Presentation Women’s Care Florida Drs. Breit, Dukes, Lincourt, Jones, Moore, Whitcomb, Atlanova Kate Hughes ARNP Please view and listen to the presentation prior to your visit. This information will better prepare you for your upcoming appointment with us. Please turn your speakers on. Consider getting a pen and paper to write down any questions you may have regarding the content. There are multiple links for further information within the presentation- you do not have to view all of these. You may pause the presentation at anytime. From left to right: Dr. Bruce Breit, Dr. Mellissa Moore, Dr. Yelena Atlanova, Shannon Ratke ARNP, Kate Hughes ARNP, Dr. Anne Marie Jones, Dr. Wendy Whitcomb, Dr. Ester Lincourt, Dr. Steven Dukes Winter Park This is our main location. All ultrasounds are completed at this location All locations have full lab services available Waterford Lakes Oviedo during your routine pregnancy Weeks 8-28 1 visit per month Weeks 28-36 2 visits per month Weeks 36 to Birth 1 visit per week • • • • • • • • • Detailed health history Identification of medical problems Discuss any medications being taken Complete physical exam including pelvic exam Lab tests Check weight and blood pressure Calculate due date Discuss genetic screening as appropriate Address questions or concerns • Checking your weight and blood pressure • Measuring your abdomen to check your baby’s growth (middle and late pregnancy) • Listening for the baby’s heartbeat (after the 12th week of pregnancy) • Tests and screenings based on your age, health history, ethnic background, or the results of other tests. • Answering any questions that you have concerning your pregnancy a timeline 20 weeks Ultrasound for fetal anatomy and gender 28 weeks 35 weeks Blood glucose test to ensure gestational diabetes has not developed Group B Strep Swab* 36 weeks We will begin pelvic checks to assess your cervix and position of baby, these will continue weekly until you deliver *Group B Strep Swab http://www.acog.org/~/media/For%20Patients/faq105.pdf?dmc=1&ts=20120221T1220307366 Winter Park Memorial Hospital Their “boutique” baby place has many amenities and services available to suit your family. Please visit their website at http://www.winterparkhospital.com/en/services/dr-p-phillips-baby-place We also ask that you preregister at the hospital online or drop off the form that will be provided to you at your visit. preparing for your little one Classes are available at Winter Park Memorial Hospital. You can sign up online and view available classes at http://www.winterparkhospital.c om/en/services/dr-p-phillipsbaby-place – For first time parents we recommend the Gift of Motherhood Series. – There are also classes available for siblings, grandparents, and infant first aid is available. preparing for your little one • We offer screening for chromosomal abnormalities and open neural tube defects in the practice. • You have the option to decline or complete genetic screening. • Is genetic screening right for you? – How important is the assurance of a normal screening test? – If the results of a screening test are positive will you choose a more invasive diagnostic test that carries a possibility of losing the baby? – Would a firm diagnosis affect how you handle the pregnancy or prepare for the baby? – If you opt out of further testing, how will you handle the uncertainty about your baby's health? preparing for your little one • Most, but not all affected fetuses will be detected – Incorporates both first-and secondtrimester screening – First trimester screening involves: Fetal nuchal translucency (NT) • Ultrasound to measure the thickness of the neck and markers in your blood • This is non invasive and carries little to no risk • The blood test and ultrasound are combined to generate a risk for abnormality. - If the risk is high, the patient falls into a "screen-positive" category, is immediately informed and offered further testing (see diagnostic testing below). - If the initial test is negative the patient goes on to the second trimester testing http://www.americanpregnancy.org/prenataltesting/firstscreen.html preparing for your little one • Second trimester screening-involves a blood test called the MSAFP • MSAFP measures markers in your blood as a screening for spinal (or open neural tube) abnormalities and some other fetal and placental anomalies. • We recommend all patients have this screening because it effects management of your pregnancy. – Even if you decline First trimester screening http://www.americanpregnancy.org/pren ataltesting/afp.html preparing for your little one You have the option to choose diagnostic tests only or as a follow up if screening is abnormal. - First trimester : CVS (Chorionic villus sampling) http://www.americanpregnancy.org/pren ataltesting/cvs.html - Second trimester : Amniocentesis http://www.americanpregnancy.org/pren ataltesting/amniocentesis.html • These tests carry some risks including infection and miscarriage. • You may be sent to a specialist to have these tests performed. preparing for your little one In general a healthy diet full of fresh vegetables, fruits, and meats with whole grain is preferred. – Here is a link for further reading on nutrition and pregnancy. • http://www.acog.org/~/media/For%20Patients/faq001.pdf? dmc=1&ts=20120221T1230486370 During pregnancy an extra 300 calories per day is all that is necessary. – The common phrase “eating for two” is not an accurate statement and should be avoided to prevent excessive weight gain. preparing for your little one • • • • • • Raw/uncooked food Soft, unpasteurized cheeses Excessive caffeine Unwashed vegetables Alcohol High mercury fish A comprehensive list of safe versus unsafe fish http://www.americanpregnancy.org/preg nancyhealth/fish mercury.htm For a more detailed explanation of foods to avoid http://www.americanpregnancy.org/preg nancyhealth/foodstoavoid.html We do not recommend that you smoke cigarettes during pregnancy. If you do currently smoke, some useful resources to help you quit are recommended below: • 1-800-Quit-Assist • http://www.marchofdimes.com/pregnancy/alcohol_smo king.html There is no known amount of alcohol that is safe to consume during pregnancy Illicit drugs are not recommended For more information and a useful video on the topic please visit http://www.zeroexposure.org/ Please refer to the handout of safe medications during pregnancy given to you. It is also available on our website at • http://www.medfusion.net/templ ates/groups/3655/5438/OB_Med ications2.pdf If there is any question please call our office and speak to us before taking any medication, OTC supplement, or herbal preparation. for the health of your baby We recommend you use a prenatal vitamin with DHA. These can be purchased at your local drugstore and used during your pregnancy. If you would prefer a prescription please discuss this during your visit. Pre-pregnancy weight Recommended weight gain Underweight (BMI less than 18.5) 28 to 40 pounds Normal weight (BMI 18.5 to 24.9) 25 to 35 pounds Overweight (BMI 25 to 29.9) 15 to 25 pounds Obese (BMI 30 or more) 10 to 15 pounds BMI calculator Link: http://www.nhlbisupport.com/bmi/ For healthy pregnant women exercise is recommended during pregnancy. Research shows that regular exercise: • • • • • Increases overall energy prevents high blood pressure prevents gestational diabetes decreases post-partum depression decrease the “aches and pains” of pregnancy, including low back pain • helps to prepare the body for labor For healthy pregnant women exercise is recommended during pregnancy. We recommend 30 minutes or more of moderate exercise a day on most, if not all, days of the week. In the absence of either medical or obstetric complications. As a rule if you can carry on a conversation while you're exercising you are going at the right level. If you can't speak normally, you're likely pushing yourself too hard.. Do not lay flat on your back for exercise after 4 months gestation For healthy pregnant women exercise is recommended during pregnancy. If you were not working out prior to pregnancy it is okay to start walking daily. • The mayo clinic has further information on this topic – http://www.mayoclinic.com/health/pregnancy-andexercise/PR00096 If you were working out prior to pregnancy in general you can continue your workout routine. • Walking, running, swimming, elliptical, stationary bicycle, prenatal yoga, prenatal palates are all examples of safe activities during pregnancy. • In general you should avoid contact sports, sports that place you at a high risk for falling, and heavy weight lifting during pregnancy. during pregnancy There are multiple resources available to you to help you track the development of your baby during the pregnancy. http://www.acog.org/~/media/For%20Patients/faq1 56.pdf?dmc=1&ts=20120221T1258209759 Mayo clinic has information that tracks the pregnancy by weeks at http://www.mayoclinic.com/health/prenatalcare/PR00112 There are many other available resources. We caution you, however, to avoid blogs and the information contained within them for making health care decisions. • • • • • • Round ligament stretching pain Heartburn/Acid reflux Back pain Evening leg cramps Constipation Sleep positioning All of these are addressed in further detail http://www.americanpregnancy.org/commondiscomforts/ • Many vaccines are safe during pregnancy and promote health of mother and baby. • Vaccines given during pregnancy in our office – Tdap- safe after 20 weeks and provides whooping cough protection for your infant • Family members with close contact to child can also receive this vaccine in the office. – Influenza- recommended during flu season • Vaccines after pregnancy – Rubella and Chickenpox may be given after birth if you are not immune Is a small parasite that should be avoided during pregnancy • Do not change cat litter boxes or clean bird cage while pregnant – If you are cleaning them gloves and mask are recommended. • Wash all fruits and vegetables well before eating • Avoid digging in gardens without gloves • Cook all meat through and wash hands well after handling raw meat For more information on pets in pregnancy http://www.marchofdimes.com/pregnancy/stayingsafe_pets.html during pregnancy Sexual activity is considered safe during routine pregnancies. • Sex cannot harm your baby or cause a miscarriage If you have bleeding, pain, or discomfort during intercourse please stop what you are doing and do not resume intercourse until discussed in the office. • For more information http://www.mayoclinic.com/healt h/sex-during-pregnancy/HO00140 during pregnancy Air travel and car travel is safe during pregnancy until 34 weeks. – After that time air travel should be avoided and car travel should be limited to trips 1 hour from home. – For longer trips please discuss with physician prior to traveling. Be sure when traveling to fasten the lap belt under your abdomen and across the tops of your thighs to avoid pressure on baby. Walk around every 2 hours for at least 5 minutes to promote circulation Cruises should be completed prior to 24 weeks gestation per cruise line guidelines For more travel information: http://www.americanpregnancy.org/pregnancyhealth/travel.html These ultrasounds are optional and for enjoyment. • They are not part of your routine prenatal care. These are available at our facility optimal between 28 and 32 weeks. This can be a nice way to “meet your baby” prior to delivery Domestic violence is more common during pregnancy. If you are in an unsafe living situation please discuss this with us. Further resources 1-800-799-SAFE (7233) http://www.acog.org/~/media/For%20Patients/faq083.pdf?dmc=1&ts =20120221T1419100569 during pregnancy Pain management in labor - http://www.mayoclinic.com/health/laborpain/PR00065 Choosing a pediatrician Circumcision – http://www.healthychildren.org/english/agesstages/prenatal/decisions-tomake/pages/Circumcision.aspx Breast or bottle feeding – https://www.americanpregnancy.org/firstyearoflif e/breastfeedingandbottle.html Cord Blood Storage Contraception after delivery Remember most babies are born healthy! Enjoy your pregnancy RELAX BREATHE SMILE You have a great team here to work for you! Women’s Care Florida Presentation information created by Kate Hughes ARNP-BC