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Obstetric Care
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ACNE
AVOID: Accutane |
ANTIBIOTICS
AVOID: Cipro |
COLDS/HAYFEVER Benadryl, Claratin *AVOID IF PROBLEMS WITH BLOOD PRESSURE
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CONSTIPATION
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COUGH
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CRABS/LICE
Avoid:
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GAS
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HEADACHES
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HEARTBURN (AVOID LYING DOWN FOR AT LEAST 1 HOUR AFTER MEALS)
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HEMORRHOIDS
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HERPES Acyclovir |
LEG CRAMPS Benadryl |
NASAL SPRAY
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NAUSEA Vitamin B6 25mg 3 times daily |
PAIN
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RASH
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SLEEP AIDS
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THROAT
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TOOTH PAIN
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YEAST INFECTION
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Healthy Diet
The first step toward healthy eating is to look at the foods in your daily diet. Having healthy snacks that you eat during the day is a good way to get the nutrients and extra calories that you need. You may find it easier to eat snacks and small meals throughout the day rather than three big meals a day.Meal Planning
Pregnant women need to eat an additional 100-300 calories per day. This is not a lot of food. It is equivalent to a small snack such as one half of a peanut butter and jelly sandwich and a glass of low fat milk.Extra Nutrients
Pregnant women need extra iron and folic acid and these are usually prescribed in a pill form as prenatal vitamins. Taking folic acid for 1 month prior to pregnancy and during the first three months of pregnancy can reduce the risk of certain birth defects such as spina bifida. Check with your doctor before taking any vitamins, herbs or other supplements that are not prescribed for you. Just because a product is natural does not mean it is safe to use during pregnancy.
FOOD GROUPS
As much as possible, you should try to incorporate a balance of healthy foods in your diet. The best way to do this is by following the food pyramid listed below:
| FOOD GROUP | SERVINGS | EXAMPLES |
| Grains | 6 ounces | 1 cup of cereal, 1 slice of bread, or ½ cup of cooked rice or pasta can be considered as 1 ounce |
| Vegetables | 2 ½ cups | 1 cup of raw or cooked vegetables or vegetable juice, or 2 cups of raw leafy greens can be considered as 1 cup |
| Fruits | 1 ½- 2 cups | 1 cup of fruit or 100% fruit juice, or ½ cup of dried fruit can be considered as 1 cup |
| Meat and Beans | 5-5 ½ ounces | 2-3 ounces of meat, poultry, or fish, ½ cup cooked dried beans, 1 egg, 2 tablespoons peanut butter, or ½ cup nuts or seeds equals 1 ounce |
| Milk | 3 cups | 1 cup of milk or yogurt, 1 ½ oz of natural cheese, or ounces of processed cheese can be considered as 1 cup |
Key Nutrients During Pregnancy
| Nutrient | Reason for importance | Sources |
| Calcium (1000 mg) | Helps build strong bones and teeth | milk, cheese, yogurt, sardines |
| Iron (27 mg) | Helps create the red blood cells that deliver oxygen to the baby and also prevents fatigue | Lean red meat, dried beans and peas, iron-fortified cereals |
| Vitamin A (770 mcg) | Forms healthy skin and helps eyesight, helps with bone growth | Carrots, dark leafy greens, sweet potatoes |
| Vitamin C (85 mg) | Promotes health gums, teeth, and bones. Helps your body absorb iron | |
| Vitamin B6 | Helps form red blood cells, helps body use protein, fat and carbohydrates | Beef, liver, pork, ham, whole grain cereals, bananas |
| Vitamin B12 (2.6 mcg) | Maintain nervous system, needed to form red blood cells | Liver, meat, fish, poultry, milk (only found in animal foods, vegetarians should take a supplement) |
| Folate (600 mcg) | Needed to produce blood and protein, helps some enzymes | Green leafy vegetables, liver, orange juice, legumes and nuts |
Special Concerns
- Vegetarian Diet
- Be sure you are getting enough protein. You will probably need to take supplements, especially iron, B12, and vitamin D
- Lactose Intolerence
- During pregnancy, symptoms of lactose intolerance often improve. If you are still having problems after eating or drinking dairy products, talk with your doctor. We may prescribe calcium supplements if you cannot get enough calcium from other foods. Remember, calcium can also be found in cheese, yogurt, sardines, certain types of salmon, spinach, and fortified orange juice.
Foods To Avoid In Pregnancy
- Raw meat: avoid uncooked seafood and undercooked beef or poultry due to risk of bacterial contamination, toxoplasmosis and salmonella
- Deli meat: In rare cases, may contain bacteria called listeria that can lead to pregnancy complications and miscarriage. If eating deli meat, reheat until steaming to kill any bacteria.
- Fish with mercury: avoid fish with high levels of mercury including shark, swordfish, king mackerel and tilefish. For other fish, limit consumption to two servings per week.
- Smoked seafood: refrigerated, smoked seafood should be avoided due to risks of listeria contamination.
- Raw shellfish: including clams, oysters, and mussels can cause bacterial infections. Cooked shrimp is safe.
- Raw eggs: Raw eggs or any foods containing raw eggs can be contaminated with salmonella. This includes some homemade ceasar dressings, mayonnaise, and homemade ice cream
- Soft cheeses: imported soft cheeses may contain listeria. Soft cheeses made with pasteurized milk are safe.
- Unpasteurized milk: may contain listeria which can lead to miscarriage.
- Pate: refrigerated pate or meat spreads should be avoided due to risks of listeria
- Caffeine: Avoid caffeine during the 1st trimester to reduce the risk of miscarriage. After the first trimester limit caffeine intake to the equivalent of 1 cup of coffee a day or less. Excess caffeine may be associated with miscarriage, premature birth, low birth weight, and withdrawal symptoms in infants.
- Alcohol: there is NO amount of alcohol that is known to be safe during pregnancy and therefore it should be avoided. Continue to avoid alcohol while breastfeeding.
- Unwashed vegetables: wash all vegetables well to avoid exposure to toxoplasmosis which may contaminate the soil where vegetables are grown.
Recommendations For Weight Gain During Pregnancy
Underweight women with a low weight gain during pregnancy appear to have an increased risk of having a low birth weight infant and preterm birth. On the other hand, obese women have an increased risk for having a large for gestational age infant, post term birth, and other pregnancy complications. There is an increased risk of small for gestational age births in women who gain less than the recommended weight, based on pre-pregnancy weight. Women who exceed the weight gain recommendations double their risk of having a very large infant. It may also increase the risks of childhood obesity and makes weight loss more difficult after delivery.
Recommendations for weight gain during a singleton pregnancy are as follows:
- Underweight women (BMI less than 20): 30-40 lb
- Normal weight women (BMI 20-25): 25-35 lb
- Overweight women (BMI 26-29): 15-25 lb
- Obese women (BMI >29): up to 15 lb
Prenatal Vitamins
We recommend a daily prenatal vitamin to help provide the best balance of nutrition for you and your baby. either over the counter or prescription vitamins are fine. If you cannot tolerate a prenatal vitamin, we recommend 2 children’s chewable vitamins a day instead. If vitamins are causing nausea, try taking them at nighttime with a snack. If constipation is an issue, increase the fiber in your diet, drink more fluids and increase activity. An over the counter stool softener may be added if needed.Artificial Sweeteners
These are OK to use but we would recommend limiting it to 1-2 servings per day. If you have diabetes, the artificial sweeteners are better than sugar to help control your blood sugars.Exercise and Sex
In an uncomplicated pregnancy, we recommend 30 minutes or more of exercise daily which includes aerobic activities (walking, jogging, biking, aerobic classes, yoga, swimming, tennis, etc). Weight training and toning are fine. You can continue your usual workouts but may need to reduce intensity or shorten them. It is a good idea to listen to your body during exercise and drink plenty of fluids. After 20 weeks you should avoid lying flat on your back during exercise. Your target heart is calculated by your age. Basically, if you are breathing hard, slow down. Avoid activities with a high risk of falling or trauma to your belly. Sex, you bet! you can have sex during pregnancy unless you are having complications or you are too uncomfortable. If there is any concern for sexually transmitted diseases, then use condoms or don’t have sex.Exercise and sex should be avoided at times.
This includes:
- Vaginal bleeding
- Leaking amniotic fluid
- Preterm labor
- Chest pain
- Regular uterine contractions
- Decreased fetal movement
- Growth restricted baby
- Headache/Dizziness/Weakness
Sleep
It is normal to feel more tired when you are pregnant. You may also notice you need more sleep than usual. Try to get at least 8-10 hours of sleep per night. Sometimes you will require significantly more so listen to your body and plan extra sleep time when you are tired.
It is safe for women experiencing a normal pregnancy to lie on their back for sleep. However, sometimes lying on your back can cause your blood pressure to drop. Hot or cold sweats and nausea may occur. If this happens, don’t worry, you did hot hurt your baby. Many women find it helpful to put a pillow behind them to support the back and hips. As your pregnancy progresses, it may require more pillows and frequent position changes during the night to keep comfortable.
Smoking
If you smoke, SO DOES YOUR BABY!!!!!!! This is a very important fact of pregnancy. The placenta (afterbirth) is the organ that connects the developing baby to you. It consists mostly of blood vessels and is attached to your uterus on one side and to your baby on the other side by way of the umbilical cord. Its job is to allow the passage of nutrients, oxygen, vitamins and other substances to pass from your blood to the baby allowing it to grow and develop. It also carries away your baby’s waste products so your kidneys, liver, and lungs act for the baby until his/her organs are mature enough to do well on their own outside the womb (37-42 weeks of pregnancy).
Cigarette smoke contains more than 2,500 chemicals. It is not known or certain which of these chemicals are harmful to a developing baby. However, both nicotine and carbon monoxide (the same gas released from a car’s exhaust) are believed to play a role in causing bad pregnancy outcomes. These chemicals are taken directly from your lungs, to your blood, to your baby’s blood. Imagine how these chemicals affect the fragile tissues of your developing baby.
Here Are Some Known Complications From Smoking During Pregnancy:
- Low Birth Weight Baby: Low birth weight can be caused by prematurity (birth less than 37 weeks), poor growth, or a combination of both. Prematurity is increased in pregnant smokers and is the number one cause of neonatal death and chronic illness in babies. Problems such as cerebral palsy, life-long lung, kidney, or other organ problems, mental retardation and learning disabilities are much more common in premature and low birth weight babies.
- Placenta Previa: Low-lying placenta that covers part or all of the opening to the uterus. Placenta previa blocks the exit of the baby from the uterus causing the baby and mother to bleed.
- Placental Abuption: The placenta tears away from the uterus causing the mother and baby to bleed.
- Stillbirth
- Preterm Premature Rupture of Membranes: The water breaks before 37 weeks of pregnancy, which is associated with an increase of preterm and low birth weight births.
The effects smoking has on your baby continue when you take him/her home. Children exposed to smoke in the home have higher levels of lung problems such as asthma, pneumonia, or bronchitis. They also suffer from more ear infections than children not exposed to smoke. Even more troubling is the increased incidence of Sudden Infant Death Syndrome (SIDS) found in children exposed to smoking in the home. A child exposed to smoking in the home during the first few years of life are at an increased risk of developing asthma. The March of Dimes recommends women stop smoking prior to becoming pregnant and remain smoke-free throughout pregnancy and once the baby is born. The more a pregnant woman smokes the greater the risk to her baby. However, if a woman stops smoking by the end of her first trimester (first three months), she is no more likely to have a low birth weight baby than a woman who never smoked. Even if a woman is not able to stop smoking during her first or second trimester, stopping during the third trimester (the last three months) can improve her baby’s growth. The effects smoking has on your baby continue when you take him/her home. Children exposed to smoke in the home have higher levels of lung problems such as asthma, pneumonia, or bronchitis. They also suffer from more ear infections than children not exposed to smoke. Even more troubling is the increased incidence of Sudden Infant Death Syndrome (SIDS) found in children exposed to smoking in the home. A child exposed to smoking in the home during the first few years of life are at an increased risk of developing asthma. The March of Dimes recommends women stop smoking prior to becoming pregnant and remain smoke-free throughout pregnancy and once the baby is born. The more a pregnant woman smokes the greater the risk to her baby. However, if a woman stops smoking by the end of her first trimester (first three months), she is no more likely to have a low birth weight baby than a woman who never smoked. Even if a woman is not able to stop smoking during her first or second trimester, stopping during the third trimester (the last three months) can improve her baby’s growth.
Ways To Quit Smoking
Talk to your doctor. No matter what your approach to quitting, a conversation with your doctor can make the difference between success and failure. Quitting cold turkey is a great way. If you want to try a quitting aid such as a nicotine patch, gum, or the medication Zyban or Wellbutrin, your doctor can help you choose a method right for you. The use of a nicotine patch and/or gum has not been adequately studied; therefore, they should only be considered during pregnancy when non-medical treatments, such as counseling, are not successful. Because potential benefits seem to outweigh potential risks, research to determine the safety and efficacy of medications is underway. Some tobacco control experts have reported that if nicotine replacement therapy is used during pregnancy, products with intermittent dosages, such as gum or an inhaler, should be tried first. If the nicotine patch is used, it should be removed at night to reduce fetal nicotine exposure.
Great Start (1-866-66-START) is a national pregnancy specific smoker’s quit line operated by the American Legacy Foundation.
Alcohol
There is no safe amount of alcohol so we recommend avoiding all alcohol during pregnancy. Drinking alcohol can cause birth defects, mental retardation and abnormal brain development.Sauna and Hot Tubs
It’s okay! You deserve the muscle soothing and relaxation of a warm tub or sauna, but keep the thermostat no warmer than 102 degrees Fahrenheit.
If you feel overheated, always listen to your body and remove yourself from the source. Try to keep the upper half of your body out of the water to help prevent overheating.
Seat Belts
Please wear your seat belts at all times while in the car or on a plane. The proper placement is across your lap below the belly for the lower belt and across the chest between the breasts for the upper belt. If you are involved even in a minor accident, this may save the life of you and your baby. If you are involved in a car accident, call our office immediately. You may need to be monitored.Travel
Traveling is safe during pregnancy for most women. The best time to travel is between weeks 14 – 18 as most common emergencies usually happen in the first and third trimester. If you are planning a trip out of the country, discuss this with your doctor and check with the CDC to see if any specific vaccines are needed.
For flights, or cruises, find out whether your airline or cruise line have any travel restrictions during pregnancy. Have a prenatal check up before you leave on your trip and take a copy of your health records with you. If long trips are planned, drink plenty of fluids and walk every few hours. This can reduce the risk of developing blood clots in the legs.
Stay in the Cincinnati area after 36 weeks because you could go into labor and we want to be there to welcome your newborn into the world!
Working / School
A woman can usually continue working or attend school until she goes into labor. We may want to restrict your work if you are having pregnancy complications depending on your job activities. Also, women who have strenuous jobs may be at higher risk for early delivery or smaller babies. Please discuss this with your doctor.Choosing a Doctor for Baby
You will need to decide on a doctor for your baby’s care by the time you deliver. This is usually a pediatrician or a family practice doctor. The hospital will send your baby’s information and test results to your chosen doctor. Your baby is commonly seen within 1 week after birth by his/her doctor. There are many excellent doctors in our area to choose from. You will need to contact the doctor’s office prior to delivery and make sure they are accepting your insurance and are taking new patients. We can provide you with a list of doctors if you have trouble locating one. Many baby doctors do not come to the hospital. There are excellent pediatricians which take care of newborns at the hospital only and will provide hospital care for your baby if needed.
Pain Relief In Labor
There are many options to provide pain relief while you are in labor. We are supportive of whatever you choose. Common options include:
- Nubaine: This is a narcotic given with an injection or IV and helps take the edge off the strong contractions. It usually makes you sleepy. It can be given in early labor. We avoid giving this near delivery time as your baby could be born extra sleepy and not cry well.
- Epidural: This is a safe and popular option available any time of day at Mercy Fairfield hospital. A specialist called a nurse anesthetist stays in the hospital 24 hours per day to provide these for you. It requires a fine, thin catheter or tube to be place in your back when you are in active labor. Medicine slowly drips through the tubing to provide excellent pain relief throughout labor. It is removed after delivery.
- Local: Many of our patients deliver without pain medication. Sometimes we need to give you a small injection of numbing medicine for stitches called lidocaine. It feels like a small pinprick when we inject the medicine.
In general, we encourage you to see how you do during your contractions. The pain relieving options are available to you at any time.
Episiotomy
We plan to help you deliver your baby with the least amount of trauma. Episiotomies are not routinely needed and many of our patients deliver without the need for any stitches. Sometimes we need to make a small incision at the vaginal opening to help the baby deliver. We make sure you are numb and then will stitch the area after delivery. The stitches dissolve over time and do not need to be removed. We provide you with medicine to keep you comfortable after delivery.Forceps / Vacuum
Obstetrics is our name and obstetrics is our game. We are highly skilled in the use of vacuum and forceps for deliveries. We will recommend using them only if medically indicated. Our goal is to deliver your baby in the safest manner. There are definitely times when this is the safest way to help your baby into this world.Cesarean Section
We are highly skilled in this area and will perform when needed. For more information on the procedure, go to:www.uptodate.com and enter cesarean section.Vaginal Birth After Cesarean Section (VBAC)
Our practice is ideally set up for those interested in VBAC. The physician on-call will always be present in the hospital with you and immediately available for emergencies. For additional safety, mom and baby are continuously monitored in labor. More information is available at:
www.uptodate.com (enter VBAC)
Influenza Vaccine
Seasonal flu vaccines are recommended during pregnancy to reduce the risk of serious infections in moms and their babies. Pregnancy causes the immune system to weaken so pregnant women are higher risk. The best way to protect your newborn baby is to be vaccinated and breast feed. If you are planning to become pregnant or are currently pregnant, talk with your doctor about getting vaccinated.Circumcision
A circumcision is the removal of excess foreskin from the penis in baby boys. We perform this procedure for you while you and your baby are still in the hospital. All babies receive local numbing medication and are soothed by suckling during the procedure. It takes a few minutes to perform and babies heal in 1-2 weeks. We recommend applying Vaseline to the baby’s penis with each diaper change to prevent sticking to his diaper while he heals.
This is an optional procedure. It may help reduce infections and penis cancer in males. Many parents decide to not have their baby circumcised. We respect your choice in this matter.
Umbilical Cord Banking
Your baby’s blood is a valuable source of cells that could be used by your baby or another family member to treat nearly 80 life-threatening diseases. New treatments with cord blood for diseases such as cerebral palsy, diabetes, and heart disease are currently being studied. Umbilical cord blood can easily and safely be obtained immediately after delivery. Parents can choose to have their baby’s blood saved. Insurance does not generally cover this.
If you are interested in saving your baby’s cord blood, you can order a kit and bring it with you to delivery. Recommended website for more information: www.viacord.com
Dental Care
Cavities and gum disease are more common during pregnancy due to the hormonal changes. You may notice your gums bleed easily. To prevent this, we recommend brushing your teeth twice a day and flossing every day. Also visit your dentist on a regular basis for checkups and teeth cleaning. Cavities and dental problems should be treated. Bad teeth can lead to infections in the uterus or premature delivery of your baby so take care of your pearly whites!Overdue Babies / Induction
Your due date is considered 40 weeks. It is reasonable to anticipate your delivery sometime during the week of your due date. However, 10% of pregnancies will continue 2 weeks past the due date. We recommend additional testing for your baby at 40 weeks if you have risk factors or around 41 weeks. We generally recommend inducing your labor at 41-42 weeks if your cervix is ready. We induce sooner if there are any concerns.
Induction of labor is a process where we give you medication to stimulate contractions. It can sometimes take more than 24 hours or increase your cesarean section risk especially if it is your first baby.
It is important to allow your baby to fully grow and develop before we schedule a delivery. Babies born more than 1 week early can have complications and are more likely to require oxygen and be admitted to the special care nursery. This could even have long term affects on a child’s health. If we recommend delivery before 39 weeks, then it is for a medical reason.
Cats
If you have cats, avoid changing the litter box or use gloves to change it. Toxoplasmosis is a very rare infection that we can get from cat feces.Postpartum Depression
40-80% of women experience mood changes after their delivery. This most commonly starts 2-3 days after delivery and usually goes away by 2 weeks. It is important to eat properly, get adequate sleep and reduce stress during this time to help with the symptoms. Sometimes the symptoms require treatment especially if mom is not bonding or enjoying her baby; unable to care for herself or the baby; feeling excessive sadness, depression or anxiety. Please schedule an appointment if you feel a problem is occurring. We are known for our compassionate care and have effective treatments for postpartum depression.Domestic Violence
Hotline #: 1-800-799-SAFE (1899)When Should I Call the Doctor?
If you are 37 weeks or more (3 wks from your due date) you should call if you have any of the following:
Regular, painful contractions occurring approximately every five minutes for an hour. Each contraction should be lasting approximately 30-45 seconds.
OR
Contractions every 10 minutes for at least an hour if you live more than 30 minutes from the hospital, if you have a history of fast labor, or if you were more than 3 cm dilated at your last visit.
Vaginal bleeding: You may have some normal spotting for a day or 2 after a vaginal exam, after intercourse, or when you lose your mucous plug. Call immediately if you have any other vaginal bleeding.
Rupture of membranes: If you think your water broke then call right away. We will want to evaluate you in the office or hospital.
Decreased fetal movement: If you feel the baby is not moving normally, then you want to do kick counts. Lie down on your side and count how many times the baby moves in an hour. If you feel 10 movements that is reassuring. If you don’t, then have something to eat or drink and again count for an hour. If you still don’t feel 10 movements then contact us.
You do not need to contact us if you have lost your mucous plug and are not having regular contractions or other signs of labor.
Please click here to download the above pregnancy information.