Download Your Guide to Pregnancy - State of Franklin OB/GYN Specialists

Your Guide to Pregnancy
State of Franklin
OB/GYN Specialists
Compassionate Care for Women
A division of State of Franklin Healthcare
423-794-1300 | www.sofhaObGyn.net |
Our Physicians
Alfonzo Arze, M.D.
F.A.C.O.G.
Rachel Bevins, D.O.
F.A.C.O.G
Jott Hallman, D.O.
F.A.C.O.G.
Stephanie Burks, W.H.N.P.
Ginger W. Carter, M.D.
F.A.C.O.G.
Courtney Hodshon, M.D.
F.A.C.O.G.
Holly Falin, F.N.P
Chad A. Drey, M.D.
F.A.C.O.G.
Grover E. May, M.D.
F.A.C.O.G.
Melissa Grissinger, F.N.P.
John Green, M.D.
F.A.C.O.G.
Jill Talley-Horne, M.D.
F.A.C.O.G.
Rebecca Wilkins, F.N.P.
Tonya Wilson, A.N.P.
The content of this booklet has been approved by State of Franklin OB/GYN Specialists
This booklet contains paid advertising by Mead Johnson & Company LLC. All other content of this booklet was developed by the
healthcare provider who is solely responsible for its contents.
2
Office informat
ion
We have two locations to better serve you.
Johnson City Location: 301 Med Tech Parkway Suite 200, Johnson City, TN 37604
Elizabethton Location: 1505 West Elk Ave. Suite 1 , Elizabethton, TN 37643
Office Phone: 423-794-1300
Office Hours: Monday through Friday 8:00am until 5:00pm
*We receive phone calls from 8:00am - 4:30pm. Please reserve your after hours calls for urgent issues only.
Phone calls made outside of regular office hours should be reserved for emergencies. Unless your call is
urgent, please call during office hours so your chart can be available for reference.
You can reach us after hours by calling our main office number at 423-794-1300 and the physician on call
will contact you. If you have not received a return call within 30 minutes, please call back. We try to answer all
calls as soon as possible; however due to emergencies, we may be unable to return your call immediately.
When calling, it is better if we can speak to you directly because relayed messages may not be accurate.
In addition, please have a pharmacy phone number available when calling.
Our office also offers an online tool that provides anywhere, anytime access to your personal health care
needs! With our patient portal, you can message any of our providers or make changes to your
appointments. We hope that you will utilize this tool throughout your pregnancy, as we view this as the
most convenient and effective method for routine communication. Please ask anyone in our office how
to set-up your account.
Pregnancy Guide
Congratulations! You have now entered into one of the most exciting experiences of your life. Even if this is not
your first pregnancy, what you will experience over the next several months will certainly be unique and exciting
since no two pregnancies are exactly alike.
This brochure was designed to give you an overview of what to
expect during your pregnancy and into your delivery. If you
have additional questions or need more information
about any subject, please ask a provider. Please keep
in mind, there will be variations depending upon
your individual pregnancy.
Compassionate Care for Women
3
First Trimester
The first trimester is defined as the first 13 weeks of your pregnancy. Most women determine that they may
be pregnant between the 4th and 8th weeks of pregnancy.
What changes will you experience?
The first sign of pregnancy is usually the lack of menstruation. Other signs, which are experienced in varying
degree and sometimes not all, are the following:
• Fatigue and tiredness
• Nausea (possibly with vomiting)
• Food cravings or aversions
• Breast tenderness
• Increased frequency of urination
• Emotional swings similar to PMS
• Weight gain - usually minimal and in some cases weight loss occurs.
• Dizziness related to blood pressure changes and blood sugar changes are common.
• Mild uterine cramping
• Vaginal Bleeding – Spotting is not uncommon. Any bright red uterine bleeding should be reported as you
need further evaluation based on blood type.
How will the fetus change?
Dramatic growth and development of the fetus occurs in the first trimester. The fetus starts off as a cluster of
cells no bigger than a pinpoint and ends up the size of your thumb (approximately 3 inches). By the end of
the first trimester the baby weighs about 3 ounces. The baby’s heartbeat can be seen via ultrasound as Early
as six weeks and can be heard by Doppler at approximately 10-12 weeks.
First OB Appoint
ment
At your New OB appointment we will:
• Obtain your medical history and complete necessary paperwork
all designed to assist your provider in determining the best care
for you and your baby.
• Complete physical examination
• Review of studies for blood type, anemia, and STD infections
• Urinalysis to screen for sugar, protein, red/white blood cells, and
bacteria; also includes a urine culture.
• Review of urine drug screen results
• Pap smear
- GC Chlamydia testing
• Ultrasound to help determine due date (for those 6 weeks
gestation or greater).
We have 9 OB physicians and
5 nurse practitioners that are
available to provide care for you
during your pregnancy. During
your pregnancy you will have the
opportunity to meet each provider
personally. Our nurse practitioners
provide in office care only. Your
delivery will be provided by the OB
physician that is assigned call duty
on that particular day.
Other tests may be necessary based on your current medical condition and your family history. Your provider
will discuss these if needed.
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Medicat
ion List for OB Pat
ient
s
If you develop any of these symptoms or problems, please try the medications listed. If symptoms persist, please
notify our office. All medications are available at local 24 hour convenient stores. Only take these medications if
you are not allergic to them.
Problems
Medications
Cold or Flu
Sudafed*, Tylenol, Tylenol Cold, Benadryl, Guaifenesin
Cough
Robitussin DM, Halls Cough Drops, Mucinex DM
Allergies
Benadryl, Sudafed*, Tylenol Allergy Sinus, Zyrtec, Claritin, Allegra
Headaches
Tylenol
Diarrhea
Imodium AD, Kaopectate
Constipation
Metamucil, Citracel, Fibercon, Colace, Miralax
Hemorrhoids
Preparation H, Anusol, Tucks Pads
Heartburn
Tums/Maalox, Mylanta, Pepcid AC
Emetrol, Unisom
Yeast Infection
Monistat7, Monistat3
*Sudafed is not recommended for patients with blood pressure issues.
**Nausea is very common. Some simple lifestyle changes can make a
big difference. First, try eating small, frequent meals. Snack on nuts,
fruits, crackers, toast, and similar foods. Avoid strong odors and flavors.
Ginger has been reported to be helpful for some who may prefer a
more natural therapy. We also recommend adding vitamin B6
(pyridoxine) 25 mg with each meal and at bedtime. Adding one-half
of a doxylamine (Unisom SleepTabs) 25 mg tablet two or three times
daily to the vitamin B6 can make a dramatic difference in your
symptoms. These over-the-counter remedies are safe
and effective and should be your first treatment option.
Compassionate Care for Women
5
Foods t
o Avoid During Pregnancy
Because pregnancy affects your immune system, you and your unborn baby are more susceptible to the
bacteria, viruses and parasites that cause foodborne illness. Even if you don’t feel sick, some “bugs” like Listeria
and Toxoplasma can infect your baby and cause serious health problems. Your baby is also sensitive to toxins
from the food that you eat, such as mercury in certain kinds of fish.
Keep this checklist handy to help ensure that you and your unborn baby stay healthy and safe. Invest in a
food thermometer to check the temperatures of cooked food.
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Don’t Eat These Foods
Why
What To Do
Soft CHEESES made from
unpasteurized milk, including
Brie, Feta, Camembert,
Roquefort, Queso Blanco, and
Queso Fresco
May contain E. Coli or Listeria
Eat hard cheeses such as
Cheddar or Swiss or check the
label and make sure that the
cheese is made from pasteurized
milk
Raw COOKIE DOUGH or CAKE
BATTER
May contain Salmonella
Bake the cookies and cake. Don’t
lick the spoon!
Certain kinds of FISH such as a
shark, swordfish, king mackerel,
tilefish (golden or white
snapper), limit white (albacore)
tuna to 6 ounces a week
Contain high levels of mercury
Eat up to 12 ounces a week of
fish and shellfish that are lower
in mercury such as shrimp,
salmon, pollock and catfish
Raw or undercooked FISH (Sushi)
May contain parasites bacteria
Cook fish to 145B
Unpasteurized JUICE or cider
(including fresh squeezed)
May contain E. Coli
Drink pasteurized juice. Bring
unpasteurized juice or cider to a
rolling boil and boil for at least 1
min. before drinking.
Unpasteurized MILK
May contain bacteria as
Camplobacter, E. Coli Listeria or
Salmonella
Drink pasteurized milk
SALADS made in a store such as
ham salad, chicken salad, and
seafood salad
May contain Listeria
Make salads at home following
the food safety basics: clean,
separate, cook and chill
Raw SHELLFISH such as oysters
and clams
May contain Listeria
Cook shellfish to 145B
Raw or undercooked SPROUTS
such as alfalfa, clover, mung
bean and radish
May contain E. Coli or Salmonella
Cook sprouts thoroughly
Be Careful with These Foods
Why
What To Do
Hot dogs, luncheon meats, cold
cuts, fermented or dry sausage,
and other deli-style meat and
poultry
May contain Listeria
Even if the label says that the
meat is precooked, reheat these
meats to steaming hot or 145B
before eating
Eggs and pasteurized egg
products
Undercooked eggs may contain
Salmonella
Cook eggs until yolks are firm.
Cook casseroles and other dishes
containing eggs or egg products
to 160B
Eggnog
Homemade eggnog may
contain uncooked eggs, which
may contain Salmonella
Make eggnog with a pasteurized
egg product or buy pasteurized
eggnog. When you make
eggnog or other egg-fortified
beverages cook to 160B
Fish
May contain parasites or bacteria
Cook fish to 145B
GENDER REVEAL/3D ULTRASOUND
Typically gender reveals are performed between 16-18 weeks. 3D Ultrasounds are typically
performed between 28-32 weeks. You will be provided with a CD that includes still photos and
video clips.
There is no guarantee that pictures will be provided as the scan depends
on the baby’s cooperation.
These Ultrasounds are elective and are not covered by your insurance.
Please ask the front desk for details regarding cost and methods of
payment.
**Please note that this exam is NOT reviewed by a physician.
Compassionate Care for Women
7
OB Checklist
s
1st Trimester
2nd Trimester
3rd Trimester
q Results of labs
q Blood Type
q 3D Ultrasound
q Fetal Kick Counts
q Repeat C-Section
q Group B Strep (GBS)
q Glucose Tolerance Test
q Labor Precautions
q Rhogam (if indicated)
q When to go to Hospital
q Anesthesia Consult
q (423) 302-1436 to
schedule consult
q Induction of Labor
q Schedule of visits
q Routine US
q Routine Labs
q Medicines
q Foods to Avoid
q Travel
q How to contact provider
in case of emergency
q Provide Rotation
q Hospital Pre-Admission
q Franklin Woods
Community Hospital
Directions
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q Breast / Bottle Feeding
Information
q Pediatrician
q Fetal Kick Counts (10
kicks in two hours)/
Pre-term labor
2nd Trimester
The second trimester starts at week 13 through the 27th week.
What changes will you experience?
If you happened to experience some of the less desirable effects of pregnancy in the first trimester, you will
be glad to know that most women report a decline in those symptoms during the second trimester. The
following is a list of changes that you may experience between the fourth and seventh month:
•
•
•
•
•
•
•
•
•
Increase or decrease in fatigue and tiredness
Indigestion, heartburn, or gas
Swelling in the breasts, ankles, feet, hands, and/or face
Bleeding from your nose or from your gums
Constipation
Vaginal discharge (usually white in color)
More frequent urination
Wardrobe change - most women will start wearing maternity clothes sometime in their second trimester
Weight gain
How will the fetus change?
Between the fourth and seventh month, the baby’s weight will increase from around 3 ounces to almost 2
pounds. The length will have nearly quadrupled to approximately 12 inches long. Your baby is moving more
and you may experience fluttering called “quickening” in the beginning to outright kicking by the end of the
second trimester.
Developmentally, your baby has grown into a complete little person. All organs have developed (although
immature) and he/she is already sucking and swallowing. It is important that the baby now working on
gaining weight and maturing all its organs to guarantee his/her healthy delivery.
2nd Trimester OB Appoint
ment
s
Unless your doctor otherwise instructs you, your appointments will continue on a monthly basis through the
second trimester.
•
•
•
•
•
•
Weight and blood pressure monitoring
Determining the height (by tape measure) and/or size (feeling the outside) of the uterus
Fetal heartbeat monitoring
Glucose tolerance test (test for blood sugar) between the 24th and 28th week
Rhogam - antibody screen
Class instruction - information about classes you may take to prepare for labor and delivery, new baby care
and breast feeding instruction can be obtained through Labor and Delivery at the hospital
• Paperwork - you will need to fill out pre-admissions forms and submit them to the hospital where you will
be delivering. You may want to contact your insurance company to clarify what they will expect from you,
your doctor, and the hospital
• Ultrasound
Compassionate Care for Women
9
3rd Trimester
The third trimester is defined as the 27th week to term. This is often termed the “showing and glowing” period.
You could deliver your baby anytime during this period and, thanks to modern technology, he/she most likely
would survive. The best chance for a healthy baby is to deliver as close to your due date as possible.
What changes will you experience?
During the last stage of pregnancy, your body will continue to change. Some of the changes you may
experience are the following:
• Increase in intestinal problems like heartburn, gas, or constipation
• Increased swelling in your legs and extremities. Staying off of your feet and elevating them can reduce
swelling.
• Abdominal aches and itchiness due to increased size and pressure
• Backaches
• Difficulty sleeping - use more support pillows for your abdomen and legs
• Headaches and dizziness
• Sinus and nasal congestion problems (including nose bleeds)
• Breast swelling and leaking of colostrum
• Braxton-Hicks contractions - usually felt late in the trimester, you will experience a painless hardening of
your abdomen that usually lasts for less than a minute.
How will the fetus change?
The baby will grow dramatically during this trimester. The length will grow up to 20 inches long and the
weight will triple. Average delivery weight at the end of 40 weeks is between 7 and 8 pounds. Your baby is
growing hair and even finger and toenails. By the 8th month your baby’s movements may be settling down
because there is simply less room (the intensity of movement is expected to be less, but the baby should
move 10 times in two hours). Usually, the baby has settled into a vertex position where the head is down into
the pelvis area. Your doctor will usually be able to externally feel where the baby’s head and bottom are sitting.
3rd Trimester OB Appoint
ment
s
Beginning at the third trimester, your doctor will request to schedule your appointments weekly at 35-36
weeks. All the routine tests such as weight, blood pressure, abdominal measurement and fetal heart rate
monitoring will continue.
Other tests that may occur are the following:
• GBS culture done at 35-37 weeks
• Cervical exam - internal exam to determine effacement and dilation
You may want to be prepared to discuss childbirth with your doctor at the beginning of this trimester.
Clarifying your expectations and fears about delivery with your doctor will help guarantee a successful and
joyous birth experience.
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Labor & Delivery
During the last month of pregnancy, there are a lot of signs that your body is preparing you for delivery. You
may or may not experience the following:
• “Nesting” instinct or a sudden energy boost and desire to organize
• Increased Braxton-Hicks contractions
• A lightening or dropping of the baby which results in an increase in the frequency of urination and allows
you to breathe easier
• Upset stomach with/without diarrhea
• Loss of mucous plug which may cause some spotting
• Spotting due to the opening of the cervix (cervical exams and/or intercourse may also cause spotting)
• Home remedies to try to bring on labor should be avoided
When is it really labor?
The game of guessing if it’s really labor or just Braxton-Hicks will get old quickly as you near your due date.
Don’t despair - every practice contraction is pushing your baby closer to the real thing.
When to go to the hospital?
1. Rupture of membranes - this can be a big gush of fluid or trickle of fluid that does not stop (see below for
more information).
2. Regular, painful contractions every 3-5 minutes for an hour. Contractions
are timed from the start of one contraction to the start of the next
contraction.
3. Bleeding like a menstrual period.
4. A sudden and significant change in fetal kick
movements.
Ruptured membranes can occur before the onset
of labor. If you suspect that your membranes have
ruptured you should call your doctor immediately.
It is not always obvious and sometimes it can
be confused with loss of urine or normal vaginal
discharge. Undetected or ignored ruptured
membranes can lead to infection. If labor does not
begin within 24 hours of the water breaking, then the
doctor may choose to induce labor with medications such as
Pitocin.
Compassionate Care for Women
11
Pain Management
Natural childbirth is sometimes a goal for many women during delivery. However, it is important to know
what pain relief options are available and to be prepared to instruct your caregiver of your choice. The
following is a partial list of pain relief options you may or may not choose:
Epidural - one of the most common choices, the epidural numbs the lower half of the body while still
allowing you to maintain control of your muscles. It is an injection into the back. Often a line is left in so that
additional pain medication can be delivered if needed. Potential side effects include heaviness in the legs,
numbness and sometimes a drop in the mother’s blood pressure.
Intravenous Injection - pain medication can be delivered directly into the vein. This type of medication
will often be used to take the “edge” off the pain but may cause drowsiness and a lack of concentration. This is
generally only used in early labor.
Local Anesthesia - numbing a small area by injection. This is often used during the episiotomy or during
the episiotomy repair.
Spinal Block - this differs from the epidural in that it totally numbs the lower half of your body and is only
temporary. Additional relief would require another shot. Potential side effects may include headaches, nausea
and a drop in blood pressure. We typically give this type of anesthesia for elective C-sections only.
Elective Induction...Is It Right For Me?
These are the most common pain relief options. Your doctor may offer you additional choices.
When a woman’s labor is started before natural labor begins, it is called labor induction. A woman may desire
to have labor started for convenience or personal choice; this is an elective labor induction.
Is Elective Labor Induction OK?
In some cases, elective labor induction may not be good for your baby. There are risks when labor is induced
before you are 39 weeks pregnant and if the cervix is not ready. You and your care provider will decide
together, using guidelines, when and if elective labor induction is ok for you and your baby (certain patients
with complications may require labor induction at any stage in order to ensure the safety of the mother and/
or the baby).
What Do The Experts Say?
The American College of Obstetricians and Gynecologists (ACOG) has made some recommendations to help
care providers make safe choices about elective induction. Before your labor can be induced:
• Your due date must be certain to make sure your baby is fully developed
• You must be at least 39 weeks pregnant
• Your care provider should examine your cervix to determine if it is soft and ready to open (dilate)
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The 3 St
ages of Labor
Stage One: Beginning of labor until the cervix is fully dilated
The first stage of labor can last from 3 weeks to one hour. Effacement (thinning of the cervix) and dilation
(opening of the cervix) begins to occur. Although, this usually occurs long before a patient goes into actual
labor. The cervix is fully dilated when it reaches 10 centimeters. Contractions will be mild, lasting less than a
minute and several minutes apart. Once your contractions are painful and regular and less than five minutes
apart for more than one hour, you should consider going to the hospital to be checked. You may call the
office if you would like to speak to a provider prior to going to the hospital.
Stage Two: Active labor (fully dilated to delivery)
During this stage the baby begins to move down the birth canal until it crowns (the head is visible) and you
will feel an urge to push. The baby’s head is usually delivered face down and then the rest of the body follows
after the shoulders have been turned. The second stage of labor lasts an average of 2 hours and 45 minutes.
Contractions during this phase are usually 3 to 4 minutes apart and last a little over a minute.
Stage Three: Baby delivery to placenta delivery
The hardest work is over now and you may be holding and enjoying your baby already. During this phase
your contractions subside, the umbilical cord is cut, the placenta is delivered and any repairs from an
episiotomy or laceration will be performed. This phase usually lasts no more than a half-hour.
What is happening to your baby?
Your baby will be moved to a bed with a warming light, nametagged, and suctioned to clear its airways.
The umbilical cord will be clamped and cleaned and the baby’s general health will be assessed using an
APGAR test. The APGAR test is an acronym for appearance (color), pulse (heart rate), grimace (reflex), activity
(movement), and respiration. The best score is 10. Most babies score between 7 and 10. The assessment is
performed multiple times, so don’t be surprised if the first score is low.
Compassionate Care for Women
13
Addit
ional Notes
If you have additional questions, or need information on another topic, please take note and ask the nurse or
doctor at your next appointment. We ask that when you call the office or if you have an emergency and need
to speak to the doctor on call that you have please have a pharmacy number available so that prescriptions
can be called in if necessary. It is also important that we speak to you directly if at all possible.
We hope your pregnancy is healthy and that you have a wonderful childbirth experience.
14
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