Session 1: Week 10 – You’re Pregnant: Now What?

CBC (Complete Blood Count): Checks for anemia and other blood problems

Hepatitis B: Test for a type of liver disease.

HIV (Human Immunodeficiency Virus): Recommended by the American College of Obstetricians and Gynecologists. You are required to sign a consent form to give us permission to draw the HIV or to refuse the test. Your HIV results are confidential . We can only review the results of the test in person.

RPR Rapid Plasma Reagin: Screens for syphilis and is mandated by the state of Florida

Blood Type and Screen: Determines your blood type and antibody status. If you are Rh negative and your partner’s blood is positive, you will need a shot of a blood product (Rhogam) at 28 weeks gestation. You will also receive a Rhogam injection if you have an amniocentesis or any bleeding early in your pregnancy.

Urinalysis: Checks for urinary infection.

DNA Probe: Detects chlamydia and gonorrhea. It is a vaginal swab, urine test, or may be obtained with a pap smear

Sickle Cell Screen: Screens for genetic disorder of the blood, characterized by anemia and pain. Most common in those of African descent, but also may affect those from the Mediterranean area, Middle East and India.

Genetic Testing: Please consult with your OB provider. This is not required. You will receive a brochure about this test at your first visit. See section on screening for birth defects.

How will I know if my baby will have any problems? 

We have four ways to check in the first and second trimester: 

Cystic Fibrosis Screening

Done once in any woman’s life; pregnant or not pregnant.

Cell Free Fetal DNA Prenatal Screening

One test that we offer to pregnant women who are 10 weeks or more pregnant is called Cell Free Fetal DNA. This is a NIPT test meaning a noninvasive prenatal test. This test is done by a blood draw from mom to look for the baby’s blood in the mother’s blood stream. This test is commonly called the “gender test.” It was not developed to test fetal gender. It was developed as a way to test pregnant woman earlier for genetic disorders with their unborn baby. The test results are not 100% accurate.

The test checks for the following:

• Trisomy 21: Commonly called Down Syndrome
• Trisomy 18: Commonly called Edwards’ Syndrome
• Trisomy 13: Commonly called Patau Syndrome
• Monosomy X: Commonly called Turner Syndrome
• Triploidy
• May also be ordered to check for microdeletions known as “22q 11.2 deletion syndrome."
• May also be ordered to check for a baby’s gender meaning the X and Y chromosomes. It is rare by sometimes the test is done but no results are given and we will discuss what to do next. Please check with your insurance to see how much they will charge for the test.
• Genetic Carrier Testing​: https://www.acog.org/womens-health/faqs/carrier-screening
• Anatomy Scan – more on this in Week 3
• Diagnostic Testing - Usually done via Amniocentesis with Maternal Fetal Medicine if an abnormality is suspected.

The following medications have been taken during pregnancy and have not been shown to cause birth defects.

Even so, we recommend not using any medication unless necessary. If you take a medication routinely for a medical problem and are unsure about it, contact us prior to discontinuing the medication. Take all medication according to the manufacturer’s direction listed on the bottle, unless otherwise directed by your physician or certified nurse midwife. If your condition persists, let us know at your next appointment.

Allergy	Benadryl, Claritin, Chlor-Trimeton, Tylenol Allergy/ Sinus, Zyrtec
Cold and Flu	Actifed, Benadryl, Chlor-Trimeton, Claritin, and Dimetapp. Nose sprays: Afrin, Neo-Synephrine 1/3%, Saline Nasal Spray, Breathe Right Strips, Vicks Vapor Rub, warm salt/water gargle
Constipation	Bulking product (can be used regularly): Citrucel, Fibercon, Metamucil. Stool softener: Colace, Surfak Gentle laxative: Milk of Magnesia (limit use). Add prunes and raisins to diet
Cough	Cough drops/Lozenges: Cepacol, Halls, Ricola. Cough Syrup: Robitussin, Robitussin PE, Robitussin C/F, Robitussin Maximum Strength Cough Suppressant, Vicks Cough Syrup
Diarrhea	Use for up to 24 hours and only after the 12th week of pregnancy: Imodium AD or Kaopectate. Drink Gatorade, NOT water
First Aid Ointment	Bacitracin, J&J, Neosporin, Polysporin
Insomnia	Benadryl 25 mg, Tylenol PM, Unisom 25 mg (use no more than three nights in a row)
Headache/Pain	Tylenol (acetaminophen) or Extra Strength Tylenol
Heartburn/Indigestion	Maalox, Mylanta, Rolaids, Tums (preferable), Pepcid AC (as directed and let your provider know you are taking this), Zantac 75 mg
Gas	DiGel, Gax-X, Mylicon, Riopan
Hemorrhoids	Anusol suppositories or cream, Preparation-H suppositories or cream, Tucks (Witch Hazel wipes)
Nausea/Vomiting	Vitamin B6 (25 mg every six hours or four times daily – no more than 100 mg in 24 hours. Take alone or with Unisom), B-Natal Pops (do not exceed two in 24 hours – must be special ordered by pharmacy or on Internet. Do not use with other Vitamin B6 combination), Unisom (doxylamine 25 mg – ½ tablet every four to six hours with Vitamin B6, Sea Bands (motion sickness wrist bands)
Rashes	1% Hydrocortisone cream or ointment, Aveeno oatmeal bath, Benadryl cream. Caladryl lotion or cream
Yeast	Monistat 3, Monistat 7 – do not use any one-day over-the-counter products
Medications NEVER to be taken:	Acutane, Lithium Tetracycline, Vibramycin, Valproic Acid, Vitamin A

Q: What about nausea and vomiting? Will it ever end?

A: About 50% of all pregnant women will experience nausea with vomiting during their pregnancy. Another 25% will suffer with nausea alone. Symptoms generally peak at 8-10 weeks and resolve around 13-14 weeks.

Q: What can I do or take to help me with nausea and vomiting?

A: Dietary changes and medications can alleviate symptoms in most cases. Prescription medications may be needed in more severe cases. Begin by modifying your behavior and diet. Avoid strong or offensive odors, eat small and frequent meals, and drink fluids between meals. Eat dry, bland, and high-protein foods. Keep crackers at your beside for the morning. Avoid having an empty stomach. Decrease your intake of iron.

Q: Help! Nothing is working and I can’t keep anything down. What do I do?

A: If you have continuous vomiting for more than 24 hours (unable to even keep liquids down), you should call our office for an evaluation.

Backache:

• Focus on maintaining good posture when you’re seated or standing. Stand straight, with your chest high, and your shoulders back and relaxed.
• Try to avoid standing for long periods of time. If you’re on your feet a lot, try resting one foot on an elevated surface.
• If you need to pick something up, remember to squat instead of bending at the waist.
• Avoid lifting heavy things.
• Use heating pad on low setting to your back, take a warm bath or shower.
• Try a chiropractor who specializes in pregnancy care.
• Wear low-heeled (but not flat) shoes.
• Try sleeping on your side, not your back, with pillows tucked beneath your belly and between your knees for gentle support.
• Practice pregnancy-safe exercises designed to strengthen and support your abdomen and back.
• As your abdomen grows, consider wearing a supporting garment or belt to help take some of the pressure off your back.
• When seated, try to elevate your feet and make sure your chair offers good back support. Use a lumbar pillow for back support.
• Try to get plenty of rest.
• If the back pain is linked to stress: Meditation, prenatal yoga, and extra rest can all be helpful ways to manage your stress levels.
• You can use ice packs to provide relief for back discomfort
• Prenatal massages can be wonderfully relaxing and soothing, as well.
• Contact your health care provider if you have a low backache that goes around your stomach and does not go away within one hour after you change position or rest. This might be a sign of premature labor.

Bleeding Gums

• Maintain regular dental care (regular cleanings) brush with a soft bristle toothbrush, floss carefully (Your physician will provide a dental clearance letter if needed). 
• Healthy eating and taking prenatal vitamins are also an important factor in maintaining both oral and general health during pregnancy, Getting proper nutrition is imperative.

Breast Tenderness

• Wear of good fitting Bra (wearing a larger-size bra or sports bra helps).
• Opt for loose-fitting clothes that won’t rub or irritate the skin.

Dizziness

• Avoid standing for long periods of time. If you must stand, make sure that you keep your feet moving to help increase circulation.
• Avoid getting up quickly from sitting or lying down positions. This is a common reason for dizziness, lightheadedness, and fainting.
• Eat regularly. Avoid long periods between meals; it is better to snack throughout the day 
• Avoid hot baths or showers.
• Avoid lying on your back once you reach the middle of your second trimester.
• Wear loose, comfortable clothing to avoid restricting circulation.

Edema

• Many women experience edema during the 3rd trimester, usually increasing as the day goes.
• Elevate your feet (Sit with your feet propped up whenever possible).
• Avoid excessive salt intake (To avoid fluid retention).
• Wear a support hose or support knee socks (Put them on in the morning before you become swollen).
• Drink plenty of water.
• Contact your physician if you notice sudden swelling or puffiness in your face or hands.

Fatigue

• Increased rest, well balance diet (iron and protein rich foods).
• Shortness of breath: Sleep in a propped or tilted position.

Heartburn

• Eat 6 small meals throughout the day instead of three regular meals. This can prevent your stomach from becoming too full.
• Don’t eat too close to bedtime (2-3 hours before).
• Propping up your pillow to elevate your head above your stomach (gravity can help). You can purchase a foam wedge that can get you at a good angle to avoid heartburn.
• No spicy foods or other trigger foods such as chocolate, fried foods, and caffeine.
• If you’ve tried other ways and nothing seems to work, there are antacids that are deemed safe to take (Like TUMS).

Insomnia

• Plan and prioritize sleep time.
• Try to exercise about 30 minutes each day unless directed not to by your healthcare provider.
• Sleep on your left side to improve blood flow and nutrients to your fetus and kidneys and avoid lying on your back for extended periods of time.
• Use a pregnancy pillow to prop you in a comfortable position.
• Drink plenty of fluids during the day, especially water, and reduce the amount you drink 2 hours before bedtime.
• Stop eating spicy, or fried foods, and eat frequent smaller meals throughout tne day.
• Snoring is common during pregnancy, but if you’re having pauses in your breathing, get checked for sleep apnea. Also, have your blood pressure and urine protein checked—especially if you are swollen or have headaches.
• If you have Restless Leg Syndrome, it may be due to iron or folate deficiency so get tested.
• If you can’t sleep, don’t force yourself, to try to read or meditate to relax.
• Use a nightlight instead of turning on the lights in the bathroom which will help you get back to sleep faster.
• Try meditation to settle your brain and calm your nerves. Go online for some great meditation options.
• Avoid caffeine late in the day.

Leg Cramps:

• Mostly in the 2nd and 3rd trimester.
• Do calf stretches. Stretch with your heels flexed. Stretch before bed if you get cramps at night.
• If you get a cramp, straighten your leg, heel first, and wiggle your toes. Gently massage. Walk out a cramp rather than massaging the muscle. Avoid sitting or standing in one position for a long time. Move around. Avoid sitting with your legs crossed.
• Take a walk every day or do other regular exercise to avoid cramping, with your doctor’s OK.
• Drink plenty of fluids to keep your muscles hydrated.
• If you get cramps at night, take a bath before bed to relax leg muscles.
• Eating more magnesium-rich foods, such as whole grains, beans, dried fruits, nuts and seeds.
• Get adequate calcium.

Nosebleeds

• Avoid nasal sprays and drops except saline preparations, sit down and firmly pinch the soft part of your nose, just above your nostrils, for 10 to 15 minutes without releasing the pressure.
• Lean forward and breathe through your mouth. This will drain blood down your nose instead of down the back of your throat.
• Sit or stand upright, rather than lying down, as this reduces the blood pressure in the veins of your nose and will discourage further bleeding.
• Place a covered ice pack, or a packet of frozen peas wrapped in a tea towel, on the bridge of your nose. If the bleeding doesn’t stop, seek medical advice.

Numbness and Tingling of Hands

• Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks.
• Wearing a wrist splint to keep your wrist straight, usually just at night.
• Doing exercises to stretch and strengthen the muscles in the hand and arm.
• Learning ways to protect your joints as you go through your daily activities.

Vaginal Discharge

• A normal discharge is thin, clear or milky white, and mild smelling. (Call your doctor if yellow, green, gray or strong and foul odor accompanied by redness or itching, or vulvar swelling)

Changes in sense of smell:

• Enjoy fresh citrus fruits or drinking fresh citrus juices; drinking lemonade or plain water with a slice of lemon.

Shortness of breath:

• In the last trimester of your pregnancy your growing baby pushes your uterus against your diaphragm. The diaphragm is moved up about 4 centimeters from pre pregnancy.
• Practice good posture, sleep in a propped or tilted position.
• A wedge-shaped pillow along your back can also be helpful.
• Exercise (aerobic, low impact, yoga, deep breathing, relaxing, avoid stress)

It is important to talk to a medical professional about all the medications you are taking, including prescription pain pills. By talking to a medical professional before the pregnancy, you can reduce the chances of your baby being born with Neonatal Abstinence Syndrome (NAS). Click here for more information.