Download Guide to Your Pregnancy - Paragon Health Associates Provide

a
g u i d
e
t
o
y
o u r
p r e g n a n
c
y
Welcome to Paragon Health Associates.
Thank you for choosing Paragon for
your obstetrical care. Paragon is
a family of doctors, NURSE-midwives, and
nurse practitioners who PROVIDE serviceS
AT sIX offices in the greater Akron area.
We hope this packet helps you understand
how services are offered and
guides you through your pregnancy.
Paragon’s Mission
Paragon Health Associates is an organization dedicated to impr oving the quality of women’s lives in this community
by expanding the range of health car e options beyond the boundaries of conventional obstetrics and gynecology .
The Paragon Health team models excellence, innovation, and ef fectiveness in the comprehensive and holistic
delivery of women’s health services. Conventional medical and/or complementary options ar e chosen, in partnership
with our patients, in a continuum fr om illness to wellness through a lifetime of change.
Each Paragon member commits to working as a team while using his or her unique gifts, skills, wisdom, and
energy for the compassionate care of our patients.
Our caring relationship with those we serve and with each other is our most powerful tool for healing.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Your Obstetrical Care
"Making the decision
to have a child - it's
momentous. It is to decide
forever to have your heart
go walking around on the
outside of your body."
- Elizabeth Stone
Pregnancy is one of the most meaningful events in a woman’ s
with physicians to provide routine preventative care and
life, and we appreciate the opportunity to share in this
education to our patients.
experience. Paragon Health Associates offers the widest range
We are proud to also offer the largest certified nurse-
of obstetrical care options in the region. The choice of
midwifery program in the area. Our certified nurse-midwives
obstetrician, midwife, and hospital is a very personal decision.
are credentialed by the American College of Nurse-Midwives
Our providers deliver at Akron City Hospital and Akron General
and are all licensed in the State of Ohio. Nurse-midwives
Medical Center. Each hospital has a dedicated gr oup of
provide all aspects of a woman’s health care with an emphasis
physicians who deliver only at that hospital. This commitment is
on preventative health and education. The option of r eceiving
unique to Paragon Health Associates and was cr eated to
midwifery services is available at both ar ea hospitals. Working
achieve an even higher quality of car e.
with our physicians, they provide a comprehensive team
Our small group size enables a patient to become better
approach. The physicians and certified nurse-midwives
acquainted with the physicians who will deliver her baby , and
are available 24 hours a day to attend to patients in labor and
allows them to get to know her. Nurse practitioners will work
for any and all emergencies.
D
Paragon Health Associates provides the highest quality
Active participation of patients and their families is
care and the greatest variety of options to women in
encouraged throughout the pregnancy. Open houses
the Greater Akron area. All low risk patients have the
are held to achieve this goal. W e are looking forward
opportunity to choose either a physician or certified
to working with you to create the best possible birth
nurse-midwife for their prenatal care and delivery.
experience in each and every situation.
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Hospitals and Offices
hospitals
Akron City Hospital
330-375-3000
Akron General Medical Center
330-344-6000
Summa Barberton Hospital
330-615-3000
Each hospital provides a variety
of childbirth classes.
Arrangements can be made
with the appropriate hospital.
At Paragon, we are pleased to be able to of fer you a
o u r l o c at io n s
wide range of office locations at which you can
receive your care. Although you can be seen at any
office if needed, we would pr efer that you choose
one office as your “home base.” It is her e that your
chart will be found and the vast majority of your
Akron-East
330-869-9777 • 468 East Market Street
Akron, Ohio 44304
Akron-West
330-869-9777 • 1 Park West Blvd., Suite 200
Akron, Ohio 44320
Barberton
330-475-0266 • 28 Conservatory Drive, Suite C
Barberton, Ohio 44203
Cuyahoga Falls
330-923-3138 • 1860 State Rd., Suite D
Cuyahoga Falls, Ohio 44223
Ellet
330-784-5406 • 493 Canton Road
Akron, Ohio 44312
Green
330-899-9696 • 1700 Boettler Road, Suite 225
Uniontown, Ohio 44685
Stow/Hudson
330-650-4241 • 1305 Corporate Drive, Suite A
Hudson, Ohio 44236
Kent
330-677-3638 • 1951 State Route 59, Suite C
Kent, Ohio 44240
visits should take place. Keep in mind that not all of
our providers see patients at every of fice. This may be
important to you when selecting your home base.
We are equally pleased to be one of the only
groups in town to give you the option of delivering
at Akron City Hospital, Akron General Medical
Center, or Summa Barberton Hospital. Many
insurance plans will dictate your hospital of delivery .
If you have an option, talk to your pr ovider about the
best choice for you.
Nurse-Midwifery and Nurse Practitioners
"Motherhood:
All love begins
and ends there."
-Robert Browning
nurse-Midwifery C are
Nurse Practitioners
Paragon Health Associates offers the option of nurse-midwifery
Our nurse practitioners in women’s health are registered nurses
care for our patients. Certified nurse-midwives ar e advanced
who have advanced education, clinical training, a nd certification
practice nurses educated in the two disciplines of nursing and
in women’s health care. Nurse practitioners work with women of
midwifery. They are particularly suited to caring for healthy,
all ages and their families, pr oviding information people need
low risk women across their lifespan. Nurse-midwives offer a
to make informed decisions about their health car e and lifestyle
full range of health care services from annual exams, to birth
choices. Nurse practitioners at Paragon collaborate with the
control methods, prenatal care, and labor and delivery.
physicians to provide obstetrical care. The nurse practitioners
Paragon nurse-midwives have privileges at Akr on City
will meet you at your first obstetrical visit, to conduct a detailed
Hospital and Akron General Medical Center. They work in close
medical history and exam, order necessary lab work and begin
collaboration with your physicians who are readily available
the educational process for your pregnancy. The nurses may see
should the need arise for physician services. Nurse-midwifery
you during the pregnancy for acute care and routine visits. They
care is both a safe and satisfying option for women. Nurse-
also will see you at your postpartum visit and provide family
midwifery care is available at many of our locations.
planning services. Nurse practitioners work with the physician
groups at many of our of fices.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Testing During Pregnancy
TEST
WHEN
PURPOSE
• Routine physical exam
• Prenatal blood work
• Pap test
First prenatal
visit
Screening tests determine the status of pr egnancy, any
risk factors, and help make plans for pr enatal care.
Blood tests done are blood type, blood count and
state required tests to screen for infection: hepatitis,
rubella, syphilis, chlamydia, and gonorrhea. Optional
tests - HIV and cystic fibr osis screening.
• Quad Screen
15-20 weeks
Optional screening test that may detect incr eased
risk for open neural tube defects and T risomy 18, 21.
• Gestational Diabetes Screen
• Screening for Anemia
24-28 weeks
Screening test for asymptomatic diabetes and
anemia in pregnancy.
• Antibody screen & Rhogam injection
28 weeks
To screen and prevent RH sensitization.
35-37 weeks
To screen for carriers of vaginal/rectal Group B strep,
so that preventative antibiotic therapy can be
administered in labor.
RH negative patients only
• Group B Strep Culture
ultrasound testin g
Routine screening ultrasounds will be performed at 19-21 weeks. This allows us to confirm your due date, look
at the baby’s major organs, and also determine the sex of the baby if d esired. Additional ultrasounds and other
testing may be recommended as individually indicated.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
For Your Information
Sleeping positions
in pregnancy
Finding a comfortable sleeping position can become a challenge
after the first half of pr egnancy. Some women with special health
considerations, such as hypertension or diabetes, will be asked to
sleep primarily on their left sides, as the left-side-lying position
provides for maximum blood flow to the placenta, and thus to the
baby. If you do not have any special health considerations, almost
any sleeping position, other than flat on your back, is fine. If you
are a “tummy-sleeper,” try this position: Lie down first on your
back. Place a large body pillow next to you, along the length of
dental pr ocedures
Essential dental procedures may be performed during pr egnancy.
Elective procedures of any type are best performed upon
completion of your pregnancy. If it becomes necessary to have
some dental work during your pr egnancy, this can be done safely
with minimal risk. The following points addr ess commonly asked
questions about dental procedures:
• X-rays, with abdominal shielding, can be done. Limit
your body. Bend your knee and bring the leg farthest away fr om
the body pillow up and over, rolling into the body pillow. This will
give you the feeling of lying on your tummy . If you are a back
sleeper, you may continue to lie on your back, but place a pillow
under one hip or under your shoulders so you ar e not lying
completely flat. Lying completely flat on your back after the first
half of your pregnancy can result in decreased blood flow to both
you and the baby as the weight of the uterus compr esses the
large blood vessel that lies against your spine. If you find yourself
x-rays to the minimum number needed to complete the
waking up on your back in the middle of the night, that is fine,
procedure safely.
simply readjust your position so you ar e not lying flat. If you ar e
• Local anesthetics can be used.
using the side-lying position to sleep, your hips may start to ache
• Penicillin or erythromycin antibiotics can be used if you ar e not allergic.
from lying on one side. You may need to change your position
frequently during the night to be comfortable. Large body pillows
sexual intercourse
and the use of extra small pillows will help with comfortable
Sexual intercourse can be continued as long as it is not causing
positioning. You may find that a pillow placed between your legs
you to have pain or bleeding. For certain pr oblems, you may
(if on your side) or under your knees or ankles (if on your back)
be told to avoid sex. Some women find that sex is mor e
increases your comfort.
comfortable during pregnancy if they are on top or lying side to
side. Feel free to ask questions about sexual r elations during any
of your visits.
c ho o s i ng a p e d i at r ic i a n
or family doctor
During the course of your pr egnancy, you will need to choose a
working during pregnancy
pediatrician or a family doctor to take car e of the baby at the
Generally, you can work right up to the end of your pr egnancy.
hospital. Many physicians request that you contact their of fice
The only types of jobs that might be a pr oblem are those where
before the birth of the baby. Check your insurance and make sur e
you work around certain chemicals or x-rays. Also, we r ecommend
the pediatrician you choose is on their list. Some expectant
that you don’t lift more than 20-25 lbs. during your pregnancy.
parents find it useful to have a meeting with the baby’ s doctor
Please ask any questions you may have about work.
during the course of the pr egnancy. Please ask if you need any
assistance in choosing the baby’s doctor.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
When You Should Call Paragon
Please refer to this document if you experience any of the
nausea and vomiting
following symptoms. If you are having a problem with any of
Throughout pregnancy, nausea and vomiting may be a ssociated
the following symptoms or anything you cannot explain, do
with being pregnant. It could also be associated with problems
not hesitate to call the of fice or the answering service after
arising in pregnancy that require medical attention. If you ar e
hours. We need to know what is going on to be able to
unable to keep any liquids down, have a dry mouth, or note a
participate in your care.
decrease in urinary frequency and/or volume, call us immediately.
abdominal pain and
cramping
Abdominal pain and cramping could possibly be a sign of labor .
Ginger ale, ginger tea, ginger root tablets (250mg four times a
day), Sominex and Vitamin B6 (25mg), or small fr equent meals
may offer some relief from problematic nausea and vomiting.
than five times in an hour prior to your 36th week. Report
persistent headache/visual
changes
contractions that occur five minutes apart for an hour if this is
If you experience any unusual form of headache or visual
your first pregnancy or ten minutes apart if you have deliver ed
changes, especially if you are more than 24 weeks, call the
a baby before and you are more than 36 weeks. If you
office immediately.
Report any rhythmic contractions or pains that occur mor e
experience persistent abdominal pain, call to discuss this with
your health care provider.
bleeding
In early pregnancy, any bleeding should be reported to us .
decreased fetal movements
If you note light bleeding or spotting after physical activity or
Once you have felt your baby moving (this usually occurs at
sexual intercourse, lie down and observe for 15-20 minutes.
about 18 weeks), you should continue to feel movements on a
If the bleeding/spotting stops and the baby’s movements are
daily basis. Most babies develop a schedule of pr edictable
normal, take it easy for the next 24 hours. Any further bleeding
movement. If you notice a decr ease or lack of movement, get
or cramping should be reported to us. If you ar e near your due
something to eat and then lie down on your left side. Y ou may
date, light bleeding/spotting may follow an exam in the of fice
also push on your belly to get the baby to move. Pay close
or sexual activity. This bleeding should never be as heavy as a
attention to your body and make note of any fetal movement,
menstrual period. If you experience any heavy bleeding at any
a kick, a swish, or r oll. Do not count hiccups or small flutters.
time, call immediately.
Record the time you feel the baby move for the first time.
Record the time you feel the 10th movement. Y ou should feel
at least 10 fetal movements within 2 hours. Call immediately if:
(1) you do not feel 10 movements within 2 hours, (2) it takes
longer and longer for your baby to move 10 times, or (3) you
have not felt the baby move all day .
fever
A temperature over 100.5°F that cannot be easily explained by
cold or flu symptoms needs to be reported to us. Make note of
any associated symptoms. Drink plenty of liquids to avoid
dehydration. You may take Tylenol to bring down your fever
once you have spoken to your health car e provider.
Medications in Pregnancy
"Mother love is the fuel
that enables a normal
human being to do the
impossible."
- Marion C. Garretty
It is best to expose your baby to as few medications as possible
TAKE THE L OWEST DOSE
during your pregnancy. Some medications, such as those for
Use any medication in the lowest dose possible, which gives
seizures, thyroid disease, diabetes, asthma, and high blood
the desired effect. Do not continue to use an over -the-counter
pressure are necessary and must be taken to ensur e your health.
medicine if you see no benefit.
KEEP US INFORMED
Be sure to report any medications you take on a r egular basis
to us so that their safety and need may be evaluated and
discussed with you. Do not stop any pr escription medicines
without talking to us first.
OVER-THE-COUNTER
M E DIC AT ION S
Medications and herbal medications sold over-the-counter are
not always safe to take during pr egnancy. If you find it
necessary to take a medication during pr egnancy, use the
Low Risk Medications list on the following page as a guide.
The following medications are only a sample of the available
over-the-counter medications. If you have questions about any
medication, please ask before using the medication.
Low Risk Medications
Here are some low risk over-the-counter medications that you may take for the following symptoms:
Coughs, Colds, Congestion
• Contact 12 Hour Cold, 12 Hour Cold Maximum Str ength, Severe Cold and Flu, Severe Cold and Flu Non-drowsy,
Continuous Action, Cough Formula, Cough & Sor e Throat
• Benadryl Allergy/Cold, Allergy Congestion
• Robitussin DM, Night Relief
• Tylenol Cold Non-drowsy, Multi Symptom Cold Complete, Cold Sever e Congestion Non-drowsy, Sinus Non-drowsy,
Flu Non-drowsy
• Sudafed Cold and Sinus, Cold and Cough, Non-drying Sinus, Sever e Cold Formula, Sinus Headache
• Sominex
• Any throat or cough drops, or sprays
• Actifed, Chlor-Trimeton, Vicks
Pain Relievers
Tylenol, Extra Strength Tylenol, Acetaminophen, Panadol, Tempra, Anacin Aspirin Free
Antacids
Maalox, Maalox Plus, Mylanta, Mylanta II, Riopan, Riopan Plus, T ums, Rolaids
Stool Softeners
Colace, Surfak, Metamucil, Citrucel, Fibercon, Dialose, Milk of Magnesia
Nasal Sprays
Afrin, Dristan, Neosynephrine, Ocean Nasal Spray
Diarrhea
Kaopectate or Imodium A/D, Pedialyte, Ricelyte, Rehydrate, Gatorade
Note: If diarrhea persists more than two days, or if bloody , call the office.
A recommended diet for diarrhea includes unsweetened cer eal, rice, potatoes, noodles, crackers, bananas,
applesauce, toast, soup, yogurt, vegetables, fruits. A void sweets, soft drinks, apple juice, Jell-O, or fats.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Travel in Pregnancy
travel is generall y safe
during pregnan c y.
i n t e r n at io n a l t r av e l
Here are some tips to make your trip safe and pleasant.
a trip outside the country. Please ask for the American College
car/train/bus trips
Speak with your health care professional if you are planning
of Obstetricians and Gynecologists pamphlet titled “Travel
During Pregnancy.”
Land travel of any distance is generally safe. T o have the safest
trip possible it is best to follow a couple of guidelines. Drink
and remember…
lots of fluids. Get out and str etch your legs and empty your
Take a copy of your pr enatal records on significant trips near
bladder frequently. Always use seat belts in the car . Riding in
the end of your pregnancy, or earlier if you have a risk of
the car may increase the number of Braxton-Hicks contractions.
preterm labor.
plane travel
According to an American College of Obstetricians and
Keep your travel plans flexible and easy to change. T ravel
insurance is highly recommended.
Gynecologists opinion dated 12/12/01, air travel is usually safe
As a general rule when you ar e traveling, eat well, drink plenty
in pregnancy until the last month. Airlines usually set a limit of
of fluids, rest, and walk around every hour. Take the Paragon
36 weeks for flights within the U.S. and 35 weeks for
emergency phone number with you.
international flights. Short flights are usually easier than long
flights. Women with the following conditions should consult
with their health care professional and obtain medical
clearance before flying: hypertension, diabetes that is not well
controlled, sickle cell disease, placental abnormalities, or
significant risks for preterm labor. Low cabin humidity and
changes in cabin pressure may result in an increased heart rate,
increased blood pressure, and decrease in breathing capacity
for those with heart or lung conditions. On long flights, it is
important to get up and walk and empty your bladder every 12 hours. Having an aisle seat may make this easier . It is
recommended to be well hydrated when traveling by air . Drink
plenty of water the day befor e traveling, as well as the day of
travel and the next day. Carry a water bottle with you on the
plane. For safety, it is recommended to wear your seat belt
whenever seated in the plane.
cruises
There is usually no restriction on taking a cruise until the end of
pregnancy. See the above section on plane travel. Motion
sickness may be a concer n, particularly in the first trimester. Do
not take any medicine for motion sickness unless you first
check with your health care professional. Acupressure wrist
bands (Biobands or Seabands) are safe.
ACOG December 2001 Committee Opinion: Air Travel During Pregnancy.
ACOG Pamphlet 2004: Travel During Pregnancy.
Smoking and Pregnancy
“The moment a child is
born a woman's life is
forever changed, taking
on new meaning.
Motherhood can be an
empowering, and
exhausting, experience unveiling knowledge and
insights and previously
untested strength
and stamina.”
- Joyce A. Hughes
q u i t. a n d w i n .
syndrome, or crib death) as babies of non-smokers. In general,
babies of smokers are not as healthy at birth as babies of
Smoking during pregnancy can increase the chances of a wide
non-smokers.
variety of pregnancy complications.
For some women, quitting is easier in early pr egnancy
Cigarette smoke contains not only the addictive drug
due to a sudden distaste for cigar ettes. Some studies show
nicotine, but also over 580 other compounds known to be
that women who quit smoking early in pr egnancy can reduce
cancer-causing or poisonous to the nervous system.
the risk of damage to the fetus to the level of a non-smoker .
Smoking is blamed for as many as a thir d of all babies
who are born too small in the United States. Being born
If you’re not lucky enough to develop this natural aversion,
we can offer suggestions to help you stop smoking.
too small is the major cause of infant illness and pr enatal death
How to overcome withdrawal pangs. Most people
(those that occur just before, during, or after birth). This seems
experience some withdrawal symptoms when they quit
to be the result of carbon monoxide poisoning and a r eduction
smoking. The most common symptoms include irritability,
of oxygen to the fetus thr ough the placenta. Babies of smoking
anxiety, restlessness, lightheadedness, fatigue, and
mothers are more likely to suffer from apnea (breathing lapses)
gastrointestinal upset. These symptoms will last fr om
and are twice as likely to die of SIDS (sudden infant death
a few days to a few weeks. To try to slow the r elease of
nicotine and nervousness that may r esult, increase your intake
• If you smoke for oral gratification ,
of fruit, fruit juice, milk, and mixed gr eens. Temporarily cut
try a substitute: gum, raw vegetables, popcor n, breadsticks,
back on meat, poultry, fish and cheese. Avoid caffeine, which
lemon drops or mints.
can add to the jitters. Get plenty of r est and exercise. Doing
mindless tasks or going to the movies or other places wher e
smoking is prohibited can also be helpful.
• If you smoke for stimulation ,
try to get your lift fr om a brisk walk, an inter esting book, or
good conversation.
tips to stop smoking
• Identify Your Reasons for Smoking
• If you smoke to reduce tension,
try exercise instead. Relaxation techniques or listening to
For example, do you smoke for pleasur e, stimulation, or
soothing music may also be helpful. Treat yourself to a
relaxation? Do you smoke to r educe tension or stress, to
massage or take a long walk.
have something in your hand or mouth, or to satisfy a
craving? Maybe you smoke out of habit, lighting up without
• If you smoke for pleasure,
thinking about it. Once you understand your motivations for
seek pleasure in no-smoking situations. Go to a movie, visit
smoking, it will be easier for you to find substitutes.
baby boutiques, tour a museum, or have dinner with a friend
who doesn’t smoke.
• Focus on Reasons for Quitting
When you’re pregnant, that’s easy. In addition to improving
• If you smoke out of habit,
the health of your baby, quitting smoking improves your
avoid the settings in which you habitually smoke. Y ou may
health and protects your family from harmful second-hand
have to temporarily avoid friends who smoke. Fr equent
smoke. You also save money!
places with no smoking rules instead. When you feel the
urge to smoke, take several deep br eaths with a pause
• Choose Your Method of Withdrawal
between each. Hold the last br eath while you strike a match.
Do you want to go cold turkey or to taper of f? Either way,
Exhale slowly, blowing out the match. Pr etend it was a
set a target date that isn’ t far off. Plan a full day of activities
cigarette and crush it out.
for that date. Go to the movies, exer cise, or take a long
walk. It helps to spend most of your time in places wher e
• If You Slip
smoking is not allowed. Remind your family and friends that
If you slip up and have a cigar ette, don’t despair. Just get
this is your quit day. Ask them to help you thr ough the first
right back on your program. Remember every cigarette you
few difficult days.
don’t smoke is going to help your baby . Look at smoking
as a non-negotiable issue. Tell yourself that you can’t
• Cigarette Substitutes
smoke, period.
If you smoke mainly to keep your hands busy , try playing
with a pencil, beads, a straw, or a smooth stone. You can
• Celebrate By Counting Your Days
knit, write a letter, learn to paint, do a jigsaw or cr ossword
Keep track of your smoke-free days by crossing off each day
puzzle, play cards or board games – anything that might
on a calendar. Reward yourself and plan a special celebration
make you forget to reach for a cigarette.
each month on the anniversary of your quit date.
ACOG Oct. 2005 Committee Opinion: Smoking Cessation During Pr egnancy
Pregnancy and Exercise
Paragon endorses the following ACOG guidelines as a
• Drink water liberally before and after exercise.
basis for your own exercise plan during pregnancy.
• Women who have not been physically active should
start slowly with low-intensity physical activity and
ADVICE FOR EXERCISE
DURING PREGNANCY
increase activity levels gradually. Check with your
Paragon Health Care Provider before beginning a new
exercise program in pregnancy.
• Most women can safely continue a curr ent exercise
regimen or begin mild to moderate exer cise during
• Do not exercise to the point of pain or exhaustion.
pregnancy. Swimming, stationary cycling, walking,
running, hiking, low-impact aerobics, yoga, and pilates
can all be enjoyed during pr egnancy.
• Stop exercising and consult your Paragon pr ovider if
you experience any of the following during exer cise:
Vaginal bleeding
• Regular exercise at least three times a week is
preferable to intermittent activity.
Shortness of breath
Dizziness
• The activities that are not recommended during
pregnancy include: scuba diving, contact sports, or
activities with a potential for falling such as horseback
riding or downhill skiing.
Headache
Chest pain
Muscle weakness
Calf pain or swelling
• Vigorous exercise should not be performed in hot,
humid weather.
Signs of preterm labor
Decreased fetal movement
• Jerky, bouncy motions and over-stretching should be
avoided. Exercise should be done on a firm surface to
reduce shock and provide sure footing.
• Vigorous exercise should be preceded by five minutes of
muscle warm-up and followed by five minutes of
muscle cool-down/stretching. Walking and low
resistance stationary cycling are good methods to warm
up and cool down.
Leaking of amniotic fluid
• Do not lie flat on your back to exer cise after
the first trimester.
• Eating a healthy diet will ensur e that you are taking in
enough calories to support the demands on your body
for both pregnancy and exercise. If exercise is
interfering with a healthy weight gain during your
pregnancy, you may need to eat mor e calories or cut
back on the intensity of your exer cise.
The ACOG Exercise During Pregnancy and the Postpartum period. 2002:99:171-173.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
What to Expect Now That
You’re Pregnant
Pregnancy should be a pleasant time for you, but some body changes may appear . If you know about them,
they are less likely to worry you.
norm al bo dy chan ges that occur durin g pregnan c y
Your breasts will get larger and firmer. The areola, or dark areas around your nipples, will get darker and
may develop bumps. Veins in the breast may become more noticeable. At the 4th or 5th month, your nipples
may start giving off a clear or cloudy liquid.
You may have to urinate (empty your bladder) mor e often. However, this may lessen during t he middle
months of pregnancy and then become more frequent toward the end of your pr egnancy.
You may feel sick to your stomach during the first half of your pr egnancy. Sometimes this is worse in
the morning. Also, you may feel heartbur n (a burning sensation in your chest). These discomforts can be
helped by eating smaller meals and eating mor e often. For example, rather than eating thr ee regular meals a
day, try six small meals each day. Also, try to snack on plain crackers (without butter) especially early in the
morning before getting out of bed. Try getting more rest and drinking very hot or very cold liquids. For
heartburn, try not to lie down for at least one hour after eating.
Your moods may change. It is not unusual for a pr egnant woman to feel happy one minute, then sad soon
after without an apparent reason.
You may get tired more easily.
You may notice pulling pains in your lower belly and hip ar eas. These are usually caused by the gr owth
of your uterus.
You may notice skin changes such as stretch marks or striae (pinkish lines on your br easts or belly) later in
the pregnancy and some brown blotches on your face. Cr eams, lotions or oils do not pr event these changes.
However, after pregnancy, the marks tend to fade and ar e less noticeable.
You may get constipated and have to strain to have a bowel movement. Hemorrhoids (large blood vessels
near the opening in your r ectum) may develop. Constipation is best pr evented or relieved by including more
fiber in your diet. Foods such as fr esh fruits, fresh vegetables and bran cereal are often helpful. Do not take
laxatives unless this is first discussed with your health car e provider.
You may experience changes in your legs such as cramps and possibly develop enlarged blood vessels
(varicose veins).
You may get acne and body hair may incr ease. These are usually normal results of changes in the body’s
hormones during pregnancy.
w h at t o d o i f a n y o f t h e s e c h a n g e s h a p p e n
If they are bothering or worrying you, don’ t hesitate to let us know at your next visit. If you need help sooner ,
call the office.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
The Do’s and Don’ts of Morning Sickness
“When you are a mother,
you are never really
alone in your thoughts. A
mother always has
to think twice, once for
herself and once for
her child.”
- Sophia Loren
do…
don’t…
…Eat six small meals a day - dry crackers or cer eal before you
get out of bed
…Worry about taking your vitamins or eating right now
…Eat high protein snacks
…Be near odor sources such as food, pet pr oducts, gas
stations, coffee pots and diapers
…Use Seabands and acupressure
…Try hypnosis for relaxation
…Try chewable vitamins
…Use ginger products (ginger ale, ginger preserves)
Avoid concentrated ginger capsules
…Search the internet for support
…Eat sour foods - try lemons
…Eat salty foods - try pr etzels
…Tart foods - try cranberries or Granny Smith apples
…Look at sources of visual stimulation - computer scr eens
or videos
…Be near sounds that trigger nausea
…Read magazines with perfume samples
…Travel by airplane due to turbulence, perfume/cologne odors,
and food smells. If unavoidable, a lemon carried in a baggie
may be helpful when trigger smells ar e encountered.
…Dill pickles
…Eat whatever appeals to you and eat it immediately
…Avoid heat and humidity
If these ideas don’t work, call our office. There are medications
that you may safely take during pr egnancy that may help.
…Drink fresh lemon juice and water
…Suck on atomic fireballs (candy)
From – ACOG Practice Bulletin, No. 52, April 2004
…Lie down in a darkened r oom
Suggested reading: No More Morning Sickness by Miriam Erick R.D., M.S.
Eating Right During Pregnancy
During pregnancy, it is important to eat healthy food, and enough of it, for your baby to gr ow and develop. You will
need to eat about 300 mor e calories each day than you did prior to becoming pr egnant. Despite the nausea and
occasional vomiting during early pregnancy, you should try to take your pr enatal vitamin and eat a well-balanced and
healthy diet. The following are recommendations that can be helpful:
• Vary your diet to get all the nutrients you need. Refer
• Three to four servings of dairy pr oducts and calcium-
to the chart at the bottom for r ecommended servings.
rich foods a day will help ensur e that you are getting
1000 - 1300 mg of calcium in your daily diet every day .
• Prenatal Vitamins ensure you are consistently getting
enough vitamins and minerals every day. Your Paragon
• Iron-rich foods will help you get enough of this
Health Care Provider can prescribe a prenatal vitamin
important element each day. You need three servings.
for you or recommend an over-the-counter alternative.
Refer to Sources of Iron for iron-rich foods.
• Every day you should try to eat a good sour ce of
• Folic acid helps prevent neutral tube defects such as
vitamin C and vitamin A. Good sour ces for vitamin C
spina bifida. You need at least one good sour ce of folic
are oranges, strawberries, grapefruits, papaya,
acid every day. Folic acid can be found in high levels in
honeydew, cauliflower, broccoli, brussels sprouts, green
dark green leafy vegetables, veal and legumes (lima
peppers, tomatoes and mustard greens. Good sources
beans, black beans, black-eyed peas and chickpeas).
of vitamin A are carrots, sweet potatoes, apricots,
Most prenatal vitamins supply an adequate supply of
cantaloupe, spinach, water squash, tur nip greens, beet
folic acid.
greens, and pumpkins. Do not consume excess vitamin
A as it has been associated with fetal malformations
• A healthy diet should include high fiber foods that ar e
enriched. Examples include cereals, pasta, rice, whole-
when intake is greater than 10,000 IU/day.
grain breads, fruits and vegetables.
WEIGHT GAIN IN PREGNANCY
Weight gain can be concer ning for most pregnant patients. It is important to r ealize that your baby relies on your diet
for energy and therefore you will need to eat mor e during pregnancy. ACOG recommends you add an additional 300
calories a day to your r egular diet.
See table below for recommended weight gain during pregnancy .
D
E
L
Weight Status
Weight Gain (in pounds)
Underweight
28-40
Normal Weight
25-35
Overweight
15-25
Obese
15
Carrying Twins
35-45
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Daily Food Choices
Your baby relies on your
diet for energy, so you’ll
need to eat healthy foods
during pregnancy. Vary
your diet to get all the
nutrients you and your
baby need, and be sure to
include high fiber foods
that are enriched.
The American College of Obstetricians and Gynecologists (ACOG) recommends
the following daily food choices in pregnancy:
Food Group
No. of Servings
Example of single servings
Bread, Cereal, Rice, Pasta
9
1 slice of bread; 1 ounce of cold cer eal; or 1⁄2 cup of cer eal, rice or pasta
Vegetables
4
1 cup of salad greens; 1⁄2 cup of other cooked vegetables; 1 cup raw vegetables; or 3⁄4
cup of vegetable juice
Fruit
3
1 medium apple, banana, or orange; 1/4 cup of raisins; or 4-ounce glass of orange juice
Poultry, Fish, Dry Beans,
Meat, Eggs, & Nuts
3
2-3 ounces of cooked lean poultry, fish, or meat; 1 ounce of meat = 1/2 cup
dry beans, 1 egg, 1 ounce low-fat cheese, or 2 tablespoons of peanut butter
Milk, Yogurt, & Cheese
3
1 cup of milk or yogurt; or 1 1/2 ounce low-fat cheese
Fats, Oils, & Sweets
Consume in moderation
Pregnancy Nutritional Information
SPECIAL FOOD CONSIDERATIONS
ALCOHOL
Unpasteurized milk may also contain Listeria. Listeria is a
Avoid alcohol during pregnancy. Alcohol has been linked to
bacteria that can cause infection in women and in the fetus
several problems in pregnancy including fetal alcohol
causing miscarriage or stillbirth. Any pasteurized cheese
syndrome, premature delivery, mental retardation, and low
including most hard cheese, processed cheese, cream cheese
birth weight babies.
and cottage cheese, along with yogurt, can be consumed
CAFFEINE
and need not be avoided.
Caffeine should be limited to 300 mg per day . Caffeine found
MEATS
in various coffees and teas and other drinks and foods
Listeria may also be found in raw , undercooked, or prepared
depends upon the beans, leaves, and ingr edients used and
meats, including poultry. Deli meats and hot dogs ar e
how the drink or food was pr epared. The average cup of
examples of foods that should be avoided unless they ar e
coffee (8 oz.) has about 150 mg of caf feine. Tea (black leaf)
reheated until steaming hot. Always be sur e to wash your
has about half the caffeine (75-80 mg). Most caffeinated soda
hands, and any utensils, countertops, or cutting boar ds that
(12 oz.) contains 30-60 mg of caf feine. Chocolate has caffeine
have been in contact with uncooked meats.
also. A typical chocolate bar has about 35-40 mg of caf feine.
ARTIFICIAL SWEETENERS
PREGNANCY PROTEIN REQUIREMENTS
Currently data suggests that Saccharin (Sweet-N-Low) should
It is recommended that pregnant patients consume 60-100
be avoided in pregnancy as it crosses the placenta and may
grams of protein daily.
remain in fetal tissues. The FDA has appr oved certain
APPROXIMATE PROTEIN CONTENT
artificial sweeteners for moderate use during pr egnancy.
OF THE FOLLOWING FOODS:
These FDA-approved sweeteners include aspartame (Equal or
NutraSweet), sucralose (Splenda), and acesulfame-K (Sunett).
10-13 grams
4 slices of whole grain br ead
2/3 cup cooked oatmeal
FISH AND SHELLFISH
2 oz. cashews, walnuts
Fish is important to a healthy well balanced diet.
1/2 cup peanuts
However, certain fish should be avoided due to high
3/4 cup soybeans
levels of a form of mer cury that can damage a baby’s
1 1/2 oz. whole grain ready-to-eat cereal
brain and nervous system. Fish to avoid ar e shark,
15 grams
2 large eggs
swordfish, king mackerel, or tilefish (also called white
2-3 oz. serving meat, fish, or poultry
snapper). It is safe to consume 12 ounces of other types
1⁄4 cup peanut butter
of cooked fish each week. It is important to eat a variety
1 cup cooked beans, peas, or lentils
of other fish, such as shellfish, canned fish, smaller ocean
1⁄2 cup ricotta or cottage cheese
2/3 cup almonds
fish, or farm-raised fish. Fr eshwater fish caught by family
and friends should be limited to one serving each week
18-25 grams
3 (three) 8 oz. glasses of low fat milk
(about 3-6 ounces). You should avoid raw fish like sushi,
3⁄4 cup cottage cheese
oysters, and clams as these may contain harmful bacteria
1 3⁄4 cup yogurt
including Listeria (see cheese below). Cooked shellfish is
fine when limited to 12 oz. per week.
CHEESE
Most cheeses are fine in pregnancy, however, soft cheeses
1⁄2 cup parmesan cheese
3 oz. swiss or cheddar cheese
3 1⁄2 oz. tuna
3 oz. beef, lamb, pork, dark chicken meat
2 1⁄2 oz. white meat, chicken or turkey
such as feta, Brie, Camembert, blue-veined, and Mexicanstyle cheese should be avoided because they ar e often
unpasteurized and may be contaminated with Listeria.
ACOG website. Special Nutritional Information.
FOLACIN (FOLIC ACID), VITAMIN B6 AND B12 REQUIREMENTS FO R WOMEN
Adult Women
Pregnant or Lactating
Preconception
400 mcg
Folacin:
400 mcg (mg)
800 mcg (mg)
Vitamin B6:
2.0 mg
2.5 mg
Vitamin B12:
6.0 ug
8.0 ug
FOOD
SERVING SIZE
VITAMIN
VITAMIN
FOLIC
B6 (mg)
B12 (ug)
ACID (mg)
1 cup
.10 mg
.87 ug
12 ug
Nonfat Milk
1 cup
.10 mg
.93 ug
13 ug
Cheddar Cheese
1 oz.
.02 mg
.23 ug
5 ug
Dairy Products
Whole Milk
Cottage Cheese
4 oz.
.09 mg
.80 ug
15 ug
Swiss Cheese
1 oz.
.02 mg
.25 ug
2 ug
Ice Cream
1 cup
.06 mg
.63 ug
3 ug
Butter
1 pat
--------
--------
.4 ug
Fruit
Orange Juice
4 oz.
.01 mg
--------
13.6 ug
Apple
1
.07 mg
--------
13.9 ug
Banana
1
.66 mg
--------
21.8 ug
Peach
1
.03 mg
--------
3 ug
Broccoli
1⁄2 cup
.12 mg
--------
51.9 ug
Peas
1⁄2 cup
.17 mg
--------
50.7 ug
Corn
1⁄2 cup
.08 mg
--------
18.7 ug
Potatoes, Baked
1
.18 mg
--------
5.6 ug
Shredded Wheat
1 biscuit
.07 mg
--------
14 ug
Bread, Whole Wheat
1 slice
.05 mg
--------
14 ug
Vegetables
Cereal Products
Bread, Enriched
1 slice
.01 mg
--------
8 ug
Rice
1 cup
.02 mg
--------
1 ug
3.5 oz.
.47 mg
.33 ug
6 ug
Ham
3.5 oz.
.34 mg
.83 ug
3 ug
Beef, Ground
3 oz.
.36 mg
1.68 ug
3 ug
Meat, Fish, Poultry and Eggs
Chicken
Tuna Fish
3 oz.
.39 mg
2.02 ug
13 ug
Frankfurter
1
.08 mg
.74 ug
2 ug
Peanut Butter
1 Tbs.
.06 mg
----------
Eggs, Boiled
1
.06 mg
.68 ug
13.1 ug
24 ug
ACOG Compendium
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Calcium in Pregnancy
Good sources of calcium
are dairy products, such as
milk and yogurt and other
sources such as leafy green
vegetables, nuts, seafood,
and juices and cereals
fortified with calcium. A
well-balanced diet is
necessary for healthy
bones.
Calcium is important to slow the rate of bone loss as women
Calcium cannot be absorbed without vitamin D. One of the
age. If the amount of calcium in the bloodstr eam becomes
best sources of vitamin D is fortified milk or supplements with
low, the body will remove it from the bones to supply enough
added vitamin D. Another good sour ce is sunlight. Fifteen
calcium to the rest of the body. This can result in osteopenia
minutes in the sun each day helps pr oduce and activate
(low bone density) or osteoporosis (extremely low bone
vitamin D. The recommended daily dose of vitamin D is
density) placing a woman at higher risk for fractur e.
400-800 IU (international units).
Most women need more calcium in their diets. Many women
If you are concerned about your calcium intake or your bone
get only one half or less of the daily amount of calcium they
health, please ask your Paragon Health Car e Provider about
need. Diet alone makes it dif ficult to get enough calcium
ways to get more calcium in your diet, or tests to see if your
unless you eat foods that ar e also high in fat and calories.
bones have already become weak due to osteopor osis. There
Because of this, you will likely need to take calcium
are even medications that help stop or slow down bone loss.
supplements. There are many calcium supplements, however,
your body can only absorb up to 750 mg of calcium at one
time. If you supplement more than 750 mg per day, divide it
into two doses.
American College of Obstetricians and Gynecologists
Sources of Calcium
DAILY CALCIUM REQUIREMENTS FOR WOMEN
During Pregnancy and Breastfeeding
1200 mg
Under age 35
D
800 mg
Over age 35
1000 mg
Menopausal Women on Estrogen
1000 mg
Menopausal Women not on Estrogen
1500 mg
FOOD
AMOUNT
CALCIUM
FOOD
AMOUNT
CALCIUM
Almonds
1 oz.
50 mg
Beans, green
1⁄2 cup
25 mg
Macaroni & Cheese
1 cup
300 mg
Milk, buttermilk
1 cup
296 mg
Beans, kidney, navy, lima
1⁄2 cup
50 mg
Milk, powdered
1⁄2 cup
400 mg
Bread
1 slice
25 mg
Milk, skim
1 cup
300 mg
Broccoli
1⁄2 cup
75 mg
Milk, whole
1 cup
291 mg
Carrot
1 medium
25 mg
Milkshake
1 cup
300 mg
Celery
1⁄2 cup
25 mg
Orange
1 medium
50 mg
Cheese, American
1 slice
195 mg
Pancake
4” diameter
50 mg
Cheese, Cheddar
1 oz.
204 mg
Peanut Butter
2 tablespoons
25 mg
Cheese, Swiss
1 oz.
300 mg
Perrier water
1 cup
32 mg
Cheese, Parmesan
1⁄4 cup
300 mg
Pizza
1⁄4 of 14” pie 300 mg
Cheese, Cottage
1⁄4 cup
34 mg
Raisins, dried, seedless
5/8 cup
3 oz
Corn Tortilla
1 medium
50 mg
Salmon
Cream Cheese
1 oz.
23 mg
Sesame seeds, dried, hulled 3 1⁄2 oz.
Custard
1⁄2 cup
Egg
1 medium
Ice Cream
Kale, Cooked, no stem
Lettuce
1⁄4 head
25 mg
Lobster
1 pound
150 mg
E
L
I
V
E
R
I
167 mg
100 mg
Shrimp
3 oz.
98 mg
25 mg
Spinach, cooked
1⁄2 cup
83 mg
1⁄2 cup
99 mg
Tofu
3 oz.
128 mg
3⁄4 cup
187 mg
Waffle
8” diameter
200 mg
Yogurt, plain
1 cup
400 mg
Yogurt, fruited
1 cup
300 mg
N
G
161 mg
62 mg
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Sources of Iron
DAILY IRON REQUIREMENTS FOR WOMEN (US RDA)
During Pregnancy
Breastfeeding
Premenopausal Women
Postmenopausal Women
27 mg
9-10 mg
15-18 mg
8 mg
What is eaten each day must add up to the above r equirements or the diet is insuf ficient.
Non-Meat Sources
FOOD
AMOUNT
IRON (mg)
FOOD
AMOUNT
IRON (mg)
Almonds
Apple Juice
Apricots, dried, uncooked
Asparagus, canned
Asparagus, frozen
Barley
Beans, Green
Beans, Lima, fresh
Beans, Lima, frozen
Beans, Kidney
Bean sprouts, raw
Beet Greens
Brazil Nuts
Bread, Enriched White
Bread, Whole Wheat
Broccoli
Brussels sprouts
Cashews
Cereal, Bran Breakfast
Cereal, Raisin Bran
Chard
Chickpeas
Chocolate (Bittersweet)
Corn Muffin
Corn Syrup
Cowpeas
Currants
Dandelion Greeens
Dates (pitted)
Farina (enriched)
Figs (dried)
Filberts
Kale
Lentils
Lettuce
Macaroni
2/3 cup
1 cup
10 large
1⁄2 cup
1⁄2 cup
1⁄2 cup
3 1⁄2 oz
2/3 cup
2/3 cup
1⁄2 cup
1 cup
2/3 cup
2/3 cup
1 slice
1 slice
2/3 cup
2/3 cup
3 1⁄2 oz.
1 oz.
2 cups
2/3 cup
1⁄2 cup
3 1⁄2 oz.
2 (2 1⁄2” dia.)
1/3 cup
2/3 cup
1 cup
1 cup
1⁄2 cup
1⁄2 cup
5 figs
100
1 cup
3 1⁄2 oz.
4 (large, leafy)
2/3 cup
4.7
1.5
2.3
1.9
1.1
2.0
1.1
2.5
1.7
1.8
1.3
1.9
2.4
2.4
2.3
1.1
1.1
3.8
2.9
4.0
1.8
6.9
5.0
1.8
4.1
2.1
1.0
3.1
3.0
5.0
3.0
3.4
1.6
2.1
2.0
1.1
Molasses, 1st extract light
Molasses, 2nd extract med.
Molasses, 3rd extract blackstrap
Mustard Greens
Oat Cereal (enriched)
Peanuts
Peas, green
Pecans
Pistachios
Prunes, dried, uncooked
Prune Juice
Raisins
Soybeans
Soybeans (fermented)
Soybean flour
Spinach (raw)
Walnuts
Whole Wheat Flour
Wheat Flour (Enriched)
Wheat Germ
Yeast, Brewers
1/3 cup
1/3 cup
1/3 cup
2/3 cup
1 cup
2/3 cup
2/3 cup
2/3 cup
3 1⁄2 oz.
2/3 cup
1⁄2 cup
2/3 cup
3 1⁄2 oz.
3 1⁄2 oz.
1 cup
3 1⁄2 oz.
1 cup
1 cup
1 cup
1 cup
1 tablespoon
4.3
6.0
11.0
1.8
1.2
2.1
1.9
2.4
7.3
3.9
4.1
3.5
2.8
3.7
9.0
3.1
3.1
3.3
2.9
9.4
1.4
F00D
AMOUNT
IRON (mg)
Beef Heart
Beef Kidneys
Beef, Ground
Beef, Steak
Ham
Lamb
Liver, Beef
Liver, Calf
Liver, Lamb
Oysters
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
3 1⁄2 oz.
5-8 medium
5.9
7.4
3.2
2.9
2.6
1.3
6.5
14.2
17.9
5.5
Meat Sources
American College of Obstetricians and Gynecologists
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Breast or Bottle Feeding
Will you use breast milk or formula? Even though your
Helps mothers get back into shape. Breastfeeding can also
delivery is months away, this is a good time to think about how
help your body get back to its normal size and shape. The
you’re going to feed your baby during the early months.
baby’s sucking stimulates the muscles of your uterus to r eturn
to normal.
advantages o f
breastfeeding
Breastfeeding is unquestionably an excellent way to feed your
baby. It can give you much pleasur e to have your child in close
contact with you during feeding, and, of course, this contact
gives much pleasure to your little one.
Meets complete nutritional needs. Breast milk is the
Endorsed by the AAP. For all these reasons, The American
Academy of Pediatrics recommends that infants be offered only
breast milk for the first four to six months after birth and that
breastfeeding continue throughout the entire first year.
problems with
breastfeeding
most easily digestible food that a baby can consume. It is
Are you taking medication? Almost any mother can breast
uniquely designed to meet your baby’s complete nutritional
feed her baby. Women with certain diseases or those taking
needs. No special preparation such as measuring and sterilizing
certain medications may be told that they should not nurse.
is needed, and it is definitely less expensive than formulas.
Your provider will discuss this with you.
Contains antibodies. Breast milk contains antibodies that
Overcoming doubt. One of the greatest problems of
protect young babies against infections. Antibodies ar e made
breastfeeding is a mother’s fear that she can’t do it. This is
in your body and are passed to your child in the br east milk.
common, but with a little help and instruction these fears
Breastfeeding also offers other health benefits to your child.
can be removed. If you think you want to br eastfeed, we are
If asthma or allergies run in your family , it seems that
here to help you and give you information on how to pr epare
breastfeeding can cut down the chances of these happening to
for nursing.
your baby. Babies who are breastfed also have a smaller chance
of developing diabetes and cancer of the lymph glands. Br east
Breast size doesn’t matter. Some mothers think their breast
milk contains proteins that promote brain development.
size is too small. The part of the br east that makes milk has
little to do with the br east size. Women with any size breasts or
Prevents overfeeding. Breastfeeding can help prevent
nipples should be able to nurse their childr en.
overfeeding. Breastfed infants usually get just what they need
during each feeding. There is a problem of formula-fed babies
Does it really limit your freedom? Some mothers fear that
getting too many calories and gaining too much weight.
breastfeeding limits their freedom. Many women have gone
Overweight babies often grow up to have weight pr oblems.
back to full time jobs after having a baby and continued to
nurse their babies. There are ways to save breast milk so it can
be put into a bottle for use when the mother is not home.
ACOG Educational Bulletin N0258, July 2000. Br eastfeeding: Maternal and Infant Aspects.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
The Circumcision Decision
What is circumcision? Circumcision is a surgical procedure
If I choose circumcision, what else do I need to know?
to remove the foreskin from the head of the penis. If you
You will be offered a choice of anesthesia for the pr ocedure.
choose to have your son cir cumcised and he is healthy and
You can choose between an injection of local anesthesia at
full-term, the circumcision is performed by one of the Paragon
the base of the penis and anesthetic cr eam. There is some
obstetricians before the baby leaves the hospital. Certain
discomfort and swelling associated with the injectable
infants who are born prematurely or with a condition that
anesthesia, and bruising of the skin is common. If you choose
increases the risks of elective surgery will need to have the
topical anesthesia cream (EMLA cream), it is placed on the
circumcision scheduled with a pediatric ur ologist sometime
penis one hour before the procedure. It is very helpful to know
after discharge from the hospital. Circumcision is a quick
at the time of birth that you wish the Paragon physician to use
procedure performed in the newbor n nursery.
EMLA cream, as this helps us to schedule the cir cumcision.
Tylenol is given to the infant after the pr ocedure, and the baby
Why do some parents choose to have their sons
is returned to you for comforting as soon as is practical after
circumcised? Some parents request circumcision for their
the procedure.
sons based on religious, social, or cultural beliefs. Ther e is
evidence that circumcision reduces the incidence of urinary
When must the circumcision be done? The newborn must
tract infections, sexually transmitted diseases, and penile
be at least 12 hours old and must have been seen by the
cancer. Circumcision is usually safe. The complication rate
pediatrician before circumcision will be done. Ideally, the
for circumcision is estimated at one in every 200 to 500
circumcision will be done before a feeding rather than right
procedures. Most complications are minor.
after a feeding. You may be asked to delay feeding the baby
for a short period of time so the cir cumcision can be done.
Why do some parents choose not to have their sons
Care and cleaning of the penis will be r eviewed with you
circumcised? After 40 years of research, the American
before discharge from the hospital, whether or not your son is
Academy of Pediatrics does not r ecommend routine neonatal
circumcised. Before the circumcision is performed, you will be
circumcision. There is conflicting evidence about the risks of
asked to sign a consent form. No cir cumcision is done without
contracting sexually transmitted diseases for uncir cumcised
a consent form signed by a par ent.
men. Cancer of the penis is very rar e, and may be associated
more with poor hygiene than an uncir cumcised penis. Urinary
Where can I find more information? The brochure
tract infections in boys are usually easily treated and not major
“Deciding About Circumcision” is available on request. Please
infections. Parents who decide against circumcision should feel
ask your Paragon provider (physician, nurse-midwife, or nurse
comfortable with their decision. The vast majority of boys who
practitioner) if you have questions. Mor e information about
are not circumcised do well and it is unlikely that cir cumcision
circumcision can be found on t he American Academy of
will be needed later in life. The cir cumcision procedure has risks
Pediatrics web site (www.aap.org).
of bleeding and infection.
AAP Circumcision Policy Statement 1999: 103: 686-693
ACOG Committee Opinion Circumcision 2001: 98: 707-708
Visit These Outstanding Online Sources
“The moment a child is
born, the mother is also
born. She never existed
before. The woman
existed, but the mother,
never. A mother is
something absolutely new.”
- Rajneesh
Paragon recognizes the following web sites as pr oviding
www.sport-fitness-advisor.com/pregnancyexercise.html-
thought-provoking and reputable information. Please visit
babycenter.com - Information concerning all aspects of
them and feel free to contact Paragon with follow-up
exercise during pregnancy.
questions. www.ParagonObGyn.com
www.women-in-motion.com - Informative reading on diet,
www.acog.org - The official site of the American College
exercise, and maternity clothing.
of Obstetricians & Gynecologists.
www.fitfor2.com - Dedicated to exercise and fitness
www.medem.com - The nation’s premier physicians-patients
during pregnancy.
communication connection.
www.atpregnancy.com - Offers helpful advice for
www.modimes.org - The official site of the March of Dimes
postpartum total body workout.
organization.
www.acnm.org - Information on nurse-midwifery.
www.baby.com - BabyCenter offers many links, tips, and
www.lamaze.com - Information on Choosing Normal Birth.
articles regarding pregnancy and baby information, in addition
to quick shopping.
D
E
L
I
V
E
R
I
N
G
C
A
R
E
.
N
U
R
T
U
R
I
N
G
L
I
F
E
.
Akron-East
468 East Market Street
Akron, Ohio 44304
Phone (330) 869-9777 Fax (330) 869-0052
Akron-West
1 Park West Blvd., Suite 200
Akron, Ohio 44320
Phone (330) 869-9777 Fax (330) 869-0052
barberton
28 Conservatory Drive, Suite C
Barberton, Ohio 44203
Phone (330) 475-0266 Fax (330) 475-0270
Cuyahoga falls
1860 State Road, Suite D
Cuyahoga Falls, Ohio 44223
Phone (330) 923-3138 Fax (330) 923-9652
Ellet
493 Canton Road
Akron, Ohio 44312
Phone (330) 784-5406 Fax (330) 784-3654
Green
1700 Boettler Road, Suite 225
Uniontown, Ohio 44685
Phone (330) 899-9696 Fax (330) 899-9596
Hudson
1305 Corporate Drive, Suite A
Hudson, Ohio 44236
Phone (330) 650-4241 Fax (330) 650-5790
kent
1951 State Route 59, Suite C
Kent, Ohio 44240
Phone (330) 677-3638 Fax (330) 676-0753
www.ParagonObGyn.com
9/10