Caring for You and Your Baby
ABOUT PRENATAL CARE, DELIVERY, AND POSTPARTUM CARE
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Prenatal Checklist
Welcome
Fill this in following your appointments. Ask your doctor or nurse for help with the information.
We would like to take this opportunity to congratulate you on your pregnancy and welcome you to
our practice. We are very honored to be participating in your care during such a wonderful time in
your life.
My estimated due date
(based on
LMP
My prenatal labs
ultrasound
both)
(date drawn
When you are pregnant, there is a lot of information you need to know about the course of a
normal pregnancy, things to do to help assure a healthy pregnancy­­­, and what you can expect from
your prenatal care. The providers and nurses at Carilion Clinic Obstetrics and Gynecology in the
New River Valley have created this information booklet to help answer some common questions
that many women have.
)
Blood type
Antibody screen
Our goal is to provide you with the highest level of care through a team approach. Our physicians
and nurse-midwives want you to have a happy and healthy pregnancy and birth. We encourage
you to communicate with us, so that we can help answer your questions and address your
concerns.
Hepatitis B
Hepatitis C
HIV
Our providers
Rubella
Hemoglobin
Pap smear
Chlamydia
Gonorrhea
My 28-week labs
(date drawn
)
Two-hour glucose
David Roberts, M.D.,
F.A.C.O.G.
Robert J. Heineck, M.D.
Kimberly P. Simcox, D.O.
Mattie Berry, C.N.M.
Kris Conrad,
D.N.P., C.N.M.
Rebecca White, C.N.M.
Jill Devlin, D.O.
Hemoglobin
RhoGam (if Rh negative) (date given
My 35- to 36-week lab
(date collected
)
)
Group beta strep
Please let us know if there is anything we can do to enhance your experience. We look forward to
working with you and your family during this exciting time in your life!
Thank you for choosing our practice!
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About Us
Prenatal Visits
Our practice has two types of providers. We have obstetrician/gynecologists (OB/GYN) and certified
nurse-midwives (CNMs). An OB/GYN is a licensed physician and has trained to perform natural births
and cesarean births, which is a surgical procedure. The OB/GYN’s expertise is in women’s health and
caring for women throughout their adult lives from child-bearing years forward.
You may use the table below to keep track of your appointments. In general, we will plan to see you about
every four to five weeks during the first part of your pregnancy, then every two to three weeks from 28 to
36 weeks gestation. We will see you weekly during the last month of pregnancy (36 weeks until delivery).
During the visits, we will measure your uterus, listen to the baby’s heartbeat, and review any lab work with
you. We also encourage you to bring any questions you might have (some women actually find it helpful
to make a list of questions to ask, as forgetfulness is common during pregnancy!).
CNMs are registered nurses who have obtained a master’s or doctoral degree in nursing and
midwifery. CNMs also are able to provide safe and personalized care to women throughout
adulthood, from their first pap smear to post-menopausal care. CNMs provide annual well-woman
care (pap smears and breast exams) and birth control, and help women with common gynecological
problems. Nurse-midwives provide care during pregnancy, birth, and through the postpartum
period. Our CNMs and our physicians work together closely, so that there is always a physician
available for consultation or transfer of care for higher risk conditions. Please visit the American
College of Nurse-Midwives website at mymidwife.org, to find more information about nursemidwifery and the benefits of having a CNM involved in your prenatal and birth care.
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Prenatal Visits
(for your personal records, in case you would like to keep track of your visits)
Date
Weeks
Gestation
Weight
BP
Total Weight Fundal
Fetal Heart
Gain
Height (cm)
Rate
Comments
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Our Services
Your “estimated due date” (EDD) is based on a 40-week gestational period, starting with the first day
of your last menstrual period. The EDD is either confirmed or changed based on your first ultrasound.
Most babies are born somewhere between 38 and 42 weeks.
We recommend that you see each of our providers at least once during your pregnancy, so you
get to know us and we get to know you. At any point in the pregnancy, you may choose to be a
“physician only” patient (just let us know when we are scheduling your visits or when you call the
on-call provider when you think you are in labor). Our physicians are always readily available to the
on-call CNM, should she need assistance.
Your prenatal visits are scheduled according to your due date and gestational age. During your
pregnancy, diagnostic studies (such as lab work, cultures, and pap smears) are done to check your
health and for any potential risks to the baby. If the test results are normal, we will discuss them with
you at your next visit. If the tests come back abnormal, we will notify you of the results, and discuss
any additional testing or follow-up, if needed.
If you prefer to have a CNM attend your birth, please discuss this with us during a prenatal visit.
While the CNMs are not available 100 percent of the time, they will make every effort to come in
to assist you during labor and birth. If you are committed to a non-medicated birth, we encourage
you to consider hiring a doula to assist you during labor. Please feel free to discuss this with the
physicians or CNMs during a prenatal visit.
Please keep your phone number and contact information up to date, so that we can reach you if
needed. If you have worries about a test result and don’t want to wait until the next visit, please feel
free to call our triage nurse. She will be happy to share your results with you.
Prenatal Tests
In an uncomplicated pregnancy, your prenatal care visits will typically follow the schedule in the
table below. We will check your urine, weight, and blood pressure at each visit.
Initial visit
12-week visit
16-week visit
Review your medical, surgical, and family medical history. You will also have a physical exam,
lab work, and a confirmation of pregnancy ultrasound (which will help determine your baby’s
estimated due date).
Listen to the baby’s heart, review your initial prenatal labs, and review your family genetic
history. We will also schedule a screening test for Down syndrome, if desired (see the Prenatal
Tests section in this booklet for more information).
Check your uterus size and baby’s heart rate, and offer the “quad screen” to check for Down
syndrome and spina bifida, if desired (see the Prenatal Tests section). We will also help to
schedule a 20-week ultrasound to check the baby’s development.
20-week visit
Check uterine size and baby’s heart rate. Your ultrasound will be done around this time by
our ultrasonographer at the Radford office.
24-week visit
Measure your uterine size, check baby’s heart rate, and review ultrasound results. We will also
explain the 28-week labs (including giving you directions to the Carilion lab).
28-week visit
Measure uterine size, check baby’s heart rate, and draw blood work to check for gestational
diabetes and anemia (see the Prenatal Tests section for instructions). If you are Rh negative,
we will also evaluate your blood at this visit.
30-week visit
Measure uterine size, check baby’s heart, and review your 28-week labs. If you are Rh
negative, you should receive your RhoGam injection on or before this visit.
32-week visit
Measure uterine size and check baby’s heart rate. If you would like permanent sterilization,
this is great time to discuss that method of birth control with the provider, if you have not
already done so (patients on Medicaid will need to have paperwork done at least a month
before the due date).
34-week visit
Measure uterine size and check baby’s heart rate.
36-week visit
Measure uterine size and check baby’s heart rate. Today we will collect a vaginal swab to
check for GBS (see the Prenatal Tests section).
37-week and
weekly until
delivery
Measure uterine size and check baby’s heart rate. If you would like us to check your cervix let
the nurse know (although this does not have to be done routinely).
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Genetic Screening Tests
These include the first trimester nuchal translucency test (done between 10 and 13 weeks of
pregnancy) and the quad screen test (done between 15 and 20 weeks of pregnancy). These are
screening tests, not diagnostic tests, which means they cannot diagnose a genetic problem, only
identify babies who might be at higher risk for genetic problems. If you have an abnormal genetic
screening test, we will offer an amniocentesis to diagnose a problem. Amniocentesis involves
taking some amniotic fluid out of your uterus, and does have a one in 300 risk for miscarriage or
complication, even in a healthy fetus.
We generally counsel women and families to consider what they will do with the information from
any genetic screening test very carefully before deciding to do the test. If you would not choose to
do any follow-up diagnostic testing in the event of an abnormal screening test, you may decide not
to even “go down that road” with the initial testing.
• Nuchal translucency test—This optional test can help identify babies who are at high risk for
Trisomy 21 (Down syndrome) and Trisomy 18, which are genetic disorders for which there is no
cure. The test includes an ultrasound, in which the back of the neck of the fetus is measured as
well as a maternal blood test. While more accurate than the quad screen, this test does have
about a 5 percent chance of a false positive result (meaning it will come back saying the baby is
at risk when the baby is fine) and a 15 percent chance of a false negative result (meaning it will
say the baby is not at risk for problems when the baby actually does have a problem). If the test
comes back abnormal, we will recommend you follow-up at the Perinatal Diagnostic Center in
Roanoke, as well as being offered an amniocentesis. We are happy to discuss this test with you.
• Quad screen—This optional maternal blood test also is used to identify babies who might be at
high risk for the genetic disorders Down syndrome and Trisomy 18 as well as open neural tube
defects (spina bifida and anencephaly). This screening test does have a very high rate of false
positives (meaning it will come back saying the baby is at risk when the baby is fine), with some
sources saying that the test might say there is a problem in 40 babies when only one or two
actually have a problem. There is also a chance of a false negative (meaning it will say the baby
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is fine when the baby actually does have a problem). This test may identify about 75 percent
of babies who have Down syndrome and 75 to 80 percent of babies who have a neural tube
defect. If you have an abnormal result, we can offer follow-up amniocentesis. Some women
decide not to have the quad screen test at all. Talk to us if you have questions about this test.
A few other tests we recommend:
• Test for gestational diabetes (GDM) (high blood sugar during pregnancy)—This test is done
at about 28 weeks of pregnancy (sometimes we ask women at higher risk for pregnancyrelated diabetes to do an earlier test and then repeat the test at about 28 weeks). You will need
to go to the Carilion New River Valley Medical Center lab in Radford to have this test done (we
will schedule it for you at your 24-week visit, to be done just before your 28-week visit). You
are asked to not eat or drink anything except water for 12 hours before the test. On the day
of your test, when you arrive at the lab, you will have your blood drawn, then be given a very
concentrated sweet glucola drink. You will then have your blood drawn at one hour and again
at two hours after drinking the glucola. If the test shows that you do have GDM, we will contact
you to see the diabetic educator and further explain this condition. Learn more about GDM at
ncbi.nlm.nih.gov/pubmedhealth/PMH0001898/.
• Group beta strep (GBS) test—About 25 percent of women are carriers for GBS. There are
rarely any symptoms and women who are carriers don’t need any special treatment. However,
a few infants who are exposed to GBS during labor can get sick, so we test all women for GBS
between 35 to 37 weeks of pregnancy (unless they are planning a scheduled cesarean section).
Using a small cotton swab, we will gently swab just inside your vagina, down your perineum,
and barely into your anus. If you are found to be GBS positive, we plan to give you intravenous
antibiotics during labor, which helps to prevent the infant from getting ill. Even if you need the
antibiotics, the nurses can use a saline lock, so that you don’t have to be attached to the IV line
the entire labor. Learn more at cdc.gov/groupbstrep/about/fast-facts.html.
Nutrition, Weight Gain, and Healthy Diet During Pregnancy
Healthy nutrition is an important part of a successful pregnancy. Everything you eat helps to
nourish your body and helps your growing child. If you started at a normal pre-pregnant weight,
we would like you to gain between 25 and 35 pounds during pregnancy. Most women gain about a
pound a week, on average, during the second half of pregnancy. If you started out your pregnancy
overweight we would like you to gain about 15 pounds, and if you started out underweight, we
would like you to gain about 40 pounds to ensure your baby gets enough calories and nutrition to
thrive. Please discuss your pre-pregnant weight and recommended weight gain with the CMN or
physician.
Caffeine and water: You should only drink small amounts of caffeinated drinks (one to two a day),
as high caffeine consumption can cause problems. Most women feel better if they drink enough
water every day. Drinking plenty of water helps prevent constipation, urinary tract infections, and
swelling in your legs and feet. Your urine should be pale yellow (sometimes bright yellow after
taking your prenatal vitamin). If your urine appears very dark yellow to tea-colored or concentrated
you probably need to drink more water, but let us know if you have pain with urination or other
problems.
Listeria: Listeria is bacteria found in unpasteurized milk, some luncheon meats and smoked
seafood. Foods to avoid during pregnancy include soft, unprocessed or unpasteurized cheeses,
such as Brie, feta, Camembert, blue-veined cheeses, and Mexican-style cheeses such as queso
fresco, queso blanco, and panela. Also be cautious when eating hot dogs, luncheon meats, or deli
meats, unless they are heated to steaming (at least 160 degrees F). Do not eat refrigerated smoked
salmon unless it is in a cooked dish, such as a casserole, and avoid cold pate or meat spreads.
Heating the foods listed above to steaming hot will kill any dangerous bacteria making them safe
to eat. Wash all raw foods well before eating.
Semi-soft and hard cheeses, including mozzarella, are safe. You can safely enjoy any cheese that
has been pasteurized, including­processed soft cheeses, such as cream cheese and cottage cheese.
Fish during pregnancy: You may have questions about which fish are safe to eat during pregnancy.
We recommend you eat no more than two servings of fish per week. Fish and shellfish do contain
omega-3 fatty acids and other important nutrients. While pregnant, avoid eating shark, grouper,
marlin, orange roughy, king mackerel, swordfish, and tilefish, as these are known to contain high
levels of mercury. Also eat only three 6-ounce servings a month or less of the following: saltwater
bass, croaker, canned white albacore tuna, fresh bluefin or ahi tuna, sea trout, bluefish, and
American lobster (Maine lobster). You can eat a serving of chunk light canned tuna once or twice a
week. You can safely enjoy other fish in moderation, once or twice a week. Avoid raw fish, such as
found in sushi.
For more information about food safety during pregnancy, visit:
www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm
Vitamins during pregnancy: We also recommend that you take a daily prenatal vitamin, containing
iron, folic acid, and DHA. You can buy an over-the-counter brand, or we are happy to prescribe
you a prenatal vitamin—just let us know which pharmacy you prefer. If you are too nauseated to
take a regular prenatal vitamin in early pregnancy, you can take two chewable Flintstones vitamins
(with iron). Sometimes those are easier on your stomach. Also try to eat plenty of fresh fruit and
vegetables, of many different colors and types, to help nourish your growing baby.
Healthy diet: Try to eat mostly fresh, unprocessed foods, including fruits, vegetables, whole grains,
beans, nuts, legumes, low-fat dairy (good source of calcium), and unprocessed lean meats. Drink
mostly water and low-fat milk. Limit or avoid over-packaged, high-fat, fried “junk” food and fast food,
and try to limit your soda intake.
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A brief word about iron supplements: Usually your prenatal vitamin with iron is all you need to take
during pregnancy. However, some women do develop anemia, or low iron, while pregnant. If you
develop this condition, we will recommend an additional iron supplement. If we recommend you
begin an iron supplement, you should take it at a different time than your prenatal vitamin. You can
take it about 20 minutes before dinner time, with a small glass of orange juice or another source of
vitamin C (which helps your body to absorb the iron). Some women report dark stools, constipation,
or upset stomach with iron supplements. Be sure to drink plenty of water, eat a diet high in fiber,
and walk daily to help your bowels move normally. If the iron supplement is causing you problems
some women prefer Floridix brand iron (a liquid iron available at natural food stores)—it is more
expensive, but seems to be easier on your stomach.
We recommend women with anemia also increase their dietary sources of iron. Here is a list of foods
rich in iron.
• Red meat, including beef, pork, lamb, and liver
• Chicken and turkey, especially dark meat
• Oysters, clams, and scallops
• Beans, including kidney lima, navy, black, pinto,
soybeans, and lentils
• Iron-fortified whole grains including cereals, breads, rice,
bagels, cream of wheat, and pasta
• Greens including, kale, mustard greens, spinach, and
turnip greens
• Tofu
• Egg yolks
• Blackstrap molasses • Dried fruits, including raisins, prunes, dates, and apricots
• Nuts
• Vegetables, including broccoli, artichokes, string beans,
sweet potatoes, and asparagus
Exercise and Activity
Exercise is good for you and your developing baby. If you are already involved in a regular
exercise program you may continue as long as you feel comfortable and we haven’t placed you
on any specific activity restrictions. We recommend that you avoid contact sports and sports that
could be dangerous, including scuba diving, rock climbing, horseback riding, downhill skiing,
mountain biking, etc. Low-impact activities such as walking, biking, and swimming are all highly
recommended.
You may continue to have sex throughout pregnancy without any fear of harming the baby, unless
we advise otherwise. However, if you are actively bleeding or think your water may have broken,
please don’t put anything into your vagina and give us a call right away.
Generally, if an activity won’t cause you to hit or strike your uterus and does NOT cause bleeding or
contractions, it is most likely safe. We are happy to discuss your usual activities with you, if you have
concerns. We also want to remind you that it is very important to wear your seat belt every time you
are in a car. Wear it low, across your pelvic bones, just below your pregnant belly. Wearing a seat belt
could save you and your unborn baby’s life!
Employment
If you are employed outside the home, it is your responsibility to take care of yourself and
communicate your needs to your employer. While we don’t place any restrictions on healthy
pregnant women, we do recommend you consider these sensible tips:
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• Limiting your work hours to eight hours a day and 40 hours a week, if possible
• Avoiding prolonged standing or sitting (you will feel better if you can take a five minute break at
least every two hours)
• Limiting lifting heavy items to 25-35 pounds without additional assistance, unless you were
accustomed to this sort of heavy work before pregnancy
• Be sure to have adequate ventilation and try to avoid extreme temperatures
If you choose to stop working before your baby is born, it is your responsibility to discuss this with
your employer and make the appropriate arrangements. Most FMLA leave begins when you go into
labor. If there is employment associated paperwork you need completed by our office, drop off the
forms at our office and give us at least two weeks to complete the paperwork.
Pregnancy is not considered an illness. While some women may choose to stop working before the
baby is born, the providers can’t write a letter saying it is medically necessary to be off work unless
you have an actual medical reason for this.
Ultrasound
We generally do a dating ultrasound at your first visit, to help determine your estimated due date.
We will order a second ultrasound at 20 weeks gestation. This ultrasound, used to make sure your
baby is developing as expected, is done in our office near Radford by a trained ultrasonographer.
Often, you will be able to find out the gender of the baby at the 20-week ultrasound. If there are no
complications in your pregnancy, these are the only two ultrasounds we will recommend.
Fetal Movement
If this is your first baby, you might start feeling the first flutter of movement around 20 weeks
gestation. Some women, particularly those who have had a child in the past, will feel the baby move
sooner, perhaps around 16 weeks gestation. Some women may feel the baby move later than 20
weeks. Movements can be described as rolling, punching, kicking, or stretching in your uterus.
Once you have reached 28 weeks of pregnancy, you should be feeling the baby move every day.
Feeling fetal movement is a “low tech” way to tell you that the baby is doing well. Most babies have
a certain time of day when they are more active (such as just after dinner, just after you go to bed, or
first thing in the morning). Once you reach 28 weeks of pregnancy, we would like you to take time
each day, during your baby’s active time, to notice his or her movements. If you feel that your baby is
not moving normally, please give us a call right away.
Daily fetal kick count: Sometimes we ask women to do a fetal kick count. If you have been
instructed to do this daily count, we ask that you count the number of times your baby moves in
one hour, during his or her active time of the day. If the baby moves at least 10 times in one hour, no
need to call us. If your baby moves less than 10 times in that hour, we would like you to give us a call
right away.
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Medications During Pregnancy
In general, we prefer women to avoid most medications during pregnancy. However, some
medications have a long history of safe use, and we are okay with you taking them. If you are on
a medication, please discuss it with your CMN or physician. There are a few medications that are
dangerous during pregnancy so be sure all your healthcare providers, including your dentist, know
you are pregnant.
Here is a list of medications which we feel are safe during pregnancy. We recommend you try
and avoid all medications in the first trimester (first three months) of pregnancy unless absolutely
needed.
The following medications are generally considered safe, and you may take them without first
contacting our office:
For sleep:
• Benadryl (diphenhydramine), Tylenol PM, or Unisom (doxylamine)
For pain, headache, or muscle soreness:
• Tylenol (acetaminophen)—may take two regular strength every four hours or two extra-strength
every six hours as needed.
For morning sickness:
• Vitamin B6 (25 mg three times a day), works best when also taken with Unisom (1/2 a tablet once
or twice a day)
• See the following section of this booklet for other measures
For nausea, upset stomach, or gas:
• Emetrol, Mylanta (aluminum hydroxide), or Gas X (simethicone)
For heartburn:
• Tums (calcium carbonate), Zantac (ranitidine), Pepcid AC (famotidine), Mylanta, or Maalox
For constipation:
• Fiber source such as Metamucil or Citrucel or another source of added fiber
• Glycerin suppository, Milk of Magnesia, or Senekot
• Stool softener such as Colace or Surfak (ducosate)
• See the following section of this booklet for other measures
For hemorrhoids:
• Tucks medicated pads, witch hazel compresses, Anusol, or Preparation H
For upper respiratory illnesses (cough, cold, sore throat):
Note: avoid pseudoephedrine in first trimester of pregnancy (first three months) and try to use the
product best suited to your symptoms, so you use the least possible medication. Some products contain
combinations of two or more medications.
• Nasal saline spray, Benadryl (diphenhydramine), Actifed (chlorpheniramine and phenylephrine),
Afrin Nasal Spray (oxymetazoline hydrochloride), Zyrtec (cetirizine hydrochloride), Sudafed
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(pseudoephedrine), Tylenol Cold & Sinus (acetaminophen and pseudoephedrine), Nyquil
(acetaminophen, detromethorphan, doxylamine, and pseudoephedrine)
• Cough: Halls Cough Drops or other cough drops, such as Ricola, Vicks Vapo-Rub, Robitussin DM
(dextromethorphan and pseudoephedrine), Dimetapp (brompheniramine and pseudoephedrine)
• Sore throat: Chloraseptic throat spray, Tylenol (acetaminophen), and Luden’s throat drops
For diarrhea:
• Imodium AD (loperamide)
For yeast infection:
• Monistat or other vaginal yeast creams (insert the applicator carefully, don’t insert too far).
• Please contact our office if you suspect a vaginal infection, especially if it does not respond to
the over-the-counter yeast medications, because other infections can cause itching or vaginal
discharge
For allergies:
• Benadryl (diphenhydramine), Claritin (loratadine), or Zyrtec (cetirizine)
For rashes or skin conditions:
• Benadryl cream or ointment, Calamine lotion, hydrocortisone cream 1 percent, Aveeno oatmeal
baths
• Neosporin as a first aid ointment
Please AVOID taking: Ibuprofen (Motrin or Advil), Pepto Bismol, and aspirin.
Common Discomforts and Problems During Pregnancy
Vaginal spotting
Vaginal spotting occurs in half of all pregnancies, especially in the first 12 weeks. Most of the time
this spotting will resolve on its own. It sometimes occurs after intercourse of after straining to use
the bathroom when constipated and is not always a sign of miscarriage. If the spotting is light,
avoid intercourse for a day or two. If the spotting becomes heavy, like a period (with or without
cramping), avoid intercourse and please give us a call.
Vaginal discharge
Many women have an increase in vaginal discharge during pregnancy. This discharge is usually
white, cloudy or clear, and thin. If the discharge has a fishy or foul odor, causes itching or vaginal
pain, or seems to be water instead of mucus, then please give us a call.
Uterine cramping
Some cramping and uterine contractions are normal during pregnancy, as long as they are mild and
don’t occur every 10 minutes or closer. If you notice cramping pain in your lower abdomen or back
that lasts for about a minute then relaxes, especially with pelvic pressure and a hard uterus, it is
most likely a contraction. If you have a contraction every 10 minutes or closer, drink two big glasses
of water and either lie down or take a warm bath. If the contractions do not stop right away, please
call us.
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Headaches
Headaches are very common during pregnancy, due to the hormonal changes. Some measures you
can use are increasing your water intake, resting with a cold cloth or ice pack on your head, taking
Tylenol as directed, and trying to drink a caffeinated drink (such as cola or coffee). Be sure
to eat small, frequent meals and snacks to help maintain your blood sugar, which can help with
headaches. If you have a severe headache not relieved by acetaminophen, like Tylenol, please
call us.
Round ligament pain
As your uterus grows, the ligaments that help support it also stretch. The ligaments then might
spasm briefly. Sometimes women get fairly sharp pains down low in the abdomen, just above the
pubic bone or on the sides of the uterus, where the ligaments attach. These pains might increase
after being more active, especially after activities involving bending and twisting motions. If the
pains are short and go away quickly this is probably normal. Try a warm bath, sleeping with a pillow
between your knees, applying a warm pack or ice pack, take Tylenol, and avoiding twisting motions
while you work (turn your entire body versus just twisting your trunk). You can try lying on the side
that is cramping and pulling that leg toward your chest. If your pain is severe, does not go away, is
rhythmic like contractions (regular pains every 10 minutes, lasting for a minute, then relaxing) or
causes you worry, please call us.
Morning sickness or nausea and vomiting
This is a common issue during pregnancy and luckily it mostly resolves by about 13 weeks. As long
as you are able to keep down some food and fluids it should not cause any long term problems
for you or the baby (except that you might feel miserable). Some measures you can take are to
keep well-hydrated (try drinking about 1 ounce of Gatorade, water or diluted fruit juice every 15
minutes to stay hydrated). Unisom and vitamin B6 together have been shown to be helpful (see the
medication section in this booklet). You can also take Tums, Emetrol, or papaya tablets (which can
be found at natural food stores). Some find that ginger tea, ginger ale, or eating candied ginger may
also be helpful. Some women find the scent of a fresh cut lemon (or a cotton ball soaked in lemon
extract) provides some relief, as does sucking on sour lemon candies. You can try using “Sea Bands,”
which fit over your wrists and put pressure on an acupressure point—this has been shown to help
some women. Small frequent meals and snacks are a good idea too. If you can eat a high protein
bedtime snack and bland foods, that might also help (bananas, rice, applesauce, and toast).
If you should become dehydrated or are losing significant amounts of weight, or are just feeling
awful, call us for a prescription medication. We also want you to call if you are unable to keep down
anything for more than 24 hours, or if you are unable to urinate, or your urine becomes scant and
dark colored.
Swollen feet and ankles
Swelling in the feet and ankles (or hands) is very common during pregnancy. It is caused by fluid
retention and it usually gets worse late in the day. Drinking enough water is the number one way
you can help decrease swelling. You can also try limiting your intake of salty foods (such as chips,
pretzels, processed meats, and canned foods) and elevating your feet periodically during the day.
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Some women find wearing a maternity support garment can be helpful (see the hemorrhoids
section). When you lie down, try resting on your left side to help promote good circulation.
Avoid constricting clothing such as tight socks or knee high hose. We also recommend
comfortable shoes and full length support hose.
Note: Rapid onset of swelling in the face and hands can be a sign of a complication of
pregnancy, if accompanied by a severe headache unrelieved by Tylenol. Please call us if these
symptoms occur.
Leg cramps
Leg cramps can result from a variety of reasons during pregnancy. In some cases, an imbalance
between magnesium and calcium can contribute to the problem, as can the decreased
circulation in the lower legs during pregnancy. To relieve a calf cramp, extend your leg out
straight and lift your toes toward your knee (like taking your foot off the gas pedal). To prevent
leg cramps, you should not point your toes (this can cause a cramp to happen). We recommend
you try doing gentle calf stretches several times a day—stand on a stair step with your heel
hanging off the edge and gently drop your heel until you feel a non-painful stretch in your calf
muscle. You can also try an over-the-counter magnesium supplement.
Constipation
The hormones of pregnancy as well as other factors tend to increase constipation in pregnant
women. We recommend the following:
• A diet high in fiber (fruits and vegetables), including prune juice and dried plums
• Drink 6-8 glasses of water per day (your urine should be pale yellow in color—if there is a strong
odor and dark color, you are most likely not drinking enough water)
• Walking every day (this helps your bowels to move and has the added benefit of being good for
your pregnancy and baby too)
• Supplemental fiber, such as Metamucil, Citrucel, Fiber One cereal, Uncle Sam cereal, high fiber
bars, etc.
Hemorrhoids or varicose veins in the vulvar region (near your vagina)
Hemorrhoids are a common problem during pregnancy. Many women notice pain and bleeding
after a bowel movement (BM), and tenderness or irritation at the rectum from this condition.
Straining while trying to have a BM can also lead to hemorrhoids. To prevent, eat a diet high in
fiber and stay well hydrated. If you suffer from hemorrhoids, you can use a stool softener daily, if
needed. One brand is Colace, which is available at the pharmacy without a prescription. You can
also buy Tucks pads or witch hazel (make your own compress by soaking a disposable cosmetic
pad or small cloth with witch hazel). These can soothe and help shrink hemorrhoids or vulvar
varicosities. Some women find that wearing a maternity belt, which lifts the pregnant uterus,
can help reduce pelvic varicose veins. This type of garment can be purchased online (“Stork
S’port” is a popular brand), at many department stores or at maternity clothing shops.
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Varicose veins in the legs
These are also common during pregnancy. Resting frequently with your legs elevated can help
reduce the pressure in your leg veins. Consider purchasing support hose and wearing those each
time you are up and about. You may find that a maternity support belt also helps.
Back pain
Sadly, lower back pain is a common problem during pregnancy. As your uterus grows, it causes your
lower back to become more curved. We become concerned if you have an intermittent and regular
cramping pain in your lower back (every 10 minutes or more frequently), which can be a sign of
preterm labor. We are also concerned if you have a severe pain on one side of your back over your
kidney (especially if accompanied by a fever or urinary tract infection symptoms), which can be a
sign of a kidney infection.
Some measures that might help lower back pain include taking Tylenol, warm baths, having
someone massage your back for you, and being sure to use correct posture. Some women find that
wearing a maternity belt, which lifts the pregnant uterus, can help too. This type of garment can
usually be purchased online (“Stork S’port” is a popular brand), or from many department stores and
maternity clothing shops.
Insomnia
It is not uncommon to experience difficulty sleeping at some point during pregnancy, particularly in
late pregnancy, as it can be hard to get comfortable. Try a warm bath and glass of milk at bedtime.
Try to keep to a regular schedule, going to bed and waking up at the same time each day. Keep your
bedroom quiet and dark and use the bedroom only for sex or sleeping (watch TV in another room).
Consider some sort of white noise device if you live in a noisy area. If you are tossing and turning, get
out of bed, go into another room, and engage in a boring/quiet activity until you feel drowsy again.
You may take Benadryl, Tylenol PM, or Unisom as needed, and contact us if the problem is severe.
Heartburn
Heartburn can be reduced by eating smaller, frequent meals, eating slowly, limiting spicy or fatty
foods, limiting carbonated beverages, and remaining in an upright position for several hours after
eating, and trying medications (see medication list). Some herbals such as, chamomile, spearmint,
and peppermint may help. Some women find drinking buttermilk or skim milk instead of whole
milk is helpful. You can also raise the head of the bed 4 inches (using blocks, books or store-bought
risers).
Diarrhea or stomach flu
Diarrhea can cause intense cramping and discomfort and can lead to dehydration. Begin treatment
by consuming only clear liquids, such as Gatorade, ginger ale, and broth soups for 24 hours, then
gradually introduce a bland diet for the next 24 hours. If your diarrhea is not improving over time, or
your urine becomes scant and dark, please call us or your primary care provider for advice. You can
take Imodium AD for diarrhea, if needed.
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Colds, flu, sinus problems, and allergies
During pregnancy, women are more susceptible to respiratory ailments like colds and flu, and these
illnesses tend to last longer too. Most over-the-counter medications are safe to use as long as they
do not contain aspirin or ibuprofen (see the list in the section above). If you develop a fever over
100.6 degrees F, green nasal discharge, or are coughing up bloody or colored sputum, please let
us know (or call your primary care provider). We want to remind you that viruses do not respond
to antibiotic therapy. During flu season, we do recommend you get the flu vaccine (which we can
administer in our office)—it is safe and strongly encouraged for pregnant women and new parents,
and you need one each year. We also recommend you wash your hands frequently, don’t touch your
face unless you have just washed your hands, and try to stay away from people who are coughing
and sneezing. See medication section of the booklet for more information. Allergy medications such
as Benadryl, Claritin, and Zyrtec are safe to take during pregnancy.
When and How to Contact Us
During office hours, you can call the Blacksburg office at 540-961-1058 or the Radford office at 540731-4578. While we prefer you to call the office between 8 a.m. and 4 p.m., for regular questions or
non-emergency issues, we want you to know that there is a physician or CMN on-call for emergency
issues around the clock.
For after-hours emergencies or if you think you are in labor, you can always reach the on-call
physician or CMN by calling the hospital operator at 540-731-2000, who will then contact the
provider for you.
WARNING SIGNS—Call us (even after usual office hours) if you have the following:
• Decreased from normal or no fetal movement (if you are far enough along to expect daily
movement—see the section on fetal movement in this booklet)
• Bleeding like a period
• Leaking or gushing water from your vagina
• Cramping pain or contractions every 10 minutes (if you are less than 36 weeks pregnant)
or active labor signs, such as strong contractions every five minutes for the past hour)
• High fever or severe pain (Note: you may also contact your primary care provider, or go to the
emergency department, if you think it is a non-pregnancy related severe illness)
• Excessive vomiting, particularly if you can’t hold down any fluids or foods for 12-24 hours
or you have become dehydrated and cannot urinate.
• Premature labor symptoms—If you are less than 36 weeks pregnant and have cramping uterine
pains every 10 minutes or closer (your stomach tightens like a fist), you might be in preterm labor.
You may also have lower back pain, leaking water, or bleeding from your vagina, diarrhea, pain
that radiates from your uterus to your thighs/upper legs, cramps that feel like your period, and
increased pelvic pressure, like the baby is pushing down.
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Prenatal classes
Carilion offers an assortment of classes, including on breastfeeding, well baby care, low-intervention
prepared childbirth (similar to Lamaze), infant CPR, and a hospital tour. Please call 800-422-8482 for
a schedule of classes and to register. We do recommend these classes, especially if you are a firsttime parent. Ask the nurses to loan you the “Happiest Baby on The Block” DVD when you are in the
hospital after the birth of your child, too.
If you are planning natural childbirth, without the use of epidurals or IV pain medication, we strongly
recommend some sort of childbirth preparation class, so that you have the training and mental
preparation you and your partner will need to have a positive birth experience. Some women enjoy
taking a prenatal yoga class which includes information on breathing during labor, or decide to hire
a doula to help with childbirth support. Plan to discuss natural childbirth with your CMN at one of
your prenatal visits. We feel it can be a very positive and empowering experience for women who
would like to experience this.
Once you reach 36 weeks of pregnancy, please call The Birthplace at Carilion New River Valley
Medical Center to make an appointment to pre-register. You can contact The Birthplace by calling
540-731-2855 to arrange your pre-registration appointment.
Breastfeeding
Carilion has certified lactation consultants available to you in the hospital and after you go home (by
appointment), to help you with any breastfeeding questions or problems. Please feel free to call The
Birthplace lactation consultants at 540-731-2267 for more information.
Postpartum Information
After you have your baby you might have some more questions. We want you to know that we are
still available to you to answer your questions and help you in any way we can. The Birthplace nurses
will give you important information regarding your health after delivery.
We will see you here in the office at about six weeks after delivery. You can call our office once you
get home from the hospital and settled in to make your appointment. At that visit we will do a brief
exam to be sure your body is back to normal and also will discuss birth control with you, if you need
that information (see below). We recommend you continue your prenatal vitamin for at least six
weeks (or the entire time you are breastfeeding).
Postpartum Warning Signs
After you get home and settled in, you should notice you are getting better and better each day.
If you are feeling worse and worse instead, you may want to call and check in with us.
While we understand that some women may not be comfortable with the idea of breastfeeding,
we want to take a moment to encourage you to consider this method of feeding your new baby.
Breastfeeding is nature’s best way to nourish your child and your milk is uniquely suited to your own
baby’s nutritional needs and stage of life. Breastfeeding confers many benefits to both you and your
baby.
Please call us if you have any of the following postpartum warning signs:
Infants who are breastfed have fewer illnesses and are less likely to suffer from allergies and
wheezing illnesses. Breastfed babies are less likely to have SIDS (sudden infant death syndrome).
Breastfed babies score higher on IQ tests as well as on measures of social and cognitive
development. Mothers who breastfeed are less likely to develop several types of cancer or diabetes.
Mothers who breastfeed also may have an easier time losing the weight they gained during
pregnancy.
• Severe headache unrelieved by Tylenol or Motrin
A recent study suggested that there is no difference in the amount of sleep of babies who bottle
feed or breastfeed—it is a myth that bottlefed babies sleep better. Most moms also relate how
special they found the mother-baby breastfeeding bond to be, and breastfeeding releases beneficial
hormones into the mother’s bloodstream.
Here are two websites that discuss breastfeeding benefits (including research supporting this
method of feeding your child):
• womenshealth.gov/breastfeeding
• breastfeeding.com/all_about/all_about_more.html
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• Fever higher than 100.4 degrees F
• Bleeding heavily (soaking a pad in an hour or more frequently) or a foul odor to your bleeding
• Increasing pain not controlled with ibuprofen (Motrin) or acetaminophen (Tylenol)
• Feeling an increasing sense of sadness, anxiety, or depression (see below)
• Leaking pus, bleeding, or increased pain at the site of any stitches (either in the vaginal area or on
your abdomen if you had a cesarean section).
Note: If you had a vaginal tear that was repaired, it is normal to notice small pieces of the suture
material falling off after a week or two as the stitches dissolve.
Postpartum Depression
Postpartum depression is surprisingly common and our society doesn’t do that great of a job
identifying women who are suffering from it. This disorder can impact the health and well-being
of your newborn child and be a very negative experience for you. This type of depression and/
or anxiety can affect any woman, regardless of age, income, birth experience, health, or previous
history, so all women and families need to be alert for symptoms. Postpartum depression is more
common in women with a history of depression or previous postpartum depression.
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It is normal in the first week or two after your baby is born, to have some ups and downs in your
emotions. This is known as the “baby blues.” One moment you may feel happy and the next moment
you are sad or crying. This is very normal, as your hormones are changing and you have just been
through an emotional and possibly exhausting experience. However, this should resolve within a
short time frame and be fairly mild.
Method
Pros
Diaphragm and spermicidal Safe for most women
jelly
(unless latex or other
allergy)
If after a week or two (or sooner) you notice you are feeling very sad, anxious, overwhelmed, angry,
helpless, ashamed, or out of control, you might have postpartum depression. Some women even
have thoughts of hurting themselves or their baby. Women who have had a baby are at risk for
postpartum depression for a full year after the birth of the child.
If you think you have any symptoms of postpartum depression, please call us right away. We can
help you sort through the emotions you are experiencing, help you with any problems, and make
sure you receive treatment for this serious postpartum illness.
Birth Control
As you approach the end of pregnancy, we would like to discuss birth-control methods with you,
if you are interested in this information. There are a lot of methods out there, and most women can
find a method that will suit their life and family. If you have Medicaid for your insurance, and plan to
have permanent sterilization (your “tubes tied”), let us know at least a couple of months before your
due date, so that we can complete the necessary paperwork for that type of insurance.
Pros
Cons
Effectiveness and Cost
The vaginal sponge, which
contains a spermicidal
ingredient
Safe for all women (except
those with allergies to the
product)
Not the most reliable
method available; could
be considered messy to
use; must be placed before
any sexual contact and
may decrease spontaneity;
expensive
84 percent effective if you
have never given birth,
68 percent effective if you
have had a child before,
costs about $5/sponge
Reliability of the method
varies greatly; requires
training and good followup; must have a partner
who is willing to respect
abstinence days; more
difficult to use in women
with irregular periods,
breastfeeding mothers or
teens
For many couples, about
75 percent effective but can
be slightly more effective
with perfect use; cost of
classes might vary, but
otherwise free
Fertility awareness method Safe, as it is hormone free;
inexpensive after you have
completed the training
classes; compatible with
certain religious beliefs
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Effectiveness and Cost
Not the most reliable
method available; some
consider this method to
be messy; may cause UTI
or irritation; must be fitted
in the office and after
weight gain/loss; must be
placed before any sexual
contact and may decrease
spontaneity
Approximately 84 percent
effective; costs about $200
for the fitting and device
combined (so about $8/
month if used for two
years)
Condoms and spermicidal
foam or jelly
Safe for almost all women Not the most reliable;
Approximately 85 percent
(except those with allergies Must have a partner who is effective; cost is about $1/
to this method); protects
willing to use
condom
against sexually transmitted
disease
The mini-pill: an oral
contraceptive pill
containing progesterone
only
Safe for breastfeeding
Must take pill at the same
mothers or women who
time each day
can’t take estrogen; reliable
if taken correctly
Effectiveness varies,
approximately 92 percent
effective; price about $50/
month
The Pill—an oral
contraceptive pill
containing estrogen and
progesterone
Reliable method if taken
correctly; lighter and more
regular periods; welltolerated by most women
Not a good method for
breastfeeding mothers as
can decrease milk supply;
contains hormones (so
not best choice for older
smokers or women with
serious medical problems)
Approximately 92 percent
effective; price varies, but
about $20 to $50/month
The NuvaRing vaginal ring
which contains estrogen
and progesterone
Reliable method if used
correctly; lighter and more
regular periods; welltolerated by most women;
easy to use in a continuous
cycle regimen (to minimize
the number of periods per
year)
Not a good method for
breastfeeding mothers as
can decrease milk supply;
contains hormones (so not
the best choice for older
smokers or women with
serious medical problems)
About 92 percent effective;
cost is about $50/month
The Ortho Evra patch,
which contains estrogen
and progesterone
Reliable method if used
correctly; lighter and more
regular periods; welltolerated by most women
Not a good method for
breastfeeding mothers as
can decrease milk supply;
contains hormones (so
not best choice for older
smokers or women with
serious medical problems)
and does have a slightly
higher risk of blood clots
than other combined
hormone methods
Approximately 92 percent
effective; price varies, but
about $50/month
Common methods of birth control, from least effective to most effective
(and a few of the pros and cons of each method listed)
Method
Cons
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Method
Pros
Cons
Effectiveness and Cost
Very reliable if you come
back in for the injections
as scheduled; safe method
for most women; many
women have very light or
no periods on this method
May cause weight gain,
acne, decreased sex drive,
and depression in some
women
Approximately 97 percent
effective; price varies, but
about $100 every three
months (sabout $33 per
month)
Implanon—progesterone
containing implanted
device
Very reliable method; safe
for breastfeeding; lasts for
three years
Some women have side
effects from the hormone;
expensive up front cost if
no insurance
Approximately 99 percent
effective; costs about $950
(about $25/month)
Paragard intrauterine
device
Very reliable method; safe
for breastfeeding mothers;
lasts up to ten years but
can be removed before
then
High up-front cost; must
be placed by provider in
the office; many women
report heavier periods and
increased cramping pain
with menses, particularly in
the first year of use
Over 99 percent effective;
price varies, about $750
(works out to about $6/
month if used for entire ten
years)
Mirena intrauterine system
Very reliable method;
safe for breastfeeding
mothers; lasts up to five
years but can be removed
before then; causes very
light periods in most
women, with some women
reporting no periods at all
High up-front cost; must
be placed by provider in
the office; causes irregular
spotting and bleeding in
most women for the first
three to six months of use
Over 99 percent effective;
price varies, about $850
(works out to about $14/
month if used for entire five
years)
Permanent sterilization:
• Bilateral Tubal Ligation
(BTL)
Very reliable method; safe
for most people
Permanent, so some might
regret decision; can be
expensive if no insurance;
surgical procedure
that carries slight risk
(particularly the BTL);
Medicaid patients must
sign a form at least 30 days
in advance to be covered
(and must be at least 21
years old)
Over 99 percent effective;
price varies (vasectomy is
considerably less expensive
than BTL or Essure)—
should discuss cost with
your provider
Depo Provera—contains
progesterone
• Essure
• Vasectomy (for men)
Always Ask
We hope this booklet has been helpful. Please ask questions of your provider about any area we
have not covered. Any question you or a family member has is important and valid. We are here to
help you and your baby through this wonderful experience.
Notes
Please feel free to discuss birth control methods with us during your pregnancy and again during
your postpartum exam. We want to help you find the right method for you.
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Locations
We have three locations in the New River Valley to serve you for your prenatal visits. Please call the
local number below for appointment scheduling or call toll free, 877-731-4578.
Carilion Clinic OB/GYN
1997 South Main St., Suite 704
Blacksburg, VA 24060
540-961-1058
Carilion Clinic OB/GYN
2900 Lamb Circle, Suite 202
Carilion New River Valley Medical Center
Christiansburg, VA 24073
540-731-4578
Carilion Giles Community Hospital
OB/GYN Clinic
159 Hartley Way
Pearisburg, VA 24134
540-961-1058
Our patients will pre-register with The Birthplace at Carilion New River Valley Medical Center for their
baby’s birth. The Birthplace is a five-star award winner in patient satisfaction and overall quality of care.
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