-SOUTHERN CRESCENT WOMEN'S HEALTHCARE 1. Dear Patient:

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1 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 1 Dear Patient: CONGRATULATIONS! The physicians, nurse-midwives, and staff would like to WELCOME you to our practice. We are happy that you have selected us for your obstetrical care. The enclosed information is provided to help answer some basic questions you may have about your care or this practice and the providers. Please keep this book handy and bring it with you to your visits. We look forward to entering into a relationship with you that will extend long after you bring your baby home from the hospital. Our goal is to provide you with the best possible care and to make sure you have a positive experience with the staff and providers at SOUTHERN CRESCENT WOMEN'S HEALTHCARE. Be sure to visit our website at for more helpful information. We also offer the convenience of scheduling your appointments online. Sincerely, SOUTHERN CRESCENT WOMEN'S HEALTH CARE

2 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 2 TABLE OF CONTENTS Welcome Practice Philosophy 1 Care Team 5 General Practice Information 6 First Trimester Pregnancy Progress Record 7 You and Your Partner 8 First Trimester Fetal Development 12 OB Timeline 13 Prenatal Vitamins and Iron Information 14 Substance Use During Pregnancy 15 AFP plus Test 17 Cystic Fibrosis Carrier Testing 19 Parvo Virus (Fifth Disease) 20 Toxoplasmosis 22 General Health Information 23 Common Discomforts of Pregnancy 25 Midwives Tips for Morning sickness 28 Habits to Improve and Prevent Constipation 29 Nutrition in Pregnancy 30 Eating Safely During Pregnancy 33 Sex in Pregnancy 35 Exercise in Pregnancy 37 Work during Pregnancy 41 Wearing Seatbelts in Pregnancy 44 Community Resource Guide 45 Preventing Sexually Transmitted Disease 47 Frequently Asked Questions 48 Family Roles: Mother 49 Family Roles: Father 50 Common Feelings and Needs of Expectant Mothers 51 Common Feelings and Needs of Expectant Fathers 52 How am I Feeling 53

3 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 3 Second Trimester Second Trimester Fetal Development 55 What is Preterm Labor? 56 Counting Fetal Movements 58 Gestational Diabetes Screening Test 60 Love Shouldn t Hurt 61 Childbirth Education Classes 65 Pediatrician List 66 Travel During Pregnancy 68 Pain Relief in Labor 70 Information Regarding Disability Forms 73 Third Trimester Third Trimester Fetal Development 75 Group B Strep Testing 76 Women s Life Center Information 77 What to Bring to the Hospital 78 True versus False Labor 79 How to Tell When Labor Begins 81 What is an Episiotomy? 83 Postdate Pregnancy 84 Circumcision 85 Postpartum Topics Postpartum Care 88 Breastfeeding 90 First weeks at Home With Your Newborn 92 Sibling Rivalry Toward a Newborn 97 Methods of Contraception 99 Postpartum Depression 103 Six Care Safety Tips 108

4 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 4 GROUP PRACTICE PHILOSOPHY Southern Crescent Women s HealthCare is a group practice of Ob/Gyn physicians, Certified Nurse Midwives, and Nurse Practitioner s, based on the belief that all life is sacred and as such, is entitled to competent and compassionate care. The practitioners are well trained with excellent skills and experience in medical procedures and technology. Each physician, and certified nurse midwife is dedicated to making the birth of your baby a safe and pleasant experience. A group practice offers you the benefit and the expertise of a doctor and midwife. We provide twenty-four (24) hour coverage on a rotation basis. The rotation of call and limiting our practice to one hospital helps us provide the highest quality of care during your pregnancy. You have the option of choosing a doctor or certified nurse midwife for you primary care provider in labor and delivery. A Certified Nurse-Midwife is a registered nurse (RN) who has graduated from one of the advanced education programs accredited by the American College of Nurse-Midwives. All of the midwives at Southern Crescent Women s Healthcare have a master s degree and are licensed to practice midwifery by the Georgia State Board of Nursing. We have offices conveniently located in Clayton, Fayette and Henry counties to better meet the needs of our patients.

5 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 5 Southern Crescent Women s HealthCare Professional Staff Southern Crescent Women s Healthcare is proud of the team of professionals dedicated to the delivery of quality obstetrical and gynecology care. This group of highly trained individuals will be available to you throughout your pregnancy and will continue to provide outstanding gynecology care through your well woman visits. In a large group practice, however, you may not have the time to actually meet all of the providers prior to your delivery. We have included a short biography section of the professionals that you have selected for your care. PHYSICIANS W. Darrell Martin, M.D., F.A.C.O.G Elizabeth Killebrew, M.D., F.A.C.O.G Sharon A. Lynch-Miller, M.D., F.A.C.O.G Benita Bonser, M.D., F.A.C.O.G Crystal O. Slade, M.D., F.A.C.O.G. Cynthia A. Nater, M.D. Dr. Al Reynolds and Dr. Edwin Bello, Board Certified OB/GYN physicians, who also practice at Southern Regional Medical Center, provide occasional call coverage for the practice. CERTIFIED NURSE-MIDWIVES Kate Fouquier, MSN, CNM Kay Flowers, MN, CNM Desiree Clement, MS, CNM Helen Bailey, MSN, CNM Angel Miller, MSN, CNM NURSE PRACTIONERS Becky Oskey, A.R.N.P. You may schedule your prenatal visits at any of our convenient office locations Highway 54 west, Suite Upper Riverdale Road, Suite D Fayetteville, GA Riverdale, GA 1215 Eagle s Landing Parkway, Suite 209 Stockbridge, GA APPOINTMENTS

6 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 6 Midwives Kate Fouquier is a certified nurse-midwife who has been practicing since She received her nursing degree in 1976 and traveled for twenty years with her husband, Mark, throughout his career as an officer in the United States Army. In 1995, she began her midwifery training through the Frontier School of Nurse-Midwifery in Hyden, Kentucky, receiving her Master of Science, Nursing degree from Case Western Reserve University in Cleveland, Ohio. Kate and Mark have three children and four grandchildren, to date. Kate enjoys quilting, is an avid reader, and each winter heads to the mountains for a week of snow skiing. She is active on the national level with American College of Nurse-Midwives, the professional organization for CNMs. Kay Flowers as been a certified Nurse-widwife, practicing since She received her RN from Piedmont Hospital School of Nursing then joined our staff as an RN. She also was determined to be a nurse-midwife and returned to school at Emory University. Kay completed the Nurse- Midwifery program at Emory University with her Masters Degree. Kay and her husband live in Clayton County and are very active with events in their area. Desiree Clement has been practicing since 2003 after completing her Master s degree at the University of Maryland. She comes to us with a strong, diverse background in nursing and has worked in many capacities and settings due to her husband s career in the military.

7 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 7 Midwives Helen Bailey has been practicing sine 2000 after earning her Masters degree at the University of Miami. She has worked in all areas of OB and has an extensive background in high risk obstetrics. She enjoys utilizing her knowledge and expertise to support women throughout their childbearing years and beyond. Angel Miller is a certified Nurse-Midwife who has been practicing since She received her nursing degree in 1986 and earned her Bachelor of Science and Master of Science degrees in Nursing at Case Western Reserve University, Cleveland, Ohio. She is certified in nursemidwifery by the Frontier School of Midwifery and Family Nursing in Hyden, Kentucky. She recently relocated to Peachtree City, Georgia with her husband Randy and German Shepherd Bear in January She is cofounder and CEO of a successfully independent nursemidwifery practice, Womanplace Specialties, located in northeast Ohio which began in 2002 and is still flourishing. Angel has provided a comprehensive range of services in women s health, including many years experience as a labor and delivery nurse. Angel and Randy have two sons, the youngest who is in college. Angel enjoys a variety of music, loves dancing and swimming.

8 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 8 Nursing Staff Becky Oskey, Clinical Services Director. Becky is located in our Fayetteville location. As a retired Lieutenant Colonel from the United States Army, Becky brings with her over 20 years in the medical profession. Becky is responsible for the oversight of all clinical services which include nursing staff, ultrasonographers, dexascan and mammography follow-up personnel. Kelli Kalen, RN, Nurse Manager. Kelli is located in the Fayetteville office. She is a Registered Nurse who received her Bachelor of Science degree from Central Missouri State University. She has over 11 years experience as a RN and is responsible for the entire staff of medical assistants and oversees their scheduling and training. In addition, she is also responsible for the management of our lab staff. Patty Shelton, LPN, Triage. Patty is responsible for triage of our OB patients over the phone, coordinates same-day OB or work-in appointments and notification of abnormal lab results.

9 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 9 Practice Administration Diana Blondeau, CMPE, Administrator. Diana has been with Southern Crescent Women s Healthcare for many years and has over 20 years experience in the medical field. Diana is responsible for the overall administration of the practice and also functions as the practice s Privacy Director. Any concerns about your personal privacy should be directed to her. All employees report either directly or indirectly to Diana. Vanessa Dickens, M.Ed., Business Office Manager. Vanessa is responsible for the oversight, training, and direction of the appointment schedulers, front desk and switchboard at the Fayetteville office and the care and handling of medical records. Prior to her service at Southern Crescent, Vanessa spent many years in the rehabilitation and counseling field and has extensive experience with the insurance industry. LuAnn Liguori, Office Manager-Riverdale, Billing Office Manager. LuAnn is located at the Riverdale office servicing our patients from Clayton County and the surrounding area. She has been on the Southern Crescent team for over 5 years and has over 18 years of experience in the medical field. LuAnn is responsible for the oversight of the Riverdale office and all functions related to billing. Reporting to LuAnn are: billing/collection staff and front desk staff at the Riverdale office.

10 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 10 Practice Administration Charlotte McMillan, Office Manager- Stockbridge, Human Resource Manager. Charlotte is located at the Stockbridge office serving our patients from Henry County and the surrounding area. She has been on the Southern Crescent team for over 15 years. In addition to the oversight of operations at the Stockbridge office, Charlotte s responsibilities include Corporate Accounting and Human Resource functions and front desk personnel at Stockbridge. Julie Copeland, Referral Coordinator. Julie is located in the Fayetteville office. She has been a dedicated and excellent member of the team for over ten years and has many years of experience in the medical community. Julie is responsible for referral management for all patients within the practice. Kim Wright, Surgery Coordinator. Kim is located in the Fayetteville office. Kim is relatively new to the practice but has 8 years of experience in the medical field. She is responsible for the entire process revolving around the scheduling of surgery, including Cesarean Sections.

11 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 11 GENERAL PRACTICE INFORMATION A. Office Locations We have three convenient locations to serve our patients, and for the majority of your appointments, you can choose the location that is most convenient for you. However, because of equipment or staffing, a three hour glucose tolerance test can only be scheduled in the Fayetteville or Riverdale office. B. Appointments Appointments are scheduled for all of our patients at the time of your visit, by telephone or online at Please remember that it is critical for the continued good health of both you and your baby that you keep your appointments. PLEASE CALL 48 HOURS IN ADVANCE TO CANCEL OR RESCHEDULE APPOINTMENTS. Calling to cancel an appointment in advance will prevent a charge for no show appointments. Please try to reschedule your appointment to occur within one week maximum of the cancelled or missed one. Please see the enclosed OB Timeline for visit information. C. Ultrasound You will have a scheduled ultrasound around 20 weeks, unless you are referred to a specialist. Additional ultrasounds will be performed before or after this one as medically necessary. D. Phone Calls An OB phone nurse is available to answer questions or arrange work-in appointments if necessary Monday through Friday 8:30 am 4:30 pm. You can reach the nurse by calling You will speak to the operator who will forward your call, or if you get the automated system you will be given the choice of three options. * 1 - If this is an emergency and you need to speak to someone right away, this option will transfer you to the answering service and they will page the midwife on call. She will call you back as soon as possible. * 2 - If this is an urgent call you will be able to leave a message and the phone nurse will return your call within two hours. * 3 - If this is a non-urgent question you can leave a message and someone will return your call within 24 hours. After office hour calls will automatically be sent to the answering service and the midwife will return your call. After office calls should be limited to emergency calls only.

12 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 12 PREGNANCY PROGRESS RECORD Name Due Date 1 st visit 2 nd visit 3 rd visit 4 th Visit 5 th visit 6 th visit 7 th visit 8 th visit 9 th visit 10 th visit Date Weeks Pregnant Blood Pressure Weight Fundal Height Baby s Heart Rate Is the Baby Moving? NOTES

13 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 13 Congratulations you are going to be a parent! You and Your Partner Pregnancy is a time of change for the woman, her partner, and often a couple. Understanding these changes and knowing how to cope with them will help you to enjoy and take part in this special time in your life. This section presents a number of topics of interest to not only the expecting mother but also the expecting partner. Prospects of Parenthood The news that you will soon be a parent can bring unexpected emotions. You may have mixed feelings about pregnancy. You may feel joy and excitement about becoming a parent. At the same time, you may wonder if you can meet the financial and emotional responsibilities of raising a child. You may be concerned about how pregnancy and a child will change your life and your relationship with your partner, including your sexual relationship. New fathers may also feel unsure of their role during birth and as a father in general. These feelings are normal. Being honest with yourself and talking openly with your partner about your concerns can help you come to terms with emotions. It is also normal during pregnancy for the prospective parents to focus on issues that did not seem important before. Separately, you may both think about your own relationship, childhood, relationships with your parents, and hopes for your future family. Importance of Fathers Children need their fathers as well as their mothers. The role as a father can begin long before your baby is born. Men no longer fit the stereotype of not being involved until they bring the mother and baby home from the hospital. Fathers today can play an active role in pregnancy and childbirth. Partners can have a positive effect on their partner s pregnancy. Research suggests that women with supportive partners have fewer health problems in pregnancy and more positive feelings about their changing bodies. Studies also suggest that labor and birth is easier and shorter for women whose partners take part in the process. Physical and Emotional Aspects of Pregnancy Early Pregnancy Early in pregnancy, most women feel tired, need more sleep, urinate frequently, and have sore breasts. Nausea and vomiting known as morning sickness are also common. This can happen at any time of the day or night, not only in the morning. Early pregnancy is an emotional time for a woman. Sudden changes in mood are common, and she may focus her thoughts inward. Mixed feelings are common for new dads, too. They may be concerned about their partner s health. At the same time, men may feel left out as their partner focuses on her changing body and emotions. Knowing these changes are a

14 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 14 natural part of early pregnancy will help you to support each other and resolve some of your own feelings. This is a good time to get involved in having a healthy pregnancy. You and your partner can adapt your lifestyles to include a balanced diet, plenty of sleep, and exercise and to eliminate use of alcohol, tobacco, and other drugs. You should form or strengthen your own health habits now. Working together for a healthy lifestyle will benefit you, your partner, and your baby. Middle Pregnancy For most women, the middle of pregnancy is the most enjoyable part. As the woman s body adjusts to being pregnant, she usually begins to feel better. Her normal energy level returns, and morning sickness usually goes away. Some women may feel sick throughout their pregnancy. As the woman s abdomen grows, the pregnancy becomes more obvious to others. You will soon both be able to feel the baby move and may listen to its heartbeat during visits for prenatal care. Both of you may find this to be an exciting time. Late Pregnancy In the later part of pregnancy, the woman may again feel some discomfort as the baby grows larger and her body readies for birth. She may have trouble sleeping and doing routine tasks that require moving around. You both may be impatient with the pregnancy and be both excited and fearful about the upcoming birth. Women may fear for the safety of themselves and their baby during childbirth and partners may be anxious about how they will react during birth. These feelings are normal. Be honest with each other about your concerns. Late pregnancy is usually the time when most couples take childbirth classes to help them prepare for labor and birth, and breastfeeding. These classes offer a chance to learn and work together and can address many of your concerns. Pregnancy and Sexuality The changes of pregnancy can affect sexuality and levels of sexual desire for both of you. It is normal for a woman s sex drive to change with the stages of pregnancy as her body image changes and discomforts come and go. Your partner s sexual feelings may also changes as the pregnancy progresses. Being honest with each other about your needs and emotions is the key to continued intimacy and will help you enjoy a happy and satisfying sexual relationship during pregnancy. Many couples wonder if sex is safe in pregnancy and if intercourse will harm the baby or the woman. In a pregnancy with no problems, sex is considered safe and healthy. The woman s comfort should be the most important guide during sex. As pregnancy advances, you and your partner may wish to use positions that do not put pressure on her abdomen, such as lying on your sides together or you lying beneath her. If the pregnant partner does have health problems during her pregnancy, ask your care provider whether sex will be safe. If certain complications exist, you may be advised to modify your lovemaking, to use a condom during sex, using dental dams for oral sex, or to abstain from having intercourse for the health of the woman or the baby.

15 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 15 Do not have sex if the pregnant partner has any bleeding or preterm labor contractions, or if her bag of water breaks before labor. Childbirth Preparation Childbirth preparation classes are designed to give information on labor and birth. They offer another way for expectant partners to be actively involved with pregnancy and birth as the primary support person. The support person can be someone other than the father. Most classes include information on the physical process of pregnancy, labor and birth and teach couples how to use breathing and relaxation to help the woman during labor. The support person s role during labor and birth is stressed. Teamwork between the woman and her partner is encouraged during classes, and couples are urged to practice their skills together at home. The goal of childbirth classes is to make you as informed and comfortable as possible. Any questions that you may have should be written down and discussed at your prenatal visit. Labor and Birth The support person s role during labor and birth is to provide emotional support and physical comfort t the mother (helping with relaxation and breathing techniques, massage, and taking care of the needs like thirst, etc) and to help communicate with the hospital staff. The support person is also there to share in the birth of the child. Birth is now viewed in most hospitals as a family event, and your partner will be able to see as much or as little of the birth as you may wish. There may be points at which your partner feels uncomfortable or queasy. This is normal. But, your partner should try to stay and help the mother through birth. Being there and being part of the child s birth is an important and special time. Most hospitals recognize this and provide personal time right after the birth for the family to get to know each other for the first time. Unexpected situations may arise during labor and birth that require the full attention of the care provider and medical staff. In such a situation, family members other than your support person may be asked to leave the delivery room. Some partners may decide not to attend the birth. There are other ways to support the mother such as taking an active role in caring for the mother and baby after the birth, even before they leave the hospital. Finally. Having a baby is a family affair. Today, families can be defined many different ways. It is important to remember that parenting begins during pregnancy and having loving support is important for the woman and the newborn. Fathers/partners are important parents, right from the start. The more informed you both are during pregnancy, the better the experience will be for your growing family.

16 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 16 FIRST TRIMESTER

17 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 17 FIRST TRIMESTER FETAL DEVELOPMENT CONCEPTION TO SIX WEEKS OF PREGNANCY For the first eight weeks, your developing baby is called an embryo. The baby is growing inside a sac of amniotic fluid (bag of waters). Hereditary characteristics, such as, eye and hair colors were set when the sperm met the egg. The brain, nervous system, heart and lungs are forming. Tiny spots for ears, eyes and nose are showing. The arm and leg buds are forming. Your baby will be about ¼ inch to 1 inch long and will weigh less than 1 ounce. SEVEN TO ELEVEN WEEKS OF PREGNANCY This is a key time in your baby s development. All the major body organs and systems are formed though not completely developed The heart is beating. The baby s heartbeat is 120 to 160 beats per minute The stomach, liver, and kidney are developing The umbilical cord has formed; it will deliver nutrients from mother to baby until cut at delivery Eyes and ears are in a critical time of growth Facial features are forming. The head is large, since the brain grows faster than the other organs. Cartilage, skin, and muscles are starting to shape your baby s body. Fingers, toes, fingernails, ears, ankles, and wrists are forming. After eight weeks the embryo is called a fetus. The baby is still too tiny for you to feel movement. Your baby will weigh about ½ ounce to 1 ounce and will be about 2 ¼ inches long. TWELVE TO FIFTEEN WEEKS OF PREGNANCY If you could see inside the uterus, the sex of the baby would be easy to identify. The ears, arms, hands, fingers, legs, feet and toes are formed. The neck is well shaped and can support the head. Reflex movements allow your baby s elbows to bend, legs to kick and fingers to form a fist. Your baby s vocal cords are formed. Blood is now traveling through the umbilical cord to the baby and will continue to do so until the cord is cut at delivery. The face is looking more and more human each day as the eyes begin to move closer together instead of being on the sides of the head and the ears move to a normal position. The intestines move farther into the baby s body; the liver begins to produce insulin. Your baby begins to practice inhaling and exhaling movements. Your baby will weigh about ¼ pound and will be about 2 ¼ inches long.

18 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 18 Normal Pregnancy OB Visit Timeline First Trimester (6-14 weeks gestation) 1 st visit Establish pregnancy with MD, Nurse Practitioner (NP), or Certified Nurse- Midwife (CNM). A physical exam, prenatal blood work, vaginal/urine cultures, and Pap smear, as needed. New OB information folder will be given. Your next visit will be scheduled for 2-4 weeks, depending on need. 2 nd visit New OB visit with Certified Nurse-Midwife for detailed medical/surgical history review, discuss lab, Pap and culture results. A plan will be developed and initiated based on identified needs and/or problems. Introduction of SCWH practice and providers, educational materials given and reviewed, and care options presented. Baby s heartbeat will be listened to between weeks gestation. A pregnancy information booklet will be given. Second Trimester (14-28 weeks gestation) weeks AFP Plus test offered- see information sheet weeks Ultrasound for dating confirmation and fetal anatomy scan. Next visit is scheduled for 5 weeks, more frequently as indicated. Sign up for childbirth classes weeks Diabetic Screening, CBC (anemia screen), RhogGam for RH negative mothers- Informed consents read and signed. Next visit is scheduled for 3-4 weeks, more frequently as indicated. Third Trimester n (28-42 weeks) weeks Start attending Childbirth Classes. Visits every 3 weeks, more frequently as indicated weeks Group B Strep (see information sheet) and repeat CBC. Pelvic exam if indicated or if requested. Visit scheduled in 2 weeks until 37 weeks, more frequently if indicated weeks Weekly visits, more frequently as indicated. Pelvic exams starting at 40 weeks, earlier as indicated or if requested. Possible induction of labor discussed at 40 th week visit. Inductions are not scheduled for earlier than 41 weeks gestation, unless medically indicated. Congratulations On the Birth of Your Baby!

19 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 19 PRENATAL VITAMINS AND IRON INFORMATION SHEET Prenatal Vitamins: Buy these over the counter (on the shelf) at Wal-Mart. They cost about $8.75 for 240 vitamins (eight month supply). Take one pill every day, about two hours after eating with water or juice. Do not take them on an empty stomach and try not to take them with food or caffeinated drinks (for example: soda or coffee). If your stomach gets too upset when you take the prenatal vitamins, buy children s chewable vitamins (example: Flintstones) and take two pills every day (together or at separate times). Follow the same instructions for taking them as for the prenatal vitamins. Iron Pills (Ferrous Sulfate 325 mg. tablets): If your blood count is low, and you are anemic, we may ask you to take one or two iron pills every day. You can buy these over the counter (on the shelf) at Wal-Mart. They cost about $4.99 for 250 pills. Take the pills every day, two hours after eating with water or juice. Take it at a separate time of day from your prenatal vitamin. Do not take them on an empty stomach and try not to take them with food or caffeinated drinks (for example: soda or coffee).

20 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 20 SUBSTANCE USE DURING PREGNANCY What is substance use in pregnancy? Anything you eat, drink, swallow, or even breathe goes through your blood to your baby through a special organ called the placenta. All the food and oxygen the baby needs to grow goes through the placenta. Harmful things like alcohol, drugs, and cigarette smoke also move through the placenta to the baby. Even medications and caffeine can go through the placenta to your baby. If you are pregnant, any of these things can hurt your baby. For example alcohol, drugs, and tobacco can cause: Birth defects and lifelong learning problems Miscarriage, stillbirth, and infant death Low weight at birth What about Alcohol? When you drink alcohol, so does your baby. Because your baby is so small and growing so quickly, this is very dangerous. The more you drink, the greater the danger to your baby. Alcohol can cause lifelong health problems for your baby. Alcohol use can cause babies to be born with a birth defect called fetal alcohol syndrome (FAS). Babies with FAS: Have small heads and heart defects Not grow as they should Have learning problems It s best not to drink at all when you are pregnant. If you are drinking, the time to stop is now. But that may not be easy. If you need help, call our office for an appointment. What about street drugs? Pregnant women should not use any street drugs. Babies of women who use drugs may have lifelong problems or even die. Using drugs can also harm the mother. Using cocaine and other drugs can cause miscarriage, stillbirth, or brain damage. Marijuana can cause a baby to be born too early or too small Drug use can put the mother in danger too. For example, using drugs can cause the placenta to separate from the inside of the uterus before the baby is born. This can cause severe bleeding that may lead to death for the mother and the baby. It s best not to use drugs at all when you are pregnant. If you use drugs, the time to stop is now. But that may not be easy. If you need help, call our office for an appointment.

21 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 21 What about smoking? When you smoke, less oxygen gets to you and your baby. This makes it harder for you to have a healthy pregnancy. You may have a miscarriage Your baby may be born too small or too early Your baby could have learning problems or other health problems later on. Sudden Infant Death (SIDS) happens more often in babies whose mothers smoke or who live in homes with second hand smoke. If you smoke, stop now. It s not easy to quit. Call the American Lung Association for ideas, classes, or support groups ( ). Another resource is the American Cancer Society at

22 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 22 ALPHA FETO-PROTEIN PLUS (AFP PLUS OR TRIPLE SCREEN) BLOOD TEST Why is this test being offered? The triple screen blood test is offered to all pregnant women in our practice between 15 to 21 weeks gestation. It can only be done during those weeks for it to be reliable. The test screens for the amount of three substances in the mother s blood: 1. AFP (Alpha-Fetoprotein) a protein produced by the growing fetus which is present in the baby s blood, the amniotic fluid, and in small amounts in the mother s blood. 2. hcg (Human Chorionic Gonadotropin) a hormone produced by the placenta 3. Estriol a hormone produced mostly in the placenta and liver of the fetus. The amount of these three substances found in the mother s blood provides an indication that there is a risk that a baby has an open neural tube defect, Down s syndrome, or Trisomy 18. If your screening test shows a higher-than-average risk for having a baby with a certain defect, further tests may be used for diagnosis. Most women with abnormal screening tests have normal babies. What is an Open Neural Tube Defect (NTD)? With an open neural tube defect, part of the fetus body has not developed a skin covering. These open fetal defects occur most often in the abdominal wall or around the spine. The most common open neural tube defects occur around the baby s spine. With an open neural tube defect, the fetus brain, spinal cord, or their coverings do not form normally. It is important to note that NTDs are very rare, occurring in only 1-2 babies out of 1000 births. Spina Bifida is one type of NTD. When spina bifida is open (not covered by skin), it may be detected with testing. The effects of spina bifida vary. Some people with spina bifida have only mild problems. In others, it may cause leg paralysis, loss of feeling, lack of bladder and bowel control, hydrocephalus (water on the brain), mental retardation, or even death. Another type of NTD, anencephaly, occurs when the brain and head do not develop normally. Babies with this are either stillborn or die soon after birth. What is Down s syndrome? Normal cells have 46 chromosomes arranged in 23 pairs. In Down s syndrome, there is one extra copy of a chromosome on chromosome 21; therefore, it is called Trisomy 21. Down s syndrome causes mental retardation to varying degrees and sometimes birth defects, such as heart defects. Affected people have certain facial feature: a flat face, slanting eyes, and low-set ears. Even though it is one of the most common genetic (or chromosomal) problems that can happen to the fetus, it still occurs only in about 1 in 800 births. The risk of having a live baby with Down s syndrome increases with a women s age. For example, a 20 year old woman only has a 1 in 1,667 risk while a woman who is 35 has an increased risk of 1 in 378, and a 40 year old woman has a 1 in 106 risk.

23 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 23 What is Trisomy 18? This is an extra chromosome on chromosome 18. Babies with this syndrome are usually severely retarded and may die before birth or in early infancy. How is the test results reported? The test result is reported as a positive or negative. A positive screen means that there is a risk (not that the baby definitely has the defect) of certain birth defects. However, most of the time, the reason for a positive result is NOT a birth defect. The most common reasons for a positive screen result include: The due date is earlier or later than thought The substances being tested for had more variation than usual, without any fetal defects There is more than one fetus (twins or triplets) A positive screen means that there is a need for further testing. You will have an ultrasound first to see if the positive screen is simply because of a different due date. If you re original due date is correct, we will refer you to Atlanta Maternal-Fetal Medicine, P.C. These physicians are specialists who will perform a more extensive ultrasound, any other testing necessary and will provide genetic counseling regarding the specific risk that your baby has. Even those women with a positive triple screen result have a greater than 95% chance of having normal follow-up tests and delivering babies who do not have open neural defects or Down s syndrome. If the Triple Screen test is normal, does that mean that everything will be perfect with my baby? It is important to note that not every normal result of a screening test results in a baby born without birth defects. Not all cases of open fetal defects, Trisomy 18, or 21 can be predicted by testing. How helpful is the Triple Screen Test in detecting the birth defects it is checking for? No medical test is perfect. The Triple Screen test has been shown very helpful at screening for certain defects. If there is one of the following defects, the triple screen, followed by indicated added tests, will help detect it. In a California study, the triple screen with followup detected: 97% of anencephaly cases 80% of open spina bifida cases 85% of abdominal wall defects 50% or more of trisomy 18 cases In women aged 35 and under, 40-66% of Down s syndrome cases.

24 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 24 CYSTIC FIBROSIS INFORMATION SHEET What is Cystic Fibrosis? Cystic Fibrosis is a serious disease that affects many parts of the body. It causes the glands that help us to digest food, make sweat, and moisten the linings of airways in our lungs to not work right. It can cause a man to be sterile. It can also show up as problems with digestion, breathing and sweating. It most commonly causes repeated lung infections and bronchitis. What causes Cystic Fibrosis? It is a condition that is inherited from both parents. Each parent must be a carrier of a gene that does not work correctly. This one gene may be passed to the child. If it ism the child may be born with the problem. Carriers of this gene rarely show signs of the disease. If only one parent is a carrier of the gene, the child will not be born with cystic fibrosis. If both parents carry the gene, they have a 1 in 4 chance of having a baby with the disease. In other words, 3 out of 4 times parents who are both carriers will have a baby that does not have the disease. For each and every pregnancy of both carrier parents there is a 2 out of 4 chance that the baby will be a carrier but will not have the disease. There is also a 1 in 4 chance that the baby will not have received any of the genes that cause this and will not be a carrier of the disease. How common is Cystic Fibrosis? In the United States, it is most common in Caucasians, with 1 person in every 2,500 being affected by the disease. One out of 25 Caucasians are carriers of this gene and do not have problems with the disease. It is rare in non-caucasians. 1 in 11,500 Hispanics, 1 in 14,000 African-Americans, and 1 in 25,000 Asians. Who should consider testing? If you or the father of the baby is Caucasian Anyone with a relative that has cystic fibrosis If the baby s father is a known carrier Anyone with a medical problem that may be from cystic fibrosis Anyone told by a genetic counselor that there is an increased risk The decision to have the testing done is a personal one for you and the baby s father. This disease is a serious problem for the children who are affected by it. However, almost no insurance companies currently cover the charge for testing. It is covered by Georgia Medicaid. The cost for the test is about $375 each. If you are pregnant and both you and the baby s father are carriers, testing can be done on the baby while still inside the uterus to see if it has cystic fibrosis. This test is done by amniocentesis or CVS sampling. To learn more about this test and about Cystic Fibrosis: Cystic Fibrosis Foundation National Society for Genetic Counselors 6931 Arlington Road Executive Office Bethesda, MD Canterbury Drive Wallingford, PA If you contact your insurance company regarding coverage for this test, you will need the following information: CPT code: 83891, 83912, 83901, Diagnosis code: V77.6 Test code:

25 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 25 PARVOVIRUS B19 INFECTION (FIFTH DISEASE) What is Parvovirus B19? Parvovirus B19 is a virus that commonly infects humans; about 50% of all adults have been infected sometime during childhood or adolescence. Parvovirus B19 infects only humans. There is animal parvovirus, but they do not infect humans. Therefore, a person cannot catch Parvovirus B19 from a dog or a cat. What illnesses does Parvovirus B19 infection cause? The most common illness caused by parvovirus B19 infection is fifth disease, a mild rash illness that occurs most often in children. The ill child typically has a slapped Cheek rash on the face and a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. The child is usually not very ill, and the rash resolves in 7 10 days. Once a child recovers from parvovirus infection, he or she will develop lasting immunity, which means that the child is protected against future infection. An adult who has not previously been infected with parvovirus B19 can be infected and become ill. They may develop a rash, or joint pain, or swelling, or both. The joint symptoms usually resolve in a week or two, but they may last several months. Are these illnesses serious? Fifth disease is usually a mild illness. It resolves without medical treatment among children and adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without longterm disability. During outbreaks of fifth disease, about 20% of adults and children are infected without getting any symptoms at all. Is there any way I can keep from being infected with Parvovirus B19 during my pregnancy? There is no vaccine or medication that prevents parvovirus B19 infection. Frequent hand washing is recommended as a practical and probably effective method to reduce the spread of parvovirus. Excluding persons with fifth disease from work, child care centers, schools, or other settings is not likely to prevent the spread of parvovirus, since ill persons are contagious before they develop the characteristic rash. I ve recently been exposed to a child with fifth disease. How will this affect my pregnancy? Usually, there are not serious complications for a pregnant woman or her baby because of exposure to a person with fifth disease. About 50% of women are already immune to parvovirus B19, and these women and their babies are protected from infection and illness. Even if a woman is susceptible and gets infected with parvovirus B19, she usually experiences only a mild illness. Likewise, her unborn baby usually does not have any problems attributable to parvovirus B19 infection. Sometimes, however, parvovirus B19 infection cause the unborn baby to have severe anemia and the women may have a miscarriage. This occurs in less than 5% of all pregnant women who are infected with parvovirus B19 and occurs more commonly during the first half of pregnancy. There is no evidence that parvovirus B19 infection causes birth defects or mental retardation.

26 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 26 If I ve been exposed to someone with fifth disease, what should I do? If you are exposed to someone with fifth disease, call the office and we will perform a blood test to see if you have become infected with parvovirus B19. A blood test for parvovirus may show: (1). You are immune to parvovirus B19 and have no sign of recent infection; (2) that you are not immune and have not yet been infected; (3). That you have had a recent infection. If you are immune, then you have nothing further to be concerned about. If you are not immune and not yet infected, then you should try to avoid further exposure to fifth disease. If you have had a recent infection, we will discuss your plan of care. There is no universally recommended approach to monitoring a pregnant woman who has a documented parvovirus B19 infection. At SOUTHERN CRESCENT WOMEN'S HEALTHCARE, we will refer you to the perinatalogist for ultrasounds and possibly more blood tests. If the unborn baby appears to be ill, other diagnostic and treatment options are available, and we will discuss these options with you and their potential benefits and risks.

27 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 27 TOXOPLASMOSIS What is toxoplasmosis? Toxoplasmosis is an infection caused by the parasite Toxoplasmosis gondii. More than 60 million people in the United States probably carry the parasite, but very few have symptoms because the immune system usually keeps the parasite from causing illness. However, expectant mothers should be cautious because an infection can cause problems in pregnancy. How is toxoplasmosis spread? Cats play an important role in the spread of toxoplasmosis. They become infected by eating infected rodents, birds, or other small animals. The parasite is then passed in the cat s feces. Litter boxes, garden soils, and sand boxes are used for elimination by cats and can be a source of contamination. You do not have to give up your cat! The best way to protect yourself and your unborn child: Wash your hands with soap and water after exposure to soil, sand, raw meat, or unwashed fruits and vegetables. Cook your meat completely (no pink should be seen and the juices should be clear). The internal temperature of the meat should reach 160 degrees Do not sample meat until it is cooked Wash all cutting boards and knives thoroughly with hot soapy water after each use Wash and /or peel all fruits and vegetables before eating them Wear gloves when gardening or handling sand from a sandbox. Wash hands well afterward. Avoid drinking untreated water Do not change litter boxes

28 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 28 GENERAL HEALTH INFORMATION 1. It is best if you do not use any medications during the first 12 weeks of your pregnancy, unless recommended for a specific condition. It is a general rule that medications should be avoided during pregnancy unless indicated but, if a specific condition develops, there are a number of medications that have been widely used for years and have been demonstrated to have a wide margin of safety. 2. Take your prenatal vitamins daily, about two hours after eating with water or 100% fruit juice. Do not take them first thing in the morning on an empty stomach. If you are unable to find a prenatal vitamin that you can tolerate, take two children s chewable vitamins as a substitute (together or separately as with a prenatal vitamin: two hours after eating with water or 100% fruit juice). 3. We recommend that you decrease your intake of caffeinated drinks to two servings per day (including coffee, teas, and colas with caffeine) during pregnancy. If you are a heavy user, decrease gradually to prevent caffeine withdrawal headaches. 4. Avoid alcohol. There is no amount that is considered safe. 5. Nausea and vomiting are common in early pregnancy. Try the suggestions listed on the Tips for Morning Sickness information sheet. If nothing stays in your stomach for greater than forty-eight (48) hours after following the information sheet s recommendations, call the triage nurse or nurse-midwife on call. 6. If you get a minor illness, such as a cold, runny nose, mild sore throat, slight fever (temperature under 100.4, which lasts less than 3 days) chills, muscle aches or headache, the medications below can be used. 7. If a fever (temperature of or greater) develops, take extra strength Tylenol (two pills every three to four hours) to keep your temperature less than COLD, HAYFEVER & HEAD CONGESTION Follow the directions on the package and do not exceed the recommended dose Any products in the following families of drugs: Tylenol (e.g., Tylenol Severe Cold and Sinus), Benadryl, Robitussin, Sudafed, Actifed, Triaminic, Chlor-Trimeton, Claritin) Other comfort measures for colds include: Salt water nasal drops; warm, wet compress to your sinus area to help them open and draining; keep room heat on a lower setting - it helps keep the air from being too dry; a vaporizer or humidifier can help keep moisture in the air; sleep on extra pillows to keep your head elevated; be sure to drink lots of fluids, such as, 100% fruit juices and water to help keep you will hydrated.

29 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 29 Coughs The only active ingredient found to be effective in over-the-counter cough medicines is DM (dexatromethoraphan), e.g., Robitussin DM Sore Throat Chloraseptic spray Warm salt water gargles Throat lozenges Diarrhea Avoid foods containing milk products and caffeine. Kaopectate (although has not been shown to be as effective as Imodium) Imodium AD Constipation Fibercon Metamucil Citrucel Colace 100mg tablets twice a day Unrefined bran 1-2 teaspoons twice daily Uncle Sam s cereal works Milk of Magnesia or a Fleets enema at bedtime if condition unresolved by other methods Hemorrhoids Tucks may want to keep them cool in refrigerator for increased pain relief Anusol HC cream and suppositories Ice packs Heartburn & Gas Liquid remedies work more effectively for rapid relief than do tablets. Products containing simethicone Tums Mylanta Complete Maalox Max Papaya Riopan Pepcid AC Pepcid Complete Zantac Fever, Muscle Aches and Headaches Tylenol-Regular Strength 2 tablets every 4-6 hours Tylenol Extra Strength 2 tablets every 4-6 hours AVOID: aspirin products, ibuprofen products, such as, Advil, Nuprin and Motrin IB, and naproxen products, such as, Aleve or Anaprox during pregnancy, unless directed to take by your provider.

30 -SOUTHERN CRESCENT WOMEN'S HEALTHCARE 30 COMMON DISCOMFORTS OF PREGNANCY DISCOMFORT ORT CAUSE ACTIONS Bad Dreams *Subconscious fears *Talk with someone supportive *A way of working *They are not predictive through concerns *High hormone levels Bleeding Gums *Increased blood volume *Use a soft toothbrush/ brush gently *Congested mucous *Eat more foods with Vitamin C membranes *Floss daily Bowel Changes *Decreased movement *Eat raw fruits, vegetables, prunes (Constipation) of intestines due to and whole grain or bran cereals pregnancy hormones *Drink lots of water (8-10 glasses daily) *Not enough fiber/fluids *Drink a cup of hot water 3x a day in diet *Exercise (walk) *Pressure from growing *See information sheet uterus Dizziness * Effects of pregnancy *Get up slowly when you have been hormones on bl. Vessels lying down (they constrict more slowly) *Drink 8-10 glasses of water daily *Sudden changes of *Eat regular meals position (standing up) *Do not stay in the sun too long *Enlarged uterus restricts *If cannot resolve with common remedies, return of blood from lower report symptoms to provider extremities to brain Fatigue *Changes in hormones *Exercise each day *Lie down at least once a day *Eat 5-6 meals a day Frequent Urination *Pressure on bladder *Limit fluids in the evening from growing uterus *Avoid caffeine it s a diuretic *Call health care provider if it is associated with burning, fever, or significant back pain Headaches *Changes in hormones *Drink more water cause pressure in blood *Get more rest vessels to change *Eat a snack *Stress, fatigue, hunger *Exercise *Take Tylenol *If frequent, severe headaches occur in late pregnancy, this may be a sign of a more serious problem; you should inform your provider Heartburn *Stomach acid gets into *Don t lie down after eating for 2 hrs. the esophagus *Avoid spicy and greasy foods *Take antacids (see approved meds list)