Frequently Asked Questions

Obstetric (Pregnancy) Questions & Information

Cold / Flu, Allergies & Respiratory Symptoms
  • Rest & drinking lots of fluids, and a humidifier can relieve many symptoms.
  • Tylenol (acetaminophen): use for fever and pain or flu-like symptoms. Follow package instructions; do not take more than 4000mg per day. Note: many “cold” and “flu” medicines contain acetaminophen so be sure to read labels.
  • Sudafed (pseudoephedrine): use according to package instructions. You will have to ask for this medication at the pharmacy counter and sign for it. Variations include: Mucinex-D, Tylenol Cold and Sinus.
  • Benadryl (diphenhydramine): use according to package instructions, available in adult and pediatric (liquid form) dosing
  • Robitussin, Mucinex (guaifenesin): a cough syrup and expectorant, good to help thin mucus
  • Any cough drops or throat sprays, choose sugar-free if you have Gestational Diabetes
  • Claritin (loratidine), Zyrtec are available over the counter to treat seasonal allergies
  • NasalCrom or saline spray use according to package directions
  • Neti Pot: very useful to relieve stuffiness and sinus symptoms
  • Vaporub or heating pads on your back to help soothe aching muscles
  • DO NOT USE Afrin, prolonged use of Afrin can actually make sinus drainage worse. Avoid Alka-Seltzer Cold, Aleve Cold and Sinus, and Advil Cold and Sinus (avoid any product that contains aspirin, ibuprofen or naproxen).
Nausea / Vomiting
  • Clear liquids and popsicles. Do not go more than 2 hours without eating something small like crackers or bland fruit.
  • Emetrol is available without prescription. Soda crackers may help. Safe prescription medicines, in the form of pills or suppositories, can be phoned in when desired. Call if these measures are ineffective. Occasionally, intravenous fluids are needed. Vitamins and iron may be discontinued until symptoms improve.
  • If you are unable to keep fluids down or if you are unable to eat/drink without vomiting for more than one day, call the office.
  • Ginger is an excellent anti-nausea treatment. It is available at Trader Joe’s and Whole Foods in candy form, the pickled ginger with sushi may work, and ginger snap cookies may be a good alternative to saltines
  • Peppermint is a natural way to settle your stomach. It may work if you eat an Altoid mint in the morning (getting rid of the bad taste in your mouth), eat some breakfast, THEN brush your teeth. Brushing your teeth on an empty stomach is an easy way to trigger nausea when you are pregnant
  • Sea-Bands or Motion Sickness bands: these are available in most pharmacies or health food stores and use pressure points on the wrists to relieve nausea
  • Bonine: an over-the-counter medication for motion sickness
  • B-6: 50mg daily will help relieve nausea
  • Unisom: sometimes this helps some women- 112 tablet with 50mg Vitamin B-6. Follow the package dosing instructions on Unisom regarding frequency of dosage
  • If your nausea becomes intolerable, call the office to see if prescription medication is appropriate in your case.
Diarrhea
  • The most common reason for diarrhea is eating something disagreeable or coming in contact with a minor stomach virus. When this happens, the best treatment is to let the diarrhea run its course
  • Drink LOTS of water to avoid dehydration, it happens faster than you think
  • Electrolyte replacers such as Pedialyte and Gatorade may be helpful to prevent dehydration
  • The BRAT diet (bananas, rice, applesauce, tea & toast) is the staple for treating diarrhea. It will allow your stomach and intestines to rest while giving you some food that is easy to digest. Be careful not to drink too much tea or tea high in caffeine.
  • Avoid dairy products and fruit juices-these will make the diarrhea worse!
  • Warm tub soaks for your irritated behind! Use moist wipes and keep your bottom clean
  • Loperamide (Immodium AD): use according to package instructions if the diarrhea is persistent
  • If the diarrhea persists more than 2-3 days call your doctor or primary care physician
Constipation
  • Drink lots of water
  • Mild to moderate exercise 20-30 minutes per day can help, just a nice walk around the block in the evening!
  • Colace (docusate): 100mg take one once or twice a day. Available as a generic in any drug store or grocery store, Colace is a stool softener not a laxative
  • Senokot (senna): a vegetable laxative, safe for use in both pregnancy and lactation
  • Miralax: now has a generic, it’s tasteless when mixed with any liquid including water. If Senokot has not helped, Miralax can be very effective; however, its safety in lactation (breastfeeding) has not been clearly established
  • Fleets enema: available over the counter both as a brand and generic
  • Milk of Magnesia or Phillips Caplets: may be used according to package directions
  • Dulcolax: laxative may also be used in both pregnancy and lactation
Reflux / Indigestion
  • This is a common concern in pregnancy. Small, frequent meals can help
  • Lansoprazole (Prevacid) & Cimetidine (Tagemet)
  • Pepcid (famotidine) 20mg daily: also available as a generic
  • Antacids like Tums & Rolaids: generally don’t help much but are helpful sources of additional calcium and can be good to keep in your bag for an emergency ‘flare up’ of indigestion
  • Mylanta, Maalox, Gaviscon: these are available as liquids and chewable tablet forms. They are good for symptom relief and all available as generics
  • Peppermint (Altoids) can relieve indigestion
  • DO NOT TAKE Pepto-Bismol (like aspirin, it is a salicylate and may cause issues with bleeding, especially during the 3rd trimester).
Hemorrhoids
  • Over the counter cream such as Preparation H (or a generic) apply to hemorrhoids several times daily
  • Over the counter cortisone cream can be applied to hemorrhoids to relieve swelling and irritation
  • Tucks/Witch Hazel pads applied as needed. Keep them in the refrigerator, the cold is very soothing. Tucks pads also make good compresses when draped over peripads and worn against the affected area
  • Use flushable wipes after bowel movements to avoid irritation
  • Sitz baths/warm tub soaks are soothing and can help decrease swelling and irritation
Muscle Pain
  • Tylenol (acetaminophen): use according to package directions, do not take more than 4000mg per day
  • Bengay, Icy Hot, Tiger Balm: these ‘sports-type’ rubs are safe and often soothing for back or hip aches (sciatic nerve pain). Avoid using them on the abdomen. Some of them are available as a patch that can be applied to the skin
  • Heating Pads: again avoid them on your abdomen. Alternating heat with cold (ice packs) can also be helpful in relieving muscle pain. 10 minutes heat, 10 minutes cold
  • Warm baths (avoid taking a hot bath). Epsom salt baths can also be beneficial (the Magnesium has been shown to be helpful).
  • Massage
Headache or Fever
  • Tylenol (acetaminophen) is the drug of choice for pain or fever. Follow the dosing instructions on the bottle, no more than 4000mg per day.
  • Drink 8-12 oz of WATER an hour if you have a fever to help avoid dehydration
  • Call for a fever over 100.4
  • DO NOT TAKE Advil, Aleve, Aspirin, or Ibuprofen to relieve your fever
  • Migraines are a common occurrence in pregnancy, particularly if you have a history of them. Lie down in a dark room, use cold compresses, but do not take Excedrin Migraine
Insomnia
  • Try to establish a regular sleeping schedule – a search for “sleep hygiene” should also offer some helpful tips.
  • Maintain a cool, calm environment in your bedroom
  • Avoid distracting, stimulating activities such as video games, the internet, and television prior to bedtime
  • Moderate, regular exercise will help you sleep better. A moderate walk 20 minutes a day will make for an easier labor and help you sleep better
  • Use pillows for support and comfort
  • Tylenol PM (acetaminophen & diphenhydramine): can be used as a sleep aid
  • Benadryl (diphenhydramine): may also be used for sleep, follow package instructions
Yeast Infection
  • Over the counter yeast creams/inserts which contain Miconazole such as Monistat may be safely used during pregnancy. The best kind provides both a cream/ovule which is inserted into the vagina, plus an extra tube of cream to apply to the outside of the vagina for relief from external itching
  • In pregnancy, 7 day treatments are most effective
  • If no relief occurs 48 hours after self treatment, call the office
Safe Medications to Take During Pregnancy:
  • Diphenhydramine (Benadryl)*
  • Dextromethorphan (Robitussin®)*
  • Guaifenesin (Mucinex® [plain], Robitussin) *
  • Docusate (Surfak or Dulcolax)
  • Attapulgite (Donnagel)
  • Actifed (chlorpheniramine and phenylephrine)
  • Dimetapp (brompheniramine and phenylephrine)
  • Mylanta
  • Senna (Senokot)
  • Loperamide (Immodium AD)
  • Ranitidine (Zantac) or Famotidine (Pepcid)
  • Antacids
  • Emetrol (Fructose, Dextrose, and Phosphoric Acid)
  • Vicks Vapor Rub® mentholated cream
  • Claritin or Claritin D (loratadine with or without pseudoephedrine)
  • Mentholated or non-mentholated cough drops
  • Sugar-free cough drops for gestational diabetes should not contain blends of herbs or aspartame
  • Pseudoephedrine ([Sudafed®] after 1st trimester)
  • Acetaminophen (Tylenol®)*
  • Saline nasal drops or spray
  • Warm salt/water gargle

* Note: Do not take the “SA” (Sustained Action) form of these drugs or the “Multi-Symptom” form of these drugs. Do not use Nyquil® due to its high alcohol content.

Safe Medications to Take During Pregnancy:
  • Diphenhydramine (Benadryl)*
  • Dextromethorphan (Robitussin®)*
  • Guaifenesin (Mucinex® [plain], Robitussin) *
  • Docusate (Surfak or Dulcolax)
  • Attapulgite (Donnagel)
  • Actifed (chlorpheniramine and phenylephrine)
  • Dimetapp (brompheniramine and phenylephrine)
  • Mylanta
  • Senna (Senokot)
  • Loperamide (Immodium AD)
  • Lansoprazole (Prevacid), Cimetidine (Tagemet) & Famotidine (Pepcid)
  • Antacids
  • Emetrol (Fructose, Dextrose, and Phosphoric Acid)
  • Vicks Vapor Rub® mentholated cream
  • Claritin or Claritin D (loratadine with or without pseudoephedrine)
  • Mentholated or non-mentholated cough drops
  • Sugar-free cough drops for gestational diabetes should not contain blends of herbs or aspartame
  • Pseudoephedrine ([Sudafed®] after 1st trimester)
  • Acetaminophen (Tylenol®)*
  • Saline nasal drops or spray
  • Warm salt/water gargle

* Note: Do not take the “SA” (Sustained Action) form of these drugs or the “Multi-Symptom” form of these drugs. Do not use Nyquil® due to its high alcohol content.

A full term pregnancy is 37 to 42 weeks long. The estimated due date is determined from the first day of your last menstrual period (LMP) and is averaged out to be 40 weeks. If you are unsure of your last menstrual period or have irregular periods, an ultrasound can be done in the first trimester to help determine your due date. An infant delivered prior to 37 weeks is considered preterm.

The cause of preterm labor is not completely understood. There are many factors that may increase the chances of developing this complication. Some of these factors include carrying twins or triplets, untreated urinary tract (bladder) infections, or having had a preterm delivery in the past. It is also possible to develop preterm labor for no apparent reason.

“Labor” is the condition in which the uterus contracts in a regular coordinated pattern causing the cervix to open and prepare for delivery. If these contractions occur along with changes in the cervix between 20 and 37 weeks, then the diagnosis of preterm labor is made.

Awareness of possible preterm labor is one of the best methods that may help prevent a preterm birth. The following are often warning signs and symptoms of preterm labor:

  1. Uterine contractions are tightening of the uterine muscle. During a contraction, your uterus will tense up and feel hard.
  2. Contractions occur normally throughout pregnancy and are generally painless and irregular in sequence. Preterm labor contractions may also be painless but there is often a pattern to them. Contractions that occur every 15 minutes or more
    than 4 to 6 contractions per hour consecutively for more than 2 hours may cause the cervix to soften or open.
  3. Menstrual-like cramps felt in the low abdomen area just above the pubic bone that may be constant or come in waves.
  4. Dull lower backache located mainly in the low back or around the sides. It may be constant or intermittent. It is generally not relieved by a change in position.
    Pelvic pressure, a feeling of fullness or increased heaviness and pressure in the pelvic area. It is often described as a feeling that the baby is going to “fall out”.
  5. Intestinal cramping that may or may not be associated with diarrhea. It may feel like “gas pain.”
  6. Change or increase in vaginal discharge. The color may be pink or brown tinged. The discharge may change to a thick mucous or be thin and watery.
  7. A feeling that something may not be right. This may occur without any specific cause.

If you should detect any of the above signs or symptoms we advise monitoring for contractions. This is accomplished by emptying your bladder and then lying down, tilted slightly on your side. Use a pillow to support your back. Place your fingertips in the top of your uterus. Feel if your uterus is getting hard or not. If you feel contractions, time the duration from the beginning of one contraction to the next. Also time the length of each contraction.

Monitor the contractions for at least one hour. Sometimes resting will stop the contractions or at least slow them down. Other times dehydration can be the culprit. Drinking a glass of water may also help. Please call us if you have more than 4 to 6 contractions in one hour or if any of the other symptoms should occur, especially any spotting, bleeding, or other change in your vaginal discharge.

If you have had a previous pregnancy with preterm labor, your doctor will be monitoring you more closely in your future pregnancies. You are at an increased risk to have preterm contractions if you have had them in previous pregnancies. To screen for preterm labor, your doctor may perform an ultrasound to check the length of your cervix and/or place you on the fetal monitor to check for any contractions that you may be having.

Remember you are looking for any changes from your normal pattern. If you are unsure if you are contracting or any of the other warning symptoms, please do not hesitate to contact our office at any time. Early recognition of preterm labor may prevent a preterm delivery.

You are encouraged to call our office anytime you have concerns about your pregnancy. We are available to provide you with medical care and reassurance every day of the week. You may reach our office 24 hours a day, by calling our office. If you are calling during our office hours of 8:15 am to 5pm, one of our experienced triage nurses will return your call. When you call the office after office hours, the answering service will handle your call, contact our on-call physician so that he/she will be able to call you and address your concern. If you have an urgent concern and have not received a call in 30-45 minutes, please call again.

Please call us right away if any of the following occur:

  • A significant change or decrease in fetal movement
  • Bright red vaginal bleeding or spotting (other than blood tinged mucous)
  • Sharp, severe, and lasting abdominal pain
  • Contractions/abdominal tightening/menstrual-like cramping
    • if the contractions occur 4-6 times an hour consistently for 2 or more hours
    • if the contractions are increasing in intensity and are not relieved by rest
  • When in labor your contractions should be 5-7 minutes apart for more than an hour with increasing intensity
  • Persistent leaking of watery fluid or a gush of watery fluid from the vagina. Try to note color (clear, green, yellow, bloody).
  • Fever greater than 100.4 if the cause is not known.
  • Call if you are suddenly quite ill but are unable to determine why.

Aches and Pains

You may feel stretching and pulling pains in the abdomen that sometimes runs down the groin and thighs or vagina. These may be due to the pressure of the uterus or nerves running through the pelvis. These pains are usually made worse by standing and are relieved by lying down.

Backaches and aching over the pubic/pelvic bone are due to the pressure of the baby’s head, your weight increases and the normal loosening of joints in this area. Maintain good posture, use lumbar support whenever possible. Heat over the area may give some relief. Use an abdominal support or binder if necessary. If these symptoms do not resolve, please contact our office for an appointment since these symptoms may indicate other problems.

Constipation

Constipation results from relaxed intestinal muscles and from pressure caused by a growing uterus. To help prevent constipation, make sure you eat fresh or dried fruits, raw vegetables and whole grain breads and cereals every day. Drink 8-10 glasses of liquid. Water is best but you can drink fruit and vegetable juices for variety. Caffeine tends to cause your body to lose fluids so avoid liquids such as coffee, tea and colas. If necessary, you can use Metamucil, Citrucel or Colace. It is not necessary to have a bowel movement everyday as long as the stool is soft.

Dizziness, Fainting, Lightheadedness

These conditions can occur at any time during your pregnancy. It is probably due to the extra blood going to your uterus and legs. These symptoms are usually relieved by lying down on your left side and hydration. To avoid feeling dizzy or lightheaded, move around more instead of standing or sitting in any one position for a while. If the symptoms persist, please contact our office.

Heartburn

Heartburn or indigestion may cause a burning feeling in your chest or a burp of bitter fluid, especially during the latter part of your pregnancy when your baby is large enough to exert some pressure on your stomach. You may use antacids in liquid or tablet form such as Turns, Gelusil, Mylanta or Maalox. You may want to avoid sodium bicarbonate products as they can cause you to hold water.

  • Try to eat 5-6 small meals instead in a day.
  • Do not lie down or bend over after meals. When resting after a
  • Avoid fatty and fried foods.
  • Avoid black pepper, chili powder, beverages with caffeine and meat meal, prop yourself up with pillows in bed or sit in a chair. extracts (bouillon or broth).
Hemorrhoids and Varicose Veins

Pressure on the large veins behind the uterus causes the blood to slow its return to the heart. This can lead to varicose (swollen and twisted) veins in the legs and hemorrhoids (varicose veins around the anus).

  • Avoid tight garments, knee highs or garters.
  • Sit with your legs raised whenever possible.
  • Wear support hose. If you shower at night, put them on as soon as you wake up. If you shower in the morning, put them on after you have elevated your feet for 5 minutes.
  • Avoid constipation. Warm tub baths and Tucks will help relieve hemorrhoid discomfort.
  • Do not sit with your legs crossed, especially at your knees.
  • When standing, keep your legs moving so the blood can be pumped back upwards. You can shuffle your feet, raise your knees up or walk in place.
Leg Cramps

Cramps in yiegs or feet may be due to a change in calcium metabolism during your pregnancy. One way to prevent muscle cramps is to drink more low-fat or nonfat milk or eat more calcium-rich foods such as dark green vegetables, nuts, grains and beans. If you do get a cramp, relieve it by gently stretching the muscle. Stretch your leg with your foot flexed toward your body. Pointing the foot away from the body can make it worse. A warm, moist towel or heat pad wrapped on the muscle may also help.

Nausea and Vomiting

Nausea and vomiting, often called “morning sickness” are common in early pregnancy. Many women have it at other times of the day. Usually morning sickness resolves after 3 months.

  • Eat frequent small meals whether you are hungry or not.
  • Try starchy foods such as plain crackers, toast, rice cakes, zwieback, dry breakfast cereals or a sandwich.
  • Avoid fatty, fried or spicy foods. will help.
  • Keep sleeping and working areas well ventilated to get rid of odors.
  • Drink liquids between meals rather than with the meals. Sometimes carbonated drinks such as ginger ale, 7-up, or seltzer

If symptoms are persistent and you cannot hold down any food or liquids, please notify us right away.

Skin Changes

You may have changes in your skin color during pregnancy. Your nipples darken and you may notice a dark line down your abdomen running from your umbilicus (belly button) through the pubic area. You may also have blotchy brown pigmentation (discoloration) of your forehead or cheeks. Stretch marks are pink, red or purple streaks in the skin over the breasts, abdomen, thighs, or buttocks. Creams and lotions do not prevent them. Most of these changes will fade after delivery but may not disappear completely.

Tingling

Tingling and numbness of the fingers and a feeling of swelling in the hands are common during pregnancy. They are probably due to the swelling of tissues in the narrow passages in your wrists and will disappear after pregnancy. If they affect your muscle strength or motor skills, please bring it to our attention.

Frequency of Urination

Frequency of urination is common in pregnancy. The growing uterus presses on the bladder and causes you to urinate more frequently. Later in pregnancy, there is pressure from your baby’s head on the bladder. Drink less fluid after your evening meal if you are having trouble getting enough sleep because of getting up in the night to urinate.

Headaches

Headaches are common during pregnancy, especially during the 1st and 3rd trimesters. They rarely signal a serious problem. The causes of the headache are uncertain. In the first few months of pregnancy, they may be caused by normal changes in your hormone levels and an increase in blood volume and circulation. In the second trimester, pregnancy related headaches may disappear as your body becomes used to the hormonal changes. Towards the end of the pregnancy, headaches tend to be related more to posture and tension from carrying extra weight. Talk to your provider about ways to help prevent or lesson the severity
of headaches.

Congestion and Nosebleeds

During pregnancy, you may have a runny or stuffy nose or occasional nosebleeds. These symptoms often begin toward the end of the first trimester and may continue until after delivery. To help relieve symptoms of congestion and dryness, you can use a humidifier in your room to help moisture in the air. Some women prefer the steam of a warm shower before bed to help relieve congestion. You may also use saline drops or nose spray to help moisten passages.

Swelling

It is normal for your body to produce and retain more fluid during pregnancy, particularly during the last few months. This can cause slight swelling especially in the legs, feet and ankles, but also the hands and face. Tips to relieve some swelling are:

  • Elevating feet and legs.
  • Lying on your side.
  • Frequent breaks throughout the day to elevate your feet.
  • Avoid crossing your legs when sitting.
  • Do not salt food, and reduce sodium consumption.

Swelling can be dangerous when accompanied by severe headache, blurred vision,
dizziness or severe pain in the belly. Please contact your provider if you experience any combination of these symptoms. Also call your provider if one leg is much more swollen than the other, especially if you also have pain or tenderness in your calf or thigh.

During pregnancy, you may have a runny or stuffy nose or occasional nosebleeds. These symptoms often begin toward the end of the first trimester and may continue until after delivery. To help relieve symptoms of congestion and dryness, you can use a humidifier in your room to help moisture in the air. Some women prefer the steam of a warm shower before bed to help relieve congestion. You may also use saline drops or nose spray to help moisten passages.

Changes in fetal movement may reflect changes in fetal well-being. By keeping a record of the number of times your baby moves during the day, you can provide useful information for your physician on the well-being of your baby.

Each baby tends to have its own pattern of activity and some babies are more active than others. Normally, a mother feels between 20 and 200 fetal movements per day after 24 weeks.

Recommendations for fetal movement counting are as follows: When you arise in the morning, pay attention to your baby’s movements and begin counting the number of movements you experience. Three simultaneous movements would be counted as three movements. If you have not noted 20 fetal movements by noon, have lunch and sit in a quiet location to continue your movement counting. Sometime lying on your side can help. If by early to mid afternoon you still have not reached a count of 20, notify your health care provider. Also call if you: 1)feel no movements in 8 hours; or 2) observe that the pattern of fetal movement has changed significantly from the usual pattern.

Fetal monitoring – Non-Stress Test [NST]

During your pregnancy, your physician may recommend that you have fetal monitoring done called a Non-Stress Test (NST). This is done in our office by one of our nurses. Fetal monitoring is one method of providing reassurance regarding fetal well being. You will be monitored in such cases as elevated blood pressure, preterm labor, gestational diabetes, decreased fetal movement or any other complication that is determined by your physician.

You may eat normally prior to your (NST). Do not smoke 2 hrs prior to your fetal monitoring (of course, we strongly recommend that you do not smoke at all!). The monitoring process itself will take at least 20 minutes and possibly longer if needed. Two elastic belts will be placed around your abdomen to hold the sensors in place. These sensors record the baby’s heart rate and monitor your uterus for contractions. During the test, this information is traced onto graph paper for interpretation by your physician. The results will be explained to you immediately after the test.

Travel is not usually harmful and does not normally increase complications of pregnancy. However, due to the unpredictability of preterm labor, we do not recommend any airplane travel during the third trimester.

Exercise

Regular exercise (30 minutes at least three times a week) is healthier than intermittent activity. Limit strenuous activity to less than 15 minutes. Drink plenty of fluids before and after you exercise. Precede exercise with a five-minute warm-up such as slow walking. Always gently stretch before and after exercising. Avoid heart pounding exercise that drives your pulse past 140 beats per minute. Avoid vigorous exercise in the heat. Avoid jerky, “bouncy” motions. Do not perform any exercise while flat on your back after the fourth month of pregnancy. Avoid extreme flexing of joints (deep knee bends) or exercise employing the Valsalva maneuver (bearing down as with a bowel movement); e.g. weight lifting.

Sexual Relations

You can have intercourse throughout your pregnancy unless you experience pain, bleeding or leaking of water from the vagina. As the uterus increases in size, you may find a side-by-side position to be more comfortable. Your sexual desires may vary during the course of your pregnancy and this is normal. If you have a history of repeated miscarriages, or if the current pregnancy is complicated by abnormal bleeding, intercourse should be avoided during the first three months.

To minimize the risk of uterine infection, you should avoid intercourse following delivery until all stitches have healed and you have come back for your post-partum visit. Have your partner use a condom until you have started another form of birth control.

Work

Most women can continue their jobs throughout their pregnancy. In fact, keeping active may help you stay healthier and help pass the time more quickly. If you have a question about your particular job, we can talk it over at your prenatal visit. If you are at risk for preterm labor or other high-risk factors, we will talk with you about any necessary changes to your work schedule.

Hot Tubs and Saunas

Due to possible risk to the baby, we do not recommend using hot tubs or saunas while pregnant. It is okay to take warm baths (as long as they are not too hot) and not spending too much time (i.e. more than 15 minutes) with an elevated body temperature.

True labor is nearly impossible to judge until your cervix is checked.  Here are some helpful guidelines for when to call about labor.

  1. You have a leakage of fluid that you do not feel is urine.
  2. You have bleeding, other than pink or brown blood with mucous.
  3. Contractions are 3-5 minutes apart, and this lasts for one to two hours.
  4. Contractions are less often, but painful, and have an increase in intensity and frequency over a two hour period.

(If this is not your first baby, and your previous labor went quite fast, you may modify the above guidelines)

False labor is characterized by Braxton Hicks contractions, which are sporadic (irregular), infrequent uterine contractions that are typically not felt until the second or third trimester and usually only mildly crampy/uncomfortable. Most importantly, these contraction do not induce cervical change.

If patients have any concerns they can always call the office. Sometimes, drinking a glass of water, rhythmic breathing, and lying down on the left side and relaxing can alleviate false labor contractions and pain.

Raw or Under-cooked Meat, Fish or Poultry (and deli-meats)

In General: Cook beef, veal, and lamb to 145° F. Cook pork and all ground meats to 160° F. Cook poultry to 165° F.

Avoid sushi or other raw foods or dishes, as well as under-cooked meats or fish.

Avoid mercury containing fish. Examples of fish with low levels of mercury, such as salmon, shrimp, pollock, tilapia, or trout, are safe to eat.

Avoid refrigerated meat of any kind (including ham, turkey, roast beef, hot dogs, bologna, prosciutto, and pâté) unless heated until steaming (165° F). Also avoid dry, uncooked sausages (such as salami and pepperoni) unless heated until steaming.

Eggs

Don’t eat raw or under-cooked eggs. This includes items that may contain raw or under-cooked eggs, such as cookie dough, eggnog, custard, etc.

Unpasteurized Milk or Cheese (or unpasteurized juice)

Avoid any unpasteurized milk or cheese or food dishes that contain them (unless heated to an appropriate safe temperature).

Caffeine

Current guidelines and studies suggest that mild to moderate caffeine consumption is safe (less than 200mg per day). The caffeine in quantities found in typical beverages is generally safe (1 standard cup of coffee equals ~100mg caffeine). So a 2 cups of coffee per day limit is a good rule of thumb.

Avoid all diuretics (fluid pills) during pregnancy unless otherwise directed.

For more information on diet and nutrition during pregnancy see here:

ACOG. 2018. Nutrition during pregnancy. American College of Obstetricians and Gynecologists. https://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy

In the first 11 weeks, Folate supplement of 400-800 mcg per day is desirable to reduce the chance of neural tube defects (spina bifida). The chance of these defects without extra supplements is 1 in 1,000 infants. The recommended amounts of Folic Acid and Iron are contained in your regular prenatal vitamin supplements, and it is suggested that you take these throughout the entire pregnancy. It is NOT recommended to take supplements that contain Vitamin A.

Because teeth and gums need special care at this time, have your teeth cleaned early in your pregnancy and every 6 months (routine care).

Remember to tell your dentist that you are pregnant. Your gums are softer and spongier than normal, so brush with a soft toothbrush and floss gently at least twice a day. If necessary, teeth may be safely treated and extracted. Local anesthesia can be used, but please ask us before agreeing to general anesthesia or X-rays.

It is recommended to defer care that is considered strictly cosmetic until after delivery.

General Guidelines:
  • Local Anesthetic agents are satisfactory, preferably without Epinephrine. Epinephrine would be acceptable if bleeding is a significant concern.
  • It is recommended to avoid inhalation agents or heavy sedation during procedures unless anesthesiology monitoring is utilized. We would consider procedures under general anesthesia safe when administered by an anesthesiologist in the appropriate setting.
  • X-rays can be performed as indicated with the use of abdominal shielding.
  • Left lateral decubitus positioning may help avoid syncopal episodes.
  • Approved Antibiotics: Erythromycins, Penicillins, Cephalosporins, Augmentin & Zithromax (Contraindicated Antibiotics: Tetracyclines and Quinolones)
  • Approved Pain Medicine: Acetaminophen (Contraindicated Pain Medicine: Ibuprofen products and other NSAIDs). After 13 weeks gestation, these can be used for less than 5 days duration.

We will be glad to assist in reviewing any proposed medication use from a pregnancy perspective.

We utilize the guidelines of the American Institute of Ultrasound in Medicine to perform ultrasounds. This ensures that you receive a quality exam, and that the needed studies are performed. Every pregnancy will receive at least two ultrasound exams. If you have concerns about an ultrasound, please feel free to ask your doctor or our medical staff. There are times when having an ultrasound may be appropriate for your reassurance of specific concerns. Be sure you discuss this with your doctor or medical staff so that we may be able to determine if this or other studies would be right for you. Extra scans can be requested; however, they are not covered by your insurance unless they are considered medically necessary, and you must pay for an elective scan out of pocket.

Currently, we do one first trimester sonogram at around 8-10 weeks into your pregnancy, and then one routine anatomical survey at around 18 weeks. The anatomical survey is imaging that will provide important information about your pregnancy and your baby. This ultrasound assesses your baby’s growth and development, confirms your uterus is developing as it should, and can detect early signs of certain birth defects. We are happy to provide pictures for any sonogram. Due to time restraints, CD’s may or may not be done for the second trimester anatomical survey at 18 weeks. Any sonogram after the 16-18 week anatomical sonogram is considered optional or elective, and will not be covered by your insurance carrier unless ordered by the physician.

Towards the end of pregnancy, the cervix begins to change and become more thin. As this occurs, patients may experience more mucous-like discharge and it may be blood tinged as well – often called a “bloody show.”

Sometimes, instead of a steady discharge, this cervical mucous can accumulate at the cervix and come out all at once. When this happens patients often report that they noticed a “mucus plug.” It can be white, slightly brown, yellow or pink-red in color. It should not have a foul odor or strong smell.

The quantity of alcohol required to cause abnormalities in your baby is unknown. However, daily drinking of alcohol, binge drinking (drinking a lot, but only once in awhile), and social drinking have all been shown to have harmful effects on the fetus.

Because we do not know how much alcohol is safe, we recommend that you do not drink alcohol during your pregnancy.

If you have any concerns or feel that alcohol consumption might be an issue, please feel free to discuss with your physician.

It is recommended that you stop smoking entirely during your pregnancy. Smoking one pack or more per day is associated with problems, such as poor growth and inadequate placenta formation.

When you become pregnant, be certain to tell your OB physician or nurse practitioner if you are taking any medication or drugs. Some drugs and medicines can be harmful to the baby’s development. For this reason, from the earliest stages of your pregnancy, take only drugs or medicines prescribed or approved by us. These include antibiotics, antihistamines and stimulants, pills for weight reduction, tranquilizers or sleeping pills. Don’t take any drugs from a health food store or take “homegrown remedies” until you talk with us. Even if your friend or family member did great taking the drug, it may not be good for you and your baby.

It is essential that you avoid drugs such as marijuana, cocaine, heroin, speed (amphetamines), barbiturates, LSD or other hallucinogens. Talk with us if you need help to stop a drug habit.

Vaccines help protect you and your baby against serious diseases.  When you get vaccines, you aren’t just protecting yourself – you are giving your baby some early protection too.  

Flu Vaccine – pregnancy can make you more susceptible to the flu.  Catching the flu increases your risk for serious problems for your developing baby, including premature labor and delivery.  The flu vaccine provides protection for you and your baby for several months after birth.  Flu season varies, but it is recommended to get vaccinated by the end of October.

Whooping Cough Vaccine (Tdap) – Whooping cough (pertussis) can be serious for anyone, but can be life-threatening for your newborn.  Up to 20 babies die each year in the United States due to whooping cough.  About half of babies younger than 1-year-old who get whooping cough need treatment in the hospital.  It can be hard to know if babies have whooping cough as many do not cough at all, instead it causes them to stop breathing and turn blue.  Getting the vaccine during pregnancy allows some of the protective antibodies to pass to the baby before birth.

COVID-19 Vaccine – The American College of Obstetricians & Gynecologists (ACOG) and the Society of Maternal-Fetal Medicine (SMFM) have strongly recommended the Covid vaccine for all women with the chance of pregnancy.  Some of the new variants are specifically dangerous to younger women, especially during pregnancy.

During your pregnancy, your physician may recommend that you have fetal monitoring, call a Non-Stress Test (NST).  This is done in our office by one of our nurses.  Fetal monitoring is one method of providing reassurance for cases such as elevated blood pressure, preterm labor, gestational diabetes, decreased fetal movement, or any other complication that is determined by your physician.

You may eat normally prior to your NST.  Do not smoke 2 hours prior to fetal monitoring (of course, we strongly recommend no smoking at all!).  The monitoring process will take at least 20 minutes, and possibly longer if necessary.  Two elastic/velcro belts will be placed around your abdomen to hold sensors in place.  These sensors record the baby’s heart rate and monitor your uterus for contractions.  During the test, this information is traced onto graph paper for interpretation by your physician.

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