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Home , Amniocentesis, Prenatal testing

August 2014

Prenatal

NEW YORK STATE HEALTH INSURANCE PROGRAM Care (NYSHIP) for Empire Plan enrollees and for their enrolled dependents, COBRA enrollees with their Empire Plan Congratulations on your benefits and Young Adult Option enrollees ! Every baby deserves a healthy beginning. You can take steps before your baby is even born to help Five Important Steps to Having a Healthy Baby ensure a great start for your 1. Call your doctor infant. That’s why The Empire As soon as you think you are pregnant, call your doctor. Plan offers mother and baby You can do the most for your baby during the first three the coverage you need. months of pregnancy, so try to start your doctor visits as When your primary coverage soon as possible. is The Empire Plan, The The Empire Plan covers your maternity care under the Empire Plan Future Moms Medical/Surgical Program. You may choose a participating Program provides you with or non-participating provider for your maternity care. special services. Participating Provider If you choose a participating provider (obstetrician, family practice physician or certified nurse-), there are no copayments for prenatal visits, delivery or your six-week checkup 3 Early Symptoms of Pregnancy after delivery. You pay only your copayment for covered services 4 Take Action to Be Healthy at participating laboratories. Exercise During Pregnancy To locate an Empire Plan participating provider or laboratory, call 5 The Empire Plan toll free at 1-877-7-NYSHIP (1-877-769-7447) 6 The Future Moms Program and select the Medical Program. Or, visit the New York State 7 Your Healthy Diet During Pregnancy Department of Civil Service web site at https://www.cs.ny.gov. 8 Medications and Pregnancy Select Benefit Programs, then NYSHIP Online. Follow the prompts to the NYSHIP Online home page, and click on Find a Provider. Skincare Products to Avoid Always check with the provider before you receive services to make 9 Feeding Your Baby sure he or she participates in The Empire Plan for New York State 10 New Parents government employees. 11 Choosing Your Baby’s Doctor Spending 12 Extended Care: Medical Case Management This issue of Reporting On is for information purposes only. 13 Postpartum Depression Please see your doctor for diagnosis and treatment. Read your plan materials for complete information about coverage. 14 Questions and Answers 16 Resources Non-Participating Provider The maternity specialist will ask For more information on the If you choose a non-participating you some questions to determine services offered by the Future provider (obstetrician, family if there are any potential concerns. Moms Program, see page 6. practice physician or certified Questions may include: 4. Be informed nurse-midwife), after the annual • Is this your first pregnancy? Ask your doctor or nurse-midwife, deductible is met, The Empire • Have you had problems during the doctor’s nurse and the maternity Plan pays 80 percent of the previous ? specialist questions. Community reasonable and customary • Do you have ? resources and web sites listed on charges for maternity care up • Do you get urinary the back cover of this publication to your coinsurance maximum. tract infections? provide even more information. Be You pay the balance, until the informed. Make sure you know how coinsurance is met. There are If you choose to participate in the Future Moms Program, you will you can have a healthy pregnancy separate charges for services and baby. at non-participating laboratories. receive the following: 5. Enroll your baby for coverage 2. Call The Empire Plan at • A toll-free number you can call Remember to change from Individual 1-877-7-NYSHIP for answers to your questions coverage to Family coverage or add (1-877-769-7447) about important topics, such as pregnancy, labor, nursing and your baby to your Family coverage. The Empire Plan Hospital Program postpartum depression – staffed provides your hospital coverage If you are an active employee, by registered nurses, 24 hours at hospitals or licensed birthing contact your agency Health a day, seven days a week centers through the Empire Plan Benefits Administratorwithin Hospital Program, administered • A helpful book – 30 days of your baby’s birth. by Empire BlueCross BlueShield. Mayo Clinic Guide to If you are a retiree, write to the You must call for preadmission Healthy Pregnancy Department of Civil Service certification before maternity and • Educational materials to help you Employee Benefits Division, other hospital admissions related handle any unexpected events Albany, New York 12239, within 30 days of your baby’s birth.* to your pregnancy. • by a registered nurse 3. Enroll in the Future for common pregnancy risks like * Retirees of Participating Agencies: Call the Health Benefits Administrator Moms Program premature delivery or depression at your former agency. As soon as you know you are • Useful tools to help you, your pregnant, call 1-877-7-NYSHIP doctor and your Future Moms (1-877-769-7447) and select nurse keep track of your pregnancy Option 2 for the Hospital Program and spot possible risks for preadmission certification and to • Free phone consultations with learn about the Future Moms a dietitian, pharmacist, lactation Program. Call early – during the first consultant, exercise physiologist month of pregnancy, if possible – or licensed behavioral health and tell the representative you’re clinician, if needed calling about your pregnancy.

2 RO Prenatal Care/August 2014 Early Symptoms of Pregnancy

Fatigue • Take your prenatal vitamins with Frequent Urination Supporting a pregnancy will take your evening meal or before bed For many women this symptom a lot of your energy, especially in rather than on an empty stomach. begins around the sixth or seventh the first trimester. It is important to Fortunately, the symptoms lessen week after conception as the get plenty of rest. Fatigue is related for many women as they end their starts to grow. Initially this to the high levels of the hormone first trimester. In the meantime, may also be due to enlarged progesterone. Eating foods rich be sure to incorporate healthy ovaries taking up space in in protein and iron may help. nutritional choices so that you and the pelvic cavity. This may be Remember to take a prenatal vitamin your baby get the essential daily bothersome, but not worrisome. for optimal nutritional support. requirements for optimal health. If you develop burning with urination, blood in your urine, or Nausea Constipation fever, you must call your doctor. Although often called morning During pregnancy your digestive sickness, nausea during pregnancy system may slow down. Although Cramping/Spotting can happen at any time. Hormone uncomfortable, it is not dangerous A small amount of cramping that levels are a contributing factor, and can be managed. Do not take resembles menstrual cramps can including rising levels of the any laxatives unless instructed to be normal. Remember your uterus hormones, human chorionic do so. Also try these tips: is a muscle and it is working with gonadotropin (hCG) and/or the developing pregnancy. On • Increase your fluid intake. estrogen. Not every women occasion, cramping may be experiences nausea, so do • Increase your fiber; eat more accompanied by spotting. Again, not be concerned if you are fresh fruits and vegetables. spotting may be perfectly normal. not experiencing this symptom. • If you’re not already exercising, However, if at any time you Try the following to relieve add mild exercise to your experience heavy, bright red any sickness: daily routine. bleeding or severe, constant • Eat small frequent meals. The • You may take a stool softener cramping, please notify your doctor. stomach empties slowly during such as docusate sodium: Emotions pregnancy and may not hold 100mg, up to twice a day. It is natural to be worried that a large meal. Avoid spicy, fried This medication is safe during every twinge is something to be and greasy foods. pregnancy; it is added to many concerned about and you may • Keep crackers at your bedside. prenatal vitamins. find yourself very emotional. Try Some women find that eating Breast Changes to focus your energy and thoughts crackers before getting out of Breast changes are one of the very on the positives! bed or moving around can help. earliest symptoms in pregnancy. • Some women have aversions to Rising hormone levels can cause certain smells. Identify the trigger breast tissue to become swollen, situations and avoid them. heavier and sore. While this may • Try fresh ginger. Ginger can be be uncomfortable, there is nothing found in certain beverages, such to worry about. Invest in a good as sodas or teas. Make sure to supportive bra to ease some of look for items made with real the discomfort. ginger. You can also try grating fresh ginger into a beverage.

RO Prenatal Care/August 2014 3 Take Action to Be Healthy

If you become pregnant, or are and pregnancy complications. over-the-counter drugs (including planning on becoming pregnant, Folic acid is also naturally found herbal supplements) that are you will need to adjust your lifestyle in orange juice, peanuts, green not prescribed by a doctor who to ensure that you and your baby leafy vegetables, beans, broccoli, knows you are pregnant. are as healthy as possible. asparagus, peas, lentils and • Eat a balanced diet. Your baby • Get early, regular care. Talk to enriched grain products. is nourished by what you eat, so your doctor about prenatal care, • Stop smoking. Smoking during choose healthier foods and avoid your lifestyle and personal and pregnancy can lead to low those with no nutritional value. family medical history. These , and • Gain enough weight, but not discussions can help your doctor stillbirth. Babies of mothers who too much. Health care providers identify possible risk factors and smoked during pregnancy are recommend that a woman of recommend treatment or lifestyle more likely to have poor lung normal weight gain 25 to 35 changes specific to your situation. development, , respiratory pounds during the course of • Take a prenatal multivitamin. infections or even Sudden Infant pregnancy. Ask your doctor A good prenatal vitamin will Death Syndrome (SIDS). Avoid how much weight you should have higher levels of folic acid, second-hand smoke; it is just gain, based on your weight which helps protect against as dangerous. before pregnancy. birth defects, premature birth, • Stop drinking alcohol, using illicit Based on information from the March low birth weight, drugs, taking prescription and of Dimes and WebMD

Exercise During Pregnancy

Moderate exercise for at least • Relieving some emotional strains • After your first trimester, avoid 30 minutes on most, if not all, days after your baby’s birth, when exercise that requires you to lay of your pregnancy is recommended some women are affected by flat on your back for extended unless there is a medical reason to postpartum depression, or periods of time, which can avoid exercise, according to the “baby blues”. reduce blood flow to the uterus. American College of Obstetricians Always be mindful of your safety • Avoid overheating and stay and Gynecologists (ACOG). during exercise and take the hydrated before, during and Exercise during pregnancy can following precautions: after exercise. benefit both you and your baby by: • Discuss your plans for exercise • Make sure you do a full cool • Preventing high blood pressure with your doctor before you begin. down and stretch thoroughly and that • Avoid activities that put you after exercise. sometimes develops during at high risk for injury, such as Brisk walking, swimming, jogging pregnancy downhill skiing, horseback and dancing are usually safe • Building stamina for labor riding or contact sports. and effective forms of exercise and delivery • Keep your heart rate at a during pregnancy. Or, try prenatal • Easing common discomforts moderate level; a good rule of yoga or aerobics classes designed like constipation, backache, thumb to follow is to make sure for pregnant women. fatigue and varicose veins you are able to speak comfortably Based on information from the March • Enhancing well-being and during exercise. If you cannot say of Dimes and WebMD promoting early recovery and more than a few words without weight loss after labor and delivery becoming out of breath, lower your exercise intensity.

4 RO Prenatal Care/August 2014 Prenatal Testing

Prenatal tests are medical tests you • Bacteria in your urine, which Empire Plan Coverage receive while you are pregnant. They could indicate an infection that The Empire Plan covers in full help your doctor monitor your health can pose a serious risk for both all routine pre- and postnatal during pregnancy and the health of you and your baby. visits and urinalyses received from Empire Plan-participating your developing baby. • Sugar in your urine, which can obstetricians/gynecologists, Some prenatal tests are given to be a sign of diabetes. Your doctor family practice physicians or all pregnant women. These include may suggest additional tests if certified nurse-. blood pressure checks and blood sugar shows up in your urine. Additional testing, based on and urine tests. • Protein in your urine, which can medical necessity, is also Your doctor will listen to your baby’s indicate a urinary tract infection or, covered, but may be subject to heartbeat at each visit (beginning later in pregnancy, a pregnancy- a copayment. The Empire Plan when your baby’s heart is related condition that includes Basic Medical Program covers developed enough to be heard – high blood pressure. Your doctor services received from non- participating providers. (See usually by about 12 or 13 weeks). may suggest additional tests if your NYSHIP General After about 20 weeks, your doctor your urine has protein in it. Information Book and Empire will begin measuring your abdomen • Gestational diabetes. A glucose Plan Certificate for more to follow your baby’s growth. A tolerance test that is usually information about The Empire normal heartbeat and growth rate performed at about 28 weeks Plan Basic Medical Program.) are important signs that your baby identifies this condition. is developing properly. Prenatal • Presence of Group B the pregnancy and follow the baby’s care also usually includes tests streptococcus (GBS). Your doctor growth and development. This test for the following: performs a cervical test at about also helps determine the presence • Hepatitis B, syphilis, HIV the sixth month of your pregnancy. of more than one baby, the level of and other sexually transmitted If the bacteria is present (common fluid around the baby, the health diseases that could be dangerous for many women and considered and location of the and to a developing baby. a normal part of a woman’s the sex of the baby. • Cancer of the cervix. This is ruled reproductive system), you may Your doctor may suggest more out with a pap smear. receive treatment during labor to tests, including , • Presence of antibodies in your protect the baby from becoming a test of the fluid surrounding the blood to show immunity to rubella infected during birth. baby that detects certain genetic (German measles) and varicella • (CF), an inherited abnormalities; chorionic villus (), which can cause disease that can severely affect sampling (CVS), a sampling of birth defects if you are infected breathing and digestion. the baby’s tissue from the fingerlike during pregnancy. Your doctor may perform other projections in the placenta; and/or • Anemia (low red blood cell count) prenatal tests over the course a fetal non-stress test that to make sure you are getting of your pregnancy, depending measures the frequency of a enough iron. Too little iron could on you and your partner’s medical baby’s movement in the womb cause you to feel especially tired and family history. These tests can and how the baby’s heart rate and possibly increase your risk of include a blood screening for alpha- relates to the movement. delivering your baby too soon. fetoprotein (AFP) given between the If you have any questions about • Your blood type, including whether 16th and 18th weeks of pregnancy. prenatal tests or the terms used or not you carry a protein called the This screening determines a baby’s here, discuss them with your Rh factor. Women who do not have risk for certain disorders, including doctor. If you are unsure whether the Rh factor are considered Rh . a test will be covered, call negative and usually need a series One or more may also The Empire Plan toll free at of injections to protect their babies be offered. An uses 1-877-769-744 (1-877-7-NYSHIP) from a possible blood problem. sound waves to create a picture of before you receive the test. the baby and helps the doctor date RO Prenatal Care/August 2014 5 The Future Moms Program

Pregnancy is an exciting and as high risk for pre-term labor, Call at Any Time special time, but it can also be additional support and education You can call the Future Moms a little overwhelming. are available through the High Risk Program at any time for As a part of your health plan you Pregnancy Program (see page 12). information relating to your pregnancy or delivery or if can sign up for the Future Moms Shortly after you join the Future you have questions about Program – a pregnancy support Moms Program, you’ll receive your benefits or course of program designed just for moms- a Future Moms Program treatment. Nurses are available to-be. Whether this is your first Welcome Kit in the mail. 24 hours a day, seven days a pregnancy or your fifth, the Future This packet includes: week at 1-877-7-NYSHIP Moms Program can help you • A Future Moms welcome letter (1-877-769-7447). Spanish- along the way. with a toll-free number, available speaking nurses are available As soon as your doctor confirms 24/7 for help with all your and, if you speak a language your pregnancy, call The Empire pregnancy-related questions other than English or Spanish, we have access to a language Plan and notify us that you are • The book, Mayo Clinic Guide line. If you have trouble pregnant. This call is important. to Healthy Pregnancy speaking or hearing, you When you call, your pregnancy- • A Maternity Care Diary, which will can use TTY/TTD services. related hospital admissions will be help you track milestones during Call 800-257-6494 or call the precertified, so you will be covered your pregnancy, including your relay center at 800-828-1140. at the highest level when you are baby’s development and how Call your health care provider admitted. Also, you will speak with your body may be changing for a nonemergency medical a maternity specialist who will ask condition or illness. If you have you some basic questions about 28 Weeks a medical emergency, call 911 your pregnancy. The maternity Around the 28th week of or your local emergency specialist will ask you if you would pregnancy, your Future Moms number immediately. like to participate in the Future Program nurse will call to check Moms Program. in with you again. Your nurse will When you sign up for the Future discuss your most recent checkup, on the birth of your child and Moms Program you receive: confirm that you have had the check on how you and the baby appropriate tests and screenings are doing. Your nurse can also • Your own maternal health coach and answer any questions you offer additional support if you have • Access to a registered nurse have about prenatal tests, delivery the baby blues or are suffering helpline 24 hours a day, seven options, caring for your baby or from postpartum depression. After days a week any other health concerns on this call, you will receive a birth kit • Helpful and informative materials your mind. that includes information on infant throughout your pregnancy on After this phone call, you will care and home safety. topics including your baby’s receive another packet with The Future Moms Program development and growth, fitness helpful information about your third provides a valuable element of and nutrition, feeding your baby, trimester and preparing for labor, additional support and guidance choosing the right doctor and with topics including delivery during and after your pregnancy. infant safety options and postpartum depression. Initial Assessment After Delivery At the beginning of the program, Your Future Moms Program nurse a nurse will ask questions to check will call you two to four weeks after risk factors. If you are identified your delivery to congratulate you

6 RO Prenatal Care/August 2014 Your Healthy Diet During Pregnancy

It’s important to eat smart and Healthy eating hints Foods to avoid make healthy food choices to Meals: Eat four to six smaller • Raw fish, especially raw shellfish support your baby’s growth meals a day instead of three bigger • Soft-scrambled or runny eggs during pregnancy. Try to eat ones to help relieve the heartburn and foods made with raw or foods from each of the five and discomfort you feel as your lightly cooked eggs food groups every day. They baby grows bigger. • Unpasteurized juices provide important nutrients Snacks: Cheese, yogurt, fruit • Raw sprouts, especially that you and your baby need. and vegetables are satisfying, alfalfa sprouts In general, most women need healthy snacks. Peanut butter around 300 extra calories per and nuts are also good, if you • Unpasteurized milk and day during pregnancy. However, aren’t allergic to them. any foods made from it the exact amount of extra calories Liquids: Drink at least six to • Unpasteurized soft cheeses, you need depends on your weight eight glasses of water, juice such as brie, feta, Camembert, before pregnancy. Talk to your or milk every day. Roquefort, and queso blanco health provider to learn more about • Herbal supplements and some a healthy eating plan that’s right Vitamins: Take a multivitamin herbal teas for you. Be sure to watch serving or prenatal vitamin every day. sizes and remember fatty foods Ask your health care provider • Fish high in mercury, including (like doughnuts and chips) and if you also need to take an iron shark, swordfish, king mackerel sweets (like sodas, cookies or calcium supplement. and tilefish. It’s okay to eat up and candy) don’t give your baby Caffeine: Limit your caffeine to to 12 ounces a week of fish enough of what he or she needs 200 milligrams daily (the amount containing small amounts of to grow. in one 12-ounce cup of coffee). mercury. These 12 ounces can Caffeine in coffee depends on the include shrimp, salmon, pollock, brand you drink and how it’s made, catfish and canned light tuna. (Eat so check the label on the package, only 6 ounces of albacore tuna.) or ask at your coffee shop. Try • Raw or undercooked meat, decaffeinated coffee (has a smaller poultry, seafood and hot dogs. amount of caffeine). Caffeine is Deli meats (such as ham and also found in tea, chocolate, bologna) can cause food soda and some over-the-counter poisoning. Avoid them or heat medicine, so read labels to know them before eating. how much caffeine you’re getting. • Refrigerated pâtés, meat spreads or smoked seafood. Canned and shelf-stable versions are safe.

RO Prenatal Care/August 2014 7 Medications and Pregnancy

FDA Pregnancy Categories • Category X - There is used if the cough is severe. You The Food and Drug Administration documented evidence of fetal also may use cough drops and categorizes medications based on abnormalities. Risks completely salt water gargles. possible risks to the . outweigh the benefits of these Most often, the best remedy • Category A - Human studies medications and they will is fluids, rest and time, but if have shown no risk to the never be prescribed. you develop a fever or your fetus. These medications are What should I take if I have symptoms last longer than considered safe. a cold or allergies? 7-10 days with no improvement, • Category B - Animal studies have • For a headache you may call your obstetrician. not shown any risk to the fetus or take acetaminophen (Tylenol), What should I take if I have if they have, human studies have a Category B drug. Extra heartburn? shown no risk. These medications strength is acceptable. • Maalox - This is a category B are generally safe. • For a runny nose or allergies drug for occasional heartburn. • Category C - Animal studies have you may take diphenhydramine • ranitidine (Zantac) - This shown an adverse effect on the (Benadryl) or loratadine (Claritin). is a category B drug for fetus but no human studies have Both are Category B. Note: persistent heartburn. been done. However, potential Avoid allergy medications • TUMS - This is a category benefits of the medication may found behind the pharmacy C drug. Try the first two outweigh the possible risk. counter (including Claritin D). medications first. • Category D - There is • For a cough, first try increasing The best way to avoid heartburn documented risk to the fetus fluids, using a humidifier is to eat small frequent meals. based on data from human and elevating your pillows. Drink plenty of fluids and avoid experiences. Category D guaifenesin (Robitussin), spicy or fried foods. will rarely be prescribed. a category C drug, can be

Skincare Products to Avoid

While most products are On the label: Differin (adapalene), Soy completely safe, there are a Retin-A, Renova (tretinoin), Although generally considered handful of skincare ingredients Retinoic acid, Retinol, Retinyl safe, soy has estrogenic effects, best avoided while pregnant linoleate, Retinyl palmitate, which can worsen the “mask of or breastfeeding. Tazorac and Avage (tazarotene). pregnancy” (dark splotches on Retinoids Salicylic acid facial skin, also known as Retinoids are a type of vitamin A This mild acid is used to treat or chloasma). praised for reducing wrinkles and certain skin disorders, including On the label: Lethicin, improving skin tone. However, acne. BHA, or beta hydroxy acid, Phosphatidylcholine, Soy, studies have shown that high is a form of salicylic acid. High Textured vegetable protein (TVP) doses of vitamin A during doses of salicylic acid have shown Makeup pregnancy can be harmful to to cause birth defects and various Products marked “noncomedogenic” an unborn child. Oral retinoids, pregnancy complications. Note: or “nonacnegenic” are oil-free and such as isotretinoin (Accutane, Alpha hydroxy acids, sometimes don’t clog pores. These are safe an acne treatment), are known listed as AHAs, glycolic acid, and will not affect the health of your to cause birth defects. or lactic acid, are safe. baby. Minerals-only makeup lines On the label: Salicylic acid, are also safe, as they sit on top of Beta hydroxy acid (BHA) skin and are not as easily absorbed. 8 RO Prenatal Care/August 2014 Feeding Your Baby

The most precious gift you can Breast milk is usually easily If you plan on breastfeeding, check give your baby is a healthy start digested by a baby, and may to see if a lactation consultant is in life. Deciding whether to breast reduce gas and discomfort. available at the hospital where or bottle feed your baby is a big Studies show that babies fed you plan to deliver. If you are in decision. Consider the pros and breast milk may have a lower a group that is considered cons of each and discuss this incidence of vomiting, diarrhea, nongrandfathered (that is either decision with both your baby’s ear infections and other types administratively determined or has pediatrician and your own doctor of infections. Breastfeeding also settled its contract with New York before your baby is born. promotes correct development State), you are also covered for Babies fed either breast milk of the jaw, teeth and speaking comprehensive breastfeeding or formula can grow and abilities. And, breast milk is support and counseling. This develop normally, and each almost always available and free. benefit is covered at no cost to offers advantages. Whichever Breastfeeding can also benefit you during pregnancy and/or the you choose, feeding time is a the mother, who may lose weight if you are in a wonderful opportunity to bond gained during pregnancy more nongrandfathered group and with, as well as nourish your easily, have less chance of use a participating provider. baby and to stimulate intellectual, developing anemia after delivery Formula social and emotional development. and the risk of developing certain Formula is a safe and healthy Breast Milk diseases later in life. Breastfeeding alternative to breast milk. A variety can also help reduce the risk of Breast milk is a complete form of formulas are available and each uterine bleeding after delivery by of nutrition for almost all babies offers essential nourishment and releasing hormones that can help and has extra ingredients that different compositions for the mothers feel calm and relaxed, cannot be duplicated. However, digestive and dietary needs which may help protect from there can be cases when of babies. postpartum depression. breastfeeding is not always the Certain formulas are very similar best option. Discuss this decision Breastfeeding and Your to breast milk. Some mothers with your baby’s pediatrician and Empire Plan Benefits combine breast milk and formula your own doctor. If you are in a group that is feeding, which benefits the baby The American Academy of considered a nongrandfathered by providing unique nutrients Pediatrics recommends feeding plan (that is either administratively present in breast milk and enables a baby breast milk exclusively determined or has settled its the mother and other caregivers (no water, juice, nonhuman milk, contract with New York State), to take advantage of the benefits formula or food) for the first six you are covered for one double of formula feeding. months of a baby’s life, and to electric breast pump per If you decide to feed your baby continue breastfeeding throughout pregnancy in conjunction formula, be sure the one you the baby’s first year. with birth. choose provides DHA and ARA; Breast pumps are available for Benefits of Breast Milk these nutrients support healthy purchase at no cost to you when brain and eye development. Breast milk contains fatty acids you use a participating supplier. to promote brain development, Your formula should also be Visit https://www.cs.ny.gov/ebd antibodies and other substances fortified with calcium, iron, easy- and select Using Your Benefits, that help protect a baby from to-digest protein and a healthy then Empire Plan Providers, illness. It naturally provides ideal level of calories and vitamins and Pharmacies and Services and amounts of protein, sugar, fat, most minerals. These are all vital to the click the link under the Medical/ vitamins, growth factors, hormones baby’s health and development. Surgical Program to access and additional nourishment that a the online directory. Or, Ask your pediatrician for a baby needs for healthy growth and call 1-877-7-NYSHIP recommendation about which development. And, as the infant (1-877-769-7447) and formula is best as your child grows, breast milk changes to select 1 for the Medical Program. grows and changes. adapt to the child’s changing needs. RO Prenatal Care/August 2014 9 New Parents

Many new parents may have never recalls and reviews, Dependent Care Advantage cared for a baby until their own is including www.safekids.org, Account (DCAAccount) born. A baby can be exciting and www.cpsc.gov and A Dependent Care Advantage unfamiliar at the same time, and it’s www.jpma.org. Note: It is Account, or DCAAccount, is normal to be nervous about not recommended to use a available to eligible employees parenting. You have a vital role in secondhand car seat. of New York State Executive Branch who are Management/ the health and well-being of your • Introduce new foods into your baby. The following are helpful tips Confidential employed by the baby’s diet as your doctor Unified Court System or to get you off to the right start: advises you. Be aware of food represented by Council 82, • Share the tasks of feeding, allergies in your family that your CSEA, DC-37, Legislature, changing and caring for your baby may have inherited. NYSCOPBA, PBA, PEF baby so that both parents • Dress your baby appropriately or UUP. can get rest. for the weather. Make sure Will you need for • Do not overload your baby’s your baby’s room is the right your baby? The DCAAcount crib, bassinet, stroller (or any temperature (65ºF is ideal). could help save you money by allowing you to pay for place your baby may sleep) • Take your baby out for walks or with lots of stuffed toys and/or your child’s care with pre-tax activities. Babies love the sights dollars. Under this program, blankets. This increases risk of and sounds of the outdoors and you may set aside up to SIDs or suffocation. benefit from new experiences $5,000 in pre-tax salary for • Childproof the nursery, bathroom, and stimuli. eligible child care. See your kitchen, fireplace – any area of • Hold, cuddle and play with your agency Health Benefits your house that poses a threat baby. This helps both you and Administrator for details or to your baby – and check the your baby thrive and form a visit www.flexspend.ny.gov. safety of any baby furniture or strong bond. Employees of Participating gadgets (cribs, high chairs, Employers and employees of • Smile, talk and laugh with your strollers, swings, playyards) Participating Agencies: Ask baby. Studies show that a baby that you purchase or are given your agency Health Benefits can hear your voice while in the secondhand. There are a number Administrator if a similar womb and can recognize parents of web sites with baby product benefit is available to you. within the first week of life.

10 RO Prenatal Care/August 2014 Choosing Your Baby’s Doctor

Follow this checklist of questions when choosing your Your Pediatrician baby’s doctor: Choosing a pediatrician is an ___ Is the doctor an Empire Plan participating provider? important part of planning for a new baby. This is the doctor ___ At what hospitals does the doctor admit patients? who will care for your child as ___ Are these hospitals in The Empire Plan network? he or she grows and develops. ___ Who covers for the doctor if he or she is unavailable? A good time to start looking is about six or seven months ___ Are the doctors who cover for the doctor affiliated into your pregnancy. Ask with the same hospitals? Are they board certified? relatives and friends for ___ What is the physician’s pediatric background? Is he or recommendations. Talk to she board certified? Does the doctor have a subspecialty parents in your neighborhood if your child has special medical needs? or get referrals from your own doctor. Request a tour of ___ What are the office hours? the pediatrician’s office and ___ When is the best time to call with routine questions? request to meet the doctor ___ Is emergency coverage available 24 hours a day, and staff who work there. including weekends? ___ How long does it take to get a nonemergency appointment in this office? ___ Do you and the doctor have similar views on sensitive topics and parenting issues (such as breastfeeding, single parenthood, alternative medicine, circumcision and co-sleeping)? ___ Are waiting rooms and exam rooms clean and engaging for you and your child? ___ How friendly and helpful is the office staff?

Health Care Spending

The Health Care Spending Reviewing your expenses from Council 37, PBA, PIA, UUP or if Account (HCSAccount) helps previous years can help you you are designated Management/ State employees pay for health- determine how much to contribute. Confidential or if you are a non- related expenses with tax-free You can set aside $100 to $2,500 judicial employee of the Unified dollars. This includes un- per year in an HCSAccount. Under Court System. Additional eligibility reimbursed expenses (such federal law, any money that you put requirements apply; see your as copayments and deductibles) into your HCSAccount must be Health Benefits Administrator, for medical, hospital, laboratory, used for expenses incurred during usually located in your personnel prescription drug, dental, vision the plan year in which it was or Human Resources office, for and hearing. You have an contributed. Unless you experience additional information. opportunity to enroll each fall a qualifying event, you cannot during the HCSAccount open change the amount of your enrollment period. HCSAccount annual election. Before participating in the You may be eligible to enroll HCSAccount program, you in a HCSAccount if you are should carefully consider what represented by CSEA, PEF, your eligible expenses might be. NYSCOPBA, Council 82, District RO Prenatal Care/August 2014 11 Extended Care: Medical Case Management

Medical case management is attending physician will identify High Risk Pregnancy Program a voluntary program to help treatment options covered under The High Risk Pregnancy identify and coordinate covered The Empire Plan so that you and Program is a component services you or your baby may your family have the information of the Future Moms Program need. You must call The Empire available to make the best medical that is designed specifically Plan toll free at 1-877-7-NYSHIP decisions possible. The nurse for women who have been (1-877-769-7447) and choose the will also identify any community identified as high risk. Like other elements of the Future Hospital Program for this service, resources that may be available. Moms Program, participation which is available through the When you accept medical case is voluntary. Benefits Management Program. management, inpatient services If you are identified as high risk Some serious conditions, will be coordinated by the and elect to participate in the such as neonatal (newborn) Empire Plan Hospital Program, High Risk Pregnancy Program, complications may require extended administered by Empire BlueCross you will be contacted at least care. If your baby needs this type BlueShield. Outpatient services once a month by your Future of care, you may be faced with will be coordinated by the Medical/ Moms Program nurse for many decisions about treatment Surgical Program, administered ongoing assessments. plans and facilities. The Benefits by UnitedHealthcare. This additional support is Management Program can provide Even if you do not elect to tailored to your individual information that may help you make participate in the Medical Case needs. The timing of these calls will be based on the the best possible choice based on Management Program, always severity and control of the patient’s situation. call The Empire Plan within 48 symptoms and/or risk factors. Preadmission certification hours or as soon as reasonably and concurrent review help possible if you are admitted to the Benefits Management the hospital. Anyone can make Program determine if medical the call, but you are responsible case management would be for ensuring that The Empire Plan appropriate. If the Benefits is notified. You will pay a higher Management Program decides share of the cost if you do not that this service could help you, follow The Empire Plan Benefits your baby or any member of your Management Program procedures. family covered by The Empire Plan, a nurse coordinator who is familiar with benefits available under The Empire Plan and local and regional health care resources will contact you. The nurse will meet with you and your family to discuss the patient’s medical situation. Your acceptance of this service is voluntary. With your written consent, the nurse and your

12 RO Prenatal Care/August 2014 Postpartum Depression

For most women, the birth of a child support also may contribute to More about Postpartum is a time of joy and happiness. At the problem. In addition, there Depression the same time, 50 to 80 percent of are factors unrelated to delivery There is helpful information new mothers experience symptoms that place the mother at risk for about postpartum depression of postpartum depression, or the developing postpartum depression. on the customized Empire Plan “baby blues” during the first week These include a personal or family Mental Health and Substance after delivery. These feelings of history of depression or mood Abuse Program web site at moodiness, depression, anxiety, disorders, relationship problems, www.achievesolutions.net/ irritability and fatigue, sometimes unemployment of the mother or empireplan. You can find self-help questionnaires, attributed to after-delivery hormonal her partner or other stressful events articles and other resources changes, typically last only a few during the preceding year. by going to the Mental Health days and are gone within two What should you do if you Condition Center and selecting weeks of the birth. think you are suffering from Depression, then choosing However, for some new mothers, postpartum depression? Postpartum Depression. these feelings are more intense First, don’t be afraid to let your If you think you or a loved one and do not subside. This is a more is suffering from postpartum doctor know what you’ve been serious form of depression that depression, or if you have experiencing. Unfortunately, may develop at any time within questions, call The Empire Plan you may be one of as many as a year of . Women with toll free at 1-877-7-NYSHIP 50 percent of women with this postpartum depression can (1-877-769-7447) and select problem who never acknowledge experience any number of Option 3 for the Mental the symptoms or seek treatment Health and Substance symptoms, the most common of and therefore suffer needlessly. Abuse Program. which are extreme sadness, crying, Once your doctor is aware of guilt, feelings of hopelessness the problem, he or she can help and/or worthlessness, difficulty you determine the best form of concentrating, fatigue, changes in treatment for you. This may include eating habits and insomnia. In more counseling from the physician extreme cases, fear of harming the or a mental health professional, baby (though this rarely happens) involvement in a postpartum and suicidal thoughts can occur. depression support group, What causes postpartum medication or a combination of depression? two or more of these approaches. Most experts agree that it is the Remember that you may get result of many factors. Evidence valuable support by telling your suggests that changes in hormones partner or a relative or friend how after delivery such as estrogen, you’re feeling. Finally, take care progesterone and thyroid are of yourself. Eat well, get plenty involved. Complications during of rest, try to exercise every day, labor and delivery, a severe case of ask for help from others and baby blues, having a “difficult baby,” spend time with friends. stress and lack of emotional

RO Prenatal Care/August 2014 13 Questions and Answers

Q. Will my dental work pose a Q. I am a victim of domestic Childbirth Education Classes risk to my unborn baby? violence. Where can I go In the sixth or seventh month A. Routine dental work should for help? of your pregnancy, you and a continue throughout your A. Call the New York State Coalition partner may want to take a childbirth education class. pregnancy and should not Against Domestic Violence hotline These classes usually run up to cause concern. In fact, delaying toll free at 1-800-942-6906; for a eight weeks and may include: needed dental work could be Spanish-speaking representative, • Information about what to risky. Badly decayed teeth or call 1-800-942-6908. And, talk expect during pregnancy, impacted wisdom teeth can with your doctor. Your baby’s labor and delivery cause infection that could health is at stake. • Suggestions of proper diet spread and endanger both Q. Is it safe for me to use and exercise you and your baby. When your household cleaning products • Relaxation and breathing body is fighting to stay healthy, while I’m pregnant? by-products and chemicals are techniques to use during A. Some cleaning agents may labor and delivery produced and travel through cause birth defects after your bloodstream. If these • The best support your partner prolonged direct contact chemicals reach your uterus, can give you during delivery with your skin. Be careful not they may cause premature labor. • A chance to meet and to use cleaners with strong Research suggests that women spend time with other fumes, like oven cleaners. Wear who have gum disease or expecting parents gloves and facial protection and periodontitis may be seven Taking a childbirth education work in a well-ventilated area. times more likely to have a baby class can reduce your stress Read labels or contact the born too early and too small. by preparing you for pregnancy, manufacturer to find out more labor and delivery. Contact your Be sure to tell your dentist or about a product’s safety. You doctor’s office, local hospital hygienist you are pregnant so can also call your doctor to or birthing center for more necessary precautions are check if the substance is information and to make taken. Avoid X-rays unless they dangerous for pregnant women. a reservation. are absolutely necessary. Q. If a woman is HIV positive, Note: Any charges for these services will not Q. Is touching raw meat or will her baby be born be reimbursed by The cleaning my cat’s litter box HIV positive too? safe during pregnancy? Empire Plan. A. New drugs can reduce the A. A parasite that causes risk of HIV-positive mothers It is better to be tested for HIV is found in raw passing the virus onto their during pregnancy than to wait meat and cat feces; it can cause babies to 2 percent or less, until delivery. If a woman without severe brain damage in the compared to about 25 percent prenatal HIV test results fetus. Pregnant women should for untreated mothers. It is declines HIV testing during practice good hygiene when important for a woman delivery, hospitals are required handling raw meat, avoid considering pregnancy or to conduct expedited HIV contact with sandboxes and who is already pregnant to testing on her newborn. litter boxes and wear gloves have an HIV blood test. The Treatments for mom during or when gardening. New York State AIDS Hotline shortly after delivery can reduce provides information about transmission from mother to free anonymous testing. Call baby by up to two-thirds. If toll free 1-800-541-2437; you are HIV positive, do not for a Spanish-speaking breastfeed your baby. The representative, call toll HIV virus can be carried in free 1-800-233-7432. breast milk.

14 RO Prenatal Care/August 2014 Q. I’m 36 years old. Is pregnancy Q. How can I prevent exposing between the ages of two and safe after age 35? my baby to dangerous levels four months. While there is no A. While advances in medical care of lead? way to predict which babies will can help women over age 35 A. A home built before 1978 may die from SIDS, there are ways have safer pregnancies than in contain high lead levels that can to lower your baby’s risk: the past, there is a higher risk be dangerous to pregnant • Put your baby to sleep on his of pregnancy complications. women and children. Be aware or her back (unless advised These include high blood of lead paint on surfaces such otherwise by your doctor), pressure, gestational diabetes, as windowsills, railings and stair even for naps. placental problems, miscarriage edges, especially at a height • Place your baby on a firm or stillbirth, or having a baby that a child may chew. Before mattress and not a soft with a like renovating or buying an older surface (like a waterbed). home, consider testing the Down syndrome. • Do not use fluffy pillows or painted surfaces for lead. Good prenatal care is especially comforters, or put soft pillow- Your local health department important in order to minimize like toys in your baby’s crib. can recommend experts. risks and improve your chances • Keep your baby’s face and If lead is found, hire an expert for a healthy pregnancy and child. head uncovered during sleep. who follows safety precautions Q. Is there any reason to limit fish (such as blocking off the room) • Do not let your baby get too intake during my pregnancy? to remove it. Stay out of the warm during sleep. A. Yes. Certain types of fish may home until the paint is gone • Take your baby for regular be contaminated with high and a thorough cleanup is well-baby checkups and levels of mercury or industrial completed. Afterwards, make routine immunizations. pollutants that are harmful to sure painted surfaces are in • Do not smoke during your unborn baby. Avoid eating good condition, especially those pregnancy or allow smoking swordfish, shark, king mackerel your baby can touch. around your baby. Smoking or tilefish, which can contain high To minimize levels of lead in during pregnancy has been levels of mercury. It’s okay to eat tap water, the Environmental associated with an increased up to 12 ounces a week of fish Protection Agency recommends risk of SIDS. See page 16 for that contains a small amount of running your tap water until it is smoking cessation resources. mercury. The 12 ounces can cold – at least 60 seconds – include shrimp, salmon, pollock, and a minimum of two minutes catfish and canned light tuna if the tap has not been used for (6 ounces for albacore tuna). more than six hours. Use only Q. Is it possible for me to transfer cold tap water for drinking, a sexually transmitted disease cooking and making infant (STD) to my unborn baby? formula. Call your local health A. Sexually transmitted diseases department or your doctor if in pregnant women may cause you have questions. spontaneous or Q. I have heard of babies dying complications in your newborn, of SIDS. What is it and how including pneumonia, eye can I reduce my baby’s risk? infections and permanent A. SIDS is “sudden infant death neurological damage. If you syndrome,” the diagnosis for the think you have a sexually sudden unexplained death of an transmitted disease, see your infant under one year of age. doctor as soon as possible. SIDS is the leading cause of Most STDs are treated easily. death in infants between one The earlier a woman seeks month and one year of age. treatment, the less likely she is to Most SIDS deaths occur pass the disease on to her baby.

RO Prenatal Care/August 2014 15 Resources

All 1-800, 1-877 and 1-888 telephone numbers are toll free. The Empire Plan NurseLineSM and Future Moms Program Alcoholism and American Heart Association Substance Abuse 1-800-AHA-USA-1 1-877-7-NYSHIP NYS Office of Alcoholism (1-800-242-8721) (1-877-769-7447) You can call this number and Substance Abuse Services HIV/AIDS 1-800-522-5353 to reach an experienced NYS AIDS Information Hotline, registered nurse, 24 hours Cancer NYS Department of Health a day, 7 days a week. You National Cancer Institute 1-800-541-2437 can call the same number 1-800-4-CANCER In Spanish: to reach The Empire Plan’s (1-800-422-6237) 1-800-233-7432 NurseLine’s Health Information Library. Enter PIN number 335 Diabetes Lead Exposure and a four-digit topic code from American Diabetes Association National Lead Information The Empire Plan NurseLine 1-800-DIABETES Center Hotline, U.S. Environmental (1-800-342-2383) brochure. If you do not have Protection Agency your brochure, ask the Domestic Violence 1-800-424-LEAD NurseLine nurse to send NYS Coalition Against Domestic (1-800-424-5323) you one. Violence Hotline Oral Care 1-800-942-6906 American Dental Association In Spanish: 312-440-2500 Smoking Cessation 1-800-942-6908 Pregnancy and Birth Defects New York State Smokers’ Quitline, Environmental Health March of Dimes NY residents NYS Department of Health 1-888-MODIMES 1-866-697-8487 1-800-458-1158 (1-888-663-4637) North American Quitline Consortium, Food and Nutrition residents of other states Growing Up Healthy Hotline, 1-800-QUIT-NOW NYS Department of Health (1-800-784-8669) 1-800-522-5006 Heart Health This Reporting On is based in part on information from: • American Academy of Pediatrics • March of Dimes www.aap.org www.marchofdimes.com • American Congress of Obstetricians • National Institutes of Health and Gynecologists www.nih.gov www.acog.org • U.S. Environmental Protection Agency • American Dental Association www.epa.gov www.ada.org • U.S. Food and Drug Administration • American Medical Association www.fda.gov www.ama-assn.org • WebMD • Centers for Disease Control and Prevention www.webmd.com www.cdc.gov New York State Department of Civil Service, Employee Benefits Division, Albany, New York 12239 • https://www.cs.ny.gov It is the policy of the New York State Department of Civil Service to provide reasonable accommodation to ensure effective communication of information in benefits publications to individuals with . These publications are also available on the Department of Civil Service web site (https://www.cs.ny.gov). Check the web site for timely information that meets universal accessibility standards adopted by New York State for NYS Agency web sites. If you need an auxiliary aid or service to make benefits information available to you, please contact your agency Health Benefits Administrator. NYS and PE Retirees, NYS and PE COBRA Enrollees and Young Adult Option Enrollees: Contact the Employee Benefits Division at (518) 457-5754 (Albany area) or 1-800-833-4344 (U.S., Canada, Puerto Rico, Virgin Islands). This Report was printed using recycled paper and environmentally sensitive inks. AL1341 RO Prenatal Care/August 2014