nasal passages can keep the nasal passages moist and decrease nosebleeds. If they persist despite ice compression for 5-10 minutes and head tilting back, please call us. For bleeding gums, good dental care should continue including flossing, but you may want to change to a softer toothbrush.

Numbness or Tingling

As a result of tissue swelling and fluid retention, you may develop a carpal tunnel syndrome-like effect in your fingers, with numbness or tingling in one or both hands that usually resolves after delivery. Wrist splints may lessen the symptoms. Nerves may also be compressed by the uterus that can cause pain in the hips or lower legs called sciatic nerve pain. Rest or a maternity support belt may be helpful, and again, symptoms usually resolve after delivery.

Pressure under the Rib Cage

This is another discomfort which can occur as the baby presses against the organs of the upper abdomen. This pressure often feels like a sore spot or bruised area, especially under one rib. Sitting in a straight-backed chair with a pillow behind the lower back helps relieve the pressure and facilitates breathing. A warm bath or heating pad may also help.

Shortness of Breath

Shortness of breath often occurs in the last few months. Several factors contribute to this: Your blood is more dilute, less oxygen-rich, and your additional bulk/weight contribute to the exhaustion and the pressure of the uterus against the diaphragm makes it harder to take a deep breath. You may find you need more time to do your usual activities. You should rest more frequently and may need to stop some overly strenuous activities. It is very helpful to control your rate of weight gain. Sleeping with your head elevated or on your side may help at night. If shortness of breath is extreme or comes on suddenly and persists, please let us know.

Skin Changes

Dry itchy skin, pigment changes, and stretch marks can occur during your pregnancy. An emollient cream may help relieve the dryness and itchiness. Some women develop brownish discolorations on their face, skin, or a brown line appears in the middle of their abdomen. These are related to hormone changes and will fade after delivery in most cases. Whether you will develop stretch marks on your breasts and abdomen will be determined by your skin type/elasticity, hereditary factors, and total weight gain during pregnancy. No creams will prevent or eliminate them.

Swelling

Some swelling is normal in the hands, face, legs, and feet during your pregnancy, especially towards the end. Continue to drink plenty of water, avoid high sodium foods (pretzels, potato chips, salted popcorn, etc.) Exercising and elevating your legs when able will also help. Notify our nurse if you have a sudden increase in swelling.

Vaginal Discharge

This increases for most women during pregnancy. It is usually a white or pale yellowish discharge. Maintain good hygiene. Douching is not recommended during pregnancy. If you have persistent itching or irritation, please call us to check for possible yeast infection/vaginitis.

Varicose Veins

The weight of the uterus and growing baby may compress and slow blood flow from the lower body. This may result in bulging veins in the legs or perineum. To relieve leg soreness and swelling, you may try wearing support hose, elevating your legs, exercising regularly, and avoiding crossing your legs. Notify our nurse if a vein becomes suddenly tender or more swollen.

Weight Gain

A healthy weight gain for most women is between 25‐35 pounds for the entire pregnancy. If you are overweight, you should gain between 15‐25 pounds. If you are underweight or pregnant with twins, you may need to gain more. Most of this comes during the last three months when the baby is growing very rapidly. Pregnancy is not the time to attempt weight loss.

Medications During Pregnancy

List of Medications

All drugs have potential side effects and should be used only when the risk of taking the drug has been weighed against the benefit. During the first trimester (3 months), it is best to avoid all medications if possible. Your doctor should be made aware of any prescription medications you are taking, or of any herbal or homeopathic substances you are using during pregnancy. It is also important to notify all other health care providers, including dentists, that you’re pregnant. We are available to consult with your other physicians or dentist if prescription drugs are indicated. For your convenience, we have listed a number of medications which are permitted in pregnancy with reasonable, necessary and sparing use.

Problem	Medication	Directions
Allergies (seasonal)	Benadryl Claritin Zyrtec	Follow package directions
Cold and Congestion	Sudafed, Benadryl, Tylenol Products, Claritin and Mucinex	Follow package directions. It is best to use single symptom medications.
Constipation	Metamucil (fiber) Colace (stool softener) Fibercon (fiber)	Follow package directions. See constipation section above.
Cough	Robitussin Throat lozenges	Follow package directions.
Diarrhea	Imodium	Follow package directions. Avoid Pepto Bismol.
Fever	Tylenol	Follow package directions.
Headache	Tylenol Extra Strength Tylenol	Follow package directions. See headache section above.
Heartburn	Antacids: Maalox Mylanta Tums Rolaids Pepcid AC	Take antacids ½ hour before meals and before bedtime. Other medications: follow package directions. Avoid Alka Seltzer. See heartburn section above.
	Zantac Tagamet
Hemorrhoids	Anusol HC Preparation H	Follow package directions. See hemorrhoids section above.
Morning Sickness	Vitamin B6 and Unisom	B6 25 mg 2-3 times a day/Unisom once daily at bedtime. See morning sickness section above.
Pain, muscle aches	Tylenol	Follow package directions. Avoid aspirin and ibuprofen. Call nurse if pain persists.
Rash	Benadryl lotion Cortaid cream	Follow package directions.
Vaginal Yeast Infection	Gynezole 1 Monistat	Follow package directions.

Other illnesses during pregnancy

Flu-like Symptoms

The flu is a contagious disease and both the seasonal flu (influenza) and the Novel H1N1 flu (formerly known as “Swine Flu”) are serious infections that can be dangerous, sometimes causing hospitalization and even death. Pregnant women are more likely to get sick with the flu than others and have more serious complications such as pneumonia and preterm labor. We want you to stay healthy, therefore, it is a important to take steps to protect yourself from the flu.

Vaccines: We encourage our patients to be vaccinated against seasonal influenza each year as soon as vaccines become available. The yearly seasonal flu vaccine is a combination vaccine that also protects against Novel H1N1.
Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something, such as a surface or objects with flu viruses on it, and then touching their mouth or nose.
Take these everyday steps to protect your health:
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze.
  Alcohol‐based hand cleaners are also effective.
- Avoid touching your eyes, nose or mouth. Germs spread this way.
- Avoid close contact with sick people. If you are sick with flu‐like illness, it is recommended that you stay home for at least 24 hours after your fever is gone, except to get medical care or for other necessities. Keep away from others as much as possible to keep from making others sick.

Colds/Congestion/Cough/Sore throat

Colds and other viruses are common in pregnancy and seem last longer while you are pregnant. Extra rest, plenty of fluids, and the over-the-counter remedies mentioned above are best. If you have a fever higher than 101 degrees and/or your symptoms persist, please call us. If your sore throat seems to be extreme and you are concerned that it may be strep, please call and we will be happy to fax an order to the lab at the hospital for screening for strep throat.

Exposure to Chicken Pox, Fifths Disease

Both of these viruses are a risk for your unborn babe, but only if you get the disease, and most adults are immune to them. If you have had a close exposure, we would be happy to have a lab test done to verify your immunity.

Urinary Tract (Bladder) Infection

Women are at an increased risk of urinary tract infection during pregnancy. Because a UTI can cause preterm labor, we want to treat it as soon as possible. Please call and get further instructions from the nurse if you are having any of the following symptoms:

Painful urination, particularly at the end of voiding
Frequency—needing to empty your bladder more often than is usual with this pregnancy
Bladder pain or irritation
Blood in your urine
Uterine cramping
Any of the above, with flank (lower back) pain

Activities during Pregnancy

Dental care

Daily flossing, brushing, and routine dental visits should be continued. If your dentist feels X-rays are necessary, have them properly shield your abdomen. Local anesthetics such as Xylocaine or Novacaine are safe.

Exercise

Daily exercise is highly recommended for all women during an uncomplicated pregnancy. Exercise is helpful to maintain your health, combat fatigue of early and late pregnancy, and benefit your labor and post-partum period. Exercise can improve muscle tone and strengthen and lessen some of the aches and pains during the pregnancy, including back pain. It may improve your mood and help you to sleep better. Keep in mind that now is NOT the best time to take up a vigorous new sport or exercise program. If you already exercise regularly, you can continue in moderation. Be sure to drink plenty of fluids while you exercise. Very high levels of exercise for long periods of time may be problematic for blood flow through the uterus and are not recommended. Women who enjoy aerobics usually should switch to low impact in mid‐pregnancy. In late pregnancy when many exercises are awkward, lap swimming is especially good. Brisk walking, jogging, swimming, dancing, or racket sports are all fine, as long as you do them for fun and do not push yourself to exhaustion (heart rate should not exceed above 140 bpm). Avoid sports and entertainment which might be bumpy or jerky, or have potential for falls.

Hot tubs/Swimming

Sitting in a hot tub or sauna is discouraged due to the extreme temperature, but you’re fine to dangle your feet/legs in a hot tub. Swimming is fine as long as you’re not having any watery vaginal discharge and/or bleeding (if that’s the case, contact our clinic immediately).

Nutrition

Things to be aware of during pregnancy:

Healthy Eating: Eating a well balanced diet is an important part of staying healthy throughout your life, but it’s especially important during pregnancy for you and your baby. A healthy balance of meats, vegetables, fruits, grains, and dairy are recommended. Good sources of protein may be obtained from lean meats, poultry, fish, and milk products. The remainder of the diet should be well balanced with vegetables, fruits, whole grain breads, and whole grain cereal products. Be cautious of fats and concentrated sugars (candy, soft drinks), which have many empty calories. If you have some fluid retention, watch out for very salty foods (canned meats, canned soups, chips, pretzels, etc.). Read labels! There is hidden salt in so many prepared foods. Do not eliminate salt from your diet, however.
Vitamins: A daily prenatal vitamin supplement is recommended for every woman in pregnancy. If you are a vegetarian, please discuss this with your doctor. You will need to be sure you are getting adequate protein, iron, vitamins B12 and vitamin D.
Folic acid/Iron: Be sure that 0.4 to 0.8 mg (400 – 800 mcg) of folic acid is included in your prenatal vitamin. This is especially important during and before becoming pregnant to decrease certain types of birth defects. Prenatal vitamins also have a sufficient amount of iron needed for most women to prevent iron‐deficiency anemia during the pregnancy. Very large doses of vitamins may be harmful and should be avoided.
Caffeine: Caffeine is contained in coffee, tea, chocolate, colas, and some other soft drinks. It is a drug and should be limited to 1-2 servings a day.
Alcohol: Alcoholic Beverages are NOT recommended! Drinking alcohol during pregnancy can put the baby at risk for growth restriction, birth defects, problems with joints and limbs, and mental and behavioral problems. There is no known safe level of alcohol in pregnancy.
Mercury: Fish is a good source of protein and other nutrients, however, some types may contain high levels of mercury which may affect the baby’s development. Fish such as shark, king mackerel, and swordfish should be limited. No fish should be eaten raw (sushi).
Smoking: Smoking is strongly discouraged, as it is known to decrease the amount of oxygen received by the fetus, therefore impairing growth and development. Passive exposure to tobacco use by other household members has the same effect on the fetus. A baby born to a smoking mother is more susceptible to respiratory infections and other physical ailments. Please ask us about information/programs which can help you to stop smoking and have a healthier lifestyle for you, your baby, and others around you.

More information about Nutrition During Pregnancy can be found at
http://www.acog.org/~/media/For%20Patients/faq001.pdf

Painting

Paint fumes are not toxic unless metallic based. Remember to wear a mask and keep the area well ventilated by opening windows/doors. Do not climb on steep ladders or paint awkward angled areas that could potentially lead to a fall.

Sex

Sexual activity/intercourse can continue throughout the pregnancy unless you are at risk (bleeding, spotting, history of a low lying placenta “previa,” ruptured membranes, or premature deliveries). Please keep in mind that it is not uncommon to have a little bit of spotting after intercourse, but should resolve within a day or two. If you are high risk, your physician will advise if and when you should resume intercourse.

Tanning, hair color

Tanning is not harmful to your baby, although it is discouraged due to the increased risks of skin cancer. Hair permanents, hair coloring, and fingernail sculpting are safe. You may want to have a hair spot color test done if you’ve never had your hair dyed, for possible skin reaction.

Theme Parks

In general, attending a theme park while pregnant is not a problem, but you should avoid all rides where you might be “thumped or bumped.” Also be sure to rest frequently, and drink plenty of fluids.

Toxoplasmosis

Toxoplasmosis is a common infection in people, birds, and animals that often is not noticed or may cause mild flu-like symptoms. The infection can cause problems for a fetus (when the mother becomes infected). Human infection usually happens when a person eats food that contains the toxoplasmosis parasite, such as undercooked meat. You also can get infected by touching an infected cat or its feces. You should avoid these behaviors while pregnant.

Travel

Travel poses no specific risks during pregnancy, but there are minor precautions to observe. Consider access to obstetric care. Travel will not cause premature labor, but there is a possibility that you may deliver in different surroundings with an unfamiliar obstetrician. If traveling, we recommend you stop frequently and walk around to aid circulation. Also, be sure to drink plenty of fluids. Extended travel after 34 weeks is discouraged and should be discussed with your doctor. If you’re planning to fly while pregnant, check with the airlines to find out what their guidelines are.

Additional information: http://www.acog.org/~/media/For%20Patients/faq055.pdf

Warning Signs

Call Nurse Immediately If Have One of the Warning Signs

If you have any of the following warning signs, please call the nurse at the office immediately so she can make recommendations for further evaluations or treatment. If this occurs afterhours or on the weekend, you can reach the on call doctor by calling the office number.

Vaginal Bleeding: any amount of vaginal bleeding warrants contacting our nurses to describe your symptoms and letting us know your blood type, so we may proceed with recommendations and/or treatment.
Leaking fluid (ruptured membranes or any other gush from the vagina)
Decreased fetal movement after 25 weeks
Pelvic pain or contractions before 35 weeks of pregnancy that continue for more than a short period of time
Difficulty breathing and/or pain or pressure in your chest
Consistent high heart rate (more than140 beats per minute) or a feeling of heart pounding
Any redness and/or constant pain behind the calf or knee
Severe nausea and vomiting
Persistent dizziness, headache or blurred vision
Difficulty or painful urination
Extreme swelling
Fever or chills
Severe abdominal pain

Prenatal Testing

Ultrasound

An ultrasound exam is a test that makes an image of your fetus from sound waves. These sound waves are produced by a device called a transducer. The transducer is either moved across your abdomen or placed in your vagina, depending on the structures that need to be viewed and the size of your baby. Ultrasound is used to provide an accurate gestational age of the baby, as well as check the baby and placenta for any concerns. Most pregnant women will have an ultrasound performed at about 20 weeks to check for normal anatomical features of the baby, as well as growth, and gender, if desired. You are welcome to invite family members to be there when you have this ultrasound performed.

NST

NST stands for non-stress test, which is a test done at the hospital to assess the wellness of the baby. The mom will have the monitor placed around her abdomen and it will check for contractions, fetal heart rate (detecting any distress), and amniotic fluid level. Mom is sometimes asked to push a button when the baby moves, which makes a mark on the monitor strip. The nurse/doctor is looking for the baby’s heart rate to increase when he kicks, just as yours does when you move. More information is available at http://www.acog.org/~/media/For%20Patients/faq098.pdf

Cystic Fibrosis Carrier Testing

This is a blood test that is offered during the first 12 weeks of pregnancy. It only shows whether you are a carrier of the gene that can be passed to your child, not whether or not your baby has CF. If the test result is positive, additional testing will be required.

Group B Strep

At about 36 weeks in your pregnancy, you will be tested for group B streptococcus (GBS). For this test, a swab is used to take cell samples from your vagina and anal area. Many women are carriers of this bacteria, and it causes no problems for them, but GBS can be passed to a baby during birth and cause illness in the newborn. If a woman tests positive for GBS, she will be given antibiotics during labor to help prevent the baby from being infected. This link provides more detailed information: http://www.acog.org/~/media/For%20Patients/faq105.pdf

Glucose Screening

A glucose screening test, done between 24 and 30 weeks, will check for signs of gestational diabetes. This test requires you to drink a sweet liquid, and then have your blood drawn an hour later. If results show that your blood sugar is too high, your doctor can teach you how to control it.

Testing for Genetic Disorders: Alpha Fetoprotein (AFP), Triple Screen, Quad Screen, Maternal Serum Screening, Serum Integrated Screen

Each of these are variations of the same type of blood tests that can be done to screen for some birth defects. Your doctor will offer these tests to you, and you can decide if you wish to have them done. For more information see: http://www.acog.org/~/media/For%20Patients/faq165.pdf

http://www.acog.org/~/media/For%20Patients/faq094.pdf

Amniocentesis

An amniocentesis may be performed to test for genetic disorders, or to check fetal lung maturity before delivery. An amniocentesis requires a small sample of the fluid surrounding your developing baby (the amniotic fluid), which is then tested in a lab. Detailed information is available at
https://intermountainhealthcare.org/ext/Dcmnt?ncid=520490487

Complications in pregnancy

Most pregnancies are not complicated, but occasionally there are factors that cause a pregnancy to be classified as high risk. Your doctor is the best source of information for any questions you may have, however, the following links are provided as an additional resource for you.

Hospital Information

Prenatal Classes

Our physicians recommend prenatal education classes for all of our obstetric patients, especially first time parents. It is recommended that you register for classes before 28 weeks, in order to allow time for completion before delivery.

We now offer Prenatal Classes at our Provo office. Please call the office at 801 374-1801 to ask for details. Each hospital also offers Prenatal Classes. Additional information can be found at the following links:

American Fork Hospital: http://intermountainhealthcare.org/hospitals/americanfork/services/women/classes/Pages/ PrenatalEducation.aspx

Timpanogos Regional Hospital: http://timpanogosregionalhospital.com/our-services/womens-services/childbirth-education.dot

Utah Valley Regional Medical Center: http://intermountainhealthcare.org/hospitals/uvrmc/services/women/maternity/Pages/ PrenatalEducation.aspx

Hospital Pre-Registration

Pre-registering at the hospital you will be delivering at will save you time when you go into labor. You can stop by the admissions area of the hospital anytime before your due date to fill out the paper work or ask for the registration forms at our front desk. Once you are pre-registered, you can go directly to Labor and Delivery to be evaluated and admitted.

Becoming Acquainted with Your Hospital

We encourage our patients to do learn all they can about the facility they will be delivering in. Doing so will decrease your anxiety and facilitate a smoother admission when it is time for delivery. There are virtual tours available at the following links, as well as other information from the hospitals.

American Fork Women’s and Children’s Services: http://intermountainhealthcare.org/HOSPITALS/AMERICANFORK/SERVICES/WOMEN/Pages/ home.aspx

Timpanogos Regional Hospital Women’s Services: http://timpanogosregionalhospital.com/our-services/womens-services/

Utah Valley Regional Medical Center maternity and newborn services: http://intermountainhealthcare.org/hospitals/uvrmc/services/women/maternity/Pages/home.aspx

When to Go to the Hospital

Leaking fluid, with or without contractions. If you are close to your due date and your “bag of water” breaks, go directly to the hospital and do not wait for contractions.
Regular, strong contractions: 3-5 minutes apart, from the start of one to the start of the next, and increasing in strength, going on for more than an hour. If you are unsure if you’re in labor and it’s during office hours, you may contact our office to see if you can be checked there first. Labor that begins before 35 wks needs to be evaluated as soon as possible at the hospital.
Bleeding (more than just spotting).
Additional information about How to Tell When Labor Begins can be found at http://www.acog.org/~/media/For%20Patients/faq004.pdf

Choosing a Pediatrician

It is important to find a pediatrician for your baby while you are still pregnant. Important things to consider as you choose a doctor for your baby include location, office hours, on call availability and having a physician or practice who can be supportive of your decisions about child care. Please speak with one of our nurses or doctors if you need a recommendation for a Pediatrician in the area.

Induced Labor

Labor usually begins on its own between 37 and 41 weeks of pregnancy. Some of our patients schedule an elective induction date (at 41 weeks for first time moms, and 39 weeks for those who have delivered before) in case they have not delivered spontaneously at that point. There is more information about elective inductions at the following link: https://intermountainhealthcare.org/ext/Dcmnt?ncid=51061832

There are several methods for inducing labor. The following link goes into detail about these methods: http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/hw194662/labor-induction-and-augmentation.aspx#hw194662-sec

If the doctor agrees to an elective induction, our office will schedule that at the hospital you are planning to deliver in. The time you are scheduled to come in may change suddenly, as patients who present to labor and delivery in spontaneous labor have priority, as do patients needing a medically indicated induction. American Fork and Utah Valley Regional Medical Centers will call their scheduled patients either the night before, or the morning of the induction to give instructions about going to the hospital. Patients at Timpanogos Regional Hospital are instructed to call the hospital and check with the Labor and Delivery nurse the morning of their scheduled induction.

Labor, Delivery and the Postpartum Period

There is a short overview provided about your time in the hospital at this link: http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn9759/labor-delivery-and-postpartum-period.aspx#tn9760

Postpartum Care—After the Baby Comes

Having a newborn causes a lot of physical and emotion changes in one’s life. The secret to weathering this change is to allow yourself plenty of time to rest and adjust to your new role as a parent. You will probably have questions as you bond with this new little one. Most concerns about your baby should be addressed by your pediatrician, but we are happy to continue to care for you during the postpartum period (the weeks after delivery). Please contact our nurses with any questions you may have, or check out the following links:

After Childbirth

http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn9759/labor-delivery-and-postpartum-period.aspx#tp22261

Postpartum Recovery and Coping

http://intermountainhealthcare.org/health-resources/health-topics/healthwise/content/tn9759/labor-delivery-and-postpartum-period.aspx#tp22261

Caring for Yourself After the Baby

https://intermountainhealthcare.org/ext/Dcmnt?ncid=51062842

Getting in Shape After the Baby Comes

http://www.acog.org/~/media/For%20Patients/faq131.pdf

Postpartum Depression

http://www.acog.org/~/media/For%20Patients/faq091.pdf

Breastfeeding Support

General

Valley OB-GYN is a strong supporter of breastfeeding. If you have questions or concerns about breastfeeding, please feel free to contact our nurses for help. Detailed information is available at http://www.acog.org/~/media/For%20Patients/faq029.pdf The following are links to breastfeeding support services:

American Fork Hospital: http://intermountainhealthcare.org/hospitals/americanfork/services/women/Pages/ BreastFeedingSupport.aspx

Support Group at Utah Valley Regional Hospital: http://intermountainhealthcare.org/services/womennewborn/classes/Pages/home.aspx

Mastitis (Breast Infection)

Mastitis is fairly common while nursing, especially in the early days after delivery. The symptoms are a red, tender lump in the breast, a flu-like general achiness, and a fever. If you have any of these symptoms, please call our nurses right away. See will provide instructions for treatment, and an oral antibiotic can be called in to the pharmacy for you. You should continue to nurse while on the antibiotic and you will be feeling much better soon.