Premier Women's Health and Pregnancy Appointments

Transcription

1 Premier Women s Health A Prescription for a Healthy, Happy Pregnancy Appointments Normal, healthy patients are seen as follows: Every 4 to 5 weeks during the first 28 weeks of pregnancy. Every 2 weeks during weeks 28 through 36 of pregnancy. Weekly visits after the 36 th week of pregnancy. Patients with complications in pregnancy may need to be seen more often as determined by the physician. At your first appointment you will meet with the nurse practitioner. You will have blood drawn and be given a prescription for prenatal vitamins. The prenatal blood work includes: Blood type/rh A test to find out if you are immune to Rubella (most of us are vaccinated for this at 12 years old) Complete Blood Count (CBC) to check for Anemia and to check platelet count HIV and Syphilis tests (as required by the State of Ohio) Hepatitis B testing Sickle cell screening (for African-American patients only) Toxoplasmosis (patients with cats) During each visit, your care will include: Calculation of the baby s gestational age (how far along you are) Calculation of the baby s size by measuring the top of the uterus (fundal height) after 20 weeks. Weight check Blood pressure check Urine screening for hydration status, sugar in the urine, and protein in the urine. WE ARE NOT CHECKING FOR A BLADDER INFECTION (UTI) AT EVERY VISIT. If you are having symptoms of a bladder infection, such as painful urination, please request a special collection cup from the medical assistant who brings you in. The most common infection in pregnancy is a UTI and sometimes there are no symptoms. Fetal heart tones (may not be heard by external Doppler until weeks gestation) At about 8-10 weeks, you will return to meet your doctor. Lab results will be reviewed An exam, including a pap smear (if you are due for one before the baby is due), gonorrhea and Chlamydia testing (mandated by state law) will be done. An ultrasound will be done to give the final due date and see the baby s heartbeat. This is a transvaginal ultrasound (meaning we use a probe internally to do the ultrasound). A second ultrasound will be done between weeks to check growth and development of your baby. If you are interested in knowing if the baby is a boy or a girl, we will try to tell you at this ultrasound. Unless your physician specifically states otherwise, your due date is NOT changed based on the results of the ultrasound at weeks. 1

2 Between weeks, a third ultrasound will be done on first time pregnant women, patients who have had previous cervical surgery, and women with prior preterm birth. This will be a vaginal ultrasound to look at the cervix (opening to the uterus). Nutrition and Weight Babies grow and develop rapidly during their nine months in the womb. Your diet is the source of nutrients and energy that support this growth. Studies have dramatically illustrated how closely baby s health at birth is tied to the mother s diet during pregnancy. Good nutritional habits are essential during pregnancy. You need to eat the following on a daily basis. o Four servings of protein o Two servings of vitamin C foods o Four servings of calcium-rich foods o Three servings of green leafy vegetables, yellow vegetables and yellow fruits o Two servings of other fruits and vegetables o Five servings of whole grains and legumes (beans) o Iron-rich foods o At least 64 oz of fluids (Not including caffeine-based fluids. Milk counts for only 2/3 water) o An additional 300 calories a day are needed in pregnancy, after 12-13, if you are of a normal weight at the beginning of pregnancy. For overweight and obese women, you may only need extra calories a day. Normal weight gain of pounds by the time you have reached full term is ideal. If you are overweight (a body mass index or BMI of more than 25) at the start of pregnancy, it is recommended you limit weight gain to pounds. If you are obese (a body mass index of 30 or more), it is recommended you limit your weight gain to pounds. During the first three months of pregnancy, a gain of 3-5 pounds is average. For the rest of the pregnancy, an average gain is about ¾ to 1 pound per week for women of a normal weight. Caffeine intake should be limited to 1-2 servings a day or roughly mg a day. See March of Dimes website for more specific information about the milligrams of caffeine in different products. Artificial sweeteners should also be limited to 1-2 servings a day. Splenda is the most studied artificial sweetener and seems to be very safe in pregnancy. Aspartame (NutraSweet or Equal) is also safe. A note on salt intake during pregnancy; simply salt your food to taste do not restrict your salt intake unless we specifically tell you to do so! Please do not drink alcohol. Fetal Alcohol Syndrome is a direct result of alcohol consumption during pregnancy and is the leading preventable case of mental retardation. Other adverse affects of alcohol consumption during pregnancy include baby s facial abnormalities, decreased height, hyperactivity, problems with learning, attention, memory, problem solving, poor coordination, impulsiveness, and speech and hearing impairments that persist into adolescence and adulthood. We do not know if there is a threshold below which alcohol can be consumed without harming the fetus. Because of this, we recommend that pregnant and breastfeeding women abstain from alcohol use pending confirmation of alcohol s role in fetal development. We strongly recommend that all pregnant women stop smoking. Or if this is impossible, drastically reduce smoking as much as possible. Exposure to secondhand smoke must also be decreased. Cigarette smoke contains a variety of poisons, including nicotine, cyanide, and carbon monoxide, all of which cross the placenta to the baby. In addition, cigarette smoking has been associated with an increased risk of miscarriage, stillbirth, fetal growth retardation, and sudden infant death syndrome (SIDS). This may be your best opportunity to give up the smoking habit. Please feel free to discuss smoking cessation with us. 2

3 Exercise & Rest Exercising at least 3 times a week is a great way to maintain your health and generally helps women to feel better in pregnancy. You may bowl, swim, and do aerobic activity, but you must never exercise to exhaustion. In addition, drink plenty of water and avoid becoming overheated. There is NO heart rate limitation in pregnancy, however if you were not exercising before pregnancy, start slowly! We recommend that you do not: Try NEW exercises that require precision, balance, and coordination. Perform exercises that require you to lie on your back after 28 weeks of pregnancy. Other Sexual intercourse is safe at any time during pregnancy unless you have vaginal bleeding, ruptured membranes, or have been specifically instructed NOT to have intercourse. Do not douche after sexual intercourse or any time during your pregnancy. Hair dye has not been studied in pregnancy. The American College of Obstetricians and Gynecologists state that hair dye is probably safe in pregnancy. If you work with hair dye, you should wear gloves while applying dye and work in an area with good air circulation. The best advice for anything about which we have limited information in pregnancy is to avoid use in the first twelve weeks if possible. Good dental hygiene has been associated with healthy pregnancy outcomes, and so we encourage you to visit the dentist as you regularly would. The dentist will generally be familiar with what he/she can and cannot do in the pregnancy, but should the dentist have any questions please have him/her call our nurses. The most commonly used antibiotics for dental infections are penicillin and amoxicillin, both of which are safe in pregnancy. Pain medications, while habit forming, are generally safe in pregnancy when used for short amounts of time. Labor and Delivery Childbirth education helps you and your partner have a happier and healthier pregnancy and delivery. While some people are at first reluctant to attend childbirth education classes, most find that they enjoy these classes a great deal. Multiple organizations offer a variety of courses including classes for those who know that they are having a cesarean section delivery. We will give you more information about these classes later in the pregnancy. Hospital choice for your delivery depends largely on your preference and insurance requirements. Our physicians deliver at Riverside Methodist Hospital, The Ohio State University Medical Center, St. Ann s Hospital and Dublin Methodist Hospital. Our doctors are comfortable with caring for you and working with the staff at all of these hospitals. Hospital tours can be scheduled two months prior to your delivery should you wish to tour before making a hospital choice. Please call the following numbers to schedule a tour. o Riverside: o OSU: o St. Ann s: o Dublin Methodist: (option 1) 3

4 Birthing rooms are available at each of the four hospitals. It is important that you check with your insurance carrier for any restrictions of hospital choice prior to your delivery. Your insurance benefits may be greatly reduced or simply not cover your delivery. Please inform the on-call doctor of any hospital restrictions at the time of your labor. Physician Coverage is provided on a rotating basis by all of our doctors. This means that one of our physicians will be on call 24 hours a day 365 days a year. Even though your personal physician would like to promise to deliver your baby, the doctor on call when you go into labor will actually do the delivery. If you wish, you may choose to see each of our doctors at least once prior to your due date, but it is not required. The on-call doctor can be reached at any time by calling our office number, (614) Prior to delivery, please choose a pediatrician or family practitioner to care for your baby. Before you deliver, be sure to contact you pediatrician or family practitioner to discuss our upcoming delivery. Also, give her or his name to the labor and delivery nurses. Travel is not restricted, but we do ask that you do not fly after 36 weeks of pregnancy. Illness and Medications You DO NOT need to call us before taking any of the medications on this list. If the pharmacist informs you that a medication is Category A or B, this medication is also safe to take, even if not on our list. If you have any prescription medications which you are unsure about, please call our office. We encourage you to try to limit medication use as much as possible. Generally, amoxicillin, Keflex (Cephalexin) and Marcrobid (Nitrofurantion) are okay to take if you are not allergic. Some employers require a note if you miss work for pregnancy related reasons. If your employer requires a note, please call us the day you are absent from work to speak with one of our nurses. Colds and Flu Only Tylenol (the generic is Acetaminophen) for aches, pains, and fever Plain Sudafed (red box) for congestion Robitussin DM for cough Chloraseptic spray/lozenges for sore throat Call your primary care provider (PCP) for appointment if you have: Fever over for more than 3 days Shortness of breath or heaviness in your chest Symptoms more than 10 days that are not improving No Aspirin, Ibuprofen, Motrin or Advil products Allergies Benadryl, Zyrtec, Claritin, Flonase, Singulair, Allegra and allergy shots All over the counter allergy medications are safe Constipation 4

5 Metamucil (can increase blood sugars if you are diabetic), Citrucel, and Fibercon (the powder version of these medications work the best) Milk of Magnesia Colace (over the counter) Mg at bedtime (most prenatal vitamins already have 50 mg of colace in them) Senakot 8.6 mg (over the counter laxative) Miralax Increase fluid and fiber intake (Fiber One cereal, prunes or prune juice, vegetables, etc. see Increase or begin exercise Diarrhea Imodium AD and Kaopectate B.R.A.T diet (bananas, rice, applesauce, tea and toast) Increase fluids like water and Gatorade Call your primary care provider for appointment if you have: No improvement in diarrhea in 2-3 days with medications Diarrhea and fever over Nausea and vomiting Vitamin B6 (50 mg three times a daily) and Unisom (both over the counter) Snacks every two hours to keep food in stomach (try fluids like lemonade, ginger ale, and 7-up and snacks like crackers. Peppermint/spearmint tea or candy may also help. Papaya or papaya enzymes help some women). For some women acupressure bands (sea bands) may help. Prescription medications are available if needed Medications for reflux, such as over the counter Zantac, also help some women with nausea even if they are NOT having signs of reflux (i.e. GERD) Call us for an appointment if: You are unable to keep fluids down for more than 24 hours Have dark urine and are not urinating as frequently You are feeling weak and dizzy Have vomiting along with fever>100.4 or pain under your ribs on the right side Heartburn/Reflux Maalox or Mylanta (liquid forms tend to work best), Zantac, Pepcid, Prevacid, and Tums Eat small; bland meals (avoid spicy or greasy foods) Do not lie down for at least one hour after eating Try to avoid liquids with meals (drink only between meals if possible) DO NOT TAKE ALKA-SELTZER OR PEPTO-BISMOL Menstrual Like Cramps Very common in the first 12 weeks Increase water intake Call us for appointment: 5

6 Any severe pain or cramps accompanied by bleeding Headaches Only Tylenol (extra strength is ok) Call us for appointment: If the headache is not relieved by Tylenol You are having blurred vision, double vision, dizziness or ringing in ears with headache or facial swelling Acne Should not use: Accutane (Isotretinoin), tetracycline, doxycycline, and minocycline Probably safe: Benzoyl peroxide (benzac, benzamycin, beroxyl, desquam, triaz, vanoxide), hydrocortisone (vanoxide-hc), salicylic acid, topical erythromycin, clindamycin Discuss with a provider: Differin Gel, Retin A Hemorrhoids Anusol and Preparation H Increase fiber, start colace (see above), sit in lukewarm tub 2-3 times daily Call us or you PCP: If your hemorrhoids are not improving or bleeding Nose or Gum Bleeds Common in pregnancy Call us for appointment: You have more than three nosebleeds that last longer than 5 minutes, or one that won t stop Leg Cramps Common in pregnancy Increase fluids, calcium (take mg over the counter calcium carbonate or calcium citrate in divided doses), and potassium (increase food like bananas or over the counter K+ 10 milliequivalents/day) Call us for appointment: Leg cramps persist after increasing calcium and potassium (see instructions) Only one leg is hurting all the time You have a reddened area on the back of the calf that is warm to touch It hurts to flex your toes toward your nose Yeast Infection Over the counter yeast medication (7 day insert) Only insert the applicator halfway into the vagina and do so gently Vaccines Ok to have: TB skin test, Flu shots, Tetanus booster, Hepatitis A and B Viral Exposure Fifth s disease 6

7 Call for appointment if exposed, we will draw blood work. Watch for fever/rash Roseola No concern Chicken Pox or Shingles No concern if you have had chicken pox or have had the vaccine Call us immediately if you have not had chicken pox, or the vaccine, and you have direct exposure Scarletina (Scarlet Fever) or Strep Throat Use good hand washing to avoid infections Call PCP for appointment if you develop sore throat and fever There is limited information about pregnancy and over the counter herbs. If you are taking any over the counter herbs, we recommend you discuss this use with one of our providers. For information about food safety see Special note about breastfeeding: Anti-histamines (such as Claritin, Zyrtec and Benadryl) may decrease milk supply. Decongestants (such as Sudafed) do not generally limit milk production. Zantac and Pepcid may also decrease milk supply and should be used with caution in breastfeeding. Optional Testing During Your Pregnancy Not all insurance carriers pay for the tests listed below. If you have concerns that your insurance company will not cover the test, please check with your insurance carrier prior to requesting the test to avoid unexpected costs. Cystic Fibrosis Carrier Testing Cystic Fibrosis (CF) is: A lifelong disease which causes multiple lung infections and bowel absorption problems. While CF is treatable, at this time there is no cure. For a child to have CF, both parents have to carry the gene. Many people who carry the gene are healthy and have no family history of CF. Approximately one in thirty to one in sixty Americans carry the gene. A pregnant mother can have a blood test at any time during the pregnancy (or before pregnancy) to see if she carries this gene. If a mom tests positive as a carrier, the father of the baby should then be tested. If he is negative, there is very little risk for the baby to have CF. If the father is also a carrier of the gene, there is a one in four (25%) chance that the child will have CF. Alternatively, when both parents carry the gene for CF the baby will be tested soon after delivery for the disease and treatment begun if the baby does have CF. In the state of Ohio, all babies are tested for CF with routine newborn screening blood work; however, this test is not as specific as the test done if it is known that both parents carry the gene and can miss children who have the disease. Please let us know if you would like the blood test for cystic fibrosis carrier status done during your pregnancy. This test can be done at any visit. Chromosome Testing We now offer a simple maternal blood test to identify Trisomy 21 (Down s syndrome). This test is nearly 100% accurate and is typically drawn after the 10 th week of pregnancy. As a simple blood draw it has no risk to the pregnancy. This test also screens for Trisomy 13 and 18, but has a little less accuracy than Trisomy 21. If interested please discuss this further with your physician. 7

8 AFP AFP (Alpha Fetal Protein) is a simple blood test between weeks of pregnancy to rule out open neural tube defects such as Spina Bifida. This is an optional test and is just a screening, it does not guarantee positive or negative results. If positive, further testing can be done. Cord Blood Banking Cord blood can be collected from the umbilical cord and placenta after the baby is born but before the placenta is delivered. Cord blood contains stem cells that can be used to treat some types of illnesses such as disorders of the blood, immune system, and metabolism. Options exist to then have the cord blood stored in a private bank or a public bank. If you are interested in cord blood banking, you need to decide which company you want to use. You contact them to obtain a collection kit which you will bring with you to the hospital when you are in labor. The obstetrician will collect the cord blood and you are then responsible for sending it to the bank you have chosen. Obstetrics Payment Information Congratulations on your new pregnancy! Below is information about how we will help you pay for this delivery. If you have insurance, we will bill your insurance company, unless you are covered under a plan which we do not have a contract. Please call your insurance company to verify coverage. Also, be sure to provide a current copy of your insurance card for accurate billing. If you change insurance mid-pregnancy, please inform us immediately. Normal vaginal delivery charge is $ This represents the 14 routine prenatal visits, delivery, and postpartum visit. Listed below are items not included in the charge listed above, which will be billed to your insurance throughout your pregnancy. These charges may become your responsibility once your insurance responds. If your insurance company does not pay for any services, you will be asked to pay at your next scheduled appointment. The prices listed below are approximate cost only. Please ask any questions. 1. First Ob counseling visit (confirm pregnancy with nurse practitioner) $200.00, this includes the venipuncture (blood draw) and urine pregnancy test. 2. The lab company will bill your insurance company for the following labs: CBC, Hepatitis B, Rubella, blood grouping, Rh factor, Serology (syphilis), HIV, antibody screening, urine culture, and Hemoglobin-electrophoresis (African American women only). 3. The 2 nd visit is with the physician, which includes an ultrasound, office visit, pap smear and vaginal cultures. Ultrasounds (normally 2) 1 st ultrasound performed at the 2 nd visit with your doctor range from $ nd ultrasound performed at your week appointment is $525 Non-Stress tests, performed on high risk pregnancies, are $250 each Other labs AFP (optional at weeks) Glucose and CBC (24-28 weeks) GBBS culture (36 weeks) 8

9 Cesarean Delivery $ Cesarean Delivery of twins $4375 Vaginal Delivery of twins $$4900 VBAC (vaginal birth after cesarean) $ Deliveries more complicated may require more labs, ultrasounds and visits. Patients with Insurance If you have co-insurance and/or high deductibles, we require payment by the end of the 28 th week of pregnancy. We will call your insurance company after your 1 st ultrasound to verify coverage. To help you, we can provide a payment plan with the last payment being made by the end of your 28 th week of pregnancy. It is recommended that you keep up with the payment schedule. After the second appointment, payment is based upon your insurance plan. For example, if your insurance company requires you to pay 20% in co-insurance, then we ask for you to pay that amount by your 7 th month of pregnancy. Self-Pay Patients If you do not have insurance, we ask that you follow the schedule below to pay for your pregnancy. We do offer a 40% discount for our self-pay patients. 1. First visit with the nurse practitioner $ Second appointment with the doctor $ The second appointment includes an office visit, ultrasound, Pap smear, and vaginal cultures. If we do not receive payments from you in a timely manner, we reserve the right to reschedule your visit or refer you to another caregiver or facility. These charges do not include any hospital or anesthesiologist charges you may incur. You may wish to contact them for more information. If there are any questions you have that we did not answer, please call us at Thank you and again congratulations! 9