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Your Guidebook for the Next Nine Months In the next nine months you will create a whole new person. It’s an amazing time and there’s a lot to know. We’re here to help with some of the most common concerns you may have during your pregnancy—from your due date to what to eat, how much to exercise, how to prevent morning sickness and some of the common discomforts that can occur during pregnancy. The following information is to be used as a guide only. It should never replace advice from your physician. If you have questions and concerns, do not hesitate to call or visit your doctor. 1 2 Baby’s Birthday Prenatal Office Visits Feeling the Baby Kick Most pregnancies last around 40 weeks (or 38 weeks from conception). The best way to calculate your due date is to count 40 weeks from the start of your last period. This is a pretty solid target. But remember: it’s just as normal to deliver 1–2 weeks on either side of that date. Good prenatal care is fundamental to making a healthy baby. We encourage you to begin prenatal care as soon as you find out you are pregnant. We encourage your partner to visit with you and take an active part in your pregnancy. This is a special time to learn about yourself and your baby. Don’t be afraid to ask questions. If this is your first pregnancy, it may be hard to tell whether your baby has moved. Many women describe their baby’s movements as butterflies, bubbles or gas. You can expect to feel your baby move for the first time between 18 and 24 weeks. If this isn’t your first baby, you may start to feel movements as early as 13 weeks. Your doctor will probably want to see you on the following recommended schedule: • 4–28 weeks—1 prenatal visit per month • 28–36 weeks—1 prenatal visit every 2 weeks • 36–40 weeks—1 prenatal visit per week 3 What to Eat Weight Gain Eating a variety of healthy foods during your pregnancy will provide the important nutrients your baby needs for growth and development. You should also begin taking a prenatal vitamin with folic acid and omega-3 fat docosahexaenoic acid (DHA). Choose foods from the following five food groups: fruits, vegetables, lean protein, whole grains and dairy products. When you’re pregnant, it is generally recommended you eat about 300 calories more per day than usual. Pregnancy is not the time to begin a weight loss program. Following are the recommendations for total pregnancy weight gain and the rate of weight gain in the second and third trimesters: Total If you’re underweight <18.5 BMI 28-40 pounds If you’re normal weight 18.5-24.9 BMI 25-35 pounds If you’re overweight 25-29.9 BMI 15-25 pounds If you’re obese 30 or >BMI 11-20 pounds Rate 1 pound/week 1 pound/week ½ pound/week ½ pound/week 4 What Not to Eat Most foods are safe; however, there are some foods that you should avoid during pregnancy. Some contain high levels of chemicals that can affect your baby’s development. Some can put you at risk for getting an infection that can hurt your baby. Avoid eating: • Fish high in mercury like: swordfish, shark, king mackerel and tilefish. It is recommended women eat no more than 12 ounces a week (2 average meals) of a variety of fish and shellfish low in mercury. • Raw fish, especially shellfish (oysters and clams). 5 How to Exercise • • • • • Undercooked meat, poultry, seafood and hot dogs. Deli meats (ham, salami and bologna) can cause food poisoning; avoid them or reheat them before eating. Refrigerated pates and meat spreads. Canned versions of these are safe. Refrigerated smoked seafood unless it has been cooked, as in a casserole. Soft-scrambled eggs and all foods made with raw or lightly cooked eggs. Unpasteurized milk or any food made from it including soft cheeses like Brie, feta, Camembert, Roquefort and Mexican-style, unless they are labeled as made with pasteurized milk. • • • • Unpasteurized juices. Raw vegetable sprouts, including alfalfa, clover and radish. Herbal supplements and herbal teas. Large quantities of caffeine (limit caffeine to less than 200 mg/day). There are many benefits to exercising during pregnancy including helping you prepare for labor and delivery. If you exercise regularly, you should be able to continue your activity in moderation. If you don’t exercise regularly, you can safely begin an exercise program after consulting with your doctor. Talk with your doctor to make sure you don’t have any obstetric or health conditions that would limit your activity. For most pregnant women, at least 30 minutes of moderate exercise is recommended on most, if not all, days of the week. Try walking, swimming, cycling and low-impact aerobics. Running in moderation is safe for women who have been running before pregnancy. Avoid downhill skiing, water sports, contact sports and scuba diving. Exercise can help: • Ease or prevent back pain, constipation, bloating and swelling • Boost your mood and energy levels • Help you sleep better • Prevent excess weight gain • Prevent and treat gestational diabetes • Increase stamina and muscle strength Exercise safely: • After the first trimester, do not lie flat on your back. • Avoid exercising in hot, humid weather. • Drink plenty of water. • Wear comfortable clothes, listen to your body and don’t overdo it. 6 No Smoking, Alcohol or Drugs Drugs If you abuse drugs, you are taking a chance with your health and the health of your baby. Babies born to mothers using street drugs often are born smaller and too early. They are at higher risk of miscarriage and stillbirth, having feeding problems, blood circulation problems and brain damage, as well as long-term behavioral problems. If you have a problem with alcohol or drug use, please seek help before becoming pregnant. If you are pregnant now, seek help as soon as possible. 7 Sex is Safe Be honest and open with your doctor. If you are pregnant and have been drinking alcohol, using illegal substances, or if you smoke, let your doctor know. Smoking The Surgeon General’s warning: “Smoking by pregnant women may result in fetal injury, premature birth, and low birth weight,” now appears on cigarettes. Pregnant smokers have a higher chance of miscarriage and stillbirth. Babies of smoking mothers have a higher chance of being born early and too small. Low-birth-weight babies (less than 5 ½ pounds) can suffer serious health problems throughout their lives. Alcohol The alcohol a mother drinks is shared with her baby. The more she drinks, the more the baby receives, increasing the chance of serious growth and development problems including fetal alcohol syndrome. Medical experts have not been able to determine a safe amount of alcohol. Therefore, to protect your baby from alcohol-related danger, you should not drink any alcohol. In a pregnancy that is proceeding normally, sex is safe and healthy until shortly before the baby is born. A few things to keep in mind include your comfort and sex drive. Fatigue, nausea and breast tenderness early in pregnancy and weight gain, back pain and other symptoms as the pregnancy progresses, may make sex the last thing on your mind. Spotting after intercourse may occur. If bleeding persists, call your doctor. If you have concerns about sex during pregnancy because of underlying health problems, ask your doctor whether sex will be safe. Help for Common Discomforts Morning Sickness Generally, morning sickness or sometimes “all day sickness” strikes in the first trimester, from about 8 weeks until 14 weeks. The more nauseous you get, the less you eat. The less you eat, the more nauseous you get. The good news is in most women, nausea stops between the third and fourth month. Here are some tips to help you cope: • Keep crackers by your bed and eat a couple 5 to 10 minutes before you get out of bed • When you do get up, do it slowly; sit on the side of the bed • Eat regular small meals (5–6 each day) • Reduce fatty, spicy or highly sweetened foods • Get fresh air See the list of safe medications in this booklet. If your nausea or vomiting is severe, contact your doctor. Indigestion/Heartburn Feeling a burning sensation in your stomach is very common in pregnancy. It is caused by your growing baby and by hormonal changes that allow stomach contents to back up into the esophagus. To lessen your chance of heartburn: • Eat small, regular meals • Avoid fatty, rich or spicy foods • Avoid lying down for at least a half hour after meals • If necessary, sleep propped up on a pillow Discuss your symptoms with your doctor and see the list of safe 8 medications in this booklet. Frequent Urination Hormones and the pressure your expanding uterus is putting on your bladder can cause you to urinate more frequently during the first three months of your pregnancy. This should lessen in your second trimester, only to return late in the third trimester when your baby’s head may press squarely on your bladder. Pain with urination, blood in the urine or fever may indicate infection. If you experience any of these, contact your doctor. Constipation This is a very common problem during pregnancy. Blame hormones and an expanding uterus again. Here are some tactics to try: • Drink water (at least six 8 oz. glasses/day) • Eat foods high in fiber like fruits, vegetables or bran cereals • Exercise daily Not all laxatives or stool softeners are safe during pregnancy. See the list of safe medications in the booklet or talk to your doctor before taking any constipation medication or remedy. 9 Hemorrhoids Many pregnant women experience hemorrhoids or varicose veins in the rectum. They are aggravated by constipation and pressure from your growing uterus. Tips for avoiding hemorrhoids are the same as avoiding constipation. You may also find relief by taking a warm bath, trying witch hazel or ice packs, sleeping on your side or sitting on a donut shaped pillow. See the medication list in this booklet or talk with your doctor if you cannot find any relief. Swelling During pregnancy, the body produces approximately 50% more blood and body fluids to meet the needs of the developing baby. Swelling is a normal part of pregnancy. Swelling usually occurs in the legs, ankles and feet. Sudden swelling, especially in the hands and face, vision problems and severe headache may indicate a more serious problem and should be discussed with your doctor. Here are some helpful hints to help you cope: • Elevate your legs when possible • Avoid standing for long periods • Avoid salty foods • Rest in bed on your side • Wear support tights or stockings • Drink plenty of water to flush the body Getting Enough Sleep During the first three months of your pregnancy it is normal to feel very fatigued, so allow yourself to get the rest you need. During the last few months of pregnancy you may find it difficult to find a comfortable position or to stay comfortable throughout the night. Try experimenting with pillows to discover a comfortable sleeping position. Some women find that it helps to place a pillow under their abdomen or between their legs. Also, using a bunched-up pillow or rolled-up blanket at the small of your back may help to relieve some pressure. Avoid lying flat on your back on a hard surface for a prolonged period of time after the first trimester. Back Pain Pregnancy can be tough on your back. The most common cause of back pain is strain on your back muscles and weakness in your abdominal muscles. Here are some things you can try: • Apply heat and cold to your back, or massage the painful area • Wear shoes with good arch support • Avoid standing for long periods of time • Add a pillow to your chair for back support • Sleep on your side with a pillow between your legs • Avoid lifting heavy objects • Wear a maternity support belt If the pain persists, talk to your doctor; it may indicate a more serious condition. Your doctor can also recommend physical therapy, special braces or medication for pain. 10 Shortness of Breath Many women experience this sensation at about 31–34 weeks of pregnancy. As your uterus grows it presses the digestive organs and the diaphragm up toward the lungs, limiting their ability to fully expand when you take a breath. If you had mild asthma before you were pregnant, you may find that your asthma symptoms worsen. Tips to relieve this uncomfortable feeling include: • Sit up straight to give your lungs as much room as possible to expand • Sleep with your upper body propped up on pillows or in a reclining chair • Move more slowly so your heart and lungs do not have to work as hard 11 Leg Cramps These painful spasms can wake you from a sound sleep and may start appearing during the last 3 months of pregnancy. To prevent these frustrating leg pains: • Stretch your legs before bed (especially your calf muscles) • Drink plenty of water throughout the day • Eat 3 to 4 servings of calcium rich foods every day • Avoid pointing your toes when you stretch or exercise If a cramp strikes: • Stretch and massage your calf muscle • Walk and then elevate your legs • A hot shower, warm bath or ice massage can also help Round Ligament Pain Round ligament pain is a sharp pain or jabbing feeling in the lower belly or groin area. It is one of the most common complaints during pregnancy and is considered a normal part of pregnancy. It is the result of the stretching of ligaments as the uterus grows. Warm baths, massage, rest, heat or slow changes in position can help with the pain. If you experience severe pain, fever, chills or difficulty walking, call your doctor immediately. Numbness and Tingling The swelling in your body may press on nerves, resulting in tingling and numbness in the legs, feet and hands. The skin on your belly may feel numb, too, because it is so stretched out. Fortunately, the problem usually ends after pregnancy. your mucus plug.” This is a thick mucus discharge sometime associated with dark blood. This is normal and not a cause for concern. If you experience pain, soreness or itching in your vaginal area or if your discharge is bloody, watery or smells bad, contact your doctor. Vaginal Discharge It’s quite common to have more vaginal discharge during pregnancy. What you’re noticing is normal leucorrhea, the odorless discharge that you may have noticed in your underwear before you were pregnant. There’s just a lot more of it now, partly because of increased estrogen production and greater blood flow to the vaginal area. Closer to your due date, it is not unusual to “lose Nosebleeds Nosebleeds do tend to occur more often during pregnancy. They are caused by hormonal changes and increased circulation to the mucous membranes. To prevent nosebleeds: • Drink water • Blow your nose gently • Keep your mouth open when you sneeze • Humidify the air in your home • Saline nasal sprays or drops may help Hot Baths, Showers and Hot Tubs It is perfectly fine to take a hot bath or shower throughout your pregnancy as long as the temperature isn’t over 100 degrees Fahrenheit. If you have to ease your foot into the tub, it’s too hot. A hot bath can damage your baby’s developing cells, and though you can cool off by sweating, your baby can’t. Hot tubs and saunas should be avoided. 12 Travel As long as there are no identified complications or concerns with your pregnancy, it is generally safe to travel at all times during your pregnancy. The main concern is the chance of an unexpected event occurring while you are out of town. If contractions or illness should occur while traveling, seek medical care. Avoid long distance travel the last six to eight weeks of your pregnancy. If your pregnancy is considered high risk, discuss your plans with your doctor. Tips for travel include: • Move around often to improve circulation • Stay hydrated; drink plenty of fluids 13 Colds, Flu, Infections • • • Wear a seat belt at all times. The lap belt should be positioned below your abdomen across your hips; use the shoulder strap as well. Carry snacks and take plenty of bathroom breaks Bring your prenatal records if you are traveling a long distance Pregnant women can be more vulnerable to infections, such as coughs, colds, and flu. Some illnesses will not harm your baby; however, some infections can be serious. You can help protect yourself and your baby by washing your hands and not sharing drinking glasses or utensils. Common Cold A virus is usually the cause of the common cold. You can expect a cold to last about one to two weeks. If your symptoms persist beyond two weeks or you experience shortness of breath or a fever you may have a more serious infection. Please contact your doctor. To relieve cold symptoms you can use Sudafed, Claritin, a neti pot and nasal sprays. Using a humidifier in your bedroom at night may also help. Flu Influenza is a contagious respiratory illness that is also caused by a virus. If you get the flu during pregnancy, you’re more likely than other adults to have serious complications. It is recommended that all pregnant women get the flu vaccination during flu season (October– March). If you think you have the flu even if you’ve been vaccinated, call your doctor right away. He or she may be able to prescribe an antiviral medicine to prevent or treat the flu. Symptoms include high fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose and muscle aches. Fifth Disease Fifth Disease is a common childhood illness that’s usually pretty mild. But if you get infected during pregnancy, it may hurt your baby. Pregnant women with young children and those who work with children, like teachers and child care providers, are at greater risk of exposure and infection. Most unborn babies are not harmed if their mother gets Fifth Disease. But some babies do become infected. The virus can make it hard for babies to make red blood cells causing dangerous anemia, heart failure, miscarriage and stillbirth. Symptoms of Fifth Disease include: a rash on the face that looks like a slapped cheek, fever, headache, sore throat and joint pain. If you think you have been exposed to Fifth Disease, call your doctor right away. 14 Chickenpox Chickenpox is a viral illness that affects children. If you develop chickenpox during pregnancy, you are at risk of complications such as pneumonia. For your baby, the risks depend on the timing and include serious birth defects. The good news is that between 85 to 95 percent of pregnant women are immune to chicken pox. If you’re exposed to chickenpox during pregnancy and you’re not immune, contact your healthcare provider immediately. Miscarriage Zika Complications Pregnancy can be such an exciting time, and you may not want to think about the possibility of miscarrying. However it is beneficial to be informed, in the unfortunate event that you find yourself or someone you know faced with a miscarriage. Symptoms can include: • Bleeding that progresses from light to heavy • Cramps • Abdominal pain • Fever • Weakness • Back pain Until we know more, the Centers for Disease Control and Prevention recommends special precautions for pregnant women. Take steps to prevent mosquito bites by: • Using Environmental Protection Agency (EPA) registered insect repellents with DEET or oil of lemon eucalyptus. When used as directed, EPA-registered repellents are proven safe and effective, even for pregnant and breastfeeding women. • Remove standing water where mosquitoes could lay eggs. • Keeping mosquitoes out by installing screens on all windows or making sure all window screens are in good repair before opening windows. • Find more information about Zika and pregnancy at cdc.org. Some aches, pains and symptoms are normal during pregnancy and some are cause for concern. If you experience the symptoms listed above, contact your doctor right away. 15 If you experience any of the following symptoms, contact your doctor immediately. • Bleeding from the vagina or rectum • Severe and continuous vomiting • Your baby’s activity level declines significantly • Sharp or continuous pain in your abdomen • Your water breaks • Fever greater than 100.4 Preparing for Childbirth We encourage you and your partner to attend our Childbirth Preparation Series. These classes are offered once a week over a 4-week time span in two-hour sessions. This series is perfect for firsttime parents. If you have taken childbirth class and are looking for a refresher course, we encourage you to take our one-day Childbirth Preparation Workshop. These classes provide in-depth, detailed information covering the following areas: • Lamaze childbirth techniques (breathing, relaxation and massage) • The different types of childbirth options available • How to become more confident about labor, childbirth, breastfeeding and newborn care • Making informed decisions about labor, childbirth, breastfeeding and newborn care • • When and how to get support Pain management You can find more information about these and other helpful classes such as Prenatal Nutrition, Prenatal Breastfeeding Class, Newborn Care Class, Newborn Safety Class, Daddy Training Camp and Infant CPR Class at carepointhealth. org./#obg-maternity-events. 16 Labor No two deliveries are alike. There is no way to predict how your specific delivery is going to go. However, you can know the stages of the labor process and what to generally expect. Pre-Labor As your due date approaches you may notice that your abdomen gets hard and then soft again. You may even find that you are having what is referred to as Braxton-Hicks or false labor pains. They can occur more frequently if you are physically active. These false labor or pre-labor pains can last for days or weeks. A warm bath and resting may help relieve some of your discomfort. 17 It is sometimes hard to determine if you are in true labor. Never be embarrassed if you react and think you are in labor. Sometimes the difference between real and pre-labor can only be determined by a vaginal exam. If you feel uncomfortable or concerned about any pre-labor or pregnancy symptoms, it’s always best to call your doctor. Labor At the beginning of labor, contractions are usually mild and somewhat irregular, becoming progressively stronger and more frequent. • You may feel lower back pain, a feeling like menstrual cramps, and/or pressure/tightening in the pelvic area • Once contractions start, keep a record for an hour. During true labor, the contractions last about 50–80 seconds, they occur at regular intervals and they don’t go away when you move around When to call your doctor and go to the hospital: • Your water might break (notice the color of the fluid, the odor and note the time); even if you are not experiencing contractions, it is time to head to the hospital • If you experience any bleeding from the vagina • If you are having constant, severe pain • You don’t feel any movement from your baby or the movements are reduced it ës time to go ! 18 Cesarean Delivery A cesarean birth happens through an incision in the abdominal wall and uterus rather than through the vagina. There are many reasons for a cesarean delivery including the size of the baby, placental location, multiple births, fetal distress, arrest of labor, some maternal medical conditions or a history of previous cesarean birth. • If you have a cesarean delivery you can expect: • You will be given an anesthetic— usually an epidural that will numb the area from the abdomen to below the waist, so that nothing can be felt during the procedure • 19 • • The doctor will make an incision in your abdomen and uterus to deliver your baby This incision will usually be made horizontally (often called a bikini cut), just above the pubic bone Your uterus will be closed with stitches that later dissolve on their own; stitches or staples will be used to close your abdomen After the delivery, you and your baby will be monitored carefully in the hospital; recovery time may be a day or two longer than a vaginal delivery The birth of your child is one of the most important moments in your life. You and your baby are very important to us, and our Pampered Pregnancy program is proud to be an integral part of more than 3,000 births annually. We provide a birth experience that is compassionate, family-centered, and as unique as each of our patients. The Pampered Pregnancy program is designed to assist you in making informed decisions regarding your birth experience and offer you a wide variety of services and amenities that are not seen in a traditional hospital setting, such as: • The opportunity for private consultations with our Pampered Pregnancy Coach to help you navigate and coordinate all aspects of your pregnancy and childbirth experience • A wide-variety of prenatal, childbirth and postpartum classes • Informative newsletter providing tips on pregnancy, preparing for a new baby, and labor/delivery • Fully equipped labor, delivery and recovery suites • A family-centered maternity care nursing model, with the same nurse caring for you and your baby • A special care nursery with • • experienced staff and physicians to take care of your baby’s special needs Encouragement and support for each family member to be actively involved during labor, birth, postpartum, and newborn care Newborn lullaby announcing each new birth throughout the hospital For more information or to register for CarePoint’s Pampered Pregnancy program, call us at 201-821-8819 or contact us online at carepointhealth. org. One of our Pampered Pregnancy Coaches will contact you. 20 Quick Guide to Medications Some medications are generally considered safe to take during pregnancy. But others are not, or their effects on your baby may not be known. When you meet with your doctor to confirm you’re pregnant, ask what meds are okay to take. Also, tell your doctor about any alternative medicines or supplements you take, even if the label says “natural.” 21 No drug is considered 100% safe to use during pregnancy. Check with your doctor before taking any medication, especially during the first trimester. Allergy • Benadryl (diphenhydramine) • Claritin (loratadine) Cough/Congestion (temp less than 100° F) • Sudafed (pseudoephedrine) after the first trimester • Mucinex/Robitussin (guaifenesin) • Claritin (loratadine) • Afrin nasal spray (3 day limit) • Saline nasal spray Minor Aches and Headache • Tylenol (acetaminophen) Sore Throat • Tylenol (acetaminophen) • Throat lozenges/spray Constipation • Docusate (Colace) • Metamucil • Senokot • Miralax • Konsyl Diarrhea • Kaopectate • Imodium • Clear liquids for 24 hours Nausea • Vitamin B6 • Unisom, ½ tablet • Ginger capsules Hemorrhoids • Preparation H • Anusol suppositories or cream • Tucks pads Gas/Bloating • Gas-X (simethicone) • Maalox/Mylanta Heartburn • Maalox/Mylanta • Pepcid (famotidine) • Zantac (ranitidine) • Tums Rashes • Benadryl (diphenhydramine) • Calamine lotion • Hydrocortisone ointment • Aveeno oatmeal bath/lotion 22 Go the Full 40 According to AWHONN (the Association of Women’s Health, Obstetrical and Neonatal Nurses), your baby needs at least a full 40 weeks of pregnancy to grow and develop. Inducing labor or scheduling a c-section even a week or two early is associated with a host of risks. While it may seem convenient, labor should only be induced when it is medically indicated. Your baby will let you know when it is time for him or her to arrive, so whenever it is possible, let it naturally occur! For more information about this initiative, go to: www.gothefull40.com. 23 Obstetrical Emergency Department CarePoint Health offers an Emergency Department (OBED) just for pregnant patients. In order to meet the special needs and health concerns of our expectant mothers, we have created emergency rooms that specialize specifically in obstetrical care. Our OBEDs are the first of their kind in New Jersey! The OBEDs offer our patients greater ease of access, less exposure to airborne illnesses, more privacy, and better and faster targeted care performed by a board certified OBGYN physician. If you think you may be in labor, or if you are experiencing any complications or problems, you should contact your doctor immediately. You may also go to the hospital for evaluation and, upon evaluation, you may be admitted for delivery. 24 Know your rights New Jersey law and regulation states that when a patient is seen for emergency services, New Jersey insurance companies are required to hold the patient harmless. That means your insurance company is legally obligated to only hold you responsible for your in-network amount, regardless of the participating status of the hospital. CarePoint Health will bill accordingly to hold your insurance company to this NJ State regulation. For more information about this state mandate, visit: http://www.state. nj.us/dobi/division_insurance/ managedcare/mcconsrights.htm 25 If for some reason you receive any statements that reflect an amount other than this in-network amount, please contact your Pampered Pregnancy Coach or the Insurance Help Desk at 866-600-3100 and we will find out if your insurance company has not held you harmless or if a billing error has occurred and if so, help resolve it for you. You may also contact your Coach or the Insurance Help Desk at any time with questions about EOBs or statements you have received or for any additional questions or concerns you may have. 26 Christ Hospital 176 Palisade Avenue Jersey City, NJ 07306 (201) 795-8200 Parking Located on: 142 Palisade Avenue Hoboken University Medical Center 308 Willow Avenue Hoboken, NJ 07030 (201) 418-1000 Parking Located on: 371- 4th Street & Clinton St.