Pregnancy Handbook
PREGNANCY HANDBOOK | 1
IMPORTANT PHONE NUMBERS Physician Name Specialty _____________________________________ _____________________________ _____________________________________ _____________________________ _____________________________________ _____________________________ _____________________________________ _____________________________
Phone ___________ ___________ ___________ ___________
IN CASE OF AN EMERGENCY Insurance Co:______________________________________________________________________ Insurance #: _______________________________________________________________________ Preferred Hospital: __________________________________________________________________ Known Allergies: ___________________________________________________________________ Emergency Contact: ________________________________________________________________ Phone:___________________________________________________________________________ Emergency Contact: ________________________________________________________________ Phone: ___________________________________________________________________________
OB PATIENT CONCERN LINE 681-378-4562 A dedicated phone line exclusively for our pregnant patients that will put you directly in touch with an OB nurse. APPOINTMENTS To schedule an appointment at any location, call 304-691-1400. www.marshallhealth.org/obgyn | c
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Disclaimer: The contents of this publication are for informational purposes only and should not serve as a substitute for professional advice, diagnosis or treatment. Always seek the advice of your Marshall Health physician or health care provider for any questions you may have regarding a medical condition. 2 | MARSHALL OBSTETRICS & GYNECOLOGY
TABLE OF CONTENTS ABOUT MARSHALL OB/GYN..............................................................4 WELCOME..........................................................................................................7 APPOINTMENTS...........................................................................................8 Office Visits Schedule....................................................................................8 What to Expect.................................................................................................8 TESTING...............................................................................................................9 Routine Tests......................................................................................................9 Optional Tests.................................................................................................10 Ultrasounds......................................................................................................10 FIRST TRIMESTER.....................................................................................11 Morning Sickness.........................................................................................12 Miscarriage.......................................................................................................12 SECOND TRIMESTER..............................................................................13 THIRD TRIMESTER....................................................................................14 CONCERNS OR COMPLICATIONS................................................15 When to Call....................................................................................................15 Symptom Relief & Medications...........................................................16 Gestational Diabetes..................................................................................17 Preeclampsia...................................................................................................17 Maternal-Fetal Medicine..........................................................................18
HEALTHY CHOICES..................................................................................19 Nutritional Guidelines................................................................................19 Foods to Avoid...............................................................................................19 Exercise Guidelines......................................................................................20 Activities During Pregnancy..................................................................20 Working While Pregnant..........................................................................21 Vaccines..............................................................................................................21 Domestic Violence.......................................................................................21 FREQUENTLY ASKED QUESTIONS...........................................22 SIGNS OF LABOR.......................................................................................23 Full-Term Labor..............................................................................................23 Pre-Term Labor...............................................................................................23 POSTPARTUM..............................................................................................24 What to Expect..............................................................................................24 When to Call....................................................................................................24 Depression........................................................................................................25 SIDS.......................................................................................................................25 RESOURCES...................................................................................................26 Maternal Addiction Recovery Center...............................................27 Marshall Pediatrics.......................................................................................28 PREGNANCY HANDBOOK | 3
MARSHALL OB/GYN
ABOUT MARSHALL OB/GYN OUR PRACTICE Marshall Obstetrics & Gynecology is a group practice of highlyqualified physicians offering a full range of gynecology and obstetric care. We are dedicated to providing thorough, comprehensive and compassionate care to all of our patients. We hope to meet your needs in a timely and efficient manner. We strive to educate our patients in medical matters so they can make informed decisions regarding treatment options.
OUR SERVICES We provide the following obstetrical care for both normal and high-risk pregnancies and have an attending physician in the hospital 24/7. • • • • •
General obstetrics Ultrasounds MARC prenatal addiction services Maternal-Fetal Medicine (for high-risk pregnancies) Non-stress tests
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In addition to obstetric care, we offer the following services: • • • • • • • •
General gynecology for all ages Reproductive endocrinology and infertility Screening mammography Gynecologic cancers Pediatric and adolescent gynecology Urogynecology to treat bladder control and prolapse Robotic surgery for gynecologic problems Aesthetics, including Botox® and Juvederm®
Our providers and staff are honored to care for you and your family at Marshall Obstetrics & Gynecology.
OHIO
2
Proctorville
4 1
Winfield
Wilson
35
Ona
Huntington
Barboursville
Milton
Culloden
3
Teays Valley Scott Depot
Hurricane
10
Salt Rock
OUR LOCATIONS We have three locations for your convenience. You may be seen at any of our locations or our affiliate, the Perinatal Center at Cabell Huntington Hospital, throughout your pregnancy
1
Marshall University Medical Center
2
East Huntington
3
Teays Valley
4
Perinatal Center at Cabell Huntington Hospital
An outpatient department of Cabell Huntington Hospital 1600 Medical Center Drive | Suite 4500 Huntington, WV 25701 304-691-1400 Additional obstetric services: Ultrasounds by Perinatal Center at CHH, non-stress tests
5170 U.S. Route 60 | Suite 3400 Huntington, WV 25705 304-399-2480
300 Corporate Center Drive | 3rd Floor Scott Depot, WV 25560 304-691-1800 Additional obstetric services: Ultrasounds, Perinatal Center, non-stress tests, lab services
1616 13th Ave. | Suite 100 Huntington, WV Perinatal: 304-526-2124 Hypertension: 304-399-6897 Additional obstetrics services: Ultrasounds, non-stress tests, diabetes education, hypertension clinic PREGNANCY HANDBOOK | 5
MARSHALL OB/GYN
WEST VIRGINIA
MARSHALL OB/GYN
OUR TEAM Our team is dedicated to providing you the best in obstetric care. If your physician is not on call or available when you go into labor, one of our other qualified physicians will deliver your baby.
David C. Jude, MD
Chairman Obstetrics & Gynecology
Jared Brownfield, MD
Lisa G. Burke, MD
Obstetrics & Gynecology Robotic Surgery
Obstetrics & Gynecology BotoxÂŽ Therapy
Obstetrics & Gynecology Robotic Surgery
Maternal-Fetal Medicine/ High Risk Pregnancy
David G. Chaffin, MD
Kevin J. Conaway, MD
Kelly Cummings, MD
Hisham A. Keblawi, MD
Brenda L. Mitchell, MD
Ally Roy, MD
Jennie L. Yoost, MD, MSC
Yolanda Y. Campbell, MD
Maternal-Fetal Medicine/ High Risk Pregnancy
Amanda Pauley, MD
Obstetrics & Gynecology Robotic Surgery
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Obstetrics & Gynecology Robotic Surgery
Obstetrics & Gynecology Robotic Surgery
Urogynecology
Obstetrics & Gynecology Robotic Surgery
Pediatric/Adolescent Gynecology
Congratulations on your pregnancy, from our family to yours! We look forward to caring for you during this exciting time.
Pregnancy is a time of major physical and emotional changes, and it is perfectly normal to have many questions about it. We have designed this handbook to help answer some of those questions and concerns...and hopefully offer some reassurance, too. Please take a few minutes to read over the following information and refer to the handbook throughout your pregnancy when you have questions. If you don’t find the answer you need, we are always more than happy to address any questions you may have.
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APPOINTMENTS
APPOINTMENTS OFFICE VISITS SCHEDULE After your initial OB appointment, you will typically be seen on the following appointment schedule, although it could vary slightly: • Every 4 weeks until 28 weeks of pregnancy • Every 2 weeks between 28 and 36 weeks of pregnancy • Once a week between 36 weeks of pregnancy and delivery Although most pregnancies proceed normally, every pregnancy poses some degree of risk. Assessing the risk is an ongoing process and a central part of prenatal care. Complications can arise without warning so each visit is very important for your care and also for the care of your unborn baby. If you cannot keep one of your appointments, please call to reschedule.
WHAT TO EXPECT AT YOUR APPOINTMENT Every Visit • Urine test: This routine urine test checks for proteins, sugar, or chemicals that may be an indication of infection or dehydration. • Weight: It is normal to gain weight during pregnancy, but we want to make sure you aren’t gaining too much or too little, as this may be a sign that we need to evaluate your health or the baby’s health. • Blood pressure: Consistently checking blood pressure during pregnancy is important, as high blood pressure can be very dangerous for you and your baby. • Fetal heart rate: We will listen to the baby’s heartbeat each visit. • Evaluate uterine size: This helps us determine the growth of your baby
10-14 Weeks • Screening for Down Syndrome and other chromosomal abnormalities • Genetic testing through nuchal translucency screen or cell free fetal DNA • Review medical history • Physical exam, if not performed during weeks 6-8
4-8 Weeks (First Visit) • Review medical, surgical and obstetric history • General physical examination that may include a breast and pelvic examination • Pap smear, if indicated • Prenatal blood work: Blood type, immunity to rubella (German measles), blood count to evaluate for anemia, Hepatitis B, HIV or other infectious disease screenings, as indicated. • Urine analysis • Review initial prenatal labs • Optional: Cystic fibrosis carrier screening
27-36 Weeks • Tdap: Immunization to protect against pertussis (whooping cough)
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18-20 weeks • Ultrasound to check anatomy and possibly gender • Optional: Maternal Serum Alpha-Feto Protein screen for neural tube defects 24-28 Weeks • Screen for gestational diabetes • If blood type Rh negative: antibody screen and Rhogam injection
35-37 Weeks • Group B Streptococcus screen is performed to check/ screen for bacteria that can cause pneumonia or serious infection to the baby • Pelvic exam to check cervix for early dilation • Additional screening labs as indicated. Postpartum • 2 and 6 weeks after delivery • Physical examination, as needed • Discussion of contraception • Depression screening
TESTING
TESTING ROUTINE TESTS Blood type and Rh factor Rh is a protein found on most people’s red blood cells. If you do not have the protein, you are Rh negative. Most pregnant women who are Rh negative need treatment (Rhogam shot) to protect the fetus from getting a blood disease that can lead to anemia. Anemia Anemia occurs when the amount of red blood cells or hemoglobin (the substance that carries oxygen to organs) becomes reduced. Hepatitis Hepatitis is a viral disease that attacks the liver. There are several types of the hepatitis virus. Hepatitis A is spread by poor hygiene through a method called fecal-oral transmission. There is a risk of preterm labor and delivery if a patient becomes severely infected. A vaccine is available if you and your doctor determine this is best for you. All pregnant women are tested for hepatitis B. Babies can get hepatitis B from an infected mother during pregnancy and birth. Women considered at risk are tested for hepatitis C. Sexually Transmitted Infections (STIs) STIs can complicate your pregnancy and can affect your baby’s health. Some STIs — chlamydia, gonorrhea, syphilis and trichomoniasis — can be cured with antibiotics that can be taken during pregnancy. Viral STIs such as genital herpes have no cure; however, medicine reduces symptoms and steps can be taken to lower the risk of passing the infection to the baby.
HIV Human immunodeficiency virus (HIV) is the virus that infects and destroys the body’s immune cells and causes a disease called AIDS. HIV and AIDS infection are lifelong—there is no cure, but there are many medicines to fight both HIV infections and the infections and cancers that come with it. Rubella Rubella, also known as German measles, virus causes rash, mild fever and arthritis. If a woman gets rubella while pregnant, she is put at risk for a miscarriage or her baby could be born with serious birth defects. Diabetes screen An oral glucose challenge test is given between 24 and 28 weeks. You will be asked to drink a special sugary solution. Then, your glucose level will be determined after one hour. If your blood sugar is too high, we will ask you to do a more involved threehour test. All women are screened for diabetes prior to pregnancy and between 24 and 28 weeks. Urine tests Urine is collected at every appointment to test for protein, glucose, bacteria and urinary tract infections (UTIs). Other tests Other testing may be directed based on your medical, surgical, obstetric and family history. PREGNANCY HANDBOOK | 9
TESTING
OPTIONAL TESTS
ULTRASOUNDS
Down Syndrome screening All pregnant women are offered screening for Down Syndrome. Your risk of having a baby with Down Syndrome depends primarily on your age and genetic history. These tests are designed to determine if you are at higher risk for having a baby with Down Syndrome than the average for your age. Each of these test are just screens and false positive and false negative results are possible. There are generally three different screening tests. • First trimester screening: transvaginal ultrasound and blood work • Second trimester screening: blood work only • Cell Free Fetal DNA screening: looks for fetal genetic material in the maternal blood
How does an ultrasound work? An ultrasound uses sound waves to create a “picture” of your baby on a monitor. With a standard ultrasound, a gel is spread on your abdomen. A special tool is moved over your abdomen, which allows your doctor and you to view the baby on a monitor.
Ask your doctor about these tests to determine which one is right for you. Amniocentesis This rarely used test is only done in high-risk pregnancies. Toxoplasmosis This is an infection caused by the parasite named Toxoplasma gondii that can invade tissues and damage the brain, especially in a fetus and a newborn baby. Symptoms include fever, fatigue, headache, swollen lymph glands and muscle aches and pains. It can be contracted by: touching the hands to the mouth after gardening; cleaning a cat’s litter box or anything that came into contact with cat feces; by eating raw or partly cooked meat; or touching the hands to the mouth after touching raw or undercooked meat. Cystic fibrosis Cystic fibrosis (CF) is one of the most common serious genetic diseases. CF causes the body to make abnormal secretions leading to mucous build-up. CF mucous build-up can impair organs such as the pancreas, intestines and the lungs. CF is not visible on an ultrasound and cannot be treated before birth. Maternal Serum screen This is an optional test at 15-20 weeks to determine the risk of open spina bifida. Fetal Well Being Tests Higher risk pregnancies may have tests of fetal well being. These tests are designed to monitor the health of the baby and the function of the placenta. These tests usually will begin around 32 weeks for high risk pregnancies, but may begin earlier or later depending on the pregnancy complication. Common tests of fetal well being are: • Nonstress test: fetal heart rate is continuously monitored for 15-30 minutes or more • Amniotic fluid test: ultrasound is used to measure amniotic fluid • Biophysical profile: combines ultrasound and nonstress test 10 | MARSHALL OBSTETRICS & GYNECOLOGY
When is an ultrasound performed? An ultrasound exam can be performed at any point during the pregnancy. Women commonly have an ultrasound between 18-20 weeks. An anatomy ultrasound is performed to see if there are no abnormalities with your baby. Mid-Pregnancy Ultrasound During a mid-pregnancy ultrasound, your caregiver will: • Check the baby’s heartbeat. • Measure your baby’s size. • Check to see if there is more than one baby. • Check the location of the placenta. • Access the amount of amniotic fluid in the uterus. • Check the baby for physical abnormalities. • Try to determine your baby’s gender. An ultrasound exam is also used as part of the first trimester screen and biophysical profile (BPP). Based on exam results, your doctor may suggest other tests or other types of ultrasound to help detect a problem. For more information about various topics regarding pregnancy, please visit the American College of Obstetrics and Gynecology Patient Education page: https://www.acog.org/Patients.
All OB/GYN ultrasounds at Marshall Obstetrics & Gynecology are read by our fellowship-trained maternal-fetal medicine specialists. Quick and reliable responses are provided for any concerning situations.
FIRST TRIMESTER
FIRST TRIMESTER (Fewer than 14 weeks) During the first trimester, your body undergoes many changes. Hormonal changes affect almost every organ system in your body. These changes can trigger symptoms even in the very first weeks of pregnancy. Your period stopping is a clear sign that you are pregnant. Other changes may include: • Extreme tiredness • Tender, swollen breasts. Your nipples might also stick out. • Upset stomach with or without throwing up (for morning sickness - see page 12) • Cravings or distaste for certain foods • Mood swings • Constipation (trouble having bowel movements) • Need to urinate more often • Headache • Heartburn • Weight gain or loss As your body changes, you might need to make changes to your daily routine, such as going to bed earlier or eating frequent, small meals. Eating healthy is also important. You should discuss dietary needs including prenatal vitamins, iron and water with your physician. Fortunately, most of these discomforts will go away as your pregnancy progresses. Some women might not feel any discomfort at all. If you have been pregnant before, you might feel differently this time around. Just as each woman is different, so is each pregnancy.
First Trimester Facts • • • •
You may not gain much weight Your due date is calculated 40 weeks from the day of your last period, not the day you conceived. Your sense of smell may become much stronger. You probably won’t look pregnant.
First Trimester Screen
The first trimester screen, or nuchal translucency screen, is a screening test done at 11 to 14 weeks to detect higher risk of: • Chromosomal disorders, including Down syndrome and Trisomy 18 • Other problems, such as heart defects This test involves both a blood test and an ultrasound exam called nuchal translucency screening. The blood test measures the levels of certain substances in the mother’s blood. The ultrasound exam measures the thickness at the back of the baby’s neck. This information, combined with the mother’s age, helps doctors determine risk to the fetus. There have not been any risks or side effects with the first trimester screen, but there is a 5 percent false positive rate. Therefore, there is a chance that the baby will be normal even if abnormal results were found. Your doctor may suggest other tests depending on the results of the screen.
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FIRST TRIMESTER
MORNING SICKNESS In the first trimester, hormone changes can cause nausea and vomiting. Although it can occur at any time of day, this is called “morning sickness.” Morning sickness usually tapers off by the second trimester. Causes It is not certain what exactly causes morning sickness, but it is thought to be related to a combination of hormonal increases of human chorionic gonadotrophin (hCG) and estrogen and physical changes such as enhanced sense of smell, sensitive stomach and stress. Call your doctor: • If you’ve lost 2 or more pounds within a week. • If you’re vomiting blood. • If you are dehydrated. • If you develop nausea and vomiting after 9 weeks. • If you are still experiencing nausea and vomiting after 20 weeks. • If you get dizzy when you stand up. • If you have constant pain in the abdominal area, headache, fever or swelling in the front of your neck. Over-the-counter medications Do not use any medication without consulting with your doctor first. Not all medications help everyone, however, some women have relief by using the following OTC medications: • Vitamin B6 • Antihistamines • Vitamin B6 and doxylamine (Unisom) • Reflux medicines (Zantac or Pepcid)
Spotting early in pregnancy doesn’t mean miscarriage is certain. Still, contact your doctor right away if you have any bleeding.
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What else might help? • Eat several small meals instead of three large meals to keep your stomach from being empty. • Don’t lie down after meals. • Eat dry toast, saltines or dry cereals before getting out of bed in the morning. • Eat bland foods that are low in fat and easy to digest, such as cereal, rice and bananas. • Sip on water, weak tea or clear soft drinks, or eat ice chips. • Avoid smells that upset your stomach. • Eat cold or room temperature foods to avoid strong aromas. • Avoid fatty foods and anything spicy, acidic or fried. • Brush your teeth or rinse your mouth after eating. • Drink a moderate amount of fluids between meals. • Drink cold, carbonated beverages. • Avoid non-food items that cause nausea. • Get some fresh air. • Relax and get plenty of rest. • Take your prenatal vitamins. • Try ginger or peppermint.
MISCARRIAGE A miscarriage is a pregnancy loss from natural causes before 20 weeks. As many as 20 percent of pregnancies end in miscarriage. Often, miscarriage occurs before a woman even knows she is pregnant. Signs of a miscarriage can include: • Vaginal spotting or bleeding • Cramping or abdominal pain • Fluid or tissue passing from the vagina Treatment In most cases, miscarriage cannot be prevented. Sometimes, a woman must undergo treatment to remove pregnancy tissue in the uterus. Counseling can help with emotional healing. Please call the office if you think you could be experiencing a miscarriage. Blood work and/or ultrasounds may be done to help find out what is happening. Also, if you have Rh negative blood type you will likely need Rhogam.
SECOND TRIMESTER
SECOND TRIMESTER (14 to 27 weeks) Most women find the second trimester of pregnancy easier than the first, but it is just as important to stay informed about your pregnancy during these months. You might notice that symptoms like nausea and fatigue are going away, but other new, more noticeable changes to your body are now happening. Your abdomen will expand as the baby continues to grow. You will begin to feel your baby move during this trimester.
As your body changes to make room for your growing baby, you may have: • • • • •
What should I expect? • • •
• • • •
Your doctor will track your baby’s growth by measuring from the pubic bone to the top of your uterus. A Doppler instrument will be used to listen to your baby’s heartbeat. Your doctor will address fetal movement. Flutters and kicks usually begin around 20 weeks for first time pregnancies and 16 weeks for women who have had prior pregnancies. Genetic tests may be performed to test for chromosomal conditions. Blood tests will be given to check blood count and iron levels, as well as gestational diabetes and infections. A urine test will be performed to test the amount of protein in your urine and look for infection. Depending on blood tests and ultrasounds, your doctor may perform further diagnostic testing.
• •
•
Body aches, such as back, groin or thigh pain. Stretch marks on your abdomen, breasts, thighs or buttocks. Darkening of the skin around your nipples. A line on the skin running from belly button to pubic hairline. Patches of darker skin, usually over the cheeks, forehead, nose, or upper lip. This is sometimes called the mask of pregnancy. Numb or tingling hands, called carpal tunnel syndrome. Itching on the abdomen, palms, and soles of the feet. (Call your doctor if you have nausea, loss of appetite, vomiting, jaundice or fatigue combined with itching confined to palms and soles of the feet. These can be signs of a serious liver problem.) Swelling of the ankles, fingers and face.
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THIRD TRIMESTER
THIRD TRIMESTER (28 weeks or more) You’re in the home stretch! Some of the same discomforts you had in your second trimester will continue. Because the baby is getting bigger, many women find breathing difficult and notice they have to go to the bathroom even more often. Don’t worry, your baby is fine, and these problems will lessen once you give birth.
Some new body changes you might notice in the third trimester include: • • • • • • • • • • •
You become short of breath more easily Heartburn Swelling of the ankles, fingers and face Hemorrhoids Tender breasts, which may leak a watery pre-milk called colostrum Your belly button may stick out Trouble sleeping Headache or vision changes Right upper belly pain The baby “dropping”, or moving lower in your abdomen Contractions, which can be a sign of real or false labor
As you near your due date, your cervix becomes thinner and softer (called effacing). This is a normal, natural process that helps the birth canal (vagina) open during the birthing process. Your doctor will check your progress with a vaginal exam as you near your due date.
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Common tests during your third trimester: •
•
•
•
Fetal kick counts. You should feel your baby move 10 times in two hours. If you feel your baby’s movement has decreased, please eat and drink something and sit or lie down. If you still don’t feel your baby move 10 times in two hours, call your doctor. Group B streptococcus screening: This test is done at 35 to 37 weeks to look for bacteria that can cause pneumonia or a serious infection in newborns. A swab is used to take a sample from your vagina and perineum to be tested. Antepartum Surveillance: High risk pregnancies may have antepartum surveillance of fetal health with monitoring the baby’s heart rate or measuring the amount of amniotic fluid with an ultrasound. When these tests begin and how often they are performed depends on many factors including the gestational age of your baby and the problem that you are having. You should receive a vaccine for whooping cough (Tdap) during the third trimester. Vaccination while pregnant will give some immunity to your baby after birth. Women who are Rh negative will receive Rho (D) immune globulin at 28 weeks to prevent some types of anemia in babies.
Make sure to pre-register at Cabell Huntington Hospital so that most of the paperwork is completed before you come in for delivery.
PREGNANCY CONCERNS
PREGNANCY CONCERNS WHEN TO CALL THE OFFICE You are very important to us. Please let us know if a problem arises or if you have any concerns including: • Decrease in fetal movement after 24 weeks. • Persistent and severe lower pelvic pain. • Any vaginal bleeding. • Leakage or rupture of the “bag of water” or amniotic sac. This can be a small trickle of fluid or a large gush. Note the color, amount, time and if there is any odor. • Contractions (a tightening and relaxing of the uterus). True contractions generally become longer, stronger, and closer together. Call when your contractions are 5-7 minutes apart or are causing a lot of discomfort. • Symptoms of a urinary tract infection (painful urination, feeling like you must urinate right away or blood in the urine). • Fever of 100° F or above. • Severe headaches—especially if accompanied by visual disturbances or swelling in the face or hands. • Vomiting more than 2-3 times a day. • Vaginal itching, burning, foul odor and/or increased vaginal discharge.
If a problem occurs, call the office at 304-691-1400 or OB patient concern line at 681-378-4562. During normal office hours, one of our nurses or physicians will help answer any of your concerns. After usual office hours, you will be put in contact with the physician on call.
Our physicians are always available. Most problems and concerns can be addressed over the phone without an office or hospital visit. PREGNANCY HANDBOOK | 15
PREGNANCY CONCERNS
SYMPTOM RELIEF & MEDICATIONS Below is a list of common symptoms and what can be taken during pregnancy to alleviate them. It is very important to take into consideration how far along you are in your pregnancy. Any herbal remedies or nutritional supplements must be cleared by your doctor before taking.
Symptom
Throughout Pregnancy
After 12 weeks
Comments
Nausea & Vomiting
1 tablet vitamin B6 and ½ tablet Unisom before each meal and at bedtime, B-natal Therapops/lozenges, Dramamine, Bonine
1 tablet vitamin B6 and ½ tablet Unisom before each meal and at bedtime, B-natal Therapops/lozenges
Increased protein, ginger products, small frequent meals, crackers, dry toast, pre-natal vitamins before bedtime and Sea-Bands acupressure devices all decrease incidence of nausea and vomiting
Diarrhea
Imodium AD, Pedialyte, Gatorade
Imodium AD, Pedialyte, Gatorade
Increase fluid intake. Avoid spicy food.
Constipation
Colace, Metamucil, Dulcolax, Miralax
Colace, Metamucil, Dulcolax, Miralax
Increase fluids and fiber in diet (whole grains, fruits, vegetables). Call 304-691-1400 if stool is bloody or constipation lasts longer than 3 days.
Indigestion
Mylanta, Mylanta II, Tums, Rolaids, Zantac, Pepcid AC
Mylanta, Mylanta II, Tums, Rolaids, Zantac, Pepcid AC
Do not take Pepto-Bismol or anything containing aspirin.
Extra-Strength Tylenol
If you experience a temperature over 101°F that doesn’t respond to ExtraStrength Tylenol and lasts longer than 24 hours call the office.
Fever above 101°F
Call your doctor
Call your doctor at if fever lasts longer than 24 hours
Allergies, Cold & Sinus
Benadryl, Zyrtec, Claritin, Allegra
Robitussin, Cough drops, Saline nasal spray
Note: No “D” in decongestant in the above
None of the following should be used anytime during pregnancy: Motrin, Advil, Excedrin, Aleve, Ibuprofen. If you experience elevated blood pressure, do not use decongestants unless ordered by your doctor. No medicated nasal spray should be used without a doctor’s order.
Cough drops, Saline nasal spray
Sore Throat
Cloraseptic spray, Cepacol lozenges
Extra-Strength Tylenol, Cloraseptic spray, Warm water salt gargle
If you experience a temperature over 101°F, call 304-691-1400.
Headaches & Minor Pains
Regular Strength Tylenol (no more than 4 per day)
Regular Strength Tylenol
If you experience pain that is not relieved by this treatment, call the office.
Ways to ease back pain during pregnancy • • • • • • • • •
Wear low-heeled shoes with good arch support. Ask for help when lifting heavy objects. When standing for long periods, place one foot on a stool or box. If your bed is too soft, have someone help you place a board between the mattress and box spring. Do not bend over from the waist to pick things up – squat down, bend your knees and keep your back straight Sit in chairs with good back support, or use a small pillow behind the lower part of your back. Try to sleep on your side with one or two pillows between your legs for support. Avoid sleeping on your back. Apply heat or cold to the painful area or massage it. Ask your physician for exercises to strengthen the muscles that support your back.
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PREECLAMPSIA
Gestational diabetes happens only during pregnancy and can cause health problems for the baby and the mother if not controlled. Gestational diabetes occurs when blood sugar levels are too high during pregnancy.
Preeclampsia is a condition also known as toxemia. It starts after 20 weeks of pregnancy and causes high blood pressure , protein in the urine and problems with the kidneys and other organs.
Symptoms Usually there are no symptoms.
Symptoms can include: • Water retention and swelling • Headaches • Blurred vision • Excessive fatigue • Nausea or vomiting • Upper right abdominal pain • Infrequent urination • Shortness of breath • Easily bruised
Testing If you are high risk, you may be tested at your first prenatal visit. Routine testing for diabetes will be ordered at 24-28 weeks. If you do not pass the screening test, you will take a second longer test. Treatment Most women with pregnancy related diabetes can control their blood sugar levels by following a healthy meal plan from their doctor. If you are diagnosed with gestational diabetes, you will be referred for diabetes education at the CHH Perinatal & Hypertension Center. Some women also need medications to keep blood sugar levels under control. Women with gestational diabetes have an increased risk of: • Preeclampsia • Early delivery • Cesarean birth • Having a big baby, which can complicate delivery • Baby born with low blood sugar, breathing problems, and jaundice Who is at risk? • Women over the age of 35 • Women who are obese or overweight • Women who have previously had gestational diabetes • Women who have had a very large baby • Women with a family history of diabetes • Women who have had an unexplained stillbirth before • Women who are African American, Native American, Asian American, Hispanic, Latina or Pacific Islander
Who is at risk? All pregnant women are at risk for developing preeclampsia. Women at higher risk include: • First time mothers • Gestational hypertension or preeclampsia history • Genetic history • Women carrying multiple babies • Women younger than 20 and older than 40 • Women with prior high blood pressure or kidney disease • Women who are obese or have a BMI of 30 or more Preeclampsia affects both mother and baby. Left untreated, preeclampsia can cause maternal stroke, seizures or fetal death. If you have preeclampsia, close maternal and fetal surveillance is necessary to determine the best time to deliver your baby. Some women with preeclampsia need inpatient observation while others may be watched closely without being admitted to the hospital until time for delivery.
Women with gestational diabetes should be tested for diabetes 6-12 weeks after giving birth and then every 3 years. The child should frequently be tested for diabetes throughout childhood.
MISCARRIAGE (SEE PG. 12) MORNING SICKNESS (SEE PG. 12)
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PREGNANCY CONCERNS
GESTATIONAL DIABETES
PREGNANCY CONCERNS MATERNAL-FETAL MEDICINE Specialized, comprehensive care for women with high-risk pregnancies is provided by our skilled team of physicians and nurses. Drs. David Chaffin and Kelly Cummings are fellowship trained Maternal and Fetal Medicine specialists with expertise in caring for women with high-risk pregnancies due to: • High blood pressure • Gestational diabetes • Preterm labor • Placenta previa • Miscarriage risk • Carrying more than one baby • Other conditions that may endanger the health of the mother or baby Additional services include: • Maternal addiction services (MARC) - see page 27 • Amniocentesis • Cervical cerclage • Extensive ultrasound (2D, 3D or 4D) • Non-stress tests • Diabetes education • Telemedicine
David Chaffin, Jr., MD, FACOG
Kelly Cummings, MD, FACOG
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Patients can be seen by our high-risk physicians at: Marshall University Medical Center An outpatient department of Cabell Huntington Hospital 1600 Medical Center Drive, Suite 4500, Huntington 304-691-1400 Marshall Health - Teays Valley 300 Corporate Center Drive, 3rd Floor, Scott Depot 304-691-1800 CHH Perinatal & Hypertension Center 1616 13th Avenue, Suite 100, Huntington 304-526-2124 (Perinatal); 304-399-6897 (Hypertension)
“Marshall Health is the only practice I refer to for maternal-fetal medicine services because of the quality of care provided to my patients.” -Bassam Shamma, MD
HEALTHY CHOICES
HEALTHY CHOICES NUTRITIONAL GUIDELINES Diet Focus on the quality of food intake and strive to maintain a healthy, well-balanced diet. Vitamins Take a prenatal vitamin supplement as recommended by your doctor. Foods to Avoid
Water Drink plenty of fresh water throughout the day. Weight Gain Recommended weight gain during pregnancy is approximately 20-30 pounds for normal weight women. The recommended weight gain varies based on pre-pregnancy weight. Discuss this with your doctor during the initial prenatal visit.
AVOID CERTAIN FISH • Swordfish, shark, tile fish, king mackerel and fresh tuna. These large fish harbor high levels of methyl mercury that can affect brain and neurological development in the fetus. Limit white (albacore) tuna to 6 ounces a week. • Refrigerated smoked seafood unless it is used in a cooked dish, such as a casserole. AVOID RAW OR UNDERCOOKED FOODS • Raw or undercooked meat, poultry, seafood and eggs. These foods may contain a variety of harmful bacteria and viruses. Use a meat thermometer when preparing meat and poultry. • Dough or batter made with eggs. Cook eggs until they are not runny. REHEAT DELI MEATS INCLUDING HOT DOGS • If consuming deli ham, turkey, bologna, salami and hot dogs, reheat until they are steaming hot. Certain bacteria sometimes found in these foods may cause serious health problems. • Avoid refrigerated pâté or meat spread. AVOID UNPASTEURIZED DAIRY FOODS AND JUICES • Milk and soft cheeses made with unpasteurized milk unless they are fully cooked. This includes Mexican queso cheese. • Juices such as cider purchased from roadside stands, farms or in some stores. These products may contain E. coli or listeria. Check labels for pasteurization. PREGNANCY HANDBOOK | 19
HEALTHY CHOICES EXERCISE GUIDELINES
ACTIVITIES DURING PREGNANCY
Exercise in pregnancy promotes healthy well-being.
Travel
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Exercise may help decrease discomforts such as nausea, heartburn, swelling and insomnia, improve digestion and reduce constipation, and improve stamina and flexibility for labor and delivery. You can continue mild to moderate exercise during pregnancy (unless restricted by your doctor). Regular exercise (at least 3 times a week) is preferable to intermittent activity. Avoid exercising flat on your back after the first trimester (12 weeks). You may need to modify the intensity of your workout. Do not exercise to the point of exhaustion, palpitations and excessive shortness of breath. Choose exercises that do not require balance. Do not participate in activities where there is potential for even mild abdominal trauma. Avoid becoming overheated. Drink lots of water before, during and after exercise. Pre-pregnancy exercise routines should be resumed gradually after delivery. Check with your doctor first. Recommended exercises: walking, stationary biking, swimming, low-impact aerobics, light free weights and yoga (avoid certain movements as your balance may be affected by the pregnancy).
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Continue to wear your seat belt at all times. Place the lap belt under your abdomen as low as possible. If traveling for a long distance, try to get up and walk or stretch every 1-2 hours. Do ankle exercises occasionally while sitting to keep blood circulating in your legs. We recommend you stay within approximately 1 hour of home during your last month of pregnancy. Airlines may refuse to let you fly within the United States after 36 weeks of pregnancy and after 32 weeks for international flights. Travel is not recommended for pregnant women in areas with malaria or where Zika outbreaks are ongoing. Zika is an illness spread by mosquitos that can cause serious birth defects. Take the office phone number with you in case you have any questions while away. Sex If your pregnancy is progressing normally, you do not need to alter your sexual activities. Intercourse will not harm the baby. Comfortable positioning is important. You may be advised to limit or avoid intercourse for the following reasons: bleeding, abnormal placenta location, premature labor or rupture of membranes (leaking amniotic fluid). Massage and Chiropractic Treatment Soft tissue massage treatment is safe in pregnancy. Inform your massage therapist that you are pregnant before beginning treatment. Chiropractic care should be performed by someone who is very experienced in treating pregnant patients and should be discussed with your physician.
DOMESTIC VIOLENCE
The majority of women are able and encouraged to continue working during pregnancy. Continuing to work improves mood and decreases the risk of some pregnancy complications. Occasionally adjustments will have to be made. It is not advised to lift more than 20 pounds or climb a ladder during pregnancy. Documentation can be provided from your doctor to advise your place of employment on any restrictions. In rare circumstances, it may be recommended to discontinue working while pregnant due to certain high risk pregnancy complications. If one of these issues arises during your pregnancy, you will be advised by your physician to stop working and documentation can be provided for your place of employment.
Is your relationship abusive?
As you prepare for maternity leave, we are happy to complete FMLA papers for your place of employment. Please allow 10 business days to finalize.
VACCINES Vaccines cause your body to make protective antibodies against the disease for which you are being vaccinated. Newborns cannot get many vaccines until they are 2-6 months old. Some of the antibodies from the vaccines that you get when you are pregnant are passed to your baby before birth. This helps protect your baby from illness during the first few months. Be sure to discuss the vaccines you have had with your physician. Your physician will recommend the vaccines you need based on your medical history and lifestyle. If you do not get the recommended vaccines when you are pregnant, talk to your physician about vaccines you can get right after the baby is born. Are vaccines safe? Most vaccines are safe for you and your baby. Several infectious diseases, such as the flu, are much more severe during pregnancy and we encourage all pregnant women to receive the flu vaccine during pregnancy.
Emotional or physical violence is not a part of a normal, healthy relationship. How do you know if your relationship is abusive? Ask yourself these questions… • • • • • •
Does your partner make jokes at your expense or put you down? Do they threaten you or throw things when they are angry? Have they pressured you to perform a sexual act? Have they physically hurt you in the past year? Do they say that it is your fault if they hit you? Do they promise it won’t happen again, but it does?
If you answer “yes” to any of these questions, your relationship is not healthy. Talk with your physician.
If you are in an abusive relationship, it is not your fault. No one deserves to be abused. Please tell someone you trust about the abuse or call the National Domestic Violence Hotline at 800-799-SAFE (7233).
Vaccines that are safe during pregnancy include: • • • •
Influenza Pneumonia Hepatitis A and B Tdap
The Centers for Disease Control (CDC) says the hepatitis A vaccine can be considered in pregnancy and risks of the vaccine should be weighed against the risk of developing the virus in pregnancy. Vaccines that should not be given during pregnancy: • • •
Nasal spray flu vaccine Varicella (chickenpox) vaccine Measles-mumps-rubella (MMR) vaccine
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HEALTHY CHOICES
WORKING WHILE PREGNANT
FREQUENTLY ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS Am I allowed to have caffeine? Yes, but limit caffeinated beverages (including coffee, hot or iced tea and sodas) to no more than 2 cups per day. Is it okay to paint or use cleaning products while I am pregnant? Yes, as long as you do so in a well-ventilated room.
What type of harmful agents should I avoid while pregnant? Almost everything that goes into your body is shared with your baby. By putting harmful substances in your body, you put your baby at risk! • • •
DO NOT SMOKE, DRINK ALCOHOL or TAKE STREET DRUGS (including marijuana). Avoid second-hand smoke. Avoid handling soiled cat litter.
Can I use insect repellent? Insect repellent with DEET is safe to use and is recommended in areas with potential for mosquito or other insect borne diseases.
What are some common ways to avoid overheating? Avoid saunas, hot tubs and tanning beds. Drink lots of water when outside. Stop doing activities when you start getting hot.
Can I get my hair dyed or highlighted? Hair coloring is generally safe during pregnancy, especially after the first 12 weeks. Am I able to get a tattoo and piercing while pregnant? You should avoid getting a tattoo or piercing while pregnant.
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Am I able to get dental work done while pregnant? Routine dental work is encouraged. It is up to the dentist as to whether the work is necessary. Local anesthesia is safe. Most antibiotics that are used by dentists, including penicillins and cephalosporins, are safe. For dental x-rays, use abdominal shielding. We can also provide a letter outlining these guidelines for your dentist.
SIGNS OF LABOR
SIGNS OF LABOR FULL-TERM LABOR • Labor begins when the cervix opens or dilates. The uterus contracts and the abdomen becomes hard at regular intervals. • False labor (Braxton-Hicks) contractions may be confused with true labor. Braxton-Hicks contractions are usually irregular, occur in the afternoon or evening when you are tired, and often go away after you lie down. • True labor usually occurs when contractions are 4-5 minutes apart or closer, last 45-60 seconds, and continue for at least one hour. You should call your doctor if labor has begun, your “water breaks” (a sudden gush of fluid or trickling fluid from the vagina), or you have constant severe pain with no relief between contractions. We then recommend going to the hospital for labor and delivery. • There is no need to call if you lost your mucus plug (pinkish tinged mucus). This can happen several weeks before delivery. It is common for this to occur after a cervical exam. If you experience vaginal bleeding at any time during your pregnancy, you should call the office. • Barring any serious issues that would warrant an early delivery recommendation, labor will not be induced prior to 39 weeks gestation. To optimize the best care and outcome for both mother and baby, the recommendation to continue the pregnancy will often extend to 41 weeks gestation if natural labor has not occurred on its own. After 41 weeks, fetal surveillance will likely be recommended if the patient desires to avoid an induction and wait for natural labor. No pregnancies should continue past 42 weeks of gestation.
PRE-TERM LABOR Pre-term labor is labor that begins before 37 weeks. Some warning signs are: • • • • • • •
Four or more uterine contractions per hour—these may be painless. Menstrual-like cramps felt low in the abdomen. These may be constant or may come and go. Dull, low backache that radiates to the sides or the front and is not relieved by change of position. Pelvic pressure that feels like the baby is pushing down. Stomach cramps or the feeling of “gas pains” with or without diarrhea. Increase or change in vaginal discharge—may become pink or brown-tinged, mucous-like or watery. A general feeling that something is not right. You may just not feel well, even without a specific cause.
Call the office immediately if you are experiencing any of these symptoms. PREGNANCY HANDBOOK | 23
POSTPARTUM
POSTPARTUM WHAT TO EXPECT Lochia — A bloody vaginal discharge that usually turns pink then yellow or white six weeks after delivery. Perineal Discomfort — Soreness from the delivery or an episiotomy. Use cold packs or apply chilled “Tucks” pads. Take sitz baths or soak area in warm water. Fatigue — Try to sleep when your baby sleeps. Ask for help and be specific! Take it easy. Limit visitors during the first few weeks. Eat a healthy diet. After Pains — Pains in the uterus as it continues to contract and shrink to its pre-pregnancy shape. After pains may be worse when breastfeeding. Take Tylenol or ibuprofen if needed. Sweating — You may experience profuse sweating, but this will stop with time. Difficulty with Bowel Movements — You may experience constipation. Take short walks, eat foods high in fiber, increase fluids or use a mild stool softener. Hemorrhoids — You can try a medicated cream, chilled “Tucks” pads, or warm sitz baths. Difficulty Urinating — Try a warm sitz bath or spray water over the perineum while urinating. Increase fluids. Do Kegal exercises. Swollen, Painful Breasts — Wear a well-fitting bra. Apply ice packs (bags of frozen peas work well) to reduce swelling. Frequent breastfeeding helps to encourage milk flow. Prior to nursing, try using warm compresses. Engorgement (when your milk comes in) usually lasts about 36 hours. If you do not plan to breastfeed, wear a snug sports bra, use ice packs, and DO NOT extract any milk from your breasts. If fever occurs, call the office. Mastitis — If you experience fever, a painful breast lump or a red patch on your breast, call the office ASAP. For reduction of mastitis risk, use lanolin ointment or ensure proper latching of your baby during breastfeeding. Baby Blues — Due to hormonal changes, expect mood swings and occasional “baby blues” for the first few days after delivery. Get as much rest as possible. Eat a wellbalanced diet. Take time out for yourself. Talk to your partner, a friend, or your doctor about how you are feeling. Menstrual Periods — It may be a matter of weeks or even months before you resume periods. Avoid intercourse until after your postpartum visit with the doctor. You can get pregnant even if you have not resumed your menstrual period! 24 | MARSHALL OBSTETRICS & GYNECOLOGY
Your first postpartum visit will occur at two to four weeks after the delivery of your baby. Call our office at 304-6911400 to schedule your postpartum appointment if you did not schedule one before delivery. WHEN TO CALL You are very important to us. Please let us know if a problem arises or if you have any concerns including: • • • • • • • • • • • • • • •
Fever higher than 100.4° F. Nausea and vomiting and unable to keep fluids down. Pain or burning during urination. Bleeding that is heavier than normal. Severe pain in your pelvic area. Pain, swelling and tenderness in your legs. Chest pain. Red areas or painful lumps in your breasts. Perineal pain or pain from an incision that gets worse. Vaginal discharge that smells bad. Severe depression. Baby blues that last for more than 2 weeks. Feelings of anger, depression or sadness that worsen over time. Panic attacks. Thoughts of harming yourself or the baby.
POSTPARTUM
POSTPARTUM DEPRESSION
SUDDEN INFANT DEATH SYNDROME (SIDS)
CDC research shows that nationally about 1 in 9 women experience postpartum depression symptoms. These symptoms are more strongly felt and last longer than what is known as “baby blues,” a term used to describe the sadness, irritability, anxiousness and loneliness many women experience a few days after their delivery.
The exact cause of SIDS remains unknown. However, actions can be taken to help reduce the risks of SIDS and other sleep-related infant deaths.
Risk factors include a history of depression or a home life that lacks support. It is also more common when the baby is premature, unhealthy or colicky. Life stresses such as a loss of job, divorce and caring for multiple children can amplify these feelings as well. Symptoms • • • • • • • • • •
Lasting sadness Trouble falling asleep or sleeping too much Irritable No longer enjoying what you used to Tiredness Overeating or loss of appetite Withdrawing from loved ones and/or your baby Feeling angry Crying more than usual Experiencing guilt and doubt about whether you are being a good mom
Treatment Postpartum depression is treatable. If you think you are depressed, ask your physician for a referral to a mental health professional.
Ways to reduce the risk of SIDS • • • • • •
•
Always put your baby to sleep on their back on a firm surface. Share your room - not your bed - with the baby. Your baby should not sleep in an adult bed, on a couch or on a chair alone or with anyone. Do not put toys, pillows or loose bedding in your baby’s sleep area. Help keep your baby from overheating by setting the room to a comfortable temperature and making sure they are not overdressed. Do not smoke, drink alcohol or take street drugs. Once your baby is breastfeeding well, consider using a pacifier while sleeping. Do not attach the pacifier to anything like a string or stuffed animal as that increases the risk for choking or suffocation. Give your baby plenty of tummy time when they are awake and someone is watching.
Please contact us if you have thoughts of harming yourself or your baby. PREGNANCY HANDBOOK | 25
RESOURCES
RESOURCES PRENATAL CLASSES We encourage all obstetrical patients to look into prenatal classes at Cabell Huntington Hospital. Childbirth classes are available as well as classes on breastfeeding, infant CPR, new baby care, and sibling classes. For information or to register, please call 304-526-BABY.
COMMUNITY SERVICE ORGANIZATIONS • • •
Cabell County Family Resource Network: 304-697-0255 United Way, Cabell County Substance Abuse Prevention Partnership, Education Matters, Financial Stability and Success by 6: 304-523-8929 Huntington City Mission: 304-523-0293
EARLY CHILDHOOD/ DEVELOPMENT/ DAY CARE • • • • •
Birth to Three: 304-523-5444 Head Start & Pre-K: 304-697-4600 LINK Child Care Resource & Referral: 1-800-894-9540 TEAM for WV Children: 304-523-9587 WV Help Me Grow: 1-800-642-8522
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HEALTHCARE/ NUTRITION • • • • • •
Cabell Huntington Health Department: 304-523-6483 Ebenezer Medical Outreach: 304-529-0753 Medicaid: 304-528-5800 WIC – Cabell County: 1-800-953-1009/304-302-2013 WV Children’s Health Insurance Program: 1-877-WVACHIP Family Child Care Food Program: 304-751-5253
CRISIS AND EMERGENCY NEEDS • • • • • •
Maternal Addiction & Recovery Center (MARC): 304-691-8730 - see page 25 Abuse Hotlines (children and adult protective services, domestic violence): 1-800-352-6513 Branches Domestic Violence Shelter: 304-529-2382 Information & Referral (referrals, utility assistance, food and clothing pantries, etc.): 304-528-5660 Poison Control Center: 1-800-222-1222 Marshall OB Concern Line: 681-378-4662
RESOURCES
MATERNAL ADDICTION & RECOVERY CENTER (MARC) The Maternal Addiction & Recovery Center provides comprehensive obstetrical care, outpatient addiction care and counseling for expectant mothers with opiate addiction. In partnership with the Marshall University Joan C. Edwards School of Medicine, Marshall Obstetrics & Gynecology and Marshall Psychiatry, MARC is committed to the safety and well-being of addicted mothers and their unborn children. Services Patients receive optimal obstetrical care under the direction of our maternal-fetal medicine specialists while participating in an opiate addiction maintenance program that uses buprenorphine (e.g. Subutex®). Patients are evaluated and regularly seen by a certified addiction counselor. MARC focuses on the health and safety of mothers with substance use disorders and their babies throughout pregnancy with medical care, counseling and a builtin support network.
MARC focuses on the health and safety of mothers with substance use disorders and their babies throughout pregnancy.
Patient Requirements In order to participate in the MARC program, patients must: • Be pregnant. • Attend weekly group therapy meetings and individual counseling sessions. • Attend additional Narcotics Anonymous or Alcoholics Anonymous meetings. • Comply with recommended obstetrical care. • Urine and blood testing are performed routinely. For some patients, a brief hospitalization (1-3 days) is required to stabilize them on the optimal dose of buprenorphine. Costs associated with the program are covered by most health insurance and Medicaid programs in the Tri-state area. Referrals Self-referrals are welcomed and encouraged. Health care providers may refer patients to MARC. Call 304-691-8730 to make a referral, to sign up or for more information.
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RESOURCES MARSHALL PEDIATRICS OUR PRACTICE If you are looking for a physician to care for your newborn, our team of over 40 pediatricians is dedicated to providing compassionate general and specialty pediatric care for patients up to 21 years old. SERVICES • • • • • • • • • • • • • •
General pediatrics Adolescent medicine Allergy-immunology Behavioral/developmental Cardiology Endocrinology Gastroenterology & nutrition Hematology-oncology Hospitalist care Neonatal-perinatal medicine Neurology Neurosurgery Ophthalmology NowCare. Walk-ins welcomes.
For more information, call 304-691-1300 or visit www.marshallhealth.org/pediatrics.
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OUR LOCATIONS Marshall University Medical Center An outpatient department of Cabell Huntington Hospital 1600 Medical Center Drive | 3rd Floor Huntington, WV 25701 304-691-1300 3rd Avenue 915 3rd Avenue Huntington, WV 25702 304-691-8900
East Huntington 5170 U.S. Route 60 | Door D Huntington, WV 25705 304-399-4422 NowCare: Weekdays, 9 a.m. - 7:30 p.m. Weekends, 9 a.m. - 2:30 p.m. Teays Valley 300 Corporate Center Drive | 1st Floor Scott Depot, WV 25560 304-691-8870
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REFERENCES: https://www.womenshealth.gov/pregnancy/youre-pregnant-now-what/ https://www.mayoclinic.org/tests-procedures/nonstress-test/home/ovc-20188875 https://www.natera.com/panorama-test https://www.acog.org/Patients https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/art-20044581 https://www.womenshealth.gov/a-z-topics/stis-pregnancy-and-breastfeeding General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011; 60 (No. 2): 26.
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Name: Date: Weight:
lbs.
oz. Length:
Hospital: Doctor: Special Memories: PREGNANCY HANDBOOK | 31
304-691-1400 • www.marshallhealth.org/obgyn •
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