OB Patient Information

This comprehensive guide has been designed to help you during and after your pregnancy.

Introduction

The purpose of prenatal care is to find and to prevent problems that may occur during pregnancy and soon after your baby is born. You and your baby's well being are very important to us.

Your first visit will include a complete physical examination including a Pap smear, cultures, blood work, and possibly an ultrasound (vaginal or abdominal depending on how far along you are). Your second visit will involve a somewhat lengthy teaching session about your pregnancy. Please review our packet before that visit to help formulate your questions.

Subsequent office visits are then scheduled at four-week intervals until your seventh month of pregnancy at which time your visits will be at two-week intervals. During your last month, you will be seen weekly. This may vary depending on problems you have during your pregnancy.  Your doctor will discuss this with you.

During your fourth month of pregnancy, we offer and recommend a blood test called the Triple Screen, which screens for some birth defects.

Please try to make all of your appointments one to two weeks in advance and let us know as soon as possible if you need to cancel.

Please refer to the list of medications provided in your packet, which may help with some of your discomforts and are safe to take during pregnancy.  Avoid having any X-rays done including dental X-rays and nitrous oxide “laughing gas”.  If X-rays are absolutely necessary, please tell them you are pregnant so they may shield you appropriately.

Dr. Larson-Ohlsen tries to be available for the delivery of her own patients. Another doctor may admit you to the hospital and manage your labor or any complication of pregnancy.  There will be occasions when Dr. Larson-Ohlsen is unavailable and the physician on call (another physician in The Group for Women) will take care of you and perform your delivery. They will do their best to help your delivery experience be as wonderful as possible!

You must notify the doctors if you have any of the following symptoms: 

• Heavy vaginal bleeding (soaking two pads per hour for 2 to 4 consecutive hours in the first trimester, or bleeding as heavy as a period during your 2nd or 3rd trimester)

• Severe abdominal pain

• Back pain that does not subside

• Persistent severe headaches

• Pain with urination

• Leakage of fluid from the vagina

• Foul smelling vaginal discharge

• Chest pain

• Painful swelling of your legs

Remember that while pregnancy may be associated with some physical discomforts, it is a very special time that only you and your baby can share. HAVE A WONDERFUL PREGNANCY!!!

Obstetric Patient Financial Responsibility

We hope the following will explain the financial commitment that you have assumed for your prenatal care and delivery.  The prices are as follows:

We ask that you pay the prenatal deposit by your 8th month of pregnancy in monthly installments.  Any credit balance will be held until after all delivery charges are paid, then any overpayment will promptly be refunded to you.  After 60 days from the date of billing your insurance for your delivery, we expect full payment whether it is from your insurance company or from you.

If you have no insurance, the total fee of $2,500.00 for the prenatal and vaginal delivery is to be paid in monthly increments and final payment will be due by the beginning of your 8th month of pregnancy.  There will be no additional expenses added to this amount.

Nausea

Morning Sickness

Before you go to bed - Be sure to have plenty of fresh air in the room where you sleep.  Household odors, such as the smell of soiled clothes, may upset your stomach. Place crackers, dry bagels, dry cereal, or plain bread within reach of your bed.

Before you get out of bed in the morning - Eat one of the above foods. Do not put margarine or butter on the bread.

When you get up - Get out of bed very slowly, taking several minutes, and avoiding sudden movements.

Before breakfast - Eat more of the bread, cereal, or crackers before making breakfast.  When cooking, have a window open to decrease the smell of cooking food.

Nausea During the Day

Meals - You are more likely to feel nauseated when your stomach is empty so eat several small meals per day rather than three large ones. Do not drink fluids or eat soup at mealtimes. If you are thirsty, try eating chips of ice. You may feel like eating a regular meal sometime during the day. Do not overeat at this time.

Foods to Avoid - Foods with a lot of fat and highly seasoned foods tend to upset the stomach. Avoid foods that give you gas. Some examples of foods to avoid:

            Fried, greasy foods            

            Salad dressing

            Fatty meats           

            Mayonnaise

            Butter           

            Pastries

            Margarine        

            Onions

            Gravy           

            Chili

            Bacon           

            Garlic

Between meals - Drink small sips of liquids frequently. Consume liquids such as water, milk, fruit juices, coffee, tea, and soups ONLY between meals.

If your nausea causes persistent vomiting, consult your doctor. She may have other suggestions for you.

A Plan for Eating to Control Nausea

Before getting out of bed - Crackers, plain bread or toast, or dry cereal.  Jelly or jam if you wish.

Breakfast -

            Cereal with 1/4 cup of milk

            Toast (no margarine or butter)

Lunch -

            Cottage cheese or lean meat (fish or poultry)

            Plain bread

            Vegetable or fruit

Between Meals (30 minutes or more after lunch) -

            Milk, tea, coffee, fruit juice, or soup. Take one or two sips at a time

Dinner -

            Lean meat

            Potato

            Dark green or yellow vegetables

            Plain bread

            Dessert

Snack (30 minutes or more after dinner) -

            Milk or other liquid, one or two sips at a time

THIS EATING PLAN DOES NOT GIVE YOU ALL OF THE FOODS YOU NEED DURING PREGNANCY.  When your nausea subsides, begin eating all of the foods listed on your prenatal diet.

Calcium

Calcium is important for the maintenance of the health of your bones and for the developing bones of your baby.  The best source of calcium is milk or milk products.  The recommended daily requirement is one quart or four 8-ounce servings.  Skim or 2% milk is recommended over whole milk because they have the same nutritional value but less fat and fewer calories.

Patients who are lactose intolerant should take two (2) Tums twice a day for a calcium supplement.

Milk Substitutes

Below is a list of dairy products with their protein and calcium contents.  You can compare each with the levels listed for a glass of milk to calculate how to make substitutions. 

Prenatal Exercises

Exercises for Good Posture - While standing, tuck buttocks in and tilt pelvis forward to straighten spine. Pull your shoulders back gently and relax your arms. Position your head back so that it is in line with your spine and pull your chin in. Practice this position often as it improves your posture and relieves backaches.

Pelvic Floor Exercises - Lie on your back with your legs straight out and crossed at the ankles. Tighten your buttocks and hold the position. While keeping buttocks tightened, tighten the muscles at the tops of your legs and squeeze them together. Tighten the muscles of your rectum, vagina, and urethra. Keep all of these muscles tightened for a few seconds then relax. Repeat three times twice per day. This will strengthen all of the pelvic muscles.

Kegel Exercises - While sitting, standing, or lying down, push as if to urinate then contract these muscles as if to stop the flow of urine. Hold for a few seconds then relax. This should be done often throughout life to strengthen the muscles of the vagina.

Pelvic Rock - Lie on your back with your legs bent at the knees and your feet flat on the floor.  Tighten your buttocks, tilting your pelvis forward, flattening your back against the floor.  Contract and relax three times twice per day. This will strengthen your abdominal muscles and relieve backaches.

"Blowing Out the Candle" Exercise - Lie on your back with a pillow under your head. Bend your knees and put your feet flat on the floor. Imagine that there is a burning candle in front of you. Take a deep breath and let it out naturally. Continue to blow out air as if to blow out the flame of a candle. Keep blowing until you feel that there is no more air and then blow more. You will feel your abdominal muscles tighten. Relax and inhale. Repeat three times twice per day. This will strengthen your abdominal muscles.

Tailor Sit Exercise - Sit on the floor cross-legged. Gently push your knees apart and toward the floor.  Release. Repeat three times twice per day. This will strengthen your pelvic and upper leg muscles.

Bodybuilding Exercises -

1.  Lie flat on the floor.  Take a deep breath and release it slowly. While taking another deep breath, raise your right leg, keeping your knees straight and toes pointed, then flex your foot and lower your leg while you exhale.  Repeat with the other leg.  Do this exercise 3-5 times with each leg.  Finish by taking a deep breath, exhale slowly, and relax.

2.  Lie flat on your back with your arms straight out at both sides.  Take a deep breath and let it out naturally.  Take another deep breath and, while inhaling, slowly raise your leg as high as you can with your leg straight and toes pointed.  Keep your other leg straight and flat on the floor.  When you cannot raise your leg any higher, flex your foot and lower your leg outward towards the arm on the same side.  Exhale slowly while lowering your leg.  To return to your original position, inhale; raise your leg from the side position with your leg straight and toes pointed.  When you cannot raise your leg any higher, flex your foot, and exhale while lowering your leg to its original position.  Repeat with the other leg.  Do 3-5 times with each leg.

Relaxation Exercises -

1.  Lie in a comfortable position on the floor or bed with pillows beneath your head and knees.  Focus on relaxing all of the muscles in your body: legs, arms, pelvis, abdomen, back, neck, shoulders, facial muscles, etc.  Breathe quietly and naturally.  Practice this exercise.  It will help you relax between contractions during labor.

2.  Lie in a comfortable position on the floor or bed supported by pillows.  Tighten one area of your body, such as your right arm, and relax the rest of your body.  Do this for 10 seconds then relax.  Repeat with each part of your body.  Do this exercise twice per day. This will help you to relax the other parts of your body when your uterus is contracting during labor.

Elevation of Legs to Reduce Swelling -

1.  Lie on your back with your feet propped up at a level that is higher than the rest of your body.  Circle your feet 3-4 times in both directions.  Stay in this position for 15-20 minutes 2-3 times per day.

2.  Sit on a chair with your feet resting on a table or another piece of furniture so that they are at a higher level than your thighs.  Stay in this position for 15-20 minutes as often as possible.

Breathing Techniques for Labor -

1.  Cleansing Breath: Deep breath, in and out, at the beginning of a contraction.

2.  Chest Breathing: Slow rhythmic breathing, inhaling through the nose and exhaling through the mouth.  Your rate of breathing should be 6-8 breaths, per minute, to the count of “IN-2-3-4-5, OUT-2-3-4-5”.

3.  Cleansing Breath: Deep breath, in and out, at the end of a contraction. 

Pregnancy Discomforts and Coping Measures

Below is a list of discomforts and ways of coping.  It is important to avoid over-the-counter or prescription medications unless their use has been discussed with your prenatal care provider.

Nausea and Vomiting - Eat a few dry crackers before getting up in the morning; eat more often but less at a time; avoid foods that trigger nausea; avoid smoking and alcohol.  Bear in mind that nausea usually lasts only for the first trimester!  (Note:  Tell your prenatal care provider if the nausea and vomiting are severe).

Increased Vaginal Discharge - You can wash more often with a non-irritating soap, but it is important not to douche, which may lead to infection.  (Note: alert your prenatal care provider if the discharge has a foul odor, causes itching or burning, has an unusual color, or if you see blood).

Leg Cramps - Because they may be caused by a calcium and phosphorous imbalance, be sure you are getting enough calcium (dairy products, dark green leafy vegetables, corn tortillas) and cut down on carbonated beverages (they contain too much phosphorous and sodium).  Exercise.  (Note:  Tell your prenatal care provider if you have a severe pain in your leg that lasts more than a few minutes).

Backache - To minimize “swayback” in late pregnancy, stand with buttocks tucked in and knees slightly bent.  Attend the session on exercise during pregnancy or other exercise classes for pregnant women.

Hemorrhoids - Avoid constipation by eating high fiber foods (fruits and vegetables, whole grain breads and cereals) and drinking 6 - 8 glasses of fluid every day.  Avoid over-the-counter medications unless suggested by your prenatal care provider.  Try gauze pads soaked with witch hazel to reduce burning and itching.

Swelling of Feet, Ankles and Legs - Elevate feet and legs when possible.  Avoid salty foods.             

Varicose Leg Veins - Elevate feet and legs as much as possible and wear support hose.  Exercise is also helpful, especially if your job requires that you stand or sit for long periods of time.

Shortness of Breath - In late pregnancy, use a few extra pillows under your head and upper back to avoid having the baby push against your diaphragm.

Heartburn - Eat smaller meals, more frequently and change position when the burning sensation occurs.  High fat or very spicy foods and coffee tend to increase heartburn.

Stress and Mood Swings - Seek support and understanding of family, friends and co-workers.  Support can take different forms:  making it easy for you to go to doctor appointments, allowing you to take breaks from work, listening to your concerns, not smoking or drinking around you, and accepting changes in your mood as a normal part of pregnancy.

Important Facts About RH Factor

Your doctor may inform you that blood tests done at your first or second prenatal visit indicate that you have Rh-negative blood.  Being Rh-negative is important to you and your obstetrician.  An Rh-negative mother who is carrying an Rh-positive baby can develop antibodies against her baby's red blood cells.  In the next pregnancy, these antibodies can cross the placenta and destroy the red blood cells of the developing fetus.

Prior to 1968, Rh disease was a frequent cause of fetal death.  Many babies required premature delivery and some subsequently died in the nursery either from Rh disease and the anemia associated with it or from complications of prematurity.

In 1968, Rhogam (Rh immune globulin) became available for widespread use.  This medication is given to women who are Rh-negative and prevents them from making antibodies against the red blood cells of their babies.  Since 1968, millions of Rh-negative women have received an injection of Rhogam after delivery of an Rh-positive baby and following abortions or miscarriages.  As a result, the incidence of Rh disease has fallen dramatically.  However, approximately 2 of every 100 Rh-negative women will develop antibodies before delivery.  Available information indicates that this is most likely to occur during the last 12 weeks of pregnancy (23-40 weeks gestation). Research has shown that the administration of Rhogam during pregnancy, as well as within 72 hours following delivery, decreases the chances of a woman developing antibodies from 2 per 100 to 2 per 1000 - a reduction of approximately 90%.

A small number of women (approximately 5,000 each year) will develop antibodies if they do not receive Rhogam during pregnancy as well as after delivery.  However, once Rh antibodies have developed, the situation cannot be reversed or treated and significant problems may occur in later pregnancy.  Treatment of an Rh baby can be quite expensive and, in some cases, premature delivery or the death of a severely affected baby cannot be prevented.

The Committee on Obstetrics: Maternal and Fetal Medicine of the American College of Obstetricians and Gynecologists now recommends that Rh-negative pregnant women should receive Rhogam at 28 weeks gestation.  Rhogam is safe both for you and your fetus.  After delivery, your baby's blood will be tested and, if it is Rh-positive, a second dose of Rh will be administered to you within three days.  This will protect you against Rh-positive cells that may have entered your circulation during or immediately after delivery.

Many practitioners will also give Rhogam if you experience vaginal bleeding during your pregnancy.  Please call the office if you experience any vaginal bleeding so we can assess if you need Rhogam.
 

Hepatitis B Vaccine

Hepatitis B is a viral infection that can cause liver disease.  The virus is spread through blood and body fluids, including saliva.  Passing through the birth canal of a hepatitis B carrier can infect infants.  Children living in the same house with a hepatitis B carrier are at risk of contracting the disease, especially for the first five years of life.

In the United States, 200,000 to 300,000 hepatitis B infections occur each year.  The infection may occur in childhood or adolescence but complications from the infection often do not show up until later in life.  Approximately 5,000 people die of the complications each year in the United States.  Fortunately, improved vaccines allow you to begin to protect your child from hepatitis B at birth.

The American Academy of Pediatrics recommends the immunization of all children at birth to protect them from contracting the disease and to eventually eliminate it entirely.  At least 20 other countries have similar recommendations.  Routine blood screening of all pregnant women during their prenatal care is also suggested.

The first dose of the hepatitis B vaccine should be administered to all newborns before they are discharged from the hospital.  At the time of your baby's birth, you will be asked to sign an informed consent to allow administration of the first dose of the vaccine.  A second dose is recommended at 1 to 2 months and a third dose at 6 to 18 months of age during routine pediatric appointments.  While the full duration of protection induced by receiving three doses of the hepatitis B vaccine administered in infancy is unknown, it has been proven that more than 95% of the children who receive the recommended doses of the hepatitis B vaccine receive protection against the illnesses caused by the hepatitis B virus.

No serious reactions have been related to this vaccine and most children have no associated side effects.  The side effects that sometimes occur - body aches, redness and swelling at the site of the injection, are usually mild and temporary.  If these symptoms occur, they begin within 24 hours after the shot is given and go away within 48 to 72 hours.

Over the Counter Medications for Pregnant Women

Although it is best to NOT take any medications during pregnancy, we know that there are times when medications are necessary for relief of some common problems.  This is a list of over-the-counter medications that your physician has approved during pregnancy.

Upper Respiratory  Infections (cold, flu) -

Tylenol Cold & Allergy

Sudafed

Tylenol Sinus   

Actifed (after 1st trimester)

Rescon-DM           

Naldicon

Senior D

Robitussin cough syrup

Vicks cough drops or vapor rubs

Sucrets lozenges           

Theraflu

Chloroseptic    

Fever (secondary to upper respiratory infections or flu) -

            Tylenol (Regular or Extra-Strength) in regular adult doses

*Please avoid Advil, Motrin, Nuprin, Alleve, or other ibuprofen products and Aspirin.

Headaches -

            Tylenol (Regular or Extra-Strength) in regular adult doses

*Please avoid Advil, Motrin, Nuprin, Alleve, or other ibuprofen products and Aspirin.

Diarrhea -

            BRAT = Bananas * Rice * Apple Sauce * Toast

            Kaopectate

            Imodium

*Please avoid Pepto-Bismol.

Constipation -

            Lots of fluids & fruits

            Fibercon         

            Citrical

            Metamucil           

            Ducolax Suppositories

Hemorrhoids -

            Preparation H with HC           

            Anusol

Nausea -

            Emetrol           

            Nestrex

            Vitamin B-6

Indigestion -

            Mylanta         

            Tums

            Maalox           

            Gas-X

            Rolaids

*Please avoid Pepto-Bismol.

Working Restrictions

What restrictions do physicians suggest for

working patients with normal pregnancies?

All Jobs

Jobs That Require Standing or Walking 

Jobs That Require Physical Exertion 

Sex During Pregnancy

These days, people talk about sex more easily than ever before.  Nevertheless, when it comes to the subject of sex during pregnancy, a little of the old standoffishness seems to persist.  Women are often reluctant to bring up the subject with their obstetricians.  Worse, both men and women frequently keep their innermost fears and feelings to themselves.

Particularly if this is your first child, your pregnancy will probably be a time of erratic mood swings for you and your partner.  You may alternately feel fatigued, exhilarated, content, d