I'll get to know you. 

9 months is a long time to grow someone, but a great amount of time to get to know someone. My staff and I look forward to getting to see you frequently throughout those months! Almost always, I deliver my own patients. So when you're in labor, I'll be the one at your side.

I'll listen to you.

My schedule is set so that my time with you is blocked off so that no matter how long of an appointment is needed, we make it happen. Let me know what's on your mind! If its something that could just be a conversation, lets do a Telehealth Facetime visit!

I'll take good care of you.

I've had great training, and I truly love what I do. I'll always do our best—to give you good information, keep you healthy, and make your visits enjoyable.

Safe Medications

Wonder which medications are OK to take during your pregnancy? Just download our Safe Medications List. And you're always welcome to call us at 615.223.0200 with questions.

Lab Tests

We have an in-house lab technician, so tests are easy to take care of during your regular appointments. As required by law, we perform the following tests on all patients:

• Prenatal Screening for HIV, Syphilis, Hepatitis B, and Rubella

• Glucose Screening for Gestational Diabetes

• Strep Screening

We can also test for other abnormalities, like Cystic Fibrosis and Spina Bifida. However, not all insurances cover these, so we always recommend that you check with your carrier first.

First Trimester Advice

You're pregnant, now what? You might have numerous questions. Below, we will try to answer those questions you might have. We will go over nutrition, weight gain, exercise, dental care, nausea and vomiting, vitamins, air travel and possible testing during pregnancy.

Nutrition

Both fetal and maternal outcomes can be affected by maternal nutritional status during pregnancy. All women should receive information focused on a well-balanced, varied, nutritional food plan that is consistent with her access to food and food preferences. If you are financially unable to meet nutritional needs, we can refer you to federal food and nutrition programs, such as Special Supplemental Nutrition Program for Women, Infants and Children.

Weight Gain

Ideally, women should have a normal BMI before pregnancy and then adjust their diets during pregnancy in order to gain a recommended amount of wight and to obtain the appropriate nutrition for both maternal and fetal benefit. However, women are becoming pregnant when they are obese and are gaining more weight than is necessary during pregnancy and are retaining the weight postpartum. For a woman with a normal BMI (18.5-24.9) the average weight gain can vary between 25-35lbs. If a woman is overweight with a BMI of 25.0-29.9, the weight gain should be between 15-25lbs. For obese ladies with a BMI of 30.0 or greater, the weight gain should be limited to 11-20lbs. Of course, ladies pregnant with more than one baby, the weight gain is increase to 37-54lbs for normal BMI, 31-50lbs for overweight BMI, and 25-42lbs for obese BMI. Progress toward meeting these weight gain goals should and will be monitored and specific individualized counseling will be provided if considerable deviations are noted.

Exercise

In normal, healthy, uncomplicated pregnancies, 30 minutes or more of moderate exercise per day on most, if not all, days of the week is recommended for pregnant women. A moderate exercise program as part of the treatment plan for women with gestational diabetes mellitus is recommended. During pregnancy a wide range of recreational activities appears to be safe during pregnancy. If you should have any questions if a specific sport is safe, we will discuss with you the potential dangers/precautions you should take. Pregnant women do need to avoid lying on your back during exercise as much as possible. We would not suggest that you take up a new activity or exercise routine during pregnancy. A physically active woman with a history of or risk of preterm delivery or IUGR may be advised to reduce her activity in the second trimester and third trimester. Some warning signs to terminate exercise while pregnant include the following:

• Chest pain

• Vaginal bleeding

• Dizziness

• Headache

• Decreased fetal movement

• Amniotic fluid leakage

• Muscle weakness

• Calf pain or swelling

• Regular uterine contractions

The following medical conditions are absolute contraindications to aerobic exercise in pregnancy:

• Restrictive lung disease

• Cervical insufficiency or cerclage

• Persistent second trimester or third trimester bleeding

• Placenta previa confirmed after 26 weeks of gestation

• Ruptured membranes

• Preeclampsia or pregnancy-induced hypertension

Dental care

It is important that pregnant women continue usual dental care in pregnancy. We will send a written note to your dentist explaining what is safe during your pregnancy. Routine brushing and flossing, scheduled cleanings, and any medically needed dental work are safe during pregnancy. During pregnancy, your gums will bleed more easily and that is normal. Dental use of X-rays (with shielding of the abdomen and thyroid) and local anesthesia (lidocain with or without epinephrine) are safe during pregnancy. If emergent conditions that require immediate treatment, such as extractions, root canals, and restoration (amalgam or composite), may be managed at any time during pregnancy.

Nausea and Vomiting

Nausea and vomiting affects more than 70% of pregnant women and can diminish the woman's quality of life. For women with prior pregnancies complicated by nausea and vomiting, it is reasonable to recommend pre-pregnancy and early pregnancy use of multivitamin because studies show this reduces the risk of vomiting requiring medical attention. First -line therapy for nausea and vomiting is vitamin B6 with or without doxylamine. Other nonpharmacologic treatments for mild cases include increasing protein consumption and taking powdered ginger capsules daily. Rarely do we see a woman with hyperemesis gravidarum, a severe form of pregnancy-associated nausea and vomiting that occurs in less than 2% of pregnancies. In those cases, women may require more intense therapy, including hospitalization; additional medications; intravenous hydration and nutrition.

Vitamins

The recommended dietary allowances for most vitamins and minerals increase during pregnancy. The National Academy of Sciences recommends 27mg of iron supplementation (present in most prenatal vitamins) daily because the iron content of the standard American diet and the endogenous iron stores of many American women are not sufficient to provide for the increased iron requirements of pregnancy. Recent evidence suggests that vitamin D deficiency is common during pregnancy especially in high-risk groups, including vegetarians, women with limited sun exposure (i.e. those who live in cold climates, reside in northern latitudes or wear sun and winter protective clothing), and ethnic minorities, especially those with darker skin. Women need to supplement their diets with folic acid before and during pregnancy.

Air Travel

Occasional air travel during pregnancy is generally safe. Most commercial airlines allow pregnant women to fly up to 36 weeks of gestation. Some restrict pregnant women international flights earlier in gestation and require documentation of gestational age. Women should check with the individual flight carrier. Air travel is not recommended at any time during pregnancy for women who have medical or obstetric conditions that may be exacerbated by flight or that could require emergency care. The duration of the flight also should be considered when planning travel. Pregnant women should be informed that the most common obstetric emergencies occur in the first and third trimester. Use of support stockings during flight have certain preventive measures needed to reduce the risk of lower extremity edema and venous thrombotic events. The seat belt should be placed low on the hipbones.

Fetal Tests of Well-Being

There are some indications for initiating testing include, but are not limited to:

Maternal conditions

• Insulin-treated diabetes mellitus

• Hypertensive disorders

• Chronic renal disease

• Cyanotic heart disease

Pregnancy-related or fetal conditions

• Pregnancy-related hypertension

• Decrease fetal movement

• Oligohydramnios and polyhydramnios

• IUGR

• Previous fetal demise

• Multiple gestation

To determine what testing is needed and when to begin testing will depend on the condition or conditions a pregnant women may have. The following tests are commonly used in clinical practice to assess fetal status and are described below:

• Assessment of fetal movement (i.e. kick counts) Laying on one side counting baby movements. 10 movements in a 2 hour period. If 10 movements are felt in first hour, that is considered to be reassuring.

• Nonstress test (NST) fetal heart tracing for accelerations. 2 accelerations in a 20 minute time frame or 40 minutes. If not reactive, then a BPP is performed.

• Biophysical profile (BPP) ultrasound checking for 2 movements, 2 practice breathing, 2 amniotic fluid amount, 2 for heart rate. Reassuring BPP is 8/8

• Modified biophysical profile (NST plus amniotic fluid index [AFI] or deepest vertical pocket of amniotic fluid)

• Doppler ultrasoundgraphy of umbilical artery blood flow velocity

Repeat testing should be performed when the condition that initiated testing persists. Typically, the NST and BPP are repeated at weekly intervals, some may even require twice weekly testing.

Regardless of your health during your pregnancy, be assured we will be with you every step of the way. We will do our very best to keep both you and your little miracle healthy throughout your pregnancy. Do know in pregnancy, conditions can arise at any time. We are prepared to tackle whatever obstacle(s) comes our way. Congratulations!

STONECREST MEDICAL CENTER

Childbirth Classes: StoneCrest offers plenty of classes that can help you prepare for the new baby. Learn relaxing and coping skills for birth, or how and why to breastfeed. Just check out the schedule and register online.

Pre-Register for Delivery: When you're going into labor, the last thing on your mind is paperwork. So if you're planning to deliver at StoneCrest, you can pre-register online. If you have any questions, call StoneCrest at 615.768.2022.