An excellent resource provided to you by our office where you are able to view lab results, any message to physician, new appointment request and request refills. It is sometimes much easier to reach the Doctor or Nurse Practitioner through our messaging system for non- emergent questions or concerns. Please keep your password in a safe place so that you can always access it. If you forgot your passcode and it needs to be reset, please call the office and ask to reset the passcode or you can reset yourself from our website to our EMR patient portal link.

You can book an appointment without calling us from our website www.womensobgyncare.com and create an account with Healow button. Please arrive at least 15 minutes early for your appointments, and 30 minutes before if this is your first time visit at our office. As a courtesy to all of our patients, we aim to see everyone at the scheduled time and reduce patients wait time. We value every single patient that gives us the opportunity to care for them, so arriving on time allows for generous provider-patient interaction time. For visits not related to your routine pregnancy visits, (described in the prenatal section of FAQ ), please always contact the office to schedule. Moreover at the time of check-in you can mention the reason in the office’s return patient visit form.

You always receive appointment reminder email (if you sign up for the patient portal) and automatic telephone call for your appointment reminder and also give you an option for your appointment confirmation with the automatic answering call set up. You will also get paper copy of your next appointment reminder from our office at the time of check-out.

All lab work ordered in the office has variable turnaround times. Please allow us to review all labs and contact you accordingly. For results that require immediate response, we will contact the patient or primary contact. All other labs will be discussed in detail at your following visit. Results will be uploaded in patient portal within 7-10 days from the time results are received.

Refill requests for prescriptions can be submitted directly through patient portal after FIRST checking with your pharmacy to see if you have any refills left on your current prescription. Please always check with your pharmacy for generic brands of any prescriptions we send prior to purchasing.

If you have a life-threatening emergency, please go to your nearest hospital or ER center. For bleeding, leaking of fluid or decreased fetal movement after 28 weeks of pregnancy, please contact our office at 281-953-1710, extension 3, choose your provider and leave your name and number–our on-call provider will assist you. For all other questions, please send a message through your patient portal or contact the office during business hours from Monday - Friday, 8:30 am - 5:00 pm.

Your first OB visit is very important. We will obtain a thorough medical history on you and the father-to-be. Your weight and blood pressure will be taken. A urinalysis will be performed, and you will be given samples of prenatal vitamins along with this pregnancy guide. We will calculate your due date which will be estimated based on your period. This date becomes a “monitoring progress” date. Your pregnancy is measured in weeks and an average term pregnancy is 280 days or 40 weeks from the first day of your last menstrual period. It is important to remember that only one in twenty babies are delivered exactly on the calculated day, although most are born within two weeks of the expected day. Due Date = Last Period (1st Day) minus 3 months plus 1 week (Example: Last Period 10-12 = Due Date 7-19) Your EDD (Estimated Due Date), will be confirmed once Ultrasound is done depending on your first visit examination. Your blood will be drawn for prenatal laboratory work. These routine-screening labs will check for any infection mother might have that may affect the baby and any other problems that mother can have, and it can affect the pregnancy, eg. hepatitis B (a virus transmitted by bodily secretions), HIV, reactive plasma reagent (screens for syphilis), immunity to rubella (German measles), blood type and screen, and complete blood count, etc.

On follow-up visits, your weight and blood pressure will be checked. You will be asked to provide a urine specimen on every visit. Urine is tested for protein, which could lead to a condition known as preeclampsia and glucose, which is a possible indication of gestational diabetes, we can also assess if you have been drinking enough water or if you have possible Urinary infection. Your hands and feet will be checked for swelling. A doppler will be used to hear the baby’s heart tones. Fetal activity and the size and growth of the baby will be checked. At twenty weeks a routine anatomy ultrasound is scheduled. Ultrasounds are done in our office, unless your physician determines a specialist is required for co-management of your prenatal care. An ultrasound uses sound waves to create a picture of the baby moving inside your uterus. Ultrasound tests are used to determine if the baby is developing properly, check the baby’s heart rate, and confirm the baby’s position and size. At twenty-four to twenty-eight weeks you will be screened for gestational diabetes, and anemia. Diabetes occurs when there is a problem with the way the body uses insulin. When insulin is not used properly, the level of glucose (sugar) in blood becomes too high. Because the hormones of pregnancy increase the body’s resistance to insulin, approximately 7% of pregnant women will develop diabetes during pregnancy. This condition usually subsides after pregnancy, but women who have had gestational diabetes are more likely to develop diabetes later in life. A one-hour glucose tolerance test involves drinking a sugary drink and having your blood drawn one hour later (You do not need to come prepared for this test, just 2 hours after your meal of any kind the test can be done). This will measure your blood sugar level. If the test reveals a high level of glucose in your blood, a more extensive three- hour Glucose Tolerance test will be conducted (This test requires fasting- no food or water for 6-8 hours). Your blood will also be drawn again to check for anemia. If you are Rh negative, you will receive a Prescription for Rh injection by 24 weeks visit (to be administered around 28 weeks, after your blood type and antibody types are confirmed in the office and your injection is sent by your pharmacy to our office/your home). Only 15% of women are Rh negative. This means if your baby is Rh positive, you may form antibodies that fight against your baby’s blood. The injection can prevent sensitization for up to twelve weeks. You will have this injection again after delivery if your baby is Rh positive. You will be monitored for preterm labor- which is labor that starts when you are less than thirty-seven weeks pregnant.

Warning signs include an increase or change in vaginal discharge especially with bleeding, pelvic or low abdominal pressure that comes and goes away, abdominal cramps with or without diarrhea and regular contractions that do not subside with rest, hydration or Tylenol. High blood pressure, also known as toxemia or preeclampsia develops in fewer than 10% of pregnant women globally. The cause of this potentially serious condition is unknown.

Warning signs are elevated blood pressure, right upper quadrant pain, blurred vision, persistent headaches, and significant swelling of hands, feet, and face. The internet can be a source of excellent pregnancy related information. When reviewing information on your computer, do consider unknown sites, and sites trying to sell you products, and avoid such sites/information. Websites that you may find useful include: Pregnancy complications (marchofdimes.org), High Blood Pressure During Pregnancy | cdc.gov, https://www.acog.org/womens-health/pregnancy

You will be seen in our office at least 8-10 times during your pregnancy. However, every pregnancy is different, and some patients may need to be seen more frequently. Below you will find an example of what to expect at every visit.

At each office visit we will collect your vital signs which include: blood pressure, heart rate, weight and a urine collection. You will be asked about nausea, vomiting, bleeding, leaking, and fetal movement when appropriate. After 10 weeks of gestational age we will assess fetal heart tones with a fetal Doppler, depending on your BMI. It is important to refer this book to every visit so that specific questions can be answered. We also encourage patients to keep a journal or log of questions they have in between visits and address them during your time in the office with the Provider. It is important if you are a diabetic patient that you bring your glucose log to every visit so that we may assess if your regimen is controlling your sugar levels, unless its being managed by a specialist. Please also update us about any other providers you are seeing, if has changed any of your medications.

An initial ultrasound (US) after your pregnancy confirmation visit will be done after 6 weeks of gestational age. This US is done to confirm a pregnancy that is within the uterus and to establish your due date. The most accurate way of dating a pregnancy is based on the first day of the last menstrual period for women with regular menstrual cycles or by early First Trimester Ultrasound. The next ultrasound will be done between 18 and 21 weeks gestational age to identify fetal anatomy and development. If the Doctor requests additional ultrasounds after 20 weeks, there is usually a medical underlying reason such as excessive or poor fetal growth. It is important to note there will be no change in your due date after such ultrasound. With the improvement of technology, some facilities offer 3D or 4D ultrasounds. Many establishments are not regulated by medical professionals with the training and knowledge to interpret these non-medical ultrasounds. Long term effects to the mother or fetus due to these longer and higher frequency scans are not known. We do not encourage our patients to seek these additional ultrasounds, however if you choose to do so, please proceed with caution and make an informed decision. No letter of approval will be signed from our office since this is an elective choice of the patient and does not required our approval.

To be able to provide care during your pregnancy, there are several labs that are required for standard of care in our office. Keep in mind that some labs may be patient specific and not listed below. Fees will be billed by the preferred lab of your insurance company approximately 4-6 weeks after collection. If you have any concerns or question related to billing, please contact your insurance preferred laboratory directly. *Texas law (Chapter 81.090 of the Texas Health and Safety code), requires providers caring for pregnant women to test for HIV and Hepatitis B in the first trimester with consent of the patient. It is required that HIV testing, repeated in the third trimester. Retesting for other STD infections in subsequent trimesters is up to the provider’s discretion but recommended by Texas Department of State Health Services HIV/STD Program. 24-28 weeks- needs blood type, antibody screen again

Panorama® is a DNA screening test that can tell you important information about your pregnancy. You can find out if your baby is at risk for having Down syndrome or other chromosomal abnormalities. Panorama can also tell you the gender of your baby. Non-invasive and highly accurate, Panorama has the lowest false positive rate of any prenatal screening test for the commonly screened chromosomal abnormalities, trisomies 21, 18 and 13. And, Panorama can be done as early as ten weeks into your pregnancy using a simple blood draw of Mother.

Chromosomal Abnormalities Trisomy 21 (Down syndrome) Trisomy 18 (Edwards syndrome) Trisomy 13 (Patau syndrome) Triploidy Babies with Down syndrome have three copies of chromosome 21 and have intellectual disabilities that range from mild to moderate. Children with Down syndrome will need extra medical care depending on the child’s specific health problems. Early intervention has allowed many individuals with Down syndrome to lead healthy and productive lives. The presence of medical conditions, like heart defects, can affect the lifespan in these children and adults; however, most individuals with Down syndrome will live into their 60s. Miscarriage occurs in about 30% of pregnancies with Down syndrome while overall about 1 in 600 babies are born with Down syndrome. Sex Chromosome Abnormalities Monosomy X (Turner syndrome) Klinefelter syndrome Triple X syndrome XYY syndrome Babies with monosomy X are females who have one X chromosome instead of two. Unfortunately, a high proportion of pregnancies with monosomy X will result in a miscarriage in the first or second trimester of pregnancy. Babies with monosomy X that make it to term may have heart defects, learning difficulties, and infertility. In most cases, girls with monosomy X will need extra medical care including hormone therapies at various stages of life. Microdeletions 22q11.2 deletion syndrome Prader-Willi syndrome Angelman syndrome 1p36 deletion syndrome Cri-du-chat syndrome The 22q11.2 deletion syndrome, also called DiGeorge syndrome or Velo-Cardio-Facial syndrome (VCFS), is caused by a missing piece of chromosome number 22. About one in every 2,000 babies is born with the 22q11.2 deletion syndrome. The majority of children with this disorder have heart defects, immune system problems, and specific facial features. Most children with 22q.11.2 deletion syndrome have mild-to-moderate intellectual disability and speech delays; some will also have low calcium levels, kidney problems, feeding problems and/or seizures. About one in five children with the 22q11.2 deletion syndrome have autism spectrum disorder; 1 in 4 adults with 22q11.2 deletion syndrome have a psychiatric illness, like schizophrenia.

Although the majority of pregnancies result in deliveries of healthy babies, every woman has a background risk for having a baby with a chromosomal abnormality. The Panorama screening test can estimate your pregnancy‐specific risk of having a baby with one of these conditions. When you get your Panorama results, your report may state the following: Low Risk High Risk No Result A Low Risk result indicates that it is unlikely that your baby is affected by one of the conditions on the Panorama panel. Note, however, that a low risk result does not guarantee a healthy pregnancy as Panorama is not a diagnostic test and only screens for certain conditions. Just as with other screening tests, Panorama may indicate High Risk results when your baby is healthy (false positive) or may miss a chromosomal abnormality (false negative) in the pregnancy. Given these possibilities, it is important to discuss all test results with your health care provider and obtain any recommended follow-up testing. Please be advised that no matter how much you would like to know about this information for the baby you are carrying, or me as a physician would like to know about mother and baby I am taking care of, we have to rely on Insurance coverage and payment criteria. Please check with your Insurance about coverage and payment about the test before you proceed for testing. You can also check with the lab company regarding the same for payment options as well. Please ask for the brochure and Lab information card for further details. You can also visit following website for further details about test, www.panoramatest.com

Calories and Weight Gain You need an average of only 300 extra calories daily during pregnancy (one bagel or ½ a deli sandwich). “Eating for Two” will result in excessive weight gain. Most women will lose only 15-20 pounds in the first few weeks postpar-tum, with the rest stored as fat, so weight gain of 30-35 pounds is ideal (0-5 pounds in the first 12 weeks, and 1 pound a week after that). Eat small frequent meals to avoid heartburn and hypoglycemia. Eat what you enjoy, but make healthy choices and go easy on sugars and starches to prevent excessive weight gain and gestation-al diabetes. Protein Proteins are the building blocks for both your body and that of your baby. Pregnant women require 60 grams of protein per day. Foods that are rich in protein include: meat, eggs, beans, and dairy products. Vegans may experience more of a challenge in obtaining the recommended total protein on a daily basis. If you find it difficult to add sufficient amounts of protein to your diet during your pregnancy, please consult with your physician. Carbohydrates Carbohydrates, or food sugars, are the body's main source of energy. There are both simple and complex carbohydrates. Simple sugars provide a quick energy boost and include foods such as honey, fruit juice, hard candies and some processed foods. Starches are more complex sugars but also contain fiber. Complex carbohydrates include breads, rice, pastas, fruits, vegetables and whole grains. Fiber Your daily intake of fiber should be increased to between 25 to 30 grams during pregnancy. You should not try to increase to this amount all at once; you should allow 3 to 4 weeks to gradually and comfortably increase to 30 gm of fiber per day. Your dietary plan should include 5 servings of fruit, vegetables, and/or grains per day. Whole grains are preferable. For example, choose breads with 2 grams of fiber per slice; these are usually made from 100% whole wheat or whole grain flour. High-fiber cereals are also available such as All Bran, Fiber One, Raisin Bran, or 40% Bran Flakes. High-fiber cereals may also be sprinkled over yogurt for variety. Choose your snacks carefully as there are many high-fiber snacks available. Fi-Bars, bran muffins and wheat crackers are all good snack choices during pregnancy. As you increase the fiber in your diet, it is also important that you increase your liquid intake as well. A minimum of 2liters of water per day is not excessive and can help to prevent constipation. Other choices of liquids include: decaffeinated beverages, coconut water, lemonade, and iced herbal teas. Fats Fats help your body utilize vitamins, proteins, and carbohydrates. Fats not required by your body are immediately stored as fat tissue. There are two types of fats: saturated and unsaturated. Saturated fats are largely derived from meats and dairy products and tend to be solid. Unsaturated fats are derived from plants and vegetables and are usually liquids, such as vegetable oil. Too much saturated fat can increase your cholesterol and ultimately cause heart disease. Saturated fats should account for no more than 10% of your daily calories; unsaturated fats should account for no more than 20%. One gram of fat has 9 calories. Water More water is often the solution to many problems and complaints in pregnancy. Pregnant women need to drink at least 10 cups (2.3 liters) of fluids daily. The best fluid to drink is water. Avoid sodas and juices. You have more blood volume in your body when you are pregnant. You need to drink enough water to keep up with this increased volume. If you do not, you will get dehydrated quickly and experience cramping, dizziness, constipation, leg cramps, headaches, low amniotic fluid, and many more symptoms. Water also helps flush out waste products from cells so it aids in liver and kidney function for you and your baby. Always carry water with you. If you have trouble drinking water, try adding lemon to flavor the water or drink water in small sips throughout the day. Example of Daily Nutrition Intake: 2 liters of water minimum (buttermilk, coconut water, water with lemon or fruit pieces can be counted as water) 1 cup of milk & 1 cup of yogurt 1 cup of coffee/tea if you wish to continue 1 bowl of salad OR ½ at lunch & ½ at Dinner 1-2 servings of fruit (one fruit can be watery, and other like plum, peach, pear, apple or banana) 1-2 cups of vegetable ≤ 1cup of cooked rice(we might instruct to eat less quantities if your weight gain is excessive) 1-2 cups of protein (meat, beef, chicken, lentils/beans, eggs) Try to limit the following foods to only ONCE per week and be conscious of portion Soda, juices, and Ice-creams Fried Foods/Deep fried foods & Fatty food Excessive carbohydrates like pasta, pizza, tortillas, breads daily in excessive quantities Refined Sugars, Candies, Cookies, Cakes, donuts & Chocolate Things to keep in mind/Cautions in your diet: Fish-Certain fish accumulate high levels of mercury from swimming in polluted waters. Avoid fish from contaminated lakes and rivers that may be exposed to high levels of polychlorinated biphenyl. Remember, this is regarding fish caught in local waters and not fish from your local grocery stores. These fish include blue fish, striped bass, salmon, pike, trout, and walleye. The FDA recommends avoiding those fish that are highest in mercury, including shark, tilefish, swordfish, and king mackerel. Shellfish, shrimp and smaller fish such as snapper, catfish, tuna, and salmon are lower in mercury, and can be included up to 12 ounces a week is recommended. Tuna steak is higher in mercury than canned tuna, and should be limited to 6 ounces a week. (If you would like more information on fish in pregnancy, go to: www.epa.gov/waterscience/fishadvice/advice.html). Another helpful web resource is: http://www.americanpregnancy.org/pregnancvhealthlfishmercurv.htm. Raw Seafood – The majority of seafood borne illness is caused by undercooked shellfish, which include oysters, clams, and mussels. Cooking helps prevent some types of infection, but it doesn’t prevent the algae-related infections that are associated with red tides. Raw shellfish pose concern for everybody and they should be avoided altogether during pregnancy. Raw Eggs – Raw eggs or any foods that contain raw eggs should be avoided because of the potential exposure to salmonella. Some Caesar dressings, mayonnaise, homemade ice cream or custards, and Hollandaise sauces may be made with raw eggs. Unpasteurized eggnog should also be avoided. Deli Meat- Highly processed meats such as hotdogs contain chemicals that are not healthy for any humans, pregnant or not. While there is no evidence of direct fetal harm caused by eating hotdogs or other highly processed meats, we recommend making healthier choices except on rare occasions. Raw Meat – Uncooked seafood, rare or uncooked beef or poultry should be avoided because of the risk of contamination with coliform bacteria, toxoplasmosis, and salmonella. Raw fish and meat that can carry parasites and other microbes that could cause potential harm to the mother and fetus. While these infections are extremely rare, it is wise to avoid raw meat and fish for this reason. Liver – There is some concern about the amounts of vitamin A in liver. Large amounts of vitamin A have the potential to pose a risk to an unborn baby. The safest approach is to avoid eating liver. Soft Cheeses – Imported soft cheeses may contain bacteria called Listera which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection, or blood poisoning which can be life threatening. The soft cheeses to avoid include – brie camembert Roquefort, feta, gorgonzola and Mexican style cheese that include queso blanco and queso fresco. Soft non-imported cheeses made with pasteurized milk are safe to eat. Listeria is killed by high temperatures so deli meats heated in the microwave until steaming are certainly safe. Unpasteurized Milk – Unpasteurized milk may contain bacteria called Listeria which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning which can be life threatening. Make sure any milk that you drink is pasteurized. Unwashed Vegetables – Yes, vegetables are safe to eat so you still need to eat them. However, it is essential to make sure they are washed to avoid potential exposure to toxoplasmosis. Toxoplasmosis may contaminate the soil in which the vegetables are grown. INFECTION PRECAUTIONS To avoid toxoplasmosis during pregnancy, do not garden without gloves, empty cat litter boxes, change bird cages, or eat raw meat or raw eggs. In order to avoid Listeriosis, do not eat blue­ veined or soft crumbly cheeses (swiss and cheddar are okay), deli meats, hot dogs, or raw oysters. All meats, including dell meats, should be cooked thoroughly. If you wish to consume sushi, make sure that it comes from a reputable source. Do not eat tuna sushi. Pate’ – Pate’ should be avoided because it may contain the bacteria Listeria Herbal Remedies – Don’t take anything without checking with your health care provider Artificial sweeteners – Not enough is known about their affects. Occasional use is considered safe SUBSTANCES THAT CAN HARM YOUR BABY Caffeine – Although most studies show that caffeine intake is moderation is okay, there are others that show that caffeine intake may be related to miscarriages. Avoid caffeine during the first trimester to reduce the likelihood of a miscarriage. Some research shows that large amounts of caffeine are associated with miscarriage, premature birth, low birth weight, and withdrawal symptoms in infants. The safest thing is not to consume caffeine. As a general rule in later stages of your pregnancy, caffeine should be limited to less than 250 mg per day. Caffeine is a diuretic, which means it helps eliminate fluids from the body. This can result in water and calcium loss. It is important that you are drinking plenty of water, juice, and milk rather than caffeinated beverages. One 12-ounce can of cola contains about 50 mg of caffeine. One 8-ounce cup of coffee can contains approximately 100 mg to 150 mg of caffeine. Alcohol – There is NO amount of alcohol that is known to be safe during pregnancy, and therefore alcohol should be avoided during pregnancy. Prenatal exposure to alcohol can interfere with the healthy development of the baby. Depending on the amount, timing and pattern of use, alcohol consumption during pregnancy can lead to Fetal alcohol Syndrome or other developmental disorders. These babies can have physical, mental, behavioral, and/or learning disabilities with possible lifelong implications. They may also have heart, lung, and kidney defects and poor coordination or motor skills delays. If you consume alcohol before you know you were pregnant, stop drinking now. Alcohol should continue to be avoided during breast feeding. Exposure to alcohol as an infant poses harmful risks, and alcohol does reach the baby during breastfeeding. Cigarette Smoking: Smoking is associated with low birth weight in infants and poor pregnancy outcomes. We strongly recommend that you do not smoke and avoid second hand smoking exposure. Marijuana: The effects of smoking marijuana during pregnancy are unknown. In animal studies, maternal administration of high doses of THC has been shown to cause birth defects. Heroin, amphetamines, barbiturates. Cocaine: All of these drugs are associated with harmful effects on the fetus and may be fatal to the unborn baby. Infectious Diseases: Report any contact with infectious diseases such as Fifth's Disease, Rubella or Chicken Pox (if you have not had it before). Temperature Precautions: DO NOT use hot tubs or Jacuzzi tubs during pregnancy. Avoid heating your body to temperatures of 100.4 or above. Avoid immersion in hot baths for prolonged periods at high temperatures. Treat fevers with Tylenol (acetaminophen). Paint: Use only latex or water soluble paints. Use only in a well ventilated area (open windows and doors and use fans to ventilate). Avoid contact with solvents. Environmental Hazards: Compact Fluorescent Light Bulbs contain small amounts of mercury. If a bulb breaks, leave the area and close the door to the room. Have someone else properly dispose of the broken bulb. See detailed instructions on proper clean-up procedures at: http://www.epa.gov/cfl/cflcleanup.html. Call this number if you are exposed to a potentially hazardous substance: Teratogen information lines: Texas Teratogen Information Service at 1-800- 733-4727 or Texas Teratogen Information on Pregnancy Services at 1-855-884-7248. Which vitamins/supplements should I take? Folic acid is a B vitamin that has been shown to reduce the risk of spina bifida. 1mg (1000 micrograms) is recommended during the month prior to pregnancy and for the first 2 months after conception to reduce this risk. More folic acid may be recommended if you have a personal or family history of spina bifida including a prior affected child. A prenatal vitamin is a general multivitamin with 800-1000 micrograms of folic acid, as well as calcium and iron. Most women continue their vitamins after the second month to help reduce anemia and make up for any imperfections in diet. If you are not anemic and eat a well balanced diet, stopping prenatal vitamins at 2 months of pregnancy is acceptable. After 12 weeks the baby begins to make bone and will draw the necessary calcium from your bones. To prevent bone loss, 1000-1500 mg of calcium is recommended. This equates to 4-5 servings of milk, yogurt or dairy. Since this is difficult to consume, take a calcium supplement (usually 500-600 mg) to make up the difference. Don’t take calcium and iron (in the multivitamin) at the same time as they can offset each other’s absorption. While calcium citrate (“Citracal”) is the best absorbed, other types of calcium such as fruit flavored “Tums” and “Viactiv” (chocolate flavored) may be more appealing. If you eat fish 3 times weekly you are getting plenty of Omega-3 fatty acids, or Essential Fatty Acids (EFAs). If not, take a supplement containing 200mg of DHA (from fish oil or flax seed oil). There is a growing body of evi-dence that EFA deficiency may contribute to a number of pregnancy complications including preterm labor and preeclampsia. EFAs may help fetal eye and brain development, may improve mom’s skin, hair and nails, and are also passed into the breast milk. Iron Supplements: Some women develop anemia, or low iron, during pregnancy. If you develop this condition, we will prescribe or recommend an iron supplement taken separately than prenatal vitamins. Some women report dark stools, constipation, or stomach upset with iron supplements. Be sure to drink plenty of water, eat a diet high in fiber and walk daily to help your bowels move normally

Regular exercise builds bones and muscles, gives you energy, and keeps you healthy. It is just as important when you are pregnant. Becoming active and exercising at least 30 minutes on most, if not all, days of the week can benefit your health by: reducing backaches, constipation, bloating, and swelling, increasing your energy, improving your mood, and helping you sleep better. Regular activity helps keep you fit during pregnancy and may improve your ability to cope with the pain of labor. Safe Exercises: Most forms of exercise are safe during pregnancy. Walking and swimming are excellent! Bicycling is fine until late pregnancy. Prenatal Yoga (not Bikram Yoga) is also a great preparation for birth. Jogging and aerobics can be continued provided the guidelines below are followed. Prohibited Activities: Contact sports such as hockey, soccer, and basketball could result in harm to you and your baby. Activities such as gymnastics, water and/or snow skiing, and horseback riding are also not recommended because of the potential for abdominal trauma and/or falling. Scuba diving should be avoided as the fetus may be at risk for decompression sickness. General Guidelines for exercise: Thirty minutes of moderate exercise per day is recommended 5 to 7 days per week. Competitive sports are discouraged to avoid injury. After the first trimester of pregnancy, no extensive exercise should be performed while lying flat on your back.Please use a pillow to elevate your right hip. Avoid exercises that involve the valsalva maneuver (pushing or increasing abdominal pressure with held breath). Caloric intake should be increased to meet the needs of both the pregnancy and exercise. Maternal core temperature should not exceed 100.4°F, so avoid saunas, steam rooms, and hot tubs. Discuss other heat exercise with your physician. Hormones produced during pregnancy cause the ligaments that support your joints to become relaxed, making the joints more mobile and more at risk of injury. Therefore, avoid jerky, bouncy or high impact motions that may strain your joints and increase your risk of injury. Deep flexing or extension of joints should also be avoided for this reason. Brisk/vigorous exercise should not be performed in hot, humid weather or if you have a fever. Always begin each exercise session with 5-10 minutes of a warm-up activity. After exercising, cool down by slowly reducing your activity. Fluids should be taken liberally before and after exercise. If necessary, interrupt your activity in order to replenish fluids. Begin exercise slowly and increase their activity gradually. Warm up about 5 minutes before you do vigorous exercise. Slow walking or stationary bikes with low resistance are good warm-ups. Avoid deep flexion or extension of joints because your tissues are lax. Activities that require jumping, jarring motions or rapid changes in direction should be avoided because joints are not stable. Exercise during pregnancy may provide additional health benefits to women with gestational diabetes. Consult your physician about unusual symptoms during or following exercise. Warning signs to stop activity in pregnancy and notify provider, vaginal bleeding and/or fluid leaking from the vagina, shortness of breath prior to exertion, dizziness, headache, chest pain, muscle weakness, calf pain or swelling, uterine contractions, or decreased fetal movement. When doing cardiovascular exercise (walking, running, biking, elliptic-cal training) a good guideline is to keep your heart rate at a maximum of about 130 beats per minute. This will allow blood flow to go to the uterus as well as your large muscles. If you are working out with weights, modify exercises that require you to be flat on your back or flat on your stomach after 12 weeks. Cut out abdominal exercises, they won’t be effective. If you are not a regular exercise, walk for 20-30 minutes 3-5 times a week, and consider a prenatal yoga or pilates class.

We measure pregnancy from the first day of your last period. There are 40 weeks in the average pregnancy; with the assumption that you conceived 2 weeks after your period started (you are only actually pregnant for the last 38 of the 40 weeks). When counting in months, start from the conception date, not the period date. So, if you are 10 weeks pregnant you got pregnant 8 weeks, or 2 months ago. If you did not get pregnant at the average time (you ovulated earlier or later than the 14th day), your due date will be based on the measurements from your first Ultrasound or LMP whichever is accurate as confirmed by physician. We also commonly talk about “trimesters” (or thirds) of the pregnancy. The first trimester includes up to 13 weeks, the second trimester is 14-27 weeks, and the third trimester is 28 weeks until delivery.

About 9-40% of diagnosed pregnancies end in miscarriage (Depending on Maternal Age). The good news is the younger the age of a patient (less than 40), lesser the risk of miscarriage. In most cases of miscarriage, the embryo stops growing before the cardiac system is developed, and we never see a heartbeat on ultra-sound. Once we see a strong heartbeat, the risk of miscarriage is much lower. If the baby has a heartbeat after 8 weeks from the last period, the risk of miscarriage is less. After 12 weeks 6/7 days, the risk is less. Many patients choose to wait to tell others about the pregnancy based on these statistics. This is a personal choice which depends on how you would feel about others knowing that you had a miscarriage if this should occur.

Sex is safe in pregnancy unless you have complications such as bleeding, preterm contractions or a low-lying placenta. While sex may make you have mild contractions, it will not make an otherwise healthy pregnant woman go into premature labor. Unless we tell you otherwise, continue your normal sexual practice if you want to or you can use condoms, and or avoid ejaculation inside you.

Most experts think that using hair dye during pregnancy is not toxic for your fetus. There are different types of hair coloring, including: Permanent color Semipermanent color Temporary color There are no studies conducted so far that tells you that it is harmful or not, but we do advice to wait for the second trimester (after organogenesis) before they dye their hair to be on safe side. You can use natural hair color like Hena. These all contain chemicals. Studies on animals show that high doses of these chemicals do not cause serious birth defects. Also, only a small amount of chemicals from hair dye is absorbed through the scalp. Hair coloring including highlights are safe during pregnancy.

Inhaling volatile paint fumes is not good for any human, pregnant or not. While normal casual exposure to paint does not cause birth defects, use good judgment if you are painting and make sure the room is well ventilated.

Routine dental work is safe during pregnancy and we encourage you to keep up with your normal dental health routine. Most dentists will require a note from us saying that the visit is safe, and we can give you a standardized letter to take to your visit. If you need extensive dental work we can discuss the best options for medications with your dentist.

When we lay on our back the large blood vessels that run close to our spine can be compressed by the pregnant uterus. In the third trimester this can decrease blood flow to the baby. At the same time, blood flow to your head will be decreased and you may feel dizzy and lightheaded. While there is no evidence that lying on your back sometimes is harmful, blood flow to the baby will be maximized if you tilt your abdomen even slightly to the left or the right. Assuming you have a normal healthy heart, either the right side or the left side is fine. Before the third trimester most women can lie comfortably on their back as blood flow is not significantly affected, and it is safe as well.

Exposure to very high temperatures (more than 103°F) for long periods of time in baths, hot tubs or saunas can increase the risk of spina bifida the first 2 months of pregnancy. Normal temperature baths (98-101 degrees) are safe and can be very relaxing. If you are concerned, put a thermometer in your bathtub.

Obstetric ultrasound has been extensively studied and found to be safe for the baby. While no fetal harm has been found, current recommendations are to limit the use of ultrasound to that which is medically useful or necessary. In our office this includes an average of 3- 4 ultrasounds. These include an ultrasound performed at the first trimester to confirm viability and dating, a detailed ultrasound at 20-22 weeks to assess the baby’s anatomy, and an ultrasound for growth and fetal well being at about 32-36 weeks. Only any medically necessary ultrasounds are ordered later in pregnancy. If you would like to have 3D- 4D ultrasound is not medically necessary but may be chosen at 28-32 weeks to get a picture of the baby and preserve your memories. It is your personal preference, and we do not need to provide you with any kind of approval for that.

Yes, you can keep your cat. You may have heard that cat feces can carry the infection toxoplasmosis. This infection is only found in cats who go outdoors and hunt prey, such as mice and other rodents. If you do have a cat who goes outdoors or eats prey, have someone else take over daily cleaning the litter box. This will keep you away from any cat feces. If you have an indoor cat who only eats cat food and doesn’t have contact with outside animals, your risk of toxoplasmosis is very low.

Please refer to our medication list to see safe choices for medications in pregnancy. If you need a medication that is not on the list please call us during business hours for advice.

Our Providers delivers at Memorial Hermann Hospital Southwest, Memorial Hermann Hospital Southwest Sugar Land as well as Houston Methodist Hospital Sugar Land. All of these Hospitals have state-of-the-art labor and delivery facility, and Memorial Hermann Southwest Hospital Labor and Delivery Unit is just minutes away from our practice location. Anesthesia and neonatology services are in house 24 hours a day, and all rooms are large and private with private bathrooms. The hospital encourages “rooming in” so that you are not separated from your baby, and a lactation consultant is on staff to assist you after delivery.

Patients are encouraged to register at Memorial Hermann Hospitals and Houston Methodist Sugar Land Hospital at or after 28 weeks. You can visit the hospital, make a phone call, or register online. If you would like to schedule a tour you can do so by calling 713.222.CARE. The schedule for tours can be found at www.memorialhermann.org, Houston Methodist Sugar land Hospital.

Most people deliver close to their due date (40weeks from the last period). About 10% of women deliver before 37 weeks. It is likely that some patients go past their due date in the first pregnancy than in subsequent pregnancies. While it is sometimes safe to go as long as 2 weeks over the due date, we generally recommend induction at 41 weeks. If you have had a preterm (less than 37 weeks) delivery before, you are 1.5-2 times higher risk to have another preterm delivery. If you are in need to have a planned Cesarean section, we generally will schedule it at about 39 weeks or 37 weeks if you have twins earlier if indicated by your pregnancy care.

Women's OBGYN Care PLLC currently have four female physicians and whoever is the provider on call the day you are admitted, will deliver your baby. The Hospitalist OBGYN group will only deliver you in an emergency.

After an uncomplicated vaginal delivery, you can stay 24-48 hours per most Insurance rules. After an uncomplicated Cesarean section, you may be ready to leave as soon as 48 hours, or as long as 96 hours maximum per Insurance rules. Baby will be under care of pediatricians on call provided by the Hospital, who will take care of baby’s discharge. We will need to see you in our office at 7-14 day after a Cesarean Section for a quick Incision check and at 5-6 weeks for a routine postpartum check up.

Most Hospitals now a days have pediatrician available and on call in hospital, who will take care of your baby from birth to discharge. You will need a pediatrician who will take care of the baby once you get discharged from hospital. If you do not have one already, we will recommend some excellent doctors for you to consider or you can choose from your Insurance website. Some patients like to meet and interview the doctor before delivery. After discharge, the first visits with the pediatrician are anywhere between few days to few weeks of life, and you can make this appointment as soon as the baby is ready for discharge per Hospital pediatrician recommendations.

If this is your first baby, you may want to take a childbirth class. While this is not required it may help you to be more comfortable about what to expect. Most people take a class in the last 2-3 months of pregnancy. The hospitals have a very good basic childbirth classes and many other classes available to choose from. The class schedule is available at www.memorialhermann.org (in the “classes and events” section, look for “prepared childbirth” classes and the location of hospital) and at For Patients: Web-Based Learning | Houston Methodist

This is a personal choice, but in my practice the great majority of patients do opt for an epidural. Epidurals are a very safe and effective means of controlling the pain associated with childbirth. Complications from an epidural are extremely rare and often easily corrected (such as a severe headache). You do not have to make any arrangements for an epidural prior to your delivery day. Anesthesiologists are available 24 hours a day to help you whenever you request their services. We will provide you a booklet written by group of anesthesiologists that goes over pain control during labor including epidural for you to read about.

Some patients like to write a “wish list” of events that they hope to happen at the birth of their baby. While forming a written birth plan is optional, we generally do not recommend it. Instead we feel that it is important to discuss your wishes with your doctor so that she can convey your wishes to the nursing staff at the hospital, as long as it doesn’t jeopardize your or baby’s health. The doctor will do her best to adhere to your plan within the boundaries of safety, knowing that the labor process is very dynamic and unpredictable and unplanned events happen frequently. An important part of forming a birth plan is accepting that it may change and you will allow your doctor to make the best decisions for you and your baby at all times during the labor process will help us have a healthy baby and healthy mother.

Vaginal birth after a C-section (VBAC) is offered at our practice. Patient is eligible based on many criteria met, along with lengthy discussion of reason for past Cesarean section, and possible success rate based on that. Please mention this during your pregnancy visits to find out what are your unique chances of possible TOLAC. We do not provide any guarantee of successful TOLAC, but if criteria met, we can certainly try it safely, after going through consent form.

We cannot predict when a patient will have a medical need to be induced, such as high blood pressure, poor fetal growth, low amniotic fluid, or being more than a week past your due date. Your doctor will explain in detail why induction of labor is necessary if this should occur. The decision to induce labor is the result of a complex set of decisions, the end-point of which is that the mother’s and/or baby’s health will be better with the baby on the out-side than the inside. If we recommend a medically necessary induction we expect your full cooperation even if induction was not your desire. Some patients may choose an “elective” induction which is not medically necessary but is timed to provide convenience for family members, work schedules, or to coincide with your doctor’s recommendations based on your unique situation. Elective inductions are scheduled at around 39 weeks.

There is no evidence that routine episiotomies are beneficial, and we try to avoid them. At times your doctor may decide that it is safer to make a small episiotomy that to risk a large tear, but this decision is not made until the baby’s head is partially delivered. There are variable factors that we cannot control including the size of the baby and your body’s ability to stretch, which ultimately affect your ability to deliver without an episiotomy.

The American Academy of Pediatrics does not recommend circumcision for any medical reason. Still, many couples opt to have their baby boy circumcised for religious, cultural or cosmetic reasons. If you decide to have your baby circumcised we will call a urologist to perform the procedure with local anesthesia, usually on the day after birth.

Blood from your baby’s umbilical cord contains stems cells, which may be collected and stored after the baby’s birth. Stem cells have numerous current and possible future medical uses that warrant consideration. At present there is no public banking system but you can pay a private company to store it for you. If you are interested in cord blood collection, visit the websites of Cord Blood Registry (www.cordblood.com) and Viacord (www.viacord.com) to learn more. We can give you the necessary collection kits in our office if you decide to proceed.

In our experience the best breastfeeding class comes when you have your baby in your arms. While physically preparing the breasts is unnecessary, you may want to mentally prepare by taking a breastfeeding class, which can be scheduled through the hospital you will deliver at. Most of our patients have found that the lactation consultant in the hospital can get you off to a good start without any other preparation. If you need help after the baby is born, we can recommend a lactation consultant which can be arranged at home or at a location such as La Lache League, etc. You should also inquire about how to obtain free breast pump through your insurance plan too.

If you have a true emergency that cannot wait until the office reopens (if you are in labor, for example) our office number will prompt you to connect to an operator who will page the doctor on call. While we are always available in emergencies, we ask you to use your judgment and not disturb the doctors after hours with matters that can be dealt with the next business day. Examples of reasons to call the emergency line (24 hours) in the first and second trimester include vaginal bleeding that is more than spotting, persistent cramping, any severe pain, and fever higher than 101.0°F, or vomiting that is pre-venting fluid intake for more than 24 hours. Examples of reasons to call the emergency line (24 hours) in the third trimester include leaking amniotic fluid (a persistent trickle or gush of watery fluid), vaginal bleeding that is more than spotting, decreased or absent fetal movement (at rest, you should feel at least 6-10 small movements in an hour, after drinking orange, or apple juice or Lemonade), or regular, painful contractions. If you are 36 weeks or more, you have not had a C-section before, and you do not have risk from trying for a vaginal delivery, call us when your contractions have been 5 to 10 minutes apart or less for at least an hour. If you are worried or not sure if you are in labor, it is always best to call. If you feel that you need to go to the hospital at any time, please call us first so that the doctor on call can advise you and let the hospital know that you are coming.

Vaginal spotting Vaginal spotting occurs in half of all pregnancies, especially in the first 12 weeks. Most of the time, this spotting will resolve on its own. It sometimes occurs after intercourse or after straining to use the bathroom when constipated, and or could be a sign of miscarriage. There is nothing you can do to prevent or provoke the spotting. If the spotting is light, avoid intercourse for a few weeks. If the spotting becomes heavy, like a period (with or without cramping), please give us a call. Avoid long physical activities without breaks, hydrate and rest. Vaginal discharge Many women have an increase in vaginal discharge in pregnancy. This discharge is usually white, cloudy, or clear, and thin. If the discharge has a foul or fishy odor, causes itching or vaginal pain, irritation or seems to be water instead of mucus, then please give us a call, we might need to see you in the office to check for presence of infections. Cramping Some cramping and uterine contractions are normal in pregnancy, as long as they are mild, self-resolving without doing any remedies and don’t occur every 10 minutes or closer. If you notice cramping pain in your lower abdomen or back that lasts for about a minute then relaxes, especially with pelvic pressure and a hard uterus, it is most likely a contraction. If you have six or more contractions in one hour (every 10 minutes or less), drink two big glasses of water and either lie down or take a warm bath or take Tylenol 500 mg tab. If the contractions do not stop, please call us. Swollen feet and ankles Swelling of the feet and ankles is very common in pregnancy. It is caused by fluid retention, and it usually gets worse late in the day. Drinking enough water and limiting your salt intake can help reduce swelling, as can elevating your feet periodically during the day. We also recommend comfortable shoes and full-length support hose. Note: Rapid onset of swelling in the face and hands can be a sign of complication of pregnancy, if accompanied by a severe headache unrelieved by Tylenol. Please call us if these symptoms occur. Hemorrhoids or varicose veins in the vulvar region (near your vagina) Hemorrhoids are a common problem in pregnancy, and many women notice pain, bleeding after bowel movements (BM), and tenderness or irritation at the rectum from this condition. Straining while trying to have a BM can also lead to hemorrhoids. To prevent, eat a diet high in fiber and stay well hydrated. If you suffer from hemorrhoids, you can use a stool softener daily, if needed. One brand is Colace or Senokot, which is available over the counter at the pharmacy. You can also buy Tucks pads or witch hazel (make your own compress by soaking a disposable cosmetic pad or small cloth with witch hazel). These can soothe and help shrink hemorrhoids or vulvar varicosities. Some women find that wearing a maternity belt, which lifts the pregnant uterus, can help reduce pelvic varicose veins. This type of garment can be purchased online or at specialty maternity stores. Please refer to list of medication provided at your first pregnancy visit. Varicose veins in the legs These are also common in pregnancy. Resting frequently with your legs elevated can help reduce the pressure in your leg veins. Consider purchasing support hose and wearing those each time you are up and about. You may find that a maternity support belt also helps. Back Pain Sadly, lower back pain is a common problem in pregnancy. As your uterus grows, it causes your lower back to become more curved. We become concerned if you have an intermittent and regular cramping pain in your lower back (every 10 minutes or more), which can be a sign of preterm labor. We are also concerned if you have a severe pain on one side of your back, over your kidney (especially if accompanied by a fever or urinary tract infection symptoms), which can be a sign of a kidney infection. Some measures that might help lower back pain include taking Tylenol, warm baths, having someone massage your back for you, and being sure to use correct posture. Stretching your back muscles in the morning and night is often helpful in preventing your muscles from getting too stiff. Some women find that wearing a maternity belt, which lifts the pregnant uterus, can help, too. This type of garment can be purchased online or at maternity clothing shops. Routine YOGA and stretching as well as daily 30 minutes or more walking from beginning of pregnancy can help manage this problem in later months of pregnancy. Morning sickness or nausea/vomiting in pregnancy This is a common issue in pregnancy, and luckily for most women, it resolves by about 13 weeks or so. As long as you are able to keep down some food and fluids, it should not cause any long-term problems for you or the baby (except that you might feel miserable). Some measures you can take are to keep well hydrated (try drinking about 1 ounce of coconut water, water, or diluted fruit juice every 15 minutes to stay hydrated). Unisom and vitamin B6 together have been shown to be helpful (see medication list). You can also take Tums, Emetrol, or papaya tablets (which can be found at natural food stores). Some find that ginger tea, ginger ale, or ginger candy may also be helpful. Some women find the scent of fresh cut lemon (or cotton ball soaked in lemon extract) provides some relief, as does sucking on sour lemon candies. You can try using “Sea Bands”, which fit over your wrists and put pressure on an acupressure point. Small frequent meals and snacks are a good idea, too. If you can eat a high protein bedtime snack and bland foods, that might help (bananas, rice, applesauce, and toast). You will be provided with a prescription for nausea and vomiting that you can take as needed. If you should become dehydrated or are losing significant amounts of weight, are unable to keep down anything for more than 24 hours, or if you are unable to urinate, or your urine becomes scant and dark colored, call our office immediately! Heartburn Pregnant women often begin to get heart burn in the first or third trimester when your pregnant belly begins to push upwards on your stomach. This pressure causes some of the acids in your stomach to linger and travel up your esophagus. You then feel a burning sensation in your chest, which can be accompanied by nausea. Preventing heartburn is the best way to deal with it! Some ways to avoid heartburn include eating six to seven smaller meals throughout the day rather than three large meals, waiting three hour or more after eating to lie down, and avoiding spicy, greasy, and fatty foods. If you are experiencing heartburn, there are a few natural things you can do to relieve the symptoms including eating yogurt or drink a glass of milk or try a tablespoon of honey in a glass of warm milk. Over-the-counter antacids like Tums may prove helpful in relieving you of heartburn problems. (See medication List) If your heartburn symptoms are severe, we may need to prescribe medication for you. Constipation The hormones of pregnancy as well as other factors tend to increase constipation in pregnant women. We recommend the following: A diet high in fiber (fruits vegetables and whole grains), including prune juice and dried plums Enough water (your urine should be pale yellow in color – if there is a strong odor and dark color, you are most likely not drinking enough water) Walking every day (this helps your bowels to move and has the added benefit of being good for your pregnancy and your baby, too). Supplemental fiber, such as Metamucil, Citrucel, Fiber One cereal, high fiber bars, etc. Round ligament pain As your uterus grows, the ligaments that help support it also stretch. The ligaments then might spasm briefly. Sometime, women get fairly sharp pains down low in the abdomen, just above the pubic bone, or on the sides of the uterus, where the ligaments attach (groin). These pains might increase after being more active, especially after activities involving bending and twisting motions. If the pains are short and go away quickly, this is probably normal. Try a warm bath, sleeping with a pillow between your knees, Tylenol, and avoiding twisting motions while you work (turn your entire body versus just twisting your trunk). Use Bengay, Icy Hot ointment, or mild heating pad in the groin area. If your pain is severe, does not go away, is rhythmic like contractions (regular pains every 10 minutes or less, lasting for a minute, and then relaxing) or because you worry, please call. Insomnia The physical and hormonal changes of pregnancy contribute to the quality of a pregnant woman’s sleep. In addition, our minds during pregnancy can be never ending, especially when we attempt to sleep at the end of a long day. Each trimester of pregnancy brings its own unique sleep issues. Most sleep problems occur in the third trimester. There is growing discomfort from the baby and the due date is quickly approaching. It is more common for pregnant women to be able to fall asleep initially, but then wake after a few hours and then remain awake until the morning. This causes a great deal of fatigue throughout the day-time hours. Here are some suggestions to help you get to sleep in pregnancy: Pillows! Pillows! Use as many supportive pillows as you need to support your tummy and back. Also place a pillow or wedge between your knees for low back support. A full-length body pillow is often popular because it can snake around your body entire body in several different ways. Eat a light snack before bed. Warm milk contains a natural sleep inducer called serotonin. Exercise. Regular exercise promotes physical and mental health. It can help with sleeping more deeply. Avoid exercising 2 hours before bedtime. Walking is okay. Relaxation techniques. Deep breathing, stretching, massage, yoga, soothing music, or a warm bath helps promote relaxation to ease your mind. Take short naps (15-30 minutes) during the day, if possible. Sleep medications should be used as a last resort in pregnancy and avoided in the first trimester. Do not use sleep medications on a regular basis. Unisom and Benadryl can be used for sleep in pregnancy. Avoid melatonin, valerian root, and your prescription sleep medications in pregnancy Practice good sleep hygiene: Avoid alcohol, caffeine and nicotine (which you should be doing anyway – you are pregnant) Establish a regular bed time and waking time. Do not go to bed when you are wide awake. Take your television and computer out of your bedroom. Avoid staying awake in your bed for long periods. If you have not fallen asleep or become drowsier within 20 minutes of lay in bed, get out of bed and do activities that make you sleepy, such as reading or a warm bath. Once you feel sleepy, try going to bed again Remember to try to avoid sleeping flat on your back, especially in the last 3 months of pregnancy and just listen to your body!! Diarrhea or Stomach flu Diarrhea can cause intense cramping, discomfort, and can lead to dehydration. Begin treatment by consuming only clear liquids, such as Gatorade, ginger ale, and broth soups for 24 hours, then gradually introduce a bland diet for the next 24 hours. If your diarrhea is not improving over time, or your urine becomes scant and dark, please call us for advice. You can take Imodium AD for diarrhea, if needed. Cold, Flu, Sinus problems, and Allergies During pregnancy, women are more susceptible to respiratory ailments like colds and flu, and these illnesses tend to last longer. Most over the counter medications are safe to use, as long as they do not contain aspirin or ibuprofen (see the list in the medication section). If you develop a fever over 100.4 degrees F, green nasal discharge, or a coughing up blood or bloody colored sputum, please let us know (or call your primary care provider). We want to remind you that most colds are viruses that do NOT respond to antibiotic therapy. During the flu season, we do recommend you get the flu vaccine without preservatives that can be given at any pharmacy without prescription. It is safe and strongly encouraged for pregnant women and new parents, and you need one each year. We also recommend that you wash your hands frequently, don’t touch your face unless you have just washed your hands, and try to stay away from people who are sick. See the medication section of this booklet. Nasal bleeding: Nosebleeds are common in pregnancy because the pregnancy hormones progesterone and estrogen make your blood vessels open wider (dilate). At the same time, your increase blood supply puts pressure on the delicate veins in your nose. The moist linings (mucous membranes) inside your nose may also swell and dry out. This may be worse in winter, a time when colds happen, and our homes tend to be warm and dry because of central heating. All this can make it quite easy for the vessels in your nose to break open, causing you to have minor bleeds while blowing nose/releasing mucus. Avoid cleaning nose without water instead use edible oil to moisturize nose, avoid extreme cold & heat exposure. Hydrate!! Nose bleeding is not harming pregnancy or baby and it is not sign of anything dangerous. Carpal Tunnel Syndrome: If you feel numbness, tingling, or in your fingers and wrists, you are probably experiencing carpal tunnel syndrome. It occurs when swelling in the wrist puts pressure on the median nerve, which runs through the carpal tunnel from the wrist to the hand. It can happen in one or both hands and the pain may be worse at night or upon awakening. If carpal tunnel syndrome becomes persistent or bothersome, discuss it with your provider. Wrist splints, available at some drug stores or surgical supply stores, can relieve the problem. Try not to be discouraged if it does not seem to get better, though because it usually improves after delivery. Breast Tenderness: Generally, occurs early in pregnancy and gradually disappears. Headaches: Often appear when nausea improves, may occur daily, and usually lessen after 14-16 weeks. Unusually severe headaches, not responding to Tylenol 500 mg, should be reported to us. Fatigue This occurs throughout the first trimester. It may feel as if you have taken some form of sleeping pill, especially in the afternoon. You may also have some difficulty sleeping at night. Vaginal bleeding In the first third of pregnancy, bleeding that is menstrual-like or heavier can be a sign of a problem. Although it is not uncommon to bleed, first trimester bleeding should be evaluated. Light staining or spotting, especially after sex, is common and is generally not a problem. After the first trimester, bleeding is unusual (except staining after sex), and should be reported. Heavy bleeding can be associated with placenta previa, abruption or emergency situations. When you are in the last few weeks of pregnancy, it is not unusual to get a discharge with blood called “show”. This is usually no heavier than a menses. Premature rupture or the membranes: When this occurs prior to 37 weeks, special precautions must be taken. Notify the provider and they will instruct you as to what to do. When the water breaks, it is usually obvious, or you will have a persistent “trickling” of clear fluid from the vagina. If you are uncertain, walk around for a 15-20 minutes: leaking will persist over time. It is continues, proceed directly to hospital emergency room and they will bring you to labor and delivery OBED for evaluation.

The American College of Obstetricians and Gynecologists' Statement: "The normal woman with an uncomplicated pregnancy and a normal fetus with a job that has no greater work hazards than those encountered in daily life in the community may continue to work without interruption until the onset of labor and may resume work several weeks after an uncomplicated pregnancy." Hazards: If you have questions or concerns concerning work hazards, provide your physician with the following information: Number of worked hours and overtime Amount of time spent sitting or standing Opportunities to rest I break periods Physical work requirements, lifting, etc Noise level Average temperature of your work environment Commuting time and/or distance Pressure relating to deadlines or workload Chain smokers in the work area 1978 Pregnancy Discrimination Law: Pregnancy and related conditions must be treated the same as any other disability or medical condition. FMLA and Disability Paperwork: If your employer or insurance company requires any forms or documentation to be completed by our office, we will be happy to assist you. These forms include: FMLA, short-term disability, or forms directly from your employer. Please allow at least 10-20 business days to complete the forms and there is a $25 charge for the completion of each form, every time its completed. Please turn these into our office in a timely manner, as the volume of paperwork for our patients prevents us from completing forms on short notice except in the case of a medical emergency.

Can I travel? If you have an uncomplicated pregnancy it is safe to travel until you are likely to go into labor. The best time to travel in pregnancy is from 14 to 28 weeks. We generally recommend staying close to home after 34 weeks, and you should not travel more than 1 hour from home, as the risk of delivery increases, and you could be in labor any time. We recommend not leaving the country in the third trimester (after 28 weeks) unless necessary (you can check with specific airline guidelines. Flying is safe in pregnancy but may increase your risk of blood clots, so wear support hose or Anti-DVT stocking or Anti Embolism stockings on long flights and move about the cabin once an hour. With long road trips make frequent rest stops to stretch your legs and maintain circulation. Traveling in pregnancy is very safe and requires that a few precautions be observed. Some healthy tips for traveling include: Schedule a prenatal check-up prior to departure. If you are traveling far from home, you should keep a copy of your records with you. If you are traveling a long distance and planning an extended stay, you may wish to see an OB in that area. Do not make plans that cannot be changed. Be sure to move about frequently and wear comfortable shoes, support stockings, and loose, comfortable clothing. Eat a balanced healthy diet with plenty of fiber to help avoid constipation. Drink plenty of fluids and carry water with you. You may wish to carry non-perishable snacks with you in case food is not immediately available. Do not take any over-the-counter or prescription medication unless your physician has approved it. Get plenty of sleep, rest often, and try not to do too much! Please ask for a travel letter to avoid full body scan if air travel is planned. Land Travel Short trips are easily managed by traveling in a car; however, you should not plan to drive more than 5 or 6 hours per day. Seat belts are a must and should be worn as designed. This includes both the lap and shoulder belt. The lap belt should be worn below your belly and across your hipbones. The shoulder belt should be placed across the chest and between the breasts. It should never be worn under the arms. You should also plan to stop every 2-3 hours to walk, stretch, and empty your bladder. Buses and trains are also safe. Keep in mind that bumpy rides are ok; be careful while navigating the narrower aisles when the transport is in motion. Air Travel Traveling by plane is safe in a commercial and/or pressurized cabin, unless specific medical/obstetrical conditions. After 36 weeks, you may need special permission from your physician to purchase a ticket for air travel. You should try to book an aisle seat when purchasing your ticket. Metal detectors at airport security will not harm your baby. When you fly, you should increase your fluid intake, empty your bladder as often as necessary, and when allowed, walk about on the plane. This is important for maintaining good circulation, especially to your lower extremities. Be sure to use pillows and blankets as needed for positioning and comfort while in your seat. Use seat belts when in your seat and remember to place them under your belly and across your hipbones. Sea Travel Traveling for the first time by sea may not be the best idea, especially in early pregnancy. This is due to the possibility of complicating the normal nausea of early pregnancy with seasickness. Be sure that any medications given are safe in pregnancy. You may wish to try a sea band, which is worn about the wrist and uses acupressure to help prevent nausea. Cruise lines have restrictions on travel in pregnancy; be sure you are aware of these restrictions before purchasing tickets. Foreign Travel Traveling out of the country during pregnancy may require quite a bit of additional planning. If immunizations are required, you must be sure that they are safe in pregnancy. You should plan to carry a copy of your records with you in case medical care is needed while you are out of the country. Be sure to abide by any travelers precautions specific to the country you are visiting. These would include recommendations on food, water, fruits, vegetables, meats and fish. NOTE: PLEASE ASK FOR TRAVEL LETTER TO AVOID FULL BODY SCAN IF AIR TRAVEL PLANS.

If this is your first pregnancy, we begin assessing for fetal movement around 20 weeks of gestational age or later. Some women, particularly those who have had a child in the past, will feel the baby sooner, perhaps around 16 weeks gestational age. Some women may feel the baby move later than 20 weeks. Movements can be described as rolling, punching, kicking, or stretching in your uterus. Once you have reached 28 weeks of pregnancy, you should be feeling the baby move, regularly, every day. Most babies have a certain time of day when they are more active (such as just after dinner, just after you go to bed or first thing in the morning). Fetal Kick Counts Starting around the 28th week of your pregnancy, if there is concern of fetal well-being, one way to quickly assess will be counting the number of times your baby moves or kicks. Keep in mind that babies have sleep and wake cycles lasting from 20 minutes to 45 minutes. A minimum of 6-10 kicks or movements within a 1-hour period is reassuring. Unfortunately, there is no consensus on a critical level of fetal movement. However, it is certain that fetal activity is generally reassuring, and that fetal inactivity does need further evaluation. If you feel a decrease in activity, have a glass of juice or Lemonade and lie down or sit in a comfortable and quiet place. Count fetal movement for one hour. If you do not feel your baby moving at least six times, notify us immediately at 281-953-1710. The following information explains how to do the fetal kick counts. When you start the kick count, note the time to determine when the 1-hour counting period begins. Example: If you start at 7:00 AM, you should have counted 10 kicks by 8:00 AM. Babies usually have several movements or kicks at once or move many times in a short time period. These can count as separate kicks for counting purposes. When your baby has moved or kicked 6-10 times, you may quit counting. Many babies move 10 times within a few minutes, well before the 1-hour time limit. HELPFUL HINTS FOR COUNTING FETAL KICKS Babies often move after you cough, laugh or change your position Babies usually begin moving after you drink something very cold or after you eat Babies usually move around after loud or sudden noises, TVs and radios Babies sometimes get hiccups! Hiccups only count as one movement in your counting process.

Selecting a Pediatrician You will need a pediatrician with privileges at the hospital you plan to deliver to see your baby from birth till discharge. If you do not have one already, we will recommend some doctors for you to consider who we trust for their excellent care. Some patients like to meet and interview the doctor before delivery, or you may be comfortable meeting the doctor when he/she comes to see your baby in the hospital. After discharge, the first visits with the pediatrician are usually at 1-2 weeks of life, and you can make this appointment as soon as the baby is born. Things you may want to discuss during the visit as part of prenatal care: Excitement and nervousness about being a new parent. Vaccinations Safety issues: crib safety, pet safety, and household safety. Sleep position for the baby. Car seats. Family history. Availability of after-hours care and in case of emergency. Concerns about food or supplies for the new baby. Childcare arrangements. Plans for returning to work or school. Questions about circumcision. Questions about breastfeeding and bottle-feeding. Preparing your other children for the new baby. Your physical and emotional well-being. Preparations you have made at home. Questions to ask yourself: Did you feel comfortable with the doctor? Yes/No Were the nurses and support staff at the office helpful? Yes/No Was everything clean? Yes/No Is the office conveniently located? Yes/No

We wish to bring you the highest level of care for both you and your baby. We deliver our patients in a hospital with a level 3 nursery and 24-hour in-house anesthesiology. We have privileges at the following hospital in the Houston area: Southwest Memorial Hermann- https://www.memorialhermann.org/southwest-pre-registration-childbirth/ Memorial Hermann Sugar Land- https://www.memorialhermann.org/sugarland-pre-registration-childbirth/ Houston Methodist Sugar Land hospital- https://www.houstonmethodist.org/childbirth-registration/ CHI St. Luke's - Sugar Land- https://www.stlukeshealth.org/locations/family-birthing-center-sugar-land-hospital/labor-delivery At the beginning of your 28th week or end of 7th month, you will need to pre-register at the hospital you will be delivering at. This is also a good time to schedule tours of labor and delivery and establish a plan for when labor begins. You want to keep in mind the designated parking areas, the pickup and drop off locations and visiting hours for family and friends and hospital access afterhours.

We strongly recommend first time parents to enroll in childbirth classes. All the hospitals have classes listed on its websites above. While it is not required, it may have you be more comfortable about what to expect during the birthing process. Our office does not prefer any specific childbirth class; we encourage our patients to look into as much detail of a class they may be interested in. We have also compiled a list of resources of books that we strongly recommend that you read. Some patients like to write a “wish list” of events that they hope to happen at the birth of their baby. While forming a written birth plan is optional, we generally do not recommend it. Instead we feel that it is important to discuss your wishes with your doctor so that your wishes can be informed to the nursing staff at the hospital. The doctor will do their best to adhere to your plan within the boundaries of safety, knowing that the labor process is very dynamic, unpredictable and unplanned events happen frequently. An important part of forming a birth plan is accepting that it may possibly change and allowing your doctor to make the best decisions for you and your baby during the labor process.

Circumcision is the removal of the foreskin or ring of tissue that covers the head of the penis. The purpose of the foreskin is to protect the glands against urine, feces and other types of irritation. The foreskin may also serve a sexual function by protecting the sensitivity of the glands. The American Academy of Pediatrics does not recommend circumcision for any medical reason. Still, many couples opt to have their baby boy circumcised for religious, cultural or cosmetic reasons. If you decide to have your baby circumcised, the procedure can be performed depending on the health of your baby, usually before discharge from the hospital. Like any surgical procedure, circumcision may cause complication (less than 1%). These might include infection, bleeding, scarring, removal of too much skin or too little skin and various injuries to the penis. The procedure causes some pain that can be minimized by using a local anesthetic to block the nerves of the foreskin. You may have to pay the cost of the procedure if it is considered an elective procedure by your insurance. Please check with your pediatrician if they do the procedure or not. Also, some pediatricians at the delivery hospital might provide this service, let your postpartum nurse or pediatrician taking care of baby know about your request for circumcision.

During your pregnancy, you are thinking about the many ways to keep yourself and your unborn baby healthy. Soon you’ll be deciding about how you will feed your baby. Your choices include exclusive breastfeeding, bottle-feeding with pumped breast milk, feeding with both breast milk and formula (combined feeding), and formula feeding. (Plain cow’s milk is not recommended in the first year of life). We want you to have information so you can make the best choices for you and your baby. Your baby’s medical care provider can also help in your decision-making. Sometimes feeding choices change as determined by each mother’s and baby’s special needs. Most formulas are cow’s milk or soy based with other ingredients added. If you choose formula feeding or combined feeding, check with your child’s care provider about formula recommendations. Breastfeeding More mothers today choose to give their baby’s the healthiest start through breastfeeding. Human milk is nutritionally complete and made for human babies’ optimal growth and development. Breast milk changes according to baby’s needs. Many professional organizations (American Academy of Pediatrics, U.S. Department of Health and Human Services and World Health Organization) recommend breastfeeding for six to twelve months or longer because of the many benefits for baby, mother and family. Breastfeeding for any length can benefit for baby, mother and family, but the longer the breastfeeding, the greater the benefits for mother and baby. The many benefits of breastfeeding include: For the Baby: Helps protect the digestive system from harmful bacteria, which lessens the risk of severe diarrhea requiring hospitalization. Decrease odor to stools and reduces diaper rash. Decrease risk of constipation, ulcerative colitis, and Crohn’s disease. Improves intelligence and nervous system development (breast milk has DHA for the brain) Creates a strong bond between a mother and child. Feels comforting and helps decrease pain and illness. Provides improved wound healing. Decreases the risk or severity of: Sudden Infant Death Syndrome (SIDS) Allergies, Eczema Ear infections (RSV), asthma Childhood obesity, blood pressure problems, cardiovascular disease Childhood diabetes and cancer (lymphoma) Dental and speech problems Preterm and low birth weight babies especially need these benefits Is clean, ready to eat, and always available food in any situation? For the Mother, breastfeeding: Is the ultimate convenience. Breast milk is free, ready to serve and at the right temperature. Mothers can renew their supply with no preparation or clean up. It’s a good excuse to sit and relax. You can even feed baby if you’re really tired. Saves money on medical bills since baby is healthier and because you are not buying formula. William Sears, M.D., estimates cost of formula (2004) as $1,200 the first year for formula and $ 2,500 hypoallergenic formulas. Causes the release of hormones which can decrease anxiety and stress while increasing confidence (feelings of nurturing, mothering and improved mood, if all is going well). Improves weight loss between three and six months postpartum. Can delay menstrual cycles (should not be used as a contraceptive method!) Decreases the risk of: Breast, Uterine and ovarian cancer Heart disease Osteoporosis Diabetes Rheumatoid arthritis Urinary tract infections For the Family and Community Lowers the rate of infant sickness and death. Lowers health care costs (fewer clinic visits and hospitalizations, less medications). Uses fewer natural resources and less waste products as a result. Provides less waste and less pollution to the environment. Contributes to a more productive workforce. Breastfeeding mothers need less time off for sick babies. Companies gain recognition for caring about employees’ families. Saves the family hundreds of dollars in formula. When to Contact your OBGYN;: Mother’s breasts are painfully overfull (engorged) and baby can’t breastfeed. Mother develops a tender, swollen area in breast, especially when accompanied by fever and flu-like symptoms (chills and body aches). Mother worries that she has low supply. Please call your pediatrician for any other concerns related to Breast feeding, as it may involve your baby’s check up. Perhaps You Have the Following Concerns Regarding Breastfeeding Embarrassment: There are ways to discretely breastfeed your baby, so you and others are comfortable. We can give you suggestions. Pain: It should not hurt to breastfeed. Initial tenderness resolves shortly and there are ways to be more comfortable. Pain is a sign that you should get help from your health care provider or a lactation expert. Diet: There is no need to avoid any specific food or follow a strict diet. You can eat when hungry and drink when thirsty. Just follow diet guidelines discussed during pregnancy for breast milk production. Medication: Many medications are safe while breastfeeding, or there may be safer alternatives to the medication that is available. Please refer to the list of medication provided safe for pregnancy and breast feeding. Lifestyle: Breastfeeding is adaptable to different lifestyles. You can adjust your feeding plan for returning to work or school, or to involve others in baby’s care. Some women choose to breastfeed when at home and formula feed while they are at school or work. You may use breast pump at work to collect breast milk for use at later time. Support: Included in the breastfeeding section is a list of available classes, book suggestions, internet sites, supply resources, and lactation consultants and educators. Friends and family who have had good experiences breastfeeding are great resources. Success: Most women can breastfeed for as long as they desire. The longer time period a mother breastfeeds, the greater the benefits for mother and baby. However, breastfeeding is a LEARNED SKILL for both mother and her baby. It takes time and support for mother and baby to figure out what they need to do. The first two weeks can be very challenging. It becomes more “natural” and relaxing after that. Some mothers may need to supplement breastfeeding with formula to provide for baby’s nutritional needs. Others may have to change their choice of feeding methods. Making these changes does not mean that a woman has failed, but rather that she has succeeded as a mother by adapting to her own needs and to her baby’s specific needs. Use of breast pump may also help in certain situations. Bottle Feeding Some mothers prefer to bottle feed whether cultural or personal choices. Bottle feeding can be done with pumped breast milk, or supplemental formula. Preparation. Before using new bottles, nipples and rings, they should be sterilized by submerging them in a pot of boiling water for five minutes. Allow them to dry on a clean towel. For future cleanings, place bottles, nipples and rings in the dishwasher or clean them in hot, soapy water. Most baby supply stores carry handy bottle gear such as bottle drying racks or dishwasher baskets for nipples, rings and bottle caps. Discuss any feeding questions with your baby’s care provider. Record feedings. Start a diary of feedings, wet diapers and bowel movements. This can be a great reference when seeing your child’s care provider. Bottle preparation. There is no health reason to feed warmed milk, but your baby may prefer it. When you are ready to feed your baby, you can warm the bottle in a pot of hot water – not boiling – or by running it under the tap. You can also buy a bottle warmer designed for this purpose. If your baby is accustomed to drinking bottles at room temperature or slightly cold, you do not have to preheat bottles. Never use a microwave to heat a bottle of breast milk or formula. Since a microwave oven heats unevenly, it can create hot pockets, which may lead to burns. It also breaks down nutrients. Avoid “bottle propping” or putting your child to bed with a bottle. This will decrease the risk of ear infections, choking and bottle tooth decay. Also, feeding is a time for bonding with baby and parents. Breast engorgement. In seven to ten days after delivery, your breast will decrease and feel almost like they did before pregnancy. When this occurs, you have NOT lost your milk. Your breasts are adjusting to what the baby takes at each feeding. Most women find they are most uncomfortable when their milk comes in – around three to five days after delivery. Following are some measures you can take to ease the discomfort that is caused by engorgement during this time, if you DO NOT WISH TO CONTINUE TO PRODUCE BREAST MILK. Don’t pump, even to relieve engorgement – it encourages milk production Wear a snug-fitting bra as much as possible. Sports bras are especially helpful Avoid nipple stimulation, checking for milk and pumping, which encourages your breast to produce milk Apply cold compresses or ice packs to your breast as often as tolerated. Green cabbage leaves are a natural alternative to relieve engorgement Take a mild pain reliever, such as acetaminophen or ibuprofen, as needed.

During the last few weeks of pregnancy, it is important to have the things you will need during your hospital stay prepared. We have provided a list of things that are typically needed by patients. It is important to check with each labor and delivery unit on any specifics that you may have a question about. Please remember that everything on this list is not required, as they are only suggestions Shampoo Toothbrush/toothpaste Deodorant Hairbrush Cosmetics Moisturizer Other toiletries Glasses, in case you have to remove contact lenses Comfortable PJs (bring a couple), slippers, and a robe CDs, Magazines or Books Video and still cameras (don’t forget the batteries ad to clear your memory cards Socks Pillows Playing cards, puzzles, magazines, books Laptop and your favorite DVDs Hard candies/lollipops to suck on during labor Pencil, notepad, and a watch for timing contractions Phone numbers for family and friends Nursing bra, if you plan to breastfeed Underwear (several pairs) Street clothes for when discharged home A going-home outfit for the baby, including socks, onesie, diaper, and hat, mittens Baby blanket Infant car seat

Neck or back massage tools, rice sock, tennis ball, hot water bottle, medical ice bags Lip balm Massage lotion or oil Snacks for labor support person Music for labor (if you need) Gatorade or another similar electrolyte replacement drink

The following list suggests the very basic supplies needed to care for your baby. If your budget allows, you can add extra items. Buy ahead of time as much as you need to feel prepared and to care for the baby without feeling hassled. Purchase other items as you need them. Items do not need to be new, just safe and clean. Watch for garage sales, other special sales, or exchange items with family or friends as needed. Clothing Avoid buying large quantities of newborn sizes that your baby will quickly outgrow. Diapers, if using cloth diapers, 3-4 dozen. Diapers, disposable 12 per day. (If you are using disposable diapers, cloth diapers work nicely as burp cloths and 1-2 dozen are helpful). Diaper pins (if using cloth diapers) 8-12. Shirts (tie front or snap) 6-8. Sleepers, nightgowns, 4-6. One-piece rompers (above the knees; snap at the crotch; for spring or summer baby) 4-6. One-piece stretchies (long pants with or without feet) 4-6; for fall or winter baby; 2-3 for spring or summer baby. Pairs of booties or boot-like socks 4-6. Waterproof pants if using cloth diapers 3-4. Caps (knitted for winter; brimmed for summer) 1. Bunting or hooded jacket (winter) 1. Blanket sleepers (winter) 2-3. Bibs, washable, 4-6. Bedding Receiving blankets (at least 4-5) Waterproof pads Fitted Sheets Bumper pads Lightweight blankets Quilted Mattress Bathing Hooded towels 2-3. Wash clothes 8-12. Mild soap 1 bar or bottle. Oil or lotion – 1 bottle. Baby bathtub (optional) – 1. No-Tears baby shampoo – 1 bottle. Nail clippers. Breastfeeding Supplies Support/ Nursing Bra Bra Pads (5-6 washable, 2-3 dozen disposable) Breast pump (to learn how to set up) Formula Equipment/Supplies 4 oz bottles, nipples and caps 4. 8 oz bottles, nipples and caps 4-8. Extra nipples and caps 2-4. Disposable bottle (if using disposable system) inserts 1 box of each size. Formula in ready-to-feed, powdered or liquid concentrate form – 1 week supply to start with. Boiled sterile water – 1 gallon to mix with formula. Equipment Crib/bassinette/cradle Changing table (optional). Diaper pail with cover. Thermometer. Diaper bag. Infant carrier/car seat. Stroller. Baby swing (optional). Rocking chair (optional). Portable crib or playpen (optional). Intercom or baby monitor. Soft carrier or backpack (optional). Other Rubbing alcohol/cotton balls for cord care Petroleum jelly (Vaseline) for lubricating rectal thermometer or circumcision care Sterile gauze pads Ointment for diaper rash (A&D or Destin) 1 tube Diaper wipes

Pre-Labor Information As your expected day of delivery approaches there are frequently many questions concerning the symptoms you are experiencing including labor, discomfort of late pregnancy, and your admission to the hospital once labor has started. We hope that the following information will be of assistance to you as your pregnancy nears a successful conclusion. Symptoms of Late Pregnancy During the last few weeks of pregnancy, you may experience an increasing and annoying upper and lower abdominal pressure as the uterus rapidly increases in size. Because of the pressure of the uterus on the bladder, which lies directly in front of the uterus, you may experience frequency of urination and may have some difficulty holding your urine. You also may notice rectal pressure and more frequent small bowel movements. There is also a tendency for increased swelling of the legs and swelling of the lips of the vagina. All these symptoms are normal. The best treatment for these symptoms is to get off your feet, elevate your legs, and get as much rest as possible between your activities. Remember, being active as much as possible and doing exercises that helps you stay active, are the few ways you can help your body to come in labor. It is best if you sleep on your side and not on your back during the last few months of pregnancy. If you wake up on your back do not be alarmed, simply turn to your side. Also, do not restrict your food intake. Eat plenty of fresh fruits and vegetables to keep your bowel movements soft and normal. It is important to drink at least six to eight glasses of water per day and to avoid caffeine. You may experience increasing irritability of the uterus; it will periodically contract and become hard. These contractions normally do not cause pain; however, the contractions may be a sign that the uterus is preparing for labor. There may also be an increase in your vaginal discharge during this time, but this discharge should not cause any irritation, itching or soreness. If it does, please notify your provider. Disposable panty shields help when the discharge is heavy. Tub baths are permissible as long as you are careful not to slip in the tub. Hot tubs are not recommended. Restlessness and some difficulty sleeping frequently occur during the last few weeks of pregnancy. Fresh air, short walks before bedtime, or a warm shower or bath before bedtime may be helpful. If the problem persists, discuss it with us at your next clinic visit, especially if you are not getting adequate rest. Engagement is a medical term often referred to as “baby dropping.” This means that the infant’s head or buttocks have settled into the pelvis prior to labor. If this is your first pregnancy, engagement will usually occur about two or three weeks prior to the onset of labor. After the woman has had a child, the time of engagement is unpredictable. It may occur several weeks before delivery or it may not occur until labor begins. You can usually tell if engagement has taken place because it is easier to breathe, the baby is lower, and you may experience increased pelvic pressure and more frequent urination as described above.

Common symptoms of labor include aches in the lower back and increased pelvic pressure and abdominal cramping. The lower abdominal cramping feels similar to menstrual cramps. These symptoms may be preceded or accompanied by the passing of the mucus plug, and it should not alarm you. The mucus plug, or more accurately mucus discharge, may be blood-tinged and sticky and it is frequently seen in individuals who are experiencing their first pregnancy and labor. If you see bright red bleeding, as heavy as a period, call the office immediately and leave a detailed message if it is after business hours. Once labor has begun you may drink clear fluids, and eat small meals as tolerated, but do not eat a large meal. Following the aches in your lower back, pelvic pressure, and low abdominal cramps you may expect irregular, short uterine contractions. These contractions will become regular and more evenly spaced. Gradually they will get closer together and last for a longer period of time. The best way to time contractions is to write down the clock time when each contraction begins. For example 2:02, 2:07, 2:12, 2:17, thus five minutes apart. When you should leave for the hospital is dependent upon: Is this your first or subsequent baby Other factors which would influence the length of your labor such as previous c-section, previous VBAC (vaginal birth after cesarean) and need for antibiotics in labor. The length of previous labors How far you live from the hospital The hallmark of true labor is consistency. True labor contractions become consistently closer, longer and harder. False labor contractions are inconsistent in length and time between each one. They may not have a definite pattern. If there is any question as to whether you should leave for the hospital, please call the office. We prefer you call before going to the hospital. Timing Contractions Use a clock or watch with a second hand. Feel your upper belly (uterus) while lying down on your left or right side. If it is hard and you can't press your fingertips in, this is a contraction. When your belly starts to get hard, this is the beginning of a contraction. Write down the time the contraction begins. The time from the beginning of one contraction to the beginning of the next contraction is how far apart the contractions are. Write down how long the contractions last. The length of the contraction is from the beginning of the contraction to the end. This is measured in seconds (contractions usually last 30 to 90 seconds). Time your contractions for at least 60 minutes. If you are less than 37 weeks gestation and have 4 or more contractions in one hour, rest and drink at least one liter of water (4 eight ounce glasses). If the contractions continue, go to and call our office at 281-953-1710 If you are greater than 37 weeks gestation and contractions are every five minutes, or less, for at least one hour, go to Labor & Delivery. Anytime you think your water has broken, no matter how far along you are or whether you are having contractions, go to Labor & Delivery. Why is it important to time contractions? By learning to recognize and time contractions, you may be able to keep your baby from being born too soon with the help of your doctor. If you are at the end of your pregnancy (full term), you will need to time your contractions to know when active labor has started. Ask your healthcare provider when to call about contractions. Always call if you are confused about how you are feeling. Ruptured Membranes In approximately ten percent of pregnancies, the amniotic membrane ruptures prior to the onset of labor. This is sometimes referred to as water breaking. When it happens there is usually a gush of clear fluid that may be mistaken for a loss of urine from the bladder. Ruptured membranes may also cause a constant trickle of fluid from the vagina. If you notice a constant loss of watery fluid from the area of the vagina, your membranes are most likely ruptured. If you think or are unsure if your membranes are ruptured, call the on call the office at 281-953-1710 within one hour. Back Labor One of the most difficult labors for women and care providers to deal with is “back labor”. Back labor is caused by the baby’s head in the “occiput posterior (OP)” position, meaning when the back of the baby’s head is pressing against the mothers sacrum (lower spine). This OP position causes back pain with each contraction, and sometimes discomfort between contractions. It can also lead to slower labors and longer pushing stage. Many factors influence the position of your baby for labor. Reclining in a sofa or chair causes the pelvis and the baby to tip back If the placenta is located on the front wall of the uterus, an OP position is also favored Tight abdominal muscles also can encourage the baby to pick an OP position Crossing your legs when you sit lessens the room in the front of the pelvis so the baby must lie in the back In the “good old days,” women used to do lots of work that required them to lean forward, such as kneeling on the floor to scrub it, and leaning over washboards, etc. Also, good posture was very important and women did not slouch in chairs. It was not ladylike to cross legs and women sat up straight, so many of the problems with babies in the OP position are a result of the modern lifestyle. There is hope, however. The guidelines that follow are adapted from Understanding and Teaching Optimal Fetal Position, a book by Jean Sutton and Pauline Scott, a midwife and a childbirth educator from New Zealand. Ways to encourage rotation of the baby The last six weeks of your pregnancy, choose upright and forward leaning postures. This allows more space for the big part of the baby’s head to get into the pelvis. Keep your knees lower than your hips. For example, watch TV in a straight-backed chair, or kneel on the floor, or even lean over a beanbag chair or labor ball. If you sit in a soft sofa, sit on a firm pillow or use a low back pillow to help hold your back upright. Rest or sleep on your side with the upper knee touching the mattress. This makes your abdomen go forward. Put a pillow behind your back and between your thighs. If the baby is persistently OP, we may even suggest for you to sleep on your abdomen with lots of pillows, or on a waterbed. Sitting on a rocker or chair that is ergonomic can also be helpful. Swimming with your abdomen forward (like breast stroke or crawl) is recommended. Yoga can be helpful, but deep squats are not suggested. Acupuncture or pressure, or even homeopathic can also be helpful. Positions to avoid Semi-reclining: This gives the baby less space and less opportunity to get into the pelvis in the correct position. Long car trips in bucket seats, for the same reason as mentioned above. Sitting with legs crossed. Not only does this decrease room for the baby, it makes varicose veins much worse. Our grandmothers were right, cross your legs at the ankle or sit “like a lady”. Deep squats.

Many women are concerned about how they will cope with pain during labor and childbirth. The experience of pain is subjective and varies from one person to the next and from one pregnancy to the next. Discussing pain relief and being aware of your options ahead of time will help you make the right choices when the time comes. The following is a brief review of the most used options for pain management by our patients and providers. Types of pain relief typically fall under the categories of comfort measures, analgesia and anesthesia. Comfort measures include such things as meditation, rhythmic breathing, position changes, use of focal point, aromatherapy, music, showers and baths. These techniques are discussed in greater detail in several textbooks aas well as many childbirth classes. Some women desire to have an un-medicated birth experience. For a non-medicated birth to minimize your use of pain medications consider the following: Be aware of your personal choice, but be flexible to change your decision if needed Childbirth preparation (classes with your partner) Support from one or two people Analgesia is a medication given directly into a vein through intravenous (IV) tubing. Commonly used medications for analgesia are stadol, nubain, demerol, & fentanyl. Other medications may be used for pain relief in labor. These medications are narcotics and have been used for many years in the management in labor and are given in small doses. Side effects can include nausea and sedation in the mother, as well as sedation in baby. Discuss with your provider the appropriate use of these medications. Anesthesia is the blockage of feeling, including pain. An epidural fall into this category. Your provider may also use an injection, of local anesthetic directly into the tissue around the vagina. These types of medication do not affect consciousness or mental state and have the least effect on the baby. Local anesthetics can ease pain of an episiotomy or during the repair of a laceration. They may be given during labor. Epidurals ease the pain of contractions, delivery and episiotomy and repair but do not necessarily remove the sensation of pressure. You and your care providers will discuss the proper timing for an epidural. Epidurals are performed by an anesthesiologist and involve placing a small catheter into the lower back avoiding the spinal cord. An anesthetic is injected into this catheter either as a single dose and/or as a continuous infusion, depending upon the amount of time the effect is desired. Epidurals may have side effects that are closely monitored. They may cause the mother’s blood pressure to drop, which may temporarily slow the baby’s heart rate. However, steps are usually taken to prevent this. After delivery, your back may be sore for a few days at the injection sit or you may occasionally get a bad headache. For more details, read the booklet provided to you after 24 weeks visit.

Preterm labor is defined as regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. These changes include effacement (the cervix thins out) and dilation (the cervix opens so that the fetus can enter the birth canal). When birth occurs between 20 weeks of pregnancy and 37 weeks of pregnancy, it is called preterm birth. Health Risks of Preterm Birth Preterm birth is a concern because babies who are born too early may not be fully developed. They may be born with serious health problems. Some health problems, like cerebral palsy, can last a lifetime. Other problems, such as learning disabilities, appear later in childhood or even in adulthood. The risk of health problems is greatest for babies born before 34 weeks of pregnancy. But babies born between 34 weeks of pregnancy and 37 weeks of pregnancy also are at risk. Knowing whether you have risk factors for preterm birth, recognizing the signs and symptoms of preterm labor, and getting early care if you have signs and symptoms are important. Preterm labor may stop on its own. If it does not, treatments can be given that may help delay birth and reduce the risk of complications for the baby. Risk Factors Some women are at higher risk of preterm birth than others. Women who have had a previous preterm birth are at the greatest risk. Women with short cervical length also are at a higher risk. The shorter the length of the cervix, the greater the risk of preterm birth. Other factors that have been linked to preterm birth include past gynecologic procedures on cervix, current pregnancy complications in regards to length of cervix, and lifestyle factors. Diagnosis Signs and symptoms of preterm labor are listed in the box “Warning Signs of Preterm Labor” and a flyer is also given to you at or after 24 weeks visit. If you have any of these signs or symptoms, do not wait. Call your obstetrician at 281-953-1710 or go to the hospital. Even if you are having regular contractions, preterm labor can be diagnosed only when changes in the cervix are found. Your obstetrician or other health care professional may perform a pelvic exam to see if your cervix has started to change. You may need to be examined several times over a period of a few hours. Your contractions also may be monitored. You may also have a speculum examination, culture of the cervix and special tests to determine whether the membranes have been ruptured. A 24/7 in house hospital neonatologist will be notified if we feel that delivery is imminent. There are medications that are available to delay premature labor and you may require one of these medications. Most women that have premature labor do not have any risk factors, so please listen to your body. PREVENTION OF PREMATURITY IS THE BEST TREATMENT! IF YOU HAVE ANY OF THE ABOVE SYMPTOMS PLEASE NOTIFY US IMMEDIATELY!

Congratulations! It is normal to feel a bit nervous and overwhelmed after going home with a new baby. There are a few expected things that many new moms experience after delivery, and just like with pregnancy, we are available for you to contact at 281-953-1710. If you have had a normal delivery, we will typically see you here in the office four to six weeks after delivery, unless you have some medical condition that may require you to be seen sooner for added visit. You can call our office once you get home from the hospital and settled in, to make your appointment. At that visit we will do a brief exam to be sure your body is back to normal and will discuss birth control options with you if you desire. For caesarean section, we will see you in the office approximately 7-10 days after delivery. Helpful Tips Get plenty of rest. Try to nap when the baby naps! Lower your standards for housecleaning or let friends and family help. Keep visits short. Do not be afraid to tell people you need to rest or if it is baby’s feeding time. If friends offer to help, give them a job to do like laundry or shopping. Walking and fresh air are good, but no heavy lifting, sit-ups or strenuous exercise until after your office visit at 6 weeks. Drink at least 8-10 glasses of water each day. You can drive a week or two after the baby is born if you had normal delivery. Please allow 4-6 weeks of recovery if a caesarean section. We recommend you continue your prenatal vitamin for at least six weeks (or for the entire time you are breastfeeding). Emotional ups and downs can be normal for the first few days. If you cannot care for yourself or the baby, feel very sad, and crying for no reason or cannot sleep, call us so we can help. And remember, it is just as important to care for yourself, as it is to care for your new arrival! For Your Partner It is always good to have a support system when bringing home, a new baby. It is important to develop a plan or schedule to help lessen stress. Below are a few tips for your partner to keep in mind: Limit visitors or guests. Be willing to alter your routine. Consider taking time off work to help. Be an active participant in baby’s care (change diapers, bathe, comfort when fussy, etc.) Be willing to help with household chores such as cleaning, washing clothes and cooking meals. Be willing to run errands. Be willing to accept outside help from family and friends. Be willing to participate in caring for baby at night (this may mean giving up sleep.) Be willing to spend extra special time and attention with other children. Be willing to come home and take care of child while mom takes a break. Pay special attention to mom (massage, allow to cry, humor, listening, tell her she is beautiful, etc) Be aware sex life will change. Be patient with your partner and find intimacy in other ways and at other times. She may be tired when you go to bed.

If you have had a normal vaginal delivery with or without an episiotomy or a caesarean section, there are a few instructions we would like you to follow and information to keep in mind. Stitches/Sore bottom/Episiotomy Soak in warm water sitz bath, for 20-30 minutes, 2-3 times a day for 10-15 days or as long as you feel you need it (no bubble bath, lotion or oils). You will be given this from hospital to use and to take home. Use the squirt bottle provided to you from the hospital each time you use the bathroom. Pat dry gently or air dry. Take pain medication as directed. If you are breastfeeding, do not worry about making the baby sleepy. You need to be comfortable and relaxed so you can care for the baby well. Use Tucks, Preparation H or Anusol suppositories for hemorrhoids. This also helps the area of lacerations that your provider has repaired. Avoiding constipation will help. Increase the amount of fluids and fiber in your diet (bran flakes and oatmeal are good daily sources). Stool softeners such as Docusate sodium, Senokot or Milk of Magnesium are available over-the-counter. A prescription will be provided after you are discharged as well. Please refer list of medications during Pregnancy and Breast feeding. Incision care for caesarean deliveries Keep your incision dry and clean. Showering is okay but remember to pat the area dry. You may drive two weeks after cesarean delivery if you are not taking narcotics. Be very careful not to lift anything heavier than the baby. Expect to have uterine cramping for several days after delivery. You can climb stairs up and down, just minimize it for first 2 weeks. Bleeding and vaginal discharge Expect to have bleeding like a heavy menstrual period for 1-2 weeks followed by low grade spotting for 6-8 weeks if you deliver vaginally or by cesarean section. You will notice that when you are on your feet more and have increased activity, you may bleed more (this is normal). Also, you may stop bleeding for a few days and then restart. This flow will taper off and become dark brown and then pink to clear in color discharge. This discharge may continue for six to eight weeks with intermittent spotting. Use only pads, no tampons. The cervix needs time to heal. Your first menstrual cycle after delivery is often heavier than usual and may return in as early as one month after delivery or as late as12 months, every pregnancy and every patient is different. When you breastfeed, you may not have a period for several months, however, do not consider this as your birth control method. If you do not breastfeed, you should have a period within 6 to 10 weeks after delivery. No swimming or tub baths until 6 weeks after delivery. No vaginal intercourse until you come for your postpartum visit, sexual pleasure is fine as long as nothing enters the vagina. After urination continue to use squirt bottle from hospital to cleanse the perineum. Clean the rectal area after bowel movement, always wiping from the front to the back. Breastfeeding Wear a snug-fitting bra as much as possible. If breasts become engorged, you can use warm packs, warm shower for comfort and Motrin. Nipple cracks can be relieved with lanolin cream, use of nipple shield can help as well. Drink 10 glasses of fluids and increase your calorie intake about 300 calories daily. Avoid or limit caffeinated drinks to no more than two cups per day. Avoid heavily greased food and fat intake. Continue taking prenatal vitamins as long as you are breastfeeding. Note: If not breastfeeding, and breasts become engorged, you can apply cold compresses or ice packs to your breast as often as tolerated and use tight bra like sports bra, and avoid any stimulation that will invite breast milk production. Possible ways to combine breastfeeding when returning to work or school: Before having the baby, explore options at work or at school for continuing breastfeeding. Delay returning to work if possible. Learn how to use a breast pump or how to hand express before going back to work. The type of pump you choose depends on how much you will use it. You may take the breast pump with you at the hospital, to learn how to use it (get help from Lactation nurse as needed), you may also rent a pump or hand express milk. Save breast milk while on maternity leave by freezing for later use up to 6 months. Please make sure to remember to date any stored breast milk. Select a care giver for baby who has cared for other breastfeeding babies, if possible. Choose a supportive caregiver who will follow your instructions or one that is close enough to allow breastfeeding during lunch hour. Some jobs or school situations make it impossible to pump or breastfeed while at work. In those situations, baby can be given formula when away from his mother and nursed when they are together. Then both mother and baby are benefiting from nursing. Or you may want to invest into mobile breast pump, which allows you to breast pump while in any kind of work environment. The following signs and symptoms require our immediate attention Fever >100.4 Bleeding heavily (soaking one pad in an hour or more (frequently) or a foul odor to your bleeding Increasing pain not controlled with Ibuprofen (Motrin) or acetaminophen (Tylenol) Severe headache unrelieved by Tylenol or Motrin. Feeling an increasing sense of sadness, anxiety, or depression (see section on postpartum depression) Leaking pus, bleeding, or increased pain at the site of any stitches (either vaginal area or on your abdomen if you had a cesarean section) Breasts that are hot to touch and increased soreness unrelieved. Urinary frequency or pain after urination that restarts which resolved after delivery. Leg/calf pain, shortness of breath or chest pain that is still present with rest, or headaches that are not resolved with Tylenol. (Please be advised to continue walking daily 3-4 times a day for 20-30 mutes each to help reduce risk of DVT/PE which can be life threatening to a mother until up to 6 weeks after giving birth.

Postpartum depression is surprisingly common, and our society does not do that great a job identifying women who are suffering from this problem. This disorder can impact the health and well-being of your newborn child and be a very negative experience for you. This type of depression and/or anxiety can affect any woman, regardless of age, income, birth experience, health, or previous history, so all women and families need to be alert for symptoms. Postpartum depression is more common in women with a history of depression or previous postpartum depression, but it can happen even without those history and even with a good family support. It is normal, in the first week or two after your baby is born, to have some ups and downs in your emotions – this is known as the “baby blues.” One moment you may feel happy, and the next moment you are sad or crying. This is very normal, as your hormones are changing, and you have just been through an emotional and possibly exhausting experience. However, this should resolve within a short time frame, and are mild. If, after a week or two (or sooner), you notice you are feeling very sad, anxious, overwhelmed, angry, helpless, ashamed, or out of control, you might have postpartum depression. Some women even have thoughts of hurting themselves or their baby. Women who have had a baby are at risk for postpartum depression for a full year after the birth of the child. There is nothing wrong in seeking help and seeking help for postpartum depression does not mean you are going to have depression for rest of your life. If you think you have any symptoms of postpartum depression, PLEASE call us right away. We can help you sort through emotions you are experiencing, help you with any problems, and make sure you receive treatment for this serious postpartum illness. Postpartum depression can be treated with therapy, medication and caring support. A severe condition known as postpartum psychosis requires IMMEDIATE attention. This condition usually comes on suddenly, and a woman may have hallucinations, delusions, agitation and other psychotic symptoms. There is a low incidence of this disorder, estimated at one to three in 1000 postpartum women. The goal is to seek help before this develops. Your partner should call us if you are unable to do so, as these symptoms might require Emergency Room visit, for treatment. What Are Strategies I Can Try to Help Prevent Postpartum Depression? Get enough rest- sleep when the baby sleeps. Get friends, family, or neighbors to come and help if you need some time to rest or help with your stress level. Eat well-balanced meals that provide adequate nutrition. Get regular exercises, even If it is just a short stroll at first, work up to longer walks. Do what you like to do, and you will be more likely to continue exercising. Remember, it is NOT your fault that you feel this way, and the best thing to do is to accept these emotional swings, get plenty of rest, good food, and fresh air.

After nine months of carrying around that extra weight, you are probably ready to think about your own fitness, including how to shed those last few pounds that did not disappear when your baby was born. On average, women gain about 25-30 pounds during pregnancy, 15 to 20 of which are usually lost within a month of having the baby. That is when it gets tough. Those last five to ten pounds can be hard to get rid of, but consistent, safe exercise can help you do just that and maintain your wellbeing, too. If you had your baby by Cesarean Section, your body would need more time to heal and regain strength, and chances are you will feel less like plunging into an exercise routine. Start slow and use caution when exercising, especially with your abdominal muscles. It is important to consult with your doctor to develop a safe exercise program. Getting back to an exercise routine after the birth of your baby should be a gradual process. Slow walks during this initial period will not only help you to feel you are getting back into fitness routine, but help you relieve tension and get some fresh air. Do not push yourself- work to establish a regular walking time and keep a steady pace. A full-fledged return to the aerobic activities you participated in pre-pregnancy usually comes around the time of your postpartum visit, or after about six weeks. One exercise, which may have been discussed prior to your delivery is Kegel exercises. Kegel exercises, the small contractions of the muscles at the vaginal wall and opening, are very simple and easy to do. They will help to repair and strengthen the pelvic floor. A handout will be provided at your postpartum visit (or in resource section). Back Pain and Posture Back pain and posture concerns are still present in the postpartum period. The abdominal wall is loose now that the uterus is no longer pressing against it, and it cannot adequately support the lower back. Try to incorporate low-back exercises and range-of-motion movements to ease the strain and strengthen the lower back. You may also have upper-back strain caused by fatigue and breast weight if you are lactating. Shrugging the shoulders and performing flexibility exercises for the chest and back should provide relief. Use support for upper body and arms if you are breastfeeding. Toning Your Middle You may be anxious to begin abdominal exercises but do only what you are capable of. Pelvic tilts and abdominal compression exercises are a good place to start. Remember to tighten the pelvic floor when performing these since they may place pressure on it and stretch it further. As your pelvic floor gradually becomes stronger, other curl-up exercises may be added. Some women like wearing waist shapers, although not mandatory and variable results occur. Abdominal binders do not help lose weight on your abdomen; you may purchase at your discretion. Pay specific attention to close the gap in abdominal muscles (Diastasis of Rectus muscles) by watching (YouTube) exercises for Diastasis of Rectus muscles. Start with few repetitions per day and increase as your body can tolerate. Nutrition Your first instinct may be to start eating less to expedite weight loss, but since breast-feeding and increased physical activity require more energy during the postpartum period, it is not recommended. New mothers who breast-feed their babies should not cut their calorie intake. In fact, they should increase it. Breast-feeding mothers need to take in an additional 300-500 calories per day to provide their babies with the proper nutrients. If you skimp on calories, you are less likely to get the nutrients both you and your baby need. This does not mean you increase fat, and carbohydrate intake only. If you want to maintain your weight from childbirth, please follow balanced nutritional guidelines we have discussed during pregnancy. Alcohol and Caffeine Occasional consumption of small to moderate amounts of caffeine-containing products is not contraindicated during breastfeeding according to guidelines of the Institute of Medicine (IOM). However, consuming large amounts of caffeine may interfere with your ability to breastfeed effectively and may adversely affect your infant in other ways as well. Alcohol may also impair a mother’s ability to nurture and care for her infant, so it should be still prohibited as long as breast feeding continues.

Your routine postpartum visit will be scheduled four to six weeks after your delivery. For caesarean section, there will be an initial check one week after delivery followed by the routine postpartum visit. During your exam you will be asked about your general well-being and adjustment to being a new mom, whether you are breast or bottle feeding, and about your emotional status. There will be a pelvic exam to ensure that your body is returning to pre-pregnancy state. One of the most important topics of discussion will be selecting birth control. There are several options to choose from, and we recognize this can be very overwhelming. We have compiled a general overview for the options currently available and will discuss in detail your family planning needs to help you select the most appropriate method. *Information here may no longer be accurate **One important thing to note is that we are unable to know what your insurance will cover for your contraceptive choice. If you are interested in one of the above methods, you can always check with your insurance first about what method is covered before selecting an option. We can provide you with billing codes for the specific method you are interested in to help assist you. Permanent Methods For couples who are absolutely sure they no longer want to conceive, there are a few permanent options available. Each option requires an in-depth discussion with your provider and partner. It is important to note that although some providers offer reversals, most permanent methods are just that, permanent. The chances of the successful reversal vary for each procedure and each carry their own emotional and physical risk, and no Insurance covers it. Tubal Ligation (a.k.a “tubes tied”) During this female sterilization procedure, both fallopian tubes are closed by being cut, tied or sealed with an electrical current. This prevents the egg from moving down the tube and keeps the sperm from reaching the egg. This is an outpatient surgical procedure and may require three to five recovery days. If you have just had a baby, we recommend waiting at least six weeks to schedule this procedure. Vasectomy During this male sterilization procedure, the vas deferens tube is severed preventing the release of sperm. This is typically an office procedure performed by a urologist and may require a few days for recovery. A vasectomy is the least expensive permanent birth control method with least complications

Dealing with a loss of any kind is a very emotional experience. Whether a loss occurs early or late in pregnancy, the emotional hardship can be similar. Miscarriage, or spontaneous abortion, is defined as a pregnancy loss before 20 weeks’ gestational age. Miscarriage is almost always a sign that there was a problem with the way the pregnancy was forming and has nothing to do with anything the mother did or could have done. Although it is difficult to identify specific reasons on why a miscarriage occurred, there have been some identifiable factors known that increase risk such as advanced maternal age, smoking, alcohol and drug use, history of spontaneous abortions, overweight or underweight prior to conception. If you have spotting or light bleeding in the first few months of pregnancy, call our office during office hours and discuss this with one of our medical assistants. If you have heavy bleeding (more than a period), heavy cramps, or significant abdominal pain, inform the office immediately, and plan to visit the emergency room. Depending on the gestational age, options will be discussed on how to move forward with removing products of conception if they are not passed naturally.

Dealing with a loss of any kind is a very emotional experience. Whether a loss occurs early or late in pregnancy, the emotional hardship can be similar. Stillbirth, or intrauterine fetal demise, is defines as fetal death after 20 weeks of gestation. Similarly to spontaneous abortions, there have been risk factors attributed to increased risks that include high blood pressure, advanced maternal age, chromosomal anomalies, placental abnormalities, maternal obesity, diabetes or infections or other reasons. After delivery, many parents opt to complete a pathological report on the placenta to help identify a specific cause. The labor and delivery unit are excellent in providing care during this emotional time by allowing bonding with the parents, photos, and preparing keepsakes such as footprints, or a lock of hair. Some parents make the decision to have funeral services, in which the hospital can also provide excellent resources. In the office, we can also provide emotional support and resources that may be beneficial during your grieving period. As with any pregnancy, postpartum blues or depression are still risks and must be assessed for.

Since every insurance plan is different, it is important that you understand the way your policy works. Before your first visit our staff will check on your benefits and will be able to explain this to you when you arrive. Most insurance companies pay us for the prenatal care (about 13 visits) as well as the delivery in one lump sum after you deliver. Usually you will have one copay for the whole package (the “global fee”). If you have visits that are not related to normal prenatal care, these will be additional charges to your insurance and will have additional co-pays. Tests such as ultrasounds are billed separately and have separate co-pays. Most policies have a deductible or patient portion that you will be asked to pay before you deliver. The hospital will bill your insurance separately, as will other doctors at the hospital including the anesthesiologist and pediatrician. Remember, your doctors are medical experts, not insurance experts. Please direct your insurance and billing questions to the support staff.