your guide to pregnancy - sofhaobgyn.net · dramatic growth and development of the fetus occurs in...

Compassionate Care for Women

Your Guide to Pregnancy

423-794-1300 | www.sofhaObGyn.net |

State of FranklinOB/GYN Specialists

A division of State of Franklin Healthcare

The content of this booklet has been approved by State of Franklin OB/GYN Specialists

This booklet contains paid advertising by Mead Johnson & Company LLC. All other content of this booklet was developed by the healthcare provider who is solely responsible for its contents.

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Alfonzo Arze, M.D.F.A.C.O.G.

Jott Hallman, D.O.F.A.C.O.G.

Stephanie Burks, W.H.N.P.

Rachel Bevins, D.O.F.A.C.O.G

Courtney Hodshon, M.D.F.A.C.O.G.

Melissa Grissinger, F.N.P.

Ginger W. Carter, M.D.F.A.C.O.G.

Rebecca Wilkins, F.N.P.

Chad A. Drey, M.D.F.A.C.O.G.

Grover E. May, M.D.F.A.C.O.G.

Tonya Wilson, A.N.P.

John Green, M.D.F.A.C.O.G.

Jill Talley-Horne, M.D.F.A.C.O.G.

Our Physicians

Holly Falin, F.N.P

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Office informationWe have two locations to better serve you.Johnson City Location: 301 Med Tech Parkway Suite 200, Johnson City, TN 37604Elizabethton Location: 1505 West Elk Ave. Suite 1 , Elizabethton, TN 37643

Web: www.sofhaObGyn.net

Office Phone: 423-794-1300 Office Hours: Monday through Friday 8:00am until 5:00pm*We receive phone calls from 8:00am - 4:30pm. Please reserve your after hours calls for urgent issues only.

Phone calls made outside of regular office hours should be reserved for emergencies. Unless your call is urgent, please call during office hours so your chart can be available for reference.

You can reach us after hours by calling our main office number at 423-794-1300 and the physician on call will contact you. If you have not received a return call within 30 minutes, please call back. We try to answer all calls as soon as possible; however due to emergencies, we may be unable to return your call immediately.

When calling, it is better if we can speak to you directly because relayed messages may not be accurate. In addition, please have a pharmacy phone number available when calling.

Our office also offers an online tool that provides anywhere, anytime access to your personal health care needs! With our patient portal, you can message any of our providers or make changes to your appointments. We hope that you will utilize this tool throughout your pregnancy, as we view this as the most convenient and effective method for routine communication. Please ask anyone in our office how to set-up your account.

Pregnancy GuideCongratulations! You have now entered into one of the most exciting experiences of your life. Even if this is not your first pregnancy, what you will experience over the next several months will certainly be unique and exciting since no two pregnancies are exactly alike.

This brochure was designed to give you an overview of what to expect during your pregnancy and into your delivery. If you have additional questions or need more information about any subject, please ask a provider. Please keep in mind, there will be variations depending upon your individual pregnancy.


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First TrimesterThe first trimester is defined as the first 13 weeks of your pregnancy. Most women determine that they may be pregnant between the 4th and 8th weeks of pregnancy.

What changes will you experience?The first sign of pregnancy is usually the lack of menstruation. Other signs, which are experienced in varying degree and sometimes not all, are the following:• Fatigue and tiredness• Nausea (possibly with vomiting)• Food cravings or aversions• Breast tenderness• Increased frequency of urination• Emotional swings similar to PMS• Weight gain - usually minimal and in some cases weight loss occurs.• Dizziness related to blood pressure changes and blood sugar changes are common.• Mild uterine cramping• Vaginal Bleeding – Spotting is not uncommon. Any bright red uterine bleeding should be reported as you

need further evaluation based on blood type.

How will the fetus change?Dramatic growth and development of the fetus occurs in the first trimester. The fetus starts off as a cluster of cells no bigger than a pinpoint and ends up the size of your thumb (approximately 3 inches). By the end of the first trimester the baby weighs about 3 ounces. The baby’s heartbeat can be seen via ultrasound as Early as six weeks and can be heard by Doppler at approximately 10-12 weeks.

First OB AppointmentAt your New OB appointment we will:• Obtain your medical history and complete necessary paperwork

all designed to assist your provider in determining the best carefor you and your baby.

• Complete physical examination• Review of studies for blood type, anemia, and STD infections• Urinalysis to screen for sugar, protein, red/white blood cells, and

bacteria; also includes a urine culture.• Review of urine drug screen results• Pap smear

- GC Chlamydia testing• Ultrasound to help determine due date (for those 6 weeks

gestation or greater).

Other tests may be necessary based on your current medical condition and your family history. Your provider will discuss these if needed.

We have 9 OB physicians and 5 nurse practitioners that are available to provide care for you during your pregnancy. During your pregnancy you will have the opportunity to meet each provider personally. Our nurse practitioners provide in office care only. Your delivery will be provided by the OB physician that is assigned call duty on that particular day.

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Medication List for OB PatientsIf you develop any of these symptoms or problems, please try the medications listed. If symptoms persist, please notify our office. All medications are available at local 24 hour convenient stores. Only take these medications if you are not allergic to them.

Problems Medications

Cold or Flu Sudafed*, Tylenol, Tylenol Cold, Benadryl, Guaifenesin

Cough Robitussin DM, Halls Cough Drops, Mucinex DM

Allergies Benadryl, Sudafed*, Tylenol Allergy Sinus, Zyrtec, Claritin, Allegra

Headaches Tylenol

Diarrhea Imodium AD, Kaopectate

Constipation Metamucil, Citracel, Fibercon, Colace, Miralax

Hemorrhoids Preparation H, Anusol, Tucks Pads

Heartburn Tums/Maalox, Mylanta, Pepcid AC

Nausea** Emetrol, Unisom

Yeast Infection Monistat7, Monistat3

*Sudafed is not recommended for patients with blood pressure issues.**Nausea is very common. Some simple lifestyle changes can make a big difference. First, try eating small, frequent meals. Snack on nuts, fruits, crackers, toast, and similar foods. Avoid strong odors and flavors. Ginger has been reported to be helpful for some who may prefer a more natural therapy. We also recommend adding vitamin B6 (pyridoxine) 25 mg with each meal and at bedtime. Adding one-half of a doxylamine (Unisom SleepTabs) 25 mg tablet two or three times daily to the vitamin B6 can make a dramatic difference in your symptoms. These over-the-counter remedies are safe and effective and should be your first treatment option.


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Foods to Avoid During PregnancyBecause pregnancy affects your immune system, you and your unborn baby are more susceptible to the bacteria, viruses and parasites that cause foodborne illness. Even if you don’t feel sick, some “bugs” like Listeria and Toxoplasma can infect your baby and cause serious health problems. Your baby is also sensitive to toxins from the food that you eat, such as mercury in certain kinds of fish.

Keep this checklist handy to help ensure that you and your unborn baby stay healthy and safe. Invest in a food thermometer to check the temperatures of cooked food.

Don’t Eat These Foods

Soft CHEESES made from unpasteurized milk, including Brie, Feta, Camembert, Roquefort, Queso Blanco, and Queso Fresco

Raw COOKIE DOUGH or CAKE BATTER

Certain kinds of FISH such as a shark, swordfish, king mackerel, tilefish (golden or white snapper), limit white (albacore) tuna to 6 ounces a week

Raw or undercooked FISH (Sushi)

Unpasteurized JUICE or cider (including fresh squeezed)

Unpasteurized MILK

SALADS made in a store such as ham salad, chicken salad, and seafood salad

Raw SHELLFISH such as oysters and clams

Raw or undercooked SPROUTS such as alfalfa, clover, mung bean and radish

Why

May contain E. Coli or Listeria

May contain Salmonella

Contain high levels of mercury

May contain parasites bacteria

May contain E. Coli

May contain bacteria as Camplobacter, E. Coli Listeria or Salmonella

May contain Listeria


May contain E. Coli or Salmonella

What To Do

Eat hard cheeses such as Cheddar or Swiss or check the label and make sure that the cheese is made from pasteurized milk

Bake the cookies and cake. Don’t lick the spoon!

Eat up to 12 ounces a week of fish and shellfish that are lower in mercury such as shrimp, salmon, pollock and catfish

Cook fish to 145B

Drink pasteurized juice. Bring unpasteurized juice or cider to a rolling boil and boil for at least 1 min. before drinking.

Drink pasteurized milk

Make salads at home following the food safety basics: clean, separate, cook and chill

Cook shellfish to 145B

Cook sprouts thoroughly

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Be Careful with These Foods

Hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry

Eggs and pasteurized egg products

Eggnog

Fish

Why


Undercooked eggs may contain Salmonella

Homemade eggnog may contain uncooked eggs, which may contain Salmonella

May contain parasites or bacteria

What To Do

Even if the label says that the meat is precooked, reheat these meats to steaming hot or 145B before eating

Cook eggs until yolks are firm. Cook casseroles and other dishes containing eggs or egg products to 160B

Make eggnog with a pasteurized egg product or buy pasteurized eggnog. When you make eggnog or other egg-fortified beverages cook to 160B

Cook fish to 145B

GENDER REVEAL/3D ULTRASOUNDTypically gender reveals are performed between 16-18 weeks. 3D Ultrasounds are typically performed between 28-32 weeks. You will be provided with a CD that includes still photos and video clips.

There is no guarantee that pictures will be provided as the scan depends on the baby’s cooperation.

These Ultrasounds are elective and are not covered by your insurance. Please ask the front desk for details regarding cost and methods of payment.

**Please note that this exam is NOT reviewed by a physician.


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OB Checklists1st Trimester

q Results of labs q Blood Type

q Schedule of visitsq Routine USq Routine Labs

q Medicines

q Foods to Avoid

q Travel

q How to contact provider in case of emergency

q Provide Rotation

q Hospital Pre-Admission

q Franklin Woods Community Hospital Directions

2nd Trimester

q 3D Ultrasound

q Repeat C-Section

q Glucose Tolerance Test

q Rhogam (if indicated)

q Anesthesia Consultq (423) 302-1436 to

schedule consult

q Breast / Bottle Feeding Information

q Pediatrician

q Fetal Kick Counts (10 kicks in two hours)/ Pre-term labor

3rd Trimester

q Fetal Kick Counts

q Group B Strep (GBS)

q Labor Precautions

q When to go to Hospital

q Induction of Labor

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2nd TrimesterThe second trimester starts at week 13 through the 27th week.

What changes will you experience?If you happened to experience some of the less desirable effects of pregnancy in the first trimester, you will be glad to know that most women report a decline in those symptoms during the second trimester. The following is a list of changes that you may experience between the fourth and seventh month:

• Increase or decrease in fatigue and tiredness• Indigestion, heartburn, or gas• Swelling in the breasts, ankles, feet, hands, and/or face• Bleeding from your nose or from your gums• Constipation• Vaginal discharge (usually white in color)• More frequent urination• Wardrobe change - most women will start wearing maternity clothes sometime in their second trimester• Weight gain

How will the fetus change?Between the fourth and seventh month, the baby’s weight will increase from around 3 ounces to almost 2 pounds. The length will have nearly quadrupled to approximately 12 inches long. Your baby is moving more and you may experience fluttering called “quickening” in the beginning to outright kicking by the end of the second trimester.

Developmentally, your baby has grown into a complete little person. All organs have developed (although immature) and he/she is already sucking and swallowing. It is important that the baby now working on gaining weight and maturing all its organs to guarantee his/her healthy delivery.

2nd Trimester OB AppointmentsUnless your doctor otherwise instructs you, your appointments will continue on a monthly basis through the second trimester.

• Weight and blood pressure monitoring• Determining the height (by tape measure) and/or size (feeling the outside) of the uterus• Fetal heartbeat monitoring• Glucose tolerance test (test for blood sugar) between the 24th and 28th week• Rhogam - antibody screen• Class instruction - information about classes you may take to prepare for labor and delivery, new baby care

and breast feeding instruction can be obtained through Labor and Delivery at the hospital• Paperwork - you will need to fill out pre-admissions forms and submit them to the hospital where you will

be delivering. You may want to contact your insurance company to clarify what they will expect from you,your doctor, and the hospital

• Ultrasound


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3rd TrimesterThe third trimester is defined as the 27th week to term. This is often termed the “showing and glowing” period. You could deliver your baby anytime during this period and, thanks to modern technology, he/she most likely would survive. The best chance for a healthy baby is to deliver as close to your due date as possible.

What changes will you experience?During the last stage of pregnancy, your body will continue to change. Some of the changes you may experience are the following:

• Increase in intestinal problems like heartburn, gas, or constipation• Increased swelling in your legs and extremities. Staying off of your feet and elevating them can reduce

swelling.• Abdominal aches and itchiness due to increased size and pressure• Backaches• Difficulty sleeping - use more support pillows for your abdomen and legs• Headaches and dizziness• Sinus and nasal congestion problems (including nose bleeds)• Breast swelling and leaking of colostrum• Braxton-Hicks contractions - usually felt late in the trimester, you will experience a painless hardening of

your abdomen that usually lasts for less than a minute.

How will the fetus change?The baby will grow dramatically during this trimester. The length will grow up to 20 inches long and the weight will triple. Average delivery weight at the end of 40 weeks is between 7 and 8 pounds. Your baby is growing hair and even finger and toenails. By the 8th month your baby’s movements may be settling down because there is simply less room (the intensity of movement is expected to be less, but the baby should move 10 times in two hours). Usually, the baby has settled into a vertex position where the head is down into the pelvis area. Your doctor will usually be able to externally feel where the baby’s head and bottom are sitting.

3rd Trimester OB AppointmentsBeginning at the third trimester, your doctor will request to schedule your appointments weekly at 35-36 weeks. All the routine tests such as weight, blood pressure, abdominal measurement and fetal heart rate monitoring will continue.

Other tests that may occur are the following:• GBS culture done at 35-37 weeks• Cervical exam - internal exam to determine effacement and dilation

You may want to be prepared to discuss childbirth with your doctor at the beginning of this trimester. Clarifying your expectations and fears about delivery with your doctor will help guarantee a successful and joyous birth experience.

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Labor & DeliveryDuring the last month of pregnancy, there are a lot of signs that your body is preparing you for delivery. You may or may not experience the following:

• “Nesting” instinct or a sudden energy boost and desire to organize• Increased Braxton-Hicks contractions• A lightening or dropping of the baby which results in an increase in the frequency of urination and allows

you to breathe easier• Upset stomach with/without diarrhea• Loss of mucous plug which may cause some spotting• Spotting due to the opening of the cervix (cervical exams and/or intercourse may also cause spotting)• Home remedies to try to bring on labor should be avoided

When is it really labor?The game of guessing if it’s really labor or just Braxton-Hicks will get old quickly as you near your due date. Don’t despair - every practice contraction is pushing your baby closer to the real thing.

When to go to the hospital?1. Rupture of membranes - this can be a big gush of fluid or trickle of fluid that does not stop (see below for

more information).2. Regular, painful contractions every 3-5 minutes for an hour. Contractions

are timed from the start of one contraction to the start of the nextcontraction.

3. Bleeding like a menstrual period.4. A sudden and significant change in fetal kick

movements.

Ruptured membranes can occur before the onset of labor. If you suspect that your membranes have ruptured you should call your doctor immediately. It is not always obvious and sometimes it can be confused with loss of urine or normal vaginal discharge. Undetected or ignored ruptured membranes can lead to infection. If labor does not begin within 24 hours of the water breaking, then the doctor may choose to induce labor with medications such as Pitocin.


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Pain ManagementNatural childbirth is sometimes a goal for many women during delivery. However, it is important to know what pain relief options are available and to be prepared to instruct your caregiver of your choice. The following is a partial list of pain relief options you may or may not choose:

Epidural - one of the most common choices, the epidural numbs the lower half of the body while still allowing you to maintain control of your muscles. It is an injection into the back. Often a line is left in so that additional pain medication can be delivered if needed. Potential side effects include heaviness in the legs, numbness and sometimes a drop in the mother’s blood pressure.

Intravenous Injection - pain medication can be delivered directly into the vein. This type of medication will often be used to take the “edge” off the pain but may cause drowsiness and a lack of concentration. This is generally only used in early labor.

Local Anesthesia - numbing a small area by injection. This is often used during the episiotomy or during the episiotomy repair.

Spinal Block - this differs from the epidural in that it totally numbs the lower half of your body and is only temporary. Additional relief would require another shot. Potential side effects may include headaches, nausea and a drop in blood pressure. We typically give this type of anesthesia for elective C-sections only.

These are the most common pain relief options. Your doctor may offer you additional choices.

Elective Induction...Is It Right For Me?When a woman’s labor is started before natural labor begins, it is called labor induction. A woman may desire to have labor started for convenience or personal choice; this is an elective labor induction.

Is Elective Labor Induction OK?In some cases, elective labor induction may not be good for your baby. There are risks when labor is induced before you are 39 weeks pregnant and if the cervix is not ready. You and your care provider will decide together, using guidelines, when and if elective labor induction is ok for you and your baby (certain patients with complications may require labor induction at any stage in order to ensure the safety of the mother and/or the baby).

What Do The Experts Say?The American College of Obstetricians and Gynecologists (ACOG) has made some recommendations to help care providers make safe choices about elective induction. Before your labor can be induced:

• Your due date must be certain to make sure your baby is fully developed• You must be at least 39 weeks pregnant• Your care provider should examine your cervix to determine if it is soft and ready to open (dilate)

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The 3 Stages of LaborStage One: Beginning of labor until the cervix is fully dilatedThe first stage of labor can last from 3 weeks to one hour. Effacement (thinning of the cervix) and dilation (opening of the cervix) begins to occur. Although, this usually occurs long before a patient goes into actual labor. The cervix is fully dilated when it reaches 10 centimeters. Contractions will be mild, lasting less than a minute and several minutes apart. Once your contractions are painful and regular and less than five minutes apart for more than one hour, you should consider going to the hospital to be checked. You may call the office if you would like to speak to a provider prior to going to the hospital.

Stage Two: Active labor (fully dilated to delivery)During this stage the baby begins to move down the birth canal until it crowns (the head is visible) and you will feel an urge to push. The baby’s head is usually delivered face down and then the rest of the body follows after the shoulders have been turned. The second stage of labor lasts an average of 2 hours and 45 minutes. Contractions during this phase are usually 3 to 4 minutes apart and last a little over a minute.

Stage Three: Baby delivery to placenta deliveryThe hardest work is over now and you may be holding and enjoying your baby already. During this phase your contractions subside, the umbilical cord is cut, the placenta is delivered and any repairs from an episiotomy or laceration will be performed. This phase usually lasts no more than a half-hour.

What is happening to your baby?Your baby will be moved to a bed with a warming light, nametagged, and suctioned to clear its airways. The umbilical cord will be clamped and cleaned and the baby’s general health will be assessed using an APGAR test. The APGAR test is an acronym for appearance (color), pulse (heart rate), grimace (reflex), activity (movement), and respiration. The best score is 10. Most babies score between 7 and 10. The assessment is performed multiple times, so don’t be surprised if the first score is low.


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Additional NotesIf you have additional questions, or need information on another topic, please take note and ask the nurse or doctor at your next appointment. We ask that when you call the office or if you have an emergency and need to speak to the doctor on call that you have please have a pharmacy number available so that prescriptions can be called in if necessary. It is also important that we speak to you directly if at all possible.

We hope your pregnancy is healthy and that you have a wonderful childbirth experience.

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your guide to pregnancy - sofhaobgyn.net · dramatic growth and development of the fetus occurs in...

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