We

Love

To

Deliver.

5 First Village DrivePinehurst, North Carolina 28374910-295-0290www.pinehurstsurgical.com

ContentsIntroduction ................................................................. Page 2

The Team .........................................................................Page 3

Contact Information .................................................Page 4

Testing and Visits ..................................................... Page 5

Nutrition and Weight Gain ................................. Page 6

Water, Water, and Water! ..................................... Page 7

Nausea/Vomiting ...................................................... Page 8 - 9

Food Concerns during Pregnancy ...................Page 9- 10

Constipation ................................................................. Page 11

Vaccinations ................................................................. Page 12

Exercise during Pregnancy ................................. Page 12-13

Safe over the counter Medications ................. Page 13

Pets ..................................................................................... Page 13

Notes ................................................................................. Page 14

Congratulations on your pregnancy!We are pleased you have chosen

us to help plan for the arrival

of your baby. To assist in your

preparation, we have put together

information that will guide you

throughout your pregnancy. We

hope you find this information

helpful. You are encouraged to

ask questions. This packet will

provide you with information but it

is no substitute for medical advice

directly from a provider.

~ 2 ~

The TeamYour team consists of board certified (or eligible) obstetricians, physician assistants, and nurse practitioners. You will meet all of our providers during your prenatal visits. Each of our providers may have different perspectives and unique approaches to obstetrical care. However, we all strive to practice to the highest standards based on our national guidelines. Our goal is to have a healthy pregnancy for you and your baby.

OB SecretaryShe will be your main point of contact during the entire pregnancy. She will help schedule your appointments, arrange referrals, and direct questions to your providers. She can be reached by calling (910) 295-0289.

Delivering Physician Our physicians take call on a rotating basis. Unless your delivery is scheduled, we cannot predict when your baby will arrive. Therefore, the physician on call when you present in labor, will be the one who attends your delivery. We deliver our patients at First Health Moore Regional Hospital, in Pinehurst, North Carolina.

Sanford OfficeWe have an ancillary office in Sanford, North Carolina. Appoint-ments are available at our office in Sanford if the location is more convenient for you. Please be sure to let us know and we will schedule appointments there. Please be aware that ultrasounds will need to be done at our Pinehurst office as well as any special fetal monitoring.

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Contact InformationIf a question or concern arises during

Mon – Fri, 8:00am – 5:00pm call:OB secretary (910)295-0289

If a question or concern arise after business hours or on weekends call:

(910) 715 -1000* *This is the main line to First Health Moore Regional Hospital. Identify your-self as a patient of Pinehurst Surgical Clinic, Women’s Care Center and you will be connected to the appropriate person.

Our providers are available for your care 24 hours a day, 7 days a week. Below is an example of reasons to contact your provider out-side of routine office hours:

• Prolonged nausea or vomiting• Heavy or new vaginal bleeding• Decreased fetal movements• Fever, temperature greater than 100.4 F• Diarrhea• Significant shortness of breath• Persistent headache• Vaginal leakage of fluid• Severe abdominal or pelvic pain• Contractions more than 6 times in an hour & you are less

than 37 weeks• If you think you are in labor

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Prenatal Testing and VisitsBelow is an overview of testing that is considered routine during your prenatal care. However, there will be instances where additional testing may be necessary. If so, you and your provider will discuss these changes and recommendations.

Visit ScheduleThere is an expected visit schedule for routine prenatal care. However, individualized care may be necessary dependent on circumstances related to the pregnancy and your health. Below is the anticipated schedule of visits.

Visit and TestingConfirmation Appointment - Bedside Ultrasound

Initial OB visit – History, Physical Exam, Prenatal testing, and Gyn screening. *Pap Smear if indicatedEarly genetic screening offered Anatomy Ultrasound

2nd trimester genetic screening

3rd trimester screening

Group B Strep screen

Occurs6 – 13 weeks

10 – 14 weeks

15 – 21 weeks

24 – 28 weeks

34 – 36 weeks

ReasonConfirms pregnancy and establishes estimated due

Screen for blood type, infectious disease, and pap smear obtained, if indicated.Optional testing for genetic conditions including Down’s Syndrome

Assess fetal development*In most cases, gender may be seen at this time.Optional testing for genetic conditions as well as spina bifida

Diabetes screening and CBCRhogam if indicated

Screening for Group B Strep, if present, mother will receive antibiotics in labor

Gestational Weeks Frequency of visit10 -28 weeks Visits every 4 weeks28 – 36 weeks Visits every 2 weeks36 – 40 weeks Visits every 1 week

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NutritionDuring your pregnancy you need an additional 300-500 calories a day. Most of these calories should be obtained from lean protein, whole grains, calcium rich foods, fruits and vegetables.Limit your intake of juice. We recommend diluting juice with water. Make sure all juice is pasteurized and 100% fruit juice.Calcium is important for your baby and you. Milk should be 1% or skim milk.

Weight GainYour expected weight gain is based on your pre-pregnancy weight and BMI. We will work with you to establish your weight gain goal.

BMI Recommended Weight Gain

Underweight Less than 19 28 - 40 pounds

Normal weight 19 – 25 25 – 35 pounds

Overweight 26 – 30 15 – 25 pounds

Obese 30 – 40 5 – 15 pounds

Morbidly Obese Greater than 40 Referral to Maternal Fetal Medicine Specialist

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Water, Water, Water!

During pregnancy, you need an additional 300-700ml of water each day. That’s an extra 6-8 glasses of water a day.

Here are some facts about hydration during pregnancy that you need to know:

• Women who don’t drink enough water during pregnancy are likely to experience an increase in certain pregnancy symptoms, such as constipation during the third trimester and morning sickness during the first trimester

• Consuming enough water during pregnancy helps to prevent urinary tract infections.

• Water is the best source of hydration for pregnant women. It’s all natural and it helps you avoid extra calories and caffeine that are found in coffee and soda.

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Nausea and Vomiting During PregnancyNausea and vomiting is a normal part of pregnancy, but there are steps you can take to feel better.

Eating tips• In the morning, eat a few crackers and rest for 15 minutes before getting up.

• Eat small meals or snacks often, every two hours. Try not to skip meals.

• Eat what you feel like and eat when you are hungry, though you may want to avoid cooking or eating spicy, fatty or fried foods because of the smell.

• If cooking smells bother you, open windows and turn on the stove fan. If possible, ask someone else to cook. Eat cold food instead of hot, as it may not smell as strongly.

• Sniffing lemons or ginger can sometimes help an upset stomach.• Eating salty potato chips can help settle the stomach enough to eat a meal.

Fluid intake• Sip small amounts of fluid often during the day.• Avoid drinking fluids during, just before or immediately after a meal.

Food that might help• Salty: Chips, pretzels• Tart/sweet: Pickles, lemonade• Earthy: Brown rice, mushroom soup, peanut butter• Crunchy: Celery sticks, apple slices, nuts• Bland: Mashed potatoes, gelatin, broth• Soft: Bread, noodles• Sweet: Cake, sugary cereals• Fruity: Watermelon, fruity popsicles• Liquid: Juice, seltzer, sparkling water, ginger ale• Dry: Crackers

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Lifestyle StrategiesGet plenty of fresh air and avoid warm places. Feeling hot can add to nausea.

Try acupressure wrist bands.

Try ginger (Ginger ale, ginger root capsules or ginger syrup) an alternative remedy thought to settle the stomach. Doses of up to 250 mg four times a day to be safe.

Try Chamomile or Peppermint tea.

Try really sour Lemon drops.

MedicationsDiclegis contains doxylamine (an antihistamine) and pyridoxine (vitamin B6). It is safe and effective in treating nausea and vomiting. There are other mediations used during pregnancy for severe nausea and vomiting. We recommend close consultation with your provider to determine the best treatment for you.

Foods to Avoid During PregnancyThere are foods and preparations of food that can be harmful to your pregnancy. Some things can make a pregnant patient very sick; others may significantly affect your baby. Below is a list of food you should avoid.

• Soft Cheeses, unless the label says it's pasteurized - examples are brie, camembert, feta, blue cheese, queso Blanco, queso fresco, and panela

• Undercooked Meat• Fresh Juice, unpasteurized• Sayonara, Sushi• Raw Cookie Dough• Homemade Caesar Dressing

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• Homemade desserts - including mousse, meringue, and tiramisu, can contain raw eggs

• Fresh Pre-Stuffed Poultry• Cold cuts and hot dogs• Pâtés • Unwashed Fruits/Veggies• Raw Sprout

Other considerations…Swordfish, tilefish, king mackerel, and shark contain high levels of methyl mercury - You can safely eat up to 12 ounces of seafood a week, so choose fish that are low in mercury: catfish, salmon, cod, and canned light tuna. If you like albacore (white) tuna, limit yourself to 6 ounces per week

CaffeineThe March of Dimes recommends women who are pregnant or trying should limit caffeine to 200 milligrams per day. That’s one 12-ounce cup of coffee. But remember, caffeine is also found in soda, tea, chocolate, and many energy drinks.

AlcoholYou already know that heavy drinking during pregnancy can lead to serious birth defects. What you may not know is that even small amounts of alcohol could be harmful. No amount of drinking has been found to be safe during pregnancy, so it’s best to avoid all forms of alcohol. This includes wine, beer, coolers, and traditional eggnog, which contains alcohol and raw eggs.

Doggie BagsUnless you’re headed straight home from the restaurant, don’t ask for a doggie bag. The inside of your car can get warm quickly, allowing bacteria to multiply. If you do take home leftovers, put them in the fridge within 2 hours of when the meal was originally cooked.

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ConstipationConstipation can be a major complaint during your preg-nancy. Here are some approaches to deal with this problem.

• Eat a high fiber diet: Ideally, you will consume 25 to 30 grams per day of dietary fiber from fruits, vegetables, breakfast cereals, whole grain breads, prunes and bran.

• Drink a lot of fluids: Drinking plenty of fluids is important, particularly when increasing fiber intake. Drink 10 to 12 cups of fluids each day.

• Exercise routinely: If you are inactive, you have a greater chance of constipation. Walking, swimming and other moderate exercise helps the intestines work by stimulating your bowels. Schedule exercise three times a week for 20-30 minutes each.

• Over-the-counter remedies: There are over-the-counter products such as Metamucil, Colace, peri-colace, benefiber that will help relieve your constipation.

• Reduce or eliminate iron supplements: Iron supplements may contribute to constipation. Good nutrition can often meet your iron needs during pregnancy. Taking smaller doses of iron throughout the day rather than taking it all at once can reduce constipation.

Routine laxative use is not advised during pregnancy.Please discuss with your provider before using any laxatives.

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VaccinationsVaccines help keep a pregnant mother and her baby healthy. Below is a list of vaccinations that are safe to take during your pregnancy.

Hepatitis A – if indicated

Hepatitis B – if indicated

Influenza – recommended during pregnancy

Meningococcal – if indicated

Pneumococcal –if indicatedTdap - recommended during pregnancy

27 – 36 weeks

Tetanus/Diphtheria - if indicated

Exercise during Pregnancy• Regularly exercise at least 3 times a week. This is standard and encouraged in most circumstances.

• Vigorous exercise should not be in hot, humid weather.

• Avoid jerky, bouncy motion.

• Avoid deep flexion or extension of joints because your tissues are lax.

• Warm up about 5 minutes before you do vigorous exercise.

• Follow vigorous exercise with a period of gradually declining activity such as stretching.

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• Get up from the floor gradually to avoid reduced blood flow to your brain and dizziness.

• Drink lots of water before and after exercise.

• If you are not already following an exercise plan, start slowly and advance your activity gradually.

• If you have any unusual symptoms, stop your exercise program and consult your provider.

Medications Safe to take during your PregnancyHere are some “Over the Counter” treatment options for a variety of symptoms. We consider these safe to use during your pregnancy.

Aches/Pains Tylenol (Regular or Extra-Strength)Heartburn Tums, Zantac, Prilosec, PepcidIndigestion Mylanta, Gas-X, Pepto-BismolAllergy relief Allegra, Claritin, Benadryl, MucinexCold/Cough Acetaminophen Cold and Sinus, Robitussin, Medicated LozengesDiarrhea ImodiumYeast Infection Vaginal yeast treatment, 3-7 day kitConstipation Colace, Peri-colace, Metamucil, Benefiber. Miralax after discussing with your care provider

PetsToxoplasmosis is a bacteria that comes from cat feces and urine that could potentially cause birth defects. We recommend caution with litter box cleaning. If it is unavoidable, you must wear a mask to cover your nose and mouth. Please wear gloves and perform in a well-ventilated area. Wash your hands and any exposed skin with warm soapy water.

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Notes

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5 First Village DrivePinehurst, North Carolina 28374910-295-0290www.pinehurstsurgical.com