New Experience OB/GYN & Medspa Anita Fulton MD, FACOG 21334 Kuykendahl Rd Suite A Spring, TX 77379 Phone: 281-528-7676 Fax:281-528-8859 Congratulations on your pregnancy! Having a baby is a joyous time in a woman’s life. It also comes with a tummy load of questions and anxieties. Take a deep breath. We’re here to help. Enclosed in this packet is some useful information about your pregnancy, nutrition, and prenatal care. Dr Fulton Delivers at Tomball Regional Medical Center, Houston Northwest, and St. Luke’s Vintage. Feel free to call anyone of these hospitals that you are interested in that also will accept your insurance and schedule a tour. Tomball Regional Houston Northwest St. Luke’s Vintage 605 Holderrieth Boulevard Tomball, TX 77375 (281) 401-7500 710 F.M. 1960 West Houston, TX 77090 (281) 440-1000 20171 Chasewood Park Dr Houston, TX 77070 (832) 534-5000 Clinic hours are from 9:00am-12:00pm and 1:00pm-5:00pm on Monday and 7:00am to 3:00pm Tuesday through Friday. Our office provides Ultrasounds through Sound Choices on Tuesdays which is only ordered through Dr Fulton. If you have an emergency after office hours you can reach Dr. Fulton by calling our office phone number (281) 528-7676 which will then direct you to our 24 hr answering service. Dr. Fulton and our medical staff look forward to caring for you during this exciting time in your life. Dr. Fulton cares about your health and well-being of you and you’re your baby, and will strive to help you enjoy this very special time. Thank you for choosing New Experience OB/GYN for your prenatal care. What to Expect What to expect at each prenatal visit is a gradual and exciting introduction to the newest member of your family! Over the course of your pregnancy, you will see, hear and feel your new baby. At delivery, you will finally be able to put a face to the precious child you've come to know. At the first visit, you will begin to establish a new bond with Dr. Fulton. Discussion will begin with the date of your last period to establish your due date. Your health history will be reviewed. If you have any medical problems such as high blood pressure or diabetes, these issues will be addressed. Modifications to the number or frequency of visits and ultrasounds will be made. Various outside factors in your life need to be addressed. For example, if you have cats, we ask you not to change their litter box or get too snuggly with them. If you travel for business or have a particularly strenuous job, this should be discussed. Some basic rules of thumb are: 1. Check with your doctor on all prescription drugs. 2. Stay away from smoking and alcohol. 3. Keep exercise to 30 minutes a day maximum for aerobics and keep your pulse under 140 beats per minute. 4. Travel is okay on an individual basis, up to about 30 weeks. After going over this information, you will receive an exam. A breast check and pap smear will be done, as well as cultures for bacteria and blood work to check your blood type and count, to rule out any sexually transmitted diseases, and to check your carrier status for cystic fibrosis. Now for the most exciting part: the ultrasound to see your little bundle of joy! Depending on how far along you are, you may see a heartbeat, arm and leg buds, and sometimes even spontaneous movement of the baby. The next visits are every four weeks, up to 28 weeks gestation. They are quick and easy. Each time, your blood pressure, weight, and urine are checked. Your tummy is measured for growth and the heartbeat is heard. This enables us to assure you of adequate growth and to determine that no problems are arising from your changing hormones. At 16 weeks gestation, a blood test is done to check for Spina Bifida, Down's Syndrome, and other chromosome related problems. If the test result is abnormal, or if you are 35 years old or over, you may choose to have genetic testing. Dr. Fulton will discuss this with you, if appropriate. At 20 weeks a routine ultrasound will be done. This ultrasound is done to check the fetal growth and anatomy. Fetal gender may be given out if desired. During this time movement from the baby will become apparent. This is the time to begin planning your birthing classes, looking for pediatricians, and starting to get your nursery ready at home. At 24 to 28 weeks blood work is done to screen for diabetes in everyone. If abnormal you will have to do a 3 hour glucose tolerance test. We suggest that every patient doing the test bring something they enjoy reading or for 3 hour testers a blanket to rest in our MedSpa room. At 28 weeks, your visits increase to every two weeks. If you have RH Negative blood you will receive a Rhogam injection at 28 weeks to prevent RH Disease. Some insurance do not cover the injection therefore you may be given orders to go to the hospital. At 30 weeks you will meet with the office manager to go over any insurance questions you may have. Also to make sure that your hospital is in network with your insurance, especially if you may have a Medicaid insurance plan. If you have a printed birthing plan we can make a copy for the hospital and for the office so on your special day your delivery can go as planned. At 36 weeks, you're on the downhill slide. Visits take place weekly. The same checks are done, but now an additional test for Group B Strep is performed and additional blood work. Group B strep is found in 8-10% of all women and can be very dangerous in preterm infants. Antibiotics are given to protect the baby before or during labor. Your cervix will usually be checked each week in the hope of noting progress toward labor. These weekly visits continue until you go into labor or until 41 weeks (40 weeks is full term). At 41 weeks we discuss induction because going more than one week overdue is usually considered dangerous. We will also still go by your birthing plan as much as possible. PLEASE DO NOT HESITATE TO CALL THE OFFICE EVEN AFTER HOURS IF YOU ARE HAVING ANY COMPLICATIONS OR LABOR SIGNS And then, it feels like it all happened so fast. The baby is here, and you have a face to behold and fingers and toes to count! But it's just beginning — the diapers, the sleepless nights, they're asking to borrow the car keys. What to do after you find out your pregnant * Call insurance company to notify them of your pregnancy (weeks 1-12) * Register for prenatal classes if you are interested (weeks 28-32) * Fill out hospital pre-admission forms (weeks 30-34) * Select a pediatrician (weeks 30-34) which our office has cards. Below is a diagram to help you understand you appointments and scheduled test. Weeks Appointments Test Concerns & Reasons to call our office. 1-16 Visit every 4 weeks Prenatal labs, Pap test, Vaginal culture. Miscarriage, Bleeding, pelvic pain, severe vomiting 16-20 Visits every 4 weeks AFP or Amnio, Ultrasound at 18-20 weeks Bleeding, abdominal or pelvic pain or pelvic pressure, leakage of fluid 20-24 Visits every 4 weeks 24-28 Visits every 4 weeks 28-36 Visits every 2 weeks 36-40 Visits every week Decreased fetal movement, bleeding, pelvic pain, leakage of fluid 1hr Glucose, CBC, & Rhogam at 28weeks (if needed) Decreased fetal movement, bleeding, abdominal or pelvic pain, frequent abdominal cramps, headaches, visual changes Strep B Culture at 36 weeks and Blood work Decreased fetal movement, bleeding, abdominal or pelvic pain, frequent abdominal cramps, headaches, visual changes Persistent & consistent hard contractions, bleeding, leaking fluid, headaches, visual changes, decrease fetal movement 2 wks after delivery Only if C-Section 6 wks after delivery Post Partum Check incision Signs of depression, breast infection, heavy bleeding, fever lower abdominal pain, foul smelling vaginal discharge Signs of depression, breast infection, heavy bleeding, fever lower abdominal pain, foul smelling vaginal discharge Laboratory Testing              Complete Blood Count ( CBC ) screen identifies different types of anemia and platelet abnormalities. Blood type and antibody Screen looks for potential incompatibility between your blood and your baby’s blood. Rubella testing done to confirm immunity to German measles. If you are non-immune, you should avoid exposure to infected individuals. A rubella vaccination should be obtained after delivery. HIV testing is offered and strongly recommended. Aside from the obvious importance to your health, identification of an HIV infection will also aid the prevention of transmission to newborns Varicella ( Chicken Pox ) testing is recommended if you are unsure whether or not you have has chicken pox. If you are non-immune, you should avoid exposure to infected individuals. A vermicelli vaccination should be obtained after delivery. Syphilis testing is important. Syphilis can cause severe birth defects if undetected. Hepatitis B is a virus, which can lead to liver disease and liver cancer. Special precautions are taken at the time of delivery to prevent transmission to your baby if you are found to be a carrier. Hepatitis C testing will be performed for those patients interested in a water birth. Thyroid ( TSH ) there are Hyperthyroidism and Hypothyroidism, which we will be checking to make sure your thyroid is in normal rang. Cystic Fibrosis is a life-long illness that is usually diagnosed in the first few years of life. This disorder causes problems with breathing and digestion. Cystic Fibrosis does not affect intelligence. Cystic Fibrosis testing may not be covered by your insurance. The estimated carrier risk is as follows: Ashkenazi Jewish 1/25, Non-Hispanic Caucasian 1/25, African American 1/65 and Hispanic-American 1/46. Urine Culture test for urinary tract infections, which are more common in pregnancy, usually less symptomatic and can lead to kidney infections if left untreated. Gonorrhea and Chlamydia ( STD’s )DNA probes are used to screen for infections of the cervix which can infect newborns. Group B Streptococcus Culture is done between 35-37 weeks. We follow the guidelines recommended by the American College of Obstetricians and Gynecologists to administer antibiotics during labor for all pregnancies at risk for an infection. If your occupation or social circumstances predispose you to other infectious diseases such as Tuberculosis, Fifth Disease or Toxoplasmosis, additional testing may be appropriate. We Need To Know Please call us if you have any of the symptoms listed below:          Persistent headaches Blurred vision or seeing spots Sudden weight gain Sudden swelling Run a temperature of 101 or greater Any vaginal bleeding, regardless of color or cramping Abdominal pain Any loss of amniotic fluid (can feel like a gush, or slight leaking) A decrease fetal movement Medications used in Pregnancy/Breastfeeding Condition Allergy Cold and Flu Safe Medications to Take During Pregnancy* Benadryl Tylenol (acetaminophen) or Tylenol Cold, Warm salt/water gargle, Saline nasal drops or spray, Sudafed, Actifed, Dristan, Neosynephrine*, Robitussin DM, Trind-DM, Vicks Cough Syrup, Romilar, Halls* *Do not take "SA" (sustained action) forms of these drugs or the "MultiSymptom" forms of these drugs. Constipation Metamucil, Citrucil, Fiberall, Fibercon, Colace, Senekot Diarrhea For 24 hours, only after 12 weeks of pregnancy: Kaopectate, Immodium, Parepectolin First Aid Ointment J & J, Bacitracin , Neosporin Headache Tylenol (acetaminophen) Heartburn Maalox, Mylanta ,Tums, Hemorrhoids Preparation H, Anusol Hc, Analpram 1% HC, Nausea /Vomiting Phenergan(25mg supp or tab) / Emetrol (if not diabetic) / Sea bands Rashes Hydrocortisone cream/ointment, Caladryl lotion, Benadryl cream, Oatmeal bath (Aveeno) Yeast Infection Monistat or Terazol Do not insert applicator too far Herpes Outbreak Valtrex 500 mg- Outbreak 2 times a day for 5 days Bacterial Vagniosis Metro Gel (not in first trimester) Iron Supplement Slow Fe 50mg / Feosol 45 mg Or any over the counter supplement , call the office for help Common Over-the-Counter Medication that are safe to take during pregnancy:             Anusol HC (Hydrocortisone cream) 2-4 times a day topically (Hemorrhoids) Benadryl (Dyphenhydramine) 25-50mg every 6 hours as needs (Antihistamine) Chlor-Trimeton (Chlorpheniramine) 4mg every 6 hours as needed (Antihistamine) Colas (Docusate Sodium) 100mg 2xs daily (Stool Softner) Maalox or Mylanta 30 mins after meals (antacids) (better than Tums-also safe) Robitussin 10ml every 4 hours as needed (cough) (any over-the-counter types) Sudafed (Pseudoephedrine) 60mg every 6 hours as needed ( non-drowsy decongestant) Tylenol (Acetaminophen) 6 hours as needed ( Headache, pain, or fever) total dose not to exceed 4000mg every 24hrs Common Over-The-Counter Medications to Avoid Unless Otherwise Directed: Aspirin Advil, Motrin, Nuprin (Ibuprofen) Aleve ( Naproxen) Morning (All Day) Sickness Helpful Hints  Always try to keep something in your stomach, starting from the minute you wake up.  Eat small amounts frequently.  Chew gum  Avoid fats & greasy foods that tent to upset the stomach. For this reason, avoid fried foods & foods cooked with grease, oils or fat meats. Eat very little, or none of the following :  Butter, Margarines, Oils  Mayonnaise, Salad dressing  Pie crusts, pastries  Bacon, Fat back  Gravy  Highly seasoned foods such as those cooked with:  Garlic,  Onion,  Pepper,  Chili & other spices may upset your stomach. Prenatal Vitamins: The amount of nutrients a woman needs during pregnancy is significantly higher than prepregnancy. Prenatal vitamins are recommended for all women-even those with an excellent diet-to provide the extra nutrients needed to sustain a healthy pregnancy. By providing extra nutrients to the body, both mother and baby can be healthy and happy during pregnancy. We ask that you take a prenatal vitamin on a daily basis, if you are not satisfied with the prenatal vitamins that were prescribed to you or if you are having problems with them, please contact our office and we can help you in every way we can. There are many choices out there and we would be happy to help you in choosing a prenatal vitamin that is good for you. Good Nutrition during Pregnancy Congratulations! You are now eating for more than one. This guide will help you choose the most healthful foods for you and your baby. What foods should I eat? You will need an additional 200 to 300 extra calories from nutrient-dense foods compared with how you ate prior to your pregnancy. It will be important to carefully consider the foods you consume during your pregnancy. This is a time to eat more foods that are nutrient-dense, and fewer sweets and treats. Use these guidelines to choose a healthy diet: Daily guidelines for eating healthy during pregnancy Eat a variety of foods. Use the MyPyramid website (www.mypyramid.gov) as a guide to choose the amounts of foods in each food group.            Choose whole grain carbohydrates that are a good source of fiber. Take your prenatal vitamin daily and/or any other prescribed vitamins and minerals. Your prenatal vitamin should contain at least 400 mcg of folic acid. The March of Dimes suggests that 70 percent of all neural tube defects can be avoided with appropriate folic acid intake. Choose at least one good source of folic acid. Foods rich in folic acid include green leafy vegetables, fruits (orange juice, strawberries), and fortified cereals. Drink or eat four servings of dairy products or foods rich in calcium. Eat at least three servings of iron-rich foods. You should get 18 milligrams of iron in your diet daily. Good sources include enriched grain products, lean meat, poultry and fish, eggs, and green leafy vegetables. Choose at least one good source of Vitamin A every other day. Foods rich in Vitamin A often have a yellow or orange color to them. They include carrots, sweet potatoes, apricots, and cantaloupe. Avoid alcohol. Alcohol has been linked with premature delivery and low birth weight babies as well as Fetal Alcohol Syndrome. Limit caffeine to 300 mg per day. You may choose: two 5-ounce cups of coffee, three 5-ounce cups of tea, or two 12-ounce glasses of caffeinated soda. You may use some non-nutritive, artificial sweeteners during pregnancy. The FDA has approved the use of aspartame (Nutrasweet®), sucralose (Splenda®) and acesulfame-K. The FDA does not recommend saccharin because it can remain in fetal tissues. Eat salty foods in moderation. Salt causes your body to retain water and could lead to an elevation in your blood pressure. Do not diet! Even if you are overweight, your pregnancy is not an acceptable time to lose weight. You or your baby could be missing essential nutrients for good growth. Are there foods that are harmful to eat during pregnancy? There are specific foods that you will want to avoid during your pregnancy. Hormonal changes during pregnancy can have a negative effect on your immune system and put you at greater risk for contracting a foodborne illness. The Centers for Disease Control have found that contracting the foodborne illness Listeria during pregnancy can cause premature delivery, miscarriage, and even fetal death. Pregnant women are 20 times more likely to contract Listeria. You can decrease your chances of contracting Listeria by avoiding hot dogs, luncheon meats, soft cheeses, and unpasteurized milk products. Soft cheeses include feta, Brie, Camembert, blue-veined cheeses, and Mexican-style cheeses such as queso blanco and queso fresco. Other foods that are more likely to cause foodborne illnesses include sushi, rare beef, raw eggs, Caesar dressing, and mayonnaise. Another food of concern for pregnant women is fish. Although fish is a low-fat, healthful protein choice, there are certain fish that have elevated levels of methyl mercury or PCBs, a pollutant in the environment. Consuming fish with high levels of methyl mercury during pregnancy has been associated with brain damage and developmental delay for your baby. Shark, swordfish, king mackerel, and tilefish have higher levels of mercury and should be avoided. The March of Dimes cautions against eating fish that may contain higher levels of PCBs. Fish in this category include bluefish, bass, freshwater salmon, pike, trout, and walleye. How much weight should I gain? Gaining the right amount of weight during pregnancy by eating a balanced diet is a good sign that your baby is getting all of the nutrients he or she needs and is growing at a healthy rate. Weight gain should be slow and gradual. In general, you should gain about two to four pounds during your first three months of pregnancy and one pound a week for the remainder of the pregnancy. A woman of average weight before pregnancy can expect to gain 25 to 35 pounds during the pregnancy. You may need to gain more or less depending on whether you are underweight or overweight when you get pregnant. Recommendations also differ if you are carrying more than one baby. Where does all the weight go?  Baby, 8 pounds  Placenta, 2-3 pounds  Amniotic fluid, 2-3 pounds  Breast tissue, 2-3 pounds  Blood supply, 4 pounds  Fat stores for delivery and breastfeeding, 5-9 pounds  Uterus increase, 2-5 pounds TOTAL: 25-35 pounds What if I am gaining too much weight? Try to get your weight gain back on track. Don't consider losing weight or stopping weight gain altogether. You should try to slow your weight gain to recommended amounts, depending on your trimester. During the first trimester, you should gain 2 to 4 pounds total; during the second and third trimester, you should gain 1 pound per week. Consider trying these diet changes to gain weight more slowly:  Eat the appropriate portion size and avoid second helpings.  Choose low-fat dairy products.  Exercise; consider walking or swimming on most if not all days.  Use low-fat cooking methods.  Limit sweets and high-calorie snacks.  Limit sweet and sugary drinks. What if I am not gaining enough weight? Every woman is different and not everyone will gain at the same rate. You should talk to your doctor if you are concerned that you are not gaining enough. Weight gain can be hindered by nausea and morning sickness. (See suggestions for when you are not feeling well.) Excessive vomiting can be a symptom of hyperemesis gravidarum, which you should discuss with your doctor. Consider trying these diet changes to gain weight within appropriate ranges:  Eat more frequently. Try eating 5-6 times per day.  Choose nutrient and calorically dense foods such as dried fruit, nuts, crackers with peanut butter, and ice cream.  Add a little extra cheese, honey, margarine, or sugar to the foods you are eating. What can I eat if I am not feeling well? Pregnancy symptoms vary. Some women may have difficulty with morning sickness, diarrhea, or constipation. Here are a few suggestions on how to deal with these symptoms.  Morning sickness: For morning sickness, try eating crackers, cereal, or pretzels before you get out of bed. Eat small meals more frequently throughout the day. Avoid fatty, fried foods.  Constipation: Increase your fiber intake by eating high fiber cereal and fresh fruits and vegetables. Also, make sure you are drinking plenty of water - at least eight glasses per day.  Diarrhea: Increase your intake of foods containing pectin and gum fiber to help absorb excess water. Good choices include: applesauce, bananas, white rice, oatmeal, refined wheat bread, and smooth peanut butter.  Heartburn: Eat small frequent meals throughout the day. Try drinking a glass of milk before your meal. Avoid caffeine. Try not to lie down after eating a meal. Are cravings normal? Many women will have food cravings during pregnancy, but there are others who do not. If you have food cravings, it's okay to indulge as long as it fits into a healthy diet and does not occur too often. If you are craving non-food items such as ice, laundry detergent, dirt, clay, ashes, or paint chips, you may have a condition known as pica. You should discuss this with your doctor immediately. Eating nonfood items can be harmful to you and your baby and may be a sign of a nutritional deficiency such as iron deficiency. During pregnancy a woman is higher risk for a food borne illness because her immune system is not functioning as it normally does. This makes it harder for her to fight off some potentially harmful bacteria found in the food she eats. Here are some simple rules to follow throughout your pregnancy to help avoid a food borne illness:  Wash hands well before and after handling raw meats  Wash fruits and vegetables before eating  Cook all meats thoroughly  Avoid juices that are not pasteurized  Avoid raw eggs  Avoid raw sprouts as they may harbor more harmful bacteria  Avoid raw seafood, meat or sushi  Avoid soft cheeses such as feta, brie, camembert, or homemade cheeses, unless they are made with pasteurized milk ( check labels )  Hot dogs and deli meats should be heated until steaming hot to kill off potentially harmful bacteria called listeriosis,which can grow at refrigerator temperatures.  Seafood is another common area of concern for pregnant women. Remember that fish and shellfish contain many essential nutrients, proteins and Omega-3 fatty acids, which can offer many nutritional benefits. What we are concerned about during pregnancy is exposure to fish and shellfish that have higher levels of mercury in them. Here are some simple rules to follow regarding fishg and shellfish during pregnancy :  Avoid shark, swordfish, tilefish and king mackerel, they contain high levels of mercury  Limit all other fish and shellfish to no more than 12 ounces per week, or about 2-3 servings per week  The five most commonly eaten fish that are low in mercury are; shrimp, canned light tuna, salmon, Pollock and catfish.  Limit albacore or “white” tuna no more than 6 ounces per week Consuming alcohol during pregnancy: Drinking alcohol during pregnancy can cause physical and mental birth defects. Each year, up to 40,000 babies are born with some degree of alcohol-related damage. Although many women are aware that heavy drinking during pregnancy can cause birth defects, many do not realize that moderate-or even light-drinking also may harm the fetus. In fact, no level of alcohol used during pregnancy has been proven safe. Therefore, our office recommends that pregnant woman do not drink any alcohol-including beer, wine, wine coolers, and hard liquor throughout their pregnancy and while nursing. In addition, because women often do not know they are pregnant for a few months, women who may be pregnant or those who are attempting to become pregnant should abstain from drinking alcoholic beverages. Recent government surveys indicate that about 13% of pregnant womon drink during pregnancy. About 3% of pregnant women report binge drinking (five or more drinks on any one occasion ) or frequent drinking ( seven or more drinks per week ). Women who binge drink or drink frequently greatly increase the risk of alcohol-related damage to their babies. When a pregnant woman drinks, alcohol passes swiftly through the placenta to her fetus. In the unborn baby’s immature body, alcohol is broken down much more slowly than in an adult’s body. As a result the alcohol level of the baby’s blood can be even higher and can remain elevated longer than the level in the mother’s blood. This sometimes causes the baby to suffer lifelong damage. Smoking During pregnancy: Smoking nearly doubles a woman’s risk of having a low-birth weight baby. In 2004, 11.9% of babies born to smokers in the Untied States were low birth weight (less than 5.5 pounds), compared to 7.2% of babies of nonsmokers. Low birth weight can result from poor growth before birth, preterm delivery or a combination of both. Smoking has long been known to slow fetal growth. Smoking also increases the risk of preterm delivery (before 37 weeks of gestation). Premature and low birth weight babies face an increase risk of serious health problems during the newborn period, chronic lifelong disabilities ( such as cerebral palsy, mental retardation and learning problems ), and even death. The more a pregnant woman smokes, the greater her risk of having a low birth weight baby. However, if a woman stops smoking even by the end of her second trimester of pregnancy, she is no more likely to have a low birth weight baby than a woman who never smoked. A recent study suggest that women who smoke anytime during the month before pregnancy to the end of the first trimester are more likely to have a baby with birth defects, particularly congenital heart defects. The risk of heart defects appears to increase with the number of cigarettes women smokes. Can smoking cause pregnancy complications? Smoking is associated with a number of pregnancy complications. Smoking cigarettes doubles a women’s risk of developing placental problems. These include:  Placenta previa (a low lying placenta that covers part or all of the opening of the uterus)  Placenta abruption (in which the placenta peels away, partially or almost completely, from the uterine wall before delivery). Both can result in heavy bleeding during delivery that can endanger mother and baby, although cesarean delivery can prevent most deaths. Smoking in pregnancy increases a womans risk of premature rupture of the membranes ( PROM ), when the sac that holds the baby inside the uterus breaks before completion of 37 weeks of pregnancy. Usually when it breaks, normal labor ensues within a few hours. If the rupture occurs before 37 weeks of pregnancy, it often results in the birth of a premature baby. Babies whose mothers smoked during pregnancy are up to three times as likely to die from sudden infant death syndrome ( SIDS ) as babies of nonsmokers. HOW BIG IS MY BABY? Weeks 3 & 4: Poppyseed Right now your little zygote is settling into your uterus… Week 7: Blueberry Average size: .51 inches Baby's brain is growing fast... Week 10: Prune Average size: 1.2 inches, 14 oz. Baby's arm joints are working, soon the legs will too.. Week 5: Appleseed Average size: .13 inches** Baby's major organs and systems are now forming... Week 6: Sweet Pea Average size: .25 inches Blood is starting to circulate... Week 8: Raspberry Average size: .63 inches, .04 oz. Those little arms and little legs are moving like crazy.. Week 9: Green Olive Average size: .9 inches, .07 oz. A Doppler device might pick up a heartbeat Week 11: Lime Average size: 1.6 inches, .25 oz. Fingers and toes are no longer webbed.. Week 12: Plum Average size: 2.1 inches, .49 oz. Almost all vital systems are fully formed... Week 13: Peach Average size: 2.9 inches, .81 oz. Teeth and vocal cords are appearing... Week 16: Avocado Average size: 4.6 inches, 3.5 oz. Eyebrows, lashes, and hair are filling in... Week 14: Lemon Average size: 3.4 inches, 1.5 oz. Liver, kidney, and spleen are continuing to develop... Week 17: Onion Average size: 5.1 inches, 5.9 oz. Skeleton is hardening, and fat is accumulating... Week 15: Naval Orange Average size: 4 inches, 2.5 oz. Legs are finally longer than arms... Week 18: Sweet Potato Average size: 5.6 inches, 6.7 oz. Baby's moving like crazy -- feel anything yet? Week 19: Mango Average size: 6.0 inches, 8.5 oz. Vermix caseosa is coating baby's skin... Week 20: Cantaloupe Average size: 6.5 inches, 10.6 oz. Boy or girl, genitals are fully formed... Week 21: Banana Average size: 10.5 inches ***, 12.7 oz. Taste buds are starting to work... Weeks 22-24 (Month 5): Papaya Average size: 10.5-11.8 inches, 12.7-20.8 oz. Nipples are sprouting, and face is fully formed! Weeks 25-28 (Month 6): Eggplant Average size: 13.6-14.8 inches, 1.5-2.2 lb. Immune system is preparing for the outside world... Weeks 29-32 (Month 7): Squash Average size: 15.2-16.7 inches, 2.5-3.8 lb. Sleeping and waking cycles are establishing... Weeks 33-36 (Month 8): Honeydew Average size: 17.2-18.7 inches, 4.2-5.8 lb. Growth is slowing, and baby may soon descend... Weeks 37-Delivery (Month 9): Watermelon Average size: 18.9-20.9 inches, 6.2-9.2 lb. Full term! Baby's finally ready for the outside world... Dr. Anita Fulton 21334 Kuykendahl Rd. Suite A Spring, Tx. 77379 Summary of My Birth Plan General Information: Patient Name: ___________________________________________________________________________ Due Date: _________________ Blood Type: __________________________Rh Factor: ________________ Allergies:________________________________________________________________________________ Hospital center where you plan on delivering: o St. Luke’s Vintage o Tomball Regional Hospital o Houston Northwest Hospital If I go past my due date and there are no health risks for me or my baby I would prefer one of the following: o Not to be Induced o To be Induced After delivering I plan on: o Not Breastfeeding o Breastfeeding o Breastfeeding & formula My partner would like to help: o Clamp and cut the umbilical cord I would like to: o Have a mirror to watch the delivery o Hold the baby immediately after birth Circumcisions: o Yes for circumcision o No Cord Blood Banking: o Yes or interested in information o No o Donate to the hospital Do you have a pediatrician in mind or would you like a referral to one? o Yes o No You may request a visit with your pediatrician before delivery. After delivering my birth control method will be: ____________________________________________. If you wish to have a tubal ligation please sign the consent form and discuss with Dr.Fulton 30 days before delivering. Congratulations on your pregnancy and Thank you for choosing our office for your prenatal care