Online Prenatal

Education

PresentationOb-Gyne Associates of Lake

Forest, Ltd.

Part One

Instructions Please view and listen to the presentation

prior to your visit. This information will better

prepare you for your next visit with us.

Please turn your speakers on.

Consider getting a pen and paper to write down information and any questions or concerns you may have.

There are multiple links placed throughout the slides for further information-you do not have to view all of these.

You may arrow forward or backward at any time.

Our Physicians From Left to Right: Dr. Maureen Tart, Dr. Jill Holden, Dr.

Tanya Huang, Dr. Michael Hubbell, Dr. Elizabeth Oh and

Dr. Heather Heiberger

Office VisitsPreparing for your little one

We encourage our

patients to meet with all

the doctors during her

pregnancy. Please make

an appointment with each

doctor a couple of times.

Patients will be delivered

by the doctor on-call from

our practice, unless you

are having a scheduled C-

section or an induction.

Schedule of VisitsDuring your routine pregnancy

Weeks 8 to 30

1 visit per month

Weeks 30 to 36

2 visits per month

Weeks 36 to Birth

1 visit per week

The Initial VisitPreparing for your little one

Detailed health history

Discuss any medications being taken

Check weight and blood pressure

Complete physician exam including pap smear (if due)

Calculate due date

Address any questions or concerns

Discuss potential testing and timing

Later Visits (Weeks 8 to 36)Preparing for your little one

Urine Sample testing for glucose and

protein (Bring your first morning urine)

Check weight and blood pressure

Measuring your abdomen to check

your baby’s growth (fundal height)

Listening for the baby’s heartbeat

(after 12 weeks of pregnancy)

Ultrasound for fetal anatomy (21

weeks)

Answering any questions that you

have concerning your pregnancy.

Later Visits (Weeks 36 to Birth)Preparing for your little one

Group Beta Strep Culture (35-36 Weeks)

Internal Cervix Check

Access the cervix and position of the baby,

which will continue until you deliver

Tdap (whooping cough) booster if due

Inductions and Birth PlansPreparing for your little one

Inductions will be scheduled close to 41 weeks

Earlier inductions will be for medical purposes only

For patients that have created a birth plan, they must be reviewed by all the doctors in the practice. We cannot honor a birth plan unless we have verified that it allows us to safely take care of the mother and baby

Hospital Affiliation Northwestern Lake Forest Hospital

Our main office is located steps away from Lake Forest Women’s Health Center, where your baby will be delivered.

Please visit the hospital’s website at http://www.lfh.org/obstetrics_maternity_womens

We also ask that you preregister at the hospital online or mail the form provided to you.

ClassesPreparing for your little one

There are several classes available at Lake Forest Hospital

Please refer to the handouts in your folder or visit the link for a listing of classes and availability

Sign up for classes early, as they do fill up quicklyhttp://www.lfh.org/event_calendar?eventType=maternity

Genetic Screening TestsPreparing for your little one

We offer screening for chromosomal abnormalities and open neural tube defects in the practice.

You have the option to decline or accept complete genetic testing.

Most, but not all abnormalities will be detected Incorporates both first and

second trimester screenings

Genetic Screening TestsFirst Trimester Screening

First Trimester Screening involves: Non-invasive prenatal testing (NIPT)

and Nuchal Translucency (NT)

NIPT

A highly accurate test that screens patients for some common

prenatal genetic disorders such as Down’s syndrome (trisomy

21), Edward’s syndrome (trisomy 18), and Patau’s syndrome

(trisomy 13) by drawing blood from the mother

Analyzes fetal DNA that is circulating in the maternal blood from

the breakdown of fetal cells found mainly in the placenta.

NT

An ultrasound of the fetal neck that is often performed in

conjunction with NIPT testing

A normal NT reduces the risk of cardiac and spinal abnormalities

of the fetus.

Genetic Screening Tests First Trimester Screening

When NIPT and NT are performed:

NIPT is done any time after 10 weeks of

pregnancy but can be done at the same time

as the NT ultrasound which is 11-12 weeks.

The turnaround time for NIPT is about 10 days

while the ultrasound is read immediately.

Who Gets Tested:

We strongly encourage all high risk patients get

screened. You are considered high risk if:

You are 35 years or older

You have an abnormal ultrasound

You have a personal or family history of genetic problems

We do not recommend that twin pregnancies

get screened

Genetic Screening Tests First Trimester Screening

Implications of a Positive Test:

These tests are highly accurate but are still

considered screening tests.

In the event of a positive test, you will be

referred for genetic counseling and possibly

further diagnostic testing such as chorionic

villus sampling (CVS) or amniocentesis.

Implications of a Negative Test:

Important to remember that these tests are

not 100% accurate

There are false negative results, so a

negative test cannot absolutely rule out an

affected fetus

At the present time, this is the best screening

test available

Genetic Screening TestsSecond Trimester Screening

Second trimester screening involves a

blood test called MSAFP

MSAFP measures a marker in your blood as

a screening for spinal (or open neural tube)

abnormalities and some other fetal and

placental anomalies.

Diagnostic Testing for

Chromosomal abnormalitiesFirst Trimester If you are high risk or have an abnormal

screening test, you have the option to choose diagnostic testing.

First Trimester: CVS (Chorionic Villas Sampling)

Occurs between Weeks 10 to 13 during pregnancy

Link for more information: http://americanpregnancy.org/prenataltesting/cvs.html

You will need a referral to a high risk OB Specialist if you desire this

Diagnostic TestingSecond TrimesterSecond Trimester: Amniocentesis

Occurs after 16 weeks of pregnancy

Link for information:

http://americanpregnancy.org/prenataltesting/amniocentesis.html

These tests carry some risk including infection and miscarriage

This also requires a referral to a high risk OB Specialist to perform

Diet and NutritionPreparing for your little one

In general, a healthy diet full of fresh vegetables, fruits, lean meats, and whole grains are preferred

Pregnant women need to drink 8-12, eight ounce glasses of fluid per day

Eat 8-9 ounces of protein per day

Cold Cuts and Tuna (white chunk vacuum packed) are Ok

You will need at most an extra 300 calories per day (equivalent to a peanut butter/jelly sandwich)

Foods to AvoidPreparing for your little one

Raw/Uncooked Food

Seafood: Shark, King Mackerel, Tilefish,

Swordfish, or Raw Fish of any kind. It is

okay to consume a total of 12 oz. per

week of fish and shellfish

Refrigerated smoked seafood unless it

is an ingredient in a cooked dish such

as a casserole

Unpasteurized milk, juice, or apple

cider

Soft cheeses such as gorgonzola, Brie,

feta, camembert, and queso

Excessive caffeine

Alcohol

Unwashed fruits and vegetables

Important Nutrients for PregnancyPreparing for your little one

Calcium: helps develop strong bones

1300 mg per day

In milk, cheese and yogurt

Also found in broccoli, kale, cabbage, almonds, white beans, and brazil nuts

Iron: important for healthy blood

30 mg per day

Found in red meats, spinach, enriched breads and cereals, dried fruit, and peanut butter

Folic Acid: for blood and new cells

Found in dark green vegetables, liver, yeast, nuts, legumes, and whole grains

Tip: Iron and Calcium “compete” for absorption. Take these supplements about an 1.5 hours apart. Have a Vitamin C source (such as juice or fruit) with your iron to improve absorption.

Pregnancy DON’TSPreparing for your little one

Do not use Hot Tubs or Saunas

Do not use Tanning Beds

Do not change cat litter (toxoplasmosis)

Pregnancy DO’s and OK’s

Ok for hair dyes

Ok for manicure or pedicure

Acrylic nails ONLY if in a ventilated area

Ok for massage, but make them aware you are pregnant (they may require a letter from the physician)

Piercings, please remove prior to coming to the hospital (except for ears)

Seatbelts, they are safe

and necessary

Ok for Latex based

painting, ONLY in well

ventilated area

Ok for Refinishing, ONLY in

well ventilated area

Ok for household

chemicals/cleaning

products

It is ok to work until delivery

Smoking, Alcohol and Illicit &

Recreational Drugs We do not recommend

smoking during pregnancy. If you currently smoke, here are some ways to assist you in quitting: http://www.cdc.gov/tobacco/

campaign/tips/

http://www.heart.org/HEARTORG/GettingHealthy/QuitSmoking/Quit-Smoking_UCM_001085_SubHomePage.jsp

It is not safe to consume alcohol while pregnant and use any illicit and/or recreational drugs

Online Prenatal

Education

PresentationOb-Gyne Associates of Lake

Forest, Ltd.

Part Two

Instructions Please view and listen to the presentation

prior to your visit. This information will better

prepare you for your next visit with us.

Please turn your speakers on.

Consider getting a pen and paper to write down information and any questions or concerns you may have.

There are multiple links placed throughout the slides for further information-you do not have to view all of these.

You may arrow forward or backward at any time.

Prenatal VitaminsFor the health of your baby

We recommend that you use a prenatal vitamin with DHA and one with at least 400 mg of folic acid

Prenatal vitamins can be purchased at a drugstore and taken during your pregnancy

If you prefer a prescription, please discuss this during your next visit

Safe Medications During PregnancyFor the health of your baby

During pregnancy, medication should be used sparingly. However, if necessary, the following over the counter medications and herbal remedies have been determined to be safe during pregnancy.

Headaches/Generalized Pain: Tylenol (Acetaminophen)

Cold/Flu Symptoms: Sudafed (pseudoephedrine, okay in 1st and

2nd trimesters, fine in 3rd trimester with normal blood pressure)

Robitussin (guaifenesin and dextromethorphan)

Mucinex

Cough Drops

Vitamin C Lozenges

Steam and the use of Saline Spray for congestion

Safe Medications During PregnancyFor the health of your baby

Sore Throats: Cepacol lozenges (benzocine and menthol)

Halls lozenges

Luden’s

Sucrets

Chloraseptic Spray

Salt Water gargle

Allergies: Benadryl (diphenhydramine)

Claritin (non-drowsy)

Zyrtec (cetirizine)

Buffered saline drops or irrigation fluid

Insomnia: Benadryl (diphenhydramine)

Safe Medications During PregnancyFor the health of your baby

Heartburn or Indigestion:

Gaviscon (aluminum magnesium)

Maalox

Mylanta

Mylicon

Pepcid AC (famotidine)

Tagamet OTC (cimetidine)

Tums (calcium carbonate)

Zantac

Rash / Hemorrhoids:

1% hydrocortisone cream/ointment

Anusol

Preparation-H

Tucks

Safe Medications During PregnancyFor the health of your baby

Constipation-Stool Softeners: Colace (docusate)

Surfak

Constipation-Bulk Fiber: Metamucil

Fibercon

Citracel

Increased fluids/dietary fiber

Constipation-Laxatives: Milk of Magnesium

MiraLax (polyethylene glycol)

Diarrhea: Immodium (loperamide)

Leg Cramps: Slow release magnesium

Safe Medications During PregnancyFor the health of your baby

Nausea: Emetrol

Vitamin B-6: 50 mg, twice a day

Papaya extract

Ginger & Raspberry Tea

Commonly Used Prescription Medications: Asthma medication including

aerosolized steroids

Skin therapies for chronic issues like eczema, psoriasis, acne (unless they contain retinols)

Anti- depressants (be sure to discuss with the doctors)

Weight Gain

Pre-Pregnancy

Weight

Recommended

Weight Gain

Underweight

(BMI less than 18.5)28 to 40 pounds

Normal Weight

(BMI 18.5 to 24.9) 25 to 30 pounds

Overweight

(BMI 24.9 to 29.9) 15 to 20 pounds

Obese

(BMI greater than 29.9) 10 to 15 pounds

Exercise During PregnancyResearch shows that regular exercise:

Increases overall energy

Prevents high blood pressure

Prevents gestational diabetes

Decreases post-partum depression

Decreases the “aches and pains” of pregnancy, including low back pain

Helps prepare the body for labor

Exercising Guidelines Now is not the time to start a

new exercise program, but most things you already doing are fine

Stay hydrated and cool

As a rule, if you can carry on a conversation while exercising, you are at the right level. If you can’t speak normally, than you may be pushing yourself too hard

We recommend 30 minutes or more of moderate exercise 5-6 days per week, in the absence of medical and obstetric complications.

Some good ideas: Swimming,

walking, and prenatal yoga

Bad ideas: Contact sports,

Horseback riding (unless you are

already doing this),

Rollerblading, Skiing (water and

snow), Ice Skating, Skydiving,

Thrill Rides, and all day theme

parks

DO NOT lay flat on your back for

exercise after 4 months

gestation

Traveling Guidelines It is okay to travel until 35 weeks internationally and 36

weeks in the U.S unless risk factors are identified It is better to fly than drive due to sitting and being unable

to get up and move around Be sure to fasten the lap belt under your abdomen and across

the top of your thighs .

Cruises should be completed before 24 weeks of pregnancy

Walk around every 2 hours for at least five minutes to promote circulation and consider compression stockings worn on the flight.

If you do travel, request a copy of your prenatal records to take with you and check where the nearest hospital is located to your destination

Common Pregnancy Concerns Round ligament stretching pain

Heartburn/Acid Reflex

Back Pain

Evening Leg Cramps

Constipation

Sleep positioning

All of these are addressed in detail at the link below. If you have any additional questions, please bring those with you to your next appointment.

http://americanpregnancy.org/commondiscomforts

Comfort During PregnancyFeeling Tired: Listen to your body and rest more; take

napsBreast Discomfort: Wear a larger, well fitting supportive bra.

Try cold compresses (a washcloth dipped in water) on your breasts as needed. If you experience thickening and lumps of your breasts, please call our office.

Urinating Often: Avoid liquids close to bedtime. Accept

that you will be getting up once a night to urinate.

Headaches and Vision Changes: Drink more water and eat something.

Rest and try to relax. Use a hot moist towel over your eyes and forehead.

Comfort During PregnancyNausea and Vomiting:

Eat small, frequent meals (every 2 hours) so your stomach is never

empty

Eat a few crackers or other food you can tolerate before getting out

of bed in the morning or even during the night if you wake up

Eat a protein snack (cheese, egg, meat, fish, nuts, or peanut butter)

at bedtime

Eat crystallized ginger, drink ginger tea or chew papaya extract

tablets to help settle your stomach

Heartburn:

Avoid caffeine, carbonated beverages, chocolate, and high acid

foods such as citrus, tomatoes, mustard, vinegar, spicy, and fried or

fatty foods

Don’t eat large meals. Instead, eat multiple small meals

Drink liquids between meals, instead of “washing down” food at

mealtime

Do not eat within 2 to 3 hours of bedtime

Sleep propped up on a pillow

Try an over-the-counter antacid

Vaccines Many vaccines are safe during

pregnancy and promote the health of the mom and baby

The vaccines offered in our office: T-dap: given after 20 weeks of

pregnancy and provides whooping cough protection for your child

Influenza: recommended during flu season

Vaccines after Pregnancy Rubella and Chickenpox may

be given after your baby is born if you are not immune

ToxoplasmosisToxoplasmosis is a small parasite that should be avoided while pregnant

Do not change or clean litter boxes or cages while pregnant If you have to clean them, gloves and a mask are

recommended

Wash all fruits and vegetables well before eating

Avoid digging in gardens without gloves

Cook all meat thoroughly and wash hands well after touching raw meat

Sexual ActivityDuring your pregnancy

Sex is considered safe during routine pregnancies

Sex cannot harm your baby or cause a miscarriage

If you have bleeding, pain, or discomfort during intercourse, please stop what you’re doing and do not resume intercourse until your next visit

3D/4D Ultrasound

These ultrasounds are optional

and for your enjoyment

They are not part of your

routine prenatal care

These are optimal at our

office between 28 and 32

weeks of pregnancy

Please call the office at

847.234.3250 for more

information or to schedule

Domestic Violence

Domestic violence is more common during

pregnancy. If you are in an unsafe living

situation, please discuss this with us.

Decisions to Consider During Pregnancy

Pain management during labor

Circumcision

Choosing a Pediatrician

Breast or Bottle feeding

Cord Blood Storage

Contraception after delivery

Decisions to ConsiderAfter your baby is born Breastfeeding: Consultants available

Circumcision: Done prior to discharge from the hospital

by one of our doctors; not the pediatrician

Pediatrician: Check with insurance to be sure they are

accepted. You can also check the Lake Forest Hospital

Physician Referral List.

Car Seat: A must have for discharge from the hospital.

Be sure to unpack and clean prior to delivery so you

know how to operate straps and base.

Post Partum Birth Control: Breastfeeding is not a form of

birth control. We do have a specific pill for

breastfeeding moms. You will discuss this more at your 6

week postpartum appointment.

When to call our office ALWAYS call the office prior to going to the hospital

Call with a fever over 101 that persists longer than 24 hours

Asthmatics, with cough or fever

Vomiting for greater than 8 hours and unable to keep down

fluids

Diarrhea for more than 24 hours

Vaginal bleeding

Decreased fetal movement if over 26 weeks

Leaking of fluid from vagina

Contractions or abdominal pain

*Please do not call the office for loss of mucous plug, this

unfortunately does not signal imminent labor*

**Please be courteous to the doctors and call after hours only for

emergent issues that cannot wait for the office to open. It is NOT

an emergency for test results, ultrasound results, etc.**

Recommended BooksTitle: While Waiting

Authors: George E. Verrilli, M.D., F.A.C.O.G. and Ann

Marie Mueser, Ed. D

Title: What to Expect

When You’re Expecting

Author: Heidi Murkoff

Bring Your QuestionsTo your next appointment

Please make a short list of

questions for you and the doctor to discuss at your

appointment. A list of

questions can expedite your

appointment and guarantee

that questions can be

answered in the allotted

appointment time.

Please download, print, and complete the

Certificate of Completion, which is found

under the Prenatal Education tab on the

Patient Portal. Bring the certificate with you

to your next appointment so we have

confirmation that you viewed this

presentation. Thank you!