healthy guide · 2020. 9. 16. · BMIs do not need to gain the same amount of weight as women with...

healthypregnancyguideSM

Do’s & Don’tsPrenatal VitaminsPregnant women should consume the following each day through diet or supplements:• Folic acid 400-800 micro-grams (until the end of the first trimester)• Iron 30 mg (or be screened for anemia)

Prenatal vitamins are unlikely to be harmful, therefore they can be used to ensure adequate consumption of several vitamins and minerals in pregnancy. However, their necessity for all pregnant women is uncertain, especially for women with well-balanced diets.

Nutrition & Weight GainPregnant women should be advised to eat a healthy, well-balanced diet and typically should increase their caloric intake by 350-450 calories/day. Women with higher BMIs do not need to gain the same amount of weight as women with normal or low BMIs.

AlcoholAlthough current data suggests that consumption of small amounts of alcohol during pregnancy (less than 7-9 drinks per week) does not appear to be harmful to the fetus, the exact threshold between safe and unsafe, if it exists, is unknown. Therefore, alcohol should be avoided in pregnancy.

Artificial SweetenersArtificial sweeteners can be used in pregnancy. Data regarding saccharin are conflicting. Low (typical) consumption is likely safe.

Fish ConsumptionPregnant women should try to consume two to three servings per week of fish with a high DHA and low mercury content. For women who do not achieve this, it is unknown whether DHA and n-3 PUFA supplementation are beneficial, but they are unlikely to be harmful.

Raw & Undercooked FishIn line with current recommendations, pregnant women should avoid undercooked fish. However, sushi that was prepared in a clean and reputable establishment is unlikely to pose a risk to the pregnancy.

Other Foods to Avoid• Raw, undercooked meat and unpasteurized dairy products• Foods being recalled for possible Listeria contamination• Unheated deli meats could also increase the risk of Listeria, but the risk in recent years is uncertain.

Wash vegetables and fruit before eating them.

Exercise & Bed-RestPregnant women are encouraged to exercise regularly. There is no known benefit to activity restriction or bed-rest.

Reference: Obstetrics & Gynecology, April 2018, Volume 131 Issue 4

CaffeineLow-to-moderate caffeine intake in pregnancy does not appear to be associated with any adverse outcomes. Pregnant women may have caffeine, but should limit it to less than 300 mg/day (typical 8-ounce cup of brewed coffee has approximately 130 mg of caffeine). An 8-ounce cup of tea or 12-ounce soda has approximately 50 mg of caffeine, but exact amounts vary based on the specific beverage or food.

Smoking, Nicotine & VapingWomen should not smoke cigarettes during pregnancy. If they are unable to quit, they should reduce it as much as possible. Nicotine replacement (with patches or gum) is appropriate as part of a smoking cessation strategy.

MarijuanaMarijuana use is not known to be associated with any adverse outcomes in pregnancy. However, data regarding long-term neurodevelopmental outcomes are lacking; therefore, marijuana use is currently not recommended in pregnancy.

Oral HealthOral health and dental procedures can continue as scheduled.

Avoiding InjuryPregnant women should wear lap and shoulder seat belts while in motor vehicles and should not disable their airbags.

Hot Tubs & SwimmingAlthough data is limited, pregnant women should avoid hot tub use in the first trimester. Swimming pool use is not discouraged during pregnancy.

Hair DyesAlthough data is limited, because systemic absorption is minimal, hair dye is presumed to be safe in pregnancy.

TravelAirline travel is safe in pregnancy. Make sure you are familiar with the infection exposures and available medical care for each specific destination. There is no specific gestational age at which women must stop travel. Airline travel is typically not recommended after 36 weeks. Pregnant women must balance the benefit of the trip with the potential of a complication at her destination. Avoid areas with Zika Virus exposure risk.

Insect RepellentsTopical insect repellents (including DEET) can be used in pregnancy and should be used in areas with high risk for insect-borne illnesses.

Sexual IntercourseThere are no restrictions regarding sexual intercourse during pregnancy unless you are bleeding, have placenta previa at greater than 20 weeks of gestation, or ruptured membranes.

ENCIRCLE HEALTH2500 E Capitol Drive • Suite 1650Appleton, WI 54911

THEDACARE - APPLETON1818 N Meade Street • Suite 330Appleton, WI 54911

THEDACARE - NEENAH200 Theda Clark Medical Plaza • Suite 270Neenah, WI 54956

PHONE 920.749.4000FoxValleyOBGYN.com

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ELIVERY

Feeding Your BabyWhether you choose to breastfeed, bottle feed or do a combination of the two, you need to be comfortable with your decision on how to feed your infant. Many women find it helpful to discuss their feeding plan with their obstetrician, pediatrician, primary care provider, lactation consultant or friends and family. Women’s Health Specialists has a lactation consultant that sees patients before and after delivery. Call the office to schedule an appointment. There are many things to consider, but in the end the decision has to be right for you.

Breast milk provides a type of immunity to an infant called passive immunity. Colostrum is the first milk a woman produces when she begins to breastfeed, and it contains large numbers of antibodies called secretary immunoglobulin. This protection is invaluable to a newborn. However, it only protects against infection through their digestive tract; it does not provide bloodstream antibodies to protect against various vaccine-avoidable illnesses. Therefore, despite the antibodies provided to your infant with breast milk, it is important to adhere to vaccine recommendations.

Car Seat Safety Do’s & Don’tsIt’s important that new parents learn car seat safety before welcoming their baby.

Did you know?• Four out of five car seats are used/installed incorrectly• The back seat is the safest place for children to ride• Car seats reduce the risk of infant death in a crash by 71percentBuckling up the right way on every ride is the single most important thing a family can do to stay safe in a vehicle. Child restraints and seat belts, when installed and used properly, can prevent injuries and save lives.

Car Seat Safety InspectionsThese checks are provided by certif ied child passenger safety technicians to ensure proper fit and usage. Car seats will be checked with the most recent recall and expiration information. The technician will then make sure you have the correct seat for your child and ensure that it is correctly installed. Please try to install the car seat prior to your appointment and have your vehicle and car seat manuals available. Bring the child to be fit in the car seat, if applicable.

If you are an expectant parent, it is recommended to schedule fitting prior to your due date. Free car seat checks are available by appointment only. There may be additional community events scheduled as well.

Locations in Your Community:

POST DELIVERY 17

Calumet County 920.849.1432Calumet County Courthouse206 Court St, Chilton, WI

Winnebago County 920.231.6578Town of Menasha Fire Department1326 Cold Spring Rd, Neenah, WIWinnebago County Sheriff’s Department4311 Jackson St, Oshkosh, WI

Outagamie CountyPublic Health Department 920.832.5100Grand Chute Fire Department 920.738.22302250 West Grand Chute Blvd, Appleton, WI

Ascension 800.362.9900Offers appointments in Calumet, Outagamie, and Winnebago counties along with scheduled community events

WELCO

ME LETTER

WELCOME 1

Congratulations!Congratulations on your pregnancy! We are honored that you have chosen Women’s Health Specialists as your health care provider.

Did you know that Women’s Health Specialists has served women in the Fox Cities for more than 50 years? While many things have changed in the past 50 years, our passion for caring for women through each phase of their lives has not. We believe in educating and empowering women and providing personalized, compassionate care through clinical excellence.

Women’s Health Specialists is unique in that we are a private, physician-owned practice. We have three clinic locations in the Fox Cities to ensure that our patients have easy access to care, wherever it is most convenient, at ThedaCare Regional Medical Center - Appleton, ThedaCare Regional Medical Center - Neenah and Encircle Health.

Our physicians also have the privilege to practice and deliver babies at ThedaCare Regional Medical Center - Appleton, ThedaCare Regional Medical Center - Neenah and Ascension NE Wisconsin - St. Elizabeth Campus. Because of this, you can rest assured that wherever you go, we will be there to take exceptional care of both you and your baby!

Thank you again for putting your confidence in Women’s Health Specialists! We are excited to begin this pregnancy journey with you.

Postpartum DepressionAfter having a baby, many women get a mild type of postpartum depression called postpartum blues. Within two or three days after giving birth, you may be moody, irritable, anxious, crying or have trouble sleeping or concentrating. These symptoms usually resolve within two weeks. Women with postpartum depression, however, have more severe symptoms that last longer. Depression symptoms can start within a month after giving birth, but can last as long as 12 months. Women with a history of depression are more at risk for postpartum depression. It is important to contact your obstetrician if symptoms last longer than two weeks or if you are unable to care for yourself or your baby.

Newborn ScreeningPrior to discharge, but after your newborn is 24 hours old, a few drops of blood is taken from your baby’s heel and put onto a special test paper that is sent to the Wisconsin State Lab of Hygiene to be tested and screened for a number of conditions and disorders you wouldn’t know your baby has otherwise. With early detection, these conditions/disorders can be successfully treated. The test is simple, safe and the results will be delivered directly to your baby’s doctor.

SIDSSIDS stands for Sudden Infant Death Syndrome and is categorized as the unexplained death of a seemingly healthy baby less than one year old. This usually takes place while a baby is asleep. To lower your baby’s risk of SIDS, the following steps are recommended:

JaundiceNewborn jaundice is the yellowing of a baby’s skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. Sometimes a newborn’s still-developing liver may not be mature enough to remove bilirubin. Newborn jaundice typically goes away on its own as a baby’s liver develops and as the baby begins to feed. Bilirubin levels peak between three to seven days after birth. You should contact your baby’s doctor if the jaundice spreads or deepens in color, fever reaches over 100 degrees Fahrenheit, if your baby feeds poorly, becomes lethargic or makes a high-pitched cry. If treatment is needed, photo-therapy is commonly recommended.

Nursing Your Newborn After BirthWhen the placenta releases with delivery, this along with “suckling” of the infant, causes a change in hormones to stimulate lactation or the formation of milk in the breasts. This process actually begins at about 16 weeks of pregnancy, but is suppressed by hormones until after delivery.

16 POST DELIVERY

• Always put your baby to sleep on his or her back • Keep the crib as bare as possible. Use a firm crib mattress, and keep toys and extra blankets out• Have your baby sleep in your room but NOT in your bed• Don’t use commercial devices that claim to reduce the risk of SIDS

• Breastfeed your baby, if possible• Offer a pacifier at bedtime• Immunize your baby• DO NOT SMOKE around your baby• Keep your baby from overheating• Run a fan to keep air circulating

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3RD TRIMESTER 15

FMLA and short-term disability paperworkIf you are currently employed and plan to take time off of work following the delivery of your newborn, it is recommended that you discuss your leave with your employer. If possible, we recommend that you obtain and turn in any FMLA and short-term disability paperwork to your obstetrician prior to delivery. We will then complete the paperwork and return it to you within one week. Your paperwork can be faxed to 920.749.4015 or dropped off at our office.

CircumcisionMany parents elect to have their baby boys circumcised. Circumcision is a surgical procedure to remove the foreskin that covers the tip of the penis. This is an optional procedure. Possible benefits include a decreased risk of urinary tract infections, penile cancer and sexually transmitted diseases. There is a low risk of bleeding or infection. The baby might also feel some pain. Parents should make their decision based on the benefits and risks, as well as their own religious, cultural and personal preferences.

Vitamin K for NewbornsThe American Academy of Pediatrics strongly recommends that ALL newborns have Vitamin K administered within one hour after birth. Babies do not receive adequate Vitamin K from their mothers during pregnancy, or from their breast milk. Vitamin K is needed to help blood clot and prevent serious bleeding. Without Vitamin K, infants are at risk for developing Hemorrhagic Disease of the Newborn which can result in bleeding into the brain and cause severe disability or death. Giving newborns a single muscular injection of Vitamin K shortly after birth can prevent Hemorrhagic Disease of the Newborn until they are able to build up their own supply of Vitamin K. There are no significant side effects linked to the injection of Vitamin K. Giving your baby Vitamin K is a simple and safe way to prevent a very serious disease.

Ophthalmic ErythromycinErythromycin ointment is placed into your baby’s eyes shortly after delivery to prevent infection from gonorrhea or chlamydia which can lead to blindness. Erythromycin ointment is given to infants born to mothers even without a history of these infections because the infections can still be present with little to no symptoms. If the ointment were only given to babys whose mothers had known infections, many cases of preventable infections and/or blindness could occur. The ointment may cause cloudiness and sometimes some mild redness or swelling in the baby’s eyes for a few hours after application.

Postpartum VisitThe postpartum period begins when the infant is delivered and ends 6-8 weeks later. Recommended follow-up visits are at 1-2 weeks and six weeks for a cesarean section, and six weeks for a vaginal delivery. During this visit, the obstetrician will discuss your mood, sexual activity, contraception, pre-existing medical conditions, infant feeding method and the timing of future visits for health care screening.

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Analgesic:Medication, like Stadol, Nubain or Fentanyl, given to lessen the pain but still allows mobility in labor.

• Systemic medication which means it affects the whole body. • Administered in an IV or injected into a large muscle group. • Takes the “edge off” the peaks of your contractions and increases your ability to relax. May cause drowsiness.

Nitrous Oxide:Commonly called “laughing gas,” Nitrous Oxide can be used to lessen pain throughout labor, delivery and recovery. Also, Nitrous Oxide allows you to maintain mobility during labor. • Inhaled through a mask to relieve pain, decrease anxiety and induce euphoria. • Self-administered using a face mask. You decide how much to use and when to stop using it. A good alternative for those opposed to needles.

Epidural Anesthesia: Regional anesthetic administered by an anesthesiologist or nurse anesthetist that numbs your uterus, abdomen, lower back and possibly your lower extremities. • A thin, flexible catheter is inserted into your lower back and then the medication is injected into the catheter. • Alters your ability to feel pain without altering mental state. • Mobility in lower extremities is limited so you are confined to your bed.

14 3RD TRIMESTER

Mucous PlugThe mucous plug accumulates in the cervix during pregnancy. If your mucous plug comes out before 37 weeks, contact your obstetrician. After 37 weeks, labor could begin within hours or within 1-2 weeks. Losing your mucous plug does not necessarily mean labor is imminent.

Post-term PregnancyA post-term pregnancy, also called a prolonged pregnancy, is one that has extended beyond 42 weeks.

Signs of LaborEach labor experience is different and labor can start in many different ways. Your obstetrician will be able to advise if you can continue to monitor your symptoms at home, or if it’s time to head to the hospital. Only four percent of women will deliver on their due date. The normal duration of pregnancy is 37 to 42 weeks, which is referred to as “term.” Call the clinic or go to the hospital if:

• You have contractions every five minutes lasting about one minute for at least an hour • You are experiencing a lot of pain with frequent contractions even if they remain irregular• You experience your water breaking or leaking of vaginal fluid• You experience bright red vaginal bleeding• You experience decreased fetal movement• You are feeling like you have to push

Diet the Day of DeliveryIf your obstetrician has scheduled you for an induction, you should discuss with them if you can eat breakfast before you arrive. Typically you are allowed a “light” breakfast, but you should clarify with your obstetrician. If you are scheduled for a cesarean section, you should have NO food or drink for eight hours prior to the surgery. Once your baby is delivered, you will be able to eat and drink whatever you can tolerate.

Medication Options in Labor

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PATIENT NOTES:

DOB

DUE DATE

OBSTETRICIAN NAME

DATE BP WEIGHT FUNDAL HT. FHR ALBUMIN GLUCOSE

3RD TRIM

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3RD TRIMESTER 13

Tdap VaccinationAt 28 weeks of gestation, your obstetrician will recommend that you receive the Tdap vaccination. The Tdap vaccination protects against tetanus, diphtheria and pertussis. Pertussis, more commonly known as whooping cough, is a highly contagious disease that causes severe coughing and can be a life-threatening illness in newborns. When given in pregnancy, your body will make antibodies against pertussis to protect the baby after he or she is born. This vaccination is highly recommended for the well-being of yourself and your baby. If you have any concerns or have had a previous reaction to a vaccine, please discuss with your obstetrician.

Reference: The American College of Obstetricians and Gynecologists from the book “Your Pregnancy and Childbirth: Month to Month”

Gestational Diabetes ScreeningBetween 24 and 28 weeks, your obstetrician will have you do a glucose tolerance test. This test measures your body’s response to glucose in order to screen for gestational diabetes. Gestational diabetes is a type of diabetes that develops only during pregnancy. During the test, you will be given a sugary beverage that you will need to drink within 5 minutes. One hour later a blood sample will be taken to measure your glucose level. If your glucose level is elevated, then your obstetrician will have you do further testing.

Biophysical Profile (BPP)A biophysical profile is a test done in the third trimester, if indicated, to check on a baby’s well-being. The test is a fetal ultrasound to evaluate the baby’s heart rate, breathing, movements, muscle tone and amniotic fluid level.

Non-Stress Test (NST)The non-stress test is a simple, noninvasive way of checking on your baby’s health. This test records your baby’s movement, heartbeat and contractions. The NST involves attaching two belts to the mother’s abdomen. One belt is to measure fetal heart rate, and another to measure contractions. This is typically done in the third trimester if needed.

Group B StrepPregnant women between 35 and 37 weeks of gestation are screened by a vaginal swab for group B beta-hemolytic streptococcus (GBS). Women who have a positive result are treated

with antibiotics while they are in labor to prevent a possible infection in your baby.

If your baby does get GBS through the birthing process, there are some signs to be looking for such as poor feeding, a fever, sleeping more than usual, irritability or skin color being off. If GBS is not treated in the baby, it can be serious and lead to pneumonia or meningitis.

4 1ST TRIMESTER

Prenatal TestingThe following is a list of tests and screenings we offer to our prenatal patients:

• Blood type/antibody screen• Hemoglobin and hematocrit to check for anemia• Rubella to screen for immunity. If results come back negative, it’s important to avoid exposure to people with rubella and get vaccinated after delivery• Varicella, also known as chicken pox, to screen for immunity. If not positive, then it’s important to avoid people with active chicken pox• Urine protein to check for baseline protein level• Urine culture to check for infection as you can be symptom free and still have an infection• Pap test per OB guidelines• HIV • Syphilis• Hepatitis B • Chlamydia or Gonorrhea for treatment. If positive, then test for cure within three to four weeks and a retest three to four months• Genetic and aneuploidy screenings

Anticipated CareWe recommend the following prenatal care visits for first-time moms with an uncomplicated pregnancy history:

• Initiate care prior to 10 weeks• Every four weeks thereafter until 28 weeks• Every two weeks from 28 to 36 weeks• Weekly from 36 weeks until delivery

Moms with more risk factors will be seen more often.

Fetal Development Weeks 25-40

12 3RD TRIMESTER

Weeks 25-28

Your baby’s lungs begin to produce surfactant, a substance that is necessary for the baby’s lungs to function after he or she is born. The highest levels of surfactant production occur during the third trimester. Your baby can make grasping motions. His or her eyes can open and close and sense changes in light.

Weeks 30-33The lanugo, or fine hair that covers your baby’s body, begins to disappear; however some babies will still have patches of lanugo on their shoulders, back and ears when they are born. The hair on your baby’s head starts to grow and thicken. The baby begins to gain weight more quickly, about half a pound per week.

Weeks 34-35More fat is accumulating under the baby’s skin. Most babies will turn into a head-down position for birth if they have not already.

Weeks 36-37Your baby takes up a lot of space in the amniotic sac. There is not as much room for rolling and somersaults, but you will continue to feel strong kicks and good fetal movement.

Weeks 38-40The brain continues to grow and grows by one-third between weeks 35 to 39. The liver and lungs are also completing their growth during these last few weeks. You may feel your baby drop into your pelvis which is known as lightening.


Breast PumpIf you plan to breastfeed and/or pump-and-feed after delivery, then you may want to consider obtaining a breast pump. Through the Affordable Care Act, health insurances often provide a breast pump to you at no or a minimal cost. Please contact your insurance company to inquire about your insurance plan’s specifications on receiving a breast pump and what information they require from you and your obstetrician.

RhogamYour blood type and antibody screen will be done at your prenatal appointment. If you have a negative blood type you will need an injection of Rhogam anytime you bleed or spot during pregnancy and routinely at 28 weeks. This helps to prevent antibody formation from occurring if you are carrying a fetus with a positive blood type.

1ST TRIMESTER

Weeks 4-6The placenta begins to develop during this time frame and the neural tube begins to form. The brain, spinal cord and backbone will form from the neural tube. The heart, lungs, nose, mouth and ears begin to develop as well. Your baby is about the size of a pumpkin seed.

Week 8All major organs and body systems have begun to form. Your baby is about the size of a raspberry.

Weeks 9-12The intestines begin to develop and buds for future teeth appear. The bones start to harden and muscles begin to develop. Your baby moves on his or her own now but you will not be able to feel this movement until the second trimester. Your baby is about the size of a plum.



1ST TRIMESTER 5

Nausea & VomitingNausea and vomiting is a common condition in pregnancy. Even though it is often referred to as morning sickness, it can occur at any time of the day. Typically, it is not harmful to you or your developing baby, but it can cause discomfort. • Try “bland” low-fat meals (bananas, rice, applesauce, toast and tea) • Try dry toast or crackers prior to getting out of bed in the morning• Eat small frequent meals/snacks throughout the day instead of three large meals• Drink small amounts of fluids often. If water is not agreeable, try water with lemon, Ginger Ale or Gatorade• Avoid smells that bother you• Ginger products can help with nausea: ginger tea, ginger candy, ginger capsules or Ginger Ale • If you find your prenatal vitamin makes the nausea worse, try to take it at bedtime with a snack instead of in the morning • Over-the-counter Vitamin B6 and Doxylamine (Unisom)* are safe medications that can be taken for nausea in pregnancy. 10-25 mg of Vitamin B6 can be taken 3 to 4 times daily, alone or with the Doxylamine (Unisom)

*Doxylamine (Unisom) can cause drowsiness so it is best to take it before bedtime. Half of a tablet is often tolerable during the day.

If your nausea and vomiting is not improving with the above recommendations, please notify your obstetrician.

Reference: https://www.acog.org/Patients/FAQs/Morning-Sickness- Nausea-and-Vomiting-of-Pregnancy

Influenza VaccinationThe influenza vaccination is recommended for all pregnant women at any point during their pregnancy. Pregnant women are at an increased risk of complications from the flu. If you have questions or concerns, it’s important you express those to your obstetrician beforehand.

Medication UseOnce you learn you’re expecting, we recommend that you discontinue any non-prescribed medications, or supplements. However, we do recommend that you take a prenatal vitamin with DHA. It’s important to discuss all prescription medications with your obstetrician at your first prenatal appointment or by phone beforehand. For a list of safe over-the-counter medications, visit foxvalleyobgyn.com/medications.

UltrasoundsTo help date your pregnancy, you will have an ultrasound scheduled with your prenatal appointment. There will also be an ultrasound scheduled around 20 weeks to look for structural anomalies in the fetus. Any other ultrasounds are done at the discretion of your obstetrician.

6 1ST TRIMESTER

Boy or Girl RevealIf you choose to know the sex of your baby prior to delivery, we can typically provide that information at your 20-week ultrasound. This can be communicated in-person or we can write that information on a reveal card to be opened later. From there, the possibilities are endless for a special reveal party. Happy planning!

Baby Shower PlanningMany women choose to have a baby shower in the weeks leading up to their baby’s due date. Having a baby shower is a personal choice, but can help parents prepare for their baby’s arrival. To get started with planning, we recommend you talk with your loved ones about hosting the shower and consider registering for things you know you will need once your baby arrives. You can find endless baby shower ideas on Pinterest or through a quick internet search. Follow us on Pinterest!

NurseryGetting your nursery prepared as your due date nears is exciting for both moms-and-dads-to-be. You will want a safe sleeping space for your baby without bumpers. It’s a good idea to baby proof the room, such as using anti-tip restraints on dressers or bookshelves, using outlet protectors, and ensuring no cords are within a child’s reach. You might choose to have a certain color palette or theme for the room. Both you and your baby will spend many hours in the nursery dreaming and playing.

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TRIMESTER

2ND TRIMESTER 11

Kick CountsFetal movement is an excellent indicator of a baby’s well-being. Kick counting involves the counting and tracking fetal movements. A reliable kick counting record can document changes in the fetal movement pattern, allowing expectant mothers to alert their obstetrician of potential problems.

Here are tips for counting kicks:• Choose a time when the baby is active, such as after a meal• Sit comfortably or lie on your side• Write down the time when you feel your baby move• Count each movement until the baby has moved 10 times (This can take from 20 minutes to two hours)

• Try to do it at the same time each day

If you don’t meet 10 kicks in two hours or you notice a significant change in your baby’s normal pattern, notify your obstetrician immediately.

Sleeping PositionsIt is recommended that pregnant women do not sleep flat on their back or stomach after 16 -18 weeks. Pregnant women should lie on either side or place a pillow under their hip so the body is tilted but not flat. A body pillow often helps too.

Leaking BreastsDuring pregnancy your breasts may leak a yellowish fluid called colostrum. This is completely normal. Leaking breasts are most common in the 3rd trimester, but can happen at anytime during pregnancy or not at all.

10 2ND TRIMESTER 1ST TRIMESTER 7

Weight Gain Guidelines

Underweight <18.5 28-40 lbs.

Normal 18.5 - 24.9 25-35 lbs.

Overweight 25-29.9 15-25 lbs.

Obese >30 11-20 lbs.

Reference: Obstetrics & Gynecology, Number 548, January 2013 (Reaffirmed 2018)

For guidelines to healthy eating visit: Choosemyplate.gov


PRE-PREGNANCY WEIGHT CATEGORY BODY MASS INDEX

RECOMMENDED RANGE OF TOTAL WEIGHT GAIN (lb)

1ST TRIMESTER

88 2ND TRIMESTER

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Choosing a Doctor For Your Baby Now is a good time to think of who you want to care for your baby after delivery. Some patients choose to see a pediatrician while others prefer to see a family practice physician. It is important to ensure that your provider is accepting new patients. Typically if the physician you choose is already seeing someone within your household, then he or she will accept care for a new family member. When arriving at the hospital for delivery, the nurse will ask who you would like to care for your child following delivery. They will ensure that your doctor, or rounding hospitalist, sees your child

during their hospital stay.

To get started finding your baby a doctor, we suggest visiting the following resources:

1 ThedaCare: thedacare.org/find-a-doctor You will be able to search for a family practice physician and/or pediatrician and review the doctor’s profile. Be sure to select “Accepting New Patients”

when searching.

2 Ascension: healthcare.ascension.org/doctors You will be able to search for a family practice physician and/or pediatrician and review the doctor’s profile. You may have to call their office to ensure the doctor you choose is accepting new patients.

Choosing Childcare If you will be needing childcare after delivery, it is a good time to start researching your options. We recommend considering the following when choosing the best fit for your baby:

• What is the cost and how are payments made?

• What is the caregiver ratio to children and how many children attend the day care?

• Is the caregiver licensed/accredited? If so, by whom?

• What meals and snacks are served? Who provides the food?

• What is a typical day like?

• What is the policy on behavioral problems/discipline?

• What degrees or certificates do the staff have?

• What security measures are in place?

• Are there any days or weeks that they are closed?

• Can parents check in throughout the day or drop in?

• Do they offer in-home services?

• Could family members help out?

2ND TRIMESTER 9

Weeks 13 to 16 The eyes begin to move and your baby’s arms and legs can flex. The organs for taste and smell are developing as well. Your baby’s kidneys are now producing urine. The eyelids, ears and upper lip can be seen and he or she can hear sounds.

Weeks 17 to 20The skin glands begin to produce vernix, a waxy material that acts as a waterproof barrier to protect the baby’s skin. Soft hair called lanugo starts to form and cover your baby’s body. Your baby’s movements become stronger and you may start to feel his or her first kicks. By week 20, your baby is about the size of a small cantaloupe.

Weeks 21 to 24You may notice your baby reacting more to certain sounds, especially loud noises. He or she may respond with startled movements and move his or her arms and legs. You can also detect if baby is having hiccups, which often feel like jolting movements that are rhythmic. Your baby can respond with movement to familiar sounds, such as your voice. His or her lungs are fully formed but not yet ready to function outside the womb.


When To Call UsThe health of you and your baby are very important to us. Call us if you feel like something isn’t right or if you experience any of these symptoms:

• Sudden puffiness in hands or feet

• Blurred vision

• Fever of 100.4 degrees or higher

• Pain during urination

• Feeling like you may faint or pass out

• Vomiting for 24 hours

• Low backache

Where to go in an emergency: • Less than 37 weeks:

ThedaCare Regional Medical Center - Neenah

Ascension St. Elizabeth Hospital - Appleton

• More than 37 weeks:

ThedaCare Regional Medical Center - Appleton

ThedaCare Regional Medical Center - Neenah

Ascension St. Elizabeth Hospital - Appleton


• Increased uterine activity

• Menstrual-like cramps

• Diarrhea

• Increased pelvic pressure

• Vaginal leaking of fluid

• Spotting or bleeding

Kick CountsFetal movement is an excellent indicator of a baby’s well-being. Kick counting involves the counting and tracking fetal movements. A reliable kick counting record can document changes in the fetal movement pattern, allowing expectant mothers to alert their obstetrician of potential problems.

Here are tips for counting kicks:• Choose a time when the baby is active, such as after a meal• Sit comfortably or lie on your side• Write down the time when you feel your baby move• Count each movement until the baby has moved 10 times (This can take from 20 minutes to two hours)

• Try to do it at the same time each day

If you don’t meet 10 kicks in two hours or you notice a significant change in your baby’s normal pattern, notify your obstetrician immediately.

Sleeping PositionsIt is recommended that pregnant women do not sleep flat on their back or stomach after 16 -18 weeks. Pregnant women should lie on either side or place a pillow under their hip so the body is tilted but not flat. A body pillow often helps too.

Leaking BreastsDuring pregnancy your breasts may leak a yellowish fluid called colostrum. This is completely normal. Leaking breasts are most common in the 3rd trimester, but can happen at anytime during pregnancy or not at all.

10 2ND TRIMESTER 1ST TRIMESTER 7

Weight Gain Guidelines

Underweight <18.5 28-40 lbs.

Normal 18.5 - 24.9 25-35 lbs.

Overweight 25-29.9 15-25 lbs.

Obese >30 11-20 lbs.

Reference: Obstetrics & Gynecology, Number 548, January 2013 (Reaffirmed 2018)

For guidelines to healthy eating visit: Choosemyplate.gov


PRE-PREGNANCY WEIGHT CATEGORY BODY MASS INDEX

RECOMMENDED RANGE OF TOTAL WEIGHT GAIN (lb)

1ST TRIMESTER

Influenza VaccinationThe influenza vaccination is recommended for all pregnant women at any point during their pregnancy. Pregnant women are at an increased risk of complications from the flu. If you have questions or concerns, it’s important you express those to your obstetrician beforehand.

Medication UseOnce you learn you’re expecting, we recommend that you discontinue any non-prescribed medications, or supplements. However, we do recommend that you take a prenatal vitamin with DHA. It’s important to discuss all prescription medications with your obstetrician at your first prenatal appointment or by phone beforehand. For a list of safe over-the-counter medications, visit foxvalleyobgyn.com/medications.

UltrasoundsTo help date your pregnancy, you will have an ultrasound scheduled with your prenatal appointment. There will also be an ultrasound scheduled around 20 weeks to look for structural anomalies in the fetus. Any other ultrasounds are done at the discretion of your obstetrician.

6 1ST TRIMESTER

Boy or Girl RevealIf you choose to know the sex of your baby prior to delivery, we can typically provide that information at your 20-week ultrasound. This can be communicated in-person or we can write that information on a reveal card to be opened later. From there, the possibilities are endless for a special reveal party. Happy planning!

Baby Shower PlanningMany women choose to have a baby shower in the weeks leading up to their baby’s due date. Having a baby shower is a personal choice, but can help parents prepare for their baby’s arrival. To get started with planning, we recommend you talk with your loved ones about hosting the shower and consider registering for things you know you will need once your baby arrives. You can find endless baby shower ideas on Pinterest or through a quick internet search. Follow us on Pinterest!

NurseryGetting your nursery prepared as your due date nears is exciting for both moms-and-dads-to-be. You will want a safe sleeping space for your baby without bumpers. It’s a good idea to baby proof the room, such as using anti-tip restraints on dressers or bookshelves, using outlet protectors, and ensuring no cords are within a child’s reach. You might choose to have a certain color palette or theme for the room. Both you and your baby will spend many hours in the nursery dreaming and playing.

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TRIMESTER

2ND TRIMESTER 11


12 3RD TRIMESTER

Weeks 25-28

Your baby’s lungs begin to produce surfactant, a substance that is necessary for the baby’s lungs to function after he or she is born. The highest levels of surfactant production occur during the third trimester. Your baby can make grasping motions. His or her eyes can open and close and sense changes in light.

Weeks 30-33The lanugo, or fine hair that covers your baby’s body, begins to disappear; however some babies will still have patches of lanugo on their shoulders, back and ears when they are born. The hair on your baby’s head starts to grow and thicken. The baby begins to gain weight more quickly, about half a pound per week.

Weeks 34-35More fat is accumulating under the baby’s skin. Most babies will turn into a head-down position for birth if they have not already.

Weeks 36-37Your baby takes up a lot of space in the amniotic sac. There is not as much room for rolling and somersaults, but you will continue to feel strong kicks and good fetal movement.

Weeks 38-40The brain continues to grow and grows by one-third between weeks 35 to 39. The liver and lungs are also completing their growth during these last few weeks. You may feel your baby drop into your pelvis which is known as lightening.


Breast PumpIf you plan to breastfeed and/or pump-and-feed after delivery, then you may want to consider obtaining a breast pump. Through the Affordable Care Act, health insurances often provide a breast pump to you at no or a minimal cost. Please contact your insurance company to inquire about your insurance plan’s specifications on receiving a breast pump and what information they require from you and your obstetrician.


1ST TRIMESTER

Weeks 4-6The placenta begins to develop during this time frame and the neural tube begins to form. The brain, spinal cord and backbone will form from the neural tube. The heart, lungs, nose, mouth and ears begin to develop as well. Your baby is about the size of a pumpkin seed.

Week 8All major organs and body systems have begun to form. Your baby is about the size of a raspberry.

Weeks 9-12The intestines begin to develop and buds for future teeth appear. The bones start to harden and muscles begin to develop. Your baby moves on his or her own now but you will not be able to feel this movement until the second trimester. Your baby is about the size of a plum.



1ST TRIMESTER 5

Nausea & VomitingNausea and vomiting is a common condition in pregnancy. Even though it is often referred to as morning sickness, it can occur at any time of the day. Typically, it is not harmful to you or your developing baby, but it can cause discomfort. • Try “bland” low-fat meals (bananas, rice, applesauce, toast and tea) • Try dry toast or crackers prior to getting out of bed in the morning• Eat small frequent meals/snacks throughout the day instead of three large meals• Drink small amounts of fluids often. If water is not agreeable, try water with lemon, Ginger Ale or Gatorade• Avoid smells that bother you• Ginger products can help with nausea: ginger tea, ginger candy, ginger capsules or Ginger Ale • If you find your prenatal vitamin makes the nausea worse, try to take it at bedtime with a snack instead of in the morning • Over-the-counter Vitamin B6 and Doxylamine (Unisom)* are safe medications that can be taken for nausea in pregnancy. 10-25 mg of Vitamin B6 can be taken 3 to 4 times daily, alone or with the Doxylamine (Unisom)

*Doxylamine (Unisom) can cause drowsiness so it is best to take it before bedtime. Half of a tablet is often tolerable during the day.

If your nausea and vomiting is not improving with the above recommendations, please notify your obstetrician.

Reference: https://www.acog.org/Patients/FAQs/Morning-Sickness- Nausea-and-Vomiting-of-Pregnancy

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Tdap VaccinationAt 28 weeks of gestation, your obstetrician will recommend that you receive the Tdap vaccination. The Tdap vaccination protects against tetanus, diphtheria and pertussis. Pertussis, more commonly known as whooping cough, is a highly contagious disease that causes severe coughing and can be a life-threatening illness in newborns. When given in pregnancy, your body will make antibodies against pertussis to protect the baby after he or she is born. This vaccination is highly recommended for the well-being of yourself and your baby. If you have any concerns or have had a previous reaction to a vaccine, please discuss with your obstetrician.


Gestational Diabetes ScreeningBetween 24 and 28 weeks, your obstetrician will have you do a glucose tolerance test. This test measures your body’s response to glucose in order to screen for gestational diabetes. Gestational diabetes is a type of diabetes that develops only during pregnancy. During the test, you will be given a sugary beverage that you will need to drink within 5 minutes. One hour later a blood sample will be taken to measure your glucose level. If your glucose level is elevated, then your obstetrician will have you do further testing.

Biophysical Profile (BPP)A biophysical profile is a test done in the third trimester, if indicated, to check on a baby’s well-being. The test is a fetal ultrasound to evaluate the baby’s heart rate, breathing, movements, muscle tone and amniotic fluid level.

Non-Stress Test (NST)The non-stress test is a simple, noninvasive way of checking on your baby’s health. This test records your baby’s movement, heartbeat and contractions. The NST involves attaching two belts to the mother’s abdomen. One belt is to measure fetal heart rate, and another to measure contractions. This is typically done in the third trimester if needed.

Group B StrepPregnant women between 35 and 37 weeks of gestation are screened by a vaginal swab for group B beta-hemolytic streptococcus (GBS). Women who have a positive result are treated

with antibiotics while they are in labor to prevent a possible infection in your baby.

If your baby does get GBS through the birthing process, there are some signs to be looking for such as poor feeding, a fever, sleeping more than usual, irritability or skin color being off. If GBS is not treated in the baby, it can be serious and lead to pneumonia or meningitis.

4 1ST TRIMESTER

Prenatal TestingThe following is a list of tests and screenings we offer to our prenatal patients:

• Blood type/antibody screen• Hemoglobin and hematocrit to check for anemia• Rubella to screen for immunity. If results come back negative, it’s important to avoid exposure to people with rubella and get vaccinated after delivery• Varicella, also known as chicken pox, to screen for immunity. If not positive, then it’s important to avoid people with active chicken pox• Urine protein to check for baseline protein level• Urine culture to check for infection as you can be symptom free and still have an infection• Pap test per OB guidelines• HIV • Syphilis• Hepatitis B • Chlamydia or Gonorrhea for treatment. If positive, then test for cure within three to four weeks and a retest three to four months• Genetic and aneuploidy screenings

Anticipated CareWe recommend the following prenatal care visits for first-time moms with an uncomplicated pregnancy history:

• Initiate care prior to 10 weeks• Every four weeks thereafter until 28 weeks• Every two weeks from 28 to 36 weeks• Weekly from 36 weeks until delivery

Moms with more risk factors will be seen more often.

Analgesic:Medication, like Stadol, Nubain or Fentanyl, given to lessen the pain but still allows mobility in labor.

• Systemic medication which means it affects the whole body. • Administered in an IV or injected into a large muscle group. • Takes the “edge off” the peaks of your contractions and increases your ability to relax. May cause drowsiness.

Nitrous Oxide:Commonly called “laughing gas,” Nitrous Oxide can be used to lessen pain throughout labor, delivery and recovery. Also, Nitrous Oxide allows you to maintain mobility during labor. • Inhaled through a mask to relieve pain, decrease anxiety and induce euphoria. • Self-administered using a face mask. You decide how much to use and when to stop using it. A good alternative for those opposed to needles.

Epidural Anesthesia: Regional anesthetic administered by an anesthesiologist or nurse anesthetist that numbs your uterus, abdomen, lower back and possibly your lower extremities. • A thin, flexible catheter is inserted into your lower back and then the medication is injected into the catheter. • Alters your ability to feel pain without altering mental state. • Mobility in lower extremities is limited so you are confined to your bed.

14 3RD TRIMESTER

Mucous PlugThe mucous plug accumulates in the cervix during pregnancy. If your mucous plug comes out before 37 weeks, contact your obstetrician. After 37 weeks, labor could begin within hours or within 1-2 weeks. Losing your mucous plug does not necessarily mean labor is imminent.

Post-term PregnancyA post-term pregnancy, also called a prolonged pregnancy, is one that has extended beyond 42 weeks.

Signs of LaborEach labor experience is different and labor can start in many different ways. Your obstetrician will be able to advise if you can continue to monitor your symptoms at home, or if it’s time to head to the hospital. Only four percent of women will deliver on their due date. The normal duration of pregnancy is 37 to 42 weeks, which is referred to as “term.” Call the clinic or go to the hospital if:

• You have contractions every five minutes lasting about one minute for at least an hour • You are experiencing a lot of pain with frequent contractions even if they remain irregular• You experience your water breaking or leaking of vaginal fluid• You experience bright red vaginal bleeding• You experience decreased fetal movement• You are feeling like you have to push

Diet the Day of DeliveryIf your obstetrician has scheduled you for an induction, you should discuss with them if you can eat breakfast before you arrive. Typically you are allowed a “light” breakfast, but you should clarify with your obstetrician. If you are scheduled for a cesarean section, you should have NO food or drink for eight hours prior to the surgery. Once your baby is delivered, you will be able to eat and drink whatever you can tolerate.

Medication Options in Labor

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FMLA and short-term disability paperworkIf you are currently employed and plan to take time off of work following the delivery of your newborn, it is recommended that you discuss your leave with your employer. If possible, we recommend that you obtain and turn in any FMLA and short-term disability paperwork to your obstetrician prior to delivery. We will then complete the paperwork and return it to you within one week. Your paperwork can be faxed to 920.749.4015 or dropped off at our office.

CircumcisionMany parents elect to have their baby boys circumcised. Circumcision is a surgical procedure to remove the foreskin that covers the tip of the penis. This is an optional procedure. Possible benefits include a decreased risk of urinary tract infections, penile cancer and sexually transmitted diseases. There is a low risk of bleeding or infection. The baby might also feel some pain. Parents should make their decision based on the benefits and risks, as well as their own religious, cultural and personal preferences.

Vitamin K for NewbornsThe American Academy of Pediatrics strongly recommends that ALL newborns have Vitamin K administered within one hour after birth. Babies do not receive adequate Vitamin K from their mothers during pregnancy, or from their breast milk. Vitamin K is needed to help blood clot and prevent serious bleeding. Without Vitamin K, infants are at risk for developing Hemorrhagic Disease of the Newborn which can result in bleeding into the brain and cause severe disability or death. Giving newborns a single muscular injection of Vitamin K shortly after birth can prevent Hemorrhagic Disease of the Newborn until they are able to build up their own supply of Vitamin K. There are no significant side effects linked to the injection of Vitamin K. Giving your baby Vitamin K is a simple and safe way to prevent a very serious disease.

Ophthalmic ErythromycinErythromycin ointment is placed into your baby’s eyes shortly after delivery to prevent infection from gonorrhea or chlamydia which can lead to blindness. Erythromycin ointment is given to infants born to mothers even without a history of these infections because the infections can still be present with little to no symptoms. If the ointment were only given to babys whose mothers had known infections, many cases of preventable infections and/or blindness could occur. The ointment may cause cloudiness and sometimes some mild redness or swelling in the baby’s eyes for a few hours after application.

Postpartum VisitThe postpartum period begins when the infant is delivered and ends 6-8 weeks later. Recommended follow-up visits are at 1-2 weeks and six weeks for a cesarean section, and six weeks for a vaginal delivery. During this visit, the obstetrician will discuss your mood, sexual activity, contraception, pre-existing medical conditions, infant feeding method and the timing of future visits for health care screening.

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WELCO

ME LETTER

WELCOME 1

Congratulations!Congratulations on your pregnancy! We are honored that you have chosen Women’s Health Specialists as your health care provider.

Did you know that Women’s Health Specialists has served women in the Fox Cities for more than 50 years? While many things have changed in the past 50 years, our passion for caring for women through each phase of their lives has not. We believe in educating and empowering women and providing personalized, compassionate care through clinical excellence.

Women’s Health Specialists is unique in that we are a private, physician-owned practice. We have three clinic locations in the Fox Cities to ensure that our patients have easy access to care, wherever it is most convenient, at ThedaCare Regional Medical Center - Appleton, ThedaCare Regional Medical Center - Neenah and Encircle Health.

Our physicians also have the privilege to practice and deliver babies at ThedaCare Regional Medical Center - Appleton, ThedaCare Regional Medical Center - Neenah and Ascension NE Wisconsin - St. Elizabeth Campus. Because of this, you can rest assured that wherever you go, we will be there to take exceptional care of both you and your baby!

Thank you again for putting your confidence in Women’s Health Specialists! We are excited to begin this pregnancy journey with you.

Postpartum DepressionAfter having a baby, many women get a mild type of postpartum depression called postpartum blues. Within two or three days after giving birth, you may be moody, irritable, anxious, crying or have trouble sleeping or concentrating. These symptoms usually resolve within two weeks. Women with postpartum depression, however, have more severe symptoms that last longer. Depression symptoms can start within a month after giving birth, but can last as long as 12 months. Women with a history of depression are more at risk for postpartum depression. It is important to contact your obstetrician if symptoms last longer than two weeks or if you are unable to care for yourself or your baby.

Newborn ScreeningPrior to discharge, but after your newborn is 24 hours old, a few drops of blood is taken from your baby’s heel and put onto a special test paper that is sent to the Wisconsin State Lab of Hygiene to be tested and screened for a number of conditions and disorders you wouldn’t know your baby has otherwise. With early detection, these conditions/disorders can be successfully treated. The test is simple, safe and the results will be delivered directly to your baby’s doctor.

SIDSSIDS stands for Sudden Infant Death Syndrome and is categorized as the unexplained death of a seemingly healthy baby less than one year old. This usually takes place while a baby is asleep. To lower your baby’s risk of SIDS, the following steps are recommended:

JaundiceNewborn jaundice is the yellowing of a baby’s skin and eyes. Newborn jaundice is very common and can occur when babies have a high level of bilirubin, a yellow pigment produced during the normal breakdown of red blood cells. Sometimes a newborn’s still-developing liver may not be mature enough to remove bilirubin. Newborn jaundice typically goes away on its own as a baby’s liver develops and as the baby begins to feed. Bilirubin levels peak between three to seven days after birth. You should contact your baby’s doctor if the jaundice spreads or deepens in color, fever reaches over 100 degrees Fahrenheit, if your baby feeds poorly, becomes lethargic or makes a high-pitched cry. If treatment is needed, photo-therapy is commonly recommended.

Nursing Your Newborn After BirthWhen the placenta releases with delivery, this along with “suckling” of the infant, causes a change in hormones to stimulate lactation or the formation of milk in the breasts. This process actually begins at about 16 weeks of pregnancy, but is suppressed by hormones until after delivery.

16 POST DELIVERY

• Always put your baby to sleep on his or her back • Keep the crib as bare as possible. Use a firm crib mattress, and keep toys and extra blankets out• Have your baby sleep in your room but NOT in your bed• Don’t use commercial devices that claim to reduce the risk of SIDS

• Breastfeed your baby, if possible• Offer a pacifier at bedtime• Immunize your baby• DO NOT SMOKE around your baby• Keep your baby from overheating• Run a fan to keep air circulating

ENCIRCLE HEALTH2500 E Capitol Drive • Suite 1650Appleton, WI 54911

THEDACARE - APPLETON1818 N Meade Street • Suite 330Appleton, WI 54911

THEDACARE - NEENAH200 Theda Clark Medical Plaza • Suite 270Neenah, WI 54956

PHONE 920.749.4000FoxValleyOBGYN.com

POST D

ELIVERY

Feeding Your BabyWhether you choose to breastfeed, bottle feed or do a combination of the two, you need to be comfortable with your decision on how to feed your infant. Many women find it helpful to discuss their feeding plan with their obstetrician, pediatrician, primary care provider, lactation consultant or friends and family. Women’s Health Specialists has a lactation consultant that sees patients before and after delivery. Call the office to schedule an appointment. There are many things to consider, but in the end the decision has to be right for you.

Breast milk provides a type of immunity to an infant called passive immunity. Colostrum is the first milk a woman produces when she begins to breastfeed, and it contains large numbers of antibodies called secretary immunoglobulin. This protection is invaluable to a newborn. However, it only protects against infection through their digestive tract; it does not provide bloodstream antibodies to protect against various vaccine-avoidable illnesses. Therefore, despite the antibodies provided to your infant with breast milk, it is important to adhere to vaccine recommendations.

Car Seat Safety Do’s & Don’tsIt’s important that new parents learn car seat safety before welcoming their baby.

Did you know?• Four out of five car seats are used/installed incorrectly• The back seat is the safest place for children to ride• Car seats reduce the risk of infant death in a crash by 71percentBuckling up the right way on every ride is the single most important thing a family can do to stay safe in a vehicle. Child restraints and seat belts, when installed and used properly, can prevent injuries and save lives.

Car Seat Safety InspectionsThese checks are provided by certif ied child passenger safety technicians to ensure proper fit and usage. Car seats will be checked with the most recent recall and expiration information. The technician will then make sure you have the correct seat for your child and ensure that it is correctly installed. Please try to install the car seat prior to your appointment and have your vehicle and car seat manuals available. Bring the child to be fit in the car seat, if applicable.

If you are an expectant parent, it is recommended to schedule fitting prior to your due date. Free car seat checks are available by appointment only. There may be additional community events scheduled as well.

Locations in Your Community:

POST DELIVERY 17

Calumet County 920.849.1432Calumet County Courthouse206 Court St, Chilton, WI

Winnebago County 920.231.6578Town of Menasha Fire Department1326 Cold Spring Rd, Neenah, WIWinnebago County Sheriff’s Department4311 Jackson St, Oshkosh, WI

Outagamie CountyPublic Health Department 920.832.5100Grand Chute Fire Department 920.738.22302250 West Grand Chute Blvd, Appleton, WI

Ascension 800.362.9900Offers appointments in Calumet, Outagamie, and Winnebago counties along with scheduled community events

healthypregnancyguideSM

Do’s & Don’tsPrenatal VitaminsPregnant women should consume the following each day through diet or supplements:• Folic acid 400-800 micro-grams (until the end of the first trimester)• Iron 30 mg (or be screened for anemia)

Prenatal vitamins are unlikely to be harmful, therefore they can be used to ensure adequate consumption of several vitamins and minerals in pregnancy. However, their necessity for all pregnant women is uncertain, especially for women with well-balanced diets.

Nutrition & Weight GainPregnant women should be advised to eat a healthy, well-balanced diet and typically should increase their caloric intake by 350-450 calories/day. Women with higher BMIs do not need to gain the same amount of weight as women with normal or low BMIs.

AlcoholAlthough current data suggests that consumption of small amounts of alcohol during pregnancy (less than 7-9 drinks per week) does not appear to be harmful to the fetus, the exact threshold between safe and unsafe, if it exists, is unknown. Therefore, alcohol should be avoided in pregnancy.

Artificial SweetenersArtificial sweeteners can be used in pregnancy. Data regarding saccharin are conflicting. Low (typical) consumption is likely safe.

Fish ConsumptionPregnant women should try to consume two to three servings per week of fish with a high DHA and low mercury content. For women who do not achieve this, it is unknown whether DHA and n-3 PUFA supplementation are beneficial, but they are unlikely to be harmful.

Raw & Undercooked FishIn line with current recommendations, pregnant women should avoid undercooked fish. However, sushi that was prepared in a clean and reputable establishment is unlikely to pose a risk to the pregnancy.

Other Foods to Avoid• Raw, undercooked meat and unpasteurized dairy products• Foods being recalled for possible Listeria contamination• Unheated deli meats could also increase the risk of Listeria, but the risk in recent years is uncertain.

Wash vegetables and fruit before eating them.

Exercise & Bed-RestPregnant women are encouraged to exercise regularly. There is no known benefit to activity restriction or bed-rest.

Reference: Obstetrics & Gynecology, April 2018, Volume 131 Issue 4

CaffeineLow-to-moderate caffeine intake in pregnancy does not appear to be associated with any adverse outcomes. Pregnant women may have caffeine, but should limit it to less than 300 mg/day (typical 8-ounce cup of brewed coffee has approximately 130 mg of caffeine). An 8-ounce cup of tea or 12-ounce soda has approximately 50 mg of caffeine, but exact amounts vary based on the specific beverage or food.

Smoking, Nicotine & VapingWomen should not smoke cigarettes during pregnancy. If they are unable to quit, they should reduce it as much as possible. Nicotine replacement (with patches or gum) is appropriate as part of a smoking cessation strategy.

MarijuanaMarijuana use is not known to be associated with any adverse outcomes in pregnancy. However, data regarding long-term neurodevelopmental outcomes are lacking; therefore, marijuana use is currently not recommended in pregnancy.

Oral HealthOral health and dental procedures can continue as scheduled.

Avoiding InjuryPregnant women should wear lap and shoulder seat belts while in motor vehicles and should not disable their airbags.

Hot Tubs & SwimmingAlthough data is limited, pregnant women should avoid hot tub use in the first trimester. Swimming pool use is not discouraged during pregnancy.

Hair DyesAlthough data is limited, because systemic absorption is minimal, hair dye is presumed to be safe in pregnancy.

TravelAirline travel is safe in pregnancy. Make sure you are familiar with the infection exposures and available medical care for each specific destination. There is no specific gestational age at which women must stop travel. Airline travel is typically not recommended after 36 weeks. Pregnant women must balance the benefit of the trip with the potential of a complication at her destination. Avoid areas with Zika Virus exposure risk.

Insect RepellentsTopical insect repellents (including DEET) can be used in pregnancy and should be used in areas with high risk for insect-borne illnesses.

Sexual IntercourseThere are no restrictions regarding sexual intercourse during pregnancy unless you are bleeding, have placenta previa at greater than 20 weeks of gestation, or ruptured membranes.

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