2013
By Michael Yuzefovich, MD
Millennium Gynecology
Prenatal Care Packet 2013
GynNow.com
703-224-9999 t
571-384-6702 f
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 2
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Table of Contents
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 3
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 4
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
The Ante-partum (also known as the Prenatal) period occurs from when you are first diagnosed as being pregnant to the time just before you go to the hospital to deliver your baby. There are generally 9 months in this period. However, clinicians prefer to count weeks, as weeks are much more precise. There are approximately 40 weeks that a woman is pregnant. As a reference, this 40 week mark is designated as your due date . You will be assigned a due date, and it is important that you remember it.
My Due Date is _________________________________________________________
The reality is that most babies are not born exactly on the due date . Actually no one can truly predict the day your baby is born. You may also hear the term trimester, which spans about 14 weeks in length. There are 3 trimesters in total spanning the 40 weeks.
A full term pregnancy is defined as a pregnancy 37 weeks and beyond. If your pregnancy extends into 40 weeks then you are considered Post Dates, and specialized testing becomes necessary to make sure that everything is fine. Below are common symptoms experienced in each trimester.
Nausea and Vomiting: It is common to feel morning sickness. As long as you are able to function throughout the day and tolerate some foods and most liquids, this will usually improve in several weeks. If your symptoms are more severe, you need to tell us immediately. Safe ways to help alleviate such symptoms are ginger supplementation and vitamin b6 which can be found in organic and health food stores.
Breast Tenderness: Increasing levels of progesterone produced by your ovary and newly forming placenta contribute to this effect. Safe ways to help alleviate this is by using evening primrose oil which can be purchased in most pharmacies.
nd
Round Ligament Pain : This pain is usually noticed in the creases of your hips known as the inguinal area. This pain occurs with walking as a result of your ligaments stretching as your uterus grows. If the pain is mild and only occurs when walking and resolves completely with rest- don’t worry! We encourage stretching exercises and periodic rest when pain occurs.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 5
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Physiologic Dyspnea a: This refers to a difficulty in taking a deep breath when laying flat in bed. This occurs when the uterus presses up on the diaphragm, which is a large muscle responsible for the movement of air in our lungs, and limits the amount the diaphragm can move. We recommend that you use 1-3 pillows at night to elevate your upper body so the uterus doesn’t push so much on the diaphragm. If you still continue to feel short of breath, after such maneuvers, then seek medical attention.
Fetal Movements: Women experiencing their first pregnancy (aka Prima-Gravida) usually start feeling movements around 21 weeks. Women who’ve had kids before (Multi-Gravida) usually begin to feel movements around 19 weeks. It’s common that the baby will not begin moving vigorously until 4 weeks after you first feel baby movements. After that, fetal movements must be felt on a frequent basis. Extreme movements by the baby are highly reassuring and do not suggest trouble. Baby’s can’t keep moving all the time however, as they need their sleep as well. Most babies sleep for about 40 minutes to 1 hour. At that time you may experience little movement, which is ok as long as they return to their baseline activity afterwards. If for some reason you aren’t feeling the baby move as usual, you are expected to do the following:
. This is a very valuable test that you can do to ensure fetal well being. Drink a glass of orange juice or milk, lie down on your left side, put both hands firmly on your belly, and feel for the baby to move. If you feel 10 movements in 2 hours, then be reassured. If there are less than 10 movements in 2 hours, call us immediately.
Again, it is common that the baby is not moving vigorously until 4 weeks after you first notice a movement. Also, as you approach full term, your baby will start having limited space to move. So the amount of movement may be slightly diminished, however the frequency of movements must be maintained.
rd
Braxton Hicks Contractions: A tightening of the abdomen, lasting 20-45 seconds, followed by complete resolution, is a contraction. If these contractions occur a few times/ day, they are not dangerous as they are simply Braxton Hicks. They are not associated with labor. It’s the way that your uterus begins its preparation for the real thing that may occur in the future.
Discharge 3 rd trimester: Further along in pregnancy you may begin to experience a slight, white, thick, non odorous, mucous discharge, on your panty liner a few times per day. This is secondary to increased cervical secretions. If you experience anything other than what is mentioned, you must let us know. Bloody Show is a term used to describe another discharge that occurs after the minor dilation of your cervix. This slight discharge is blood tinged and mixed with mucous. If this occurs at or near Term, don’t worry as long as the baby continues to move appropriately. Bloody Show is normal; however, if you experience any active bleeding, you must inform us
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 6
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 immediately.
Back Pain: It is common for women to start experiencing mild generalized back pain.
This is mainly from the weight of the pregnancy and compression of the nerve roots that exit through your vertebral column. This pain may occasionally radiate down the back of your thigh called Sciatic Nerve pain. If you experience these symptoms, it is advised to bed rest with a heating pad. If your symptoms are severe at any point, please contact us.
Swelling in your legs: You may begin to experience swelling in both of your legs that changes throughout the day. This is secondary to the increased volume of fluid collected in your body and gravity that causes that fluid to collect mainly in the lowest part of your body- your legs. It’s important to use a pillow to elevate your legs at night.
If the swelling occurs in only 1 leg, you must contact us immediately.
Staying safe: It is important that you avoid any situations that may cause you harm. It is best that you apply a common sense approach to this recommendation. If you feel that you are under the threat of someone or in a dangerous situation, please call 911.
Staying positive: Babies can handle an enormous amount of stress, however its always best to maintain positive emotions, by securing an environment around you that will inspire serenity and good feelings. If you require stress reduction, we recommend exercise, support groups, and even Yoga. Remember, this is your pregnancy, don’t let anyone spoil it for you.
Prenatal Vitamins: If you consume a well balanced diet, you will most likely fulfill all your nutritional needs for your pregnancy. Nevertheless, supplementation is encouraged especially for Iron, Folic Acid, Calcium, and DHA Omega 3 fatty acids, so make sure your pre-natal vitamin has these. In general, pre natal vitamins, regardless if brand named or over the counter, have similar nutrients. Sure, little differences exist, but these subtle differences are usually not clinically significant. So don’t go broke trying to buy a fancy vitamin such as Neevo or Ob Complete One, because a generic over the counter brand is nearly as good. For those moms who are too nauseous for a big pill, try a chewable Flinstones vitamin, but don’t tell Wilma or Fred!
Hydration: It is important to drink 8-10 glasses of water each day. Dehydration can lead to premature contractions.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 7
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Sex : Sex is safe in pregnancy. You won’t give the baby a headache. However, if you have a high risk condition, your doctor may advise otherwise.
Travel: It is safe to travel by plane and car. If you do, we recommend you get up from the seat every 1-2 hours for 15 minutes to increase the blood circulation in your legs.
Some airlines restrict flight overseas at 34 weeks and beyond. Most domestic airlines restrict flights 36 weeks and beyond. This is not because it is dangerous to the baby; simply the airlines do not want to take a chance that someone will deliver on their flight. It is best to check with the particular airline regarding their flight rules.
Exercise: Exercise is safe and encouraged in pregnancy. Yes, avoid starting an intense workout your body has never been exposed to. Again, exercise your common sense first.
We also advise against activities with a high risk of falling or trauma, or require a significant time laying flat on your back.
The Millennium team is a group of highly trained obstetric providers. Everyone, from our receptionist to the doctor, is responsible for your well-being. We all work together to ensure the best medical care is being delivered to you and your baby.
Standard Business Hours- In the office you will be examined by either Dr. Mike, Taryn
Thibeault NP, or Rupali Singh MD. If a situation requires hospitalized care then Dr. Mike or Dr. Singh will manage the situation.
Afterhours during the work week- Dr Mike or Dr Singh will most often manage the critical emergency in the hospital after initial assessment by the nurses and Hospitalist Group.
Hospitalist Group- As a service to our patients, Millennium Gynecology ensures that a Board Certified Doctor is present in the hospital 24 hrs a day/ 7 days a week to take care of any Millennium Mom who needs urgent medical care. It is an enormous benefit to know that a trusted Millennium affiliated physician is always in the hospital in case a critical situation occurs that needs to be dealt with that second. The Hospitalist
Group is composed of 5 physicians: Dr. Thomas/Rasul/Martinez/Duncan/Josephs that alternate each 24hr shift. Most often, after their initial assessment, will contact Dr.
Mike or Dr Singh, so they can safely take control of the situation.
Millennium is affiliated with the Georgetown School of Medicine and George Washington
School of Medicine so resident physicians and medical students may be present to learn and observe.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 8
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
If you experience:
painful contractions lasting 1 hour
leakage of fluid
unexpected vaginal bleeding
if the baby is not moving well
anything else that you consider an emergency
CALL US: 703-224-9999
During business hours- a staff member in the office will advise you.
Afterhours- a representative from our answering service will advise you to go directly to the hospital.
For afterhour non-emergency phone calls- a representative from our answering service will take a message so that a member from the office will contact you the very next business day.
Please commit our number to memory. Sometimes there may be an interruption in the answering service, mainly due to telecommunication issues. Again, if is a medical emergency – Do NOT Wait, just proceed directly to the Virginia Hospital Center.
If it is an emergency, you need to go to the Virginia Hospital Center (formally known as
Arlington Hospital.) Virginia Hospital Center is the exclusive choice hospital for Millennium
Gynecology, chosen for its excellence in patient care and outstanding patient satisfaction.
For directions to the Virginia Hospital Center, refer to your folder.
These are the steps to take:
1.
10 minutes away from the hospital, call labor and delivery 703-558-5000 and tell them you are 10 minutes away and may need a wheelchair and that you will be dropped off at the lobby.
2.
Once you arrive at the hospital, we encourage that you be dropped off at the front of the Women’s and Children’s lobby
3.
Tell the security person I am a Millennium Gynecology patient and have an emergency a.
If you are less than 20 weeks pregnant, they sometimes will send you to the
Emergency Room. b.
If you are > 20weeks, then you will be sent to the 3
Triage. rd floor to an area called
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 9
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 o Triage is an area where pregnant women are evaluated to determine if they need to truly be hospitalized or it’s just a false alarm. In Triage, the nurses will assess you and get in touch with the doctor for further instructions.
Welcome Visit: Your first visit will begin with our nurse supervisor. She will review your history and introduce you to our practice as a Millennium Mommy to Be.
Please refer to Annex A for a list of safe medications and Annex B for nutrition recommendations, at the end of this document.
The First Medical Visit:
The Clinician will review your history and address any issues that you may have.
You may have a Pap Smear and Genital cultures performed
Your due date will be assigned
Weeks 11-22 genetics:
Within this period you have to decide on the level of genetic screening you would like done. Below are the options: a.
Non-Invasive testing: These tests are not invasive and do not pose any risk to the fetus.
First Trimester Screening. This non-invasive test is performed by a specialist sonographer in an outside radiology center between 11.0 -
13.6 weeks. Ultrasound is used to measure something called the
Nuchal Translucency, which correlates with the risk of chromosomal abnormalities such as down syndrome. This test is about 93% accurate. o The location will mainly be based on your preference and the complexity of your pregnancy.
Antenatal testing center (ATC): 703-776-6654
Dr Reyes of Virginia Hospital Center: 703-558-
6077
For a list of the locations and contact information for all testing locations, please refer to the folder- Antenatal Testing Center
Quad Screen. This is a simple blood test performed 15.0 - 22.0 weeks.
This test will be performed at the same blood testing center you will be having all your blood work done. The circulating level of certain proteins in your blood correlates with the risk of chromosomal
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 10
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 abnormalities. This test is about 87% accurate. b.
Invasive Testing: These tests are associated with a minor risk to the fetus, however they are >99% accurate
CVS Test. Performed at 11.0 weeks where cells from the placenta are retrieved for chromosomal analysis
Amniocentesis. Performed at 15.0 weeks and beyond where cells from the amniotic fluid are retrieved for karyotype analysis.
Invasive testing will be performed by a Perinatologist, usually by Dr. Reyes at the Virginia Hopsital Center or by your own designated Perinatologist. Such testing is optional for all pregnant women and it is your choice to accept or decline such testing.
Weeks 18-22: a.
Level-2 Ultrasound: This test is ideally performed between 18-22wks and evaluates the major structural anatomy of the baby. It is performed at a radiology center and often will also identify the gender of the baby if you prefer. While ultrasound is an excellent means of looking at your baby, it cannot detect genetic disorders or small anatomical abnormalities.
However, a normal ultrasound is usually very reassuring.
In the office, you will receive a prescription for a Level-2 ultrasound which will have a phone number for you to call to schedule your appointment.
Most of our patients receive ultrasounds at any of the 3 locations:
1) Mount Vernon Hospital: To schedule 703-750-8200.
2) Antenatal testing center (ATC): To schedule 703-776-6654
3) Dr. Ramsey of Woodbridge: 703-494-0064
4) Dr. Reyes of Virginia Hospital Center: 703-558-6077 b.
Hospital Tour: This is a good time to think about arranging a tour of the hospital. i.
Visit www.virginiahospitalcenter.com
ii.
Click on Programs & Classes iii.
On the left side column click on Women & Infant
Health iv.
Search for Expectant Parent Tour v.
Click on Add to my classes, and fill out all necessary questions. vi.
If you do not have internet available, a Millennium
Team Member will more than happy to do it for you.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 11
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Week 28-30: c. Cord blood: Cord blood is the collection and saving of blood from the umbilical cord, instead of simply discarding it after birth. It is understood that this blood contains stem cells which are used today to treat blood cancers. It is theorized that in the future, stem cells may even treat other diseases as well.
Cord blood can be collected for private use or for public use as a donation.
If you choose private collection, this means that your baby’s cord blood will be stored for your family only. There are 2 major companies that store private cord blood and they both are very good. Their promotions vary so it is a good idea to shop around.
Millennium has the most experience with Cord Blood Registry® (CBR) and tries to obtain the best promotions for our patients. a) Glucose Testing: you will be asked to drink a sugar based beverage and your blood will be tested 1 hour afterwards. This test is used to check for pregnancy induced diabetes. It is best to be fasting and then drink the beverage 30minutes before arriving for your blood draw b) Your blood count will be checked c) Now is the best time to pre- register at the hospital! This is not mandatory, however when you are ready to deliver, there will be less paperwork to fill out so this step is recommended. To pre-register you must visit the hospital website i.
www.virginiahospitalcenter.com
ii.
Click on Medical Services iii.
Click on Women & Infant Health iv.
On the left column click on Obstetrics Pre-Admin. Form, and fill out all the following questions. v.
If you do not have internet available, a Millennium Team
Member will be more than happy to do it for you. d) Become familiar with the best way to the hospital. Pick a day when your free and take a trip to the hospital so you know where to go when your ready. e) Consider a pediatrician. This process is encouraged but not absolutely necessary. Make sure the pediatrician has an office close to your home. If you do not have a pediatrician when you have your baby, don’t worry, your baby will be assessed by a top pediatrician at the hospital. f) Rhogam - This is a required injection for women with Rhesus or "Rh(D)" negative blood type. The doctor will inform you when this is needed. If you are Rh negative you will receive an order from the Doctor and have to go to Inova Outpaitent Center located at 8503 Arlington Blvd. Suite 200,
Fairfax VA 22032, you can reach them at 703-970-3101.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 12
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Here are a few Pediatricians to consider:
Potomac Pediatric located in Woodbridge, VA 703-730-5437
Sherwood Hall Pediatrics located in Alexandria, VA 703-360-
0300
Vienna Pediatrics located in Vienna, VA 703-938-2244
It is always BEST to call your insurance company to ensure that a Pediatrician participates with your insurance. If you do not have a pediatricians before you deliver, DO NOT
WORRY a Virginia Hospital Center Pediatrician will be present at your baby’s birth & to take care of your child during your hospital stay.
Week 34-36:
(a) You will be asked to undress so a culture can be taken from your external vagina. This test looks for bacteria called GBS. We all have this bacteria in our colon, however in 30% of women, this bacteria migrates to the outside vagina during pregnancy. If it returns positive, you will be required to take antibiotics during labor, if you are having a vaginal delivery, to prevent passage of this bacteria to the baby.
(b) Transportation to the hospital- If you are a mom with significant transportation limitations and need help, Millennium Gynecology will pay for your ride to the Virginia Hospital Center. Ask a Millennium team member and they will give you a free pass to VHC.
(i) When ready to deliver and use your pass- call Yellow Cab 703-491-2222 and a tell them you are a Millennium patient and need to be taken to the Virginia Hospital Center.
1.
Conditions- This pass is only given once when you are ready to deliver. This pass can only be used to go to the Virginia Hospital
Center, and for all other locations, you will be charged. By using this pass, you indemnify Millennium Gynecology completely and assume all responsibility for any harm that occurs to you and your fetus during your transport to the hospital. If you do not agree to these conditions, you should absolutely not use this service. If this pass is used for any other destination other than VHC, Millennium reserves the right to bill you for the cost of card.
Weeks 38+:
If you make it this far, you will be asked to disrobe so a gentle cervical exam can be performed.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 13
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Prepared childbirth classes- these classes are optional and not necessary, however patients highly recommend them.
Dental Care. We are affiliated with Tysons-Dental. They offer our patients a complimentary discount and are available for emergency care. Go to www.Tysons-
Dental.com
Diabetes Center- For Moms diagnosed with Diabetes in pregnancy. The Diabetes
Center will teach Moms how to check their blood sugars, and improve their diet. o To contact the Diabetes Center Call 703-558-5718 for VHC or Call 703-698-
2500 for other locations.
Genetic Counseling- for moms with a genetic disorder, and require counseling and risk assessment.
The following is our recommended reading list which can be purchased at any major book store or on-line.
What to Expect When Your Expecting by Heidi Murkoff
Que Peude esperar cuando esta esperando by Heidi Murkoff
Your Pregnancy Week by Week by Glade B Curtis, M.D.
Baby Names: The Complete Book of Baby Names by Leslie Bolton
What to Expect the First Year by Heidi Murkoff
Your Baby’s First Year Week by Week by Glade B. Curtis
This section pertains to the time you are going to the hospital to deliver your baby.
In most instances, you know that you are ready to have your baby when: a.
Your water breaks b.
Your contractions occur every 5 minutes apart for 1 hour. c.
Sometimes, however, less obvious medical reasons necessitate having your baby delivered.
By ready , we mean that you are in labor. Labor is the process where your body produces contractions with enough force to cause your cervix to dilate. If you are pre-term (less than 37 weeks) we may need to medically stop the labor process. However, if you are 37 weeks or above- then you are ready.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 14
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
At Millennium, we believe in personal choice. Of course, certain medical factors may dictate which route of delivery is better, however assuming all things equal, a woman can elect a vaginal or cesarean delivery.
Vaginal Delivery: In a vaginal delivery, a women’s cervix must dilate a certain amount of centimeters per hour. Once the cervix is 10 cm, then you can start pushing, a process which may take 10 minutes to 2 hours of time. Most patients go home 1-2 days after a vaginal delivery. a.
Pros - Vaginal delivery is associated with faster recovery, lack of an incision, less blood loss. b.
Cons - Risk of failure to dilate, the baby shoulders becoming stuck in the birth canal, the baby lacerates the vagina and nearby organs requiring extensive repair.
What if I wish to have a vaginal delivery but do not go into labor by myself?
Don’t worry! If you do not go into labor by yourself, your labor can usually be induced.
This means that on a certain date, you will arrive to the hospital, and a medication will be gently placed by a nurse or resident in the vagina to soften your cervix. This process is usually done overnight so you can sleep through this softening process. The following day,
Dr. Mike or a designated Physician will arrive and break your water (rupture the amniotic sac), which will stimulate your body to start contracting. Sometimes, supplemental medication is used called Pitocin, which mimics our own body’s natural hormone oxytocin, which will increase the strength of the contractions. If you continue to dilate your cervix at an appropriate rate, you will likely have a successful vaginal delivery. Inductions may be fast or slow, so prepare yourself mentally that it may take a while. Once you are ready then the doctor will arrive.
Planned C-Section: In a planned c-section, a patient arrives to the hospital at a scheduled time, a spinal anesthetic is provided for pain relief, and the baby is delivered in a few minutes after starting. We pride ourselves on performing beautiful incisions that are very low and usually in the hair line. The average c/section time is 45 minutes long. You can bring only 1 special person with you into the section room. Most patients go home 2-3 days after a c/section. a.
Pros- No risk of vaginal injury, less chance for trauma to the baby, smaller likelihood of pelvic organ prolapsed in the future possibly. b.
Cons- An incision is made, it is recommended to have future deliveries by csection, risks of adhesions with having many c-sections.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 15
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
1.
BLOODWORK
You are REQUIRED to go to Virginia Hospital Center at least 24 hours prior to your scheduled delivery for Mandatory Blood work. Failure to do so will result in a delay of your scheduled delivery.
a.
While at the hospital you must go to the Outpatient Laboratory located on the 1 st floor of the hospital. For Further directions please call 703-
558-6489. b.
Patients with scheduling or transportation issues must notify the hospital and our office at least 24 hours in advance if you are unable to obtain blood work.
2.
Eating/Drinking
Please do not eat or drink anything, at least 8 hours prior to your c-section.
Failure to comply will result in an automatic Cancellation to your delivery.
3.
Hospital Arrival
On the day of your delivery you are required to arrive to Virginia Hospital
Center; Labor & Delivery (3 rd floor) at least 2hours prior to your scheduled C-
Section. Lateness to your C-section may result in postponement or cancellation.
If you’re a Millennium Mommy to Be, you will deliver at the Virginia Hospital Center. All the rooms are private, you may have an unlimited number of guests with you, wine is allowable in the delivery room for those that wish to say cheers, and the hospital has a level 3 nursery to take care of any urgent neonatal issues with a pediatric subspecialist in house 24 hours a day. If you accidently go to another hospital, care will not be provided by Millennium and it is very disheartening that we cannot care for our patients.
These are the steps to take:
1. 10 minutes away from the hospital, call labor and delivery 703-558-5000 and tell them you are 10 minutes away and may need a wheelchair and that you will be dropped off at the lobby.
2. Once you arrive at the hospital, we encourage that you be dropped off at the front of the Women’s and Children’s lobby
3. Tell the security person I am a Millennium Gynecology patient and have an emergency
4. Your driver, if they will stay, can park in the Green Parking Lot
Another advantage of being a Millennium patient is that Dr. Mike or Dr. Singh will most likely be taking care of you during your delivery. On rare occasions, when Dr. Mike or Dr
Singh are not readily available, Millennium Gynecology entrusts a select group of
Physicians at the Virginia Hospital Center to take his place. There is always a Physician at the hospital ready to take care of our patients.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 16
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Bring to the hospital whatever makes you feel comfortable. We are referring to small items which comfort you. The items we strongly recommend are:
Camera
Music to play during your delivery
Small radio
Slippers
Favorite pillow
Anesthesia in labor is not mandatory. However, the far majority of women do prefer to receive anesthesia, most often in the form of an epidural. This anesthetic is infused via a small catheter in the back which is very safe . After an optimal epidural, patients may dilate while talking on the phone or even sleeping. It is highly effective. If given at the appropriate time, it may even help facilitate the labor process. Again, the decision for an anesthetic is your choice.
Don’t worry if you didn’t make arrangements with a pediatrician prior to delivery. The
Virginia Hospital Center has an excellent team of house pediatricians that will take care of your newborn until you can comfortably transition to one.
Sometimes babies require more intensive care; in that case a baby might be transferred to the NICU (Neonatal Intensive Care Unit.) This unit is located on the second floor of the hospital. Otherwise the well baby nursery is located on the same floor that you will be located.
This refers to the period after your baby is born. After you deliver, you will be transferred out of L+D to a Post Partum area for moms that are recovering from their delivery. At the Virginia Hospital Center, you are assured a private room.
Breast Feeding: Breastfeeding is always encouraged, unless medical factors deem otherwise. If you are having trouble breastfeeding, you can request that your nurse provide you with a lactation consultant while in the hospital.
Breastfeeding information- The Hospital will provide you with significant reading material if you so request it. If you did not have a chance to review
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 17
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 the material while in the hospital and still wish to, we recommend going online to the following web address: http://ameda.com/breastfeeding/elibrary/qa.aspx
. If you do not have computer services then our office will be glad to print the forms for you
Breast Pump Rental - Maintaining adequate milk supplies without an electric or a hand-held pump is very difficult. The breast has to be stimulated to produce milk every 2-3 hours or else the quantity of milk will diminish. The nurses in the hospital will help arrange a breast pump if you choose.
Circumcision. Circumcision is a controversial process. It is mainly performed for religious and cultural reasons. It is not absolutely necessary. However, some studies have shown that circumcision decreases the incidence of HPV and HIV-2 transmission. Our philosophy- it’s your decision! Dr. Mike or Dr Singh will likely be performing this procedure on your baby boy, the next day after his birth.
Congratulations, you are almost home!
Wound Care:
Vaginal delivery- If you had a vaginal delivery and a repair was performed, you must take care of your genital area. Don’t worry, any suturing that was performed will dissolve on its own.
Rule #1 No sex for 6 weeks
Rule #2 No straining to obtain a bowel movement. Take laxatives such as
Colace 2x/day if necessary and consume lots of fruits, vegetables, prunes, and fiber. Continue to drink plenty of water.
Rule #3 Keep the vaginal area clean with warm water rinses and soap applied externally. Don’t scrub the area or clean inside your vagina. Sitz baths are nice with Epsom salt, which you can purchase in any pharmacy, but they are not necessary.
Rule #4 No Douching/ Tampons/Baths for minimum of 6 weeks
C-section Incision. Skin closure is almost always performed on the inside, and the suture will dissolve on its own. However, if staples were required, we ask that you return to the office 5-7days after delivery for removal. Staples are sometimes medically superior so do not feel alarmed if they were used, I assure you they are there for your best interest.
Rule#1 Keep the incision very dry. Use a hair dryer after the shower if you must. For patients with a larger belly that tends to cover the incision, I
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 18
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 recommend purchasing an ABD Pad in the pharmacy and applying it to the incision 2-3 x/day so it can soak up the moisture. The ABD Pad must lay directly on the incision to keep it dry.
Rule#2 Keep the incision clean with a shower 1x/day. Yes, gently apply soap to the incision and rinse off with water. You can take a shower the first or second day after your c-section. After the shower, remember to apply Rule#1.
The secret to a beautiful incision is to keep it clean and dry , even if someone accidentlay tells you otherwise, I can’t stress enough how important clean and dry is to your success.
Rule #3 No sex for 6 weeks
The general principal is simple: do as much as you can and when you start becoming sore or tired, stop and take a break. You will not hurt anything as long as you don’t do anything ridiculous. I strongly encourage walking the very next day after you deliver and being as active as possible.
Driving is permissible if you feel you can be safe on the road, able to turn the wheel and press on the brake, and are not relying on narcotic medication. If driving is not absolutely necessary, it’s preferable that you stay home and get some rest, you deserve it!
Vaginal Delivery: You can resume mild exercise after 2 weeks and gradually return to full activity at 6weeks
C-Section : You can resume mild exercise at 4 weeks and gradually return to full activity by 8 weeks
It is recommended that you continue taking medications that were prescribed for any specific medical conditions, unless told otherwise. The doctor may need to tailor your medications after delivery depending on medical circumstances.
Pain:
Vaginal: Most patients will only require over-the-counter Motrin 600-800 mg every 8 hours as needed.
C-section: If you had a c-section, you will be prescribed Percocet. Take 1-2 pills every 4-6 hours as needed for pain. You will also be recommended to take over the counter Motrin 600-800 mg every 8 hours as needed for pain. Try to transition away from Percocet to Motrin when ready. Your body will tell you when you are ready
Constipation :
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 19
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
It is recommended to continue taking Colace 100 mg 2 times per day for 6 weeks.
Pre -natal vitamins are encouraged for at least 6 weeks after delivery.
C-Section: You are recommended to make an appointment and return to the office in 1 week after having the baby and then 6 weeks after that visit
Vaginal Delivery : You are recommended to make an appointment at the office 6 weeks after having the baby.
Continued bleeding greater than a period
Pain that is not improved with your standard pain medications
Inability to urinate > 6 hours
Fever >100.4
Foul odor from the vagina
Feelings of persistent sadness or hurting yourself or others
Anything else that you consider significant and out of the ordinary
The Emergency line is always the same as the office line: 703-224-9999. If you cannot get through for some unusual reason then go to the Virginia Hospital Center
Emergency Room or your closest Emergency Room.
Because we recommend no sexual vaginal activity for 6 weeks, we prefer to discuss birth control at your 6 week post partum appointment. Prior to this date, you are recommended to consider whether you want a reversible form of birth control (ex.
Pills/Patch/ Ring/Implenon/IUD/Condoms) or Permanent Birth Control (Essure In-Office
Sterilization or Classic Surgical Sterilization)
Women often ask for ways to reshape their bodies after delivery. Abdominal binders may hide excess bulges, in case you need a temporary fix.
Breast feeding is a terrific calorie burner.
Coco Butter/ Mederma cream/ Bio Oil for stretch marks and c-section scars
Exercise and a well balanced diet is always the fundamental root to success.
Please bring this folder with you to the hospital so it can guide you.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 20
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
WE WISH YOU SUCCESS AND A WONDERFUL EXPERIENCE!
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 21
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Below, you will find a list of medications which are deemed SAFE to use during your pregnancy. These medications have been tested in clinical trials and have not shown any risk to the fetus.
Condition Safe Medications to Take During Pregnancy*
Allergy
Cold and Flu
Constipation
Diarrhea
First Aid
Ointment
Benadryl
Tylenol (acetaminophen) or Tylenol Cold
Warm salt/water gargle
Saline nasal drops or spray
Sudafed, Actifed, Dristan, Neosynephrine*
Robitussin DM, Trind-DM, Vicks Cough Syrup, Romilar, Halls*
*Do not take "SA" (sustained action) forms of these drugs or the "Multi-
Symptom" forms of these drugs.
Metamucil
Citrucil
Fiberall/Fibercon
Colace
Milk of Magnesia
Senekot
For 24 hours, only after 12 weeks of pregnancy:
Kaopectate
Imodium
Parepectolin
J & J
Bacitracin
Neosporin
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 22
Gas
Headache
Heartburn
Hemorrhoids
Infection
Insomnia
Motion
Sickness
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Simethicone (Gas-X ®, Mylicon ®, Phazyme ®)
Tylenol (acetaminophen)- extra strength is safe
Maalox
Mylanta
Tums
Pepcid
Zantac
Preparation H
Anusol
Tucks
Witch hazel
Acyclovir (Zovirax ®)
Azthitromycin (Zithromax ®)
Cepaholosporins. Examples: Cephalexin (Keflex®),
Cefazolin (Ancef ®), cefaclor (Ceclor®)
Clindamycin (Cleocin®)
Erythromycin
Penicillins. Example: Amoxicillin (Amoxil®), Amoxicillin Clavulanate
(Augmentin®), methicillin, carbenicillin.
Metronidazole (Flagyl®)
Doxylamine (Unisom Sleep Tabs®)
Dimenhydrinate (Dramamine ®)
Nausea and
Vomiting
Vitamin B6 100 mg tablet
Ginger
Sea bands
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 23
Nasal
Congestion
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
Pseudoephedrine (Sudafed ®): Avoid in first trimester. Avoid if you have high blood pressure
Rashes
Hydrocortisone cream or ointment
Caladryl lotion or cream
Benadryl cream
Oatmeal bath (Aveeno)
*Please Note: No drug can be considered 100% safe to use during pregnancy.
It is recommended that you avoid herbal medications as they have not been tested in formal clinical trials. We strongly recommend that you avoid the following herbal supplements:
Avoid these oral supplements: Arbor vitae, Beth root, Black cohosh, Blue cohosh, Cascara,
Chaste tree berry, Chinese angelica (Dong Quai), Cinchona, Cotton root bark, Feverfew,
Ginseng, Golden seal, Juniper, Kava kava, Licorice, Meadow saffron, Pennyroyal, Poke root,
Rue, Sage, St. John's wart, Senna, Tansy, White peony, Wormwood, Yarrow, Yellow dock, vitamin A (large doses can cause birth defects).
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 24
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191
You should consume about 300 more calories per day than you did before you became pregnant. Eat a variety of foods to get all the nutrients you need.
Foods to Eat:
Seafood : Seafood can be a great source of protein and iron, and the omega-3 fatty acids in many fish can help promote your baby's brain development. Try to eat 1-2 average sized portions per week of any of the fish listed below:
Canned light tuna (limit albacore tuna and tuna steak to no more than 6 ounces or 170 grams a week)
Salmon
Pollock
Cod
Dairy : Eat and drink at least four servings of dairy products and calcium-rich foods a day to help ensure that you are getting 1000-1300 mg of calcium in your daily diet during pregnancy.
The best sources of calcium are dairy products including milk, cheese, yogurt, cream soups, and pudding. Calcium is also found in foods including green vegetables (broccoli, spinach, and greens), seafood, dried peas, and beans.
Vitamin D will help your body use calcium. Adequate amounts of vitamin D can be obtained through exposure to the sun and in fortified milk, eggs, and fish.
Iron: Eat at least three servings of iron-rich foods per day to ensure you are getting 27 mg of iron daily.
The best sources of iron include enriched grain products, lean meat, poultry, fish, and leafy green vegetables.
Total brand cereal has 18mg of Iron
Foods to Limit
Caffeine : Limit caffeine to no more than 300 mg per day. The caffeine content in various drinks depends on the beans or leaves used and how it was prepared. An 8-ounce cup of coffee has about 150 mg of caffeine on average while black tea has typically about 80 mg. A
12-ounce glass of caffeinated soda contains anywhere from 30-60 mg of caffeine. Remember,
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 25
Mount Vernon Office
8109 Hinson Farm Rd, Suite 501
Alexandria, VA 22306
Oakton Office
8302A Old Courthouse Rd
Vienna, VA 22182
Woodbridge Office
14904 Jefferson Davis Hwy, Suite 407
Woodbridge, VA 22191 chocolate contains caffeine -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee.
Artificial Sweeteners: The use of saccharin is strongly discouraged during pregnancy because it can cross the placenta and may remain in fetal tissues. But, the use of other non-nutritive or artificial sweeteners approved by the FDA is acceptable during pregnancy. These FDAapproved sweeteners include aspartame (Equal or NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda). These sweeteners are considered safe in moderation
Foods to Avoid
Do not eat shark, swordfish, king mackerel, or tilefish (also called white snapper), because they contain high levels of mercury.
Avoid soft cheeses: such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese.
These cheeses are often unpasteurized and may cause Listeria infection. There’s no need to avoid hard cheese, processed cheese, cream cheese, cottage cheese, or yogurt. All soft nonimported cheeses made with pasteurized milk are safe to eat.
Unpasteurized Milk: Unpasteurized milk may contain bacteria called listeria, which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning, which can be life-threatening. Make sure that any milk you drink is pasteurized.
In addition, during pregnancy, some women feel strong urges to eat non-food items such as ice, laundry starch, dirt, clay, chalk, ashes, or paint chips. This is called pica, and it may be associated with an iron deficiency such as anemia. Do not give in to these non-food cravings -- they can be harmful to both you and your baby. Tell your health care provider if you have these non-food cravings.
Raw Meat: Uncooked seafood and rare or undercooked beef or poultry should be avoided because of the risk of contamination with coliform bacteria, toxoplasmosis, and salmonella.
Avoid deli meats (“cold cuts”) as well or warm them until they are hot before you eat them.
Avoid raw fish, especially shellfish like oysters and clams. Fish that contain high levels of mercury should be avoided as well. Mercury consumed during pregnancy has been linked to developmental delays and brain damage. A sample of these types of fish include: shark, swordfish, king mackerel, and tilefish. Canned, chunk light tuna generally has a lower amount of mercury than other tuna, but still should only be eaten in moderation in proportions as written above. Certain types of fish used in sushi should also be avoided due to high levels of mercury.
© 2011 Millennium Gynecology PLLC | 703.224.9999 | GynNow.com
The information contained in this document is proprietary. It does not constitute a doctor-patient relationship, nor can it be perceived as a clinical encounter. Recipient understands that it is intended for informational purposes only.
Millennium Mommy To Be Guide 01-2011 P a g e | 26