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www.generationsobgyntucson.com
Pregnancy Information Packet
Generations Healthcare for Women
Northwest: 2171 W. Orange Grove Road
Phone: 520.877.3800
Oro Valley: 1521 E. Tangerine Rd, Suite 361
Phone: 520.545.0573
Sahuarita/Green Valley:
1295 W. Duval Mine Road
Phone: 520.877.3800
Lazos de Familia, 344 W. Ajo Way, Tucson
Phone: 520.877.3800
www.generationsobgyntucson.com
Pregnancy Information Packet Contents
Enclosed you will find information on the practice and on common prenatal testing as well as answers
to other frequently asked questions.
The left pocket contains initial forms. Please complete and bring all forms to your first prenatal
appointment.
We welcome your questions. We believe the more you learn about what is happening during your
pregnancy, the more fun you will have and the healthier you will be.
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Table of Contents
Welcome
Office Visits
Childbirth Education Program
Telephone Availability
Billing Information
Disability and Pregnancy
Patient Rights and Responsibilities
Laboratory Testing During Pregnancy
Sonograms
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APPENDIX
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A. Maternal Serum Screening for Birth Defects
B. Group B Streptococcus and Pregnancy
C. HIV and Pregnancy
D. Advanced Maternal Age- Pregnancy After 35
E. Cystic Fibrosis Carrier Screening
F. Rh Factor in Pregnancy
G. Trisomy 21 (Down Syndrome) and Trisomy 18 Screening
Tdap Patient Information Sheet
RESOURCES:
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Useful Web Links
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Nutrition During Pregnancy
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Heartburn
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Common Foods: Select the Lower Risk Options
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Over-the-Counter Medications
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ACOG: Recommendations for Exercise During Pregnancy
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Helpful Hints for Relieving Morning Sickness
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How to tell you may be in labor
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Location, contact information and maps
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Dear Patient:
2171 W. Orange Grove Road
Tucson, Arizona 85741
Phone: (520) 877-3800
Fax: (520) 877-3801
1521 E. Tangerine Rd, Ste. 361
Oro Valley, Arizona 85755
Phone: (520) 545-0573
Fax: (520) 297-5597
1295 W. Duval Mine Rd
Green Valley, AZ 85614
Ph. 520-877-3800
Lazos de Familia Health Center
344 W. Ajo Way
Tucson, AZ 85713
Ph: 520-877-3800
www.generationsobgyntucson.com
Victor Chen, M.D., FACOG
Mary Kay Durfee, M.D., FACOG
Howard Eisenberg, M.D., FACOG
Katie Gillaspy, M.D.
Robert J. Kahler, M.D., FACOG
Janet Warner, M.D., FACOG
Carol Bronte, ANP, CNM
Valerie Crawford, FNP
Congratulations on your pregnancy, and thank you for choosing Generations! During this
anticipation-filled time of your life, you may experience many uncertainties or new
sensations. Our goal is to be right there along with you, providing you with the best quality
of medical care and service throughout your entire pregnancy and delivery.
Generations has five obstetricians. You have chosen or been assigned to one doctor who
will follow you through your pregnancy course, to answer your questions, examine you, and
order tests. You can take comfort that your doctor will come to know you very well, because
he or she will be seeing you for all of your visits.
When you go into labor, the doctor who is “on-call” will care for you. It is possible that you
may make specific arrangements with your obstetrician when your delivery is planned (i.e.:
scheduled c-section or induction). The doctor who delivers your baby may or may not be
the one who followed you through your pregnancy care, but rest assured, you will be in good
hands. A brief introduction of our physicians:
Dr. Victor Chen is a 1991 graduate of the University of Arizona College of Medicine. He
completed his residency in 1995 at Texas Tech Health Sciences Center in Odessa, Texas.
Dr. Chen is board certified by the American Board of Obstetrics and Gynecology.
Dr. Mary Kay Durfee graduated as a member of the medical honor society Alpha Omega
Alpha from the University of Minnesota School of Medicine in 1997. She completed her
residency training at the University of Utah in 2001. Dr. Durfee is board certified by the
American Board of Obstetrics and Gynecology.
Dr. Howard “Howie” Eisenberg completed his medical degree at Mt. Sinai School of
Medicine in 1987. His residency training was completed at Kaiser Permanente in
California in 1991. Dr. Eisenberg is board certified by the American Board of Obstetrics
and Gynecology.
Dr. Katie Gillaspy graduated summa cum laude from the University of Arizona and then
completed medical school at Ohio State University School of Medicine, Columbus, Ohio.
She fulfilled her residency in OB/GYN at the University of Texas Medical Branch,
Galveston, Texas.
Dr. Janet Warner is a 1998 graduate of the University of Wisconsin Madison College of
Medicine. She completed her residency training at the University of Arizona. Dr.
Warner is board certified by the American Board of Obstetrics and Gynecology.
We encourage you to ask questions, share your concerns (and your joys), and take comfort in
knowing that you will receive compassionate high-quality pregnancy care from our doctors
and staff. If you have routine questions, please call us during business hours and a medical
assistant will be happy to assist you. Our regular office hours are Monday through Friday,
8:30 am to 4:30 pm. After hours, if you have an urgent matter that cannot wait, please call us
and our answering service will page the on-call doctor.
Welcome to Generations Healthcare for Women. - The Physicians and Staff
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Office Visits
Each of our obstetricians works as a team with a nurse practitioner. Your obstetrician will follow your
care throughout your pregnancy, to answer your questions, examine you, and order tests. You can
take comfort that your doctor will come to know you very well, because he or she will be seeing you
for all of your visits.
When you go into labor, the doctor who is “on-call” will care for you. It is possible that you may
make specific arrangements with your obstetrician when your delivery is planned (i.e.: scheduled csection or induction). The doctor who delivers your baby may or may not be the one who followed
you through your pregnancy care, but rest assured, you will be in good hands.
Appointments are made during business hours. Our regular office hours are Monday through Friday, 8:30
am to 4:30 pm. We suggest you make your appointments at least a month in advance. Your family
members are welcome to come with you to your visits, however no more than two visitors can be
accommodated in the exam room.
We ask that if you are unable to keep an appointment to please call to cancel/reschedule. Someone
else will be able to use the time we had reserved for you. If we need to reschedule your appointment
due to an unexpected medical emergency, you will be contacted as soon as possible.
Childbirth Education Program
We believe that the more you learn about what is happening during pregnancy, birth and the months
after delivery, the more fun you will have and the healthier you will be.
Northwest Medical Center offers a variety of classes. We urge you to call 877-4156 or visit the
Community Education page on the Northwest Medical Center website for more information.
We also strongly recommend taking a tour of Northwest Medical Center, giving you an opportunity to
get comfortable with the Labor &Delivery area and the Mother/Baby Units. These tours are free.
For information regarding the Northwest Medical Center Childbirth Education Classes and for
information on tours please call (520)877-4156 or visit www.NorthwestMedicalCenter.com.
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Telephone Availability
We are available to you at all times, but request that you call during business hours, unless it is an
emergency. During business hours, the physicians or their medical assistants will return non-urgent
calls in late morning or the end of the day.
If you call after hours, you will be able to leave a message or be connected to the answering service in
the case of an emergency. Please remove all blocks on incoming calls to your phone. The answering
service will contact the physician on call, and your call will be returned. We are prompt about
returning after hours calls. If you are not at a number where we can call you back, the answering
service can keep you on hold and “patch” you through to the physician. If you haven’t heard from us
in 15 minutes, please call back. If we arrange to meet you at the hospital, please allow at least 30
minutes for us to arrive.
In the rare event of an answering service equipment failure, call Northwest Medical
Center’s Labor and Delivery Unit (520) 877-4200. They will be able to reach us directly.
In case of medical emergency, call 911
Generations Healthcare for Women
Locations and Phone Numbers
2171 W. Orange Grove Road, Tucson, Arizona 85741
Phone: (520) 877-3800 Fax: (520) 877-3801
1521 E. Tangerine Road, Suite 361, Oro Valley, Arizona 85755
Phone: (520) 545-0573 Fax: (520) 297-5597
1295 W. Duval Mine Rd, Green Valley, AZ 85614
Phone. (520) 877-3800 Fax: (520) 877-3801
Lazos de Famillia Health Center, 344 W. Ajo Way, Tucson, AZ 85713
Phone: (520) 877-3800
Northwest Medical Center Labor and Delivery Unit
6200 N. La Cholla Blvd.
Tucson, AZ 85741
Telephone :( 520) 877-4200
(map enclosed in this packet)
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Billing Information
Business Office: (520) 352-1032
It is our intention to provide and fully explain all financial policies and arrangements. Generations
Healthcare for Women accepts most insurance plans and will bill all insurance companies with whom
we participate. If you have questions about your coverage, referrals, co-pays, etc., please contact the
business office.
If your insurance provider has a special form for deliveries, you will need to provide us with the
completed form as soon as possible. Your insurance will be billed at the time of your delivery.
If you do not have insurance, you may be eligible for Arizona’s program for maternity care, Baby
Arizona. The Generations Healthcare for Women business office can assist you with processing the
application.
Generations Healthcare for Women will charge an “Obstetrical Package Fee”, which includes all office
visits, and physician charges for delivery. These packages can be arranged for women who are self-pay
or those with high deductible insurance plans. Charges may vary depending on the type of delivery
you have.
Payment arrangements can be made with the billing office. Payments are to be made monthly with
total payment due one month before your due date. If you leave Generations Healthcare for Women
care during your pregnancy, a bill will be generated for services provided rather than the package fee.
Hospital care, anesthesia, ultrasounds, pediatric care and lab charges will be billed separately by those
providers. To inquire about insurance coverage or cost for these services, contact Northwest Medical
Center’s billing office at (520)469-8611. Cost will vary depending on the type of delivery you have.
Disability and Pregnancy
The majority of expectant mothers can continue to work until late in pregnancy without any
complications. Sometimes, however, the physical changes that occur during pregnancy and/or the
demands of a woman’s job can create difficulties. Please let us know if you have any concerns in this
regard. We are usually able to suggest simple steps to deal with fatigue, “morning sickness”, or aches
and pains that can be particularly challenging when at work. If you experience more serious
symptoms, or concerns about potential workplace hazards to you or your baby, please inform us. We
will evaluate the situation and respond accordingly. If your doctor determines you should be placed on
disability or medical leave, you will need to obtain forms from your employer.
There is a $25.00 fee for processing the disability forms. Please allow 7-10 business days for
completion of these documents.
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Patient Rights and Responsibilities
 The patient has the right to a reasonable response to her requests and needs for treatment
of service within the healthcare providers capacity, stated mission and applicable regulations.
 The patient has the right to considerate, compassionate, and respectful care that recognizes
her personal values and belief systems.
 The patient has the right in collaboration with her healthcare provider to make decisions
involving her healthcare, including the right to accept medical care, or to refuse treatment and
to be informed of the medical consequences of such refusal.
 The patient has the right to information necessary to enable her to make treatment decisions
that reflect her wishes and participate in the consideration of ethical decisions that arise in her
care.
 The patient has the right to be informed of any human experimentation or other
research/educational projects affecting her care or treatment.
 The patient has the right to personal privacy and confidentiality of information.
 The patient is entitled to have privacy during examination, to have visitors excused and to
be informed why any observer is present, and to grant or refuse another person’s presence.
 The patient’s guardian, next of kin, or legally authorized responsible person has the
right to exercise certain rights on the behalf of the patient.
 The patient has the right to expect explanation of any portion of the bill. Where appropriate
the business office staff will assist the patient in making arrangements for payment of the bill
through a payment schedule or assistance program.
 The patient has the responsibility to provide a complete and accurate medical history to the
best of her knowledge.
 The patient has the responsibility to ask questions and seek clarification about her
diagnosis and treatment and participate in decisions involving her care.
 The patient has the responsibility to make it known whether a proposed course of
treatment is understood, and whether she is willing and able to comply.
 The patient has the responsibility to provide information about complications or
symptoms.
 The patient has the responsibility to be considerate of the rights of other patients and
clinical personnel, and to treat them with respect.
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Laboratory Testing During Pregnancy
As part of good prenatal care, our staff recommends certain tests to detect infections and other conditions in
pregnancy.
At your first OB visit the following tests will be ordered:
CBC This test will check for anemia and other factors.
Blood Type and RH A pregnant woman who is Rh negative may need to receive a blood product called anti-D
Immune Globulin (RhoGAM). This prevents the breakdown of your baby’s red blood cells, a serious condition
which causes hemolytic.
Antibody Screen This test will check for red blood cell antibodies.
Syphilis A sexually transmitted disease which can cause birth defects.
Hepatitis B If the mother has this viral infection of the liver there is an increased chance that without
treatment the baby will be infected. The baby can be treated at birth to prevent infection in most cases.
Rubella (German measles) An infection can lead to severe birth defects. If a woman is not immune, a vaccine
can be given to her after the baby is born.
Pap Smear A screening test for cervical cancer.
Chlamydia and/or Gonorrhea Screening cultures that can detect sexually transmitted diseases that can
potentially be harmful to you and your baby if not treated.
Urinalysis A screening test for urinary tract infection and culture.
TSH A screening test for thyroid disease.
Your 28-Week Visit:
Glucose Screen To check for diabetes in pregnancy.
Blood Count To recheck for anemia.
Antibody Screen If you are RH negative, administration of RhoGAM
Recommended Tests:
HIV: A blood test screening for AIDS. You can have HIV for years and not have any symptoms. If
you have HIV, even without symptoms, there is a 1 in 4 chance you could pass it to your baby. There
is treatment available during pregnancy that can reduce the risk of transmission of HIV to the baby
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Optional Tests:
AFP Quad: A blood test done between 15 to 18 weeks of pregnancy to detect increased risk of
having a baby with certain birth defects, such as an open neural tube defect (spina bifida) or Down
syndrome.
CF: A screening test for Cystic Fibrosis.
NT (First Trimester Screen): A blood test which shows if you are at increased risk of having a baby
with Down Syndrome of Trisomy 18 (chromosomal disorders). It requires a sample of your blood and
a special ultrasound measurement performed in the first trimester.
Sonograms:
Sonograms are done when medically indicated (to assist us in determining your due date, to check on
the growth of the baby, to assess bleeding, to survey the baby and placenta, etc). We only order
sonograms and ultrasounds for medical reasons.
You will probably be referred by your physician to one of the following:
Genesis OB/GYN Women’s Diagnostic Imaging Center
6060 N. Fountain Plaza Drive, Suite 200
Tucson, AZ 85704
Phone: (520) 545-0930
http://www.genesisobgyn.org/ultrasound.html
Maternal-Fetal Medicine Associates of Arizona
Christopher A. Sullivan, M.D., FACOG
6060 N. Fountain Plaza Drive, Suite 200
Tucson, AZ 85704
Phone: (520) 392-7500
http://www.mfm-az.com
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APPENDIX A
MATERNAL SERUM SCREENING FOR BIRTH DEFECTS
What is the AFP screening test?
A screening test that can be done using a small sample of a pregnant woman’s blood to identify
pregnant women who may be at increased risk for having a baby with certain birth defects, such as an
open neural tube defect (spina bifida), Down syndrome, and Trisomy 18.
How is the AFP screening test done?
A small amount of blood is drawn from a vein in the pregnant woman’s arm. The test is done at 15 to
18 weeks of pregnancy in most cases as this produces the most accurate results. Four substances
present in the blood sample will be measured. These substances are Alpha-fetoprotein (AFP), human
chorionic gonadotropin (HCG), unconjugated estriol (uE3), and dimeric inhibin A (DIA.) The
amount of each substance in the blood sample as well as number of weeks pregnant, height, weight,
race, insulin dependent diabetes, single or twin pregnancy, maternal age and any significant family
history are all taken into account to calculate the individual patient’s specific risk.
Why is the AFP test called a screening test?
A screening test can help predict the risk of a problem. It is not a diagnostic test and cannot give you a
definite “yes” or “no” answer.
What does an abnormal screening result mean?
Some women having an AFP screening test will be identified as being in the high-risk group even
though they are carrying a normal fetus. This screening result does not always mean there are
problems in the baby.
For example, the due date might have been estimated incorrectly, or twins might be present instead of
just one baby. Women in the high-risk group are offered diagnostic tests, which can give a definitive
answer. A sonogram or amniocentesis is examples of further testing, which might be offered if the
screening results are abnormal. No test is perfect. Not every abnormal result of a screening test will
mean that your baby has a birth defect. Sometimes there is no reason for an abnormal screening test.
Not every normal result of a screening test will mean that your baby does not have a birth defect. It is
up to you whether to be tested.
Some women find having the screening test is reassuring, and other women would rather not have the
information. The results of the tests can help some women make decisions about their options.
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APPENDIX B
GROUP B STREPTOCOCCUS (GBS) AND PREGNANCY
GBS is a type of bacteria that can be found in 10-30% of pregnant women. It usually does not cause
serious illness. It may be found in the digestive, urinary, and reproductive tracts of men and women.
In women, it is most often found in the vagina and rectum. GBS is not a sexually transmitted disease.
A woman with GBS can pass it to her baby during delivery. Most babies who get GBS from their
mothers do not have any problems. A few, however, will become sick. This can cause major health
problems or even threaten their lives.
If the bacteria are passed from a woman to her baby, the baby may develop GBS infection. This
happens to only 1 or 2 of every 100 babies whose mothers have GBS. Babies who do become infected
may have early or late infections. Both early and late GBS infections lead to death in about 5% of
infected babies.
A culture is the most accurate way to test for GBS. This is a simple painless procedure performed at
35 to 37 weeks. The swab is sensitive in only 97% of women.
A swab is placed in the woman’s vagina and rectum to obtain a sample. If the test results are positive,
showing that GBS is present, you will receive antibiotics during labor to help prevent GBS from being
passed to your baby.
Babies of women who are carriers of GBS and do not get treatment have more than 20 times the risk
of getting infected than those who do receive treatment. The antibiotics work only if taken during
labor. The bacteria grow so fast that if treatment is given earlier, the GBS may grow back before labor.
If you had a previous baby with GBS infection or you had a urinary tract infection caused by GBS
during pregnancy, you do not need to be tested. You will need to get antibiotics during labor.
In women who have planned a cesarean birth, it is not necessary for them to be given antibiotics
during delivery, whether or not they are GBS carriers. However, these women should still be tested for
GBS because preterm labor may occur before the planned cesarean birth and your baby’s pediatrician
will want to know the results. GBS is fairly common in pregnant women. Yet, very few babies actually
become sick from GBS infection. Treatment during labor and delivery may help prevent infection in
your baby. If you would like additional information about GBS, please ask for a brochure, and/or talk
with your doctor or nurse practitioner.
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APPENDIX C
INFORMATION ON HIV AND PREGNANCY
The human immunodeficiency virus (HIV) causes AIDS, a disease that is increasing among women of
childbearing age. A person who is infected with HIV does not get sick right away. The virus lives in the body of
an infected person for the rest of her life, and breaks down the immune system over time. It may take many
years after being infected to develop symptoms of AIDS. AIDS is a very serious disease causing much suffering
and many deaths throughout the world. There is no current cure for AIDS.
HIV is spread by contact with the body fluids of an infected person (blood, semen, vaginal secretions and
breast milk). Contact with these fluids can occur during sex, breastfeeding, sharing needles, blood transfusions
and pregnancy.
HIV affects 2 out of every 1,000 pregnant women. A woman can pass the infection to her baby as early as the
8th week of pregnancy. About half of the children infected with HIV get it from their mother during labor and
birth. Breastfeeding is another way a mother can pass the virus to her baby.
Pregnant women infected with HIV need to have their health watched more closely, with careful monitoring of
blood levels and symptoms of infection.
A woman can decrease the chance of her baby getting infected by taking medication during her pregnancy.
Without treatment, about 25% of babies born to women with HIV will get the virus. With treatment, that
number drops to about 8%. To lower the risk, infected women must take the anti-viral medications throughout
her pregnancy and during labor. Babies are given the medications for the first 6 weeks after they are born. Some
women who are HIV positive choose to terminate their pregnancies.
Generations Healthcare for Women and the American College of Obstetricians and Gynecologists (ACOG)
recommend that all women be tested for HIV early in pregnancy. It is important for your health, the health of
your baby and the health of your sexual partner. Before we order the test, we will talk to you about the testing
procedure and reporting of the results.
We recognize that it is your choice whether or not to be tested. The HIV test is a blood test, and determines if
you are carrying the virus by looking for antibodies to HIV. Antibodies usually appear within 3 months of
getting the infection, but it may take up to 6 months, so we recommend a second test if there is a chance of
recent infection.
Results of testing are confidential. They will be a part of your medical record, and will be released only with
your permission. Our medical office and hospital staff will have access to your records may also see the results.
“Anonymous” testing, where your name is not recorded, is available through the Southern Arizona AIDS
Foundation (520)628-7223 and the Pima County Health Department (520)791-7676.
If your test is positive, you will need special health care and counseling. We will assist you in obtaining the
support, information and care that you need. The CDC National Aids Hotline is 1-800-232-4636.We can add
this test to your first prenatal blood tests. Tell the person drawing your blood or sending you to the lab that you
want the test (you will need to sign a consent form); or wait and talk with you provider if you want more
information before you decide whether to be tested.
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APPENDIX D
ADVANCED MATERNAL AGE-PREGNANCY AFTER 35
Advanced maternal age is defined as an expectant mother who will be 35 at the time of delivery. If
you’re over 35 and pregnant, you’re not alone. Many women well into their 30s and beyond are
delivering healthy babies.
There’s nothing special about age 35. However, it is the age at which certain issues are recognized in
pregnancy.
UNDERSTAND THE RISKS
Some of the risks associated with a pregnancy after 35 include a multiple pregnancy, a higher risk of
pregnancy loss and a higher risk of delivering a baby with chromosomal abnormalities. Women that fit
into the advanced maternal age category are also more likely to develop gestational diabetes and high
blood pressure. Some of these risks may make it necessary for you to deliver your baby by cesarean
section.
MAKE HEALTHY CHOICES
Seeking regular prenatal care during your pregnancy will help your provider monitor your health and
your baby’s health. Eating a healthy diet is extremely important to your baby’s growth and
development. We encourage women to take a prenatal vitamin with folic acid daily and to eat lots of
protein and other essential nutrients.
Staying active can help to improve your overall health and prepare your body for labor and childbirth.
LEARN ABOUT PRENATAL TESTING AVAILABLE
There are several screening and diagnostic test available to you during pregnancy. Diagnostic tests,
such as chorionic villus sampling, genetic amniocentesis and the first trimester screen, are tests that
can provide definite results regarding the health of the baby. These tests are accurate and performed at
different stages in the pregnancy. Screening tests, such as the maternal serum screening and
ultrasounds, are tests that can provide information about whether you are at increased risk for certain
conditions during the pregnancy. If you are interested in more information regarding screening or
diagnostic testing during your pregnancy, please ask your Healthcare provider at your next visit.
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APPENDIX E
CYSTIC FIBROSIS CARRIER SCREENING
Cystic Fibrosis (CF) is a life-threatening condition affecting the ability to secrete mucus fluids
normally. Individuals with CF commonly have problems with the lungs, digestive system and
reproductive system. They often suffer from pulmonary infections and organ damage due to difficulty
in clearing secretions. The severity of CF varies from person to person. CF does not affect
intelligence, appearance or development. There is no cure for CF currently. The average life
expectancy of a person with CF is 30 years, but children born with CF today may live longer as
treatments improve.
WHAT IS A CF CARRIER?
People who receive one normal cystic fibrosis gene and one abnormal cystic fibrosis gene are called
CF carriers. They do not have the disease but have a 50% chance of passing the abnormal gene on to
their child. In order for the child to be born with cystic fibrosis, he or she would need to inherit an
abnormal gene from both parents.
WHAT IS CF CARRIER SCREENING?
Cystic fibrosis (CF) carrier screening is a genetic test that lets you know what your risk is for carrying
an abnormal gene, as well as what your chances are of having a child with CF.
HOW IS CF CARRIER SCREENING DONE?
Your blood will be drawn and sent to the laboratory for testing. Additional information regarding
family history, your race and ethnicity and your personal history will be provided to the lab. This
additional information is essential to aid in the interpretation of the blood results.
WHAT DOES A NEGATIVE SCREEN MEAN?
A negative screen does not guarantee that you are not a carrier. This test detects only the most
common changes in the CF gene.
WHAT DOES A POSITIVE TEST MEAN?
A positive screen means that the laboratory found a change in one of your two CF genes and that you
are a carrier. There is a 50% chance that you will pass this gene to your child. With a positive finding,
we recommend that your partner be screened for CF carrier status. Additional testing will be
recommended as needed based on the results.
DOES MY INSURANCE PAY FOR THE TEST?
All insurance plans are different. If you aren’t sure your insurance plan covers the test speak with the
customer service department at your insurance company or your provider.
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APPENDIX F
Rh FACTOR IN PREGNANCY
During pregnancy it is necessary to do a blood draw to find out your blood type. There are two
components to this testing, a major blood group (A, B, AB, and O) and an Rh factor (positive or
negative).
WHAT IS Rh FACTOR?
Rh factor is a protein that is found on your red blood cells. Most of the population has the Rh factor
present on their red blood cells. These groups of people are considered to be Rh positive. The rest of
the population does not have the Rh factor present on their cells, these people are Rh negative.
WHAT ARE THE HEALTH ISSUES FOR Rh NEGATIVE PREGNANT WOMEN?
During pregnancy you do not share blood systems with your baby. However, your baby’s blood can
cross the placenta into your blood.
The Rh factor becomes a problem when an Rh negative person’s blood comes into contact with an Rh
positive person’s blood. If this contact occurs, the person with Rh negative blood develops antibodies
to fight the Rh factor. In this instance the antibodies see the Rh factor as a harmful substance, or a
foreign substance that does not belong in the blood. This is called Rh sensitization. When sensitization
occurs these antibodies can go and attack the baby’s blood. This can cause a serious health condition
in the baby called hemolytic disease. Rh sensitization can also affect future pregnancies.
An Rh negative woman’s blood can become sensitized if she is pregnant with an Rh positive fetus.
Other ways an Rh negative woman’s blood can become sensitized are with a miscarriage, an induced
abortion, an ectopic pregnancy, or a blood transfusion.
HOW CAN YOU BE SCREENED FOR Rh SENSITIZATION?
A simple blood test, a red blood cell antibody screen, can be drawn and sent to the laboratory to check
for antibodies against the Rh factor.
HOW CAN Rh SENSITIZATION BE PREVENTED?
If your body has not made antibodies against the Rh factor, hemolytic disease can be prevented. Rh
immunoglobulin (RhIg), or RhoGAM, is a human blood product (made from human blood plasma)
that can prevent sensitization of an Rh negative woman. In a normal pregnancy, when the woman is
Rh negative, the RhoGAM is given by intramuscular injection at 28 weeks gestation and again after
you deliver your baby. RhoGAM is safe for use in pregnancy and has been used since the late 1960’s.
WHAT DO I DO IF I’M Rh SENSITIZED?
Every situation is unique and requires individualized treatment. Your health care provider will work
closely with you throughout the pregnancy to plan the safest course of treatment for your baby.
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APPENDIX G
First Trimester Screening for Trisomy 21 (Down Syndrome) and Trisomy 18 -Frequently Asked Questions –
Courtesy Duke University Health System
What is first trimester screening?
First trimester screening is the combination of a maternal blood test and an ultrasound measurement
to screen for chromosomal defects associated with significant mental disability, Down syndrome,
Trisomy 13, and Trisomy 18.
Down syndrome, Trisomy 13, and Trisomy 18 are chromosome problems that happen randomly at
the time of conception. These conditions are relatively uncommon, but the risk increases with a
woman’s age.
The blood screen measures two pregnancy proteins in the mother’s blood, free beta-HCG and PAPPA. The ultrasound measures the nuchal translucency, an area behind the baby’s neck that contains
fluid.
First trimester screening is performed between 11 weeks and 14 weeks gestation and is safe for the
mother and baby.
How accurate is this screening?
First trimester screening can identify 80 to 90 percent of pregnancies with Down syndrome and up to
97 percent of pregnancies with Trisomy 18. The results are expressed in a ratio, such as “the risk of
Down syndrome is 1 in 200.” This means that of 200 women with those same results, only one would
have an affected pregnancy.
It is important to realize that first trimester screening cannot diagnose or rule out any specific
condition.
What does an abnormal result mean?
An abnormal screen means that the estimated chance of having a baby with Down syndrome or
Trisomy 18 is higher than expected.
Only a small number of women with an abnormal screen result will have an affected pregnancy. If the
screen does identify an increased chance, genetic counseling and further testing will be offered.
Tests that diagnose chromosome problems in pregnancy include chorionic villi sampling (CVS) and
amniocentesis. Each has a small risk of complications that can lead to miscarriage.
Can this screen identify other problems?
Although first trimester screening is specific to Down syndrome, Trisomy 13, and Trisomy 18, other
birth defects such as heart defects can be associated with an increased nuchal translucency.
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For those who have an abnormal ultrasound measurement and otherwise normal test results, targeted
ultrasound in the second trimester will be recommended.
How does this screen compare with screening in the second trimester?
Maternal blood screening in the second trimester, offered between 15 and 21 weeks gestation,
measures multiple pregnancy proteins to estimate the risk of Down syndrome, Trisomy 18, and open
neural tube defects (ONTDs).
ONTDs are openings along the fetal spine (open spina bifida) and skull (anencephaly). About one to
two babies per thousand are affected with an ONTD.
Second trimester maternal blood screening can identify 60 to 80 percent of pregnancies with Down
syndrome or Trisomy 18 and 80 percent of pregnancies with ONTDs.
First trimester screening cannot identify a risk of an ONTD. If you elect first trimester screening,
maternal serum AFP or targeted ultrasound in the second trimester are recommended.
Who should consider first trimester screening?
First trimester screening is available to anyone who desires early pregnancy screening for Down
syndrome, Trisomy 13, and Trisomy 18.
Or, a couple with an increased chance of these chromosome problems (due to maternal age or family
history) might find it helpful to have more specific information about the pregnancy before making
decisions about diagnostic testing.
If you have decided to have amniocentesis or CVS, then this test is not necessary.
Review the American College of Obstetricians and Gynecologists position statement.
Duke Health.org, Duke University Health System. Published: Mar. 21, 2007
Updated: Mar. 21, 2007
www.dukehealth.org/healthLibrary/CareGuides/Perinatal/treatment_instructions
What is the chance that my baby will have an open neural tube defect?
The chance of having a baby with an open neural tube defect does not depend on the age of the mother. The
chance is approximately 1 in 1,000 for all ages.
© 2009 BC Prenatal Genetic Screening Program.
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Tdap Patient Information Sheet from the CDC
http://www.cdc.gov/vaccines/vpd-vac/pertussis/tdap-pregnancy
Centers for Disease Control and Prevention
CDC 24/7: Saving Lives. Protecting People™
February 2013
October 2012
The CDC’s Advisory Committee on Immunization Practices (ACIP) voted to recommend that health
care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s
prior history of receiving Tdap. To maximize the maternal antibody response and passive antibody
transfer to the infant, optimal timing for Tdap administration is between 27 and 36 weeks gestation.
For women not previously vaccinated with Tdap and if Tdap is not administered during pregnancy,
Tdap should be administered immediately postpartum.
Pertussis can cause serious and sometimes life-threatening complications in infants, especially within
the first 6 months of life. In infants younger than 1 year of age who get pertussis, more than half must
be hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of
those infants who are hospitalized with pertussis about 1 in 5 will get pneumonia and 1 in 100 will die.
Tdap Vaccine Safety for Mother and Infant
In addition to the mother being vaccinated with Tdap, she should encourage others – including dads,
grandparents and other caregivers – to get vaccinated with Tdap at least two weeks before coming into
contact with their infants.
ACIP concluded that there is no elevated frequency or an unusual occurrence of adverse events
among pregnant women who have received Tdap vaccine, or in their newborns. Tdap vaccine is
recommended after 20 weeks gestation because that optimizes antibody transfer and protection at
birth. The immune response to the vaccine peaks two weeks after administration.
Both tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT) vaccines have been used extensively
in pregnant women worldwide since the 1960s to prevent neonatal tetanus. Td and TT vaccines
administered during pregnancy have not been shown to harm either the mother or baby/fetus.
Breastfeeding Safety after Tdap Vaccination
Breastfeeding is not a contraindication for receiving Tdap vaccine. Tdap vaccine can and should be
given to women who plan to breastfeed. Breastfeeding is fully compatible with Tdap vaccination, and
preventing pertussis in mothers can reduce the chance that the infant will get pertussis. Also, by
breastfeeding, mothers can pass antibodies they’ve made in response to the Tdap shot onto their
infants, which may reduce an infant’s chances of getting sick with pertussis. This is especially
important for infants younger than 6 months of age, who have no other way of receiving enough
pertussis antibodies, since they are not fully protected until their third dose of DTaP vaccine at 6
months of age.
Genesis Tdap Information Sheet 2.2013
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Useful Web Links
Please visit the Pregnancy Services page of our website at www.genesisobgyn.org for a complete listing
of helpful links and information on the web.
Useful Links:
American Academy of Pediatrics http://www.aap.org/topics.html
American College of Obstetrics and Gynecology (ACOG) patient information
http://www.acog.org/publications/patient_education
ACOG Exercise During Pregnancy
http://www.acog.org/publications/patient_education/bp119.cfm
Babycenter.com – products and services for expectant and new mothers
http://www.babycenter.com/
Babynamer. Com – will help you find the perfect name http://babynamer.com/
Breastfeeding – La Leche League Tucson home page http://www.lllusa.org/web/TucsonAZ.html
Breastfeeding.com – Information and support http://www.breastfeeding.com/
Centers for Disease Control and Prevention –
Pregnancy Information http://www.cdc.gov/ncbddd/pregnancy_gateway/
Child Safety Seats – National Highway Transportation Safety Administration
http://www.nhtsa.gov/portal/site/nhtsa/
H1N1 Flu (Swine Flu): Resources for Pregnant Women http://www.cdc.gov/h1n1flu/pregnancy/
Diapers.com – free shipping and coupons on baby items www.diapers.com
Mayo clinic.com Pregnancy Week by Week http://www.mayoclinic.com/health/pregnancy-weekby-week/MY00331
Morning Sickness http://www.femalepatient.com/pdf/pat_0309.pdf
Pregnancy information library http://www.femalepatient.com
Womenshealth.gov The federal government source for Women’s Health Information (Spanish)
http://www.womenshealth.gov/pregnancy/
http://www.womenshealth.gov/espanol/elembarazo/
HOSPITALS
Maternity Services at Northwest Medical Center
Childbirth Education Classes http://www.northwestmedicalcenter.com/prenatal.html
The Women’s Center http://www.northwestmedicalcenter.com/womens_ctr.html
TMC Maternity Car Seat Loaner Program
https://www.tmcaz.com/TucsonMedicalCenter/Maternity/Car_Seat_Program
If you need help obtaining healthy food and health care for you and your child contact:
State Children's Health Insurance Program 877-KIDS-NOW (877-543-7669) www.insurekidsnow.gov
U.S. Department of Agriculture Food Stamps Program www.fns.usda.gov/fsp/
Women, Infants, and Children Program (WIC) www.fns.usda.gov/wic/
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Nutrition During Pregnancy
Your diet must provide both you and your developing baby with the protein, carbohydrates, fats, vitamins, and
minerals you both need. A balanced diet includes eating from each of the food groups every day. In addition,
the March of Dimes suggests that pregnant women should eat the recommended number of portions in each
food group.
Daily Requirements:
6
servings of bread and other whole grains
3-5
servings of vegetables
2-4
servings of fruits
4-6
servings of milk and milk products (low fat or non-fat)
3-4
servings of meat and protein foods (lean meats, NO fried)
6-8
glasses of water
It is important that pregnant women not overdo their intake of fats, oils and sweets. Expectant moms often
hear they are “eating for two,” however they actually only need to increase their calorie intake by 300 calories
per day. One place where dad can take a role in a healthy pregnancy is by helping mom to get the vitamins and
minerals she and the developing baby need.
Some women have trouble getting enough of certain foods. For example, lactose intolerant women may be
unable to have milk products.
A prenatal vitamin and mineral supplement should be taken once a day to help fill the gap.
One vitamin, called folic acid, deserves special mention. Getting at least 0.4 mg of folic acid every day in the
months preceding pregnancy and the first 6 weeks of pregnancy has been shown to decrease the incidence of
spina bifida, a common birth defect. Many women take prenatal vitamins or multivitamins while they are trying
to get pregnant. Foods rich in folic acid include green leafy vegetables and whole grains.
(Fish oil capsules or a DHA supplement is also advised)
Various foods should be eaten in moderation or may not be suitable for a pregnant woman’s diet due to
possible health implications. Acid indigestion, most commonly known as heartburn, can cause discomfort and
is characterized by a sharp, burning sensation just below the ribs. The pain usually comes after meals and is
often triggered by oils, chocolate, vinegar, tomato-based or citrus products, carbonated beverages, caffeinated
beverages, and foods high in fat. If you experience heartburn during your pregnancy, you may find relief by
avoiding these foods or consuming them in moderation, not eating within 2-3 hours of sleeping, or by taking an
antacid recommended by your physician.
The Food and Drug Administration (FDA) advises pregnant women, women of childbearing age who may
become pregnant, nursing mothers, and young children not to eat shark, swordfish, king mackerel and tile fish.
These fish may contain high levels of a form of mercury, called methyl mercury that may harm an unborn
baby’s developing nervous system.
Because seafood is beneficial in meeting dietary requirements for pregnant women, the FDA advises these
women to select a variety of other kinds of fish; including shellfish, canned fish, smaller ocean fish or farm
raised fish. In addition, 12 ounces per week of cooked fish can safely be eaten with a typical serving size range
from 3 to 6 ounces.
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Expectant mothers also need to be aware of harmful bacteria during their pregnancy. Listeria monocyotogenes
is bacterium that can cause a serious infection in humans called listeriosis. Food borne illness caused by this
bacterium in pregnant women can result in severe health implications for the mother, the unborn fetus, and the
nursing baby. The FDA is providing the following advice to pregnant women and other at risk consumers
about foods that have a greater likelihood of containing listeria monocyotogenes.
DO NOT EAT

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
Do not eat hot dogs and luncheon meat unless they are reheated until steaming hot
Do not eat soft cheese such as Feta, Brie, and Camembert cheeses, blue-veined cheeses (NO Mexican
white cheeses)
Do not eat refrigerated pates or meat spreads
Do not eat refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel. These
types of smoked seafood are most often labeled as “nova-style”, “Los”, “kippered”, “smoked”, or
“jerky”.
Do not drink raw (unpasteurized) milk or eat foods that contain unpasteurized milk
(NO raw sushi or rare meats)
Finally, keep in mind that more is not always better. Some vitamins, such as vitamin A, are harmful in high
dosages. If you are taking any vitamin or herbal supplement, be sure to talk to your health care provider about
it; avoid any that are not labeled for use during pregnancy.
If you are pregnant, may become pregnant or are a nursing mother, it is important to be aware of the food and
nutrients you put into your body. Remember, maintaining a healthy lifestyle before, during and after pregnancy
benefits both mother and child.
Editorial provided by George Macones, M.D., Director of Maternal Fetal Medicine at University of
Pennsylvania Medical Center
(Also:

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



General Pregnancy Precautions:
Minimize or eliminate caffeine
Eliminate all Alcohol
Stop Smoking or exposure to secondhand smoke
Avoid heavy lifting, greater than 30 pounds
DO NOT handle cat litter
Wear gloves when gardening
Avoid HOT water; ex: hot tubs or spas. WARM baths are fine!
Minimize fast food/junk food
Stop soda use
Remember, you are building your baby from the healthy food and water you eat and drink.)
Have a safe and healthy pregnancy!
* Notes in bold and parentheses were added by Grace Maternity and Women’s Health
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Heartburn
Pregnant women may get heartburn because the stomach muscles relax and food tends to back up.
Sometimes the stomach makes more acid during pregnancy. The growing womb, pressing against the
stomach, can force acid upwards causing heartburn.
Prevention






Greasy, fried or highly seasoned foods may produce heartburn. Try to figure out what foods
give you heartburn and don’t eat them.
Coffee and cigarettes can make heartburn worse because they irritate the stomach. Avoid
both.
Eat several small meals a day, instead of 3 larger meals.
Drink plenty of liquids (six 8-ounce glasses daily).
Wear clothing that is loose around the waist
Sleep and rest with your head slightly elevated.
Useful Remedies

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When you have heartburn, sip water, milk or carbonated water or have a tablespoon of yogurt,
heavy cream or half and half.
Try the flying exercise to reduce heartburn. Sit cross-legged, and raise and lower your arms
quickly, bringing the backs of your hands together over your head. Repeat several times.
Sit up. Lying down can make heartburn worse.
If heartburn is worse at night, try sleeping with the head of the bed elevated or use two or
three pillows instead of one.
A leisurely walk reduces heartburn for some women. For others, sitting quietly and breathing
deeply is helpful.
Antacids may bring relief from heartburn by reducing stomach acid (for example: Maalox,
Mylanta, Riopan, Gelusil). Ask your healthcare provider for antacids that are low in salt. Use
these antacids only occasionally since they contain minerals which may be harmful in large
amounts.
Medicines to Avoid
Some widely available heartburn medicines contain aspirin which should not be taken during
pregnancy (for example: Alka Seltzer, Fizrin)
Do not take heartburn medicines that contain large amounts of salt (for example: baking soda, soda
mint). If the suggestions offered above do not work for you, talk to your healthcare provider.
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COMMON FOODS: SELECT THE LOWER RISK OPTIONS
Type of Food
Higher Risk
Lower Risk
Meat and Poultry
Raw or undercooked
meat/poultry
Meat/poultry cooked to a safe
minimum internal temperature
Seafood
Any raw or undercooked fish,
shellfish, or food containing
undercooked seafood, e.g., sushi or
ceviche
Partially cooked seafood, e.g.
shrimp or crab.
Previously cooked seafood heated
to 165°F.
Canned fish or seafood
Seafood cooked to 145°F
Milk
Unpasteurized (raw) milk
Pasteurized milk
Egg*
Foods that contain
raw/undercooked eggs, such as
homemade Caesar salad dressings,
homemade raw cookie dough or
homemade eggnog.
Use pasteurized eggs/ egg products
when preparing recipes that call for
raw/undercooked eggs.
When eating out ask if pasteurized
eggs are used.
(*Most pre-made foods from grocery stores, such as Caesar dressing, pre-made cookie dough, or packaged eggnog are made with
pasteurized eggs.)
Sprouts
Raw sprouts (alfalfa, bean or any
other sprout)
Cooked sprouts
Vegetables
Unwashed fresh vegetables,
including lettuce/salads
Washed fresh vegetables, including
salads
Cheese
Soft cheeses made from
unpasteurized (raw) milk
Feta
Brie
Camembert
Blue-veined
Queso fresco
Hard cheeses
Processed cheeses
Cream cheeses
Mozzarella
Soft cheeses labeled “made from
pasteurized milk”
Hot Dogs and Deli Meat
Hot dogs, deli meats and lunch
meats that have not been re-heated
Hot dogs, lunch meat, and deli
meats reheated to steaming hot or
165°F
(You need to reheat hot dogs, deli meats, and lunch meats before eating them because the bacteria Listeria
monocytogenes grows at refrigerated temperatures (40°F or below). These bacteria may cause severe illness,
hospitalization, or even death. Reheating these foods destroys these dangerous bacteria and makes these foods safe
for you to eat.)
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Recommended Medication List for Pregnant/Lactating Patients
Take as directed on label
Call 877-3800 if you have any questions
Cold Medications- Tylenol products (cold and flu or allergy), Robitussen (alcohol free), Theraflu
Decongestants- Afrin or saline nasal spray, Sudafed, Tylenol sinus, Chlor-Trimeton, Dimetapp, Tavist-D
Sore Throat- Chloraseptic, Cepacol, Sucrets, Halls
Cough- Robitussen DM, Halls, Vicks Vapor Rub
Allergy- Benadryl, Claritin, Zyrtec
Nausea- Vitamin B6 (25mg twice a day)
Diarrhea- Imodium AD
Constipation- Metamucil, Colace, Senokot, Fibercon, Milk of Magnesia
Heartburn- Tums, Rolaids, Mylanta, Zantac 75, Pepcid AC
Pain- Acetaminophen (Tylenol) 650mg every 4-6 hours as needed; OR Acetaminophen (Tylenol extra strength)
1000mg every 6-8 hours as needed.
Yeast Infection- Monistat (5, 7), Femstat 3, Mycelex 7, Gyne-Lotrimin 3
Hemorrhoids- Anusol HC, Preparation H, Hydrocortisone, Nupercaine, Tucks, Sitz bath
Itching (due to minor skin irritations)- Benadryl cream/spray, Coladryl, Aveeno, Hydrocortisone
Sore Muscles/Joints- Flexall, Icy Hot
Sleep Aids- Tylenol PM, Benadryl, Unasom
Eye Drops- Visine, Aqua site
Sunburn- Soarcaine, Dermoplast, Hydrocortisone
Athletes Foot- Lotrimin cream or powder, Tinactin, Micatin
Dental Care- Local anesthesia, penicillin antibiotics, Tylenol with codeine for pain
X-Rays- Notify the technician you are pregnant, A shield of the abdomen should be provided during the XRay.
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ACOG Guidelines: Recommendations for Exercise
Benefits of Exercising Throughout Your Pregnancy
 Help relieve pregnancy related aches and pains
 Maintain or increase your level of fitness
 Boosts your mood and sense of an overall feeling of well-being
 Promotes muscle tone, strength, and endurance
 Gain less overall weight
 Helps you sleep better
 Easier for you to get back in shape after baby is born
Recommendations for Exercise
 During pregnancy, women can continue their exercise program; just keep in mind to avoid
any sport/exercise that could injure your abdomen.
 Pregnant women gain health benefits from mild-moderated exercise. Regular exercise (at
least 3 times per week) is preferred, however even 30minutes a day is beneficial. Start with
5 minutes of exercise and work your way up to 30 minutes.
 Women should be aware to modify the intensity of their aerobic exercise. You should be
able to talk without gasping for air during your routine. Stop exercising when you feel
fatigued and DO NOT exercise to exhaustion.
 Women should avoid lying on your back without movement after the first trimester. This
position can decrease cardiac output in pregnant women potentially decreasing blood flow
to uterus.
Contraindications to Exercising
 Pregnancy induced hypertension
 Preterm rupture of membranes
 Incompetent cervix/cerclage
 Persistent second or third trimester vaginal bleeding
 Intrauterine growth restriction
Women with certain medical/obstetric conditions should be evaluated to determine if exercise
regimen is appropriate.
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Helpful Hints for Reliving Morning Sickness

Keep snacks by the bed- Try eating dry toast or crackers in the morning before you get out
of bed to avoid moving around on an empty stomach.

Drink Fluids- Your body needs more water in these early months so aim to drink fluids often
during the day.

Avoid smells that bother you- Foods or odors that may have never bothered you before may
now trigger nausea. Do your best to stay away from them.

Eat small and often- Make sure your stomach is never empty by eating five or six small meals
each day. Try the “BRATT” diet (bananas, rice, applesauce, toast, and tea), which is low in fat
and easy to digest.

Try ginger- Ginger ale, tea, or candies made with real ginger can help settle your queasy
stomach.

Peppermint/Spearmint- Either smelling it in aromatherapy or tea can help curb nausea.

Take a supplement- Vitamin B6 is known to help relieve nausea. (25mg twice a day).

When to call the office- When nothing is working and you are unable to keep any fluids
down. Call our office for other prescription options.
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Labor Instructions: How to tell you may be in labor
How to tell you may be in labor:
What to do:
1. You have regular contractions every 3 to 5
minutes, for at least 2 hours. The contractions don’t
change no matter what you do, and may even get
stronger when you walk (Do It!). Remember to time
your contractions form the beginning of one to the
beginning of the next one.
1. If the contractions hurt so much that they make
you cry, then come in to Labor & Delivery. If the
contractions are regular but not strong yet, then you
may stay at home where you are more comfortable
and continue with normal activities.
2. You may have “bloody show”: It may be pink,
light red, or brown. It may be just a little when you
wipe, or with a lot of mucus.
2. “Bloody show” is a normal sign of EARLY labor.
It is not necessary to come to the hospital for bloody
show. Heavy bleeding, like a period is NOT normal
and you need to come right in.
3. Your “bag of water” may break. It could be a
large gush of fluid or a CONSTANT leak, not just
when you wipe.
3. Come to Labor & Delivery, even if contractions
haven’t started yet. Notice the color of the fluid.
Please call us RIGHT AWAY if:
 You have severe headache that doesn’t get better after Tylenol and resting quietly.
 Your baby is not moving as much as usual, and you have tried to feel baby while resting quietly and
having a cold drink.
 Your baby is NOT due yet and you are having ANY signs of labor.
 You have been given special instructions by your nurse-midwife or doctor to call in certain
circumstances.
 If you have a problem, question, or concern about your pregnancy which you believe needs immediate
attention, please CALL US! We are happy to assist you.
Northwest, Green Valley and Lazos offices: (520) 877-3800
Oro Valley office: (520) 545-0573
If your questions can wait, write them down for your next regular clinic visit.
Remember: The final decision to come to the hospital is YOURS!
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Generations Healthcare for Women
Locations and Phone Numbers
In case of medical emergency, call 911
Northwest:
2171 W. Orange Grove Road
Phone: 520.877.3800
Oro Valley:
1521 E. Tangerine Rd, Suite 361
Phone: 520.545.0573
Sahuarita/Green Valley:
1295 W. Duval Mine Road
Phone: 520.877.3800
Lazos de Familia Health Center
344 W. Ajo Way, Tucson
Phone: 520.877.3800
More Information at www.generationsobgyntucson.com
Northwest Medical Center Labor and Delivery Unit
1900 W. Rudasill Road
Tucson, AZ 85741
Telephone :( 520) 877-4200
(map enclosed in this packet)
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