Download OB Booklet - OBGYN Associates of Northern Indiana, PC

Welcome to OB­GYN Associates
Of Northern Indiana
As an expectant woman, you know the importance of taking care of yourself and your baby. As Obstetricians, we will help you have the healthiest pregnancy possible as we assist and support you throughout your pregnancy and delivery.
This booklet serves as an important guide to new mothers–to­be learning about themselves and pregnancy for the first time. To those that already have children, you will find the information serves as a useful reminder. Keep this booklet close at hand so you can refer to it as often as you wish. If you have any questions, write them down so you can ask our nurses and doctors during your next appointment. We have five obstetricians in our practice who share a call schedule for deliveries. We highly recommend that you see all of the physicians during your routine obstetric visits. Please be aware that if you choose not see to all of the physicians you may have a physician deliver your baby that you have not met.
In an emergency, please note the numbers on the front of this booklet. We hope your next months will be healthy and happy.
Physicians and Staff
Your pregnancy
Just as everyone’s body is different, every pregnancy is different. There are common physical changes, however that you may experience.
NAUSEA
™ To help relieve the discomfort of nausea: o Eat small frequent meals instead of 3 large meals each day.
o Avoid fried, greasy and spicy foods.
o Try clear liquids (Natural fruit juices, 7up, Sprite, Gatorade, apple juice, gelatin, clear broth, white grape juice).
o Vitamin B­6, 50 mg in the AM, 50 mg at Noon and 100 mg in the evening. Try a chewable Prenatal or children’s vitamin.
o Emetrol (OTC) take as directed.
™ If vomiting occurs, wait at least 30 minutes after the last emesis to introduce clear liquids, and advance your diet slowly.
™ If the physician prescribes medication for nausea/vomiting, wait 20 –30 minutes after taking the medication to begin eating. Start with small meals or clear liquids.
™ If vomiting persists and you cannot keep fluids down for more than one day, please call the office.
FATIGUE
™ It is normal to feel tired especially in the first few months of pregnancy and the last few weeks of pregnancy.
™ You should try to get at least 8 hours of sleep every night.
™ Elevate your feet as often as possible.
™ Rest on your left side to allow your blood to flow more easily.
™ Try to lie down at least once each day.
HEARTBURN
™ Do not lie flat for at least 1 –2 hours after eating.
™ Avoid spicy foods, caffeine and chocolate.
™ Sleep or rest with your head elevated on extra pillows.
™ OTC antacids are safe, use as directed on the label (Rolaids, TUMS, Mylanta, Pepcid or Zantac).
CONSTIPATION
™ Drink plenty of fluids.
™ Eat fruits and vegetables.
™ Increase your intake of fiber and bran.
™ Metamucil or stool softeners (OTC) as directed on the label.
HEMORRHOIDS
™ Increased pressure from the weight of pregnancy and constipation can result in hemorrhoids forming during pregnancy.
™ Hemorrhoids are an occluded blood vessel which swells around the rectal area. This swelling can cause pain and bleeding with bowel movements.
™ Keep bowel movements regular with plenty of fluids (water) and extra fiber in your diet.
™ Try warm baths, tucks pads and over the counter hemorrhoid creams. If these comfort measures are not successful please discuss at your next physician visit as prescription medications are also available.
HANDS/FEET SWELLING AND LEG CRAMPS
™ This is a common complaint in pregnancy, especially in the last trimester. Mild swelling of the hands and feet is normal in pregnancy due to the increase in the body’s fluid volume. Leg cramps can be a result of fatigue, standing for long periods of time, swelling and a lack of dietary Calcium. ™ Most swelling and cramping are relieved with rest and elevation of the lower legs. Try to elevate your legs when sitting down or at least elevate them for 15 minutes every 4 hours. ™ Regular exercise, walking or swimming will help increase circulation and decrease swelling.
™ Increase your intake of water and Calcium.
™ Support hose will also help decrease swelling and fatigue in the legs. You can ask for a prescription for support hose at any of your appointments.
™ For cramping, apply a heating pad to your lower legs or soak in a warm bath.
™ Report numbness or tingling in your hands or feet which is not relieved with rest, pinpoint pain, redness and/or swelling in only one leg. Also report swelling with sudden onset of headache, dizziness and/or visual changes.
FREQUENT URINATION
™ Occurs almost immediately in pregnancy. It is a result of increased weight on the bladder from the uterine growth.
™ Do not restrict your fluids. Your body requires an increase of fluids to replenish and increase the amniotic fluid surrounding the baby.
™ However, you can limit your intake of fluids before bedtime to try and decrease the number of times you are awakened in the night to urinate.
™ Report any symptoms of burning with urination, frequency and/or blood in the urine
DIZZINESS
It is common and normal to feel dizzy during pregnancy. To try to avoid dizziness:
™ Never skip meals, especially breakfast. ™ Drink plenty of fluids.
™ Avoid sugary snacks and sugary breakfast foods.
™ Increase your intake of protein (eggs, cheese and nuts).
™ Late in pregnancy, do not lie flat on your back. Lie on your left side to allow blood to flow more easily.
™ Do not make sudden position changes as this can result in a sudden drop in blood pressure.
™ Avoid walking long distances in the heat.
BACK AND ABDOMINAL DISCOMFORT
Low backache and low abdominal discomfort is common in women who have had more than one pregnancy. Should a backache become a problem try:
™ Flat shoes with support
™ Heating pad to the back, but never on the abdomen
™ Warm bath, not hot water or a hot tub
™ Tylenol or Tylenol extra strength as directed on the label.
™ Avoid standing in one place for too long.
™ Use a foot stool to elevate your hips higher than your knees.
™ If the pain comes and goes every 5­10 minutes and is accompanied by the leaking of vaginal fluid or vaginal bleeding, call the office immediately.
TRUE VS. FALSE LABOR You may have periods of “false labor” or irregular contractions that feel like your uterine muscles are knotting up. These cramps, called Braxton Hicks contractions, are normal. However, they can feel painful at times. They usually come in the afternoon or evening or when you are tired. To time the frequency of contractions note how long the contractions last from the start of one contraction to the start of the next contraction.
Braxton Hicks Contractions ™ Are irregular and do not get closer together.
™ Stop when you walk, rest or change position.
™ Are felt in the abdomen.
™ Are weak and do not get stronger or start strong and weaken.
True Labor
™ Contractions come at regular intervals and get closer together.
™ Contractions continue despite rest or movement.
™ Usually felt in the back and around to the front.
™ Increase steadily in strength.
Alert your physician if you have any of the following symptoms. Leaking of vaginal fluid
Clear fluid leaking from the vagina may indicate your bag of water has broken. This may be a large gush or a slow trickle. Infection can result if the fluid leaks over a long period of time. Loss of the mucous plug is not an emergency and can be reported at your regular office visit.
Vaginal bleeding
You may have spotting anytime during the pregnancy. Spotting can be the natural result of a vaginal exam or intercourse. If you bleed enough to wear a pad or pass blood clots, call the office immediately. Decreased Fetal Movement
You should feel the baby move at least 6 times over a one hour period after 28 weeks gestation. You are the best judge of your baby’s movements. If you feel the movement has slowed down, please call the office. To count the baby’s movement, empty your bladder, lie down on your left side and drink or eat something. Then count the number of movements you feel over the next hour. Kick count sheets are included in this packet.
Contractions
Call the office when contractions are consistently 4 –5 minutes apart for at least one hour and are painful. (see True vs. False Labor for help differentiating between Braxton Hicks contractions and true labor)
Pain
Call the office if you have pain associated with a fever over 100.5 degrees, vaginal bleeding, burning with urination or nausea/vomiting.
Call the office if you have constant low back pain or pelvic pressure unrelieved with rest.
Sudden onset of headache, blurred vision or dizziness
Fever
Call the office if you have a fever over 101 degrees The Office is open Monday through Friday from 8am to 5 pm Please call as early in the day as possible. After office hours call the office line and the doctor on­call will return your phone call. You do need to call before going to the hospital.
574­234­9050/574­232­1471
What to expect from your office visits.
™ Your first visit, an OB screen, will be scheduled with a nurse. She will review your medical history, the information in this handout and give you an overview of what to expect during pregnancy. You will also be given a pregnancy reference book. It is an excellent resource which can answer many of your pregnancy related questions and concerns.
™ At your first appointment, you will be asked to sign a privacy agreement. You should list any persons you would like to have access to your medical record. The office will not give results to anyone who is not listed on your privacy agreement. ™ Please review your OB benefits with your insurance provider. We will assist you and obtain a prior authorization for your pregnancy. However, it is ultimately the patient’s responsibility to determine what facilities/tests are covered by your insurance.
™ At each visit you will be requested to provide a urine sample. This sample is tested for protein and sugar. Please take a cup with you after each visit, so you can bring the urine sample to the office at your next visit. If you are unable to bring your urine sample, please go back and use the restroom after you have checked in with the front desk. Each bathroom is stocked with urine cups and a pen for labeling the sample with your name. This helps to keep our appointments running on time.
™ Your OB physical will be scheduled with one of the obstetrician/ gynecologists. The OB physical appointment includes an exam, pap smear and infection culture. ™ Your office appointments will rotate between all of the physicians. We want to make sure you are familiar with each of our physicians and they are familiar with you and your individual medical record. Whichever physician is on call when you go into labor will be the one who will deliver your baby.
™ Our office nurses are an important part of our OB team. Please feel free to discuss questions or concerns with them by phone or at your appointment. If they do not have the answer, they will refer the question to the physician in the office or the on­call physician. It is important to let the nurse know if you have a special concern at your appointment, so she can anticipate what may be needed to make your appointment go more smoothly.
™ Appointments are scheduled every 4 weeks from the physical to 28 weeks gestation, then every 2 weeks until 35 weeks and then every week. Please call us at least 24 hours prior to your appointment if you need to reschedule. If you are covered by Medicaid and fail 3 appointments without calling to reschedule we are required to file a report with your Medicaid case worker.
™ Your Estimated Due Date or EDD is calculated from the first day of your last menstrual period. Your EDD is 40 weeks from this date. A baby is considered full term after 36 weeks gestation. However, births normally occur anytime from 38 to 42 weeks gestation. An Ultrasound may also be used to help determine your EDD. ™ Inductions are not part of routine OB care. Inductions are normally scheduled when they are medically necessary. ™ You will be given a lab slip for blood work at least three times in your pregnancy. Please have these labs drawn before you come for your visits, so the physician can review the results with you. All labs will be ordered at the South Bend Medical Foundation unless you request another lab.
o 1st Trimester blood work
ƒ This lab slip will be given at your screen appointment. Please have the test drawn as soon as possible or at least 2 days before your physical appointment.
ƒ This panel includes: Blood type and Rh factor, Complete Blood Count, immunity status to Hepatitis B, Rubella, and Syphillis, Urine culture, HIV (If we do not check the Mother, Indiana State law requires the hospital to check the status of the baby at birth) and other bloodwork as needed.
o Prenatal Risk Assessment (PRA)
ƒ This test is ordered between 16 and 20 weeks gestation.
ƒ This test is optional, but recommended.
ƒ It can determine if your baby is at an increased risk for spinal tube deficit, Downs syndrome or Trisomy 13. A definitive diagnosis will not be made from this test. If the result shows an increased risk, an Ultrasound or Amniocentesis would be ordered for further testing.
o Cystic Fibrosis Screening
ƒ This test is also an optional but a recommended test which is ordered with the PRA.
ƒ It will determine if the mother of the baby is a carrier of the Cystic Fibrosis gene. If the mother is a carrier, then the father of the baby would also be tested. He would have to also carry the gene for the baby to carry the Cystic Fibrosis gene.
o 3rd Trimester labs
ƒ Ordered between 24 and 28 weeks gestation
ƒ Complete Blood Count and a Glucose tolerance test. You will be given a high sugar concentrated drink and asked to remain at the lab for one hour. After one hour your test will be drawn. You do not need to fast prior to this test. Try to avoid eating anything high in sugar after this test. You will feel better if you eat something high in protein and rest. ƒ If you have a glucose test result over 135, a 3 hour glucose tolerance test will be ordered. This test requires an appointment and you must fast prior to this test. ƒ Rhogam studies if you have an RH­ blood type.
o Other blood tests may be ordered in your pregnancy as needed.
™ You will not be called with lab results unless the result is abnormal. The exception is the Prenatal Risk Assessment. You will be notified whether your test shows an increase risk or not.
™ Ultrasounds are not done routinely with each pregnancy. The Physician must have a medical diagnosis to order an Ultrasound. Unfortunately, patients cannot pay cash for an elective Ultrasound. We are also unable to provide or allow a videotape of the Ultrasound, though you can generally be given a picture of your baby. You will always be called with Ultrasound results. Please do not be alarmed if a message is left for you to call the office for results.
™ A Non­Stress Test may be ordered as part of your office visit during your last 2 – 3 months of pregnancy. A monitor is attached externally to your abdomen to detect fetal heart rate and contractions. It is generally used with decreased fetal movement, symptoms of pre­term labor, gestational diabetic management or when a patient is past her due date.
STAYING HEALTHY
¾ REST
‰ Try to get at least 8 hours of sleep each night and rest at least once during the day if possible
¾ WORKING
‰ Most women are able to work during their pregnancy unless they are in a dangerous or strenuous job, or are considered to be a high risk pregnancy. ‰ You should take a 15 minute break and prop up your feet after 4 hours of work. ‰ You should not plan to return to work before 6 weeks after a vaginal delivery or 8 weeks after a Cesarean delivery. The physician will sign your return to work release at your post partum visit. If you want to return to work sooner, call for an earlier appointment after delivery.
‰ If you are sick and unable to work, we cannot write an excuse without seeing you at the office.
‰ FLMA papers should be given to the front desk around your third trimester. There is a charge for filling out these papers which can be paid at that time. Your papers will be available at the front desk at your next appointment.
¾ EXERCISE
‰ All pregnant women will benefit physically and mentally from exercise during pregnancy. (If you have been advised your pregnancy is “high risk”, please discuss exercise options with one of the physicians at your appointment.)
‰ Your OB reference book is an excellent resource for dos and don’t of exercise. Walking and swimming are both an excellent form of exercise.
‰ You should not let your heart rate exceed 140 beats/minute.
‰ Never exercise to the point of exhaustion, shortness of breath or inability to talk.
¾ SAFETY
‰ Do not push, pull or lift over 20 – 25 pounds.
‰ Avoid high heels, climbing ladders, bowling, rollerskating, ice skating, sledding, water skiing, horseback riding and any other activities which can cause abdominal injury.
‰ Avoid tanning, hot tubs and saunas.
¾ PRENATAL VITAMINS
‰ A daily Prenatal vitamin is recommended in pregnancy. Please ask one of the nurses for a prescription.
‰ If you are having any side effects with your prenatal vitamin, such as nausea or constipation, please ask one of the nurses for samples of prenatal vitamins so we can find the one which will work well for you.
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‰ If you are nauseous in the 1 trimester of pregnancy you could try a chewable prenatal vitamin or Flintstone vitamin until the nausea subsides.
¾ FOLIC ACID
‰ 800 micrograms per day is recommended in pregnancy.
‰ Most women get 200 mcg daily from their diet. Foods high in folic acid include orange juice, citrus fruits, green leafy vegetables, peanuts, broccoli and whole grain food.
‰ Folic acid has been shown to decrease some birth defects and stimulate production of the additional blood cells required in pregnancy. It also helps support development and growth of the placenta and fetus.
¾ NUTRITION
‰ It is important to eat a well balanced diet during pregnancy. Good nutrition helps promote proper growth and development of your baby.
‰ Daily serving recommendations
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4 or more servings of fruits and vegetables
4 or more servings of breads and grains
4 or more servings of milk
3 or 4 servings of meat, poultry, fish and eggs
6 – 8 glasses of water Avoid pop and drinks high in sugar
¾ FISH CONSUMPTION
‰ It is recommended that pregnant women avoid fish which have been shown to contain a high level of mercury that may harm an unborn baby. ‰ Avoid shark, swordfish, King mackerel, and tilefish
‰ Fish low in mercury include shrimp, canned light tuna, Salmon, Pollock and Catfish (Fresh albacore tuna has more mercury than canned light tuna.)
¾ DENTAL EXAMS
‰ There is no reason to avoid dental exams during pregnancy.
‰ If your dentist requires a note prior to treatment, please call the office with your dentist’s fax number and we will send a note consenting to care and giving pregnancy guidelines.
¾ BREAST CARE
‰ Your breasts may naturally be more tender and enlarged in pregnancy, so always wear a good support bra. ‰ It is normal for your breasts to secrete a clear liquid called colostrum in the final months of pregnancy.
¾ BATHING
‰ You may tub bathe or shower daily until delivery unless your bag of water has broken. Hot tubs and sauna should always be avoided.
‰ You should not swim after delivery until after your post partum check. ‰ You should not go tanning during your pregnancy.
¾ INTERCOURSE
‰ Intercourse is not harmful in normal pregnancies. You may need to vary positions during intercourse to provide greater comfort.
¾ DOUCHING
‰ Douching is never recommended and should not be done unless specifically ordered by your physician.
‰ You may use pads, but tampons are not recommended.
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If you experience vaginal discharge with burning, odor or itching please notify the office.
¾ HAIR
‰ You may notice more thickness or fullness in your hair during pregnancy due to hormonal changes.
‰ As a consequence, you may notice some of your hair falling out after pregnancy as it loses this fullness.
‰ The chemical solutions absorbed by the scalp into the bloodstream as a result of perming, tinting, highlighting and dying the hair have not been linked to the development of birth defects, but have also not been totally exonerated. Do not worry about exposure to these chemicals before pregnancy. Exposure during pregnancy is a personal decision for the pregnant Mom.
¾ TRAVEL
‰ We will be happy to provide you a copy of your OB record if you travel out of town during pregnancy.
‰ We advise against out of town travel after 35 weeks.
‰ If you travel for an extended amount of time at any point in pregnancy, we recommend you stand and stretch your legs every 1 to 2 hours.
‰ Always wear a seat belt with the strap below your abdomen.
¾ LABOR AND DELIVERY CLASSES
o Classes are available at the hospital and at our office.
o If you plan to deliver at St. Joseph Regional Medical Center, call 335­2323 to register for class. Tours of the Family Birthplace are offered by appointment or on the first Saturday of the month at noon. The Family Birthplace is located on the 4th floor of St. Joseph Regional Medical Center.
LABOR AND DELIVERY
Always call the office even after hours before going to the hospital
Please remember that the well being of you and your baby is our number one priority. Every birthing experience is different and while we can provide you with “normal guidelines” and outline the progression of labor to delivery, every birth experience varies in length and intensity. Labor and delivery is not a test of endurance or strength. It is a natural process whether medications and/or interventions are used or not.
“How do I know when I am in labor?” The following information will provide you with some guidelines you can follow:
Mucous Plug
This is a thick, gelatinous, possibly pink tinged, blob­like barrier that has “corked” your cervix throughout your pregnancy. It can be dislodged when effacement and dilatation begins. It can happen 24 hours or a few weeks before labor begins. You do not need to call the office when you lose your mucous plug. However, if you notice bright red bleeding or leakage of thin watery discharge, you should call the office.
Rupture of Membranes
How do I know if my “water” broke? Membrane rupture can occur as a gush or slow trickle. While it is easier to tell your water broke with a gush, the slow trickle can be harder to detect. If your underwear feels damp, empty your bladder and put on a pad. When the pad continues to feel damp/wet even with your bladder emptied, that can be a sign of rupture of membranes. Urine has an ammonia smell and rupture smells sweet. Even after rupture, it can still be 12 hours before you feel the first contraction. Call the office if you think your membranes have ruptured due to the risk of infection to the Mom and/or baby. Three stages of labor
x Stage 1 is the labor phase which is also divided into 3 phases
o The Early Phase is dilation from 0 to 4 cm. o The Late Phase is dilation from 4 to 10 cm.
x Stage 2 is delivery of the infant
x Stage 3 is the delivery of the placenta
The average first time labor is 14 hours while the average labor for a Mom who has delivered previously is 8 hours.
Contractions
True labor contractions will be regularly spaced. They will not slow down with rest or become further apart. They usually start in the back and move forward to the front with the abdomen or uterus becoming firm and hard. Each contraction generally lasts 40 to 60 seconds and occurs every 5 to10 minutes.
Call the office
¾ Contractions are 5 to 7 minutes apart ¾ If your water breaks or is leaking
¾ If you have bright red bleeding ¾ If you have a green colored discharge Call sooner if you have a history of short labor, a complicated pregnancy or live a long distance from the hospital.
You should not come to the hospital without notifying the physician first. (574­234­9050 or 574­232­1471)
When you arrive at the hospital, you will be evaluated by a nurse or medical resident who will check a pelvic examination and update the physician on call.
You may be monitored with a Non­Stress Test. Two straps will be placed on your abdomen to monitor the baby’s heartbeat and your contractions.
You will generally be allowed fluids and a light diet in labor. An IV may be placed as a precautionary measure to provide hydration, nutrition, or access for medication. It will not infringe on your mobility.
We encourage you to have a support person with you in labor. It is usually beneficial to have someone with you to mop your brow, feed you ice chips and provide support and encouragement. Anesthesia and Pain Relief We suggest you make a plan for pain relief prior to your delivery.
There is nothing unnatural or harmful about the use of pain relievers in labor and no medication would be prescribed which could be harmful to you or your baby. Do not hesitate to ask for pain medication if necessary. Labor can be a long and painful process and it is important for you to have energy for the delivery. We only want the best outcome for you and your baby. Nubain
x Given IV or IM.
x Helps patient to relax and increases ability to cope with contractions.
x Reaction to medication and amount of pain relief varies by patient.
x Can cause drowsiness or nausea/vomiting.
Epidural/Spinal
x A catheter is inserted in the epidural space of your spine by an anesthesiologist.
x Provides pain relief to the lower part of your body.
x Aids a patient in her ability to push more effectively.
x Requires placement of an IV and catheter for your bladder.
x Does not increase the likelihood of cesarean, but in the event of a cesarean delivery allows the Mom to be awake for the birth.
General Anesthesia x Only used in an emergency when there is no time for regional anesthetic. It is administered as close to delivery as possible to reduce drowsy side effect to the baby. Delivery
™ When the cervix is fully dilated to 10 cm you will be instructed to push. You will continue to push with each contraction until you are ready to deliver. ™ At that time, a nurse will prepare the room for delivery. Your delivery may require an episiotomy which is a small cut at the vaginal opening to prevent tearing when the baby’s head is delivered (a local anesthetic is used). However, episiotomies are not routinely necessary. ™ After delivery you will be monitored in the delivery room for about one hour. Your vital signs, amount of bleeding and uterus size will be watched. ™ Once you are ready to be moved, the baby will be taken to the nursery for his/her own measurements, examination and bathing. Your support person may accompany your newborn. You will be moved to the postpartum area for the remainder of your hospital stay.
™ The hospital does not allow videotaping of the birth. However, you may videotape as soon as the baby is delivered.
Cesarean Delivery
™ If you have had a previous Cesarean delivery, we will discuss delivery options with you around your 28 week visit. If you are a candidate for a vaginal delivery, we will have you sign a consent form and keep that on file in your OB record so all the physicians are aware of your choice. If we need to schedule a repeat Cesarean delivery, you will be contacted by our scheduler with the date and time of your delivery. According to guidelines set by the American College of Obstetrics & Gynecology, no repeat cesarean sections will be scheduled prior to 39 weeks gestation unless medically necessary.
™ You cannot eat or drink for 8 hours prior to your scheduled delivery time and you will be asked to arrive at the hospital 2 hours prior to delivery.
™ Cesarean sections are only performed when medically necessary and are not scheduled at the patient’s request. ™ Cesarean sections are performed on the Labor and Delivery unit at the hospital and you will be a patient on the post partum floor after delivery. The hospital stay is generally 2 to 3 days after delivery depending on your insurance allowance and your recovery.
™ You will need to call the office after you return home to schedule a 6 week follow up appointment.
Post Partum
Postpartum is a period of time immediately following delivery through your six week check up. ¾ You may experience slight contractions called “after pains” for the first couple of days after the delivery and as the uterus returns to normal size. ¾ You may be given a prescription for a pain reliever. We suggest you take Motrin 600 mg every 6 hours for the discomfort and also to control the amount of bleeding after delivery.
¾ Sitting in a shallow tub of warm water or sitz bath may relieve discomfort of the vaginal area.
¾ You may also experience a bloody discharge for approximately 4 to 6 weeks after delivery. ¾ Your first period after delivery is usually heavier than usual and is accompanied by more clotting. It usually starts within 4 to 12 weeks after delivery or after your stop nursing. It is possible and normal to begin periods while nursing. ¾ Call the office if o you soak more than one pad per hour o run a fever above 101 degrees o notice a foul smelling discharge from the vagina. Breast Feeding and Breast Care
™ We encourage every Mom to breast feed their newborn or at least give it a try for the first 4 to 6 weeks. Breast milk provides the baby with additional nutrition and antibodies to help fight infections and allergies. ™ Breast milk is easy to use, economical, and fosters mother/baby bonding. It will also help you to heal more quickly as the uterus contracts and returns to normal size.
™ You should begin to prepare your breasts early in pregnancy to condition your nipples. A massage cream or lanolin may be used to keep the nipples soft. ™ Your breast milk should “come in” within three days after delivery whether you are breast feeding or not. When your milk comes in the breasts can become hard, heavy and feel full. If nursing, you should feel relief of these symptoms when the baby nurses. A non­ nursing Mom can relieve these symptoms by wearing a support bra, applying ice packs and using Tylenol or Advil to relieve the pain. The milk supply will dry up within 14 days. ™ You should always have the baby nurse equally on both breasts. The more frequent the feedings, the more milk your breasts will produce. The baby will want to nurse about every 4 hours, however, you and the baby’s physician will decide what is best for you and the baby.
™ Allow your nipples to air dry before replacing your bra. A hair dryer blowing warm air across the nipples is soothing. Special nursing bras can be purchased to give extra support. ™ The Lactation consultants on the postpartum unit can help answer your questions about breast feeding while you are in the hospital and after you go home. Their phone number is 335­4127.
™ Call the office
o If one breast becomes swollen, reddened, or tender especially if accompanied by a fever. Circumcision
If you have a baby boy that you would like to have circumcised, the procedure will be done prior to being discharged. All the physicians at OB/GYN are well trained in this procedure and anesthesia is available for your son. Circumcision is the process of removing the foreskin of the penis which is often done for personal or religious reasons. Some physicians feel it is advisable for cleanliness purposes. The procedure takes a few minutes and the penis heals generally without complications. You will be given a sheet for care of the circumcision at the hospital. Do not hesitate to call the office with questions. Going Home
™ Remember you will need a car seat to take the baby home from the hospital and to use every time you travel with the baby. ™ Allow your self time to rest and heal after first going home from the hospital. A new baby places a strain on the new parents and siblings. Limit visitors until you are ready and the baby is adjusted to his/her surroundings. Take advantage of offers to help with meals and other siblings. ™ You may drive a car after one week if you did not have complications of delivery. Do not drive if you are taking prescription pain medicine. Check with your pediatrician or family practice physician for recommendations on when to take the baby out in public. ™ Intercourse should be avoided until the post partum check. ™ Call the office when you get home to schedule your 6 week post partum appointment. If you have a Cesarean delivery, please call with any incisions issues and you will be scheduled for a sooner appointment if necessary.
Postpartum Depression and the “Baby Blues”
After having a baby, many women have mood swings. One minute you may feel happy and the next minute feel like crying. You may feel sad, unable to sleep, have a loss of appetite and have a difficult time concentrating. These symptoms often start a few days after giving birth and usually resolve around 10 days postpartum. However, if your symptoms do not resolve after a few days or your symptoms are disrupting your life or keeping you from bonding with your baby, please call our office for information on postpartum depression. Symptoms of postpartum depression
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Loss of interest or pleasure in life
Loss of appetite or unexplained weight loss/gain
Less energy and motivation to do things
Inability to fall asleep, staying asleep or sleeping more than usual
Increased crying or tearfulness
Feeling worthless, hopeless or overly guilty
Feeling restless, irritable or anxious
Feeling like life isn’t worth living
Having thoughts about hurting yourself or the baby
Postpartum depression is treated like any other depression disorder with support, counseling and medication. Please call the office if you feel you have symptoms of postpartum depression.
Simple steps to help the “Baby Blues”
x Find someone to talk to about your feelings – husband, partner, family member or friend
x Seek help with childcare, errands, and household tasks
x Exercise. Go for a walk everyday
x Be honest about how much you can do without help
x Tell yourself it is okay to get overwhelmed. Don’t expect too much, especially in the first 6 weeks after childbirth.
This book is intended to be used as a pregnancy guide and to answer frequently asked questions by both first time Moms and as a refresher course to Moms who have had previous pregnancies. We have a triage nurse available from 8 am to 5 pm every day to answer your questions or provide advice. The nurses have all been trained by the physicians to answer your questions and pass along their advice in routine situations. We have your needs and concerns as our first priority. We will always call you back the same day with an answer to your questions, but your patience is appreciated as the on­call physician may be in a delivery or responding to an emergency. If you are brought in for an appointment to see the physician on call, we encourage you to call ahead in case an emergency has come up and we have to move your appointment.
OBGYN ASSOCIATES OF NORTHERN INDIANA, P.C. FEE SCHEDULE
Effective May 2015
Global fee for prenatal care and delivery:
Vaginal Delivery
Cesarean Section
*High Risk Pregnancy and VBAC can result in additional charges
Circumcision fee:
Ultrasound fee:
Limited
Complete (single pregnancy)
Transvaginal
Non­Stress Test fee:
Lab Work fees:
Blood Draw
Glucola Test (one hour)
Glucola Test (two to three hours)
Each additional hour
T­dap Vaccination (includes administration fee)
Rhogam (includes administration fee)
$4,800.00*
$5,835.00*
$ 485.00
$ 190.00
$ 330.00
$ 230.00
$ 100.00
$ 20.00
$ 30.00
$ 80.00
$ 30.00
$ 145.00
$ 243.00
1. Many insurance companies are now requiring their members to use a preferred laboratory. Please inform us if you need to utilize a lab other than the South Bend Medical Foundation. A separate billing will be sent to you from the lab. They will bill your insurance company upon receipt of the information.
2. A global fee for prenatal care (all routine prenatal visits) and delivery will be billed to your insurance company after delivery. All lab work, ultrasounds, problem visits and any additional procedures will be billed to the insurance at the time of service. If your insurance rejects payment or partial payment on these services due to deductible or co­insurance matters, payment from the patient will be due within 30 days.
3. IT IS IMPORTANT THAT YOU CONTACT YOUR INSURANCE PROVIDER to make sure that services you will be receiving are covered under your insurance plan. IT IS YOUR RESPONSIBILITY to find out if your insurance provider requires precertification, what hospital will be in network for your delivery, as well as what deductible and co­payment you may be required to pay. Contact your insurance carrier and give them your estimated due date and the hospital you will be delivering at. As soon as you receive notification from your insurance as to how many days they will allow you to stay in the hospital, and any precert information that you might receive, please extend that information to our office. Hospital benefits may be reduced if precertification is not completed prior to admission or if the stay exceeds the number of days allowed. Some insurance companies provide a baby program for all new expectant moms. By calling your insurance company early in your pregnancy you may be able to take advantage of what they have to offer.
**ALL FEES SUBJECT TO CHANGE AND ARE NOT GUARANTEED
CASH PATIENT
Patients that do not have insurance coverage during their pregnancy will need to make arrangements with an Account Representative. Please contact Justin at (574) 251­2103 extension 73213. Prepayment for the base fee must be completed prior to the seventh month of pregnancy. All additional charges such as lab work and ultrasounds will need to be paid at the time of service.
INSURANCE PATIENTS
Patients that have a coinsurance policy will need to pay their coinsurance by the seventh month of pregnancy. Monthly payments should be made. For example, for a normal vaginal delivery, if you have an 80/20 policy, you will need to pay your 20% coinsurance ($960.00) by your seventh month.
If you would like to pre­pay on your delivery through monthly payments, you may do so by calling our Account Representative, Justin, at (574) 251­2103 extension 73213. He can assist you with setting up a payment plan, in which you make your payments each month at our office or by mail. When making payments in our office, please let the front desk know you are pre­paying on your delivery.
If you have an insurance policy that requires copayments for office visits, you will need to pay your copay each time you come to see the physician.
MEDICAID PATIENTS
An eligible Medicaid card must be presented to our office at your first doctor’s visit. If for any reason a card is not available, you will be considered a cash patient until the card is obtained. If you should have a baby boy, we will also need Medicaid information or other insurance information for him in order to file the circumcision charge.
If you are participating in the Hoosier Healthwise program, you will need a referral from your primary care physician. For legal reasons, we must prohibit all electronic and recording devices in the ultrasound room. This includes taking pictures, videos, FaceTime and Skype. You will be given pictures at your initial dating ultrasound and given a disc with multiple pictures from your screening ultrasound to share with your family and friends.
Thank you for your understanding.
The Physicians of OBGYN Associates