Appointments are scheduled every 4 weeks through 28 weeks, then every 2 weeks until 36 weeks, and then weekly thereafter.

Medical problems may require more frequent visits. Many of your visits will be scheduled with your primary physician. However, you will be scheduled with each of the physicians in our office at some point. This allows you the opportunity to meet all of us in a non-emergent situation. We practice as a group for your benefit. Please feel free to bring along your partner and children to your visits. We want them to feel included in your care!

Please also keep up with your routine dental care. Dental appointments are encouraged during your pregnancy. Please inform them of your pregnancy before x-rays or medications are given.

What to expect at each visit:

• 8-12 weeks
  (New OB visit) Ultrasound to confirm due date, pelvic exam, blood work

• 12-20 weeks
  Discuss genetic testing, listen to fetal heart beat

• 20 weeks
  Ultrasound to look at fetal anatomy, gender

• 24-28 weeks
  Screen for gestational diabetes, vaccination for pertussis, Rhogam if indicated, measure height of uterus, fetal heart beat

• 30-36 weeks
  Measure height of uterus, fetal heart beat

• 36 weeks-delivery
  Fetal heart beat, determine fetal position, test for Group B strep, cervical exam

Remember that much of what you eat and drink is passed on to your baby.

• Start a prenatal vitamin if you are not on one already. These vitamins contain increased amount of folic acid, calcium, iron, and Vitamin D. Many also contain EPA and DHA, which are omega-3 fatty acids that may aid in fetal development. 

• Caffeine: Results from studies as to whether caffeine increases the risk of miscarriage are unclear. Most experts agree that less than 300-400 mg of caffeine (approximately three 8oz cups of coffee) per day is safe. Try switching to caffeine free beverages or water.

• Fish: Avoid shark, swordfish, king mackerel, or tilefish. Limit albacore tuna to 6 oz per week.

• Wash fruits and vegetables thoroughly. Avoid raw and undercooked seafood and meats, including sushi. Avoid soft cheeses and unpasteurized milk and foods. Avoid hot dogs and lunch meats unless heated to steaming. These foods may increase the risk of listeriosis, a type of food borne illness associated with miscarriage, stillbirth, and preterm delivery.

Despite the popular saying, you are not really eating for two. Most women do not need to increase their calorie intake at all in the first trimester if they are a normal weight. In the remainder of pregnancy about 300-500 extra calories are needed (equivalent to one to two snacks per day). 

These are the following recommended weight goals, which are based on your weight before pregnancy: 

• Normal weight: 25-35 pounds

• Underweight: 35-45 pounds

• Overweight: 15-25 pounds

• Obese: 0-15 pounds.

Keep crackers or a banana by the bedside to have in the morning. Combine carbohydrates with proteins, such as meat, nuts, or cheese, to keep hunger at bay. Eat frequent, small meals throughout the day. Make sure to stay well hydrated. Ginger may also be helpful.

Always wear your seatbelt when driving. Let your physician know if you are taking a long trip. It is a good idea to obtain a copy of your prenatal records and be aware of medical services available in the area you are traveling to. If you are traveling to a foreign country, you may need to update certain vaccinations. It is also a good idea to check cruise and airline policies, as restrictions may exist on travel and you may require a note from your doctor.

Exercise during pregnancy is good for you and the baby. It reduces back pain, decreases your risk of gestational diabetes and preeclampsia, promotes healthy weight gain, and can help you lose the baby weight after your baby is born. 

Aim for 30 minutes 5 days per week. If you are new to exercise, work up to this gradually. If you were active prior to pregnancy, it is safe to work out at the same level of intensity. 

Some precautions are necessary

• Drink plenty of water before, during and after.

• Wear a supportive bra and looser fitting clothes.

• Avoid becoming overheated.

• Avoid laying on your back for long periods of time. This can decrease blood flow to the baby. Many activities can be modified

Women with certain complications of pregnancy should not exercise. Check with your doctor if you have questions. 

The following activities should be avoided because of increased risk of injury.

Contact sports, skydiving, activities that may result in a fall (skiing, gymnastics, horseback riding), hot yoga, scuba diving, activities performed at high altitudes

Stop exercising and call your doctor immediately if you experience the following.

Bleeding from the vagina, feeling dizzy or faint, shortness of breath before starting exercise, chest pain, headache, muscle weakness, calf pain or swelling, regular, painful contractions of the uterus, or fluid leaking from the vagina.

Alcohol

A safe level of how much you can drink has yet to be determined by the experts, so it is recommended to avoid alcohol. 

Smoking

It is best to quit smoking as soon as you discover you are pregnant. If you smoke during pregnancy, your baby is exposed to harmful chemicals such as tar, nicotine, and carbon monoxide. These allow less oxygen and nutrients to reach the baby. This puts the baby at risk for preterm birth, low birth weight, and sudden infant death syndrome. We can help you quit.

Illegal drug use

Illegal drug use includes the use of heroin, cocaine, methamphetamines, and marijuana and use of prescription drugs for a nonmedical reason. These drugs can increase the risk for birth defects, miscarriage, preterm birth, and death of the baby. Please be honest with us if you are using illegal substances so we can monitor your pregnancy more closely and help you quit. Also, please do not attempt to quit on your own. For some drugs, withdrawal can also be harmful and is better done under supervision from your doctor.

Prescription medications: Please inform us of all medications you are taking, including herbal supplements and over the counter medicines. Do not stop taking them without first speaking to us. We may make adjustments to other medications that are safer during pregnancy. 

Please refer to the chart on the following page for safe use of over the counter medications.

Please call us if you have questions about medications not on this list.

Medication use:

• Heartburn, gas and bloating, upset stomach

  Antacids for heartburn (Maalox, Mylanta, Rolaids, Tums, Nexium, Pepcid, Prilosec)

  Simethicone for gas pains
  (Gas-X, Maalox Anti-Gas, Mylanta Gas, Mylicon)

• Cough or cold

  Guaifenesin, an expectorant (Mucinex, Robitussin),

  Cough drops,

  Vicks VapoRub,

  Sudafed

  Not safe to take: Cold remedies that contain alcohol

• Pain

  Acetaminophen (Tylenol)

• Allergy relief

  Loratadine, an antihistamine
  (Alavert, Claritin, Triaminic Allerchews)

  Diphenhydramine, an antihistamine (Benadryl)

  Zyrtec

  Saline nasal spray

• Constipation, hemorrhoids,
  and diarrhea

  Psyllium (Metamucil)

  Methylcellulose (Citrucel)

  Other laxatives and stool softeners (Colace, Miralax, Dulcolax, Milk of magnesia)

  Hemorrhoid creams (Anusol, Preparation H, Tucks)

  Loperamide, anti-diarrhea medication
  (Imodium, Kaopectate II, Maalox Anti-Diarrheal,) 

• Insomnia

  Diphenhydramine
  (Benadryl, Maximum Strength Unisom SleepGels, Sominex)

  Doxylamine succinate (Unisom Nighttime Sleep-Aid)

• Itching

  Hydrocortisone (Cortaid, Lanacort)

  Benadryl cream

• Nausea

  Doxylamine (Unisom) at bedtime with Vitamin B6 three times a day

  Dramamine, Phenergan, Zofran, Reglan

Call during regular business hours (Monday-Friday, 8 am to
4:30 pm), whenever necessary. If you have a medical problem, ask to speak to a nurse. They will be able to answer most routine questions. If not, they will consult one of us. Calls placed after hours should be for emergencies only. Calling the office line at that time will redirect you to the physician on call. Please refer to the following list to see if it is an emergency. If not, please save your questions for business hours or your next visit.

Make calls yourself. Relaying information through a third party can be confusing and misleading.

If you have an emergent concern, be as specific as you can (when contractions started, how far apart they are, intensity level, etc.)

Specific situations

• Chills and/or fever >100.5. 

• Severe abdominal pain, not relieved by rest or acetaminophen

• Persistent vomiting for more than 24 hours with inability to keep food or liquids down

• Burning or difficult urination

• Severe headaches or vision changes, especially if not relieved by acetaminophen and lasting greater than 24 hours

• Vaginal bleeding
  This can be normal during early pregnancy. If it is heavier than your period, accompanied by severe cramping, if you over 12 weeks pregnant, or know you are Rh negative blood type, call immediately

• Lack of fetal movement
  Fetal movement starts around 20 weeks, but does not become regular until around 24 weeks. You should feel movement at regular intervals during the day. As your baby grows, it will take sleep cycles. If you have not felt movement, drink a glass of juice and lay on your side in a dark room. If you still have not noticed movement, call us.

• Loss of fluid
  If you experience a large gush of fluid or are continuously leaking throughout the day and having to wear a liner or pad.

• Regular contractions every 5 minutes, increasing in intensity, for more than an hour. If you are less than 36 weeks and have more than 4 contractions in an hour, please call.