Mild increased vaginal discharge without itch or irritation
Increased urinary frequency
Changes in food preference and disposition
Darkening or pigmented areas of skin or striae (stretch marks)
Ligament pains and pressure in back, groin or pelvis
Cessation of menstruation
Nausea and/or vomiting
Breast changes (growth & tenderness)
Inability to sleep
Quickening around four-five months (fetal movement)
Abdominal enlargement due to uterine expansion
Uterine contractions (Braxton-Hicks)
Hemorrhoids Breast enlargement
Inability to sleep
Generalized aches & pains, particularly in the hips and pelvis
Mild shortness of breath
Persistent nausea or vomiting interfering with adequate food or fluid intake
Any vaginal bleeding except spotting after exam
Leaking or gushing of fluid from the vagina
Severe, persistent headaches not relieved by Tylenol and Hydration and Rest
Disturbance of vision, i.e., spots, flashes of light or blind spots
Pain or burning with urination
Irritating vaginal discharge or sores near the vaginal opening
Abdominal pain and/or cramping lasting longer than one hour
Severe dizziness or fainting
Temperature over 101 degrees F.
Cramping, contractions, tightening or pressure occurring in a regular pattern
No fetal movement or decrease in fetal movement
Sudden swelling or weight gain
Sudden decrease in urinary output, fever, or backache
…Please call if you have any new symptom that concerns you.
Nutrition is very important in pregnancy; you will feel better and your baby will benefit greatly from a healthy diet. Your diet should be well rounded and balanced in food groups; not more than 30% of fat and minimizing unnecessary carbohydrate intake. A reduction of salt intake is very important. Do not add table salt; reduce fried foods and eat plenty of fresh fruits and vegetables. Avoid sweets, starchy foods and sodas containing caffeine. Drinking enough water is very important in pregnancy and can minimize or prevent swelling, constipation and preterm contractions. Try and drink 8 glasses of water a day.
Your protein intake should consist of lean meats, cheese, eggs, legumes, fish and cooked seafood. Fish should be limited to 12 ounces/week of store bought fish, including shellfish or 6 ounces/week of fresh-caught or freshwater fish. Do not eat shark, swordfish, king mackerel or tilefish secondary to mercury content. For a more extensive list, please check the website www ewg.org.
Cheeses should be limited to pasteurized cheeses. We recommend avoiding soft cheeses like brie, feta, blue cheese, etc if they are imported or non-pasteurized. We also recommend avoiding cold hot dogs, cold lunch meat and non-cooked, smoked seafood secondary to a risk for a bacterial infection called Listeria.
Skim milk and green leafy vegetables should be incorporated into your diet as an excellent form of calcium. Having 1200-1500 mg of calcium per day is recommended. You can also take a supplement in order to reach this amount.
Fresh fruits and vegetables should be well washed and kept separate from raw meats. Do not attempt a reducing diet without consulting your Obstetrician first. Minimize foods with little nutrition value such as soda, candies and other sweets.
Taking a prenatal vitamin (PNV) daily is recommended in pregnancy and for women who are breastfeeding. Over the counter and prescription prenatal vitamins are essentially the same and you may use either. Occasionally, a prenatal vitamin can make nausea in pregnancy worse. If that occurs you can take your PNV at night to see if that helps. If you are unable to take a PNV due to nausea then take a folic acid supplement of at least 400 mcg per day. (400-1000mcg is the daily recommendation) Folic acid reduces the risk of neural tube defects and ideally is taken three months before a woman becomes pregnant. It is found in green leafy vegetables, orange juice and fortified cereals.
Many women become anemic during pregnancy as iron needs are increased during pregnancy. Anemia may cause symptoms of excessive fatigue, weakness or dizziness. Thirty-60 mg per day is recommended and is often found in your PNV. At times, it is recommended that a woman take more iron when she is pregnant. There are many excellent food sources of iron besides red meat but your provider may also recommend an extra iron tablet and this will be discussed as needed. Make sure to take iron with a source of Vitamin C such as orange juice or citrus fruits in order to increase the absorption. Calcium inhibits the absorption of iron so please avoid eating calcium rich food at the same time as your iron supplement.
On average, weight gain should be between 25-35 pounds however, it varies with each patient. You can discuss in greater detail your weight gain and expectations during your pregnancy with your provider. The important thing is to eat healthy, quality foods and maintain daily activity if allowed by your doctor.
NAUSEA AND VOMITING
Nausea and vomiting may exist in pregnancy until around 14 weeks, or later, for some women. It may be worse in the morning, but unless it becomes excessive it should not be cause for alarm.
The following suggestions may alleviate the nausea and vomiting:
1. Take daily walks in the fresh air
2. Avoid odors in the kitchen
3. Eat multiple small snacks during the day, rather than a few large, heavy meals
4. Avoid rich, spicy, fatty and fried foods or foods that do not agree with you.
5. Eating dry crackers before arising in the morning may decrease nausea.
6. Stay well hydrated by drinking at least 8-8oz glasses of water, milk or juice each day.
7. Eat high protein food and avoid greasy or fried food. Increasing complex carbohydrates can help as well.
8. Take Vitamin B6 (total of 200 mg per day including your PNV)
9. Apply acupressure to wrists with bands available over the counter.
… If necessary, contact the office for further assistance.
AVOID eating: Grouper, Marlin, Orange roughy, Tilefish, Swordfish, Shark, Mackerel (king)
Eat no more than three 6-oz servings per month
Bass saltwater, Croaker, Halibut, Tuna (cannned, white albacore),Tuna (fresh bluefin, ahi), Sea Trout, Bluefish, Lobster (American/Maine)
Eat no more than six 6-oz servings per month
Carp, Mahi Mahi, Crab (dungeness), Snapper, Crab (blue), Herring, Crab (snow), Monkfish, Perch (freshwater), Skate, Cod, Tuna (canned, chunk light), Tuna (fresh Pacific albacore)
Enjoy two 6-oz servings per week
Anchovies, Butterfish, Calamari (squid), Caviar (farmed), Crab (king), Pollock, Catfish, Whitefish, Perch (ocean), Scallops, Flounder, Haddock, Hake, Herring, Lobster (spiny/rock), Shad, Sole, Crawfish/crayfish, Salmon, Shrimp, Clams, Tilapia, Oysters, Sardines, Sturgeon (farmed), Trout (freshwater)
Following these guidelines can greatly reduce your chances of contracting Listeriosis.
Eat hard cheeses instead of soft cheeses: The CDC has recommended that pregnant women avoid soft cheeses such as feta, Brie, Camembert, blue-veined cheeses and Mexican style cheeses such as queso fresco, queso blanco, and panela.
Hard cheeses such as cheddar and semi soft cheeses such as mozzarella are safe to consume. Pasteurized processed cheese slices and spreads such as cream cheese and cottage cheese can also be safely consumed. The most important thing to do is read the labels!
Be cautious when eating hot dogs, luncheon meats, or deli meats unless they are properly reheated to steaming (or 160 degrees F.): Eating out at certain restaurants that provide deli meat sandwiches is not recommended for pregnant women since they do not reheat their deli meats. Restaurants such as Subway recommends that pregnant woment eat the following non-luncheon meat items such as meatball, steak and cheese, roasted chicken, and tuna (limit 2 servings/wk.)
Do not eat refrigerated smoked seafood unless it is contained in a cooked dish (casserole).
Practice safe food handling:
- Wash all fruits and vegetables
- Keep everything clean including your hands and preparation surfaces
- Keep your refrigerator thermometer at 40 degrees or below
- Clean your refrigerator often
- Avoid cross contamination between raw and uncooked food (hot dog juices)
- Cook foods at proper temperatures (use food thermometers) and reheat all foods until they are steaming hot (or 160 F)
Proper Temperatures for Cooking Foods:
- Chicken: 165-180F
- Egg Dishes: 160F
- Ground Meat: 160-165F
- Beef, Medium well: 160F
- Beef, Well Done: 170F (not recommended to eat any meat cooked rare)
- Pork: 160-170F
- Ham (raw): 160F
- Ham (precooked): 140F
Refrigerate or freeze food promptly.
It is best to avoid medications in pregnancy, especially in the first trimester. There are however many relatively safe medications.
Avoid alcohol, marijuana, cigarettes, birth control pills and discuss all other drugs, over the counter medications and herbal remedies with your Obstetrician. Studies have determined that the above substances can result in premature birth, low birth weight and/or increased chance of miscarriage or birth defects. Many food supplements have not been adequately studied to determine safety in pregnancy.
The medications noted below are acceptable to take while pregnant. However, we recommend not taking any medication during the first trimester as well as limiting the amount of medication that you take during your pregnancy. Do not take any other medication, unless approved by your Obstetrician.
TYLENOL for common headaches and aches of flu.
CHLOR-TRIMETON, 4 mg., BENADRYL 25 mg, CLARITIN 10 mg, or Vicks VapoRub for colds and congestion. Tylenol cold, Sudafed, ROBITUSSIN DM or COUGH DROPS without Zinc or Echinacea for sore throat or cough. Nasal Saline spray.
MYLANTA, ROLAIDS, TUMS or Zantac (if Tums has not helped) for heartburn
BRAN, extra water, fruits and vegetables for constipation
Docusate Sodium 100 mg (stool softener), Citrucel and Metamucil can also be used for constipation.
MONISTAT AND GYNE-LOTRIMIN 3 day or 7 day treatment may be used for yeast infection.
CALCIUM (not dolomite calcium or oyster shell). Tums is a good source of calcium. Consult with your Obstetrician for amount of calcium supplements necessary.
PRENATAL VITAMINS- consult with your Obstetrician for specific brand and amount of folic acid required.
HERBAL/NATURAL MEDICATIONS- all of these supplements should be discussed with your physician before taking.
The following antibiotics are available by prescription only and should be given by a physician or dentist. These antibiotics are acceptable:
Erythromycin, Penicillin, Cephalosporin or Macrodantin.
Never take Doxycycline, Minocin or Tetracycline type antibiotics or Cyprofloxin family of drugs. Aspirin, Ibuprofen, Naproxen and 1-day yeast medications are not recommended.
Be sure to inform any other care provider about your pregnancy before you accept medication or diagnostic tests. Check the label or speak with a pharmacist before taking any over- the- counter drugs. Many medications contain aspirin (acetylsalicylic acid) and should be avoided.
DENTAL WORK may be performed under local anesthesia like novacaine without epinephrine. Do not accept Nitrous Oxide gas. Do not take Tetracycline-type antibiotics.
X-RAYS, IMMUNIZATIONS AND EXPOSURE TO CHILDHOOD ILLNESSES should be discussed with your Obstetrician.
PRENATAL EXERCISE classes are encouraged. Daily activity is recommended in pregnancy. Attempt to keep your pulse below 140 beats per minute during exercise and stay hydrated.
LOW IMPACT EXERCISE is encouraged. Swimming and running are acceptable as long as you are used to doing them and feel comfortable. Stretch well to avoid back or ligament injury. You should be able to carry on a conversation while exercising. Avoid shortness of breath. If there are suspicions of premature labor, ruptured membranes or bleeding, these activities must be avoided. After the sixth month, check with your Obstetrician regarding continuing these exercises.
PERMANENTS AND HAIR COLORING are acceptable during pregnancy. Be sure to inform your stylist about your pregnancy, as there are changes in your body that may affect your hair.
HOT TUBS AND SAUNAS, less than 100 degrees F. are safe. Avoid overheating the body. This is generally felt when your scalp tingles and you begin to perspire. Exit the tub or sauna when this is first felt and do not reenter until you have cooled down.
TANNING BOOTHS should be avoided during pregnancy as well as when not pregnant as the risk in unknown.
VARICOSE VEINS may appear at any time in pregnancy. Ask your Obstetrician about support stockings (over the counter or by prescription).
INTERCOURSE throughout an uncomplicated pregnancy is acceptable. Please discuss any concerns you may have with your Obstetrician. Avoid douching, water skiing or any other activity that may increase air pressure in the vagina.
TRAVELING during pregnancy is permitted and is safe. There is no known harm from commercial air travel. However, it is best to be close to the hospital when you are nearing full term. Your physician may restrict air travel after the 34th week of pregnancy or sooner if there are complications. If you need a note for airline boarding, please give the office as much notice as possible.
Avoid prolonged sitting. Try to walk around every 60 minutes. This is especially important in the third trimester.
Keep well hydrated.
Wear loose shoes as your feet may swell.
The following are standard tests during your pregnancy:
- Blood testing is done at the initial visit to determine Rh and blood type, rubella immunity and blood count.
- Syphilis, HSV, HIV and Hepatitis B status.
- Weight and blood pressure is checked at each visit
- An initial Urine screen is done and then urine testing is done periodically to check for protein and sugar.
- Ultrasound is done to determine viability and fetal age at the first visit. Position, placenta placement, or for any signs of problems with the fetus is checked at a later date.
- Gestational Diabetes/Glucola screening is performed at 24-28 weeks.
- Group B Beta-Strep culturing is done when appropriate.
The tests noted below may be indicated. If you would like written material describing these tests, please ask.
- Amniocentesis may be recommended, if you are over 35 years of age or have a family history of genetic problems in your family or your partner’s family.
- A Sequential screen (SEQ) will be offered. This includes an ultrasound and blood test between 11-13 weeks and a 2nd blood test between 15-18 weeks to check for increased risk for neural tube defects (i.e.Spina Bifida), Down’s syndrome and Trisomy 18. The SEQ improves the accuracy of the Quad screen, which is another optional test.
- Rubella immunization will be advised following delivery if you are not already immune.
- Rh-negative mothers will be re-tested at 28 weeks. The American College of Obstetricians and Gynecologists recommend women receive Rhogam during the 28th-29th week of pregnancy if they are Rh-negative. This is to prevent the 1-2% incidence of sensitization during pregnancy that results from fetal red cells leaking into the mother’s blood system. Your baby’s Rh will be checked after delivery and if the baby has Rh positive blood, we recommend you receive another Rhogam injection within 72 hours of delivery.
- Rhogam may also be given for bleeding during pregnancy so inform your doctor of any spotting or fluid.
* Sexually Transmitted Disease testing: HIV, Gonorrhea, Chlamydia, Syphilis and Hepatitis. Herpes virus cultures are done when there are new symptoms or suspicious sores in the genital area.
* Non Stress Tests (Fetal Heart Rate Monitoring) may be recommended to determine the health of the baby and placenta.
* Genetic Counseling may be recommended if there is a family history of Genetic abnormalities, advanced maternal age or prior child with defects.
* Cystic fibrosis testing is offered but may not be covered by your insurance. It is a blood test that is a genetic screen to see if one or both parents carry the gene for cystic fibrosis.
You can reach us 24 hours a day. During the regular business hours you will reach a receptionist. Make it clear that you think you are in labor so she can give priority handling to your call.
After hours you will reach a recording. You will be directed to press “2” to reach our telephone exchange operator who will page the Obstetrician on call. If you do not hear from the Doctor within 20 minutes, call again. In the rare instance of a failure of the paging system, you can reach “Labor & Delivery” at Swedish Hospital by calling (206) 386-3288. The Doctor taking your call will need to know your name, the name of your regular doctor, estimated date of delivery, if you have had children before, frequency and duration of contractions, leakage and if there have been any prenatal problems.
If you deliver during the day and your physician is available, she will attend your delivery. If however, your delivery occurs after hours or at times when your physician is unavailable (such as vacations, meetings, holidays, nights off call, etc.) then the assigned on-call physician will care for you during your delivery. Rarely, for special occasions that require the involvement of all of the physicians in the group, a physician from another group might attend your delivery.