1. family and parenting
2. motherhood
3. pregnancy

PREGNANCY PASSPORT
Obstetrics and Gynecology
Monday - Friday
8:30 AM - 5:00 PM
(850) 785-0515
www.coastalobgynpc.com
2 LOCATIONS
Bay Medical Center
23rd Street

Hwy 77
600 ML King, Jr. Blvd.
Panama City, FL 32401-3628
(850) 785-0515
1
y 23
Hw
Mall
N
ML King Blvd.
15th Street (US Hwy 98)
11th Street
Harrison Avenue
7th Street
BMC Outpatient Center
6th Street
600
BMC

Business Hwy 98
Eckerds Cooper’s
Drugs
Downtown
Gulf Coast Hospital
Hwy 77
31
Mall
Hw
People’s
Choice
Doctors Drive
11th Street

15th Street (US Hwy 98)
Dr.
Kelly
ML King Blvd.
25
Harrison Avenue
State Avenue
Gulf
Coast
y2
23rd Street
Walmart
Harrison Avenue
Jenks Avenue
25 Doctors Drive
Panama City, FL 32401
(850) 785-0515
N
Important Numbers
Phone/OB: 785-0515,
This line is staffed during regular office hours.
Monday — Friday (8:30 AM to 5:00 PM)
This line is for questions and concerns regarding your pregnancy.
If your call is forwarded to voice mail, we will call you back at our
earliest opportunity. No appointments can be made by calling this
line. If you need new medications or refills, it is always best to try
to take care of this face-to-face during an appointment. If this is
not possible, please call knowing that if you request a phoned-in
prescription to a local drugstore — it make take up to 48 hours to
complete the process. Please be aware that we have a practice
policy restricting us from phoning in narcotic prescriptions
after office hours, at night, on weekends, or during holidays.
After Hours Emergencies
If you believe you have an emergency problem, go to the
Emergency Room, or to Labor & Delivery, or call 911 if your
situation warrants. If you believe your water has broken or that
you are in labor go directly to Labor & Delivery. Your Labor &
Delivery nurse will call us after evaluating you. The Labor &
Delivery nurse can also contact our on-call provider with your
name and telephone number.
Bay Medical Center Labor & Delivery . ................ 747-6030
Gulf Coast Medical Center Labor & Delivery........ 747-7700
Bay Medical Center ER.......................................... 747-6000
Gulf Coast Medical Center ER............................... 747-7900
Personal
Name:_________________________________________
Address:_ ______________________________________
City:__________________State:______ Zip:__________
Telephone Number:_______________________________
Work Number:__________________________________
Cell phone/Pager:________________________________
Birthdate:_______________________________________
In case of illness or accident, notify:
Name:_________________________________________
Telephone Number:_______________________________
Malpractice Insurance
We are required to inform you that your doctors, as well
as the nurse-midwives and nurse practitioner, do not
carry medical malpractice insurance. This is allowable
under Florida Law with compliance to certain conditions.
Also, you will find that this practice is our community
norm.
Your Pregnancy
Passport
We’ve developed this little book so you will have
important information about your pregnancy - at your
fingertips. Also, we have included information about some
pregnancy issues that we think you will find helpful.
Please carry your Coastal Pregnancy Passport with you
at all times. When you come to the office for prenatal visits,
give your book to the assistant taking your blood pressure and
recording your weight. Ask the assistant, nurse-midwife or
physician to update your record of labwork. In this way you
will maintain an accurate record of your health during this
pregnancy. If you are away from home, be sure you have
tucked your Coastal Pregnancy Passport into your bag - just
in case you require care while away.
WEB SITE
We maintain an excellent website with lots of useful
information about Coastal OB-GYN and many educational
materials about pregnancy and gynecological concerns. Please
visit us often!
www.coastalobgynpc.com
1
Welcome
to
COASTAL OB/GYN, P.A.
25 Doctors Drive
Panama City, Florida, 32405
BOARD CERTIFIED physicians:
Gregory K. Morrow, M.D.
Deborah J. Edgeworth, M.D.
Justo Maqueira, Jr., M.D.
Advanced Registered Nurse Practitioners
We blend the expertise of our doctors, midwive and
nurse practitioner to offer you the finest quality care.
We are very pleased to provide our advanced registered
nurse practitioner with her specialties in Women’s
Health Care. Our providers practice as a team so that
you are assured of the level of medical care your situation requires.
Noreen Burke, ARNP
2
What is a Certified
Nurse-Midwife?
A certified nurse-midwife (CNM)
is a registered nurse who has completed an
accredited educational program in nursemidwifery and passed a rigorous national
examination standardized through the
American College of Nurse-Midwives
Certification Council (ACC). In Florida,
CNMs are licensed by the Department of
Health, Board of Nursing, as Advanced
Registered Nurse Practitioners (ARNP).
Midwife means
“With Woman”
Certified Nurse - MidwiFe
A. Dale Gauthier, CNM, ARNP
3
Medical & Obstetrical
history
Age
Gravida
Para
LMP
EDD
1st US EDD
OB History
Medical History/Medications:
Prior Surgeries:
Allergies:
4
Pre-Natal Visit
record
Date
Wt
Blood P/S
Pressure
Gest FHTs
Age
5
Comments
Lab Data
Initial
Date
Test
28 wk EG
Results
Date
Test
Results
CBC:WBC
CBC: WBC
H/H
H/H
Plts
Plts
Type/Rh
Diab. FBS
Screen: 1°
I.C
Repeat: FBS
1°
Rubella
RPR
RPR
3° GTT: FBS
HBS Ag
1°
2°
HEP C
3°
HIV
HIV
Sickle
Cell/C.F.
I. C.
Quad Test
15-20
week
Other
6
Lab Data
Pelvic:
Date
Urine:
Cultures:
Results
Date
G.C.
Test
UA
C&S
Chlamydia
HSV
Beta Strep
Other:
Other:
Other:
Cytology:
Pap
Colposcopy
Wet Mount:
Tubal
Consent
Hospital
7
Results
Lab Testing
During your prenatal period, routine blood tests will normally
be ordered on two occasions. Additional blood tests will be obtained based on your individual needs. Cultures and pap smears
collected in our offices will be sent to an outside laboratory for
processing. You will receive a separate bill from the laboratory
for these services. If your insurance company requires a specific
laboratory, PLEASE NOTIFY OUR NURSING STAFF before
these tests are collected. Your urine will be tested for protein
and sugar at every prenatal visit. Group B Strep cultures will be
sent to either Bay Medical Center or Gulf Coast Medical Center
depending on your choice of delivering hospital. Blood testing is
not done in the office. Instead, you will be given written requisitions to have blood specimens drawn at the laboratory of your
choice. The laboratory will forward a copy of your results to our
office. Sometimes it takes up to two weeks for us to receive your
test results. For this reason, try to have your labs drawn in plenty
of time prior to your expected return visit so lab results can be
reviewed with you during the visit. Some of the tests we order
are required by law (i.e.: HIV and syphilis). HIV testing can be
refused, but it must be done in writing. If you will be 35 or older
when your baby is due, you may wish to have an amniocentesis
for detection of chromosomal abnormalities.
INITIAL TESTING: You will not need an appointment at
the lab for these tests. The tests give us basic information regarding
your blood type and Rh; complete blood count; immunity to rubella
(German measles); and your HIV, hepatitis, and syphilis status. If
you have never had chicken pox, it would be a good idea to check
your immune status for the varicella virus at this time, as well.
Sickle Cell Anemia screening may be advised. Many times we
order a urine culture to be sure you do not have a silent urinary
tract infection. You do not have to be fasting for these tests. We
will call you if results require special attention before your next
visit. Cystic fibrosis testing is recommended for some.
8
26-28 WEEK TESTING: These tests give us follow-up
information. We are required to screen again for syphilis, HIV, and
sometimes, hepatitis B. If you have a Rh negative blood type, this
is when you will be given a Rhogam shot. Additionally, we order
a screening test for gestational diabetes (1 hour glucose test) at this
time. Many women have a regular dinner and bedtime snack the
evening before the test and then nothing but water on the morning
of the test. It is always best to have this test done as early in the
morning as possible. If you must have the test done later in the day,
remember that you can eat eggs, cheese, milk, and meats without
affecting the test results! Plan to spend about 1 ½ hours at the lab
during this test. We will call you if results require special attention
before your next visit.
3 HOUR GLUCOSE TOLERANCE TESTING: This test
is only ordered if your screening test for gestational diabetes is
elevated. Most labs require you to call for an appointment before
having this test done. You must be fasting for this test. This means
that you must not eat or drink anything but water after 10 PM the
night before the test is drawn. Plan to spend about 4 hours at the
lab to complete this test. We will call you if results require special
attention before your next visit.
RHOGAM SHOTS: At Gulf Coast Medical Center go to
Labor and Delivery; at Bay Medical Center call the Infusion Center
at 747-6494 to make an appointment.
9
Multiple Marker Screening
The Screen is an optional blood test used to determine if a woman is at
increased risk for having a baby with Down syndrome, trisomy 18 or an
open neural tube defect. The Screen does not screen for any other genetic
problems or birth defects. The Screen is simply a screening test and DOES
NOT provide a diagnosis.
The Screen only attempts to identify which
women are at higher risk than average for having a baby with one of the three
problems. This screening test is done with a small amount of blood drawn
from the mother’s vein between the 15th and 20th weeks of pregnancy. A
significant number of women with completely normal and healthy babies will
have an abnormal Quad Screen test result. They will be offered follow-up
evaluation. Evaluation for high-risk test results may include referral to a
high-risk specialist for level II ultrasound, genetic counseling, and possible
amniocentesis. Amniocentesis is only done if the woman chooses. It involves
withdrawal of a small amount of amniotic fluid from the uterus under
ultrasound guidance. Amniocentesis is the only way to be sure of a diagnosis.
Some insurers do not cover the cost of amniocentesis and other genetic tests.
IF 1000 WOMEN HAVE A SCREEN
•
•
•
•
•
Some results will appear abnormal because of clerical error and simply
need to be recalculated based on corrected information.
Approximately 70 will have results showing a high risk for Down
syndrome and will be offered follow-up testing. Of those, only 1 or 2
will actually have a baby with Down syndrome. 68 or 69 of the babies
will not have Down syndrome.
Approximately 25 will have results showing a high risk for an open
neural tube defect and will be offered follow-up testing. Of those, only 1
or 2 will actually have a baby with an open neural tube defect. 23 or 24
of the babies will not have this problem.
Trisomy 18 is much rarer and occurs in only 1 out of 8000 births and is
a lethal condition.
Some women who carry fetuses with an open neural tube defect or
Down syndrome will not be identified as being in the high-risk group.
This is because no screening test can detect all high-risk pregnancies.
Remember, this test is optional. It is your choice to be tested - or not to be
tested. If you choose to be tested, your blood needs to be drawn between
the 15th and 20th weeks of your pregnancy. Visit our website at www.
coastalobgynpc.com for additional information. Also, ask one of us about
this test. We are very happy to discuss the test in greater detail.
10
Group B Strep
in pregnancy
Group B Streptococcus (GBS) is a common bacterium that lives within the human
body without causing harm in healthy people. GBS can be found in the intestine,
urinary bladder, and vagina in about 2-3 of every 10 women. It is not a sexually
transmitted disease, and it does not cause discharge, itching, odor, or other symptoms. It will not harm you or your sexual partner. However, GBS can seriously
harm a newborn baby. At the time of birth, babies are exposed to the GBS bacteria
if it is present in the vagina. This can result in pneumonia or a blood infection.
Full-term babies who are born to mothers who carry GBS in the vagina at the time
of labor and childbirth have a 1 in 200 chance of getting sick from GBS during the
first few days of life. Premature babies have an increased chance of becoming ill
from GBS if it is present.
We can discover who is at risk for GBS transmission by culturing every
pregnant woman shortly before the expected due date. We recommend culturing
between the 35th and 37th week of pregnancy or earlier is there is a risk of preterm labor (twins, etc.) We obtain the culture at the office during a regular prenatal
visit. The sample is collected by touching the lower third of the vagina and just
inside the anus with a sterile Q-tip. We encourage women to obtain the culture
themselves - in the privacy of the bathroom. We provide clear instructions and all
necessary equipment. It is easy, safe, and painless! If you are uncomfortable about
collecting your own GBS specimen, we will collect it for you in the privacy of the
exam room. If the laboratory grows GBS in the culture from your Q-tip sample,
we will make a note in your chart and in this booklet. We will discuss the results
with you and make a plan to prevent transmitting GBS to your baby.
If your culture is positive, we will recommend that you receive antibiotics
during labor. Intravenous antibiotics given during labor almost always prevent
your baby from picking up the bacteria during birth. It is important to remember
that GBS is typically not harmful to you or your baby before you are in labor. It
is not helpful to try to remove GBS from the vagina before labor because it very
likely will return soon after treatment is completed. The one exception is that,
occasionally, GBS can cause a urinary tract infection during pregnancy. If you
get a GBS urinary tract infection, it should be treated right then, and you should
receive antibiotics again when you are in labor.
If you carry GBS at the time of birth and you are given intravenous antibiotics
during labor, the risk of your baby getting sick from GBS is 1 in 4000. If a baby
becomes sick with GBS, it usually occurs within the first 24 hours after birth.
Nursery nurses and pediatricians are always made aware of GBS culture results
and they carefully evaluate every baby for signs and symptoms of GBS illness.
They will order special lab tests for your baby if indicated.
11
Ultrasound
At Coastal OB/GYN your care is our utmost concern and every
effort is made to give you the best attention during your pregnancy.
In addition to your visit with one of our practitioners, an ultrasound
is the best tool for documenting the process of your pregnancy.
Although ultrasounds are not a requirement for contingency of care,
while pregnant, our practitioners feel that one ultrasound per trimester
is acceptable. In addition to evaluating maternal anatomy, your baby
will be charted for growth, position, movement and fetal anatomy.
It should be mentioned that your baby’s position and maternal size
could make observation with ultrasound difficult.
During your second trimester usually between 18 to 20 weeks
we can tell you the gender of your baby. In a few instances we need
to have more than one ultrasound session to accurately determine
gender. Some parents choose to keep this a surprise so please let us
know your preference during your appointment.
Pictures are a wonderful way to record your baby’s development
but please be aware of our office policy, one free picture and then you
will incur a fee per picture.
We also offer “Fancy Features” which is a non-diagnostic 30
minute session that will show your baby in a three-dimensional
(still image) and four-dimensional (live video) perspective. Please
understand that maternal size, amniotic fluid level and baby’s position
will affect a 3D/4D ultrasound the same way it will a 2D “normal”
ultrasound. Drinking plenty of water throughout your pregnancy will
allow for better visualization for your 3D ultrasound. You will receive
a DVD and a CD along with 5 pictures to take home. Please bring no
more than 3 people with you to your Fancy Features appointment.
The “Fancy Features” ultrasound is not covered by insurance and
prepayment in required at the time the appointment is scheduled.
Ultrasound during your pregnancy is a great way to begin
connecting with your growing baby. We hope you find this part of
pregnancy enjoyable and informative as a new life develops before
your eyes.
12
Diet For A
Healthy Pregnancy
GRAINS: Recommended amount is 6 to 11 servings each day. Grain foods are
cereals, breads, rice, & pasta.
DAIRY: Recommended amount is 3 to 4 servings each day. Dairy foods are
milk (any kind), yogurt, cheeses, ice creams. If you cannot eat these dairy
products please take Calcium 600mg, three times a day (but not at the same
time you take iron tablets).
PROTEINS: Recommended amount is 3 to 4 servings each day. Protein foods
include red meats, chicken, eggs, fish, nuts, and beans.
VEGETABLES: Recommended amount is 3 to 5 servings each day. Leafy,
green, red, yellow, and orange vegetables are especially good. Salad is an
excellent choice.
FRUITS: Recommended amount is 2 to 4 servings each day.Juices have extra
sugar added and should be used sparingly or diluted. Fruits that you chew and
swallow will be your best choice.
FATS/OILS/SWEETS: (includes butter, mayonnaise, etc.) You should use
these products sparingly. NutraSweet, Equal, and Splenda may be used to
sweeten your foods.
CAFFEINE: We recommend that you restrict your intake of coffee, tea, and cold
drinks containing caffeine. Limit yourself to 2 servings a day. Heavy caffeine
use has been linked to delivery of low- birth-weight babies.
SERVING SIZE: bread - 1 slice; biscuit or bagel - ½; dry cereal-1 cup; cooked
cereal, pasta, or rice-½ cup; veggies-½ cup; meats-size of your palm or a deck of
cards; nuts-¹/³ cup; egg-2; milk-1 cup; fruit-juice, ³/4 cup fresh, 1 piece chopped,
cooked, canned-½ cup; cheese-yogurt, 1 cup; two 1” cubes; cottage, ½ cup.
FISH/SHELLFISH: Do not eat shark, swordfish, King Mackerel, or tilefish
because they contain high levels of mercury. Eat up to 12 ounces (two average
meals) a week of a variety of fish and shellfish that are lower in mercury. Five
of the most commonly eaten fish or shellfish that are low in mercury are shrimp,
canned light tuna, salmon, pollock, and catfish. Another commonly eaten fish,
albacore (“white”) tuna, has more mercury that canned light tuna. So, when
choosing two meals of fish and shellfish, you may eat up to six ounces (one
average meal) of albacore (white) tuna per week. Consuming raw seafood,
oysters or sushi is not recommended while you are pregnant.
13
Getting Enough Iron
During Your Pregnancy
Iron, an essential mineral, is needed in the blood to carry oxygen throughout the
body. Iron needs increase during pregnancy. Without enough iron, anemia can become
a big problem for you and your baby. If you become anemic, you may look pale, feel
tired, or easily become short of breath. If you are anemic at the time of delivery you
may experience increased problems due to the normal amount of bleeding expected
with childbirth. Although many everyday foods contain large amounts of iron, your
body can absorb, only 5% to 10% of the iron in food, Therefore, it is very important to
1) choose foods that are naturally high in iron; 2) prepare and eat the foods as carefully
as you possibly can, following the tips below; and 3) carefully take iron supplements
whenever we prescribe them. Here are some of our favorite tips to help you get the iron
you need.
FOOD TIPS
Keep in mind that the iron in grains and vegetables isn't absorbed as readily
as the iron in meat, fish, and poultry. On the other hand, eating meat, fish, or poultry
along with grains and vegetables increases iron absorption. So does eating a food that
contains vitamin C (an orange, tomato, potato, or broccoli, for example.) In fact, eating
a tomato with a hamburger quadruples the iron absorption! Eat poultry, fish, and meat
often to provide easily absorbable iron and increase iron absorption from other foods.
Have vitamin C rich foods with meals. Good sources are oranges, grapefruits, tomatoes,
peppers, broccoli, potatoes, watermelon, cantaloupe, strawberries, & cranberries. Choose
iron-fortified breads and cereals.
Eat iron-rich vegetables, such as spinach, broccoli, asparagus and other dark-green
veggies. Cook with iron pots and pans (cast iron.) Using iron cookware can dramatically
increase the iron content of your meals. Simmered foods such as tomato sauce, soups,
and stews draw valuable iron from the iron cookware. Even scrambled eggs become
fortified! Eat dried fruits or drink prune juice. Fruits usually do not contain iron, but
they do pick up the mineral when dried. Avoid foods that decrease iron absorption, such
as tea and coffee.
MEDICATION TlPS (PRENATAL VITAMINS AND/OR IRON PILLS)
Make sure you take your vitamin or iron pills with meat or a source of vitamin
C. You will absorb more iron. Avoid taking your vitamin or iron pills with milk, cheese,
yogurt, ice cream, eggs, coffee, tea, antacids, or calcium supplements. These will decrease
iron absorption. If you are taking both vitamin & iron pills - take them at separate meals.
Don't crush iron pills. If you can't swallow them, ask us about liquid iron. If taking iron
causes constipation, eat fibrous foods, such as bran and raw or dried fruit and vegetables.
Also, increase your water intake and, if necessary, ask us (or your pharmacist) about a
stool softener. If you are taking in enough iron, your stool should turn dark green or black.
This is a harmless passing of the unabsorbed iron and it is to be expected. Iron can be
toxic if taken in overdoses. Remember to keep your iron supplements out of children's
reach!
14
Water
Absolutely Necessary for a Healthy Pregnancy
WHY ARE FLUIDS SO IMPORTANT? Water makes up 55 to 75
percent of your body weight - that's about 10 to 12 gallons - so it's no wonder
that water is an essential nutrient that must be constantly replaced. All body
tissues contain water. During pregnancy, your blood's volume will increase up
to 50 percent. Add heightened metabolism, production of amniotic fluid, and
the growth of a brand new human being and you can see why you need more
fluids. In fact your uterus will grow to become an enormous muscle during
your pregnancy (bigger than a professional ballplayer's biggest muscle!) You
know how athletes replace vital fluids whenever there is a break in the action.
Well, your uterine muscle is under the stress of hard work 24/7 and needs
fluid replacement - even more than the toughest athlete! Even a tiny body
water deficit, such as 4 to 8 cups, can affect your well-being especially during
pregnancy or breast-feeding. Dehydration is a very real threat and is something
to be avoided at all costs.
WARNING SIGNS OF DEHYDRATION. Thirst. Dark or scanty
urine. Fatigue. Weakness. Cramps (including uterine contractions.) Dizziness.
Constipation. Fluid retention. When your body's fluid levels are low, your blood
draws fluids from the salivary glands and kidneys into the bloodstream. By the
time your mouth is parched or your urine darkens, you've probably already
lost 2 or more cups of your total body water. The key to avoiding problems is
to drink regularly and often. Avoid ever becoming thirsty in the first place!
HOW MUCH FLUID IS ENOUGH? The minimum daily requirement
of fluid is 8 to 12 cups a day (2 to 3 liters.) You need even more if you feel
thirsty or notice darker urine. Larger women, as well as those with pre-term
labor and those expecting multiple births, always need additional fluids. Also,
women working or playing hard and those living in warmer climates will need
more.
WATER…IT'S YOUR BEST BET! Because water is naturally low in
sodium, has no fat or cholesterol or caffeine, and is quickly absorbed by your
body, it should be your top choice in helping you reach your daily fluid quota.
Also, it is cheap and readily available! Milk and 100% fruit juices are good
choices too, since they supply other important nutrients besides the water.
Limit your intake of caffeinated beverages such as coffee, tea and certain
carbonated drinks which can have a dehydrating effect. Avoid beer, wine and
liquor altogether during your pregnancy.
15
Morning Sickness
Tips
Nausea and Vomiting of pregnancy, or “morning sickness”, is
among the most common and frustrating problems associated with
pregnancy. It is estimated to affect 70-85% of all pregnancies.
Below, we offer suggestions that will help in most cases.
Remember that no single remedy will be effective at all times.
Most women find that a combination of remedies are needed for
maximum and sustained relief.
1. Small, frequent meals (every 2 hours). Avoid foods that smell
“funny” or are not appealing to you at the time. Eat whatever
sounds good. Let someone else do the cooking!
2. Try the timeless remedy of crackers or toast (in bed) or just
after you get up.
3. Try ice cold beverages. Some women do better just sucking
on ice or adding a splash of lemon juice to their cold water.
4. Try eating a protein snack just before going to bed, such as
cheese & crackers, or peanut butter & toast.
5. Stop your vitamins and iron supplements (temporarily) if you
think they are adding to your morning sickness problem. Or,
try taking the vitamin at bedtime - with a snack.
6. Purchase Vitamin B-50 Complex at the grocery or pharmacy.
Buy tablets (not capsules) so that you can break them in half.
Take ½ tablet three times every day.
7. Purchase plain doxylamine 25mg tablets (Unisom) at your
grocery or pharmacy. The morning sickness recipe combines
the Vitamin B-50 Complex with the doxylamine (Unisom) and
is taken as follows:
BEDTIME: 1 doxylamine (Unisom) tablet and ½ vitamin
B-50 Complex tablet.
16
MORNING: ½ doxylamine (Unisom) tablet and ½ Vitamin
B-50 Complex tablet. MID-AFTERNOON: ½ doxylamine (Unisom) tablet and
½ Vitamin B-50 Complex tablet.
THIS IS A TERRIFIC REMEDY. IT MUST BE TAKEN 3
TIMES A DAY — EVERY DAY, TO BECOME EFFECTIVE.
There are many different varieties of doxylamine (Unisom or other
store brands) on the market and it is available over the counter. Some
brands are less expensive than others but they all work. Make sure
you check the “ACTIVE INGREDIENTS” on the label or ask your
pharmacist to help you find this medication.
8. Take ginger. You can find this spice in the health food or
vitamin stores. Get the 250mg capsules. Take one capsule 4
times each day. Try nibbling on ginger snap cookies.
9. Seasick prevention wrist bands. Available for about $5.00 at
Boating/Marine supply stores, drug stores or retail stores. You
wear them day and night. Some women swear by them, others
do not find them helpful.
10. If these suggestions do not work, give us a call. We can
prescribe medications that are not available over-the-counter.
However, they can make you very sleepy therefore it is wise
to try the other remedies first.
11. If you ever find that you are among the very few who are
unable to keep anything down (even liquids), give us a call.
In these extreme cases, we may recommend that you come
into the hospital for IV fluid therapy.
12. Take heart…In most cases, morning sickness goes away by
the 14th week of pregnancy.
17
Over-The-Counter
Medications during Pregnancy
STOMACH & INTESTINAL PROBLEMS
• Acid Indigestion: Call us if this is a persistent problem.
Rolaids, Tums, etc.
Maalox, Mylanta, etc.
Tagamet, Pepcid, Zantac, Prolosec.
• Constipation: if not relieved by increasing fluids and
improving the fiber in the diet, try Stool softeners such
as: Colace, Metamucil, FiberCon, or alfalfa tablets.
If still constipated, try Milk of Magnesia or Senekot. If
you remain constipated try Dulcolax, or finally a Fleets
enema.
• Diarrhea: Call us if this lasts more than 24 hours.
Kaopectate, Imodium.
• Gas: Simethicone, Mylicon, GasX.
• Hemorrhoids: Anusol, Preparation H, Tucks.
• Nausea & Vomiting – Other than Morning Sickness (see
pages 16 and 17). Call us if this lasts more than 24 hours
or if you cannot keep clear liquids down.
Emetrol
PAIN ( headaches, muscle aches & pains)
Tylenol (acetaminophen), regular or extra-strength.
Motrin (ibuprofen), for occasional use only after the
13th week and never after the 32nd week of pregnancy.
If you need to use ibuprofen (Motrin) more than 3 times
a day, or for more than 3 days in a row – contact us for
advice.
18
UPPER RESPIRATORY DISCOMFORTS: Call us if you
run a fever above 100.4° F. Call if your cough is producing
yellow/green sputum. If you are still smoking – STOP!
• Allergy Symptoms:
Benadryl (diphenhydramine hydrochloride)
Chlor-trimeton (chlorpheniramine maleate)
Zyrtec
• Congestion Symptoms: Sudafed (pseudoephedrine
hydrochloride), Sudafed PE (phenylephrine)
• Combination Cold, Flu, Sinus, Allergy Medications:
Actifed (triprolidine hydrochloride & pseudo ephedrine
hydrochloride)
Tylenol combination products such as Tylenol Cold &
Sinus, etc.
• Cough Syrups: Robitussin & Triaminic syrups.
• Sore Throat: Chloraseptic lozenges or spray. Also, be sure
to try the old standby of 2 tsp. salt in 6-8 oz. warm water
for gargle. You may use this as often as desired.
• Nasal Stuffiness: Any saline solution nasal spray may be
safely used – whenever needed
VAGINAL ITCHING/YEAST INFECTION: For minor
itching you may use Monistat. If unrelieved, call us.
INSOMNIA: For occasional insomnia, try comfort measures
such as food, warm bath, and massage. You may also try Tylenol
PM or Unisom, if necessary.
MINOR SKIN IRRITATIONS OR INJURIES: Hydrogen
peroxide, antibiotic ointments, Benadryl cream, and
hydrocortisone ointment are all safe for use in pregnancy.
19
2010
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31
Smoking During Pregnancy
25% of all Americans smoke cigarettes. For some people, nicotine can be as
addictive as heroin or cocaine. It is always hard to quit, but it is generally easier to
quit smoking during pregnancy than at other times during life. Pregnant women are
more motivated to quit smoking for their baby's sake. This is because it is known that
cigarettes are particularly harmful to the developing fetus. Mother's who smoke during
pregnancy are more likely than average to have: 1) miscarriage, 2) small birth weight
babies, and 3) stillbirth. Also, babies living in homes where there is cigarette smoke are
more prone to upper respiratory problems such as asthma, and there is a greater risk for
sudden-infant-death syndrome. Finally, children are less likely to start smoking if their
parents do not smoke. As you can see, it is vitally important to quit smoking. We will
work with you and help you succeed!
FIVE KEYS FOR QUITTING
1. Get Ready: Set a quit date. Reduce the number of cigarettes you smoke. Change your
environment. Get rid of ALL cigarettes and ashtrays in your home, car, and place of work.
Don't let others smoke in your home. Review your past attempts to quit. Think about what
worked and what did not. Once you quit, do not smoke - NOT EVEN A PUFF!
2. Get Support and Encouragement: Tell your family, friends, and coworkers that
you are quitting and want their support. Ask them not to smoke around you or leave
cigarettes out. Talk to your doctor or nurse-midwife (we can help!). Get individual,
group, or telephone counseling.
3. Learn New Skills and Behaviors: Distract yourself from urges to smoke. Talk to
someone, go for a walk, or get busy with a task. When you first quit, change your routines.
Take a different route to work. Drink decaffeinated tea instead of coffee. Eat lunch
outdoors. Do things to reduce your stress. Take a hot bath, exercise, read a good book.
Plan something enjoyable to do every day. Drink lots of water and other fluids.
4. Get Medication and Use it Correctly: Medications can help you stop smoking
and lessen the urge to smoke. Use of these medications will practically double your
chances of quitting and quitting for good. Ask us for advice about the use of medications
during pregnancy.
5. Prepare for Relapse or Difficult Situations: Relapses are common while quitting
for good. Most relapses occur within the first 3 months after quitting. Don't beat yourself
up over this. Just use a relapse as a learning tool and move forward. You will do better
knowing what trigger to beware of. Remember: 1) Alcohol lowers your chance of
success (we advise against alcohol during pregnancy, anyway), 2) Being around other
smokers can make you want to smoke, 3) Eat healthy and stay active, 4) There are a lot
of ways to improve your mood other than smoking. Remember, if you relapse because
of a problem - then you have two problems. The problem and the cigarette.
22
Low Back Pain
Back pain is a common complaint during pregnancy. As your
baby grows, there will be strain and stretching of the back muscles,
ligaments and joints, and relaxation of your abdominal muscles due
to the hormonal changes your body is going through.
To help ease back pain, try to be aware of how you sit, stand and
move. Tuck your tummy in and keep your back straight, as if your hair
is being pulled up.
1. Wear low heeled shoes with good arch support.
2. When standing for long periods, move in place or put one foot
on a stool.
3. If your bed is soft, place a board between the box spring and
mattress.
4. Do not bend from the waist to pick things up, squat down, bend
your knees and keep your back straight.
5. Sit in chairs with good back support, a back support pillow behind
your low back may help.
6. Sleep on your side with pillows between your legs for support.
7. A hot or cold pack applied to the area may help, or a warm shower
or bath.
8. Get on your hands and knees and curl your back up like an angry
cat, then flex down towards the floor. Repeat this 15-20 stretches
several times per day.
9.Have a massage, get a partner or friend to help.
10. A maternity support belt or girdle may help support the abdomen
and back muscles.
11. You may also find a chiropractor helpful during pregnancy.
12. Keep in mind that back pain may be a symptom of urinary
infection or pre-term labor. Call us to discuss your symptoms.
Visit us at www.coastalobgynpc.com for more information.
23
Ligament Pain
Every pregnant woman has 6 ligaments supporting the uterus. The
round ligaments (2), support the front sides of the uterus to the
pubic bone. The broad ligaments (2), support the far sides of the
uterus to the pelvic bone sidewalls. The final two, the uterosacral
ligaments, support the back of the uterus to the lower part of the
vertebrae - just above the buttocks. As the uterus begins to grow
out of the pelvis the ligaments stretch like thick rubber bands and
can cause cramping and sharp pains.
1) During the first three months of pregnancy many women report
that they feel crampy just like they do before or during a menstrual
period. This is due to the stretching of all 6 of the ligaments.
2) During the second trimester the round ligaments can cause
spasms of pain in the lower abdomen, on either or both sides. This
is a normal - but uncomfortable occurrence and usually resolves
once the uterus grows to full-term size. When round ligament pain
occurs, there is a sharp, stabbing kind of pain that is, fortunately,
brief. Round ligament pain frequently occurs with a sudden
movement, stretching, heavy lifting, or a twisting of the upper body
(like beginning to roll over in bed without first bending the knees.)
When round ligament pain occurs it can be resolved by lying on
the side that hurts - with the legs curled up against the abdomen.
A heating pad, warm bath, and/or Tylenol frequently help relieve
the discomfort. An elastic maternity belt is also helpful and can be
worn over or under your clothes. If the pain is prolonged without
improvement, or is accompanied by vaginal bleeding, fever, upper/
mid back pain, nausea, vomiting, diarrhea, or burning urination
you should contact us or report to Labor and Delivery, according
to the severity of your symptoms.
3) Low back pain caused from stretching of the uterosacral
ligaments can frequently be eased with a heating pad, warm bath,
massage, and/or Tylenol.
24
25
Urinary Tract Problems
During Your Pregnancy
Urinary tract problems are common during pregnancy. This
is due mostly to the bodily changes taking place. The pregnancy
hormones relax the muscles and valves in the urinary tract. This
causes urine to move more slowly through the system. Bladder
infections are known to travel upward. This means that a fairly
minor infection in the bladder can “back-up” through the slow
moving ureter tubes and infect the kidneys themselves. Some
germs can even cause bladder spasms that force the urine out of
the bladder and back up to the kidneys. Additionally, the growing
uterus squeezes the tubes (ureters) that carry urine from the kidneys
into the bladder. A kidney infection is always a serious problem,
especially during pregnancy. In addition to making you very ill, a
kidney infection can trigger premature labor.
Symptoms of a bladder infection: Pain and/or burning,
during or after urinating. Feeling more than your usual urgent
need to urinate. Frequent urination. Voiding in small amounts.
Sometimes blood can be seen in the urine or the urine may have a
foul odor.
Symptoms of a kidney infection: Frequently they are the
same as for a bladder infection, plus fever, chills, aches and pains
all over, and especially in the mid-back or side.
Symptoms of a kidney stone: Can occur with or without
infection. Pain that is severe and spasmodic in nature is the most
frequent symptom. The pain can be in the mid-back or lower
abdomen. Sometimes blood can be seen in the urine.
What can be done to prevent these problems? The tube
leading from the bladder to the outside is call the urethra. This
tube is very short in women. It is easy for germs from the bowel
and vagina to enter the opening to the urethra. Once there, germs
can then ascend or “back-up” into the bladder and kidney.
You can help yourself prevent urinary tract infections!
26
1. Always wipe from front-to-back instead of wiping germs from
the bowel and vagina toward the urethra.
2. Drink plenty of liquids daily so you need to empty your
bladder about every 2 hours. This will help keep the urethra cleared
of any germs. Avoid caffeinated beverages (they act like a diuretic
and can dehydrate your system). Cranberry juice may help keep
the urine germ-free.
3. Always get up and empty your bladder after sexual intercourse.
This helps flush the urethra of germs.
4.
Whenever lying down, remember to lie on your side particularly the left. This will help drain your kidney on the
opposite side.
5. Rest in a knee-chest position several times a day. This will
help drain both kidneys at the same time.
6. When prescribed, finish antibiotics until they are gone.
7. Make sure you are getting plenty of vitamin C.
Kidneys
Ureters
Bladder
Urethra
27
Headache In Pregnancy
Pregnancy offers no protection against headaches. Occasionally,
a woman with chronic headaches prior to pregnancy will
experience a reduction in headache frequency. Unfortunately,
most women with problem headaches will continue to live with
headaches during their pregnancy.
Some women who never have problems with headaches
begin to get them during the pregnancy. We think this is usually
caused by hormonal changes, blood sugar fluctuations, and
dehydration.
TIPS FOR LIVING WITH HEADACHES
1) If you are under the care of a neurologist, chiropractor, or
pain management specialist, please continue your care while
pregnant.
2) If you need medication for your headaches be sure to talk
with us about it. Some headache medications should not be
used during pregnancy.
3) Avoid headache triggers that you are aware of. Some food
triggers include; MSG food additive, chocolate, nuts, peanut
butter, bananas, onions, avocado, NutraSweet, Equal, pickled
foods, yogurt, sour cream, aged cheese, processed meats, pizza,
and caffeine.
4) Eat frequent small meals that contain some protein.
Examples of protein include dairy products, eggs, meats, and
beans. These foods help you avoid low blood sugar and this
seems to help many women avoid headaches.
5) Drink plenty of liquids. Dehydration is a common problem
during pregnancy and can contribute to headaches. Water is
28
is your best source of hydration. Remember that small amounts
of caffeine are OK to have during pregnancy - unless it is one
of your triggers. Some pregnant women experience headaches
because they withdraw from all caffeine.
6) Get plenty of sleep and rest.
7) If you think your headache may be related to sinus congestion
try using Sudafed (pseudo ephedrine) to decongest your nasal/
sinus passages. You can also place warm compresses on your
face just above and below the eyes. Saline nasal sprays can also
help reduce the pressure of sinus congestion.
8) It is OK to take Tylenol alone - or with Benadryl (Tylenol
PM) to treat your headache. Do not take Benedryl or Tylenol
PM unless you can rest for awhile in a darkened and quiet
room. The Benadryl causes sleepiness and is unsafe to use if
you are doing anything that requires you to remain alert. If
you need to remain alert, take the plain Tylenol – regular or
extra strength.
9) It is OK to take occasional doses of ibuprofen (Motrin)
after the 13th week of pregnancy and before the 32nd week of
pregnancy. We advise against using this drug in the first 13
weeks because some research suggests it may contribute to
miscarriage. Motrin should definitely not be taken after the
32nd week of pregnancy because it can contribute to circulatory
problems in newborn babies. If you need ibuprofen (Motrin)
more than 3 times a day, or for more than 3 days in a row –
contact us for advice.
10) If you are more than 20 weeks pregnant and experience
a severe or unusual headache that is unrelieved with the
combination of food and liquids, extra-strength Tylenol, and an
hour of rest in a darkened and quiet room – you should report
to Labor & Delivery for evaluation and treatment.
29
Fetal Movement
You will probably begin to feel your baby's movements sometime
between the 16th and 20th weeks of pregnancy. This early movement is
called “Quickening”. Some women feel the baby's movement throughout
the day and night. Other women will notice their baby's movement more at
certain times of the day. Research has shown that babies are generally the
most active between the hours of 10 PM and 2 AM. Perhaps the baby misses
the motions the mother makes during her waking hours! The important
thing is that once you begin feeling fetal movement you should be able
to feel your baby move every day. Being aware of your baby's movement
is one of the most important ways you can assess the baby's well-being.
After the 24th week of pregnancy it becomes increasingly important for
you to help us monitor your baby's health by monitoring fetal activity. If
you feel that your baby is not moving normally, please do a Fetal Kick
Count.
FETAL KICK COUNT
1 ) Before you begin, be sure you have not skipped a meal. If you have,
eat something nutritious before you start. Also, drink a glass of water,
milk, or juice.
2) Lie down on your left side or sit in your most comfortable chair. Try
to avoid distractions. Turn off the television. Avoid conversations and
other interruptions.
3) Remember, all fetal movement counts! As your baby grows and runs
out of room for big twists and turns, the movements may become
gentler or more subtle. This is one reason you must pay close attention
to what kind of movements the baby is making inside your womb.
4) Pay close attention to the movements of your baby. Check the time.
Count every kick or movement until your baby has moved ten times.
Most babies will move at least ten times in 30 minutes. Once you count
ten movements you can go about your normal activity.
5) If your baby has not moved ten times within 60 minutes you should
go to Labor & Delivery for additional testing. The nurses in Labor &
Delivery will contact us once they have evaluated your baby.
30
Premature Labor
Babies are considered premature if they are born before the 37th
completed week of pregnancy. Prematurity causes health problems for the
baby because their tiny lungs and other organs have not had enough time
to grow fully. Premature birth occurs in about one of every ten pregnancies.
Babies are healthiest when born close to full-term. The earlier a baby is born,
the more likely it is they will have health problems that can be immediately
life-threatening and/or remain problems throughout their lives.
Women are at increased risk of delivering prematurely if they:
1) use tobacco, alcohol, street drugs, or unprescribed medications during
pregnancy.
2) have infections that are not treated.
3) are carrying more than one baby.
4) have already delivered a baby prematurely.
5) weighed less than 100 pounds before becoming pregnant.
6) are younger than 18 or older than 40.
7) are not receiving the correct vitamins or eating the right foods.
Also, many women who have none of the risk factors can deliver early…
Therefore all pregnant women need to be careful to be on the lookout for the warning signs of pre term labor. This can be confusing because
many of the signs for premature labor are similar to the normal discomforts
of pregnancy. However, by paying close attention to what the body is saying,
many women can notice a problem in the early stages.
Caution signs to look for:
1) Irregular or regular contractions (sometimes like menstrual cramping).
2) Low backache.
3) Increased vaginal discharge, spotting, or fluid leaking from the vagina.
4) Feelings of pressure in the pelvis.
If you think you have these symptoms, take the following actions:
1) Stop what you are doing.
2) Drink two or three glasses of caffeine free liquid (water, juice,
Gatorade).
3) Rest on your left side for about an hour.
If the symptoms go away, you can go about your regular activities but keep
a watchful eye. If the symptoms do not go away, or if they return frequently,
go to Labor & Delivery for an exam.
31
Choosing A Hospital
For Birth
We are very fortunate here in Panama City to have two
excellent hospitals that provide childbirth care. Coastal OB-GYN
is proud to be affiliated with both Bay Medical and Gulf Coast
hospitals. You made a wise choice in choosing our practice for
your maternity care! Unless your insurer requires you to receive
care at one specific hospital, the choice is yours. We advise that
you tour each of the hospitals to learn which one makes you
feel more ‘at-home’ and comfortable. Also, if you are paying
for childbirth expenses ‘out-of-pocket’, you will want to visit the
business office at each hospital in order to learn of any special
discount they may offer for advanced payment.
BAY MEDICAL CENTER: 615 North Bonita Avenue.
Panama City, FL 32401. Located off MLK, Jr. Blvd. and 7th
Street in the S.E. part of town. The Women’s Center is located
on the 3rd Floor – closest to the main entrance.
Website: www.baymedical.org
Labor & Delivery – 747-6030
Accreditation: Full
Average births per month: 60
Birthing Rooms: 5. Operating Rooms: 2.
Postpartum Rooms: Private
Bathrooms: Complete with showers.
Infant Rooming-In: Yes
Well Baby Nursery: Yes
Lactation Consultant: T/W/Th/F and on-call
Infant Security System: Yes
Childbirth Classes: Yes, call 747-6992
Anesthesia Services: In-House 24 hours
Pediatricians: All local doctors are on-staff.
Emergency care for obstetric problems: Provided in Labor & Delivery
GULF COAST MEDICAL CENTER: 449 West 23rd Street.
Panama City, FL 32405. Located off 23 rd Street near the
intersection of State Avenue. The Women’s Center is located on
32
the 2nd Floor – closest to the main entrance.
Website: www.egulfcoastmedical.com
Labor & Delivery – 747-7700 Accreditation: Full
Average births per month: 180 Birthing Rooms: 10. Operating Rooms: 2.
Post Partum Rooms: Private Bathrooms: Complete with showers.
Infant Rooming-In: Yes Well Baby Nursery: Yes
Lactation Consultant: Part-Time
Infant Security System: Yes
Childbirth Classes: Yes, call 747-7700
Anesthesia Services: In-house 24 hours
Pediatricians: All local doctors are on-staff
Emergency care for obstetric problems: Provided in the ER until the 20th week.
After 20 weeks, care is provided in Labor & Delivery.
NEONATAL INTENSIVE CARE UNIT: A Level II neonatal
unit is maintained at Gulf Coast Hospital and is available for most
special needs babies with a birth weight of at least 1000 grams,
(a bit over 2 pounds.) The hospital contracts for the full-time
services of a neonatologist. If the baby’s birth weight is under
2 pounds or if the NICU is at full, the baby may be transferred
to another neonatal unit – generally to Sacred Heart Hospital in
Pensacola, FL. Occasionally, a baby is born with an unforeseen
problem requiring very specialized care, such as neonatal surgery.
At such times the situation is handled on an individual basis and
the baby is transferred to the hospital where that particular special
care is available.
**If you believe you may be in labor before your 35th week of
pregnancy, we recommend that you go to the Labor & Delivery
Unit at Gulf Coast Hospital for evaluation and treatment. This
is because most premature babies delivered at Bay Medical
Center are transferred to the Neonatal Intensive Care Unit at
Gulf Coast. Once you reach the 36th week of pregnancy, you
may choose to deliver at your preferred hospital. Be sure to
bring this Pregnancy Passport book with you to the hospital
– any time you go!
33
Travel
Usually, you don't need to cancel your travel plans due to pregnancy.
The best time to travel is between weeks 14 and 29. This is a time you are less
queasy and not experiencing some of the discomforts of late pregnancy. The
main risks you assume when traveling are: 1) developing a problem (labor?)
that needs medical attention while you are far from home, 2) developing
blood clots in the lower extremities from sitting in one position for too long,
and 3) developing a urinary tract infection by reducing your fluid intake or
delaying opportunities for emptying the bladder. If you plan to travel, try to
see us shortly before you leave and take this booklet (if it is up-to-date) with
you.
Travel Tips
• In case of emergency, ask your family or ask us for the name and phone
number of a doctor/hospital where you are going to travel.
• Keep your travel plans easy to change. Problems can come up at any time.
Buy travel insurance to cover tickets and deposits that can't be refunded.
• While you are en route, try to walk around about every hour. Stretching
your legs will lessen the risk of blood clots and make you more comfortable. It also will decrease the amount of swelling in your ankles and feet.
• Wear comfortable shoes and clothing. You may want to wear support or
pressure stockings.
• Carry some light snacks with you to help prevent nausea.
• Take time to eat. A balanced and healthy diet during your trip will boost
your energy and keep you feeling good. Be sure to get plenty of fiber to
ease constipation, a common travel (and pregnancy) problem.
• Drink plenty of fluids to help prevent urinary tract infections. Take a
bottle of water or some juice with you. Empty your bladder at least every
two hours.
• Don't take any medicine — including motion-sickness pills, laxatives,
diarrhea remedies, or sleeping pills — unless we prescribe it or it is listed
in this booklet.
• Get plenty of sleep, and rest often.
• Stretch your back muscles from time to time.
• Don't do too much. It's tempting to squeeze in as many sights as you can,
but it's vital to adjust your pace when you are pregnant.
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Car Safety
Seat belt use is twice as important when you are pregnant - not
only must you think about your safety, but now you must think
about the safety of your baby. Seat belts and air bags are your best
protection against injury.
The correct placement of the seat belt is important. Keep the lap portion of the belt under your
belly, low and across the pelvic area. The shoulder strap should come down over your shoulder,
between your breasts, and over the top of your
belly to fasten at the side.
Do not disable your air bag system.
Automobile manufacturers state that as
long as a pregnant woman is using
the seat belt properly, the risk of injury from the air bag is still less than
if she relies on the seat belt alone.
If you are involved in an auto accident during your pregnancy,
please call the office. Generally, we will recommend monitoring
in Labor & Delivery for you and your fetus - if you are involved
in more than a fender-bender. This will be especially important if
your seat belt engaged or your air bag deployed.
Finally, be sure to obtain a car seat for your baby before you
give birth. You will need one in the automobile when you leave
the hospital.
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When Should I Go
To The Hospital?
These recommendations deal specifically with questions
about normal labor, after 36 weeks of pregnancy. For questions of
premature labor or decreased fetal movement, please review those
topics found elsewhere in this booklet. If you are ever in doubt,
please call the office
What if my water breaks before I am in labor? This sometimes happens. If your water breaks we want you to report to Labor
& Delivery for evaluation. Usually it is obvious! If you think your
water is leaking but cannot be sure, you may try the ‘panty test’ at
home first - to help you decide. The ‘panty test’ involves taking a
clean pair of cotton panties (or a panty liner) into the bathroom with
you. Completely empty your bladder. Cleanse the vaginal region
with soapy water, rinse and dry off completely. You may use a
hair dryer to dry all your pubic hair. Put on the clean panties or the
fresh panty liner and walk about your house for about 15 minutes.
Return to the bathroom and check your panties or liner. If they are
damp or wet: 1) you know it isn't urine because you just emptied
completely. 2) you know it isn't vaginal discharge because you just
cleansed and dried. 3) you know it isn't perspiration because you
just dried off completely. In this case, the only way to know for sure
that your membranes have ruptured is to have special testing done
in Labor & Delivery. If you remain completely dry, go about your
normal activities but keep alert for continuing signs of leakage.
How will I know I am in labor? By definition, labor consists
of painful uterine contractions that cause the cervix to dilate. These
are not to be confused with Braxton-Hicks contractions that are
normal throughout pregnancy. Real labor contractions may start
out as mild and irregular but over time they progress to become
more predictable in timing, and they become stronger, more
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intense, and more painful. If your water remains intact, time your
contractions for at least an hour before deciding to come to the
hospital. Generally speaking, we want you to come to the hospital
when your contractions are 5 to 7 minutes apart and consistent in
nature. You should notice that they are becoming stronger over time.
If you are in very early labor (and your water has not broken) you
may want to walk, shop, go to a movie, or do some other activity
to help you relax. A warm bath is nice.
Is it false labor? False labor generally comes and goes. It can
be uncomfortable but it does not increase in strength or intensity
over time. Contractions are usually irregular in time and strength.
To rule out false labor, you can try the ‘water test’. Drink 3 to 4
glasses of clear liquid and lie on your side. If you are in false labor
the contractions will begin to taper off. If you are in real labor, no
amount of liquids will stop you. If you are unsure, you can report
to Labor & Delivery for evaluation. Don't be embarrassed that you
could end up being sent home. This happens frequently. It can be
hard to tell the difference!
What about Childbirth Classes? We highly recommend
them. Each hospital offers a good course in what to expect during
pregnancy and birth. Call each hospital to learn more about their
classes and which evenings they are scheduled. You do not have
to plan to deliver at the hospital where you take childbirth classes.
Choose the evening and location most convenient for you! See
phone numbers inside back cover.
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Effacement
0%
Cervix
100%
Dilation
0cm
Cervix
10 cm
Station
-5 station
0 station
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+5 station
Circumcision
If you are expecting a baby boy you will need to decide
whether or not you want to have him circumcised after
birth. Circumcision is a minor surgical procedure done to
remove the foreskin from the penis. Most baby boys in our
culture are circumcised for reasons of personal preference or
for religious beliefs. The American Academy of Pediatrics
has gone on the record to state that circumcision is not
medically necessary and should be performed only for
reasons of personal preference. In years past, we believed
circumcision was medically necessary to prevent disease.
It is now known that this is not the case. However, HIV as
well as other sexually transmitted diseases are more easily
transferred in uncircumcised males. The very small risk
involved is excess bleeding or infection shortly after surgery.
The large majority of parents choose circumcision.
What should I do right now? The most important thing
to do while you are still expecting is to think it over. Check
out a library book, visit our web site for more information,
and ask us questions. Try to have your decision made before
you deliver. Since several insurers consider circumcision
medically unnecessary they do not cover the cost of the
procedure. For example, Medicaid no longer pays for
circumcision. Contact our Insurance Department - now - for
more information regarding your insurance situation, our
fees and our payment requirement.
What if I decide to have the baby circumcised? If you
‘self-pay’ for our obstetric fees and have paid your note infull, infant circumcision is covered at no extra charge. We
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do not file for insurance payment of our fee through any
insurer except TRICARE. If you have any other form of
insurance (including Medicaid), we will collect the physician charge directly from you on the day the circumcision
is done. We will accept cash, check, money order, MasterCard, or VISA. We will be glad to give you a receipt. It
is best to have circumcisions performed while the baby is
in the hospital. If your financial situation makes an office
circumcision necessary, you will have to call to have it
scheduled. In this situation, we request that it be done by
the time your baby is two weeks old. In any case, you will
be carefully taught how to care for your baby’s penis during
the healing process.
What if I decide not to have my baby circumcised? Your
baby will do just fine. You will need to be responsible
for teaching him to carefully clean his penis and foreskin
every day while bathing. Your pediatrician and the nursery
nurses will help you learn how to do this (it is not hard to
do). Sometimes little boys become negligent about cleaning
(just like trying to avoid brushing their teeth!) and it will
be up to you to be sure they develop the habit of cleaning
themselves as a part of their daily routine. The risk you
face with neglected cleansing of the foreskin is chronic
inflammation and a potential for infection. Sometimes this
results in a decision to have circumcision done later in life.
Late circumcision generally requires hospitalization and can
be much more traumatic and painful.
Visit us at www.coastalobgynpc.com for more information
about circumcision and many other helpful topics!
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