CONGRATULATIONS! - Southern Crescent Women`s Healthcare

Transcription

-SOUTHERN CRESCENT WOMEN'S HEALTHCARE
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Dear Patient:
CONGRATULATIONS! The physicians, nurse-midwives, and staff would like to
“WELCOME” you to our practice. We are happy that you have selected us for your obstetrical
care.
The enclosed information is provided to help answer some basic questions you may have about
your care or this practice and the providers. Please keep this book handy and bring it with you to
your visits.
We look forward to entering into a relationship with you that will extend long after you bring
your baby home from the hospital. Our goal is to provide you with the best possible care and to
make sure you have a positive experience with the staff and providers at SOUTHERN
CRESCENT WOMEN'S HEALTHCARE.
Be sure to visit our website at www.scwhobgyn.com for more helpful information. We also offer
the convenience of scheduling your appointments online.
Sincerely,
SOUTHERN CRESCENT WOMEN'S HEALTH CARE
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TABLE OF CONTENTS
Welcome
Practice Philosophy
Care Team
General Practice Information
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5
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First Trimester
Pregnancy Progress Record
You and Your Partner
First Trimester Fetal Development
OB Timeline
Prenatal Vitamins and Iron Information
Substance Use During Pregnancy
AFP plus Test
Cystic Fibrosis Carrier Testing
Parvo Virus (Fifth Disease)
Toxoplasmosis
General Health Information
Common Discomforts of Pregnancy
Midwives Tips for Morning sickness
Habits to Improve and Prevent Constipation
Nutrition in Pregnancy
Eating Safely During Pregnancy
Sex in Pregnancy
Exercise in Pregnancy
Work during Pregnancy
Wearing Seatbelts in Pregnancy
Community Resource Guide
Preventing Sexually Transmitted Disease
Frequently Asked Questions
Family Roles: Mother
Family Roles: Father
Common Feelings and Needs of Expectant Mothers
Common Feelings and Needs of Expectant Fathers
How am I Feeling
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8
12
13
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15
17
19
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22
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25
28
29
30
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35
37
41
44
45
47
48
49
50
51
52
53
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Second Trimester
Second Trimester Fetal Development
What is Preterm Labor?
Counting Fetal Movements
Gestational Diabetes Screening Test
Love Shouldn’t Hurt
Childbirth Education Classes
Pediatrician List
Travel During Pregnancy
Pain Relief in Labor
Information Regarding Disability Forms
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60
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68
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Third Trimester
Third Trimester Fetal Development
Group B Strep Testing
Women’s Life Center Information
What to Bring to the Hospital
True versus False Labor
How to Tell When Labor Begins
What is an Episiotomy?
Postdate Pregnancy
Circumcision
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Postpartum Topics
Postpartum Care
Breastfeeding
First weeks at Home With Your Newborn
Sibling Rivalry Toward a Newborn
Methods of Contraception
Postpartum Depression
Six Care Safety Tips
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GROUP PRACTICE PHILOSOPHY
Southern Crescent Women’s HealthCare is a group practice of Ob/Gyn physicians, Certified
Nurse Midwives, and Nurse Practitioner’s, based on the belief that all life is sacred and as such,
is entitled to competent and compassionate care. The practitioners are well trained with
excellent skills and experience in medical procedures and technology. Each physician, and
certified nurse midwife is dedicated to making the birth of your baby a safe and pleasant
experience.
A group practice offers you the benefit and the expertise of a doctor and midwife. We provide
twenty-four (24) hour coverage on a rotation basis. The rotation of call and limiting our practice
to one hospital helps us provide the highest quality of care during your pregnancy.
You have the option of choosing a doctor or certified nurse midwife for you primary care
provider in labor and delivery.
A Certified Nurse-Midwife is a registered nurse (RN) who has graduated from one of the
advanced education programs accredited by the American College of Nurse-Midwives. All of
the midwives at Southern Crescent Women’s Healthcare have a master’s degree and are licensed
to practice midwifery by the Georgia State Board of Nursing.
We have offices conveniently located in Clayton, Fayette and Henry counties to better meet the
needs of our patients.
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Southern Crescent Women’s HealthCare Professional Staff
Southern Crescent Women’s Healthcare is proud of the team of professionals dedicated to the
delivery of quality obstetrical and gynecology care. This group of highly trained individuals will
be available to you throughout your pregnancy and will continue to provide outstanding
gynecology care through your well woman visits.
In a large group practice, however, you may not have the time to actually meet all of the
providers prior to your delivery. We have included a short biography section of the professionals
that you have selected for your care.
PHYSICIANS
W. Darrell Martin, M.D., F.A.C.O.G
Elizabeth Killebrew, M.D., F.A.C.O.G
Sharon A. Lynch-Miller, M.D., F.A.C.O.G
Benita Bonser, M.D., F.A.C.O.G
Crystal O. Slade, M.D., F.A.C.O.G.
Cynthia A. Nater, M.D.
Dr. Al Reynolds and Dr. Edwin Bello, Board Certified OB/GYN physicians, who also practice at
Southern Regional Medical Center, provide occasional call coverage for the practice.
CERTIFIED NURSE-MIDWIVES
Kate Fouquier, MSN, CNM
Kay Flowers, MN, CNM
Desiree Clement, MS, CNM
Helen Bailey, MSN, CNM
Angel Miller, MSN, CNM
NURSE PRACTIONERS
Becky Oskey, A.R.N.P.
You may schedule your prenatal visits at any of our convenient office locations.
1279 Highway 54 west, Suite 220
Fayetteville, GA
275 Upper Riverdale Road, Suite D
Riverdale, GA
1215 Eagle’s Landing Parkway, Suite 209
Stockbridge, GA
APPOINTMENTS 770-991-2200
www.scwhobgyn.com
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Midwives
Kate Fouquier is a certified nurse-midwife who has been
practicing since 1996. She received her nursing degree
in 1976 and traveled for twenty years with her husband,
Mark, throughout his career as an officer in the United
States Army. In 1995, she began her midwifery training
through the Frontier School of Nurse-Midwifery in
Hyden, Kentucky, receiving her Master of Science,
Nursing degree from Case Western Reserve University in
Cleveland, Ohio. Kate and Mark have three children and
four grandchildren, to date. Kate enjoys quilting, is an
avid reader, and each winter heads to the mountains for
a week of snow skiing. She is active on the national level
with American College of Nurse-Midwives, the
professional organization for CNMs.
Kay Flowers as been a certified Nurse-widwife, practicing
since 1993. She received her RN from Piedmont Hospital
School of Nursing then joined our staff as an RN. She
also was determined to be a nurse-midwife and returned
to school at Emory University. Kay completed the NurseMidwifery program at Emory University with her Masters
Degree. Kay and her husband live in Clayton County
and are very active with events in their area.
Desiree Clement has been practicing since 2003 after
completing her Master’s degree at the University of
Maryland. She comes to us with a strong, diverse
background in nursing and has worked in many
capacities and settings due to her husband’s career in
the military.
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Midwives
Helen Bailey has been practicing sine 2000 after
earning her Masters’ degree at the University of
Miami. She has worked in all areas of OB and has
an extensive background in high risk obstetrics.
She enjoys utilizing her knowledge and expertise
to support women throughout their childbearing
years and beyond.
Angel Miller is a certified Nurse-Midwife who has been
practicing since 1997. She received her nursing degree
in 1986 and earned her Bachelor of Science and Master
of Science degrees in Nursing at Case Western Reserve
University, Cleveland, Ohio. She is certified in nursemidwifery by the Frontier School of Midwifery and Family
Nursing in Hyden, Kentucky. She recently relocated to
Peachtree City, Georgia with her husband Randy and
German Shepherd “Bear” in January 2006. She is cofounder and CEO of a successfully independent nursemidwifery practice, Womanplace Specialties, located in
northeast Ohio which began in 2002 and is still
flourishing. Angel has provided a comprehensive range
of services in women’s health, including many years
experience as a labor and delivery nurse. Angel and
Randy have two sons, the youngest who is in college.
Angel enjoys a variety of music, loves dancing and
swimming.
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Nursing Staff
Becky Oskey, Clinical Services Director. Becky
is located in our Fayetteville location. As a
retired Lieutenant Colonel from the United
States Army, Becky brings with her over 20
years in the medical profession. Becky is
responsible for the oversight of all clinical
services which include nursing staff,
ultrasonographers, dexascan and
mammography follow-up personnel.
Kelli Kalen, RN, Nurse Manager. Kelli is
located in the Fayetteville office. She is a
Registered Nurse who received her Bachelor of
Science degree from Central Missouri State
University. She has over 11 years experience
as a RN and is responsible for the entire staff
of medical assistants and oversees their
scheduling and training. In addition, she is
also responsible for the management of our
lab staff.
Patty Shelton, LPN, Triage. Patty is responsible for
triage of our OB patients over the phone, coordinates
same-day OB or work-in appointments and notification
of abnormal lab results.
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Practice Administration
Diana Blondeau, CMPE, Administrator. Diana has
been with Southern Crescent Women’s Healthcare
for many years and has over 20 years experience
in the medical field. Diana is responsible for the
overall administration of the practice and also
functions as the practice’s Privacy Director. Any
concerns about your personal privacy should be
directed to her. All employees report either
directly or indirectly to Diana.
Vanessa Dickens, M.Ed., Business Office Manager.
Vanessa is responsible for the oversight, training,
and direction of the appointment schedulers, front
desk and switchboard at the Fayetteville office
and the care and handling of medical records.
Prior to her service at Southern Crescent, Vanessa
spent many years in the rehabilitation and
counseling field and has extensive experience with
the insurance industry.
LuAnn Liguori, Office Manager-Riverdale, Billing
Office Manager. LuAnn is located at the Riverdale
office servicing our patients from Clayton County
and the surrounding area. She has been on the
Southern Crescent team for over 5 years and has
over 18 years of experience in the medical field.
LuAnn is responsible for the oversight of the
Riverdale office and all functions related to billing.
Reporting to LuAnn are: billing/collection staff
and front desk staff at the Riverdale office.
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Practice Administration
Charlotte McMillan, Office ManagerStockbridge, Human Resource Manager.
Charlotte is located at the Stockbridge office
serving our patients from Henry County and
the surrounding area. She has been on the
Southern Crescent team for over 15 years. In
addition to the oversight of operations at the
Stockbridge office, Charlotte’s responsibilities
include Corporate Accounting and Human
Resource functions and front desk personnel
at Stockbridge.
Julie Copeland, Referral Coordinator. Julie is located
in the Fayetteville office. She has been a dedicated
and excellent member of the team for over ten years
and has many years of experience in the medical
community. Julie is responsible for referral
management for all patients within the practice.
Kim Wright, Surgery Coordinator. Kim is located in
the Fayetteville office. Kim is relatively new to the
practice but has 8 years of experience in the medical
field. She is responsible for the entire process
revolving around the scheduling of surgery, including
Cesarean Sections.
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GENERAL PRACTICE INFORMATION
A.
Office Locations
We have three convenient locations to serve our patients, and for the majority of
your appointments, you can choose the location that is most convenient for you.
However, because of equipment or staffing, a three hour glucose tolerance test
can only be scheduled in the Fayetteville or Riverdale office.
B.
Appointments
Appointments are scheduled for all of our patients at the time of your visit, by
telephone or online at www.scwhobgyn.com . Please remember that it is critical
for the continued good health of both you and your baby that you keep your
appointments. PLEASE CALL 48 HOURS IN ADVANCE TO CANCEL OR
RESCHEDULE APPOINTMENTS. Calling to cancel an appointment in advance will
prevent a charge for “no show” appointments. Please try to reschedule your
appointment to occur within one week maximum of the cancelled or missed one.
Please see the enclosed OB Timeline for visit information.
C.
Ultrasound
Ultrasound
You will have a scheduled ultrasound around 20 weeks, unless you are referred
to a specialist. Additional ultrasounds will be performed before or after this one
as medically necessary.
D.
Phone Calls
An OB phone nurse is available to answer questions or arrange work-in
appointments if necessary Monday through Friday 8:30 am – 4:30 pm. You can
reach the nurse by calling 770-991-2200. You will speak to the operator who will
forward your call, or if you get the automated system you will be given the choice
of three options.
*
*
*
1 - If this is an emergency and you need to speak to someone right
away, this option will transfer you to the answering service and they will
page the midwife on call. She will call you back as soon as possible.
2 - If this is an urgent call you will be able to leave a message and the
phone nurse will return your call within two hours.
3 - If this is a non-urgent question you can leave a message and
someone will return your call within 24 hours. After office hour calls
will automatically be sent to the answering service and the midwife will
return your call. After office calls should be limited to emergency calls
only.
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PREGNANCY PROGRESS RECORD
Name________________________
1st
visit
Date
Weeks
Pregnant
Blood Pressure
Weight
Fundal Height
Baby’s
Heart Rate
Is the Baby
Moving?
NOTES
2nd
visit
3rd
visit
Due Date____________
4th
Visit
5th
visit
6th
visit
7th
visit
8th
visit
9th
visit
10th
visit
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You and Your Partner
Congratulations—you are going to be a parent!
Pregnancy is a time of change—for the woman, her partner, and often a couple. Understanding
these changes and knowing how to cope with them will help you to enjoy and take part in this
special time in your life.
This section presents a number of topics of interest to not only the expecting mother but also the
expecting partner.
Prospects of Parenthood
The news that you will soon be a parent can bring unexpected emotions. You may have
mixed feelings about pregnancy. You may feel joy and excitement about becoming a parent. At
the same time, you may wonder if you can meet the financial and emotional responsibilities of
raising a child. You may be concerned about how pregnancy and a child will change your life
and your relationship with your partner, including your sexual relationship. New fathers may
also feel unsure of their role during birth and as a father in general.
These feelings are normal. Being honest with yourself and talking openly with your
partner about your concerns can help you come to terms with emotions. It is also normal during
pregnancy for the prospective parents to focus on issues that did not seem important before.
Separately, you may both think about your own relationship, childhood, relationships with your
parents, and hopes for your future family.
Importance of Fathers
Children need their fathers as well as their mothers. The role as a father can begin long
before your baby is born. Men no longer fit the stereotype of not being involved until they bring
the mother and baby home from the hospital. Fathers today can play an active role in pregnancy
and childbirth.
Partners can have a positive effect on their partner’s pregnancy. Research suggests that
women with supportive partners have fewer health problems in pregnancy and more positive
feelings about their changing bodies. Studies also suggest that labor and birth is easier and
shorter for women whose partners take part in the process.
Physical and Emotional Aspects of Pregnancy
Early Pregnancy
Early in pregnancy, most women feel tired, need more sleep, urinate frequently, and have
sore breasts. Nausea and vomiting—known as morning sickness—are also common. This can
happen at any time of the day or night, not only in the morning.
Early pregnancy is an emotional time for a woman. Sudden changes in mood are
common, and she may focus her thoughts inward. Mixed feelings are common for new dads,
too. They may be concerned about their partner’s health. At the same time, men may feel left
out as their partner focuses on her changing body and emotions. Knowing these changes are a
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natural part of early pregnancy will help you to support each other and resolve some of your own
feelings.
This is a good time to get involved in having a healthy pregnancy. You and your partner
can adapt your lifestyles to include a balanced diet, plenty of sleep, and exercise and to eliminate
use of alcohol, tobacco, and other drugs. You should form or strengthen your own health habits
now. Working together for a healthy lifestyle will benefit you, your partner, and your baby.
Middle Pregnancy
For most women, the middle of pregnancy is the most enjoyable part. As the woman’s
body adjusts to being pregnant, she usually begins to feel better. Her normal energy level
returns, and morning sickness usually goes away. Some women may feel sick throughout their
pregnancy.
As the woman’s abdomen grows, the pregnancy becomes more obvious to others. You
will soon both be able to feel the baby move and may listen to its heartbeat during visits for
prenatal care. Both of you may find this to be an exciting time.
Late Pregnancy
In the later part of pregnancy, the woman may again feel some discomfort as the baby
grows larger and her body readies for birth. She may have trouble sleeping and doing routine
tasks that require moving around.
You both may be impatient with the pregnancy and be both excited and fearful about the
upcoming birth. Women may fear for the safety of themselves and their baby during childbirth
and partners may be anxious about how they will react during birth. These feelings are normal.
Be honest with each other about your concerns.
Late pregnancy is usually the time when most couples take childbirth classes to help them
prepare for labor and birth, and breastfeeding. These classes offer a chance to learn and work
together and can address many of your concerns.
Pregnancy and Sexuality
The changes of pregnancy can affect sexuality and levels of sexual desire for both of you.
It is normal for a woman’s sex drive to change with the stages of pregnancy as her body image
changes and discomforts come and go. Your partner’s sexual feelings may also changes as the
pregnancy progresses. Being honest with each other about your needs and emotions is the key to
continued intimacy and will help you enjoy a happy and satisfying sexual relationship during
pregnancy.
Many couples wonder if sex is safe in pregnancy and if intercourse will harm the baby or
the woman. In a pregnancy with no problems, sex is considered safe and healthy. The woman’s
comfort should be the most important guide during sex. As pregnancy advances, you and your
partner may wish to use positions that do not put pressure on her abdomen, such as lying on your
sides together or you lying beneath her.
If the pregnant partner does have health problems during her pregnancy, ask
your care provider whether sex will be safe. If certain complications exist, you may be advised
to modify your lovemaking, to use a condom during sex, using dental dams for oral sex, or to
abstain from having intercourse for the health of the woman or the baby.
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Do not have sex if the pregnant partner has any bleeding or preterm labor contractions, or
if her bag of water breaks before labor.
Childbirth Preparation
Childbirth preparation classes are designed to give information on labor and birth. They
offer another way for expectant partners to be actively involved with pregnancy and birth as the
primary support person. The support person can be someone other than the father. Most classes
include information on the physical process of pregnancy, labor and birth and teach couples how
to use breathing and relaxation to help the woman during labor. The support person’s role
during labor and birth is stressed. Teamwork between the woman and her partner is encouraged
during classes, and couples are urged to practice their skills together at home.
The goal of childbirth classes is to make you as informed and comfortable as possible.
Any questions that you may have should be written down and discussed at your prenatal visit.
Labor and Birth
The support person’s role during labor and birth is to provide emotional support and
physical comfort t the mother (helping with relaxation and breathing techniques, massage, and
taking care of the needs like thirst, etc) and to help communicate with the hospital staff.
The support person is also there to share in the birth of the child. Birth is now viewed in
most hospitals as a family event, and your partner will be able to see as much or as little of the
birth as you may wish. There may be points at which your partner feels uncomfortable or
queasy. This is normal. But, your partner should try to stay and help the mother through birth.
Being there and being part of the child’s birth is an important and special time. Most hospitals
recognize this and provide personal time right after the birth for the family to get to know each
other for the first time.
Unexpected situations may arise during labor and birth that require the full attention of
the care provider and medical staff. In such a situation, family members other than your support
person may be asked to leave the delivery room.
Some partners may decide not to attend the birth. There are other ways to support the
mother such as taking an active role in caring for the mother and baby after the birth, even before
they leave the hospital.
Finally….
Having a baby is a family affair.
Today, families can be defined many different ways. It is important to remember that parenting
begins during pregnancy and having loving support is important for the woman and the newborn.
Fathers/partners are important parents, right from the start. The more informed you both are
during pregnancy, the better the experience will be for your growing family.
FIRST
TRIMESTER
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FIRST TRIMESTER FETAL DEVELOPMENT
CONCEPTION TO SIX WEEKS OF PREGNANCY
• For the first eight weeks, your developing baby is called an embryo.
• The baby is growing inside a sac of amniotic fluid (bag of waters).
• Hereditary characteristics, such as, eye and hair colors were set when the sperm met the
egg.
• The brain, nervous system, heart and lungs are forming.
• Tiny spots for ears, eyes and nose are showing.
• The arm and leg buds are forming.
• Your baby will be about ¼ inch to 1 inch long and will weigh less than 1 ounce.
SEVEN TO ELEVEN WEEKS OF PREGNANCY
• This is a key time in your baby’s development.
• All the major body organs and systems are formed though not completely developed
• The heart is beating. The baby’s heartbeat is 120 to 160 beats per minute
• The stomach, liver, and kidney are developing
• The umbilical cord has formed; it will deliver nutrients from mother to baby until cut at
delivery
• Eyes and ears are in a critical time of growth
• Facial features are forming. The head is large, since the brain grows faster than the other
organs.
• Cartilage, skin, and muscles are starting to shape your baby’s body.
• Fingers, toes, fingernails, ears, ankles, and wrists are forming.
• After eight weeks the embryo is called a fetus. The baby is still too tiny for you to feel
movement.
• Your baby will weigh about ½ ounce to 1 ounce and will be about 2 ¼ inches long.
TWELVE TO FIFTEEN WEEKS OF PREGNANCY
• If you could see inside the uterus, the sex of the baby would be easy to identify.
• The ears, arms, hands, fingers, legs, feet and toes are formed.
• The neck is well shaped and can support the head.
• Reflex movements allow your baby’s elbows to bend, legs to kick and fingers to form a
fist.
• Your baby’s vocal cords are formed.
• Blood is now traveling through the umbilical cord to the baby and will continue to do so
until the cord is cut at delivery.
• The face is looking more and more human each day as the eyes begin to move closer
together instead of being on the sides of the head and the ears move to a normal position.
• The intestines move farther into the baby’s body; the liver begins to produce insulin.
• Your baby begins to practice inhaling and exhaling movements.
• Your baby will weigh about ¼ pound and will be about 2 ¼ inches long.
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Normal Pregnancy
OB Visit Timeline
First Trimester (6-14 weeks gestation)
1st visit
Establish pregnancy with MD, Nurse Practitioner (NP), or Certified NurseMidwife (CNM). A physical exam, prenatal blood work, vaginal/urine cultures, and Pap
smear, as needed. New OB information folder will be given. Your next visit will be scheduled
for 2-4 weeks, depending on need.
2nd visit
New OB visit with Certified Nurse-Midwife for detailed medical/surgical
history review, discuss lab, Pap and culture results. A plan will be developed and initiated
based on identified needs and/or problems. Introduction of SCWH practice and providers,
educational materials given and reviewed, and care options presented. Baby’s heartbeat will be
listened to between 12-14 weeks gestation. A pregnancy information booklet will be given.
Second Trimester (14-28 weeks gestation)
15-20 weeks
AFP Plus test offered- see information sheet
18-21 weeks
Ultrasound for dating confirmation and fetal anatomy scan. Next visit is scheduled for 5
weeks, more frequently as indicated. Sign up for childbirth classes
24-29 weeks
Diabetic Screening, CBC (anemia screen), RhogGam –for RH negative mothersInformed consents read and signed. Next visit is scheduled for 3-4 weeks, more frequently as
indicated.
Third Trimester n (28-42 weeks)
29-36 weeks
Start attending Childbirth Classes. Visits every 3 weeks, more frequently as indicated
36-37 weeks
Group B Strep (see information sheet) and repeat CBC. Pelvic exam if indicated or if
requested. Visit scheduled in 2 weeks until 37 weeks, more frequently if indicated
38-41 weeks
Weekly visits, more frequently as indicated. Pelvic exams starting at 40 weeks, earlier as
indicated or if requested. Possible induction of labor discussed at 40th week visit. Inductions are
not scheduled for earlier than 41 weeks gestation, unless medically indicated.
Congratulations On the Birth of Your Baby!
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PRENATAL VITAMINS AND IRON
INFORMATION SHEET
Prenatal Vitamins: Buy these over the counter (on the shelf) at Wal-Mart. They cost about $8.75
for 240 vitamins (eight month supply). Take one pill every day, about two hours after eating with
water or juice. Do not take them on an empty stomach and try not to take them with food or
caffeinated drinks (for example: soda or coffee). If your stomach gets too upset when you take
the prenatal vitamins, buy children’s chewable vitamins (example: Flintstones) and take two pills
every day (together or at separate times). Follow the same instructions for taking them as for the
prenatal vitamins.
Iron Pills (Ferrous Sulfate 325 mg. tablets): If your blood count is low, and you are anemic, we
may ask you to take one or two iron pills every day. You can buy these over the counter (on the
shelf) at Wal-Mart. They cost about $4.99 for 250 pills. Take the pills every day, two hours after
eating with water or juice. Take it at a separate time of day from your prenatal vitamin. Do not
take them on an empty stomach and try not to take them with food or caffeinated drinks (for
example: soda or coffee).
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SUBSTANCE USE DURING PREGNANCY
What is substance use in pregnancy?
Anything you eat, drink, swallow, or even breathe goes through your blood to your baby through
a special organ called the placenta.
• All the food and oxygen the baby needs to grow goes through the placenta.
• Harmful things like alcohol, drugs, and cigarette smoke also move through the placenta
to the baby.
• Even medications and caffeine can go through the placenta to your baby.
If you are pregnant, any of these things can hurt your baby. For example alcohol, drugs, and
tobacco can cause:
• Birth defects and lifelong learning problems
• Miscarriage, stillbirth, and infant death
• Low weight at birth
What about Alcohol?
When you drink alcohol, so does your baby. Because your baby is so small and growing so
quickly, this is very dangerous. The more you drink, the greater the danger to your baby. Alcohol
can cause lifelong health problems for your baby.
Alcohol use can cause babies to be born with a birth defect called fetal alcohol syndrome (FAS).
Babies with FAS:
• Have small heads and heart defects
• Not grow as they should
• Have learning problems
It’s best not to drink at all when you are pregnant. If you are drinking, the time to stop is now.
But that may not be easy. If you need help, call our office for an appointment.
What about street drugs?
Pregnant women should not use any street drugs. Babies of women who use drugs may have
lifelong problems or even die. Using drugs can also harm the mother.
• Using cocaine and other drugs can cause miscarriage, stillbirth, or brain damage.
• Marijuana can cause a baby to be born too early or too small
• Drug use can put the mother in danger too. For example, using drugs can cause the
placenta to separate from the inside of the uterus before the baby is born. This can cause
severe bleeding that may lead to death for the mother and the baby.
It’s best not to use drugs at all when you are pregnant. If you use drugs, the time to stop is now.
But that may not be easy. If you need help, call our office for an appointment.
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What about smoking?
When you smoke, less oxygen gets to you and your baby. This makes it harder for you to have a
healthy pregnancy.
• You may have a miscarriage
• Your baby may be born too small or too early
• Your baby could have learning problems or other health problems later on.
• Sudden Infant Death (SIDS) happens more often in babies whose mothers smoke or who
live in homes with second hand smoke.
If you smoke, stop now. It’s not easy to quit. Call the American Lung Association for ideas,
classes, or support groups (1-800-586-4872). Another resource is the American Cancer
Society at 1-800-227-2345.
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ALPHA FETO-PROTEIN PLUS (AFP PLUS OR TRIPLE SCREEN) BLOOD TEST
Why is this test being offered?
The triple screen blood test is offered to all pregnant women in our practice between 15
to 21 weeks gestation. It can only be done during those weeks for it to be reliable. The test
screens for the amount of three substances in the mother’s blood:
1. AFP (Alpha-Fetoprotein) a protein produced by the growing fetus which is present in
the baby’s blood, the amniotic fluid, and in small amounts in the mother’s blood.
2. hCG (Human Chorionic Gonadotropin) a hormone produced by the placenta
3. Estriol a hormone produced mostly in the placenta and liver of the fetus.
The amount of these three substances found in the mother’s blood provides an indication that
there is a risk that a baby has an open neural tube defect, Down’s syndrome, or Trisomy 18.
If your screening test shows a higher-than-average risk for having a baby with a certain defect,
further tests may be used for diagnosis.
Most women with abnormal screening tests have normal babies.
What is an Open Neural Tube Defect (NTD)?
With an open neural tube defect, part of the fetus’ body has not developed a skin
covering. These open fetal defects occur most often in the abdominal wall or around the spine.
The most common open neural tube defects occur around the baby’s spine.
With an open neural tube defect, the fetus’ brain, spinal cord, or their coverings do not form
normally. It is important to note that NTDs are very rare, occurring in only 1-2 babies out of
1000 births.
Spina Bifida is one type of NTD. When spina bifida is open (not covered by skin), it may
be detected with testing. The effects of spina bifida vary. Some people with spina bifida have
only mild problems. In others, it may cause leg paralysis, loss of feeling, lack of bladder and
bowel control, hydrocephalus (water on the brain), mental retardation, or even death. Another
type of NTD, anencephaly, occurs when the brain and head do not develop normally. Babies
with this are either stillborn or die soon after birth.
What is Down’s syndrome?
Normal cells have 46 chromosomes arranged in 23 pairs. In Down’s syndrome, there is
one extra copy of a chromosome on chromosome 21; therefore, it is called Trisomy 21. Down’s
syndrome causes mental retardation to varying degrees and sometimes birth defects, such as
heart defects. Affected people have certain facial feature: a flat face, slanting eyes, and low-set
ears. Even though it is one of the most common genetic (or chromosomal) problems that can
happen to the fetus, it still occurs only in about 1 in 800 births. The risk of having a live baby
with Down’s syndrome increases with a women’s age. For example, a 20 year old woman only
has a 1 in 1,667 risk while a woman who is 35 has an increased risk of 1 in 378, and a 40 year
old woman has a 1 in 106 risk.
23
What is Trisomy 18?
This is an extra chromosome on chromosome 18. Babies with this syndrome are usually
severely retarded and may die before birth or in early infancy.
How is the test results reported?
The test result is reported as a positive or negative. A positive screen means that there is
a risk (not that the baby definitely has the defect) of certain birth defects. However, most of the
time, the reason for a positive result is NOT a birth defect. The most common reasons for a
“positive screen” result include:
The due date is earlier or later than thought
The substances being tested for had more variation than usual, without any fetal defects
There is more than one fetus (twins or triplets)
A positive screen means that there is a need for further testing. You will have an
ultrasound first to see if the positive screen is simply because of a different due date. If you’re
original due date is correct, we will refer you to Atlanta Maternal-Fetal Medicine, P.C. These
physicians are specialists who will perform a more extensive ultrasound, any other testing
necessary and will provide genetic counseling regarding the specific risk that your baby has.
Even those women with a positive triple screen result have a greater than 95% chance of
having normal follow-up tests and delivering babies who do not have open neural defects or
Down’s syndrome.
If the Triple Screen test is normal, does that mean that everything will be perfect with my
baby?
It is important to note that not every normal result of a screening test results in a baby
born without birth defects. Not all cases of open fetal defects, Trisomy 18, or 21 can be
predicted by testing.
How helpful is the Triple Screen Test in detecting the birth defects it is checking for?
No medical test is perfect. The Triple Screen test has been shown very helpful at
screening for certain defects. If there is one of the following defects, the triple screen, followed
by indicated added tests, will help detect it. In a California study, the triple screen with followup detected:
97% of anencephaly cases
80% of open spina bifida cases
85% of abdominal wall defects
50% or more of trisomy 18 cases
In women aged 35 and under, 40-66% of Down’s syndrome cases.
24
CYSTIC FIBROSIS INFORMATION SHEET
What is Cystic Fibrosis?
Cystic Fibrosis is a serious disease that affects many parts of the body. It causes the
glands that help us to digest food, make sweat, and moisten the linings of airways in our lungs to
not work right. It can cause a man to be sterile. It can also show up as problems with digestion,
breathing and sweating. It most commonly causes repeated lung infections and bronchitis.
What causes Cystic Fibrosis?
It is a condition that is inherited from both parents. Each parent must be a carrier of a
gene that does not work correctly. This one gene may be passed to the child. If it ism the child
may be born with the problem. Carriers of this gene rarely show signs of the disease. If only
one parent is a carrier of the gene, the child will not be born with cystic fibrosis. If both parents
carry the gene, they have a 1 in 4 chance of having a baby with the disease. In other words, 3 out
of 4 times parents who are both carriers will have a baby that does not have the disease. For
each and every pregnancy of both carrier parents there is a 2 out of 4 chance that the baby will be
a carrier but will not have the disease. There is also a 1 in 4 chance that the baby will not have
received any of the genes that cause this and will not be a carrier of the disease.
How common is Cystic Fibrosis?
In the United States, it is most common in Caucasians, with 1 person in every 2,500
being affected by the disease. One out of 25 Caucasians are carriers of this gene and do not have
problems with the disease. It is rare in non-Caucasians. 1 in 11,500 Hispanics, 1 in 14,000
African-Americans, and 1 in 25,000 Asians.
Who should consider testing?
• If you or the father of the baby is Caucasian
• Anyone with a relative that has cystic fibrosis
• If the baby’s father is a known carrier
• Anyone with a medical problem that may be from cystic fibrosis
• Anyone told by a genetic counselor that there is an increased risk
The decision to have the testing done is a personal one for you and the baby’s father. This
disease is a serious problem for the children who are affected by it. However, almost no
insurance companies currently cover the charge for testing. It is covered by Georgia Medicaid.
The cost for the test is about $375 each. If you are pregnant and both you and the baby’s father
are carriers, testing can be done on the baby while still inside the uterus to see if it has cystic
fibrosis. This test is done by amniocentesis or CVS sampling.
To learn more about this test and about Cystic Fibrosis:
Cystic Fibrosis Foundation National Society for Genetic Counselors
6931 Arlington Road
Executive Office
Bethesda, MD 20814
233 Canterbury Drive
1-800-344-4823
Wallingford, PA 19086-6617
www.cff.org
www.nsgc.org
If you contact your insurance company regarding coverage for this test, you will need the
following information: CPT code: 83891, 83912, 83901, 83896 Diagnosis code: V77.6
Test code: 100.21
25
PARVOVIRUS B19 INFECTION (FIFTH DISEASE)
What is Parvovirus B19?
Parvovirus B19 is a virus that commonly infects humans; about 50% of all adults have been
infected sometime during childhood or adolescence. Parvovirus B19 infects only humans. There
is animal parvovirus, but they do not infect humans. Therefore, a person cannot catch Parvovirus
B19 from a dog or a cat.
What illnesses does Parvovirus B19 infection cause?
The most common illness caused by parvovirus B19 infection is “fifth disease,” a mild rash
illness that occurs most often in children. The ill child typically has a “slapped Cheek” rash on
the face and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. The child is
usually not very ill, and the rash resolves in 7 – 10 days. Once a child recovers from parvovirus
infection, he or she will develop lasting immunity, which means that the child is protected
against future infection.
An adult who has not previously been infected with parvovirus B19 can be infected and become
ill. They may develop a rash, or joint pain, or swelling, or both. The joint symptoms usually
resolve in a week or two, but they may last several months.
Are these illnesses serious?
Fifth disease is usually a mild illness. It resolves without medical treatment among children and
adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without longterm disability.
During outbreaks of fifth disease, about 20% of adults and children are infected without getting
any symptoms at all.
Is there any way I can keep from being infected with Parvovirus B19 during my pregnancy?
There is no vaccine or medication that prevents parvovirus B19 infection. Frequent hand
washing is recommended as a practical and probably effective method to reduce the spread of
parvovirus. Excluding persons with fifth disease from work, child care centers, schools, or other
settings is not likely to prevent the spread of parvovirus, since ill persons are contagious before
they develop the characteristic rash.
I’ve recently been exposed to a child with fifth disease. How will this affect my pregnancy?
Usually, there are not serious complications for a pregnant woman or her baby because of
exposure to a person with fifth disease. About 50% of women are already immune to parvovirus
B19, and these women and their babies are protected from infection and illness. Even if a woman
is susceptible and gets infected with parvovirus B19, she usually experiences only a mild illness.
Likewise, her unborn baby usually does not have any problems attributable to parvovirus B19
infection.
Sometimes, however, parvovirus B19 infection cause the unborn baby to have severe anemia and
the women may have a miscarriage. This occurs in less than 5% of all pregnant women who are
infected with parvovirus B19 and occurs more commonly during the first half of pregnancy.
There is no evidence that parvovirus B19 infection causes birth defects or mental retardation.
26
If I’ve been exposed to someone with fifth disease, what should I do?
If you are exposed to someone with fifth disease, call the office and we will perform a blood test
to see if you have become infected with parvovirus B19. A blood test for parvovirus may show:
(1). You are immune to parvovirus B19 and have no sign of recent infection; (2) that you are not
immune and have not yet been infected; (3). That you have had a recent infection. If you are
immune, then you have nothing further to be concerned about. If you are not immune and not yet
infected, then you should try to avoid further exposure to fifth disease. If you have had a recent
infection, we will discuss your plan of care.
There is no universally recommended approach to monitoring a pregnant woman who has a
documented parvovirus B19 infection. At SOUTHERN CRESCENT WOMEN'S
HEALTHCARE, we will refer you to the perinatalogist for ultrasounds and possibly more blood
tests. If the unborn baby appears to be ill, other diagnostic and treatment options are available,
and we will discuss these options with you and their potential benefits and risks.
27
TOXOPLASMOSIS
What is toxoplasmosis?
Toxoplasmosis is an infection caused by the parasite Toxoplasmosis gondii. More than 60
million people in the United States probably carry the parasite, but very few have symptoms
because the immune system usually keeps the parasite from causing illness. However, expectant
mothers should be cautious because an infection can cause problems in pregnancy.
How is toxoplasmosis spread?
Cats play an important role in the spread of toxoplasmosis. They become infected by eating
infected rodents, birds, or other small animals. The parasite is then passed in the cat’s feces.
Litter boxes, garden soils, and sand boxes are used for elimination by cats and can be a source of
contamination.
You do not have to give up your cat!
The best way to protect yourself and your unborn child:
• Wash your hands with soap and water after exposure to soil, sand, raw meat, or unwashed
fruits and vegetables.
• Cook your meat completely (no pink should be seen and the juices should be clear).
• The internal temperature of the meat should reach 160 degrees
• Do not sample meat until it is cooked
• Wash all cutting boards and knives thoroughly with hot soapy water after each use
• Wash and /or peel all fruits and vegetables before eating them
• Wear gloves when gardening or handling sand from a sandbox. Wash hands well
afterward.
• Avoid drinking untreated water
• Do not change litter boxes
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GENERAL HEALTH INFORMATION
1. It is best if you do not use any medications during the first 12 weeks of your pregnancy,
unless recommended for a specific condition. It is a general rule that medications should
be avoided during pregnancy unless indicated but, if a specific condition develops, there
are a number of medications that have been widely used for years and have been
demonstrated to have a wide margin of safety.
2. Take your prenatal vitamins daily, about two hours after eating with water or 100% fruit
juice. Do not take them first thing in the morning on an empty stomach. If you are
unable to find a prenatal vitamin that you can tolerate, take two children’s chewable
vitamins as a substitute (together or separately as with a prenatal vitamin: two hours after
eating with water or 100% fruit juice).
3. We recommend that you decrease your intake of caffeinated drinks to two servings per
day (including coffee, teas, and colas with caffeine) during pregnancy. If you are a heavy
user, decrease gradually to prevent caffeine withdrawal headaches.
4. Avoid alcohol. There is no amount that is considered safe.
5. Nausea and vomiting are common in early pregnancy. Try the suggestions listed on the
“Tips for Morning Sickness” information sheet. If nothing stays in your stomach for
greater than forty-eight (48) hours after following the information sheet’s
recommendations, call the triage nurse or nurse-midwife on call.
6. If you get a minor illness, such as a cold, runny nose, mild sore throat, slight fever
(temperature under 100.4, which lasts less than 3 days) chills, muscle aches or headache,
the medications below can be used.
7. If a fever (temperature of 100.4 or greater) develops, take extra strength Tylenol (two
pills every three to four hours) to keep your temperature less than 100.4.
COLD, HAYFEVER & HEAD CONGESTION
Follow the directions on the package and do not exceed the recommended dose
Any products in the following families of drugs: Tylenol (e.g., Tylenol Severe
Cold and Sinus), Benadryl, Robitussin, Sudafed, Actifed, Triaminic, Chlor-Trimeton,
Claritin)
Other comfort measures for colds include:
Salt water nasal drops; warm, wet compress to your sinus area to help them open
and draining; keep room heat on a lower setting - it helps keep the air from being too dry;
a vaporizer or humidifier can help keep moisture in the air; sleep on extra pillows to keep
your head elevated; be sure to drink lots of fluids, such as, 100% fruit juices and water to
help keep you will hydrated.
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Coughs
The only active ingredient found to be effective in over-the-counter cough medicines is
“DM” (dexatromethoraphan), e.g., Robitussin DM
Sore Throat
Chloraseptic spray
Warm salt water gargles
Throat lozenges
Diarrhea
Avoid foods containing milk products and caffeine.
Kaopectate (although has not been shown to be as effective as Imodium)
Imodium AD
Constipation
Fibercon
Metamucil
Citrucel
Colace 100mg tablets twice a day
Unrefined bran 1-2 teaspoons twice daily
Uncle Sam’s cereal works
Milk of Magnesia or a Fleets enema at bedtime if condition unresolved by other methods
Hemorrhoids
Tucks – may want to keep them cool in refrigerator for increased pain relief
Anusol HC cream and suppositories
Ice packs
Heartburn & Gas
Liquid remedies work more effectively for rapid relief than do tablets.
Products containing simethicone
Tums
Mylanta Complete
Maalox Max
Papaya
Riopan
Pepcid AC
Pepcid Complete
Zantac
Fever, Muscle Aches and Headaches
Tylenol-Regular Strength
2 tablets every 4-6 hours
Tylenol – Extra Strength
2 tablets every 4-6 hours
AVOID: aspirin products, ibuprofen products, such as, Advil, Nuprin and Motrin IB,
and naproxen products, such as, Aleve or Anaprox during pregnancy, unless directed to take
by your provider.
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COMMON DISCOMFORTS OF PREGNANCY
DISCOMFORT
DISCOMFORT
CAUSE
ACTIONS
Bad Dreams
*Subconscious fears
*A way of working
through concerns
*High hormone levels
*Talk with someone supportive
*They are not predictive
Bleeding Gums
*Increased blood volume
*Congested mucous
membranes
*Use a soft toothbrush/ brush gently
*Eat more foods with Vitamin C
*Floss daily
Bowel Changes
(Constipation)
*Decreased movement
of intestines due to
pregnancy hormones
*Not enough fiber/fluids
in diet
*Pressure from growing
uterus
*Eat raw fruits, vegetables, prunes
and whole grain or bran cereals
*Drink lots of water (8-10 glasses daily)
*Drink a cup of hot water 3x a day
*Exercise (walk)
*See information sheet
Dizziness
* Effects of pregnancy
hormones on bl. Vessels
(they constrict more slowly)
*Sudden changes of
position (standing up)
*Enlarged uterus restricts
return of blood from lower
extremities to brain
*Get up slowly when you have been
lying down
*Drink 8-10 glasses of water daily
*Eat regular meals
*Do not stay in the sun too long
*If cannot resolve with common remedies,
report symptoms to provider
Fatigue
*Changes in hormones
*Exercise each day
*Lie down at least once a day
*Eat 5-6 meals a day
Frequent Urination
*Pressure on bladder
from growing uterus
*Limit fluids in the evening
*Avoid caffeine – it’s a diuretic
*Call health care provider if it is
associated with burning, fever, or
significant back pain
Headaches
cause pressure in blood
vessels to change
*Stress, fatigue, hunger
*Drink more water
*Get more rest
*Eat a snack
*Exercise
*Take Tylenol
*If frequent, severe headaches occur in
late pregnancy, this may be a sign of a
more serious problem; you should
inform your provider
Heartburn
*Stomach acid gets into
the esophagus
*Don’t lie down after eating for 2 hrs.
*Avoid spicy and greasy foods
*Take antacids (see approved meds list)
31
Leg Cramps
*Insufficient calcium
intake
*Poor circulation
*Changes in Ca-MagPhosphorus ratio
*Elevate legs often
*Point toes upward and press down
on kneecap
*Wear supportive hose
*Take short rests with legs raised
Low Back Pain
*Weight of larger belly
pulling on lower back
*Poor body position
when bending/lifting
*Loosening of pelvic
joints from pregnancy
hormones
*Rest often
*Maintain good posture
*Move around
*When reclining or sitting, keep your
knees higher than your hips
*Wear low-heeled shoes
*Wear maternity belt (go to
www.prenatalcradle.com)
Low Belly/abd.
(Pelvic) Pain
*Stretching of round
ligaments
*Relax in warm water
*Bend over or sit down
Moodiness
*Psychological adjustment
to pregnancy
*Talk with someone supportive
*Use relaxation breathing
*Don’t use as excuse to lash out at
loved ones
*Report symptoms of significant
depression/inability to cope
Nausea/Vomiting
*Have a snack in the morning
(dry crackers, toast, cereal)
*Eat 5-6 meals a day
*Avoid greasy/spicy foods
*Drink lots of water between meals,
but not during meals
*See “Tips for Morning Sickness” sheet
Shortness of Breath
*Pressure of growing
uterus against the
diaphragm
*Extra protection from the
brain’s lowered carbon
dioxide threshold
*Rest often
*Maintain good posture
*Sighing and needing to take deep
breaths is normal
Sore Breasts
*Effects of pregnancy
hormones causing
significant growth
*Wear a good, well-fitting pregnancy bra
Stretch Marks
*Rapid growth of uterus
*Genetic predisposition
*Wear “scars of motherhood” proudly
*Expensive creams have no effect and
will not prevent or make them go away
*After pregnancy, the color will lighten but
the stretch marks will never permanently
go away
*Pregnancy hormones cause
dark coloration
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Swelling of hands/
legs
*Slowing of blood due to
pressure from growing
uterus
*Retention of water in extravascular spaces due to
inc. bl. volume and bl.
vessel changes
*Lie on left or right side for 30 minutes
3 to 4 times a day
* Exercise often
*Drink more water
*Eat 3 servings of protein a day
*Eat “normal” salt diet (not high or low)
*Eat whole grain breads (no white bread)
*Report sudden increase in swelling if
associated w/ severe headaches after
28 weeks gestation
Uterine Cramping
*Muscle contraction
due to uterine growth
*Not drinking enough
water, especially in warm
weather or at work
*Drink more water
*Expect mild, irregular contractions as the
third trimester advances, especially in
late evening, nighttime hours
Vaginal Discharge
*Stimulation of vaginal
tissue growth caused
by pregnancy hormones
*Wear cotton underwear
*Avoid pantyhose and tight pants
*Use non-perfumed soap
*Do not use feminine hygiene
products, sprays, or powders
*Bathe the outer vaginal area daily
*Call health care provider if accompanied
by itching, burning, or irritation, or if
you think your bag of waters is broken
*Wear unperfumed lightday pads and
change frequently
*Do not douche
Varicose Veins
*Widening of veins
because of pregnancy
hormones, increased blood
volume, and the “tourniquet”
effect of uterus on the
lower extremities
*Genetic predisposition
*Avoid stockings or girdles with
elastic bands
*Wear supportive hose (thigh high or
pantyhose)
*Take short rests with legs raised
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Midwives Tips for Morning Sickness
Nausea, with or without vomiting, is known as “morning sickness” but may occur any time of
the day or night. Although we do not know exactly why women experience morning sickness,
some thoughts are: hormonal changes during pregnancy, low blood sugar, gastric overload,
slowed movement of the intestines, enlarged uterus, and emotional factors.
Take heart. in most cases morning sickness goes away by the 14th week of pregnancy.
Try the following to ease the symptoms:
•
•
•
•
•
•
•
•
•
•
Eat small, frequent meals (every 2 hours). Avoid foods that smell "funny" or are not
appealing to you at the time. Eat whatever sounds good. Let someone else do the
cooking!
Try the timeless remedy of crackers or toast (in bed) or just after you get up.
Try ice cold beverages. Some women do better just sucking on ice. And some do better
when they add a splash of lemon juice to their cold water.
Try eating a protein snack just before going to bed, such as cheese & crackers, or peanut
butter & toast.
Stop your vitamins and iron supplements (temporarily) if you think they are adding to
your morning sickness problem. Or try taking the vitamin at bedtime with a snack.
Take a vitamin B6 (pyridoxine) tablet-25 mg, three times a day-every day. Ovaltine is
enriched with vitamin B6.
Take Unisom (doxylamine) 1 tablet (25 mg) at bedtime- with the vitamin B6. In the
morning take ½ a tablet (with the B6). At 2 pm, ½ tablet with vitamin B6. Ask your
pharmacist to help you find this medication. It is available over-the-counter and some
brands are less expensive that others. In order for this to help, you need to take it
regularly not just when you feel sick.
Take ginger. You can find this spice in the health food or vitamin stores. Get the 250mg
capsules. Take one capsule 4 times each day, or try nibbling on ginger snap cookies.
Sea-Bands (seasickness prevention wrist bands) which are available at most drug stores
help many women. Some women swear by them, and others do not find them helpful.
If these suggestions do not work give us a call. We can prescribe medications that are not
available over-the-counter. However, they can make you very sleepy; therefore it is wise
to try the other remedies first.
If you ever find that you are among the very few who are unable to keep anything down for 48
hours (even liquids) give us a call. In these extreme cases we recommend that you come into the
hospital for IV fluid therapy.
34
Habits to Improve and Prevent Constipation
During pregnancy, you may experience changes in your bowel habits due to decreased
movement of the intestines due to pregnancy hormones, not getting enough fluids and fiber in
your diet and pressure from the growing uterus. There are things that you can do to prevent
getting constipated.
•
•
•
•
•
•
•
Drink plenty of water every day. You should be drinking two liters of water daily. You
may add fruit juices, but be aware of the calorie content. Do not count beverages
containing caffeine since these can be dehydrating.
Drink prune juice or hot beverages, especially early in the morning. These may help
stimulate bowel activity.
Establish regular eating, sleeping, exercise habits. You should have regular bowel
movements each day.
Eat a diet high in fiber which provides bulk in your digestive tract. Include high fiber
foods in each meal.
o Six servings of fruits and vegetables daily. Include the skins and peels of these
foods whenever possible because they contain roughage.
o Beans, peas, and lentils are great sources of dietary fiber
o Eat whole grain breads, cereals, and starches. Look for products that list whole
wheat, rye, oats, or brown rice as the first ingredients on the label. Bran cereals
are excellent sources of fiber. Uncle Sam’s Cereal (cold cereal) contains flax and
is an excellent source of fiber.
o Increase fiber gradually. Rapid increases may cause bloating and increased gas.
Empty your bowels when the need occurs. Try to avoid straining.
Avoid using laxatives since they can cause you to become dependent on them for bowel
movements.
You may use a stool softener (in the dosage recommended by the manufacturer) such as
Peri-colace, Surfak, or a bulk fiber product like Fibercon, Metamucil, and Citrucel (these
increase the bulk fiber in your stool).
35
NUTRITION IN PREGNANCY
During your pregnancy, you and your baby need additional protein, calories, vitamins, and
minerals. Careful selection of a variety of foods can provide these important nutrients. Your
typical daily intake should be about 2000 to 2200 calories a day.
Dairy
3 to 4 servings
Breakfast: 8 oz carton low-fat yogurt
Lunch: 8 oz milk (skim, 1% or 2%)
Dinner: 8 oz. milk (skim, 1% or 2%), ½ cup ice milk
Add cheese liberally to various foods
Grains/Bread
Whole grains (avoid white bread or refined floor)
6 to 11 servings
Breakfast: 2 slices whole grain bread; or 1 slice + ½ bowl Total, Product 19 or Smart Start
cereal; or 1 whole grain bagel
Lunch: Sandwich with whole grain bread; soup with rice, potatoes or corn
Dinner; Baked potato and/or corn or bread or taco shell
Meat/Protein
For those who like eggs, one dozen eggs per week fixed as you like them provides a good protein
foundation
3 to 4 servings
Breakfast; 2 eggs or 1 egg with 1 oz. cheese in an omelet
Lunch; Turkey (3 oz.)
Dinner; Taco with 3 oz meat filling
Fruits
Preferably eat whole fruits, avoid significant amounts of juice – full of high glycemic index
calories (high sugar) and you don’t get the benefit of the fruit fiber.
2 to 4 servings
Breakfast; ½ cup fruit juice or ½ cup berries
Lunch; 1 whole fruit
Dinner ½ cup applesauce or 1 whole fruit
Vegetables
Focus on green vegetables, dark green leafy vegetables. Avoid lots of corn and potatoes.
3 to 5 servings
Breakfast; carrot juice or V-8 juice
Lunch; 1 cup green beans or spinach salad
Dinner; 6 carrot sticks, cabbage salad, ½ cup of peas
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9 Quick and Easy Snacks
• Celery sticks with raisins and peanut butter
• Dried apricots or prunes
• Banana
• Hard-boiled eggs
• Yogurt
• Granola bar (low-fat)
• Handful of almonds, walnuts
• Whole fruit
• Sport shakes (contain about 9 grams of protein)
8 Common Pitfalls: Things to Avoid
• Skipping breakfast (10 to 12 hours is too long between meals for fetus and increases
caloric intake for the remainder of the day)
• Not exercising (30-minute walk in the morning can decrease appetite and increase
stamina)
• Too large serving ( when in doubt, ½ cup will usually suffice)
• Whole milk – stick with 1%, 2% or skim
• Fast food
• Fried food
• Quick snacks, such as chips, and toaster pastries
• Butter on bread and vegetables
IRON
Low iron levels can lower the oxygen-carrying capacity of the blood causing a woman to
constantly feel tired, even after adequate rest. In addition to increasing dietary iron (see list
below), the following practices will increase iron absorption: 1)consume iron-rich foods along
with foods containing vitamin C; 2) avoid consumption of tea with iron-rich foods ( the tannins
in tea inhibit iron absorption); and 3) cook in cast-iron skillets or pots.
IRON RICH FOODS LIST
Meats and Meat Substitutes
• Liver-calf, pork, lamb, beef, chicken
• Seafood-calms, oysters, shrimp, scallops, sardines, tuna, salmon
• Beef, pork, veal, turkey, duck, chicken, lamb, ham, venison, rabbit
• Peanut butter and nuts
• Sunflower seed
• Soybeans
• Dried beans and peas, lentils
• Baked beans
• Eggs
37
Vegetables and Fruits
• Green peas
• Dark green leafy vegetables-spinach, collard greens, mustard greens, turnip greens, kale,
etc.
• Broccoli
• Tomato juice, tomatoes
• Dried fruits- raisins, apricots, peaches, dates, figs
• Watermelon
• Strawberries
• Bananas
• Mangos
Breads and Cereals
• Enriched cereals- Special K, Raisin Bran, Product 19, Total, Wheaties and any other
fortified cereals, which have greater than 25% iron listed on the nutrition label
• Cream of Wheat, Malt-O-Meal, Wheatena, Oatmeal
• Whole grain and enriched breads and bakery products
• Enriched flour, cornmeal and tortilla
• Enriched macaroni, rice and noodles
Miscellaneous
• Wheat germ
• Black strap molasses
Calcium- In order for your baby’s bones and teeth to develop normally, your calcium intake
should be increased to 1,200 mg daily. Good sources include;
• Skim, 1% or 2% milk, frozen yogurt, ice milk, cheese
• Broccoli, spinach, collard and turnip greens
• Water-packed salmon, mackerel, or sardines canned with bones
Calcium Content of Some Foods
1 cup skim milk, 302mg
1 oz American cheese, 174mg
1 cup plain low-fat yogurt, 415mg
3 oz. salmon, canned with bones, 203mg
½ cup cooked turnip greens, 9mg
½ cup cooked broccoli, 89mg
Tips:
•
•
•
•
1 cup whole milk, 291mg
1 oz. part-skim mozzarella, 183mg
½ cup frozen yogurt, 89mg
3 oz baked perch, 117mg
½ cup cooked okra, 88mg
½ cup cooked beet greens, 82mg
For breakfast prepare your hot cereal with milk, instead of water
Add cottage cheese or frozen yogurt to fruit
For dinner, toss grated cheese on your salad or baked potato
For a snack, enjoy yogurt. Add fruit or low-fat granola, if you like
38
EATING SAFELY DURING PREGNANCY
During pregnancy, you can eat the same things that you normally eat when you were not
pregnant. But especially in the first few months of your pregnancy, your baby can be hurt by
poisons (toxins) or germs (bacteria). For this reason, you need to be aware of these food dangers
and learn how to choose and prepare your food safely.
What Foods Might Be Harmful to My Baby During Pregnancy?
The foods of most concern are fish, meat, milk, and cheese. Because these are important parts of
most diets, you will want to learn to choose the right fish, meat, milk, or cheese.
What’s the Problem With Fish?
Many fish—especially fish that are large, eat other fish, and live a long time—have mercury in
them.
Mercury can cause problems with the development of your baby’s brain and nerves. Fish may
also have dioxins and polychlorinated biphenyls (PCBs). These toxins may cause problems with
the development of your baby’s brain and may cause cancer.
So Should I Just Stop Eating Fish?
No. Fish is a wonderful food. It has lots of good protein and other nutrients. You can continue to
eat fish, but you may wish to cut down on the amount of fish you eat and change the kind of fish
you eat. Information about which fish are good to eat during pregnancy is listed on the back of
this page.
What Meat Is Dangerous?
In the United States most of our meat is safe to eat. However, meat that has not been kept cold or
that has not been prepared properly may have germs or parasites that could harm you or your
baby. Raw or undercooked meat may contain toxoplasmosis. Toxoplasmosis is a germ that can
damage your growing baby’s eyes, brain, and hearing.
What Do I Need to Know About Milk and Cheese?
Some cheese may contain germs (bacteria) called listeria. These germs can cause a disease called
listeriosis, which may cause miscarriage, stillbirth, or serious health problems for your baby. To
avoid listeriosis, you may want to avoid soft cheeses like Mexican-style queso blanco fresco,
feta, or Brie. The flip side will tell you which cheeses you can continue to enjoy and which types
to avoid.
How Do I Prepare Food Safely?
. Wash your hands and cooking surfaces often.
. Keep raw meat away from raw fruit and vegetables and cooked meat.
. Cook your food until it is steaming hot. Keep uneaten food cold or frozen.
Eating Safely During Pregnancy: Fish, Meat, Milk, and Cheese
Food Recommendations
Fresh Fish
Shark, swordfish, king mackerel, tilefish - Do not eat
Farmed salmon - eat no more than 1 meal a month
Albacore tuna (“white” tuna) - eat no more than 1 meal a week
Shrimp, canned light tuna, canned or wild salmon, Pollock, and catfish Eat no more than 2 meals a week
Deli Meats and Smoked Fish
Deli meat spread - Do not eat
Hot dogs, lunch meat, deli meat, deli smoked fish Do not eat unless you reheat to steaming hot
Canned smoked fish or meat spread Eat no more than 2 meals a week
Meat—
Meat—Beef, Chicken, Pork
Any meat that is rotten or raw - Do not eat
Milk and Cheese
39
Do not eat or drink:
Unpasteurized milk, feta cheese, brie cheese, camembert cheese, blue veined
cheeses, Mexican-style queso blanco fresco
Eat all you want:
Hard cheeses, semi-soft cheeses like mozzarella, processed cheese slices,
cream cheese, cottage cheese, yogurt made with pasteurized milk
Skim or 1% pasteurized milk - Drink all you want
Note: Check local advisories about the safety of fish caught by family and friends in your local waters. If you
can’t get advice on this, eat no more than 1 meal a week from fish caught in local waters and don’t eat any
other fish that week. Cook fish by broiling, baking, steaming, or grilling. Remove skin and fat before cooking. Do
not eat the fat that drains from the fish while cooking.
Cook all meats all the way through. When you eat meat, you should not see any pink inside the flesh. After
cutting up raw meat, clean the cutting surface with bleach, soap, and hot water before cutting any raw fruit or
vegetables.
For More Information
Centers for Disease Control and Prevention
http://www.cdc.gov/foodsafety or http://www.cdd.gov/travel/pregnancy
Excellent up-to-date information on food safety issues in the United States and abroad.
Partnership for Food Safety Education
http://www.fightbac.org
The Partnership for Food Safety Education has lots of good information on prevention of illness from the food
supply.
Food and Drug Administration
http://www.fda.gov/bbs/topics/news/2004/NEW01038
The Food and Drug Administration published advisories regarding the consumption of fish in March 2004.
Reading level: 6.4
With women, for a lifetime™
AMERICAN COLLEGE OF NURSE-MIDWIVES
40
SEX DURING PREGNANCY
Sex during pregnancy is a normal activity and may include cuddling, intercourse, oral sex,
manual stimulation, and masturbation. In a normal pregnancy without complications, sexual
intercourse is safe and will not hurt you or the baby. Intercourse does not cause miscarriage. If
you do not have a history or signs of miscarriage or premature labor or signs that our bag of
waters is broken, you may continue to have intercourse until you go into labor. If you have
questions about your form of sexual expression, ask your doctor or certified nurse-midwife.
Changes in Sexuality
It is perfectly normal for your feelings and your partner’s feelings about sex to change during the
pregnancy. At times, your desire for sex may increase while at other times; one or both of you
may feel less interested in sex. There is no common pattern in which couples feel more or less
interested in sex. However, there are some factors that may influence sexual desire during the
different phases of pregnancy.
• During the first trimester, many women notice a decrease in their sexual interest. This
may be related to extreme tenderness of the breasts, fatigue, nausea, vomiting, and fears
of miscarriage. For some couples, knowledge that they have conceived increases the
closeness and sexual desire that they feel.
• In the second trimester, many women have an increased interest in sex. Nausea, fatigue,
and fears of miscarriage have ceased. Another possible explanation is the increased blood
supply to the pelvic area, which can mimic sexual arousal.
• During the third trimester, either partner may feel awkward about the woman’s enlarged
abdomen. Some women may feel unattractive because of the physical changes of late
pregnancy. Parents may worry that sex will harm the baby. Occasionally, husbands may
resent all the attention their wives give to preparation for the birth. Any of these factors
may decrease sexual desire. However, it is also possible to feel a special closeness and
excitement that increases sexual desire.
Make sure that you and your partner share your feelings with each other; many women find that
they need more affection, closeness and tenderness during pregnancy. Intercourse is not the only
form of sexual expression. Other forms of intimacy can be equally satisfying.
Different Positions
As your pregnancy progresses and your abdomen becomes large, sex may become
uncomfortable. During the last months, avoid excessive pressure on your abdomen. Also, deep
penetration of your partner’s penis may be painful. Try the following positions for greater
comfort:
• Woman on top
• Rear entry
• Facing each other while lying on your sides
41
Limitations
There are some conditions under which your provider may advise you to limit or avoid sex
during your pregnancy. These conditions include:
• A history of miscarriage, premature labor or premature delivery
• Cramping or bleeding
• Infection
• Pain with intercourse
• Leaking fluid or breaking of your bag of water
Many pregnant women feel some lower abdominal, menstrual-like cramping after intercourse.
Contact your provider if the cramping does not improve four hours after intercourse. Bleeding
may occur occasionally after intercourse, due to broken blood vessels on the cervix. The
bleeding should turn brown or stop after several hours of rest. If bright red bleeding does not
diminish or stop, call the office.
Precautions
If you have oral sex, remember that air should not be blown into the vagina. This can cause an
air bubble to get into your bloodstream, which can be fatal to you and your baby.
You should never have vaginal or oral intercourse after anal intercourse due to the bacteria found
in the bowel.
Whatever form of sexual expression you choose, it is important to have only one partner.
Women who have more than one sexual partner have a greater risk of contracting a sexually
transmitted disease. These diseases are dangerous for both you and your baby.
42
EXERCISE IN PREGNANCY
Why is exercise important?
Getting regular exercise during pregnancy will:
• Help you stay healthy
• Keep your weight gain in a safe range
• Lose weight faster after the pregnancy
• Improve your mood
• Reduce stress
• Help improve sleep
Some studies have shown that women who exercise during their pregnancy are less likely to
have complications during their labor and birth.
Activity guidelines during pregnancy
It is best to use your own body, your own health, and your own regular activity level as a guide
to what your exercise program will be. Women who were very active before they got pregnant
can generally continue their exercise program with some changes made to the intensity level and
duration. Women who did not exercise regularly before pregnancy will want to start slowly.
Women with medical conditions affecting their pregnancy will need to discuss activity levels
with the provider.
Your center of gravity is lower during pregnancy. This may affect your ability to perform
exercises that you may have been able to do easily before pregnancy. You are also more
susceptible to sprains and strains while pregnant because your ligaments and joints are much
looser and more flexible. Jerky and bouncing movements should be avoided during pregnancy.
There are many safe exercises that you can do during your entire pregnancy provided you follow
some simple guidelines.
1. If you have been getting regular exercise before you became pregnant, you should be able
to maintain that exercise program. Depending on the types of exercise you did before
your pregnancy, you will probably only need to make minor adjustments to your
program.
2. If you are just starting to exercise now to improve your health during the pregnancy, you
should start very slowly and be careful not to over-exert yourself.
3. Regular exercise (at least 3 times per week) is better for you than spurts of exercise
followed by long periods of no activity.
4. Listen to your body! If something hurts, if your heart rate is above 140 beats per minute,
or if you can not hold a conversation while exercising, slow down or stop.
5. Never exercise to the point of exhaustion or breathlessness. This is a sign that you and
your baby are not getting the oxygen supply you both need.
6. Wear comfortable exercise footwear that gives strong ankle and arch support.
7. Wear a good fitting sports bra to protect your breasts.
8. Take frequent breaks and drink plenty of water.
9. Monitor your heart rate during exercise. Your pulse should be at or below 140 beats per
minute.
43
10. Avoid exercising in very hot weather. During the summer, try to get your physical
activity in the early morning or in the evening when it is cooler.
11. Contact sports should be avoided during pregnancy.
12. Weight training during pregnancy should focus on improving your muscle tone in the
upper body and abdominal area. Avoid lifting weights above you head and using weights
that strain your lower back muscles.
13. After your fourth month of pregnancy, avoid exercises that involve lying flat on your
back, because that position will decrease the blood flow to your uterus.
14. Include relaxation and stretching before and after your exercise program. You should
spend at least 5 minutes warming up before exercise and 5 minutes cooling down
afterwards.
15. Eat a healthy diet that includes plenty of fruits, vegetables, and complex carbohydrates.
Refer to Nutrition section.
Activities that should be avoided during pregnancy include:
• Downhill skiing
• Water skiing
• Scuba diving
• Horseback riding
• High impact aerobics
Safe Prenatal Exercises
There are many types of exercises that can be performed by all pregnant women who are not
having complications with their pregnancy. These include:
• walking
• cycling (a stationary bike is safer due to changes in center of gravity)
• low-impact aerobics
• water aerobics
• swimming
• stretching and toning exercise
• Yoga (recommend video: YogaMama though Amazon.com or Barnes & Noble)
• Kegel exercises
A good prenatal workout should include:
1. 5 to 10 minute warm-up
2. 20 to 30 minute low impact, low intensity aerobic activity
3. careful heart rate monitoring (pulse below 140 beats per minute)
4. 5 to 10 minute cool down period with gentle stretching, relaxation, and breathing
exercises.
Which muscle groups are most important to exercise?
In addition to your heart, the three muscle groups you should concentrate on during pregnancy
are the muscles of your back, pelvis, and abdomen.
• Strengthening your abdominal muscles will make it easier to support the increasing
weight of the pregnancy.
•
•
44
Strengthening the pelvic muscles will permit your vagina to widen more easily during
childbirth and prevent urinary problems (leaking urine when you cough or sneeze).
Strengthening back muscles and exercises to improve your posture will minimize the
strain of pregnancy on you lower back and help prevent discomfort caused by poor
posture.
When should I stop exercising?
You should stop exercising and call your health care provider if any unusual symptoms appear,
such as:
• Excessive pain
• Bleeding
• Faintness
• irregular heartbeat (skipped beats)
• pelvic pain
• difficulty walking
Exercises to help prepare your body for labor and birth
Kegel Exercise
A kegel is another name for a pelvic floor exercise. The pelvic floor muscles are attached to the
pelvic bone and act like a hammock, holding your pelvic organs. By exercising these muscles
you will be less likely to tear your perineum during birth, less likely to need an episiotomy, more
likely to have an easier birth, and less likely to have urine leakage when you cough or sneeze.
Doing kegels is easy and convenient. They can be done anywhere, anytime and no one will
know that you are doing them!
How to do the Kegel exercise
1. locate your pelvic floor muscles by trying to stop and start the flow of urine while going
to the bathroom. Once you have identified the muscles, do not continue to do the kegels
when urinating.
2. Once you have located these muscles, simply tighten and relax the muscles over and
over. Work up to doing kegels many times a day, holding the muscles tight for up to 510 seconds before releasing.
Tailor Exercise
The following exercises help to strengthen and tone the muscles you will be using during labor
and birth. Try to perform these exercises every day.
Tailor Sitting
1. sit on the floor
2. bring feet close to your body and cross your ankles
3. maintain this position for as long as you feel comfortable
45
Tailor Press
1. sit on the floor
2. bring bottoms of your feet together as close to your body as you feel comfortable
3. place hands under your knees and press down with your knees while resisting the
pressure with your hands
4. count slowly to three then relax
5. gradually increase the number of presses until your doing them 10 times, twice daily
Tailor Sitting and Stretching
1. sit on the floor with your back straight
2. stretch your legs in front of you with your feet about a foot apart
3. allow your feet to flop outward
4. stretch your hands forward toward your left foot, then back
5. stretch your hands forward toward center, then back
6. stretch your hands forward toward your right foot, then back
7. gradually increase the set of stretches until you are doing them 10 times, twice daily
Pelvic Tilt Exercise
1. tighten the abdominal muscles
2. tighten the buttocks by squeezing and tucking under
3. keep knees relaxed
Pelvic Rocking
1. get on hands and knees with your hands directly under your shoulders and knees under
hips
2. inhale deeply
3. Slowly exhale while pulling the abdomen in and tightening the buttocks so your whole
spine curls into a “C” At the same time tighten the pelvic floor muscles.
4. relax, but keep your back straight
5. repeat these steps eight times.
46
Work During Pregnancy
Can Women Work While Pregnant?
The answer to this question depends on your own health, the health of your fetus, and the type of
job you have. If you and your fetus are healthy and your job presents no greater risks than those
found in daily life, you can probably work right up until labor begins and resume work several
weeks after giving birth.
Some women may have to cut back on or stop work during pregnancy. Before your health care
provider suggests a change in your work routine, they will take several factors into account:
your overall health, how you are feeling, how well the pregnancy is going, your age, and any
problems you had with past pregnancies. Your health care provider my also ask questions about
the type of wok you do, how many hours per week you work, and whether your job duties could
harm you or the fetus.
Heavy Physical Work
Pregnant women can usually keep doing the same things they were used to doing before
pregnancy. However, some things may be hard or risky. These include heavy lifting, climbing,
carrying, standing for a long time, and activities that involve balance. If you have had a preterm
baby or a difficult pregnancy in the past, heavy physical work may be especially risky.
During the first few months of pregnancy, you may feel dizzy, sick to your stomach, and tired.
You may also be more sensitive to heat. If you feel that these symptoms put you at risk for
having accidents, ask your provider about it. Toward the end of pregnancy, your balance
changes with the changing weight and shape of your body. Also, because women tire more
easily when pregnant, even those in the best physical shape will find heavy work more tiring
than usual.
Stress
Stress-both physical and mental-is a part of most people’s lives. A certain amount of stress can
give you more energy and make you more productive. Too much stress, however, can cause
depression, headaches, tiredness, weight gain, changes in eating habits, and problems coping
with everyday life. Stress even plays a role in how well a person can resist disease.
Women who combine a full-time job with housework and child care may feel especially tired
and stressed. Your partner or others may need to take on more duties so that you can get enough
rest. Careful planning and enough sleep are very important.
There is much to be learned about the effects of stress on pregnancy. Practice stress relievers
such as: regular exercise, massage therapy, journaling.
Working Women, Pregnancy, and the Law
Before you take a job, find out from your employer if you might be exposed to toxic substances,
chemicals, or radiation. The personnel office should tell you about medical benefits, disability
coverage, and maternity leave.
47
After you get a job, discuss any concerns you may have about being exposed to toxic substances
with your employee health division, personnel office, or union representative. To find out about
laws on safety at work of o request a list of substances known to have an effect on pregnancy,
contact your state or county health department.
Your Right to Work
In the past, some employers did not let fertile women do jobs that exposed them to substances
that could harm a fetus. In 1991, however, the Supreme Court ruled that a rigid policy that
banned women of childbearing age from certain jobs discriminated against them on the basis of
their sex. Although several toxic substances found in the workplace have harmful effects on
men’s ability to reproduce, men are not banned from jobs on that basis. This Supreme Court
ruling means that it is illegal for an employer to ban women from certain jobs because they
might become pregnant while working there.
Your Right to Disability Benefits
Having a disability means that you are not able to work because of physical problems that could
keep you from performing your usual duties. Only you and your health care provider can decide
whether your pregnancy is partly or totally disabling. A disability related to pregnancy may be
one of three types.
• Disability due to the pregnancy itself. Some women suffer side effects such as nausea,
vomiting, indigestion, dizziness, swollen legs and ankles, which ma cause temporary or
partial disability. There problems are usually minor and many insurance policies do
not consider this a medical disability. You need to discuss this with your care provider
and with your employer.
• Disability due to complications of pregnancy. More serious complications such as
infection, bleeding, early labor, or early rupture of the amniotic sac that surrounds the
fetus during pregnancy will cause disability. Also, medical conditions that you had
before becoming pregnant, such as heart disease, diabetes, or high blood pressure, may
become disabling during pregnancy.
• Disability due to job exposures. Some disabilities may be linked to exposure to high
levels of toxic substances at work that could affect the fetus.
If your health care provider decides that your pregnancy is disabling, or if you have disability
forms for your insurance company, or medical leave of absence, we will be happy to complete
these for you. Please be aware of our policy:
1. There is a $10.00 charge per form. This charge must be paid when dropping
off forms. We will not complete forms without advance payment.
2. Forms may be dropped off and picked up
3. We do not fax forms
4. We mail forms only if you provide a self-addressed, stamped envelope
5. We require sever (7)business days to complete forms
48
The Pregnancy Discrimination Act
The Pregnancy Discrimination Act was passed by Congress in 1978. It requires employers that
offer medical disability benefits to treat pregnancy-related disabilities just like all other
disabilities. In other words, if you are temporarily unable to work because of your pregnancy,
your employer must give you the same rights as other employees temporarily disabled by illness
or accident. If you are partly disabled by pregnancy and your employer regularly assigns lighter
work to other partly disabled workers, the same must be done for you. If your employer
guarantees that temporarily disabled workers can return to their jobs or a job of the same level
and salary, the same must be done for you.
Unfortunately, many employers do not offer disability benefits at all for any condition.
Therefore, they are not obliged to provide disability leave for childbirth or complications of
pregnancy.
If no disability plan is offered where you work, you may qualify for unemployment or temporary
disability benefits from your state. To find out whether Georgia offers benefits and how to
qualify, contact your local unemployment office.
During pregnancy, working women have special concerns. With the advice from your care
provider and help from your employer, you should be able to avoid undue risks while you are
working and provide for any periods of disability.
It is important to eat well during pregnancy (see nutrition section). If possible, keep some
healthy snacks near your work station. Try to rest during breaks at work and after work.
Total “disability” during pregnancy occurs for very few women. Others may be disabled for
only a short time before, during or after giving birth. It varies from woman to woman and is
usually 4-8 weeks. Most women recover quickly and can soon return to their daily routines.
Talk with your care provider about any concerns you have about working while you are
pregnant.
49
WEARING SEATBELTS DURING PREGNANCY
About two-thirds of all pregnancy traumas in the United States are the result of car accidents.
Research shows that properly wearing a seatbelt-whether you are pregnant or not- can seriously
reduce the risk of injury in a car accident.
Many women have concerns about how to wear a seatbelt when they’re pregnant- and with good
reason! When lap belts are improperly worn (over the dome of the uterus), they can significantly
increase pressure on the baby and may possible lead to fetal injury.
But that doesn’t mean that pregnant women shouldn’t wear seat belts. Quite the contrary! In fact,
buckling up properly can now potentially save two lives. Regardless of the stage of pregnancy,
seatbelts should be used with both the lap belt and shoulder harness in place.
Here are some guidelines on wearing seatbelts properly:
• Place the lap belt below your expanding abdomen, across the hips.
• Lay the shoulder belt diagonally between your breast
• Make sure that both the lap and shoulder restraints are as snug as possible without being
uncomfortable
Seatbelt studies have been performed using crash dummies that simulate pregnant women. These
studies have shown that when a seatbelt is worn properly, there’s no potentially damaging force
upon the uterus or the baby. In fact, studies show that the greatest risk of fetal death in a car
accident is due to ejection of the pregnant woman from the car when she is not wearing a
seatbelt.
Remember-the greatest protection for your baby when driving is wearing both your
shoulder and lap restraints
COMMUNITY RESOURCE GUIDE
HOTLINES
• Alcohol/Drug Abuse……………………………..1-800-252-6465
• Battered Women(Clayton)………………………....770-961-7233
• Child Protective Services(Clayton)…………………770-603-4602
• Mental Health Intake………………………………..770-996-4357
• Poison Control………………………………………404-616-9000
• Rape Crisis…………………………………………..770-477-2177
• Red Cross……………………………………………770-961-2552
• United Way Help Line………………………………770-614-1000
• Promina Health Call…………………………………770-541-1111
CHILD SAFETY
• Super Safe Tots………………………………………404-321-5400
MEDICINES
• Family Care…………………………………………..404-366-5527
1000 Main Street, Forest Park
DENTAL
• Ben Massell Clinic……………………………………404-881-1858
18 7th St. NE, Atlanta, 30308
• Clayton State College…………………………………770-961-3441
5900 N. Lee St., Morrow
MEDICAL INSURANCE
• Medicaid
o Adult…………………………………………770-473-2351
o Children………………………………………770-473-2300
o Pregnant women………………………………770-473-6024
o Social Security………………………………1-800-772-1213
o PeachCare for Kids………………………… 1-877-427-3224
CHILD CARE
o Save the Children…………………………………..404-479-4200
o Community Services Authority…………………….404-363-6710
Head Start/After School
Carl Rhodenizer Center/Sheltering Arms…………..770-477-1746
Department of Family/Child Services………………770-603-4600
PARENTING CLASSES
• ABC’s of Parenting………………………………..770-473-5432
• Ga. Council of Child Abuse……………………….404-870-6565
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Adolescent Redirection……………………………404-363-6781
770-473-3947
TRANSPORTATION
o Medicaid……………………………………………1-888-224-7981
•
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52
PREVENTING SEXUALLY TRANSMITTED DISEASES (STDs)
What is an STD?
An STD is an infection that you get from someone else by having sex. You can get an STD by
having vaginal sex (penis in the vagina), anal sex (penis in the rectum), or oral sex (penis in the
mouth or mouth on the vagina).
Are STDs common?
STDs are the second most common infections in the United States and Canada. (The most
common is a cold.) Over a million people each year get STDs.
I have only had sex with my boyfriend. Do I have to worry about STDs?
Anyone who is having sex can get an STD. It is true that if you have had only one partner during
your life, you are at less risk. But it is important to remember that you never know for sure if
your partner has other partners. When you have sex with someone, it is as if you are having sex
with everyone your partner has ever had sex with.
Is AIDS an STD?
AIDS is an STD, and it is very dangerous. But there are many other STDs that are much more
common, and some of them are very dangerous too.
What are the most common STDs?
Chlamydia is the most common STD in the United States. Most women have no symptoms and
do not know when they have Chlamydia. If Chlamydia is not treated, it may cause an infection in
the pelvic organs called Pelvic Inflammatory Disease. PID can cause very bad pain during the
illness and problems getting pregnant or having a normal pregnancy in the future. Chlamydia can
be cured. Both you and your partner will have to take medicine.
Trichomoniasis, or “trich,” is another common STD. You may have a bad-smelling
discharge, and your private parts may itch or burn. Some women have no symptoms. Trich can
be cured easily if both you and your partner take medicine.
Herpes is caused by a virus. About one in every 4 adults has herpes. The first outbreak of
herpes may cause painful, burning sores on your private parts as well as leg pain, headaches, and
painful urination. There is no cure, but there are medicines that can prevent outbreaks and keep
you more comfortable when you have an outbreak.
Warts may show up as bumpy growths on your private parts. About 4 in every 10 adults
have a wart virus. For women, the biggest concern is that some kinds of warts may cause cancer
of the cervix. Once you have a wart virus, you will probably have it forever, and you can give it
to other people. Having an annual Pap test can help prevent problems with cancer of the cervix,
and—if necessary—you can have the bumpy growths removed.
American College of Nurse-Midwives
http://www.midwife.org/focus
The American Social Health Association
http://www.ashastd.org
This site provides up-to-date consumer-focused information on STDs. Brochures and newsletters
are also available.
Centers for Disease Control: CDC National STD Hotline: 1-800-227-8922 or 1-800-342-2437.
53
Frequently asked questions
Can I take a tub bath during pregnancy?
Showers and tub baths are fine during pregnancy. As you become bulkier, the difficulties
and risks of getting in and out of the tub increase, so be careful.
Can I douche?
You should not douche because douching increases the risk of infection during
pregnancy. It is not necessary to douche, even when you are not pregnant.
I’m planning to breastfeed. Is there anything I need to do to prepare my breasts?
Use only water when bathing your breasts and nipples because soap is drying.
Massaging your breasts and nipples with Lansinoh during the last two months of pregnancy may
help condition and prepare them for breastfeeding. If you are at risk for premature labor, do not
massage your breasts.
Can I color my hair?
Yes, you may color or perm your hair during pregnancy. Be aware that some women’s
hair may respond differently to these processes during pregnancy.
Can I get my nails done?
Yes, you may get your nails done in pregnancy. Be sure that there is adequate
ventilation.
Can I get into a tanning bed or spray on tan?
While we do not recommend tanning because of the skin cancer risks, the process will
not harm your baby.
Do I have to take special care of my teeth and gums during pregnancy?
If possible, take care of any dental problems before becoming pregnant. However, if you
have to have dental work done contact your dentist. You need to wear a lead shield for any X
rays and if necessary, we will provide you with a letter outlining what medications can safely be
used in pregnancy.
During pregnancy your gums may become puffy and bleed more easily because of
hormonal changes. Therefore, it is important to brush and floss your teeth every day.
Why does my lower back hurt?
During pregnancy your enlarging abdomen causes a shift in your center of gravity. Often
you try to compensate by arching your back and sticking out your buttocks causing extra strain
on your lower back. In addition, the weight of your breasts may cause your shoulders to slump
forward. This added pressure
Why do my arms and hands get numb?
The weight of your breasts may cause your shoulders to slump forward. This added
pressure compresses the joints and nerve endings that results in numbness and tingling. Good
posture and stretching exercises that focus on the upper body will help circulation and reduce
these symptoms. When sleeping, use pillows to prop your arm up.
AMERICAN COLLEGE OF NURSE-MIDWIVES
54
Family Roles: Mother
Below is a list of common household and infant-care tasks. Give each one a number from 1 to 10 based
on whether you feel that task is something a mother always does, a father always does, something a
mother and father equally share responsibility for, or something in between. If a task does not apply to
your situation, don’t give it a number. Without consulting your partner, rate each task. Have your partner
do the same on the other page. After you have both finished, compare your answers.
Mother
Always
Does
1
2
3
4
Both
Mother &
Father do
5
6
7
8
Father
Always
does
9
10
______Keep the house clean
______Wash the dishes
______Take out the trash
______Household repairs
______Do the grocery shopping
_____Take the baby to the doctor
______Do other shopping (clothes, etc)
______Wash the clothes
______Plan and cook meals
______Manage the family budget
______Diaper the baby
______Maintain the family automobile
______Bathe the baby
_______Work to support the family
______Feed the baby
_______Find childcare
______Feed and care for pets
55
Family Roles: Father
Below is a list of common household and infant-care tasks. Give each one a number from 1 to 10 based
on whether you feel that task is something a mother always does, a father always does, something a
mother and father equally share responsibility for, or something in between. If a task does not apply to
your situation, don’t give it a number. Without consulting your partner, rate each task. Have your partner
do the same on the other page. After you have both finished, compare your answers.
Mother
Always
Does
1
2
3
4
Both
Mother &
Father do
5
6
7
8
Father
Always
does
9
10
______Keep the house clean
______Wash the dishes
______Take out the trash
______Household repairs
______Do the grocery shopping
_____Take the baby to the doctor
______Do other shopping (clothes, etc)
______Wash the clothes
______Plan and cook meals
______Manage the family budget
______Diaper the baby
______Maintain the family automobile
______Bathe the baby
_______Work to support the family
______Feed the baby
_______Find childcare
______Feed and care for pets
56
Common Feelings and Needs of Expectant Mothers
Below is a list of feelings and needs that expectant mothers often have during pregnancy. It is normal to
be both “up” and “down” about being pregnant, and the way you feel may change from day to day. After
all, if this is your first pregnancy, you are finding your way through unfamiliar territory!
Feelings
I can’t believe I’m pregnant
Am I really ready to be a mother
I want to do the right things to take care
myself and my baby
My partner wants to make love,
but will that hurt the baby?
I am so tired of being trapped in this big,
Awkward body!
What will this baby be like?
I dream and fantasize about the baby all the
Time now.
I’m afraid my baby won’t be normal
I can’t wait to have the baby, but I’m afraid of
Going through labor.
Needs
Time and space to rest
Reassurance from your partner or family
that you are loved and have their support.
Follow the booklet that we have
prepared for you.
Take a childbirth class
Sex in pregnancy is okay unless you have a
complication that prevents you from having
intercourse. Talk with your provider at your
OB visits.
57
Common Feelings and Needs of Expectant Fathers
As an expectant father, you may share some of the same feelings as your partner, but many of your
feelings are different. You aren’t experiencing all the hormonal and physical changes that she is, but your
emotional adjustment to parenthood is just as complicated and wonderful. The feelings and needs below
are common among expectant fathers and may help you understand and appreciate your own feelings.
Feelings
Needs
_____________________________________________________________
I can’t believe she’s pregnant!
Am I really ready to be a father?
I want her to take care of
herself and the baby
I want to make love,
but will that hurt the baby?
Reassurance from your partner or family
that you are loved and have their support.
Follow the booklet that we have
prepared for you.
Take a childbirth class
Sex in pregnancy is okay unless you have a
complication that prevents you from having
intercourse. Talk with your provider at your
OB visits.
What will this baby be like?
I’m afraid my baby won’t be normal
She’s the one who’s pregnant, but I’m
gaining weight.
I envy all the attention she is getting.
I think her pregnant body is _________________.
I feel very strongly that I do (or do not) want to be in
the delivery room when the baby is born.
58
How am I Feeling?___________________________________
Use this think sheet to record your feelings and what you think you need from those around you. Have
the baby’s father do it too. You will then have a chance to discuss what you have written.
Mother’s Feelings
What I Need
Father’s Feelings
What He Needs
SECOND
TRIMESTER
59
60
SECOND TRIMESTER FETAL DEVELOPMENT
SIXTEEN TO NINETEEN WEEKS OF PREGNANCY
• All of the organs have developed.
• The fetus just needs time to grow and mature.
• Beneath the gums, teeth are forming.
• Fine hair begins to grow all over the body; this downy hair is called lanugo.
• Your baby’s heart is pumping about 25 quarts of blood each day.
• Fingernails and toenails begin to form, and the baby sucks and swallows.
• Your baby’s vocal cords are formed.
• The sex of the baby is identifiable.
• The legs are now longer than the arms.
• Pads are forming on the fingertips and toes, and the eyes are looking forward rather than out the
sides of the head.
• Meconium, the baby’s first bowel movement, is accumulating within the bowel.
• About one cup of amniotic fluid surrounds your baby.
• The baby’s kidneys now circulate the fluid swallowed by the baby back into the amniotic sac.
• The baby actively kicks its legs and moves its arms, but not with enough strength for the mother
to be able to feel much movement.
• It is possible, however, that you will start to feel a slight “flutter” type of movement when you are
still.
• By the end of the fourth month the baby is 3-4 inches long and weighs 5-6 ounces.
The uterus is about four inches in diameter and the mother’s tummy may show a slight bulge.
TWENTY WEEKS TO TWENTY SEVEN WEEK PREGNANCY
This continues to be a period of rapid growth.
• Your baby is almost fully formed and looks like a miniature human. However, because
the lungs are not well developed and the baby is still very small, a baby cannot usually
live outside the uterus at this stage without highly specialized care.
• Your baby’s skin is wrinkled and red.
• It is covered with lanugo (fine soft hair) and vernix (a substance consisting of oil,
sloughed skin cells and lanugo)
• Real hair and toenails are beginning to grow.
• Your baby’s brain is developing rapidly.
• Fatty sheaths which transport impulses along nerves are forming
• Meconium, your baby’s first stool, is developing.
• A special type of fat (brown fat) that keeps your baby warm at birth is forming.
• Baby girls will develop eggs in their ovaries during this time.
• The baby’s bones are becoming solid.
• By the end of the sixth month, your baby will be around 11 to 14 inches long and will
weigh about 1 to 1 ½ pounds.
61
Preterm Labor
What is Preterm Labor?
In most pregnancies, labor starts between 38-42 weeks after the last menstrual period. Labor is
considered preterm when it starts before the beginning of the 37th week.
Labor starts with regular contractions of the uterus. The cervix thins out (effaces) and opens up
(dilates) so the baby can enter the birth canal. It is not known exactly what causes labor to start.
Hormones produced by both the woman and the fetus play a role. Changes in the uterus, which
may be caused by these hormones, may cause labor to start.
Preterm labor may be a normal process that starts early for some reason or it may be a process
started by some other problem such as infection of the uterus or amniotic fluid. In most cases of
preterm labor, the exact cause is not known.
Why the Concern?
Preterm birth accounts for about 75% of newborn deaths that are not related to birth defects.
Growth and development in the last part of pregnancy is critical to the baby’s health. The earlier
the baby is born, the greater the risk of problems.
Preterm babies tend to grow more slowly. They may have problems with their eyes, ears,
breathing, and nervous system. School, learning, and behavior problems are more common in
children who were preterm babies.
Signs of Preterm Labor
If preterm labor is found early enough, delivery can sometimes be prevented or postponed. This
will give your baby extra time to grow and mature. Even a few more days may mean a healthier
baby.
Sometimes the signs that preterm labor may be starting are fairly easy to detect. The warning
signs of preterm labor are listed below. If you have any of these signs, call our office.
• Watery vaginal discharge or ruptured membranes(your waters break)
• Any vaginal bleeding before 37 weeks
• If you experience the following for 4-6 hours: pelvic or lower abdominal pressure;
constant, low, dull backache; mild abdominal cramps like a menstrual period, with or
without diarrhea; regular contractions or uterine tightening, often painless
• Constant backache or pressure without any other signs is not likely to be preterm labor
Diagnosing Preterm Labor
It can be hard to tell the difference between true and false labor. Preterm labor can only be
diagnosed by finding changes in the cervix. It is common for women to have contractions before
labor starts, sometimes called Braxton-Hicks contractions or false labor. These may be painful
and regular, but usually go away within an hour or with rest.
If you have contractions remember to: drink a liter of water in one hour
Take two extra strength Tylenol
Soak in a warm bath or shower
It the contractions continue and are more often than six times an hour, call the office.
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Women at Risk
Some women are at greater risk for preterm labor than others. Women who have little or no
prenatal care and those who have had preterm labor before are at increased risk. Preterm labor
can happen to anyone, however, without warning.
A number of other factors have also been linked to preterm labor. There are also factors linked
to the fetus that make preterm labor more likely. For instance, too much fluid in the amniotic sac
that surrounds the baby is a risk factor. Problems with the placenta or certain birth defects also
increase the risk. You may be at risk for preterm labor if any of the following applies to you:
• You have any warning signs of preterm labor
• You have had preterm labor during this pregnancy
• You had preterm labor or preterm birth in a previous pregnancy
• You are carrying more than one baby (twins, triplets)
• You have had one or more second-trimester induced abortion
• You have an abnormal cervix (due to surgery, for example)
• You have an abnormal uterus
• You have had abdominal surgery during this pregnancy
• You have had a serious infection while pregnant
• You have had bleeding in the second or third trimester of your pregnancy
• You are underweight or you weigh less than 100 lbs
• You smoke
• You use cocaine
• You have had little or no prenatal care
Despite what is known about these risk factors, much remains to be learned about preterm labor.
Half of the women who go into preterm labor have no known risk factors.
If you are at risk for preterm labor, you may be advised to take certain steps to lower the risk of
preterm birth. These steps may involve changing your life style, having more frequent prenatal
visits, and learning how to monitor your contractions.
Women at risk for preterm labor usually do not have to give up their jobs unless preterm labor
has actually been diagnosed. You may be advised to avoid prolonged standing, heavy lifting or
other hard or tiring tasks during pregnancy. You may also be advised against traveling.
If you have a history of preterm labor or preterm delivery, or have signs of preterm labor, you
may be cautioned about having sex during pregnancy. Many women worry that the uterine
contractions that often follow sex and orgasm will lead to preterm labor. Although inmost cases
the contractions stop, these are natural and realistic concerns that should be discussed with both
your partner and care provider. You may be advised to stop sexual activity and or to use a
condom to reduce the risk of infection.
63
COUNTING FETAL MOVEMENTS
Fetal Kick Counts
What is fetal movement counting?
The unborn baby is called a fetus. The baby’s “kicks” or movements, are called “fetal
movements.” Most pregnant women feel movement by the 20th week of pregnancy.
We recommend that you count fetal movements to check on your unborn baby if you feel that
the baby has not been moving for awhile (after 28 weeks). This is also called a “fetal kick
count.”
You should feel your baby move throughout the day. Your baby may be more active at different
times during the day. As the baby grows, the way you feel the baby move may change. As you
get to know your baby’s movement pattern, you will be able to report any changes to your care
provider.
How to Count
If you know that your baby is active, you do not need to do a daily fetal kick count. However, if
you ever have questions about the baby’s movements, you need to do a fetal kick count.
The best time to do a fetal kick count is after a meal or after having something sweet
and cold to drink. Lie on your side, place your hands on your belly and count the baby’s
movements. Any activity should be counted-movements, kicks, or rolling motion, swishes or
flutters.
Most babies will move 10 times in the first hour. If you feel less than 10 movements in
that hour, try eating/drinking again, walk briskly around the room, and repeat the fetal kick
count.
If your baby does not move 10 times in the second hour, call our office for further
evaluation.
The following chart will help you keep track of your fetal kick counts.
EXAMPLE
Date
Time
Number of
Movements
How Long to get
10 movements
10/15
7:03-7:40
10
35 minutes
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FETAL KICK COUNT RECORD
DATE
TIME
NUMBER OF
MOVEMENTS
HOW LONG TO GET
10 MOVEMENTS
65
GESTATIONAL DIABETES SCREENING TEST
Diabetes is a condition that causes high levels of glucose in the blood. Glucose is a sugar that is
the body’s main source of fuel. Health problems can arise when the glucose levels are too high
or not well controlled. Diabetes is of special concern during pregnancy. The form of diabetes
that occurs during pregnancy is called gestational diabetes.
Causes
Diabetes occurs when there is a problem with the way the body makes or uses insulin.
Insulin is a hormone that converts the glucose in food into energy. When the body doesn’t make
enough insulin, or when insulin is not being used properly by the body, the level of glucose in
the blood becomes too high. This is called hyperglycemia (high sugar levels in the blood).
Because gestational diabetes can occur even when no risk factors of symptoms are present, we
will test all of our patients at 24-28 weeks of pregnancy. Gestational diabetes goes away after
the baby is born. More than half of women who have gestational diabetes will develop diabetes,
although usually many years later. It’s important to let us know if you have had gestational
diabetes with a previous pregnancy.
Testing for Diabetes
The test for diabetes is safe and simple.
• On the morning of your test, do not have any concentrated sweets for breakfast. Avoid
fruit juices, sugar cereals, syrups, jellies, etc.
• When you arrive for your appointment, let the receptionist know that you need to drink
your glucola. This is a sugar drink that will be given to you. You should drink the
glucola over 5-10min.
• Note the time that you finish your drink.
• For the next hour, do not have anything to eat or drink
• At the end of the hour, we will draw your blood.
• The results return from the lab in about a week. You will be notified if your blood level
is greater than 140. Normal results will be reviewed at your next appointment.
• High levels (greater than 140) do not mean that you have gestational diabetes. A high
value means that you need further testing and you will be scheduled for a 3 hour
glucose tolerance test (3hr GTT).
• If your 3 hour test values are abnormal, you will be contacted for follow-up.
Diet
A balanced diet is important in pregnancy. The fetus depends on the food you eat for its growth
and nourishment. This is even more important if you have diabetes. Not eating properly can
cause glucose levels to change.
The number of calories in your diet will depend on your weight, stage of pregnancy, age,
and level of activity. Your diet may have to be adjusted from time to time to improve glucose
control or to meet the needs of the growing fetus. Usually diet consists of several small meals
and snacks spread throughout the day. A bedtime snack is important to keep glucose levels
stable during the night.
66
Love Shouldn't Hurt
by Nicette Jukelevics
Joanne sat bruised and exhausted, hugging her large, pregnant belly. In her mid-30s, blonde and the
blue-eyed, she was a respected teacher in an elementary school, but tonight she felt like a fugitive.
Neither her mother nor her sisters knew how to reach her or where to find her. She was ashamed to say
anything to them. But, for the first time in months, she at least felt safe.
She would sleep tonight in the shelter. In the morning, she would call the school where she taught and tell
them she needed a few days off for a family emergency. If she ever returned to her three-bedroom home,
she reminded herself, she needed to change the locks on the front door. Joanne was married to a welleducated man, with a good job. He was also a wife abuser.
Joanne is not alone. One out of every 15 pregnant women in the United States is a victim of domestic
violence each year.
WHAT IS DOMESTIC VIOLENCE?
Although even one incident is one too many, domestic abuse is defined as a pattern of behavior of
threatened or actual violence committed by a current or former intimate partner. Domestic abuse is not
only physical violence. Partners can also be emotionally or psychologically abusive by: failing to show
affection or caring for a child; interacting only when necessary; staying emotionally uninvolved and
detached.
Why? The abusive partner usually seeks to gain power and control in the relationship through fear and
intimidation. The abuser tries to control his partner's behavior by isolating her from friends and family,
monitoring her movements, belittling or humiliating her in private or in public or restricting her access to
financial resources.
He may force her to have sex or to perform sexual acts that make her feel degraded. He may limit her
access to medical care or threaten to hurt himself or take away her children if she does not comply with
his wishes. Sometimes women are not aware that they are being abused. They may believe that their
partner's behavior is due to a bad day at work, financial pressures, jealousy, depression or use of alcohol
or drugs. Often, the abuser will say he's sorry, bring her gifts, and promise never to hurt her again.
Cultural or religious norms may also play a role in one partner's response to the other's controlling or
punishing behavior.
WHO'S AT RISK?
According to a report released by the Johns Hopkins School of Public Health and the Center for Health
and Gender Equity, "Violence against women is the most pervasive yet least recognized human rights
abuse in the world…The same acts that would be punished if directed at an employer, a neighbor, or an
acquaintance often go unchallenged when men direct them at women especially within the family."
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A U.S. Bureau of Justice study reports that women of any age
and from any racial, ethnic, religious or socioeconomic
background may experience physical or psychological abuse
from an intimate partner, but that women between the ages of
19 and 29 reported more violence by intimate partners than
any other group. In the United States, domestic abuse is also
a crime. Although partner abuse exists among same-sex
relationships, violence against women is most often
perpetrated by a male partner they know and love. Many, like
Joanne, are afraid or ashamed to talk about or report it.
The Cost of Violence
•
•
VIOLENCE DURING PREGNANCY
Domestic violence tends to begin or escalate during
pregnancy. In fact, one in six women reports their first
incidence of partner abuse during pregnancy. One study
concludes that a woman is more likely to be abused by her
partner than suffer from pre-eclampsia, gestational diabetes
or placenta previa, conditions for which women are routinely
checked.
The abuser sees his partner's pregnancy as a threat; he
believes she will care more about the baby than about him.
Pregnant women in abusive relationships are at higher risk
for medical complications that include bleeding problems,
miscarriage, vaginal and cervical infections, high blood
pressure and premature labor and fetal distress. Abuse in
pregnancy also increases the risk for low-weight gain and low
birthweight infants. Once the baby is born, domestic abuse
may escalate.
WHAT ABOUT THE CHILDREN?
Young children are often silent witnesses to domestic
violence, and many are also the targets of their fathers'
physical, emotional or sexual abuse. Each year an estimated
3.3 million children in the United States are exposed to
violence by family members against their mothers or female
caretakers.
Children exposed to violence at home are likely to suffer from
chronic depression and anxiety and may express their
sadness and anger through acting out, defying people in
authority and through other behavioral problems. Children
may become too traumatized to learn or develop normally
and may be unable to reach their full potentials as adults.
Children who witness domestic violence at home are more
likely to repeat the cycle as adults. Experts say young girls
are more likely to tolerate abusive behavior from their own
intimate partners, and young boys are more likely to become
abusers themselves.
•
•
One in every five women who
seeks medical care in emergency
rooms is there as a result of
injuries inflicted in a domestic
violence dispute
U.S. businesses spend an
estimated $5 billion dollars a year
on medical expenses related to
domestic violence, and another
$100 million per year for lost
wages, time away from work, ad
employee turnover directly
related to family violence.
More than 1 million women a
year seek medical assistance for
potentially lethal injuries caused
by battering.
Approximately 2,000 to 4,000
women in the United States are
killed each year by abusive
partners or ex-partners.
Making a Safety Plan
When you feel ready to leave your home,
it will be helpful to have put aside some
things that you will need. It may be safer
to keep those items at a neighbor's or a
friend's house.
•
•
•
•
•
•
•
•
•
Extra set of car keys
Cash, checkbook or credit cards
Driver's license and social
security cards (for you and your
children), green card, passport or
work permit
Clothes for yourself and your
children
Birth certificates
Children's school records
Health insurance cards
Court papers or court orders
Lease agreements or mortgage
payment book
68
Taking the First Step
Making a decision to end a relationship with an abusive partner is often difficult. For some women, it is
the desire to protect their children that brings them to the point of asking for help. Taking action is hard
because domestic abuse usually takes place over a long period of time and a woman's self-esteem and
confidence are slowly eroded. She becomes isolated from her community. A woman may also remain in
an abusive relationship because she is afraid of what family members may say or because she lacks
financial resources. She may worry about compromising her partner's professional status in the
community. Often, she still has hope that the abuse will stop and that her partner will come to his senses.
Each woman knows when she is ready to leave an abusive relationship. When she does, she can take
the first step toward ending the abuse by asking her midwife, other medical care provider, the police or
her employer-assistance program for help.
BREAKING THE SILENCE
Help is available. Call the toll-free National Domestic Violence Hotline: (800) 799-SAFE (7233). From all
50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands, victims of domestic violence,
their families and friends receive crisis intervention, referrals to shelters, medical care, legal assistance
and social-service programs. Trained counselors who speak more than 125 languages are available.
Other Resources:
National Coalition Against Domestic Violence: http://www.ncadv.org
The National Domestic Violence Hotline: http://www.ndvh.org
Are You in a Dangerous Relationship?
Your partner may be a good provider, a successful and respected member of his profession, even a
caring father of your children. You may still love your partner and he may be sorry for hurting you and
may promise never to do it again. However, he may also behave in ways that are considered abusive and
illegal. How can you tell?
•
•
•
•
•
•
•
•
•
•
•
Have you ever been afraid of, or felt threatened by your partner?
Do you worry that things you do may cause your partner to get angry, emotionally abusive or
physically violent?
Has your partner ever attempted to injure you physically by grabbing, punching, kicking, armtwisting, choking or pulling your hair?
Has your partner ever hurt your pets or destroyed your clothing or other things you care about?
Has he threatened to destroy or take away your home or personal property?
Has your partner prevented you from taking medication, seeking medical care, or insisted on
being present at all medical appointments?
Does your partner control your access to financial resources? Decide what and how much you
can buy? Control the bank accounts? Refuse to pay bills?
Does he hide deeds to your home, wills, financial savings, and passports?
Has your partner threatened to harm himself or other people you care about? Has he ever
threatened to harm or taka away your children?
Does he prevent you from communicating with other people by withholding phone calls, keeping
you from speaking with or visiting co-workers, friends or family? Prevent you from going to work
or school?
Do you feel as though he is constantly checking up on you?
•
•
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Does your partner often put you down, devalue your abilities, and make you feel guilty, or
embarrass you in front of others?
Does your partner demand to have sex when you don't want to or when you are ill? Force you to
perform sexual acts that make you uncomfortable or hurt you? Hurt sexual parts of your body?
Insist on unprotected sex or use of pornography?
If you have answered yes to one or more of these questions, know that none of this behavior is
acceptable; you don't deserve it. You may want to seek counseling. If you feel you are in danger, help is
available to you 24 hours a day when you are ready to seek it. You can call the National Domestic
Violence Hotline toll-free, (800) 799-SAVE (7233) or (800) 787-3224 (TDD). You don't have to give your
name, and your wishes will be respected. Trained counselors who speak several languages are available
immediately. They can provide crisis assistance and information about shelters and health care centers,
as well as free legal assistance and counseling. If you are in immediate danger, you should call 911.
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CHILDBIRTH CLASSES
BETTER BIRTH FOUNDATION (Medicaid accepted)
770-297-2880
HENRY MEDICAL CENTER (Medicaid accepted)
770-389-2143
SOUTH FULTON MEDICAL CENTER (Medicaid accepted)
770-469-8870
SOUTHERN REGIONAL MEDICAL CENTER
770-541-1111
Call Southern Regional to schedule the following classes
Sibling Class
Breastfeeding Class
Lactation Consultants Available
Tours of the Women’s Life Center
Pregnancy Nutrition Class
Note: Some insurance companies will reimburse you for the cost of childbirth preparation
classes. Most require you to pay for the classes and then receive reimbursement after verification
of your attendance. Medicaid pays for childbirth classes if you attend greater than 50% of the
scheduled classes.
Southern Regional does not accept payment from Medicaid for childbirth classes. Of course,
anyone (self-pay, insurance or Medicaid) may elect to take childbirth classes and pay out of
pocket. Charges range from $80 to $100 for the series.
71
PEDIATRICIAN LIST
Becknell, Mark, M.D.
Fayetteville Medical
4000 Shakerag Hill
Peachtree City, Ga 30269
770-486-7111
Ford, Fatima, M.D.
Lama, Juan, M.D.
Palomo, Walter, M.D.
Reddy, Lankala, M.D.
Sherwood, Juan, M.D.
Southern Crescent Pediatrics
150 Medical Blvd. Suite B
Stockbridge, GA 30281
770-389-9444
Brichant, Kathie, M.D.
Chadalawada, Pura, M.D.
Mathew, Sushila, M.D.
Velez, Lucila, M.D.
Tri-County Pediatrics
110 Eagle’s Walk, Suite 1
Stockbridge, Georgia 30281
770-389-0116
Gilrane, Marixie, M.D.
Stockbridge Pediatrics
7454 Hanover Pkwy South, Ste 245
770-506-0095
Chaplin, Karen, M.D.
Stewart, Danita, M.D.
Kids World Pediatrics
288 Highway 314 Suite A
Fayetteville, Georgia 302
770-460-2131
Goza, Sara, M.D.
Muntzel, Christiana, M.D.
Fayette Medical Pediatrics
101 Yorktown Dr
Fayetteville, GA 30214
Chin, Nicola, M.D.
Youngblood,Elaine, M.D.
Williams, Wanda, M.D.
Kids First Pediatrics
7444 Hanover Pkwy Suite 150
Coleman, Maria, M.D.
Merritt, Tasha, M.D.
Jonesboro Pediatric Clinic
236 Arrowhead Blvd.
Jonesboro, Georgia 30236
770-478-9240
Collins, Jocelyn, M.D.
Eggert, Ann, M.D.
Muralidhura, Kesturkoppal, M.D.
Peachtree Pediatrics
12 Eastbrook Bend
Peachtree City, GA 30269
770-487-3330
Hoffler, Eric, M.D.
Pulliam, Patrick, M.D.
Reynolds, Melissa, M.D.
Shaw, Billy, M.D.
Wallace, Jamie, M.D.
ABC Pediatrics
Fayetteville GA 30214
770-460-2131
.
Hussianm, Ishrat, M.D.
Mauer, Chaterine, M.D.
1215 Eagles Landing Pkwy
Suite 108 & 109
678-289-8184
Iyer, Ravi, M.D.
3579 Highway 138, Suite 103
678-565-3300
72
Justice, Regina, M.D.
Smith, Ronnie Earl, M.D.
Pediatric & Adolescent Medicine
365 North Jeff Davis Dr.
770-461-5003
Kauffman, Clifford, M.D.
130 Medical Way, Suite B
770-474-0564
Kendall, Cheryl, M.D.
777 Cleveland Ave, S.W.
Suite 400
Atlanta, GA 30315
404-766-3337
Iqbal, Amjad, M.D.
189 Medical Way, Suite C
Riverdale, GA 30274
770-991-8900
Reddy, Subramanyam, M.D.
253 Upper Riverdale Rd, Suite A
Riverdale, GA 30274
770-997-3300
Singh, Amar, M.D.
6740 Shannon Pkwy, Suite 18
Union City, GA 30291
770-969-7500
Singhapakdi, Suapson, M.D.
216 Arrowhead Blvd
Jonesboro, GA 30236
770-471-4442
Kreider, Rodney, M.D.
1215 Eagles Landing Pkwy
Suite 208
770-507-4144
Sorlano, Carlos, M.D.
350 Huntington Place Ct
McDonough, GA
770-957-3393
Leard, Stephen, M.D.
214 Medical Blvd
678-289-0103
Thedford, Victoria, M.D.
South Atlanta Pediatrics
251 Medical Way, Suite A
Riverdale, GA 30274
Mynatt, John, M.D.
Sankaran, Sehkar, M.D.
McDonough Pediatrics
101 Regency Park Dr., Suite 140
McDonough, GA 30253
770-957-8626
Tomeh, Mohammad, M.D.
1203 Cleveland Ave, Suite A&B
East Point, GA 30344
404-768-3043
Potts, John, M.D.
Smith, Ronnie, M.D.
Pediatric & Adolescent Medicine
365 North Jeff Davis Dr.
770-461-5003
Winzer, Kimberly, M.D.
6524 Professional Place
Riverdale, GA 30274
770-994-4060
73
TRAVEL DURING PREGNANCY
People are now traveling more than ever before-both for pleasure and business. Many women,
therefore, need to know where and how they can travel if they are pregnant or planning to
become pregnant. In most cases pregnant women can travel safely, even to exotic destinations,
but it is important to be aware of a number of factors, particularly relating to insurance,
recreational activities, vaccination and medicines. In addition, there are a number of special rules
for pregnant women who wish t travel by air. Finally, there is a need to be careful with a number
of activities such as diving, hiking and water sports, which make particular demands on a
woman’s body during pregnancy. It is not advisable fro pregnant women to go scuba diving or
undertake activities that have a higher risk of physical injury, such as snow skiing, jet skiing, or
water skiing.
For long distance travel it is advisable to bring a copy of your medical records with you, in the
event that a medical visit or hospitalization is required, which will permit the local physician to
provide you with better, more well-informed care.
Travel Insurance Details
Although a pregnancy that progresses normally is not an illness, it will often mean that your have
had care with a doctor or nurse-midwife within the last two months prior to departure. If this is
the case, you might not be covered under the conditions of your travel insurance. Insurance
companies vary in their requirements, so it is advisable to check with your travel agent about
whether you need a written “pre-travel health statement” prior to departure. This would usually
be written by your provider. Medical assistance and maternity care are generally not covered by
travel insurance (which is different from your health insurance policy) from the beginning of the
ninth month of pregnancy.
Traveling by Air
Most airlines allow pregnant women to fly up to and including the 36th week, provided the
pregnancy has been straightforward. Under IATA guidelines, pregnant women are allowed to fly
in weeks 36 to 38 if the flying time does not exceed four hours. However, many airlines will not
carry pregnant women after 36 weeks. Make sure you check with the airline before booking a
flight. Airlines normally refuse to fly pregnant women who have previously given birth
prematurely or have had blood clots in the veins of their legs.
These factors also apply to the journey home. If you traveled out during the seventh month of
pregnancy, there is a risk that you may not be allowed to board the return flight if you are greater
than 36 weeks at the time of your return journey.
On the Plane
• The air humidity in the cabins of passenger aircraft is kept at only eight percent, so
pregnant women should drink plenty of water, particularly on long flights.
• Pregnant women run an increased risk of inflammation and blood clots in veins of the
legs and should avoid sitting still for too long.
•
•
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A pregnant woman should have an aisle seat and move around as much as possiblegetting up several times every hour. This can be supplemented with vein pumping
exercises. The same advice also applies to long car or bus journeys.
Wearing seatbelts in both aircraft and cars is recommended for all pregnant women. They
should be worn low under the uterus and shoulder restraints above the top of the uterus.
Vaccinations and Medicines
The use of medicines during pregnancy is a complicated and sometimes confusing issue. Often,
manufacturers have not undertaken the relevant clinical studies to conclusively state whether a
particular medicine is safe to take during pregnancy. Vaccines are no exception. The majority of
the manufacturers state that there is insufficient information to recommend the use of their
vaccine during pregnancy and advise avoidance. Others say there is a lack of information so their
vaccines should be used with caution.
In any situation where a medicine is required during pregnancy, your health care provider must
weigh the risks to the unborn fetus against the benefits to the mother, which then benefits the
fetus. If the benefits outweigh the risks, the medication will be prescribed. The general rule of
thumb is that “killed virus” (ie: flu) are considered safe during pregnancy while “live viruses”
(i.e.: polio, MMR) are to be avoided.
If motion sickness is a concern, Phenergan tablets are commonly used in pregnancy and a
prescription can be given prior to departure.
Special precautions should be taken to avoid severe, on-going diarrhea. Always drink bottled
water when traveling to a foreign country, particularly in the Third World. If diarrhea should
develop Lomotil has the only ingredient found to be effective in over the counter anti-diarrheas.
Rehydration salts such as Dioralyte will prevent dehydration from diarrhea. Drinking fluids such
as Gatorade or PowerAde will help restore chemical balance.
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Pain Relief During Labor and Birth
A concern that most pregnant women have is how they will cope with the pain of labor and
childbirth. Because you cannot tell in advance how your labor will progress, you should become
educated about the forms of pain control that are available so that you can make an informed
decision.
Types of Pain Relief
Having pain, or getting relief for it, should not be thought of as a sign of failure or a reason for
guilt. Each person’s perception of pain is unique. Each woman’s labor is different and everyone
experiences pain differently. That is why it is important that the decision you make about pain
relief be the right one for you.
Behavioral Techniques
Many women take a childbirth preparation class in order learn what to expect during labor and
birth. They learn breathing methods, relaxation techniques, and other ways of coping with pain
and discomfort during childbirth. These classes can be valuable, and some women are able to use
these techniques to get through childbirth without the need for pain medication. Childbirth
preparation techniques can help a woman manage pain during labor and birth, but they usually
don’t completely remove the pain. In the Women’s Life Center, you can sit in a hot shower,
walk, or use the birthing ball, along with other position changes to help relieve the discomfort of
labor. Research has shown that having the laboring woman participate in the decision-making
process about her labor management is crucial to feeling positively about the birth, regardless of
labor being and “easy” or a “difficult” one.
Pain Relief Measures
Systemic Analgesia (IV medication)
Systemic analgesics provide relief over the entire body without causing loss of consciousness.
They act on the whole nervous system, rather than on one particular area. Systemic analgesics
are often given as an injection into a muscle or vein. Sometimes other drugs are given with
systemic analgesics to relieve tension or nausea. While these drugs do not completely get rid of
pain, they do lessen its intensity.
Systemic analgesics may cause drowsiness and may make it hard to concentrate. Because these
drugs can slow the baby’s reflexes and breathing at birth, they are usually avoided just before
delivery.
Epidural Block
Epidural block, another form of local anesthesia, affects a much larger area than any of the
methods described above. It numbs the lower half of the body to a varying extent, based on the
drug and dose used. An epidural block is injected into the lower back, where the nerves that
receive sensations from the lower body meet the spinal cord. This kind of anesthesia is helpful
for easing the pain of uterine contractions, the pain in the vagina and rectum as the baby
descends, and the pain of suturing. While the drug is working, you may lose some muscle
control which makes it harder to “bear down” during the second stage of labor.
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Epidural block can have some side effects. It may cause the mother’s blood pressure to drop,
which in turn may slow the baby’s heartbeat. Preventive measures are taken to avoid this: before
you can receive an epidural, you will be given 1500cc of IV fluids; once the epidural is placed,
you will be positioned on your side to help circulation; you may receive medicine through your
IV that will help correct your blood pressure and the baby’s heartbeat; you may be given an
oxygen mask to breathe through to help increase the amount of oxygen the baby receives.
With epidural anesthesia, it may be harder for the mother to bear down and push the baby
through the birth canal. It may be necessary for the baby to be delivered with forceps or with a
vacuum extraction, special instruments that are placed around or attached to the baby’s head to
help guide the baby out of the birth canal.
If the covering of the spinal cord is punctured when the drug is given, the drug may enter the
spinal fluid or a vein. You may then get a severe headache, which can last for a day or more. If
the drug enters a vein, it could cause dizziness or very rarely, seizures. Special precautions are
taken to avoid these problems.
Spinal Block
Spinal block is the pain relief method most often used for cesarean birth. A spinal block numbs
the lower half of the body. It provides good relief from pain, starts working quickly, and is
effective in small doses.
Spinal block can sometimes cause some of the same side effects as epidural block: headaches, a
drop in the mother’s blood pressure and a drop in the baby’s heartbeat.
Local Anesthesia
Local anesthetics can be used in the vagina or the surrounding area to ease pain during delivery.
Local anesthetics usually affect a small area, and so are especially useful to repair an episiotomy
or laceration.
One advantage of local anesthesia is that it rarely affects the baby. After the anesthetic wears
off, there are no lingering effects. The main drawback of these drugs is that they do not relieve
the pain of contractions during labor.
General Anesthesia
General anesthetics are medications that make you lose consciousness. General anesthesia is
used for cesarean delivery or other urgent situations.
These drugs are given through a face mask or through the IV line. Once the drug is given, it
works very quickly, and is usually given just before delivery.
When general anesthetics are used during childbirth, the patient’s stomach may not be empty
which may cause vomiting. Special precautions are taken to avoid this complication. After you
are asleep, a tube will probably be placed in your throat to help you breathe.
After general anesthesia wears off, you will feel woozy and tired for several hours after waking
up. You may also feel sick to your stomach; this feeling usually fades within a day. Also, your
throat may be sore from the tube that was used to provide oxygen.
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Recovery from Pain Medications
What you experience as you recover from pain medications will depend on the type that was
used. In any case, once it wears off, you may feel some pain around the vagina, perineum, lower
abdomen, or back, depending on how much the muscles and tissues were strained during
delivery.
Finally…
Many women worry that anesthesia given during labor or childbirth will somehow make the
experience less “natural.” The fact is, no two labors or births are the same, and no two people
have exactly the same ability to tolerate pain. Some women require little or no pain medication,
while may others find that pain relief gives them a better sense of control over their labor and
birth.
Be prepared to be flexible. Some of the techniques described here may appeal to you more than
others. As your care providers, we are dedicated to working with you to have the birth
experience that you want and to help you make informed decisions.
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INFORMATION REGARDING DISABILITY FORMS
During the course of your pregnancy, you may require our assistance with the completion of
disability forms for your insurance company, your employer, credit card companies, and so forth.
We will be happy to complete these for you, and we want you to be aware of our policies.
1. There is a $10.00 charge per form, and payment is expected prior to completion of the
form.
2. Forms will be completed within ten business days.
3. Forms may be picked up personally or mailed via a self-addressed, stamped envelope.
We cannot fax disability forms.
Thank you.
Southern Crescent Women’s HealthCare
THIRD
TRIMESTER
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THIRD TRIMESTER FETAL DEVELOPMENT
Twenty –nine to Thirty-five Weeks of Pregnancy
• Your baby’s eyes can now open and close and can sense light changes.
• The lanugo is starting to disappear from the baby’s face. Your baby’s hearing is getting
better and the baby can now hear the outside world quite well over the sound of your
heartbeat.
• The baby exercises by kicking and stretching and can now make grasping motions.
• Your baby likes to suck its thumb.
• The bones are getting stronger, limbs fatter, and the skin has a healthy glow.
• The brain is now forming its different regions. The brain and nerves are directing bodily
functions.
• Taste buds are developing.
• Your baby may now hiccup, cry, taste sweet and sour, and respond to pain, light, and
sound.
• If you are having a boy, his testicles have fully descended from his abdomen into his
scrotum.
•
By the end of the thirty fifth week, your baby will be approximately 16 to 18 inches long
and weigh about 4 pounds.
THIRTY SIX TO FORTY WEEKS OF PREGNANCY
• Your baby is now gaining about a half pound each week.
• Your baby is getting fatter and its skin is less rumpled.
• The baby is getting ready for birth and is settling into the fetal position with its head
down against the cervix, its legs tucked up to its chest, and its knees against its nose.
• Your antibodies to disease are beginning to flow rapidly through the placenta. The rapid
flow of blood through the umbilical cord keeps it taunt which prevents tangles.
• Your baby is beginning to develop sleeping patterns.
• The baby will continue to kick and punch although it will move lower in your abdomen
to under your pelvis (this is called “lightening” or “the baby has dropped”). You will
also feel your baby roll around as it gets too cramped inside the uterus for much
movement.
• Your baby’s lungs are now mature and your baby will have a great chance of survival if
born a little early.
• The bones of the baby’s head are soft and flexible to ease the process thought the birth
canal.
• Your baby is now about 20 inches long and weighs approximately 6 to 9 pounds. Your
baby may be born between the 37th and 41st week of pregnancy. Only 5% of babies are
born on their due date and most first pregnancies go past their due date.
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GROUP B STREP IN PREGNANCY: FREQUENTLY ASKED QUESTIONS
1. What is Group B Strep (GBS)?
GBS is one of many common bacteria that live in the human body without causing harm in healthy people. GBS
develops in the intestine from time to time, so sometimes it is present and sometimes it is not. GBS can be
found in the intestine, rectum, and vagina in about 2 of every 10 pregnant women near the time of birth. GBS
is NOT a sexually transmitted disease, and it does not cause discharge, itching, or other symptoms.
2. How Does GBS Cause Infection?
At the time of birth, babies are exposed to the GBS bacteria if it is present in the vagina, which can result in
pneumonia or a blood infection. Full-term babies who are born to mothers who carry GBS in the vagina at the
time of birth have a 1 in 200 chance of getting sick from GBS during the first few days after being born.
Occasionally, moms can get a postpartum infection in the uterus also.
3. How Do You Know if You Have GBS?
Five to three weeks before your due date, during a regular prenatal visit, you or your clinician will collect a
sample by touching the outer part of your vagina and just inside the anus with a sterile Q-tip. If GBS grows in
the culture that is sent to the lab from that Q-tip sample, your clinician will make a note in your chart and you
should be notified so you can share this information when you go into labor.
4. How Can Infection from GBS Be Prevented?
If your GBS culture is positive within 5 weeks before you give birth, your clinician will recommend that you
receive antibiotics during labor. GBS is very sensitive to antibiotics and is easily removed from the vagina. A
few intravenous doses given up to 4 hours before birth almost always prevents your baby from picking up the
bacteria during the birth. It is important to remember that GBS is typically not harmful to you or your baby
before you are in labor.
5. Do You Have to Wait for Labor to Take the Antibiotics?
Although GBS is easy to remove from the vagina, it is not easy to remove from the intestine where it lives
normally and without harm to you. Although GBS is not dangerous to you or your baby before birth, if you take
antibiotics before you are in labor, GBS will return to the vagina from the intestine, as soon as you stop taking
the medication. Therefore, it is best to take penicillin during labor when it can best help you and your baby. The
one exception is that, occasionally, GBS can cause a urinary tract infection during pregnancy. If you get a
urinary tract infection, it should be treated at the time it is diagnosed, and then you should receive antibiotics
again when you are in labor.
6. How Will We Know if Your Baby Is Infected?
Babies who get sick from infection with GBS almost always do so in the first 24 hours after birth. Symptoms
include difficult breathing (including grunting or having poor color), problems maintaining temperature (too cold
or too hot), or extreme sleepiness that interferes with nursing.
7. What Is the Treatment for a Baby with GBS Infection?
If the infection is caught early and your baby is full-term, most babies will completely recover with intravenous
antibiotic treatment. Of the babies who get sick, about one in six can have serious complications. Some very
seriously ill babies will die. In the large majority of cases if you carry GBS in the vagina at the time of birth and if
you are given intravenous antibiotics in labor, the risk of your baby getting sick is 1 in 4,000.
8. What If You Are Allergic to Penicillin?
Penicillin or a penicillin-type medication is the antibiotic recommended for preventing GBS infection. Women
who carry GBS at the time of birth and who are allergic to penicillin can receive different antibiotics during
labor. Be sure to tell your clinician if you are allergic to penicillin and what symptoms you had when you got
that allergic reaction. If your penicillin allergy is mild, you will be offered one type of antibiotic, and if it is
severe, you will be offered a different one.
American College of Nurse-Midwives
Center for Disease Control
www.midwife.org/focus
www.cdc.gov/groupbstrep/
Parents Place
www.parentsplace.com
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Women’s Life Center at Southern Regional Medical Center
Information for Visitors
At the Women’s Life Center within Southern Regional Medical Center, we encourage family and
friends to visit during your hospital stay. To help us deliver the best possible care, please follow
these guidelines. If you have any questions or special circumstances that may require other
arrangements, please contact your nurse on arrival.
In general, visiting hours are from 9:00 AM to 9:00 PM. Guidelines for specific areas are as
follows:
Labor and Delivery Unit
Badges will be given to designated support persons. The designated support person must be at
least 18 years old (an exception may be the father of the baby). Badges must be worn until the
patient is moved to the Mother Baby Unit. Only siblings of the new infant may visit and must be
with an adult (other than the patient) at all times. They will be given a bracelet to wear. All other
visitors must remain in the atrium waiting area. One designated support person may be allowed
in the operating rooms.
Mother Baby and Antepartum Units
The baby’s father may visit at any time. Others may visit between 9:00 AM and 9:00 PM,
depending on the mother’s condition. Only siblings of the new infant may visit and are asked to
wear their bracelet at all times. Siblings cannot remain overnight. No other children can visit.
Neonatal Intensive Care
Due to the fragile condition of these patients, unit visitation is limited. Children other than
siblings are not allowed to visit. Please speak with your nurse concerning visiting hours.
Please:
• Do not use cell phones in the Women’s Life Center except in the front atrium waiting
area.
• Respect the patient’s privacy by knocking and waiting for permission to enter the room.
• Be mindful of other patients and take care not to disturb them.
• Do not eat or drink in the patient’s room.
• Do not visit when you are sick.
• If the staff asks you to leave (for example, if a test is being done) please do so.
• Do not sleep in public areas, such as waiting rooms and lobbies.
• Due to fire regulations, do not linger in the hallways.
• If a patient has a “No Visitors” sign on the door, please honor that. The patient may be
requesting that family and friends not visit at that time.
• Do not ask staff to share any patient information with you.
• Be respectful of taking pictures and videos. Photographic equipment is not allowed in the
operating rooms.
• Between 9:00 PM and 7:00 AM entrance to the hospital will be limited to the Emergency
Department and the Women’s Life Center.
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WHAT TO TAKE TO THE HOSPITAL
What will I need?
Consider packing the following items:
• Two nightgowns with openings in the front (front openings are helpful if you plan to
breastfeed).
• Comfortable bathrobe and slippers
• Change of underwear, socks, and bras (nursing bras if you plan to breastfeed)
• Sanitary pads (the hospital will provide large pads, but you may want a self adhesive pad.
You will not be able to use tampons for 6 weeks after you deliver)
• Toothbrush, toothpaste, floss
• Comb, brush, personal hair items
• Shampoo and conditioner
• Glasses and/or contact lenses
• Paper and pencils
• Change for vending machines
• Phone numbers for friends and family (you are not allowed to use cell phones in L&D
because of the interference with monitors in NICU)
• Loose-fitting clothes and comfortable shoes to wear home (you will not have your prepregnancy figure back yet!)
• Music tapes or CDs with portable stereo for music during labor
• Insurance information, pink prenatal lab card that you received at your prenatal
visits, papers related to your stay in the hospital.
• If you need disability forms filled out, these need to be dropped off at our office (be
aware of our policy for filling out forms).
Do not bring large sums of money or valuables with you to the hospital. You will move
from the labor suite to postpartum after the birth of the baby and it is your responsibility
to move all of your belongings.
What will I need for the baby?
• If you want to make footprints, bring an ink pad (purchase at crafts store)
• Shirt or sleeper (tee shirts are provided in the Women’s Center)
• Receiving blanket
• Diapers and wipes will be provided in the Women’s Center
• Appropriate clothing for taking the baby home
• Infant car seat (if is against the law to hold the baby in your lap while riding in a car). If
you are not sure of the installation, the fire department will help you install the car seat
correctly.
What should your partner bring?
Your partner should bring any personal items that would be needed for 48-72 hours. Families
are not allowed to bring in food to the patient rooms.
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True Labor versus False Labor
In the last several weeks of pregnancy, you may notice that your abdomen gets hard and then
gets soft again. As you get closer to your delivery date, you may find that this becomes more
uncomfortable or even painful. These irregular cramps are called Braxton-Hicks contractions, or
false labor pains. They may occur more frequently when you are physically active.
If you begin to notice contractions:
1. Drink one liter of water in an hour
2. Take 2 extra strength Tylenol
3. Soak in a hot bath
If the contractions are false labor pains, they will begin to go away. If the contractions are true
labor, they will get closer and more intense. Call us when:
1. contractions last about 60-90 seconds
2. occur at regular intervals. If this is your first baby, the contractions should be 5 minutes
apart. If you have had a baby before, your contractions should be 10 minutes apart.
3. contractions do not go away
4. there is any bleeding
False labor can occur just at the time when labor is expected to start and it is difficult to tell true
from false labor. Don’t be upset or embarrassed if your react by thinking that labor has begun.
Sometimes the difference can only be determined by a vaginal exam. When your cervix begins
to dilate, that signals the beginning of labor.
Table 2 gives you an easy reference to some of the differences between true and false labor.
Sometimes it is difficult to decide what is going on. Always feel comfortable calling the midwife
to discuss your symptoms.
Table 2
Type of change
False Labor
True Labor
Timing of contractions
Often are irregular and do not Come at regular intervals and,
consistently develop a close
as time goes on, get closer and
pattern (called Braxton-Hicks stronger.
contractions); can start out
True labor is progressive and
close together, but don’t
will not go away with rest and
increase in strength.
water.
Change with movement
Contractions may stop when
Contractions continue despite
you walk or rest, or even may movement.
stop with a change in position.
Location of contractions
Often felt in the abdomen
Usually felt in the back,
coming around to the front of
the abdomen
Time of day
Frequently start late evening.
Can start anytime of the day or
May have contractions
night
following a vaginal exam or
intercourse
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Other Reasons to Call
There are other signs that should prompt you to call the midwife and to think about going to the
hospital.
Call if:
1. your membranes rupture (bag of waters break), even if you are not having contractions.
You will know that it is your bag of waters if there is a gush of fluid that continually
leaks from the vagina.
2. you are bleeding from the vagina
3. you have constant, severe pain-do not wait for the hour to pass
4. if your baby is not moving after doing a fetal kick count.
Finally…
You are approaching a special, exciting time. Although it is impossible to know exactly when
labor will begin, you can be ready by knowing what to look for and what to expect. Having your
questions ready at your prenatal visits so that we can discuss your concerns. Being prepared will
help make your labor experience the best it can be for you and your partner.
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HOW TO TELL WHEN LABOR BEGINS
When labor is approaching, your body undergoes certain changes and provides you with signals
to let you know if this is the moment you’ve been waiting for over these past months. In order to
know the differences between these signs and phases we encourage you to read on. Knowing the
differences will help you wait through “false labor” without anxiety and be prepared for “true
labor” when it arrives.
What is Labor?
Labor is the process by which contractions of a pregnant uterus cause birth. During labor, the
cervix thins (effaces) and opens (dilation). The baby moves down the birth canal and is born.
Delivery of the placenta is the last part of labor.
Every labor is different! How long it lasts and how it progresses differ from women to women
and from birth to birth. There are, however, general guidelines for labor that your care provider
uses to decide whether labor is progressing normally. If it is not progressing normally, you may
need medical assistance or a cesarean section.
No one knows exactly what starts the labor process. However, we do know that certain
hormones, such as oxytocin and prostaglandin, cause the uterine contractions and the thinning of
the cervix.
Your Due Date
The most important thing to remember about a due date is that it is only an estimate-there is
nothing “magic” about it that will help labor begin. Women often do not give birth on their due
dates. In fact, you may not even want to tell relatives and friends an exact date so that you do
not feel disappointed or upset by phone calls and questions if the date comes and goes and labor
has not yet started. The beginning of labor is unpredictable and often happens a little early or
late. This is no cause for anxiety or alarm. In fact, labor may begin as much as 2 weeks before
or after your due date and still be considered normal.
In a normal, healthy pregnancy, we will not approach the subject of induction until you are 41
weeks pregnant. That gives us 7 days to schedule and induction.
Calling the Provider for Labor
If you think that your are in labor:
• During normal office hours, call 770-991-2200 and press 3 for the OB phone nurse. She
may instruct you to come to the office to be seen, or she may instruct you to go directly to
the hospital
• After office hours, weekends and holidays, call 770-991-2200 and press 0 for the
answering service. Once your message has been taken, the answering service will page
the certified nurse-midwife on call. You can expect a return call within 30 minutes.
However, technology fails or the midwife may be helping other patients; so, if you have
not received a return call, please call the answering service again.
• When your call is returned, let the midwife know if you are a patient of the midwives or
the physicians.
•
•
•
•
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When you arrive at Southern Regional Women’s Life Center you will be admitted and
taken to the triage area.
If you are a midwife patient, you will be evaluated by the on-call midwife.
If you are a physician patient, the triage nurse will evaluate you and a report will be given
to the on-call physician. In the event that the physician is unavailable, the midwife may
be asked to evaluate your labor, prescribe pain medication, or break your bag of waters.
Our practice is dedicated to honoring the choices that our patients make and every effort
will be made for your practitioner to be with you during the birth of your baby.
Sometimes events are beyond our control, if that occurs, you may find that a midwife
attends a physician patient; or the physician will assist a midwife patient. You may rest
assured that it is the goal of our practice to assist you in the birth of a healthy, happy
baby.
Sign
Feeling as if the baby has
dropped lower
What it is
Lightening.
Commonly
referred to as the “baby
dropping” The baby’s head
has settled deep into your
pelvis
Discharging a thick plug of
Mucus Plug. A thick mucus
mucus
plug has accumulated at the
cervix during pregnancy.
When the cervix begins to
open the plug is pushed into
the vagina. YOU DO NOT
NEED TO CALL FOR THIS.
Passing an increased bloody,
Bloody show. The onset of
mucus vaginal discharge
more rapid cervical thinning
(clear, pink or slightly bloody) and dilation, associated with
more frequent contractions.
Discharging a continuous
Rupture of membranes. The
trickle or a gush of watery
fluid filled sac that surrounded
fluid from the vagina.
the baby during pregnancy
breaks (your water breaks)
YOU NEED TO CALL IF
THIS OCCURS
Feeling a regular pattern of
Contractions. Your uterus is a
cramps or what may feel like a muscle that tightens and
bad backache or menstrual
relaxes. The hardness you feel
cramps.
is from your uterus
contracting. These
contractions may cause pain as
the cervix opens and the baby
moves into the birth canal.
When it Happens
From a few weeks to a few
hours before labor begins
A couple of weeks to several
days before labor begins
Up to 24 hours before the
onset of labor.
May break unrelated to the
onset of labor. More
commonly breaks late in
labor.
Usually at the onset of labor.
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What is an Episiotomy?
What is an episiotomy?
An episiotomy is a 1-3 inch long cut made between the opening of the vagina and your rectum.
This makes the opening of the vagina wider. Your provider may make this cut before the baby is
born to permit an easier delivery.
When is an episiotomy used?
An episiotomy may be used:
• If the baby is in distress and an episiotomy would allow the baby to be born faster
• In most forceps or vacuum deliveries
What happens after an episiotomy?
After you deliver the baby, your care provider will stitch the incision. The stitches will not need
to be removed. They will gradually dissolve after about 10 days.
The incision should heal quickly, although you may have some pain and swelling. This can be
relieved by:
• Ice on the sore area for the first 24 hours
• Sitz baths (sitting in warm bath water) several times a day
• Sprays or pads that contain a numbing medicine
• Pain medications (such as ibuprofen).
What are the benefits of an episiotomy?
The benefits of an episiotomy are:
• It may result in an easier and better repair than a jagged tear
• It may shorten the second stage of labor by relieving muscle tightness in this area
What are the risks and complications of an episiotomy?
• Increased blood loss
• Poor healing or infection of the incision
• Pain after delivery
• Pain with sex (once sexual relations are resumed after delivery)
• Discomfort in the scar
When should I call for a problem with the episiotomy?
• The pain and swelling do not get better
• You notice foul-smelling discharge from the episiotomy site
• You have a fever greater than 100.4
• You have bleeding from the episiotomy site
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POSTDATE PREGNANCY
Waiting for the birth of a child is an exciting and anxious time. Most women (80%) give birth
between 38-42 weeks of pregnancy. These pregnancies are called full-term.
However, only 5% of babies arrive on their exact “due date.” An average of 10% of normal
pregnancies goes beyond 42 weeks. In this practice, we would want you to be delivered by 42
weeks gestation.
Generally, testing for fetal well being begins around 40-41 weeks of pregnancy. Some of these
tests can be done by you, others are done in the office.
A fetal kick count is simply a record of how often you feel your baby move. After 36 weeks, if
you are concerned about your baby’s movements, you should do a fetal kick count.
• Have something to eat or drink (preferably sweet and cold).
• Lie on your side and count the baby’s movements
• You should feel the baby move 3-5 times in an hour.
If your baby does not seem to be moving 3-5 times in that hour, call our office. You will be
directed to come into either the office or to labor and delivery at Southern Regional Women’s
Center to monitor the baby with the electronic fetal monitor.
In electronic fetal monitoring, electric instruments are placed on the mother’s abdomen to record
the fetus’s heart rate in response to its own movements or to contractions of the mother’s uterus.
Two types of tests can provide reassuring information of the fetus’s health and can give early
warning if the fetus is in trouble:
Nonstress test: This test measures the way a fetus responds to its own body movements.
Normally, the fetal heart rate increases when the baby moves.
Biophysical Profile: an ultrasound exam performed to assess the baby’s well-being that uses
sound waves to create a two-dimensional picture of the baby on a screen. This picture can show
the position of the baby, the position of the placenta, as well as the baby’s heartbeat, breathing,
and body movements. Ultrasound can also measure the amount of amniotic fluid.
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CIRCUMCISION
In a few weeks, the months of waiting will be over and your new baby will be here. If the baby is
a boy, you will be asked if you want him circumcised. This is a matter that you should consider
carefully before your baby is born because it is elective surgery, one dictated more by culture,
social, and religious concerns than by medical necessity.
What is a circumcision?
Baby boys are born with a covering (foreskin) over the sensitive end (glans) of the penis. In a
circumcision, this covering is cut away, leaving the end of the penis exposed. This operation is
done either without anesthesia or after having been anesthetized with a cream placed on the penis
one to one and a half hours prior to the procedure. Some physicians feel that the anesthesia
cream causes more swelling and bleeding after the circumcision is complete and , thus, prefer to
perform it without anesthetic for that reason. This is a topic that you may want to discuss with
the physician who will be performing it. While it is true that babies feel the pain of the
circumcision while it is being done and discomfort for one to two days while it is healing, it is
also true that a newborn’s nervous system is immature and they do not perceive pain
neurologically in the same way an older child perceives pain. Their perception of pain is also
limited only to the immediate event and the baby has no memory of pain after the pain is gone.
The circumcision procedure itself takes less than five minutes.
Why are circumcisions done?
People of Muslim and Jewish faiths practice circumcision for religious reasons. Some cultures
believe that it is necessary for boys to be circumcised. Other cultures, such as the Hispanics and
Northern Europeans, rarely circumcise their sons. In this country, circumcision has been done
historically because people thought it was cleaner, helped to prevent penile cancer and bladder
infections, in addition to the cultural aspects of wanting sons to look like their fathers.
There is no evidence that circumcision helps to prevent sexually transmitted diseases. Recent
studies have shown that simply keeping the penis clean through normal bathing can be just as
good at preventing the very rare occurrences of penile cancer and bladder infections that may be
associated with the uncircumcised penis. Just as you teach your son to wash other body parts,
you can teach your son how to clean his penis as he gets old enough to learn.
When the baby is born, the foreskin is still partially attached to the glans of the penis. Over the
course of the baby’s first year of life, the foreskin slowly separates and the ability to pull back
(retract) the foreskin over the glans increases, until at about one year of age the foreskin is
usually able to be fully, or almost fully, retracted. Sometimes, as a boy grows older, the foreskin
is found to be too tight and is never able to be fully retracted, thus allowing the end of the penis
to be exposed for cleaning or for the penis to become engorged during sexual excitement. This
lack of complete separation not allowing for full retraction is rare, but when it occurs, a
circumcision would be necessary. In that case, it would be performed in a hospital under general
anesthesia by a urologist.
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What are potential complications associated with a circumcision?
Research varies in its findings on the number of complications associated with circumcision,
because studies frequently group even minor complications with the major complications that
rarely occur. One large study found that about two babies of every hundred has some problem
after surgery, including even a small amount of excess bleeding. The risk of death is about two
per million circumcisions done. The most common complications are as follows:
• Excessive bleeding, rarely requiring a blood transfusion
• Infection of the penis, very rarely associated with body-wide (systemic) infection and
death
• The foreskin may be cut too short, too long, or may heal improperly, leading to a
deformed appearance, possibly making further surgery necessary.
How is the penis kept clean if the baby is not circumcised?
As previously described, clean the penis as far back as you can gently (never forcibly) retract the
foreskin. Replace the foreskin back to its original position after bathing. This is very important,
because a serious problem can result if the foreskin is left retracted. The penis will not be harmed
or become infected under the area where you are unable to retract it. Just as the vagina naturally
keeps itself clean by secretions, the glans does the same by smegma (male secretions). By the
age of three, about 90% of boys will have fully retractable foreskins, by age seventeen, 99% will.
Should I have my son circumcised?
It is your decision, based on your religious, social, and cultural beliefs, or if there are nay
identified medical needs. The American Academy of Pediatrics has recommended that
circumcisions not be done routinely on all newborn baby boys. However, they have
acknowledged a possible association with a rare increase in bladder infections. As you are
considering whether or not to have your son circumcised, it is important that you understand
what the procedure is, what the complications are, and all the pros and cons related to the
decision. Circumcisions are usually done when the baby is about one day old in the hospital by
the OB doctor, prior to being discharged, unless you elect to have it done as a religious
ceremony, in which case you make your own outpatient arrangements. The hospital and your
pediatrician will give you information about the care of the newly circumcised penis.
POSTPARTUM
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POSTPARTUM CARE
What does postpartum mean?
Postpartum is the period of time after the birth of your baby when your body is changing back to
normal. It lasts about 6 weeks or until your uterus and other organs return to their normal size.
What special care will I need after delivery?
• Rest: You will need extra rest. However, with caring for and feeding a new baby, there is
not much time to rest! Get help from friends and family with household chores so you
will have extra time to care for the baby and yourself. Because you must feed the baby
day and night, you may need to change your sleeping schedule t get enough rest. Try to
sleep or nap while the baby sleeps. Morning and afternoon naps can be very helpful.
• Pain Relief: If you delivered the baby normally through the birth canal, pain in the area
between your rectum and vagina is common. To relieve the pain and prevent infection,
you can sit in a warm bath, put cold packs on the area, or put warm water on the area
with a squirt bottle or sponge. It is also important to wipe yourself from front to back
after a bowel movement to prevent infection. If sitting is uncomfortable, you may want
to buy a doughnut-shaped pillow at your local drugstore to help ease the pressure when
sitting. Motrin 600mg every 6 hours can also help.
• Bleeding and discharge: You will continue to have a vaginal discharge after delivery for
2 to 6 weeks. Sometimes it may last even longer. It may come out in gushes or more
evenly like a menstrual period. You may even pass blood clots. If your bleeding is more
than one maxi-pad in an hour, you should call our office. The discharge will start out red
and slowly taper off until it becomes pink and finally a yellow-whiter color. Do not use
tampons for the first 6 weeks after delivery. You will need to use pads because tampons
may bring bacteria into your body while it is still healing and cause infection.
• Constipation and hemorrhoids: It is common to be constipated or have discomfort from
hemorrhoids after delivery. You can buy hemorrhoid suppositories and ointments to help
reduce the swelling in the area of your rectum. For constipation, review the teaching
sheet in the first trimester section of this book.
• Breast soreness: Your milk will come in about 2 to 4 days after your child is born. This
may make your breasts become very large, hard, and sore. This will get better once you
start a breastfeeding routine. If you are not breastfeeding, you should wear a firm,
supporting bra and use ice packs on your breasts.
When can I start doing normal activities?
If you had a normal delivery without any problems, you can get back doing most of your normal
activities right away. You should still take it easy and avoid heavy lifting, vacuuming, and a lot
of stair climbing for the first couple of weeks. If you had a Cesarean section, you will need to
avoid heavy lifting for 6 weeks.
Exercise is one of the best ways to lose weight, get more energy, relieve stress, and build your
strength. Unless you had a Cesarean section, you can begin exercising again in about 6 weeks.
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When will my period start again?
If you are not breastfeeding your baby, you may start having menstrual periods again in about 3
to 10 weeks. If you are breastfeeding, it is hard to say when you may start your period again. It
may not happen until sometime after the first 6 months of breastfeeding, but could happen
earlier. Some women do not get their period again until they stop breastfeeding.
When will I return to my normal weight?
During birth, you lose about 12 to 14 pounds. However, this may still leave many pounds to lose
(depending on how much weight you gained during pregnancy). Losing weight takes time. It
takes most moms 8 to 12 months to return to their normal weight. Losing the weight slowly is
healthy and natural. The key is to eat healthy and exercise. After the first few months of eating
right and exercising you can begin a healthy weight-loss program if necessary. If you are
breastfeeding, you should make sure you are still eating at least 1800 calories a day. Because
breastfeeding uses a lot of calories, it usually helps women lose their pregnancy weight.
Remember to drink at least 64 ounces of water daily.
When can I have sex again?
The number of weeks you should wait before having sex depends on your specific situation. If
you had an episiotomy or a tear, you should wait at least 3 to 4 weeks before having sex so the
sutures can heal. If you had a Cesarean section, you should wait at least 4 weeks so your incision
can heal. Because it takes about 6 weeks for your uterus to return to normal size, we recommend
that you wait until after your 6 week postpartum visit. At that visit, we will begin your birth
control and discuss measures to prevent an unintended pregnancy. It is normal to feel
uncomfortable at first when you start having sex again after childbirth.
You should call the office if:
•
•
•
•
•
•
•
•
•
•
You have a fever over 100.4F
You have unusual abdominal or genital pain
You have increased pain, swelling, redness, or discharge from and episiotomy or
Cesarean section incision.
You are bleeding more than one maxi pad in an hour
The discharge from your vagina smells bad
You pass blood clots the size of an orange or larger.
Your breasts are red or warm, or they have an unusual discharge.
You are unable to empty your bladder, or you feel a burning pain when you urinate.
Your legs are red or tender.
You have felt depressed or blue for more than 3 to 4 days.
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BREASTFEEDING
Anatomy and Physiology
Breasts are glands. Inside them are tiny sacs that contain milk-secreting cells. These sacs are
clustered together into lobes. Each lobe has a single milk duct that carries milk to the nipple.
During pregnancy, your body prepares to make milk whether or not you plan to nurse. Your
breasts will slowly increase in size and weight, gaining up to an extra 1 to 1½ pounds each. You
will also notice that the nipples seem to enlarge and become darker and more pronounced. The
blood vessels supplying the breasts enlarge and become more visible.
About the fourth or fifth month of pregnancy-or even later for some women-the nipple may
sometimes drip a tiny amount of colostrums, a thick, clear or yellow-orange liquid. Colostrum is
the first milk secreted after the baby’s birth. This is the beginning of milk production. As soon
as the baby is born and the placenta (afterbirth) is expelled, a hormone is released by your body
signaling the breasts to produce milk.
Colostrum contains proteins and other substances to nourish the new baby as well as antibodies
to protect the baby from infection. Within a few days after birth, the colostrums will change to
mature milk.
Advantages of Breastfeeding
Mother’s milk is the most balanced food for a normal baby. It has the right amount of all the
nutrients the baby needs. It is more agreeable to the baby’s digestive system. Breast milk may
also help protect the baby from developing allergies. Antibodies in it can protect the baby from
infections and illness.
Breast milk is especially good for the growth and development of a premature or small baby.
However, you may not be able to start breastfeeding right away. If you have to wait for a while
because your baby is not able to suck, you can collect mild from your breasts by expressing it
manually or by using a pump. The milk can then be given to your baby through a tube. It can
also be stored for later use. You can bring your questions to us or the lactation specialist at
Southern Regional Women’s Center and we will answer your questions about how to best store
your breast milk.
Breast-feeding is good for the mother, too. The baby’s sucking releases hormones that contract
the uterus, helping it to return to its normal size more quickly. Women who breast-feed lose
weight more quickly after birth. Breast-feeding provides contact between mother and baby that
builds their relationship.
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Who can Breastfeed?
Almost every woman can produce mild after her baby is born and breastfeed with success. But
you may have questions:
Are my breasts too small?
Breast size makes no difference. The amount of milk a woman’s breasts make does not depend
on their size or shape.
Will my breasts sag or be uncomfortable?
Breast-feeding will not make your breasts sag. Your breasts may look a little different after
pregnancy, but aging causes most of the changes in breast shape. Each pregnancy, however,
does cause some change as the breasts enlarge and develop in preparation to make milk. These
changes occur whether or not you choose to breast-feed. Breasts are heavier while you are
pregnant or nursing, and the increased weight can cause the ligaments that support them to
stretch. Wearing a good support bra will help you feel more comfortable.
What if I couldn’t breastfeed last time?
If you have given birth before but did not breastfeed that does not mean you cannot breastfeed
this baby. Likewise, if you tried breastfeeding before but felt is was not a success that does not
mean you cannot do it this time. Sometimes a change in technique will solve the problem.
Although breastfeeding is the natural way to feed a baby, it still involves some learning and
practice. The lactation specialists at Southern Regional Women’s Center will be able to help you
feel secure in your techniques of breastfeeding.
How do I prepare my nipples?
Nipple size and shape do not affect the ability to nurse. If the nipples are erect, there is no need
to prepare the breasts.
A woman who has flat or inverted (turned in) nipples can still breastfeed. There are a number of
recommendations about preparing your breasts for breastfeeding, but it is not clear that any of
the methods make early breastfeeding easier. If you want to try preparing your breasts, special
plastic breast shells worn in the last month of pregnancy may help. In time, they will cause the
nipple to stick out.
Do this simple nipple test to find out if you have flat, inverted, or erect nipples:
1. Place your thumb and index finger on the areola (brown part of the nipple).
2. At the base of the nipple, squeeze gently, but firmly.
3. If your nipple flattens or retracts (inverts) into the breasts, you can begin wearing breast
shells during the last couple of weeks of your pregnancy.
We will be glad to answer any questions that you may have regarding your nipple type.
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FIRST WEEKS AT HOME WITH A NEWBORN
Preventing fatigue and exhaustion
For most mothers the first week at home with a new baby is often the hardest in their lives! You
will probably feel overworked, even overwhelmed. Inadequate sleep will leave you fatigued.
Caring for a baby can be a lonely and stressful responsibility. You may wonder if you will ever
catch up on your rest or work. The solution is asking for help. No one should be expected to
care for a young baby alone.
Every baby awakens one or more times at night. The way to avoid sleep deprivation is to know
the total amount of sleep you need per day and to get that sleep in bits and pieces. Go to bed
earlier in the evening. When your baby naps you must also nap. Your baby doesn’t need you
hovering while he or she sleeps. If sick, your baby will show symptoms. Tips to use while you
are napping:
• take the telephone off the hook
• put a sign on the door saying NAPPING, DO NOT DISTURB
• hire a baby sitter or relative to watch the baby while you nap
If you do not take care of yourself, you will not be able to care for your baby.
The Postpartum Blues
More than 50% of women experience postpartum blues on the third or fourth day after delivery.
The symptoms include tearfulness, tiredness, sadness, and difficulty in thinking clearly. The
main cause of this temporary reaction is probably the sudden decrease of maternal hormones.
Since the symptoms commonly begin on the day the mother comes home from the hospital, the
full impact of being totally responsible for a dependent newborn may also be a continuing factor.
Many mothers feel let down and guilty about these symptoms because they have been led to
believe they should be overjoyed about caring for their newborn. In any event, theses symptoms
usually clear in 1 to 3 weeks as the hormone levels return to normal and the mother develops
routines and a sense of control over her life.
There are several ways to cope with the postpartum blues:
1. Acknowledge your feelings. Discuss them with your partner or a close friend as well as
your sense of being trapped and that these new responsibilities seem insurmountable.
Don’t feel you need to suppress
2. Get adequate rest.
3. Get help with all your work.
4. Mix with other people; don’t become isolated. Get out of the house at least once a weekgo to the hairdresser, shop, visit a friend, or see a movie. Consider joining a mother/baby
play group.
5. By the third week, setting aside an evening a week for a “date” with your partner is also
helpful.
If you don’t feel better by the time the baby is 1 month old, you should contact us about the
possibility of counseling for depression.
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Helpers: Relatives, Friends, Sitters
As already emphasized, everyone needs extra help during the first weeks alone with a new baby.
Ideally, you were able to make arrangements for help before your baby was born. The best
person to help (if you get along with her) is usually your mother or mother-in-law. If not, you
may be able to hire someone to come in several times a week to help with housework or to look
after the baby while you nap or go out. If you have other young children, you may need daily
help. Contact friends, family or consider hiring a sitter. If your baby has a medical problem that
requires special care, ask about home care visits from a home care nurse.
The Father’s Role
If possible, the father needs to take time off from work to be with you during labor and birth, as
well as on the day that you and the baby come home from the hospital. If you have family who
will be able to stay with you for the first few days that you are home, the father could continue to
work. However, when the family member leaves, the father may be able to take vacation time or
to work reduced hours in order to be available to help you and the baby.
The age of noninvolvement of the father is over. Not only does the mother need the father to
help her with household chores, but the baby also needs to develop a close relationship with the
father. Today’s father helps with feeding, changing diapers, bathing, putting to bed, reading
stories, dressing, disciplining, homework, playing games, and calling the physician when the
child is sick.
A father may avoid interacting with his baby during the first year of life because he is afraid he
will hurt his baby or that he won’t be able to calm the child when the baby cries. The longer a
father goes without learning parenting skills, the harder it becomes to master them. At a
minimum, a father should hold and comfort his baby at least once a day.
Visitors
Only close friends and relatives should visit you during the first month at home. They should not
visit if they are sick. To prevent unannounced visitors, you may put up a sign saying: MOTHER
AND BABY SLEEPING. NO VISITORS. PLEASE CALL FIRST. Friends without children
may not understand your needs. During visits the visitor should pay special attention to older
siblings.
Feeding Your Baby: Achieving Weight Gain
Your main assignments during the early months of life are loving and feeding your baby. All
babies lose a few ounces during the first few days after birth. However, they should never lose
more than 7% of the birth weight (about 8 ounces). Most bottle-fed babies are back to birth
weight by 10 days of age, and breast-fed babies by 14 days of age. Then infants gain
approximately an ounce during the early months. If mild is provided liberally, the normal
newborn’s hunger drive ensures appropriate weight gain.
A breastfeeding mother often wonders if her baby is getting enough calories, since she cannot
see how many ounces the baby takes. Your baby is doing fine if they demand to nurse every 1½
to 2½ hours, appears satisfied after feedings, takes both breasts at each nursing, wets 6 or more
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diapers each day, and passes 3 or more soft stools per day. Whenever you are worried about
your baby’s weight gain, call your pediatrician. Feeding problems detected early are much easier
to remedy than those of long standing. A special weight check 1 week after birth is a good idea
for infants of a first-time breastfeeding mother or a mother concerned about her milk supply.
Dealing with Crying
Crying babies need to be held. They need someone with a soothing voice and a soothing touch.
You can’t spoil your baby during the early months of life. Overly sensitive babies may need an
even gentler touch.
Sleep Position
Remember to place your baby in his crib on his back (supine). As of 1992, this is the sleep
position recommended by the American Academy of Pediatrics for healthy babies. The back
position reduces the risk of Sudden Infant Death Syndrome (SIDS).
Taking your Baby Outdoors
You can take your baby outdoors at any age. You already took your baby outside when you left
the hospital, and you will be going outside again when you take the baby for the well-baby
check-up.
Dress the baby with as many layers of clothing as an adult would wear for the outdoor
temperature. A common mistake is overdressing a baby in summer. In winter, a baby needs a
hat because they often don’t have much hair to protect against heat loss. Cold air or winds do
not cause ear infections or pneumonia.
The skin of babies is more sensitive to the sun than the skin of older children. Keep sun
exposure to small amounts (10-15 minutes at a time). Protect your baby’s skin for sunburn with
longer clothing and a hat.
Camping and crowds should probably be avoided during your baby’s first month of life. Also,
during your baby’s first year of life try to avoid close contact with people who have infectious
illnesses.
Medical Checkup on the Third of Fourth Day of Life
Early discharge from the newborn nursery has become commonplace for full-term infants. Early
discharge means going home within 24 to 48 hours after giving birth. In general, this is a safe
practice if the baby’s hospital stay has been uncomplicated. These newborns need to be rechecked about 2 days after discharge to see how well they are feeding, urinating, producing
stools, maintaining weight, and breathing. They will also be checked for jaundice and overall
health. You should check with your pediatrician to find out when they want to see your baby.
The Two Week Medical Checkup
This checkup is probably the most important medical visit for your baby during the first year of
life. By two weeks of age your baby will usually have developed any physical condition that
was not detectable during the hospital stay. Your child’s physician will be able to judge how
well your baby is growing from the height, weight, and head circumference measurements.
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This is also the time your family is under the most stress of adapting to a new baby. Try to
develop the habit of writing down questions about your child’s health or behavior at home.
Bring this list with you to office visits to discuss with the care provider. Most care providers
welcome the opportunity to address your needs, especially if your questions are not easily
answered by reading or talking with other mothers.
If at all possible, both parents should go to these visits. Most care providers prefer to get to
know both parents during a checkup than during the crisis of an acute illness.
If you think your newborn is sick between the routing visits, be sure to call your child’s care
provider for help.
Preventing Sudden Infant Death Syndrome (SIDS)
SIDS is the sudden death of an infant under one year of age which remains unexplained after a
through case of investigation, including performance of a complete autopsy, examination of the
death scene and a review of the clinical history.
Risk factors:
• Prematurity
• Young maternal age at pregnancy
• Maternal smoking
• Second-hand smoke
• Alcohol ingestion, especially in the first trimester
• Poor prenatal care
• Low infant birth weight
Preventive measures:
• Supine sleeping-place the baby on its back to sleep
• Avoid soft bedding
• Remove comforters and stuffed animals from the crib
• Avoid overheating
Why parents choose prone (tummy) sleeping:
• Fear that the baby will spit up and choke
• Babies appear to sleep more deeply on their tummy
• Sleeping on their back may give the baby a flat head
• Relative or caregiver advised them to place the baby on its tummy
It is important that as a parent, you are able to tell family members or care givers the reasons that
sleeping on the tummy is dangerous.
• Infants that sleep on their backs are not at any increased risk for spitting up and choking.
• Infants that sleep on their back have fewer ear infections, stuffy noses or fevers.
•
•
•
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After several weeks of sleeping on their back, babies will appear more comfortable. It is
thought that by sleeping on their backs, babies do not fall into a very deep sleep and this
is somewhat protective against SIDS.
Flattening of the back of a baby’s head is called Plagiocephaly. This can be avoided by
allowing the baby “tummy time” when they are awake and being watched. Tummy time
also allows the baby to develop their chest and arm muscles.
Babies who sleep on their backs and are then change to their tummy have a higher risk of
SIDS.
As a parent, you may have to educate family members and care givers about the importance of
your baby sleeping on their backs.
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Sibling Rivalry Toward a Newborn
What is sibling rivalry?
Sibling rivalry refers here to the natural jealousy of children toward a new brother of sister.
Older siblings can feel jealousy when the baby arrives until they are 4 or 5 years old. Not
surprisingly, most children prefer to be the only child at this age. Basically, they don’t want to
share your time and affection. The arrival of a new baby is especially stressful for the firstborn
and for siblings less than 3 years old. The jealousy arises because the older sibling sees the
newcomer receiving all the attention, visitors, gifts, and special handling.
The most common symptom of sibling rivalry is lots of demands for attention: the older child
wants to be held and carried about, especially when mother is busy with the newborn. Other
symptoms include acting like a baby again (regressive behavior), such as thumb sucking,
wetting, or soiling. Aggressive behavior—for example, handling the baby roughly—can also
occur. All of these symptoms are normal. While some can be prevented, the remainder can be
improved within a few months.
How can I help prevent sibling rivalry?
During Pregnancy:
• Prepare the sibling for the newcomer. Talk about the pregnancy. Let you child feel your
baby’s movements.
• Try to schedule the sibling class at Southern Regional Women’s Center where children
can learn about babies and about sharing their parents with a new brother or sister.
• Try to give your child a chance to be around a new baby so that they have a better idea of
what to expect.
• Encourage your child to help prepare the baby’s room.
• Move your child to a different room or new bed several months before the baby’s birth.
If you are enrolling our child in a play group or nursery school, start is well in advance of
the birth.
• Praise your child for mature behavior, such as talking, using the toilet, feeding or
dressing themselves, and playing games.
• Don’t make demands for new skills (such as toilet training) during the month’s just
preceding delivery. Even if your child appears ready, postpone these changes until your
child has made a good adjustment to the new baby.
• Tell your child who will care for them while you are at the hospital.
• Read books together about what happens during pregnancy and after the baby is born.
• Look through family photographs and talk about your child’s first year of life.
In the Hospital
• Call your older children daily from the hospital.
• Try to have your older children visit you and the baby in the hospital.
• If your older child cannot visit, send a picture of the new baby.
• Encourage your partner to take the older child on some special outing, for example to the
park, the zoo, museum or fire station.
103
Coming Home:
• When you enter your home, spend your first moments with the older sibling. Have
someone else carry the new baby into the house.
• Give the sibling a gift “from the new baby.”
• Ask visitors to give extra notice to the older child. Have your older child unwrap the
baby’s gifts.
• From the beginning, refer to your newborn as “our baby.”
The first months at home
• Give your older child the extra attention needed. Help them feel more important. Try to
give your child at least 30 minutes of exclusive, uninterrupted time daily. Make sure that
your partner and relatives spend extra time with the older sibling during the first month.
Give the child lots of physical affection throughout the day.
• When you are busy attending to the baby, try to include your older child by talking with
him. When you are feeding the baby, read a story, play a game, or do a puzzle with your
older child.
• Encourage you older child to touch and play with the new baby in your presence. All
him to hold the baby while sitting in a chair with side arms. Avoid such warnings as
“don’t touch the baby.” Newborns are not fragile and it is important to show your trust.
However, you can’t allow the sibling to carry the baby until he reaches school age.
• Enlist you older child as a helper. Encourage help with baths, drying the baby, getting a
clean diaper, finding toys or a pacifier. At other times encourage the child to feed or
bathe a doll when you are feeding or bathing the baby. Emphasize how much the baby
likes the older sibling. Make comments such as “look how happy the baby gets when
you play with it her” or “You can always make the baby laugh.”
• Don’t ask the older siblings to be quiet for the baby. Newborns can sleep fine without the
house being perfectly quiet. This request can lead to unnecessary resentment.
• Accept regressive behavior, such as thumb sucking or clinging, as something your child
needs to do temporarily. Do not criticize him.
• When your child behaves aggressively, intervene promptly. Tell the older child, “We
never hurt babies.” Send the child to “time-out” for a few minutes. Don’t spank your
child or slap his hand at these times. If you hit the sibling, he will eventually try to do the
same to the baby as revenge. For the next few weeks do not leave the two of them alone.
• If your child is old enough, encourage him to talk about his mixed feelings about the new
arrival. Suggest an alternative behavior: “when you are upset with the baby, come to me
for a big hug.”
When should I call my care provider?
• The older child continually tries to hurt the baby.
• Regressive behavior doesn’t improve by 1 month.
• You have other questions or concerns.
104
METHODS OF CONTRACEPTION
What is contraception?
Contraception (birth control) is the term used for the prevention of pregnancy. There are may
ways to try to prevent pregnancy when you are having sexual intercourse. Some are much more
effective than others. They include the use of hormone medications, contraceptive devices
(barriers), periods of avoiding sex, and surgery. What follows is basic information on theses
various methods. This will help you decide which method is right for you and your lifestyle.
Remember that you need to consider whether the method you choose will also protect you from
sexually transmitted diseases. Sometimes you may need to use more than one method to prevent
pregnancy AND disease. The latex or polyurethane male condom and the polyurethane female
condom are the best protection currently available against sexually transmitted diseases. They
are the only ways to reduce your risk of being infected during sex with HIV, the virus that causes
AIDS. The birth control methods using hormones, natural family planning, and withdrawal do
not give any protection against disease.
What are the different methods of contraception?
Hormone Medications
Birth control pills (oral contraceptives), the transdermal patch (Ortho Evra), the vaginal
contraceptive ring (NuvaRing) and the Depo-Provera shots contain manufactured forms of the
hormones estrogen and/or progesterone. The hormones stop a woman’s ovaries from releasing
an egg each month. They also cause the cervical mucus to thicken, which then acts as a barrier
to sperm.
• A woman takes birth control pills according to a daily schedule prescribed by her health
care provider
• Depo-Provera, which contains a strong progesterone hormone, is given as a shot. It
prevents pregnancy for 3 months. (see below)
• NuvaRing is a flexible ring that is inserted into the vagina for 3 weeks, removed for 1
week, and then replaced with a new ring. Estrogen and progesterone are released into
your body from the ring.
• Ortho Evra is a patch that is put on the skin. The hormones are on the adhesive side of
the patch. Each patch is worn for 1 week then thrown away. This is repeated each week
for a total of three weeks, then no patch is worn for one week. This method is not
recommended if you weigh more than 195lbs.
All of these hormonal forms of birth control require visiting your health care provider for a
prescription.
Progestin-Only or Mini-Pill
The mini-pill contains only progestin (a female hormone). This method, when used daily, is
highly effective for breastfeeding women. In order for the mini-pill to be effective, it requires
taking the pill at the same time each day. It is recommended that the pill be taken 4 hours before
the most likely time of intercourse since its main course of action is to make the cervical mucus
thicker.
105
If you find that you are breastfeeding less than six times a day, you might consider an alternate
birth control method.
Injectable Contraception or “the Shot”
The only injectable (shot) contraceptive available in the United States is Depo-Provera. This
shot is given every three months. The medication causes the cervical mucus to thicken and
changes the lining of the uterus (endometrium). Additionally, progestin stops the hormone
necessary for ovulation and ovulation (production of the egg) does not occur.
Injectable contraception can be safely used during breastfeeding and does not suppress milk
production.
All of these hormonal forms of birth control require visiting your health care provider for a
prescription.
Contraceptive Devices
Foam and Condoms
Most contraceptive devices form physical or chemical barriers that stop sperm from entering the
woman’s uterus.
The male condom is a tube of thin material (latex rubber or polyurethane), which is rolled over
the erect penis just before any contact of the penis with a woman’s genitals. The male condom
provides the best protection against sexually transmitted diseases, including HIV and hepatitis B.
The female condom is a 7-inch long pouch of polyurethane with two flexible rings. It is inserted
into the vagina before intercourse. It covers the cervix, vagina, and area around the vagina. Like
the latex or polyurethane male condom, the female condom provides protection against some
sexually transmitted diseases, including HIV and hepatitis B.
Spermicides are sperm-killing chemicals that are available as foam, jelly, foaming tablets,
vaginal suppositories, or cream. They are inserted into the vagina no earlier than 30 minutes
before intercourse. Spermicidal should NOT be used alone. They should be used with another
contraceptive device, such as a condom, for increased effectiveness. Spermicidals do not protect
against sexually transmitted diseases.
Condoms and spremicides can be purchased at drug and grocery stores without a prescription.
Diaphragm and cervical cap
The diaphragm is a soft rubber dome stretched over a flexible ring. No more than 3 hours before
intercourse, the diaphragm is filled with a spermicidal jelly or cream and inserted into the vagina
and over the cervix. (The cervix is the opening to the uterus).
The cervical cap is made of latex rubber or plastic and is shaped like a cup. It is smaller and
more rigid than a diaphragm. No more than 24 hours before intercourse, the cap is filled with a
spermicidal jelly or cream and inserted into the vagina and over the cervix.
106
IUD
The intrauterine device is a small plastic device containing copper or hormones. Instead of
stopping sperm from entering the uterus, the IUD changes the physical environment of the
reproductive tract, which prevents the egg from being fertilized or implanted and growing in the
uterus. An IUD is inserted into the uterus by a medical professional. Depending on the type, it
may be worn from 5 to 10 years before it must be replaced.
The diaphragm, cervical cap and IUD require fitting or insertion by your health care provider,
Natural Family Planning (Periodic Abstinence) and the Withdrawal Method
The natural family planning methods of birth control do not depend on any devices or drugs. To
prevent pregnancy you cannot have sex for about 7 to 10 days during each menstrual cycle. To
know when it is safe to have sex, a woman must record her body temperature and changes in
cervical mucus every day.
The withdrawal method involves removing the penis from the vagina just before semen starts
coming out (ejaculation). Often sperm are deposited in the vagina before or during withdrawal,
making this method unreliable.
Sterilization
Sterilization is the surgical closing of the tubes that normal carries the sperm or eggs. A woman
or man who undergoes sterilization will no longer be able to conceive children.
In a vasectomy a surgeon cuts and seals off the tubes that carry sperm in a man. When a woman
is sterilized, her fallopian tubes, which carry the eggs from the ovaries to the uterus, are sealed
off. A vasectomy is a more minor surgical procedure than female sterilization.
These surgical procedures can be reversed but pregnancy may not result. In women, the risk of
ectopic (tubal) pregnancy is increased.
How well do the various methods prevent pregnancy?
The following chart shows the typical failure rates of birth control methods discussed in this
handout. The failure rate is the number of pregnancies expected per 100 women during 1 year of
using the method. The rates vary, depending on how correctly and consistently each method is
followed. If a method is used perfectly, the failure rate is lower than the typical rate shown here.
Use of more than one method (for example, birth control pills and condoms) can decrease the
chances of failure
107
Birth Control
Method
% of Women With Accidental
Pregnancy in First Year of Use
Spermicides
Natural Family Planning
Withdrawal
26%
25%
19%
Cervical Cap/spermicides
Women who have given birth
Women who have not given birth
40%
20%
Diaphragm/spermicides
20%
Condom
Female
Male
21%
14%
Pill
5%
IUD
With hormones
Copper
2%
0.8%
Depo-Provera
Patch (Ortho Evra)
Vaginal Ring (NuvaRing)
<1%
1%
1-2%
Female sterilization
<1%
Male sterilization
<1%
NO method
85%
As you can see, other than sterilization, the hormone medications and the IUD are the most
effective methods of birth control. However, the diaphragm and cervical cap can be nearly as
reliable if they are used properly. The least reliable methods are spermicide alone, natural family
planning, withdrawal method, and female condom.
108
POSTPARTUM DEPRESSION
About 10% of women who give birth develop postpartum depression. In contrast to postpartum
blues, postpartum depression is marked by more intense feelings of sadness, anxiety, or despair
that last more than a few days and disrupt the new mother’s ability to function. If not recognized
and treated, postpartum depression may become worse or may last longer than it needs to.
Some women appear to have a higher risk of postpartum depression. These women include
those who have had postpartum depression before and those with a psychiatric history. Recent
stressful events, such as loss of a loved one, family illness, or moving to a new city, also appear
to increase a woman’s risk for postpartum depression. There is no evidence that postpartum
depression is related to age or number of previous children. There is evidence, though, that the
lack of a supportive partner may be a major factor.
In rare cases—about 1-3 in every 1,000 births—the mother will develop a more severe mental
illness or psychosis. Women with a personal or family history of manic depression (bipolar
disorder) or schizophrenia appear to be at increased risk for such disorders.
When to Suspect Postpartum Depression
There are a number of signs and symptoms indicating that a new mother may be developing—or
already has—postpartum depression:
• Postpartum blues that don’t go away after 2 weeks, or strong feelings of depression and
anger that begin to surface 1-2 months after childbirth.
• Feelings of sadness, doubt, guilt, helplessness, or hopelessness that seem to increase with
each week and begin to disrupt a women’s normal functioning. The woman may not be
able to care for herself or her baby. She may have trouble handling her usual
responsibilities at home or on the job.
• Not being able to sleep even when tired, or sleeping most of the time, even when the
baby is awake.
• Marked changes in appetite
• Loss of interest in things that used to bring pleasure
• Extreme concern and worry about the baby, or lack of interest in or feelings for the baby.
The woman may feel unable to love her infant or her family.
• Anxiety or panic attacks. The woman may be frightened of being left alone in the hours
with the baby
• Fear of harming the baby. These feelings are almost never acted on by the woman with
postpartum depression, but they can be very frightening and may lead to guilty feelings,
which only make the depression worse
• Thoughts of self-harm, including suicide
If you have any of these signs of postpartum depression, you should take steps right away to get
the support and help you need.
109
Some Reasons for Postpartum Depression
It is not always known why some women become depressed after childbirth and others do not.
One important factor is simply biology. The hormonal and other physical changes that take
place after childbirth can affect a woman’s mood and behavior for days or weeks.
Environmental factors, such as stress, lack of sleep, feeling alone, and lack of support from
family and friends, can also play a role. Other factors are psychological—things that affect a
woman’s self-esteem and the ways in which she copes with stress.
For the most part, postpartum depression is likely to result from a combination of all of these
factors. For each woman with postpartum depression, the combination of factors that cause it are
unique, because no two women have the same biologic make-up or life experiences. This may
explain why some women develop postpartum depression and others don’t. It may also explain,
in part, why a woman who may successfully cope with the pressures and responsibilities of
everyday life may find the stress of a new baby hard to handle.
Physical Changes
The postpartum period is a time of great changes in the body. Levels of the female hormones
estrogen and progesterone drop sharply in the hours after childbirth. These decreases may
trigger depression, just as much smaller hormonal changes can trigger moodiness and tension
before menstrual periods. Because some women are more sensitive to these changes than others,
they may be more prone to having postpartum blues or depression.
Thyroid levels may also drop sharply after birth. A new mother may develop a thyroid
deficiency that can produce symptoms that mimic depression, such as mood swings, severe
agitation, fatigue, insomnia (trouble sleeping), and tension.
Many women feel exhausted after labor and birth. It can take weeks for a woman to regain her
normal strength and stamina. If a woman has had a cesarean birth, recovering from this major
surgery can take even longer.
Also, new mothers seldom get the kind of rest they need. In the hospital, sleep is interrupted by
visitors, hospital routine, and the baby’s feedings. At home, the feedings and care continue
around the clock, along with the usual household tasks. This fatigue and lack of sleep can go on
for months and be a major reason for depression.
Psychological Aspects
Many psychological factors can contribute to postpartum depression. Feelings of doubt about
the pregnancy are very common. The pregnancy may be unwanted or unplanned. Even for a
planned, unwanted pregnancy, 9 months may not be enough time for a woman and her partner to
adjust to the responsibilities of having a baby.
Sometimes a woman becomes pregnant in the hopes that the baby will bring back an estranged
partner. When this does not happen, she may feel abandoned, angry, guilty, and inadequate. Or
110
the baby may come early, forcing unexpected, stressful changes in home and work routines. If
the baby is born with a birth defect, it may be even harder for the parents to adjust.
Mixed feelings sometimes arise from a woman’s personal history. If a new mother lost her own
mother early or had a poor relationship with her, she may be unsure about her feelings toward
her new baby. She may fear that caring for the child will lead to pain, disappointment, or loss.
Feelings of loss are common after childbirth and can also contribute to depression. The loss can
take many forms: loss of freedom, along with feelings of being trapped and tied down; loss of an
old identity as one who is taken care of, or the one who is always in control; and loss of a slim
figure and feelings of sexual attractiveness.
Life Style Factors
A major factor in postpartum depression is lack of emotional support from partner, relatives, and
friends. The steady support of a mother’s partner is especially important to her throughout
pregnancy and in the weeks and months after the birth. So is a partner’s willingness to assume
household chores and share the burden of child care. If a woman is single, divorced or separated,
or living far away from her family, support may be scarce or lacking. This may make her feel
alone, overwhelmed, overworked, and unloved.
Breast-feeding problems can make a new mother feel inadequate and depressed. New mothers
need not feel guilty if they cannot breastfeed or if they decide to stop. The baby can be well
nourished with formula. Your partner can help with some of the feedings, freeing you to have
more time for yourself or for rest.
The Role of Myths
The more a woman has idealized motherhood, the more likely she may be to feel disappointed,
disillusioned, and depressed as she faces the reality of day-to-day mothering. Three myths about
motherhood are common:
Myth 1:
Motherhood is Instinctive. First-time mothers often believe that they should automatically know
how to care for a newborn. In fact, new mothers need to learn mothering skills just as they learn
any other important life skill. It takes time and patience. It takes reading child care books,
watching experienced child care givers, talking with experienced mothers, and perhaps attending
a class. Confidence usually grows as a mother’s skills grow.
Mothers may also believe that they must feel a certain way toward their newborn, or they are not
“maternal.” In fact, some women feel very little for their infants at first. Mother love, like
mothering skills, is not automatic. Bonding usually takes days or even weeks. When these
special feeling of motherhood—protectiveness, warmth, delight—begin to emerge, they need to
be nurtured.
111
Myth 2
The Perfect Baby. Most women have vivid fantasies and dreams about what their newborn will
look like. When the baby arrives, mothers have to realize that their newborn may not match the
baby of their dreams. In addition, babies have distinct personalities right from birth. Some
infants are simply easier to care for. Others are fussy, colicky, and not easily soothed or
comforted. Again, adjusting to the baby may be demanding and difficult and may add to feelings
of inadequacy and depression.
Myth 3
The Prefect Mother. Along with the perfect baby, some women are burdened by a notion of the
perfect mother. For many women, striving for perfection is a never-ending and destructive goal.
If a mother thinks she is not living up to this ideal, whether it is her own or that of her friends or
parents, she may suffer from intense feelings of inadequacy or failure.
In reality, no mother is perfect. It is not true that every woman can “have it all.” Most women
find juggling a new baby with household duties, other children, and a job or career to be
extremely demanding. They often feel this way even with a lot of emotional and financial
support.
What You Can Do
If you find that you are feeling depressed in the week or so after the birth of your child, there are
some things you can do to take care of yourself as well as your baby during this vulnerable
period.
First, rest is very important. Don’t try to do everything. Ask for help form family and friends,
especially if you already have children. Try to nap when the baby naps. If possible, have your
partner help with the feedings at night.
It is important to shower and dress each day and to take special care of yourself. It is also
important to get out of the house a little each day. Get a babysitter or take the baby with you.
Go for a walk, meet with a friend, exchange notes with other new mothers. And be sure you
spend time with your partner. Often just talking things out with someone you trust can provide
relief.
Blues that don’t go away after a few days may be a sign of a more serious depression. If your
feelings do not lessen after a few days and begin to interfere with your functioning, contact our
office. There is no sense in suffering when help is available. We are available to listen to any
fears you may have about neglecting or hurting your child.
We will refer you to counselors who specialize in treating depression. These professionals will
provide emotional support during this difficult period, help you sort through confusing and
painful feelings, and help you to make changes in your life.
112
Sometimes, medication may be prescribed along with counseling. In some cases of severe
depression or psychosis, a mother may need to be hospitalized until she can resume normal care
of herself and her child.
For women with postpartum depression, realistic goals and emotional support are critical for full
recovery. During these difficult weeks and months, you will have to learn how to nurture
yourself, as well as your family. Small, daily things can make a big difference—things like
taking time for yourself, getting out of the house, reaching out to family and friends, doing only
what is needed and letting the rest go.
Finally…
Many new mothers have periods of sadness, fear, anger, and anxiety after childbirth. It is
important to remember that these feelings are quite common. They do not mean that you are a
failure as a woman or as a mother, or that you are mentally ill. They do mean that you and your
body are adjusting to the many changes that follow the birth of a child.
If postpartum blues do not go away after a week or two, you may be suffering from postpartum
depression. Talk with us about resources for counseling and treatment. Even if your depression
is severe, treatment is available to help you return to normal as soon as possible.
113
SIX CAR SEAT SAFETY TIPS
Make sure your child has a safe ride
As a family, you’ll undoubtedly spend a lot of time in the car, traveling from play dates to soccer
matches, from the grocery store to Grandma’s house and back again. Here are some tips to make
sure your child is safe during these many trips:
1. Make sure your child rides in the back seat. The backseat is generally the safest place in a
crash. If your vehicle has a passenger air bag, it’s essential for children 12 and under to
ride in the back seat.
2. Make sure infants ride facing the rear until they are about one year old and at least 20 to
22 pounds. Infants who weigh 20 pounds before one year of age should ride in a restraint
approved for higher rear-facing weights. Always read your child restraint owner manual
for instructions on properly using the restraint. Children over the age of one and at least
20 pounds may ride facing forward.
3. Check to see that the safety belt holds the seat tightly in place. Put the belt through the
correct slot. If your safety seat can be used facing either way, use the correct belt slots for
each direction. The safety belt must stay tight when securing the safety seat.
4. Make sure the harness is buckled snugly around your child. Keep the straps over your
child’s shoulder. The harness should be adjusted so you can slip only one finger
underneath the straps at your child’s chest. Place the chest clip at armpit level.
5. Have children over 40 pounds use a booster seat. Keep your child in a safety seat with a
full harness as long as possible, until he’s at least 40 pounds. Then use a belt-positioning
booster seat, which helps the adult lap and shoulder belt fit better. A belt-positioning
booster seat, used with the adult lap and shoulder belt, is preferred for children weighing
40-80 pounds.
6. Check safety belt fit on older children. The child must be tall enough to sit without
slouching, with knees bent at the edge of the seat, with feet on the floor. The lap belt
must fit low and tight across the upper thighs. The shoulder belt should rest over the
shoulder and across the chest. Never put the shoulder belt under the child’s arm or behind
the back. The adult lap and shoulder belt system alone will not fit most children until they
are at least 4 feet 9 inches tall and weigh about 80 pounds.

CONGRATULATIONS! - Southern Crescent Women`s Healthcare

Transcription

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