Special
Delivery
A Helpful Guide
For Expectant Mothers
Welcome
to the
AHEC Family
Congratulations on your pregnancy!
This letter is to welcome you to our prenatal program here at
Southern Regional AHEC Family Medicine Center. We look forward
to providing your care throughout your pregnancy and beyond to
you and your growing family.
Whether this is your first pregnancy or fifth, we understand that each
pregnancy is unique. With this in mind, we understand you will have
many questions along the way, and we encourage you to ask them
during your visits here in our clinic. During your pregnancy, you can
expect to be seen by your doctor an average of 13 visits with visits
becoming more frequent towards the end of your pregnancy.
Your visit today was with one of our OB nurses to go over a
thorough family history. This is a very important part of your overall
prenatal care. This will help us determine the care you receive from
this point forward.
OB nurse
contact information
To contact SR-AHEC OB nurse
Lanna Jacobs-Harris, RMA
please call (910) 678-7243.
Southern Regional AHEC
Prenatal Program
(910) 678-0100
As you enter this exciting time, there are several things we would
like you to be aware of:
Your first OB appointment will be scheduled at 12 weeks. This appointment will be longer and will include a complete physical, blood work and may include a pap smear. Please plan on
being in our office for approximately 90 minutes.
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At the end of your first visit you will meet with our business manager to discuss your insurance coverage for your prenatal care.
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At the end of each visit, one of the OB nurses will schedule
your next appointment and discuss any additional testing. At
various points during your pregnancy, you will have other
screening tests that may need to be done between visits.
These tests are VERY important and must be done in a timely
manner. Please ask us if you have any questions.
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We will try and schedule you with the same one or two
physicians throughout your pregnancy. One of these physicians will be the one to deliver your baby.
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We have someone on call 24 hours a day/7 days a week. If
you have a concern that comes up and cannot wait, please do
not hesitate to call. The majority of pregnancies progress with
little or no complications. If you develop complications along
the way, we may either consult a specialist or need to transfer
your care.
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Please keep in mind, we are a family medicine practice and
also treat children and newborns. We would be honored to
continue to care for you and your baby after delivery.
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Again, congratulations and welcome!
Sincerely,
The Physicians, Nurses and Staff of Southern Regional AHEC
Family Medicine Center
SR-AHEC And Cape Fear Valley
OB Contract With Patient
Patient Name: ____________________________________
DOB: ___________________________________________
Southern Regional AHEC is a Family Medicine Residency Clinic.
Since we specialize in Family Medicine, we feel it is imperative for
you to also see an obstetrical physician during your prenatal period.
Our facility has a contract with Cape Fear Valley OB/GYN (CFVOB)
clinic. During your pregnancy, we will refer you to their office for
a visit. This visit will occur between 18-22 weeks. You will receive
an ultrasound, giving you the opportunity to see your baby. This
ultrasound gives us information on how baby is doing, so it is very
important and is REQUIRED for us to continue your pregnancy care.
When the time comes for your referrals, your doctor/nurse will let
you know. Your doctor will place an order for the referral and our
referral department will set your appointment and contact you with
the date and time. If for any reason you cannot make this appointment or need to reschedule, we ask that you contact CFVOB at
least 24 hours prior to your appointment. The ONLY reason you will
contact CFVOB directly is to cancel/reschedule your appointment.
All of your pregnancy care questions should still come to Southern
Regional AHEC.
Date: __________________
MRN: __________________
Southern Regional AHEC
(910) 678-0100
Cape Fear Valley OB/GYN
(910) 609-3500
After you are seen by CFVOB, they will send a report to our office.
We will go over that report with you at your next OB appointment.
Some information provided by the ultrasound can include the baby’s
sex, size and even changes to your due date.
By signing this contract you are agreeing that you will go to CFVOB
twice during your pregnancy, when it is ordered by your doctor. If
you have any questions, please ask. We are here for the care of
you and your baby.
Patient Signature:_______________________________________
Date: ____________________
Witness Signature:______________________________________
Date:____________________
Witness Print: _________________________________________
6 – 8 Week Visit
Today’s visit
Call your doctor if ...
Today you will meet with one of our OB nurses to go over a
thorough medical history. Information that is collected today is very
important for your pregnancy. We will have questions about your
medical history, including previous pregnancies and gynecological
history. We will also have questions regarding the overall health of
the father of the baby.
The following signs or symptoms should be reported immediately:
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Bright red vaginal bleeding;
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Persistent severe headaches, severe nausea and vomiting;
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Fever over 100.5 degrees; and
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Inability to keep liquid down resulting in reduced amount of urine.
Your baby’s bones have appeared,
internal organs are beginning to
Your body’s changes
work, and the baby’s heart has been Your uterus has grown from the size of a pear to the size of a large orange.
Your breasts may be become larger and tender. The area
beating since the third week.
around your nipples may become darker.
g
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You may have to go to the bathroom more frequently.
You may have “morning sickness” that lasts well beyond
morning.
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If you are experiencing nausea and/or vomiting, see the list of medications you can take during pregnancy.
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You may experience changes in bowel habits; constipation is a common complaint.
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Your baby’s growth
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Your baby is called an embryo at this stage. It is an inch long
and weighs approximately 1/30 of an ounce.
Your baby’s face and body are fairly well formed already.
Your baby’s bones have appeared, internal organs are
beginning to work, and the baby’s heart has been beating since
the third week.
The placenta is attached to the wall of the uterus and the umbilical cord is attached to the baby. The placenta acts as
an “almost perfect” filtering system between mother’s blood and
baby’s blood. The placenta has a fetal (baby) circulation side
and the maternal circulation side. It is the placenta and
umbilical cord that provide a way for the nutrients (food and
oxygen) to get to your baby. It also helps waste products to be
removed. Unfortunately, it also allows some harmful
substances, such as alcohol, to get to the baby as well.
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My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Key Information For Your
First Few Weeks Of Pregnancy
A big change to your family
The hormone changes that affect your body may also affect your
emotions, causing mood swings. It is very common to find yourself
crying one moment and laughing the next. Be patient, this is part of
pregnancy. You and your partner need to remember that you are in
this together. It’s an important time for both of you. Remember, you
both need time to adjust and accept your upcoming role as new or
repeat parents. Coping with some of the discomforts of pregnancy
may lead to changes in household work/routines.
Also, if you are repeat parents, remember the older kids may have
a lot of questions. Listen to them, provide answers and encourage
them since they, too, are a big part of this process.
Blood pressure
We will measure your blood pressure (BP) at every prenatal visit.
Rapidly increasing or abnormally high blood pressure can be a
sign of Gestational Hypertension. High blood pressure can cause
serious complications such as a decrease in the blood and oxygen
supply to the baby and mother. We have placed areas for you to
write your blood pressure in this booklet at each visit. This is to help
you monitor your progress during the pregnancy. Remember, we
are a team and will work together for this baby!
Weight
You’ve probably heard it already. “You need to eat more, remember,
you’re eating for two.” While it may sound like a good idea to go
back for seconds, pregnant moms generally do not need to change
their diets. Your provider will monitor your weight and speak with
you about your nutritional intake if any problems arise. You are likely
to gain approximately 2 to 4 pounds in the first three months. Your
Weight gain
The normal pregnancy weight-gain (if pre-pregnant body
mass index is normal) should be as follows:
Breasts
1.0 – 1.5 pounds
Blood
3.0 – 4.5 pounds
Extra water
4.0 – 6.0 pounds
Uterus
2.5 – 3.0 pounds
Placenta/amniotic fluid
3.0 – 3.5 pounds
Baby
7.0 – 8.0 pounds
Fat storage
4.0 – 6.5 pounds
Total
25 – 35 pounds
Regular exercise will help to keep you fit during your
pregnancy and also will help you feel better.
total weight gain throughout your pregnancy will average 25 pounds.
This number will vary for patients who are under/overweight when
they become pregnant. Most of the weight gained in pregnancy is
due to an increase of water in your body, plus the weight of your
growing baby.
Exercise routine
Regular exercise helps you to keep fit during your pregnancy and
helps you feel better as your body changes. Maintaining or even
beginning a well-rounded fitness program during pregnancy can
help prevent or reduce some of the most common discomforts. For
example, if you keep your back and abdominal muscles strong, they
will provide better support for your spine as baby gets bigger. This
will help reduce back pain. Please remember, however, to check
with your doctor before beginning any new exercise program.
Breastfeeding
You will receive a lot of literature on breastfeeding during your
pregnancy. It is never too early to start your research.
Breastfeeding is the PERFECT food for your baby but the decision
to breastfeed is a very personal one and all your options should be
considered. The American Academy of Pediatrics, the American
College of Nurse-Midwives, the American College of OB-GYN and
the American Diabetic Association all strongly recommend
breastfeeding baby for at least 12 months.
Key Information For Your
First Few Weeks Of Pregnancy
Continued from previous page
Medications
Work/household activities
It is always best to avoid medications whenever possible. If you
have back pain, that might be relieved by placing a pillow behind
you; the pillow is the best treatment. However, there may be times
during your pregnancy when medications are needed. Please
refer to the list of medications below that should be avoided during
pregnancy.
Please avoid the following during your pregnancy:
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Cat litter;
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X-rays (may be necessary after discussion with your OB
provider);
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Use of dry-cleaning solutions;
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Acrylic nail manicures;
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Children’s sandboxes;
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Working around radiation/radioisotopes;
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Working with lead or mercury, and
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Gardening without gloves.
Medications to avoid during pregnancy
Aspirin, Motrin/Ibuprofen/Advil, Tetracycline, Accutane;
Caffeine may cause problems with your pregnancy and should
be avoided as much as possible;
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Alcohol, tobacco and any illicit drugs are harmful to your baby, so avoid them, and
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If you are using any drugs or substances that may be harmful to baby, ask us about strategies to help you quit.
g
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Cystic Fibrosis screen (CF)
At your next visit, we will discuss testing you for the CF Carrier
Screen. This test will tell us if you are a carrier of CF. If you do test
positive, we will want to test the baby’s father. If you and your
partner are carriers, your unborn baby will have a 1 in 4 chance
(25%) of having CF. While the test is optional, the chances of CF
vary with ethnic groups, and we would like you to strongly consider
having the test administered. Your provider will discuss this test
more with you at the next visit, and we will need your consent in
order to do the test.
Your next visit: 12 weeks
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You will receive a complete head-to-toe physical assessment;
You will receive a pap smear and cultures for STD’s;
You will discuss labs that will be ordered and completed, and
You will discuss lifestyle changes that may need to take place during pregnancy.
Every visit
At every visit, the following procedures will be done:
g
Vital signs to include weight, temperature, pulse, blood
pressure;
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A urine specimen will be collected;
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Your uterus will be measured for growth, and
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Your doctor will listen to the baby’s heartbeat with a Doppler
monitor.
If you have any questions, don’t hesitate to contact our office. We
are here for you and baby!
12-Week Visit
Today’s visit
During today’s visit, we will:
g
Review your medical history;
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Complete a head-to-toe physical assessment and pelvic exam, including a pap smear and cultures for STD’s;
g
Discuss labs being ordered today to include Cystic Fibrosis and Sickle Cell screenings, and
g
Place a referral for you to go to Cape Fear OB clinic for your
first ultrasound.
You may be moody, irritable,
tearful, disorganized, have trouble concentrating, or have irrational
thoughts. These feelings are normal.
Your baby’s growth
Your baby (embryo) is about 2.5 to 3.0 inches long and weighs about 0.5 ounces.
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During this time, your baby’s body and organ tissues grow
rapidly.
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The head is about twice the size of the body.
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His/her eyes and ears are moving into normal position.
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Intestines move from the umbilical cord into the stomach area.
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We may be able to hear your baby’s heartbeat with a Doppler.
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Call your doctor if ...
The following signs or symptoms should be reported to your
doctor immediately:
g
Bright red vaginal bleeding, gush of fluid from thevagina
and/or four or more painful contractions within an hour.
g
Persistent severe headaches, severe nausea and vomiting.
g
Fever over 100.5 degrees.
g
Inability to keep liquid down resulting in reduced amount
of urine.
Your body’s changes
Your uterus is now the size of a grapefruit.
We may be able to feel the upper edge of your uterus (fundus) just above your pubic bone.
g
Wearing comfortable clothing provides room to grow.
g
Morning sickness often diminishes by the end of the month (but can sometimes last the entire pregnancy).
g
If you haven’t started already, you should slowly add healthier food choices and change unhealthy eating habits.
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If you haven’t stopped smoking, NOW is the time!
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You may be moody, irritable, tearful, disorganized, have trouble concentrating, or have irrational thoughts. These feelings are normal. Accept them and remember they are temporary.
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Your sexual desire may be increased/decreased; both are normal.
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My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
Consider breastfeeding
Did you know that human breast milk contains more than 100
protective ingredients not found in a cow’s milk-based formula, and
that breast milk cannot be duplicated. Your breast milk is unique
and the perfect food for your baby during the first six months of
life. Get to know other breastfeeding moms in your area. There are
many local support groups, such as the La Leche League. Please
contact Cape Fear Valley for a list of breastfeeding classes.
Rh (D) Factor screen
More than likely, you had quite a bit of blood taken during this visit.
There are many tests that we will be looking at. One of them is
called Rh blood typing. This is a test that will let us know if you are
Rh (D) negative or positive. If you are positive, there will be nothing
further that needs to be done. If you are found to be negative,
you will receive the following:
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A D-immunoglobulin (RhoGAM) injection at 28 weeks to prevent
your blood from building up antibodies that can harm baby.
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The RhoGAM injection will be given if you have certain
procedures during your pregnancy (example: amniocentesis),
or if you experience vaginal bleeding.
g
The RhoGAM injection will be given to you again after delivery
IF baby’s blood is Rh positive.
It is important to talk to your doctor if you have any questions.
Remember to stay informed.
Urine screening
During each visit to the clinic, we will ask you to collect a urine
specimen. We will be testing your urine for bacterial growth. Some
of the bacteria that can grow cause no signs or symptoms, but can
cause a serious kidney infection if left untreated. It is fairly common
to have these bacteria during pregnancy. If your urine tests positive,
we will want you to take an antibiotic. Please remember to take
the medication exactly as it is prescribed. To reduce the chance of
getting a bacterial infection, remember to wear cotton panties and
wipe from front to back.
Ultrasound
A referral has been placed for your first ultrasound. An ultrasound
is a painless test in which pictures (sonograms) will be taken of
your baby. These pictures are made possible using sound waves,
not radiation, so they are safe. A trained technician will do the
ultrasound exam. Make sure to wear clothes that allow your
abdomen to be exposed easily.
Other information an ultrasound will provide include:
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Baby’s actual age and due date;
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The number of babies you are carrying (e.g. twins);
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Position of the placenta;
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Baby’s heart rate and picture of baby’s heart;
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Amount of amniotic fluid;
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Possible birth defects, and
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Sex of the baby.
Remember, if you do not want to know baby’s sex, tell the technician
before the exam begins. Even if you do want to know baby’s sex,
remember nothing is 100% until baby is born.
Alfa Fetoprotein test (AFP)
The AFP gives you an idea of your risk for having a baby with
certain types of genetic defects, such as Down’s Syndrome or spina
bifida (opening around the spine). Remember, most babies (97%)
are born without any major defects. If the test results are elevated,
it may be due to reasons other than your baby’s condition and
further testing will be required. While this test is optional, we highly
recommend receiving it. This test is done by blood draw and will be
done at your next visit (16–18 weeks).
Helpful Information During This Time
Continued from previous page
Your libido
In early pregnancy, you may find that your desire for sex drastically decreases (especially if you have nausea, vomiting, fatigue or
breast tenderness). Since the amniotic sac normally protects and
cushions the baby, intercourse normally does not hurt the baby or
cause miscarriage.
Your next visit: 16 weeks
We will discuss doing your Alpha Fetoprotein test (AFP), which
must be done between 16–18 weeks. This is a lab test that will help
identify any chromosomal/genetic concerns.
What to expect at every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and
blood pressure;
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A urine specimen will be collected;
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Your uterus will be measured for growth, and
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The baby’s heartbeat will be listened to with a Doppler monitor.
16-Week Visit
Today’s visit
During today’s visit, we will:
g
Measure uterine growth, blood pressure, weight, listen to baby’s
heart rate and discuss any questions and concerns you may
have.
g
Administer Alfa Fetoprotein test (AFP), if desired.
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Discuss how to identify differences in pre-term labor versus false labor.
Your baby’s growth
Your baby is now about 4.4 to 5.5 inches long and weighs about
4 ounces.
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Fine hair called “lanugo” is growing on your baby’s head and is starting to cover the body for added protection in “water” for
nine months. Fingernails are well-formed.
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The arms and legs are moving, and you may start feeling this movement. This movement is called “quickening.” You may not
feel movement every day at this point, but the movements will become stronger and more frequent as your pregnancy progresses.
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The arms and legs are moving,
and you may start feeling this
movement. ...You may not feel
movement every day at this point,
but the movements will become
stronger and more frequent as your
pregnancy progresses.
Call your doctor if ...
The following signs or symptoms should be reported to
your doctor immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Fever over 100.5 degrees, and
g
Inability to keep liquid down resulting in reduced amount of urine.
Your body’s changes
Your uterus is about the size of a cantaloupe.
Your center of gravity changes as your uterus grows and this
may affect your balance…. Be careful.
g
There is an increase in the mobility of your joints that can affect your posture and cause lower back pain.
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As your uterus grows, the round ligaments supporting it can stretch and pull. This may cause a sharp pulling sensation on either or both sides of the abdomen.
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Some women may have difficulty sleeping or experience head stuffiness or nose bleeds.
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You may notice a whitish vaginal discharge; this is normal.
g
Constipation may become a problem. Please discuss this with your doctor.
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My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
Your exercise routine
It is important to stay off your back while exercising from now on.
There are many benefits to exercise, they include:
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Helping to prevent depression;
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Promoting relaxation and restful sleep;
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Encouraging concentration and improving problem solving;
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Helping prepare for childbirth and parenting;
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Helping prevent excess weight gain, and
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Improving self-esteem and well-being.
Remember to discuss starting an exercise routine with your doctor
before beginning.
Advantages of breastfeeding
Your weight
The usual weight gain is approximately one pound a week during
the rest of the pregnancy. Water contributes to 62% of the weight
gain, fat 30% and protein 8%. Slow and steady weight gain is best.
“False labor”
Braxton-Hicks contractions or “False Labor” are usually painless,
irregular uterine contractions and tightening of the uterus that
can begin as early as six weeks. These contractions occur in
preparation for labor. Most women, especially if this is your first
pregnancy, will not notice any contractions until 20 weeks. Towards
the end of the pregnancy these contractions will increase in
frequency, duration, intensity and are often confused with labor. If
you are not sure what you are feeling, ask your doctor.
There are many advantages to breastfeeding your baby.
These include:
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Easier digestion of breast milk;
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No allergy problems to breast milk;
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Less likely to cause overweight babies;
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Less constipation;
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Easier on baby’s kidneys;
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Less cases of Sudden Infant Death Syndrome (SIDS);
g
Fewer illnesses in the first year of life, and
g
Close contact with mom.
Your next visit: 20 weeks
We will discuss any questions and concerns you may have.
Every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and
blood pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
20-Week Visit
Today’s visit
Your baby’s growth
We will measure uterine growth, blood pressure, weight, listen
to baby’s heart rate and discuss any questions and concerns
you may have.
g
We will discuss how to identify differences in pre-term labor versus false labor.
g
Your body’s changes
Believe it or not, you are halfway there!
By week 20, your uterus should be around your belly-button.
g
People are definitely beginning to notice that you are pregnant.
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You may notice that you are urinating less often than previously in your pregnancy as the uterus pulls up away from your
bladder.
g
You may also notice you more easily run out of breath as your uterus grows up near your chest and lungs.
g
g
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Fever over 100.5 degrees, and
g
Inability to keep liquid down resulting in reduced amount of
urine.
g g g g Your baby is now about 6.5 - 7.5 inches long and weighs
about 9 ounces.
Your baby is practicing breathing and swallowing on a
regular basis.
Your baby continues to grow and fill out, with the head
becoming more proportional to the rest of the body.
The skin is forming multiple layers. The layers that form
your baby’s palms and feet will provide him with his own
fingerprints later in life.
My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
Your pregnant belly
Abdominal itching is often common during this point in pregnancy.
Typically itching occurs as a result of your skin stretching.
Consistent application of moisturizers can help reduce irritation.
A very small number of women develop itchy red bumps during
pregnancy and hive-like rashes on their belly, usually in the last
couple of months of pregnancy. These types of irritation are usually
more of an annoyance than something to be concerned about.
However, if you develop any type of skin rash, make sure to tell your
doctor.
Your family changes
Talk to your family about ways to help each other adjust to the
many changes you are all facing. Encourage their involvement by
inviting them to your clinic visits. Sit down and discuss the changes
to your future and share the emotions, fears and joys you are all
going through. The more the family is involved now, the easier
they will bond with the new baby and participate in his/her care. If
the father of the baby is unavailable, find someone you trust and
are comfortable with and who is willing to be your support person.
Your next visit: 24 weeks
We will discuss any questions and concerns you may have.
Every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and blood
pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler
monitor.
24-Week Visit
Today’s visit
We will measure uterine growth, blood pressure, weight, listen to
baby’s heart rate and discuss any questions and concerns you may
have.
Your baby’s growth
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Fever over 100.5 degrees, and
g
Inability to keep liquid down resulting in reduced amount of
urine.
Your baby is now about 8.4 inches long and weighs about 1.2 pounds.
g
Your baby is resting and growing inside your uterus, inside an
amniotic sac filled with fluid. This sac provides the perfect
environment for your baby. Movement is easy and the sac
serves as a cushion for the fetus against injury. The fluid in the Weight: __________
sac also regulates the temperature. The fluid level should now begin to steadily increase.
Baby’s heart rate: ___________
g
My Baby and I this visit
Body changes
Your uterus is now an inch or two above the belly button and
is about the size of a small soccer ball.
g
You may feel some tightening in your abdomen from time to time. These painless contractions are known as Braxton-
Hicks contractions.
g
You may develop varicose veins, increased heartburn and skin changes due to the constant fluctuation in hormones.
g
If you have any signs of pre-term labor, such as cramping or contractions that do not go away within an hour of rest, call your doctor immediately.
g
You may notice changes
in your skin due to the
constant fluctuation in
hormones. This is normal
during pregnancy.
Blood Pressure: __________
Fundal Height: __________
Helpful Information During This Time
More information on breastfeeding What to expect at every visit
Some more advantages to breastfeeding your baby include:
Uses 500-600 calories each day that allows you to use up
some of the extra fat you have stored during your pregnancy;
g
Helps your uterus get back to its pre-pregnancy size faster;
g
Saves time, money and extra trips to the store to buy formula
and supplies, and
g
Remember, there are no special diets/foods you need to eat during breastfeeding. You will want to make sure you eat a
well-balanced meal and try to limit alcohol and caffeine.
g
Exercise routine
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and
blood pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
At this point, it is recommended that you add 100 to 200 calories to
your diet and a full glass of water for every 30 minutes of exercise
that you do. The American College of OB/GYN advises pregnant
women to avoid exercises that cause bouncing, jumping, jarring or
high-impact motions. Remember to always check with your doctor
before beginning any exercise routine.
a glass of glucola to drink. Glucola is a very sweet drink that has
a specific amount of sugar, so it is important you drink all that is
given to you. You will then wait for one hour, and then we will draw
blood. While you are waiting the hour before your blood is drawn, it
is important that you do not eat or drink anything other than a small
amount of water. Please ask your doctor or nurse if you have any
concerns.
Weight gain
RhoGAM injection
Your weight gain may be highest during this time, the second
tri-mester. Gains of 1½ pounds per week aren’t uncommon. Many
common discomforts of pregnancy, to include constipation, nausea
and heartburn, can be reduced through a change in diet. Try to get
at least two servings of citrus fruits containing Vitamin C a day.
Gestational diabetes screen
At your next visit, or before, you will receive a blood test for
gestational diabetes. This blood test will indicate how your body is
responding to your sugar levels. Gestational diabetes is abnormal
sugar levels in your blood during your pregnancy. It usually goes
away after delivery. If your results are high, this does not mean you
have diabetes, it just means we will do further testing. When you
come for your test, you will report to the lab and they will give you
Earlier in your pregnancy, you had a test to tell us what your Rh (D)
status was. Rh (D) negative women will usually receive RhoGAM
at their 28-week appointment. Remember, this shot also will be
given after delivery of the baby if it is determined the baby is Rh
(D) positive. If you have any questions about this injection, please
discuss it with your doctor.
Your next visit: 28 weeks
We will discuss any questions and concerns you may have.
We will discuss and order your gestational diabetes test.
g
g
Pre-term labor guidelines
Your baby needs to continue to grow inside you for the full term of your pregnancy. Babies born more than three weeks early (37
weeks) are considered pre-term and can lead to a premature (preemie) baby with many associated risks. In order to avoid pre-term
labor, please report any of the following symptoms to your doctor:
Low, dull backache that does not improve with position change.
g
Four or more uterine contractions per hour. Uterine contractions may feel like menstrual cramps, a sensation
of the baby rolling up in a ball, abdominal cramping (may
be associated with diarrhea) or increases in uterine activity.
g
Increased pelvic pressure.
g
If you experience any of the symptoms listed at left, you should:
g
Stop what you are doing and empty your bladder.
g
Drink 3-4 glasses of water.
g
Lie on your left side for one hour and place your hands on
your abdomen and feel the tightening and hardening of your uterus.
g
Count how many times your abdomen tightens in one hour.
g
If you have more than four contractions in an hour, call the doctor or Labor and Delivery at Cape Fear Valley Medical Center.
28-Week Visit
Today’s visit
We will measure uterine growth, blood pressure, weight, listen
to baby’s heart rate and discuss any questions and concerns
you may have.
g
We will discuss and order your gestational diabetes test.
g
If it was determined earlier in your pregnancy that you are Rh(D) negative, you will receive your RhoGAM injection.
Helpful information during this time
g
Your baby’s growth
Your baby weighs approximately 2.5 pounds and is nearly 10 inches long.
g
The baby starts to lose the lanugo (fine hair), especially in the facial area. The baby has a large amount of vernix (cheesy-like substance) covering the body that protects the skin while sur-
rounded by the amniotic fluid.
g
Eyebrows and eyelashes may be present.
g
Brain tissue also increases.
g
You should be feeling baby move on a more regular basis.
g
Your body’s changes
You have probably gained approximately 16 pounds.
You may start noticing some swelling and/or numbness and
pain in your hands and wrists. This is actually a normal occurrence during the latter stages of pregnancy, however, please discuss it with your doctor.
g
g
It is recommended that you drink a full glass of water for every
30 minutes of exercise that you do.
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Inability to keep liquid down resulting in reduced amount of
urine;
g
Fever over 100.5 degrees, and
g
Sudden leaking of fluid that will not stop with position change.
My Baby and I this visit
Weight: __________
Baby’s heart rate: ___________
Blood Pressure: __________
Fundal Height: __________
Family changes
Baby will be here soon. It is important to plan ahead and discuss
child-care options now. Everyone needs help with child care,
and now is the time to explore various child-care options in your
community.
Diet
Try to eat a variety of foods. You should eat the following every
day:
g
6-10 servings of bread, cereal, rice or pasta;
g
3-5 servings of vegetables;
g
2-4 servings of fruit;
g
2-3 servings of protein (poultry, fish, dry beans, meat, eggs,
nuts);
g
3-5 servings of dairy products (milk, yogurt, cheese);
g
If needed, extra nutrients such as iron, vitamins B-6, B-12
and calcium may be prescribed.
Fetal movement
Your baby’s movements are becoming much more regular. Fetal
movement is a very reassuring way to determine baby’s overall
health and wellness. By now you probably have noticed when
baby seems most active. Try and count your baby’s movements
whenever he/she is most active. This should occur at approximately
the same time each day. Count the number of times you feel baby
move during this time. You should be able to feel approximately
10 movements in two hours. If there is a drastic change in fetal
movement, or if your count is much lower than days prior, please
contact the doctor’s office.
OB appointments
Since you are coming closer to your due date, we will begin to see
you more often. Up to this point, we have seen you once every four
weeks. At this time, we will schedule to see you every two weeks.
At the end of each appointment with your doctor, you will need to
see the OB nurse to schedule these appointments.
Your next visit: 30 weeks
We will discuss any questions and concerns you may have.
Every visit
The following procedures will be performed at every visit:
g
Vital signs (weight, temperature, pulse and blood pressure);
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
30-Week Visit
Today’s visit
We will measure uterine growth, blood pressure, weight, listen
to baby’s heart rate and discuss any questions and concerns
you may have.
g
We will discuss results of your gestational diabetes test, if we haven’t already.
g
Your body’s changes
You may feel clumsier than usual,
which is normal in pregnancy. Not only are you heavier, but that
pregnant belly causes a change in your center of gravity.
You may be feeling a little tired these days, especially if you are
having trouble sleeping. Try multiple pillows in various
locations; it may ease some of the weight off your back and
knees.
g
You may feel clumsier than usual, which is normal in pregnancy. The following signs or symptoms should be reported to your doctor
Not only are you heavier, but that pregnant belly causes a
immediately:
change in your center of gravity.
g
Bright red vaginal bleeding;
g
Due to hormonal changes, your ligaments are more relaxed, so g Persistent severe headaches, severe nausea and vomiting;
joints throughout your body are looser, which also will contribute g Inability to keep liquid down resulting in reduced amount of
to clumsiness.
urine;
g
You may notice your feet changing size. The relaxation of your g Fever over 100.5 degrees, and
ligaments can actually cause your feet to spread permanently,
g
Sudden leaking of fluid that will not stop with position change.
so you may want to invest in shoes in a larger size.
g
Call your doctor if ...
My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Baby’s growth
Your baby now weighs approximately 3 pounds and is
15 inches long.
g
2½ cups of amniotic fluid surround baby, but that volume
will decrease as baby gets bigger and takes up more
room.
g
Baby’s eyesight continues to develop. Even after baby
is born, he/she will keep his/her eyes closed for most of
the day. When baby does open them, he/she will
respond to changes in light but will only be able to make
out objects a few inches from his/her face.
g
Helpful Information During This Time
Mood swings
Remember earlier in pregnancy the ups and downs you emotionally
felt? They may return soon, if they haven’t already. The
combination of uncomfortable symptoms, hormonal changes and
lack of sleep
can all contribute. However, if you can’t shake the blues or feel
increasingly irritable or agitated, talk to your doctor. Although it is
fairly uncommon, some women do experience depression during
pregnancy. We are here to help! Talk to you doctor or nurse.
Planning for labor
It is a good idea to have an idea of what your intentions will be in the
delivery room. Will mom want pain relief? What kind (epidural/IV
medication)? Will the father or another member of your support
group be cutting the cord? If you are having a boy, will you want a
circumcision performed? It’s time to start thinking about who you
would like present in the room when you deliver. Moms who
vaginally deliver are generally allowed more people in the room
during delivery than a mom delivering by C-section. It is important
to discuss both possibilities. Sit down and discuss your concerns
with each other, this way there aren’t any unexpected issues during
delivery.
Episiotomy vs. tearing
An episiotomy is a surgical cut in the muscular area between the
vagina and anus. This procedure is usually performed just before
delivery to enlarge the vaginal opening. Some women tear
spontaneously in this area during delivery, even with or after an
episiotomy. Tears can range from almost undetectable to severe,
requiring stitches to repair. While episiotomies at one time were
standard, most experts now agree that the procedure should not be
done routinely. Talk to your doctor about how often and under what
circumstances he should perform an episiotomy. There is some
research that suggests massaging the area between the vagina and
anus approximately 5 weeks before delivery can help to prevent the
need for stitches. Please discuss this with your doctor if you have
questions.
Your next visit: 32 weeks
We will discuss any questions and concerns you may have.
It is important that you make decisions now about
your baby’s delivery.
Every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and
blood pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
32-Week Visit
Today’s visit
We will measure uterine growth, blood pressure, weight, listen
to baby’s heart rate and discuss any questions and concerns you may have.
g
We will check you for pre-term labor.
g
The pregnancy walk or waddle
may become increasingly apparent.
Your body’s changes
The top of your uterus is about 4-5 inches above your belly
button.
g
You may notice that your back and pelvic area feel different.
The bones in your pelvis are moving and shifting to make room for the baby’s head to pass through.
g
As this happens, the ligaments around the pelvis also stretch, which can cause some discomfort in the hip joints, back and the
front of the pelvis.
g
The pregnancy walk or waddle may become increasingly
apparent.
g
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Inability to keep liquid down resulting in reduced amount of
urine;
g
Fever over 100.5 degrees, and
g
Sudden leaking of fluid that will not stop with position change.
Your baby’s growth
Your baby weighs almost 4 pounds and is about
18-19 inches long.
g
The organ systems are now adequately developed.
g
Most likely, baby is now in “head down” position, known as vertex. You may feel most of his/her kicks and jabs under your ribs, or even feel a forceful blow to the cervix.
g
My Baby and I this visit
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
More breastfeeding information
The American Academy of Pediatrics, the American Academy
of Family Practice and many other professional organizations
recommend breastfeeding for the first 12 months, but any amount
of breastfeeding is beneficial to your baby. If you have any
questions or concerns, please let your doctor or nurse know. We
have many excellent resources in our area to help you feel more
comfortable and confident about breastfeeding. Consider contacting
the hospital and attend a breastfeeding class.
Most women go through a “nesting”
phase a week or two before delivery.
This will cause the urge to clean
everything in sight.
Exercise routine
You can continue to exercise right up to delivery, and this may
even help the delivery go more easily. Don’t exercise on an empty
stomach and make sure you replace any fluids lost during exercise.
Keep hydrated! Avoid exercising in very hot or humid weather. You
may need to modify the intensity of your exercise routine according
to your symptoms. This is not the time to exercise to exhaustion or
fatigue.
Preparing for baby
Most women go through a “nesting” phase a week or two before
delivery. This will cause the urge to clean everything in sight. If you
have the time, plan, cook and freeze some meals ahead of time.
Keep a stock of the basic foods you eat regularly that don’t spoil
easily. If friends offer to help, suggest that they cook a meal or two
for you and your family. Whether you are planning on baby sleeping
in his/her own room, or in yours, be sure the area is clean and safe.
Wash your baby’s new sheets, blankets and clothes in a mild
detergent before bringing baby home. After baby comes home, you
will have many new duties, a bit less sleep and less energy. The
best advice is to plan ahead!
It is important to plan ahead so you are not
overwhelmed once baby comes home.
Your next visit: 34 weeks
We will discuss any questions and concerns you may have.
Every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and
blood pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
34-Week Visit
Today’s visit
We will measure uterine growth, blood pressure, weight, listen to baby’s heart rate and discuss any questions and concerns
you may have.
g
We will check you for pre-term labor.
g
Your baby’s growth
Your baby now weighs about 4 ¾ pounds (cantaloupe) and is almost 18 inches long.
g
Fat layers, which help regulate body temperature, are filling baby out.
g
Baby’s central nervous system is maturing and his/her lungs
are continuing to mature as well.
g
You’ll be relieved to know that babies born between 34-37
weeks, although considered pre-term, generally do well if they
have no health conditions or problems previously diagnosed.
g
You’ll be relieved to know that
babies born between 34-37 weeks,
although considered pre-term,
generally do well if they have no health conditions or problems
previously diagnosed.
Your body’s changes
Fatigue has probably begun to set in again. Usually it is not as severe as the first trimester, but it is still quite noticeable.
g
Now is the time to slow down a little and save your energy for labor (and beyond).
g
Remember, if you have been sitting or lying down for a longer period of time, don’t jump up too quickly. Blood can pool in your
legs and feet, causing a temporary drop in blood pressure
which can cause dizziness if you get up quickly.
g
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Inability to keep liquid down resulting in reduced amount of
urine;
g
Fever over 100.5 degrees, and
g
Sudden leaking of fluid that will not stop with position change.
My Baby and I this visit
Find soothing ways to relax if you are feeling anxious or
fatigued. But, remember to get up slowly if you have been
sitting or lying down for a long time.
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
The possibility of a c-section
Approximately 30% of pregnant women in the U.S. give birth by
cesarean section (c-section). In certain cases, the surgery is
scheduled in advance, while others are in response to unforeseen
complications. Unplanned c-sections happen for many reasons,
to include the cervix not dilating, baby stops coming down the birth
canal or baby’s heart rate gives the doctor a cause for concern.
There are many reasons your doctor may need to plan a c-section.
Some of the most common reasons include:
g
A previous c-section with a vertical uterine incision, or if you
have had more than one c-section;
g
History of invasive uterine or abdominal surgery;
g
Large baby or baby lying in the wrong position (breech);
g
Multiples (twins, triplets, etc.), and
g
Placenta previa (the placenta covering an area of the cervix).
Typically, if a cesarean is needed, your partner can be with you
during the surgery.
If a cesarean is required, your medical team will start an IV and
insert a foley catheter to drain urine during the procedure. You will
be given an epidural or spinal block, which will numb the lower half
of your body but leave you alert and awake during the process. A
screen will be
put up so you don’t have to watch the actual procedure. After
several minutes, the baby will be eased out of the uterus and will be
brought up to where mom can get a glimpse of baby before he/she
is handed off to a pediatrician or nurse for the proper care. While
the doctor is examining baby, your doctor will deliver the placenta
and stitch everything back up. After the baby has been examined,
the doctor will give baby to your partner who can hold him/her
next to you so you can nuzzle and kiss while this process is being
completed.
The actual closing after surgery takes quite a bit longer than it takes
to get baby out, so be patient. When the surgery is completed, you
will be taken to a recovery room where you will be able to hold and
breastfeed baby if you want to.
Breastfeeding information
The American Academy of Pediatrics, the American Academy
of Family Practice and many other professional organizations
recommend breastfeeding for the first 12 months, but any amount
of breastfeeding is beneficial to your baby. If you have any
questions or concerns, please let your doctor or nurse know. We
have many excellent resources in our area to help you feel more
comfortable and confident about breastfeeding. Consider contacting
the hospital and attending a breastfeeding class.
Exercise routine
You can continue to exercise right up to delivery, and this may
even help the delivery go more easily. Don’t exercise on an empty
stomach and make sure you replace any fluids lost during exercise.
Keep hydrated! Avoid exercising in very hot or humid weather. You
may need to modify the intensity of your exercise routine according
to your symptoms. This is not the time to exercise to exhaustion or
fatigue.
Contingency plan
You are nearing the end of your pregnancy and may go into labor early. It is
time to start thinking ahead and making plans, if you haven’t already done
so. Give at least one friend or neighbor the keys to your house in case you
need something and can’t get home. Line up people to do the following in a
moment’s notice:
g
Take care of children;
g
Drive children to and from school and afterschool activities;
g
Feed animals, water plants and get mail, and
g
Fill in for you at work and any other obligations you may have (volunteer work, etc.)
Helpful Information During This Time
Continued from previous page
Group B Streptococcus (GBS)
At your next visit, you will be tested for GBS. GBS is a type of
bacteria that can be found in a pregnant woman’s vagina or rectum.
This bacteria is normally found in the vagina and/or lower intestine
of 15–40% of all healthy, adult women. Your doctor will use a large
Q-tip to collect some fluid from the vagina and see if bacteria are
present. If a woman tests positive, it is possible to pass GBS to her
baby during delivery. The outcome of passing this bacteria to baby
can be severe and therefore doctors include testing as a routine
part of prenatal care. If you test positive for GBS, your doctor will
recommend giving you antibiotics through your IV when you arrive
at the hospital to deliver your baby. Taking these antibiotics greatly
decreases the chances of your baby becoming ill. Remember, if
you have any questions to discuss them with your doctor or nurse.
What to expect at every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and blood
pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler
monitor.
Your next visit: 36 weeks
We will discuss any questions and concerns you may have.
You will be tested for Group B Streptococcus (GBS).
g
g
Preparing for baby
Baby will be here soon. It is time to make
sure that you have everything baby will
need and that it is clean and ready to use.
Most women go through a “nesting” phase a week or
two before delivery. This will cause the urge to clean
everything in sight. If you have the time, plan, cook and
freeze some meals ahead of time. Keep a stock of the
basic foods that you eat regularly that don’t spoil easily.
If friends offer to help, suggest that they cook a meal or
two for you and your family. Whether you are planning on
baby sleeping in his/her own room, or in yours, be sure
the area is clean and safe. Wash your baby’s new sheets,
blankets and clothes in a mild detergent before bringing
baby home. After baby comes home, you will have many
new duties, a bit less sleep and less energy. The best
advice is to plan ahead!
36-Week Visit
Today’s visit
Your body’s changes
We will measure uterine growth, blood pressure, weight, listen g You may notice easier breathing after the baby “drops” or
to baby’s heart rate and discuss any questions and concerns
moves down into the pelvis. Remember, some babies don’t
you may have.
drop until after labor begins.
g
g
We will check you for pre-term labor.
If baby does drop, you will notice more frequent urination.
g
g
You will have a test for Group B Streptococcus (GBS).
You may feel increased backache and heaviness.
g
A referral will be placed for you to go to Cape Fear OB clinic for g Pelvic/buttock discomfort is not uncommon.
g
Increased swelling of ankles and feet, and occasionally the
your second ultrasound.
hands and face, is common.
g
Braxton-Hicks (non-painful) contractions may become more frequent and more intense. This is the body’s way to prepare
g
Your baby now weighs about 6 pounds and is almost 20 inches for childbirth.
long.
g
Most likely, baby is in the “head down” position. However,
some babies settle into the head down position only a few days
before delivery. If baby is in breech (or butt/feet down) position,
Weight: __________
Blood Pressure: __________
your doctor will discuss options to turn the baby to head down
position.
g
Your baby’s growth
My Baby and I this visit
Baby’s heart rate: ___________
Fundal Height: __________
Call your doctor if ...
The following signs or symptoms should be reported to your
doctor immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Inability to keep liquid down resulting in reduced amount
of urine;
g
Fever over 100.5 degrees, and
g
Sudden leaking of fluid that will not stop with position change.
Helpful Information During This Time
Family changes
You may notice more excitement and anxiety in the household.
Unfortunately, more impatience and restlessness may be more
common as the due date approaches. Apprehension about the
baby’s health and labor and delivery are common. Sit down and
talk, remember to include children, as they may be feeling an entire
range of emotions as well.
Pack a
suitcase
for you
and one
for baby
to take
to the
hospital.
Preparing for baby’s arrival
On the next page of this book is a packing list for the hospital.
Here is a small list to get you started:
g
Pack two bags — one for mom and one for baby.
g
Bring things that make you comfortable like washcloths,
socks, lip balm, hair items, basic toiletries. If you wear contact lenses, be sure to bring your case and a pair
of glasses.
g
Bring several pair of your oldest panties as you’ll be
bleeding quite a bit for a few days (even if you have a cesarean).
g
If breastfeeding, be sure to bring a nursing bra or two.
g
Feel free to bring your own nightgowns/pajamas/robe. Hospital gowns are always available if you prefer.
g
You will need to pack clothes to wear home. Make sure
they are comfortable and yes, you will still be wearing maternity clothes for a while longer.
g
For baby: bring an outfit to go home in, a blanket and make sure to have the car seat strapped in the car.
g
Feel free to bring tape/CD player and your favorite
relaxing music. Your taste for music may change some during labor so bring a variety of options.
g
Bring phone numbers of those you want to call after baby arrives.
g
Don’t forget the camera, film and batteries. This is a once in a lifetime opportunity.
Fetal presentation
Location of the baby’s heartbeat in the lower half of your abdomen
is a clue to your baby being in the head down position. If the baby’s
position is now head down, it can be confirmed by ultrasound.
Discussion of options includes performing an external version
(turning the baby) which will be done in the hospital, planning for a
vaginal delivery when possible or scheduling a cesarean section.
Birth plan
If you have a birth plan or any special requests, please let your
nurse or doctor know as soon as possible. We will do whatever we
can to accommodate you and your family while ensuring an optimal
and healthy outcome. It is definitely time to consider who you want
in the delivery room when baby is born. Sit down and discuss with
your partner if you want pictures of the event or would like to wait
until after baby is born. It is better to plan ahead than to try and
figure these answers out when in the middle of labor.
OB appointments
You have reached a new point in your pregnancy. Since you are
coming closer and closer to your due date, we will begin to see you
more often. From now on, you will be seen every week. At the end
of each appointment with your doctor, you will need to see the OB
nurse to schedule these appointments.
Your next visit: 37 weeks
We will discuss any questions and concerns you may have.
Every visit
The following procedures will be performed at every visit:
g
Vital signs to include weight, temperature, pulse and blood
pressure;
g
A urine specimen will be collected;
g
Your uterus will be measured for growth, and
g
The baby’s heartbeat will be listened to with a Doppler monitor.
Be prepared
Pack your’s and baby’s suitcases ahead of time
It is time to prepare for your trip to the hospital. You will need to
pack a suitcase for yourself, as well as for baby. Here is a handy
packing list that will make the task easier:
Mom’s bag
Two or more well-fitting bras.
Nursing bras may make it easier to breastfeed baby.
g
Two to three pairs of cotton under-
wear. Bring your oldest pairs, as
you will bleed quite a lot and the
panties will probably get stained.
g
Two or more comfortable
nightgowns. If you plan to breastfeed, it will be easier if your gowns
open in the front. Again, don’t bring anything you don’t want to get
dirty.
g
Slippers or slip-on shoes with non-slick soles.
g
Personal care items, such as soap, shampoo, toothpaste, toothbrush,
deodorant, comb, brush, etc., and
g
Camera with plenty of film. Don’t forget to check the battery.
Baby’s bag
g
Labor “tools”
Lotion or talcum powder, so your coach can give you
massages.
g
Snack bag filled with some of your favorite things, such as
lollipops, hard candy to suck
on while you are in labor,
snack foods for your coach
and a treat for you and your
coach after delivery.
g
Lip balm or lipstick to
prevent dry lips.
g
Something for you to
concentrate on, a focal
point, such as a favorite
picture, stuffed animal, f
lower, etc.
g
Deck of cards to pass the time and books for you and your coach.
g
Favorite pillow or pillows with distinctive pillowcases to identify them as yours.
g
A portable tape or CD player with a variety of music selections, and
g
Tennis balls in a sock for back rubs.
g
One “going-home picture” outfit.
Car seat.
g
Baby bag with diapers, burp cloth and wipes for the trip home,
and
g
Blanket, hat and warm outfit, if it is cold outside.
g
g
In baby’s bag, don’t forget to pack
diapers, a burp cloth and wipes for
the trip home. Strap baby’s car seat
in the back seat of your car.
37, 38, 39, 40, 41-Week Visits
Final visits
We will measure uterine growth, blood pressure, weight, listen
to baby’s heart rate and discuss any questions and concerns
you may have.
g
We will check you for pre-term labor.
g
Your baby’s growth
Your baby probably weighs around 7 pounds and is about 21 inches in total length.
g
You will be seen by your doctor more frequently as your due
date nears to ensure a safe delivery for both you and
baby.
g
We know babies are usually mature enough to do very well on
the outside beginning around 37 weeks. We also know babies continue to grow well within mom as long as everything is
functioning normally.
g
If baby has not arrived, induction is usually scheduled at the
42nd week. Going longer than 42 weeks puts baby at
increased risk for complications. Keep in mind that the majority
of pregnancies are anywhere from 37-42 weeks long.
g
Your body’s changes
While baby’s type of movement may change as he/she takes up
more room in the uterus, it is still important to count and report any decrease in the number of movements.
g
Baby is getting big and you are getting tired. Avoid over exhaustion; take frequent breaks and prop up your feet.
g
If you are having trouble sleeping, try a hot shower before bed,
a soothing massage, pillows between your legs or sleeping on your side.
g
Call your doctor if ...
The following signs or symptoms should be reported to your doctor
immediately:
g
Bright red vaginal bleeding;
g
Persistent severe headaches, severe nausea and vomiting;
g
Inability to keep liquid down resulting in reduced amount of
urine;
g
Fever over 100.5 degrees, and
g
Sudden leaking of fluid that will not stop with position change.
If you are having trouble sleeping, a soothing
massage may help you relax and fall asleep.
My Baby and I this visit (37 weeks)
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
My Baby and I this visit (38 weeks)
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
My Baby and I this visit (39 weeks)
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
My Baby and I this visit (40 weeks)
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
My Baby and I this visit (41 weeks)
Weight: __________
Blood Pressure: __________
Baby’s heart rate: ___________
Fundal Height: __________
Helpful Information During This Time
Family changes
Keep in mind that you can deliver anytime from today until 42 weeks
of pregnancy and that only a few babies are born on their actual due
date. You and your family may become more frightened and/or
frustrated if you have not delivered. Tips on conquering these fears
and frustrations include:
g
Talk them over with your partner, friends or healthcare provider.
g
Use relaxation techniques such as deep breathing, music, quiet walks, afternoon naps and quiet time.
Enjoy this time together, and try to rest up for the big event. Review
your labor and delivery coping techniques with your support person.
Weekly cervical stripping
Towards the end of pregnancy, the cervix will start to prepare itself
for going into labor. This preparation or “ripening” results in cervical
softening (effacement) and opening (dilation). The part of the
membranes that was over the cervical opening can now usually be
felt by a vaginal exam. In order to help prepare the cervix to go into
labor and prevent your pregnancy from going much beyond your
due date, your cervix may be “stripped.” This is done by inserting a
gloved finger between the membranes and the inner wall of the
cervix. The finger is then swept in a circular motion around the inner
cervix to spate the membranes from the cervical wall. Some women
will get contractions and some vaginal spotting as a result of this
procedure. Some (but not many) will actually go into labor.
When you are admitted
Hopefully, by now, you have seen the Labor and Delivery area,
are pre-admitted and have transportation and child and pet care
arrangements taken care of. Expect to be a little nervous, the big
event is about to happen. Prior to admission, you will be given a
vaginal exam to determine where you are in labor and both you
and your baby’s vitals will be taken. If you are in active labor, your
bag of water has broken or you need close observation, you will be
admitted and taken to a labor room where your baby’s heart rate
and your contractions will be monitored by an external fetal monitor.
You will have your blood drawn and will have an IV started at this
time.
You will be asked to watch the epidural video once you are settled.
It is a good idea to watch this video even if you are not planning
on receiving an epidural. Remember, labor is intense and in a
minute you might change your mind. Cape Fear Valley’s policy
on epidurals is that this important video must be watched before
one can be given. So, watch it while you are relaxed and can
understand the important information being given.
If you have any special requests, such as the father cutting the cord
or you want to breastfeed right after delivery, let the staff know now.
Don’t forget the camera for your baby’s very first picture. Your
placenta is usually delivered within 15 minutes after baby is born but
you are usually too occupied with baby to take much notice.
Two-week checkup
At the time of discharge, you will be given an appointment
for your baby’s two-week newborn checkup. If this
appointment is not made before you leave the hospital,
please contact our office at (910) 678-0100 to schedule a
two-week checkup for baby.
Postpartum
Even though you have worked very hard and long to bring about
this birth, most mothers are too excited to sleep. Enjoy this time, it
is precious. The hospital staff will be checking on both you and baby
frequently the first day or so after delivery. These checks are done
to ensure both of you are doing well. If your child is male, you will
need to decide on whether to have him circumcised. This procedure
is usually done prior to hospital discharge. While there may be
potential benefits, at present, there is not enough medical evidence
to recommend routine circumcision.
If you are having any difficulty caring for your newborn, let the staff
know. They are there to help you feel more comfortable and to help
you with your new role.
Going home
At the time of discharge, you will be given an appointment for
your baby’s two-week newborn checkup. If this appointment is
not made before you leave the hospital, please contact our office at
(910) 678-0100 to schedule. Your doctor also will ask you to bring
your baby in for a weight check about two days after you are
discharged from the hospital. You will need to contact our office
to schedule your six-week postpartum check as well. Before leaving
the hospital, your car seat will be evaluated and instructions given.
The safest place for a newborn car seat is in the middle of the back
seat facing the rear. Remember, you are no longer pregnant so
getting pregnant is a possibility. If you would like birth control,
discuss options before you leave the hospital.
First appointments after delivery
At the baby’s first few appointments, the baby will be measured,
weighed and will receive a complete physical exam. Parenting
concerns such as feeding, bowel movements and sleep patterns will
be discussed. Be sure to write down questions you have and bring
them with you to this visit. At your six-week postpartum check, a
pelvic examination will be done to see if your uterus has returned
to normal size, along with a pap smear to check for any cervical
concerns. Your birth control method will be reviewed and revised if
needed. If other appointments are needed, they will be discussed
with you at this time.
Appendix
Baby’s First Year ...
See How I Grow
Newborn
Baby’s First Year
Here are some things you can do to help me:
I can ...
Learn to trust
g
Come quickly when I cry;
g Hold me close and speak in a friendly voice, and
g Smile at me when you are near.
g
g
g
g
g
Feel comfortable
g
g
g
g g
Turn my head from side to side;
Hold onto small objects in a tight fist;
Hear sounds and see objects that are 12 inches away;
Be fussy and cry a lot when I need something;
Sleep for about 2 or 3 hours at a time, and
Calm down when I hear a voice that I know.
Feed me when I’m hungry;
Put me on my back to sleep for naps and at night;
Pat, rub and pick me up a lot, and
Give me a pacifier to suck between feedings.
Learn to communicate
g
g
g
Sing and talk to me;
Repeat any sounds I make, and
Read to me.
Learn how my body moves
g
g
g
Keep my arms and legs free to move;
Support my head when you hold me, and
Hold me over your shoulder when you walk.
We have so much to learn
together! I may look small in my
clothes (size__________ ), but I am
growing fast. I sleep a lot but
wake up every __________ hours to eat.
I learn best with ...
Games and Toys
g
g
g
g
Mobiles and toys with music;
Pictures and things with bright colors and bold patterns;
My fingers and toes when you sing to me, and
Baby-safe mirrors attached to my crib.
1 - 2 Months
Baby’s First Year
Here are some things you can do to help me:
Learn to trust
Come quickly when I cry;
Help me suck my fist to calm myself, and
g Tell me what’s happening — I don’t like surprises.
g
g Feel comfortable
g
g
g
g I can ...
g
g
g
g
g
Lift my head when I lie on my tummy;
Roll part way from my back to my side;
Reach for objects near me;
Follow slow-moving objects with my eyes, and
Make lots of sounds and respond to voices I know.
g Let me rest if I frown or look away when we play;
Start a new activity when I get upset or bored;
Smile at me and tell me you love me;
Find me a quiet place to sleep, and
Put me on my back to sleep for naps and at night.
Learn to communicate
g
g
g
Repeat the sounds I make;
Face me toward sounds and people, and
Talk to me and listen when I “talk” to you.
Learn how my body moves
g
g
g
Give me my feet to play with;
Move my legs back and forth, and
Clap my hands and arms together.
Yes, that’s a smile you saw when I was just__________ weeks old. I love it
when you hold me close and use a soft voice to calm me. Now I sleep
about__________ hours at a time.
I learn best with ...
Games and Toys
Different
materials
rubbed
onon
mymy
skin;
Different
materials
rubbed
skin;
Soft
blocks
and
stuffed
animals
with
nono
loose
parts;
g
Soft blocks and stuffed animals with
loose
parts;
g
Music
boxes
and
squeaky
toys;
g
Music boxes and squeaky toys;
g
MyMy
body
parts
named
aloud
at at
bathtime,
andand
g
body
parts
named
aloud
bathtime,
g
Finger
games
like
“This
Little
Piggy”
and
“Pat
-a-Cake.”
g
Finger games like “This Little Piggy” and “Pat-a-Cake.”
g
g
g
3 - 5 Months
Baby’s First Year
Here are some things you can do to help me:
Learn to trust
Let me see other people and hear new things;
g Let me know you are near when I look for you, and
g Help me find and pick up a dropped toy.
g
Feel comfortable
g
g
g
g Put me on my back to sleep for naps and at night;
Give me cold cloths, teething rings or baby biscuits;
Hold and rock me a lot, and
Keep small objects away from me.
I can ...
Learn to communicate
g
g
g
g
Sing nursery rhymes;
Let me look in a mirror, and
Make silly sounds like buzzing and humming.
g
g
g
g
Learn how my body moves
Put me on my tummy to play and for exercise when I am
awake;
g
Support me when I sit on your lap, and
g
Hold things in front of me so I can reach them.
g
g
Bring my hands together and look at them;
Roll from my back or stomach to my side;
Reach for toys, even lift my chest off the floor;
Make many baby sounds, even laugh;
Show when I'm happy, sad or scared, and
Eat and sleep on a schedule.
Hear me giggle and coo! I
can sit with your help. I like
things that shake, rattle and
make noise. My favorite toy is
my____________________________.
I learn best with ...
Games and Toys
g
g
g
g
g
Large pictures or books;
“See-saw” (pull me from lying down to sitting up);
Safe, washable plastic objects I can hold;
Splash and kick in my bath, and
Call me from behind so I can look for you.
6 - 8 Months
Baby’s First Year
Here are some things you can do to help me:
Learn to trust
Use a louder voice only when I may be in danger;
g Move me or the object when I reach for something I should not have, and
g Come back after you have left me for a short time.
g
Feel comfortable
g
g
g
g Put me on my back to sleep even if I can roll over;
Talk about the things we do: bathe, eat, sleep and play;
“Baby-proof” our home so it is safe for me, and
Give me lots of hugs and kisses.
I can ...
Learn to communicate
g
g
g g
Learn how my body moves
g
g
g
g
Stop or do something new when I arch my back, turn or push away;
Read to me, ask me to repeat words and sounds;
Tell me the names of things, ask me what they are, and
Use real words, not “baby talk” with me.
Wave “bye-bye” and show me how to wave;
Let me feed myself small pieces of cracker or cereal, and
Give me plenty of room to crawl.
g
g
g
g
Rock on my hands and knees;
Stand with support from you or by holding onto furniture;
Sit alone and move around on my tummy;
Look for anything that has dropped, and
Get upset when you leave me.
Look out world!
I’m on the move. I can roll on
my side over and over. I have this
many teeth now: __________. I turn
when you call my name.
I learn best with ...
Games and Toys
g
g
g
g
g
Point to and name people I know in pictures;
Let me hold small toys in both my hands; ask me to give them to you;
Roll a ball back and forth to me;
Clap in time to simple songs and rhymes, and
Hide a toy partway and let me find it.
9 - 12 Months
I can ...
g
g
g
g
g
g
Sit by landing on my bottom after standing;
Walk sideways while holding onto furniture (“cruising”);
Pick what I want when you show me two things I know;
Understand when you tell me “No”;
Hold you tight and act shy around new people, and
Kick and scream when I am upset.
Baby’s First Year
Here are some things you can do to help me:
Learn to trust
Do not force me to go to strangers;
g Keep a routine so I will know what is happening, and
g Do not punish me — I do not understand what I did wrong.
g
Feel comfortable
g
g
g
g Put me on my back to sleep even if I can roll over;
Let me have my favorite toy;
Set limits and stick to them, and
Give me a kiss whenever I ask for one.
Learn to communicate
g
g
g
Answer me when I call you;
Use words to describe things I point to (“Want juice?), and
Ignore my temper tantrums.
Learn how my body moves
g
g
g
g
Let me mark on paper with large crayons;
Give me soft foods so I can eat with my fingers;
Play music so I can “dance”, and
Let me smell flowers.
I am “talking” to you all the time ... even if you don’t understand me. My
first “words” were and. I can take small steps, but I still like to crawl.
I learn best with ...
Games and Toys
g
g
g
g
Toy telephones;
Songs naming my body parts;
Toys that let me do what you do (broom, plastic dishes, play
food and dolls), and
Turn pages of cardboard picture books.
Baby’s First Year
Our First Year
I know you will always remember the day I was born.
During my first year, there are so many more things you
will remember. You do so much for me. You take me to
my regular checkups. You make sure I get every shot I
need when I am 2, 4, 6 and 12 months old. Remember
between12 and 19 months old, I need a chicken pox shot
too.
Please don’t smoke around me. Try to protect me from the
tobacco smoke of others; it can make me sick.
During my first year, I will grow and learn so much.
I might weigh three times more than when I was born.
I will be much taller too. So you won’t forget how fast
I change, please write down some fun things about me in
this book.
My name is special because__________________________
____________________________________________________
“See” how I grow at my clinic visits
At birth, I weighed pounds ___ ounces and was ___ inches long.
At two months, I weighed _____ pounds____ ounces.
At four months, I weighed_____ pounds____ ounces.
At six months, I weighed _____ pounds ___ ounces.
And at 12 months, I weighed ____ pounds and am ___ inches long.
Your baby might be doing the activities
described in this appendix a little earlier
or later than the ages given. If you have
questions, contact your baby’s doctor.
Baby’s First Year
Important Numbers
Important Numbers for Parents
N.C. Family Health Resource Line
Information, referral and advocacy services on pregnancy,
child health, parenting skills and fatherhood issues. Toll-free
and confidential services in English and Spanish.
1-800-367-2229
1-800-FOR-BABY
Carolinas Poison Center
1-800-848-6946
1-800-84-TOXIN
Prevent Child Abuse NC
1-800-354-5437
Emergency
911
www.nchealthystart.org
North Carolina’s number one resource for promoting healthy pregnancies and infant health.
Southern Regional AHEC
Family Medicine Center
(910) 678-0100
1601 Owen Drive
Fayetteville, NC 28304