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Prenatal Instructions from Salida Family Medicine
Congratulations on your pregnancy! You are beginning one of the most exciting and important times of your life. Your body is going to undergo a great many changes; your emotions will also undergo changes. The remarkable changes that occur in your body are truly miracles of nature. The more you understand about your pregnancy, the more you will be able to enjoy this wonderful experience. It is our privilege to be involved with the birth of your child.
 The purposes of the handouts you will receive throughout your pregnancy are to give you our ideas and recommendations throughout the stages of your pregnancy. Each handout will address specific issues and will hopefully answer many questions you have. We ask that you read each carefully and completely. Please feel free to call if you have questions - or ask at your next visit if not urgent.
OUR PHILOSOPHY
Pregnancy is a normal, natural occurrence and we like to treat it as such. We want to change as few routines in your lifestyle as possible. If you have any questions regarding the suggestions of your provider during prenatal care, labor or delivery, we want you to ask. We want this to be an exciting and happy experience with as little anxiety and nervousness as possible.
OUR ROUTINES
There are several procedures that we routinely do on all of our expectant mothers. If you have questions about why these are necessary, please ask. We will be happy to discuss our reasons with you. Our routines include the following:
1. Each patient is prescribed prenatal vitamins.
2. Lamaze classes are highly recommended for all mothers.
3. After your initial visit, we will ask to see you monthly until 28 weeks then every two weeks
until 36 weeks then weekly until delivery unless we decide otherwise.
4. Each appointment will include blood pressure check, weight check, urine check, fetal heart
tone check and measurement of your uterus.
5. An IV is usual in all patients during labor and delivery.
6. Electronic monitoring your contractions and baby's heartbeat is routine during labor.
7. Episiotomies are not done as a routine - only if needed to safely deliver your baby.
PRENATAL CARE
It is important that you see your provider regularly throughout your pregnancy. These visits are called prenatal care. Generally, you will be seen once a month until the 28th week then every two weeks until the 36th week, then weekly until delivery.
The expectant father of your child is welcomed to any appointment throughout your pregnancy. He plays a vital role in your support during this time and his participation is encouraged in every aspect. Your children are welcome also; they may feel more included in the big event if they have heard the baby's heartbeat while he/she was still in mommy's "tummy".
At your first prenatal checkup, you will be asked to complete a history questionnaire concerning your previous pregnancies. Your provider will review this with you. You will receive a physical exam including a breast exam, pelvic exam and PAP smear. Routine blood and urine tests will be done.
After the initial visit, the typical prenatal visit will include checking your blood pressure and weight, your urine will be tested for sugar and protein, and the provider will listen for baby's heartbeat, assess fetal position, and measure the height of your uterus.
Blood work, including a blood count and diabetes check, will be repeated at about 24-28 weeks. Our procedure is to get in touch with you about the results of any lab work. If you do not hear from us in a reasonable time, please call and remind us.
ON CALL AND COVERAGE SYSTEM
If you have a concern or questions during normal business hours please call our office at (719)530-3583. If it is after business hours, call the hospital OB department at (719)530-8223 and they will direct you to the provider on call. Dr. Arnett shares on-call with other providers.
Dr. Arnett will try to be available when you deliver, but occasionally due to vacations, illness, or required trips out-of-town, this may not be possible. In that instance, the on-call provider will do your delivery.
COST OF OB CARE/PAYMENT PLANS
A fee schedule and payment plan will be given to you. If you have questions, please feel free to discuss this with us.
DIET AND NUTRITION
As a general rule: You should eat the right foods in adequate amounts but avoid "junk" foods and foods high in calories that can cause you to gain needless weight.
/ Every day try to eat from these four food groups:
Bread-Cereal-Rice-Pasta: 9 or more servings daily.
Meat-Fish (Beef, veal, pork, lamb, poultry, fish, dry beans, nuts) 2 or more servings daily.
Fruit-Vegetables (citrus fruits, tomatoes, cabbage, broccoli, Brussels sprouts, cauliflower, those rich in Vitamin C and one dark or yellow vegetable for Vitamin A, spinach, beets, carrots, sweet potatoes) 4 or more daily.
Milk (all types of cheeses, ice cream, powdered milk) 3-4 servings daily.
VITAMINS
We will prescribe prenatal vitamins for you to take during your pregnancy. Please contact us, as we will want to try a different kind. (CHECK WITH KMT) Make sure you are receiving at least 1,200 mg. of Calcium a day., 30 mg. of Iron a day and 0.4 mg. of Folic Acid a day. The vitamins contain key nutrients for you and your baby.
WEIGHT GAIN
Currently the recommended weight gain in pregnancy is 25 to 30 pounds. Ideally you will gain about 3 or 4 pounds during the first three months of pregnancy and then 3 to 4 pounds per month during the rest of the pregnancy. This added weight allows you to adequately nourish your developing child. If you gain twenty pounds, here is an example of how the weight would be distributed:
Baby - 7.8 pounds
Placenta - 1 pound
Amniotic fluid -2 pounds
Uterus -2 pounds
Blood volume - 7 pounds
Breast enlargement - 1-112 pounds
Body fluid -2 pounds
Total -23 pounds
If you are underweight or overweight at the beginning of your pregnancy, we will advise you individually regarding your weight gain. An important point to remember is that pregnancy is never a good time to lose weight. After delivery, most women with proper exercise and eating return to their pre-pregnant weight within three to six months. If you breastfeed, you will usually lose weight more quickly.
MEDICATIONS
You should take only those medications prescribed or recommended by us. This is particularly important during the first twelve weeks of pregnancy, the time during which your baby is developing its arms, legs and internal organs. If you have questions about this important subject, check with us.
REMEMBER, IF YOU TAKE MEDICATIONS, SMOKE, OR USE DRUGS OR ALCOHOL -
SO DOES YOUR BABY!
SMOKING
Smoking has been proven to cause harm to the fetus and therefore should be eliminated completely during pregnancy. Smoking increases the risk of miscarriage, premature birth, and the risk of delivering a small baby prone to having more problems. Babies born to mothers who smoke during pregnancy also have a higher risk of sudden infant syndrome (SIDS) or crib death). If you cannot stop smoking completely, it is important that you at least decrease the amount you smoke!
ALCOHOL
Women who drink excessively during pregnancy, either continuously or in binges, are known to have babies with fetal alcohol syndrome. These babies often have mental retardation and various abnormalities of facial appearance. It is not known if a small amount of drinking causes any increased risk of birth defects; the best approach for the pregnant woman is to avoid alcohol altogether. Alcohol is the third leading cause of birth defects in our country
MARIJUANA
Studies have shown the cannabis preparations (marijuana, hashish, or THC) cause birth defects in animals but there is no definite information about their effects on human beings. The drug does cross the placenta to the child and therefore to be safe, you should avoid the use of these drugs during pregnancy.
CAFFEINE
Recently, concern has been raised that caffeine taken in large quantities by the pregnant woman may harm the fetus. The drug caffeine is present in many foods and beverages, including chocolate bars, colas, coffee, tea, and in some over-the-counter medications. While it is probably not dangerous to the fetus, it might be wise to avoid it as much as possible. If you cannot cut down on your coffee or tea, substitute decaffeinated varieties.
CATS
Cats ands some food animals (pigs, sheep and cattle) can harbor ai organism that can cause toxoplasmosis, a mild, usually harmless infection. However, an infected unborn child risks damage to the brain and eyes. Since a cat's intestinal tract acts as the host site for the parasite, you should not handle the cat's litter box. Wash your hands after touching the cat or its belongings. Cook all meats thoroughly to void contacting the parasite through eating contaminated meat. Dog owners need not worry. Dogs are not hosts for this parasite nor are any other diseases carried by dogs that could be harmful to pregnancy.
HERPES
If you have ever had a herpes infection, please let us know. An active herpes infection during pregnancy or delivery can have very serious consequences for your baby.
DENTAL CARE
Good dental care is important during pregnancy. We advise avoiding x-rays if possible, but, if required, your dentist will know how to protect you while taking the x-ray. Also, tell your dentist you are pregnant so he or she will give you local anesthesia only, if you need it.
HOT TUBS/SAUNAS
Exposure to relatively high temperatures, such as those in hot tubs or saunas, is thought to possibly affect the development of your baby and should be avoided. Warm baths are okay.
COMMON DISCOMFORTS
The first three months and the last few weeks are the most difficult time of your pregnancy. These are also the times when your body is undergoing the greatest changes. You may notice tiredness, nausea, vomiting, irritability and tender breasts. These are common and expected. There are conservative treatment measures that help and we will discuss these with you as they apply to you.
Urinary frequency - This occurs when the growing uterus presses on the bladder - most noticeable in early and late pregnancy. This is uncomfortable but normal during pregnancy. Do not lower your fluid intake. Report any burning, itching or pain with urination to us, as you may have an infection.
Nausea and Vomiting - "Morning sickness" is not necessarily confined to the morning. Some experience it only at other times of the day. It usually disappears by the end of the 15th week but may last longer. If this bothers you, try eating a few dry crackers, a piece of dry toast or some dry cereal before getting out of bed. Eating small meals four or five times a day is also helpful, as keeping something in your stomach throughout the day helps relieve the sickish feeling. Drink fluids between meals instead of with meals. Avoid butter, margarine and fried or spicy foods. Try drinking plain hot tea. Be sure to inform us if your nausea and/or vomiting is severe or lasts a long time.
Fatigue - During the first months of pregnancy, you feel you cannot get enough sleep. This is normal and is due to the added stress pregnancy places on your body and emotional state. Try taking an afternoon nap (if you have other children, rest when they do), pace yourself (don't try to do too many things) and take your vitamins. Do not take a sedative or tranquilizer without consulting us first.
WARNING SIGNS - WHAT TO REPORT TO YOUR PROVIDER
If any of the following symptoms appear, we want you to report these to your provider as soon as they occur - do not wait for your next appointment. In some cases, treatment may be in order to ward off trouble.
I. Any bright red bleeding from the vagina requiring a sanitary napkin or any blood with abdominal
pain.
2. Continuous severe headache.
3. Persistent severe nausea or vomiting - several times in an hour.
4. Chills and fever over 100 degrees unaccompanied by a cold
5. Swelling of face or hands or marked swelling of ankles and feet, particularly if it occurs suddenly.
Slight swelling of your ankles and feet during the last few months in hot weather or after being on
Your feet for a long time is usual, but let us know at your next appointment.
6. Severe abdominal pains not relived by changing position or having a bowel movement.
7. Very frequent, painful or burning urination.
8. A sudden decrease in the amount of urine passed - if you don't urinate for a day despite normal
fluid intake.
9. Blurring of vision or spots before the eyes.
10. Leakage or gush of fluid from the vagina before the baby is due.
11. If you have strong, regular contractions more than 3 wks before your due date.
RECOMMENDED READING
What to Expect When You're Expecting, authored by Arline Eisenberg.
While Waiting - A Prenatal Guidebook, by George E. Verrilli, M.D. and Anne Marie Mueser. Ed.D.
We will see you in about 4 weeks!
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