Dawn A. Cashie M.D.
Leslie J. Korostoff M.D.
Cheryl Twu D.O.
Susan SteinRad RNP
Congratulations! You’re going to have a baby!!
Welcome to our practice, and thank you for giving us the opportunity to
participate in the most incredible journey of your life!
YOUR PREGNANCY GUIDE AT A GLANCE
In the following pages, you will find answers to your questions about:
remedies and medications during pregnancy
travel
nutrition
sex
prenatal testing
what to stop, avoid, or limit
your body and your baby
a schedule of ideal prenatal care
* REMEMBER: Consult us first before using any medications
or therapies not listed here, or if these do not work.
Follow the directions on the bottles of the
medications listed unless instructed otherwise.
1
Remedies and Medications During Pregnancy
FOR HEADACHES:
 Motrin, Ibuprofen, Advil, Aleve and Aspirin may cause bleeding or other complications
for the baby. DO NOT USE THESE.
 Sometimes a “baby” aspirin (81mg) will be recommended for certain conditions.
 Tylenol (acetaminophen) extra strength is considered safe.
FOR NAUSEA:
 The rapid increase in hormones of early pregnancy may cause you to feel a bit queasy
or nauseous. This nausea (morning sickness) may last a few minutes, hours or all day. It
usually improves by the second trimester, week 12.
 Eat small, frequent meals so your stomach is never too full or too empty.
 Try ginger or peppermint teas; sip all day; ginger or peppermint candy; Whole Foods
Market will put 1 gram of ginger in a capsule for you to take once per day.
 BRAT diet: small, frequent amounts of bananas, rice, applesauce, tea and toast;
popsicles and jello.
 Gatorade or Power Socco type drinks to replenish salts/potassium
 ”Sea Band” wrist bands
If you vomit 6-10 times per day without holding down liquid, you must call us as you may need
a prescription medication.
FOR CONSTIPATION or DIFFICULT BOWEL MOVEMENTS:
 First, make sure that you are drinking at least 4-8 glasses of WATER per day.
 Eat more fiber: fruits (prunes), vegetables, bran cereal (Raisin Bran is good).
 Try Metamucil daily or other fiber supplements.
 Stool softeners such as Colace, Senakot or Correctal are safe (follow package
directions).
FOR HEMORRHOIDS:
 Sitz baths: soak for 20 minutes in warm tub water with one large scoop of “Instant
Ocean” (purchase at pet stores in the fish department) or Epsom salt
 Preparation H, Anusol cream or suppositories as directed.
Inform us if you have any bleeding with bowel movements.
2
FOR HEARTBURN:
 DO NOT lie down for at least 2 hours after eating.
 Avoid red sauces (spaghetti/pizza) and spicy fried foods.
 Tums (also 3 times per day meets the 1500 mg of calcium you need per day)
 Zantac (over-the-counter)
 All of the following have aluminum in them and are high in salt. Use them sparingly:
Mylanta, Maalox, Gaviscon, Riopan or Rolaids. Excess use can cause diarrhea.
If nothing helps, please call us.
FOR BACKACHE, PELVIC PRESSURE, ROUND LIGAMENT DISCOMFORT:
 Moist, hot compresses followed by massage can temporarily relieve backache. There are
licensed pregnancy massage therapists. Can also check with a massage therapy school.
 Back and abdominal supports for pregnant women are available at most durable medical
supply stores and at Babies R Us. The best one for the best price is in the J.C. Penny
catalogue.
FOR DIARRHEA:
 Try the BRAT diet (banana, rice, applesauce, tea and toast)
 Imodium AD (follow package directions)
If diarrhea (watery stools) persists for longer than 3-5 days, please call us.
FOR HEAD COLD/CHEST CONGESTION/COUGH:
 A humidifier may help relieve nasal congestion.
 You may use a saline nasal spray; Afrin nasal spray should NOT be used for more than 3
days.
 Benadryl 25mg or 50mg by mouth as directed.
 Claritin 10mg (follow package directions).
 Tylenol may be used as directed for fever, BUT if a fever of 100.4F persists beyond 72
hours, please call us.
3
What to Avoid, Limit, or Stop
 If you are smoking, drinking alcohol or using recreational drugs, you MUST STOP them
completely. They increase the risk for miscarriage, bleeding, small birth weight babies,
premature babies, developmental delays and many other serious complications.
 The FDA has issued warnings to pregnant women to avoid fish with high methyl
mercury content. Fetal exposure to methyl mercury at high levels MAY result in subtle
neurologic delays. AVOID mackerel, tilefish, shark, swordfish and canned tuna. NOTE
that average levels of methyl mercury found in fish are 0.12 parts per million and
neurologic deficits were found at mm levels 100 times that found in most fish. Striped
bass, bluefish, salmon and fish from local rivers and lakes MAY contain high levels of
PCBs and other industrial pollutants. Consumption of 12 ounces of cooked fish per week
is considered safe. In general, you should peel off the skin and fat before eating. For
more information, visit the web site www.cfsan.fda.gov/sea-mehg.html
 Cat box liter and soil may contain a harmful parasite called toxoplasmosis. It is found
primarily in cat poop. DO NOT change your cat’s liter box while you are pregnant. If you
are gardening, wear rubber/leather gloves and always wash fruits and vegetables well.
 Many herbs can be harmful to a baby and may cause preterm labor. Black/blue cohash,
buckthorn, cascara, ephedra, feverfew, mandrake, mugwart, senna, tansy and yarrow
are just a few that should be AVOIDED. For more information visit the web site
www.iparenting.com
 Your prenatal vitamin is prescribed for you and should be taken once a day. If you
cannot tolerate it, you may try 2 Flintstone vitamins per day or gummy prenatal
vitamins. If your prenatal vitamin does not contain Expecta for brain and eye
development, please purchase it and take it once a day. You can find Expecta at Target
or Kmart.
 Warm baths are very soothing BUT hot tubs and saunas are TOO HOT.
 E. Coli, listeria, salmonella and toxoplasmosis are bacteria or parasites that may cause
food poisoning or serious illness in pregnant women and children under the age of 5.
 Rare meat, fish and shellfish (sashimi, sushi, ceviche, oysters and carpaccio) are to be
AVOIDED.
 Soft cheese (Brie, feta, blue, goat, camembert, gorgonzola and Mexican soft cheese) is
to be AVOIDED.
4
 Deli meats (salami, liverwurst, and hot dogs) are to be AVOIDED. They may be
contaminated, so if you want to eat them, cook them very well.
 Unpasteurized juice and milk must be AVOIDED.
 It is best to limit caffeine consumption to 2 servings or less per day.
 Not enough is known about the effects of “artificial sweeteners” on a developing baby.
Occasional use is considered safe.
Activities During Pregnancy
 Sexual Activity can remain unchanged from your pre-pregnancy activity. It is safe and
does not harm the baby. However, as the pregnancy progresses, you may have to be
creative with position changes. STOP if you have pain, bleeding or fluid leaking from
your vagina. On occasion, your provider may advise against having intercourse.
 Exercise is very important during pregnancy and most pre-pregnancy activities may be
continued. Walking, hiking, swimming, yoga, low impact aerobics and stationary cycling
are recommended. If you haven’t been exercising, start slowly with 10 minute/day walks
for 5 days a week; gradually increase to 30 minutes per day. If you become short of
breath, decrease the intensity. AVOID abdominal exercises and those that might cause
you to fall. Horseback riding, rock climbing, downhill skiing and scuba diving are NOT
recommended.
 Travel by air, bus, car, or ship is usually safe for the healthy pregnant woman. Airlines
and cruise lines have different rules concerning their pregnant passengers. It is best to
check with the carrier as you may need a doctor’s note.
 Dental check-ups can be done twice during the pregnancy. Dental work can and should
be done if needed. Inform the dentist that you are pregnant before x-rays are taken. We
can provide a “dental letter” if necessary. REMEMBER to brush and floss regularly as
swollen, painful gums are common in pregnancy
5
Education and BabyWise
 Educational opportunities are available and we encourage you to look into those of
interest to you. Classes are available privately or at your hospital of delivery. These
classes include prepared childbirth (Lamaze, Bradley), breast feeding, infant care and
infant CPR. There is usually a fee charged for each class. The classes are very
informative, very popular, and fill up fast. Check in to those of interest to you no later
than your 7th month (28 weeks). You can also find information, videos and CDs at your
local library and on the cable TV (TLC) show “The Baby Story.”
 BabyWise, provided through Providence St. Joseph, offers a full spectrum of educational
classes and prenatal services for expectant mothers and their families. Please visit
http://www2.providence.org/holycross/services/obstetrics/Pages/services.aspx for more
information or call (818) 847-4143 to register and find out about our classes schedules
and fees.
Family Medical Leave
 Working women are encouraged to tell us if your job is physically or psychologically
stressful. By state law, you are entitled to start disability 30 days before your due date
(at 36 weeks). You will be paid disability by the state for up to 6 weeks after a vaginal
delivery or 8 weeks after a Cesarean Section delivery. The payment from the state is
usually about 1/3 less than your usual paycheck, and this money is tax free. You do not
have to declare it on your income tax return. You may also be eligible to take an extra
6-12 weeks without pay (Family Leave) and without threat of losing or changing your
work position if you have worked for your company for longer than 11 months. Check
with HR at your company for more information (Dads, too).
6
Special Reminders
DECREASED FETAL MOVEMENT:
If you are 24 - 40 weeks and you have not felt your baby move in 12 hours, or if you feel that
the movements are less than what has been normal for your baby:
 Empty your bladder
 Drink a large glass of ice cold water or juice
 Lie on your left side and try to stimulate the baby to move
If this is unsuccessful, CALL US. You may be instructed to come to the office or go to the
hospital.
BRAXTON HICKS CONTRACTIONS (FALSE LABOR):
If you are between 23-35 weeks pregnant and you experience uterine tightening that is
uncomfortable but not painful of more than 4-6 in one hour, you may be having Braxton Hicks
contractions.
 Empty your bladder (full bladder can cause irritation to uterus)
 Drink 2 large glasses of water (false labor may be caused by dehydration)
 Lie on your left side
If the tightening persists for longer than 1 hour, you may be in pre-term labor. CALL US and
plan to go to the hospital where they will monitor the contractions and possibly give you
medication(s) to stop them.
LABOR PRECAUTIONS:
If you are between 36-40 weeks pregnant and you are experiencing contractions every 5-10
minutes that seem to persist and increase in intensity, or you are having moderate vaginal
bleeding, or your water breaks, CALL US. You are either in labor, or you might need to be.
ALWAYS call us if you have an urgent problem or a question that cannot wait until your
scheduled appointment. If it is NOT an emergency, please call during office hours.
7
Schedule of Ideal Prenatal Care
Most of your visits will be quick and simple. They will include a urine sample, taking your
weight, a blood pressure check, measuring the baby’s growth, and listening to the baby’s heart
beat. We always want to know your concerns and how you are feeling. There are certain
appointments that are necessary for excellent prenatal care, and those visits are listed below
with the estimated gestational age or weeks of pregnancy when they should occur.
WEEKS OF
GESTATION
6-11
EVENTS OF PRENATAL CARE
This should be your initial visit. Be prepared to give your medical, surgical, family,
allergy, and prior pregnancy history. Discuss your concerns, but don’t worry if you
don’t have any. Plan to discuss 1st trimester screening for birth defects. These tests
can be done between 10-13 weeks. IF YOU ARE OVER 35 YEARS OLD and desire
genetic counseling for CVS, Amniocentesis or MSAFP Marker screening, discuss it
now. IF YOU ARE ASHKENAZI JEWISH and have not had a complete panel drawn,
discuss it now.
EXPECT a pregnancy test, a pelvic exam, pap smear, Chlamydia/gonorrhea cultures
and evaluation of any vaginal discharge. If you plan a CVS, a culture for BETA
STREP will be done.
BLOOD TESTS will be ordered to include a complete blood count, blood type and
Rh status, hepatitis B, syphilis, HIV, rubella, urinalysis & culture. Carrier testing for
cystic fibrosis, Tay-Sachs, sickle cell and other serious genetic disorders may be
ordered. Discuss any concerns with your provider.
Your next visit will be scheduled in 2 weeks.
8-11
YOUR BABY: has a beating heart, eyes and limb buds. He/she is ½ inch long.
A transvaginal ultrasound will be done at this visit to confirm your due date along
with a discussion of your lab results. Please come prepared with any written
questions or concerns that you may have.
Routine OB visits will be scheduled every 4 weeks.
16-20
YOUR BABY: muscles & bones are beginning to grow, webbed fingers & toes have
formed & all major organ systems are developing. At 12 weeks, fingers & toes have
separated & genitals appear. He/she is 3 ½ inches long.
A blood test to detect fetal chromosomal abnormalities will be ordered at this time.
A single small tube of blood will be taken for MSAFP. This test is VERY DATE
SPECIFIC, and must be done between 15 -19 weeks. It screens your blood for a
specific protein marker that MAY indicate a higher risk for Down Syndrome, neural
tube defects, another form of mental retardation and an enzyme deficiency. It is
only a screening test, and if it is positive, you will be offered further genetic
counseling/testing. If you had an ultrasound and a blood test for the 1st trimester
screening test for Down Syndrome, a second blood test will be drawn to complete
the MSAFP panel. If you will be 35 years old or older at your due date, you may
8
skip this test and choose CVS or amniocentesis.
An abdominal ultrasound (a.k.a. Fetal Anatomic Survey or Level II Ultrasound) will
be done by a perinatologist or radiologist depending on your insurance. This
ultrasound evaluates the fetus for abnormalities of the brain, heart, stomach,
kidney, spine, bladder, extremities, face, placenta, and cord. It also measures
amniotic fluid and looks for clues to chromosomal abnormalities. YES, it might also
show the baby’s sex. Tell the sonographer if you do not want to know your baby’s
gender.
20-27
YOUR BABY: At 20 weeks, your baby is covered with fine hair (lanugo) and
practices sucking her thumb. He/she is now 7 inches long. You may feel “fluttering”
movements.
Sign up for Childbirth Education, Infant Care, Breastfeeding and Infant CPR classes
at the hospital where you will deliver. Decide who you want to be with during your
labor and work on your “Birth Plan” (ask us). No more sleeping on your back; side
lying only. Use body pillows for support.
28-29
YOUR BABY: At 24 weeks, your baby’s eyes begin to move, his lungs continue to
develop and surfactant (essential for breathing) is produced. Rolling and kicking
movements are becoming stronger.
A 1 hour glucose test and a CBC test to screen for diabetes and anemia in
pregnancy are done at this time. If you are Rh negative, an antibody screen will
also be drawn; if it is negative, you will be given and injection of RhoGam to
neutralize the negative antibodies.
Please plan at least 1.5 hours for this appointment because you have to drink a
sugar solution and have your blood drawn 1 hour after you finish drinking. If this
test is positive, you will need the 3 hour test to confirm Gestational Diabetes. 8%
of pregnant women develop Gestational diabetes, and while most can be controlled
with diet and exercise, some women will need insulin.
This is a time to time to talk about post-partum contraception. If you desire
permanent sterilization, you must sign the consent form no later than your 32nd
week (8 months).
Ask us about CORD BLOOD BANKING and obtain the kit you will need to bring with
you to labor and delivery. You only have ONE OPPORTUNITY to bank your baby’s
cord blood. DO NOT MISS IT if you want it.
Start monitoring your baby’s movements. Ask us for a KICK COUNT SHEET.
Your OB visits will now be Scheduled every 2 weeks.
32
YOUR BABY: Your baby’s skin is becoming wrinkled, her eyes open and close, and
she is practicing breathing movements. If she were to be born now, she would
have a good chance of survival. She is about 10 inches long.
Register at your hospital of delivery; ask for the registration form if you were not
given one. Sign the consent for permanent sterilization if you desire this.
9
YOUR BABY: He is now gaining 1/4-1/2 pound per week. His lungs continue to
mature and he has sleep/wake patterns. He may have hiccups from swallowing
amniotic fluid – a good sign of normal development. He is now 14 inches long and
weighs about 2 pounds.
Call your hospital and arrange a tour of the labor, delivery, and post-partum unit.
Choose a pediatrician.
34-36
A vaginal/rectal culture will be taken for Group B Strep (no speculum needed)
Group B Strep is a very common bacteria that occurs in about 20-35% of women
and rarely produces symptoms. It can cause serious harm to the baby, so if your
test is positive, it will be treated during your labor and delivery.
Most babies will have moved into a “head down” position at this time. An
ultrasound will be done to check your baby’s head position. Now is the time to
finalize your birth plan and discuss it with your delivering doctor. Ask for the SDI
papers and turn them in to our office by your 36th week.
37DELIVERY
Your OB visits will now be every week.
The final weeks have begun. You may be feeling great excitement at the prospect
of finally meeting your baby, while you are also apprehensive about the delivery.
Take comfort that you are prepared and that your body knows just what to do.
REMEMBER to get a car seat and pack an overnight bag.
YOUR BABY: She continues to move, stretch, turn her head and wriggle her fingers
and toes. The movements may become more subtle as she rests up for delivery.
She is about 18-22 inches long and weighs between 6-9 pounds.
*If your baby has not moved in 12 hours, you need to call us and/or go to the
hospital.
WHEN TO GO TO THE HOSPITAL
 if your water breaks and contractions have not started within 12 hours (if your
Group B Strep test was positive, go to the hospital immediately).
 if you have 4 or more contractions in 1 hour that are increasing in intensity, or
 if you have vaginal bleeding like a menstrual period with or without contractions.
LISTEN TO YOUR BODY !
TRUST YOUR INSTINCTS !
HAPPY BIRTHDAY !
10