Your Guide to a Healthy Pregnancy
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YOUR GUIDE TO Healthy Pregnancy 11th edition Your Guide to a Healthy Pregnancy Dear Soon-To-Be Parents, Thank you for choosing Cleveland Clinic for five years. The Baby Friendly Hospital Initiative your obstetrics care and allowing us to help (www.babyfriendlyusa.org) is an international bring your new little one(s) into the world! program of the World Health Organization This is an exciting time for you and we are (WHO) and the United Nations Children’s here to assist in making your experience the Fund (UNICEF). best it can be. Breastfeeding offers an unmatched beginning Deciding to become a parent is one of the for all new babies and is recommended by most important decisions you will make in the American Academy of Pediatrics (AAP) your life. As babies don’t come with instruction as the primary source of nutrition for the first manuals, you rely on healthcare professionals year of life. Scientific studies have shown that for education and guidance. Our goal is to breastfed babies are healthier, have reduced provide you with the best possible information risk of Sudden Infant Death Syndrome (SIDS), to make knowledgeable decisions. and have fewer cases of childhood cancers and diabetes. Our highly trained obstetricians, maternal fetal medicine specialists, and certified nurse In addition to breastfeeding and birthing midwives deliver over 13,000 babies a year assistance, Cleveland Clinic can help you at three different hospital locations. We are prepare for the big day through classes like excited to be a part of your birthing and family “Baby Basics” and “Boot Camp for New health care team and hope that you will Dads.” We also offer lactation consultations, continue to rely on us for all your healthcare informative materials and support groups. needs. For more information about our Cleveland Clinic pediatricians and family physicians and services, go to clevelandclinic. medicine specialists offer assistance in org/obstetrics. well-baby care at our nearby family health center and hospitals. You can see a schedule Cleveland Clinic has partnered with the Ohio of the many prenatal classes we offer at Department of Health to promote safe sleep, clevelandclinic.org/childbirthed. This book while proactively working to reduce the infant can be accessed at clevelandclinic.org/ mortality rate. This includes the ABC’s of safe healthypregnancyguide. sleep: always placing your baby Alone in their crib, on their Back, and making sure the only For more information about making an thing in your baby’s Crib is a firm mattress informed decision about your baby’s nutrition, with a fitted sheet. we encourage you to speak to your provider. Making the decision about how you will feed your baby is a choice that all parents must Sincerely, face. Cleveland Clinic birthing hospitals support exclusive breast milk feeding for the Your Women’s Health Team first six months of life and are taking special steps to create the best possible environment for successful breastfeeding. We strive to renew our Baby Friendly Hospital designation every CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 2 CONTENTS 1. Mother Care | 7 2. First Trimester | 65 › Prenatal care › Your first trimester of pregnancy › Prenatal vitamins › When to call your provider › Medicine guidelines during pregnancy › Prenatal ultrasonography › Good nutrition during pregnancy › Ultrasound appointment guidelines › Dental care during pregnancy › Screening for chromosome abnormalities › Global obstetrical care › CPT codes for genetic tests › HIV testing › Vaccination during pregnancy 3. Second Trimester | 75 › Sexually transmitted diseases and pregnancy › Your second trimester of pregnancy › How smoking affect you and your baby › Welcome to the second trimester › High blood pressure › When to call your provider › Gestational diabetes › Oral Glucose Challenge Test › Toxoplasmosis and pregnancy › Coping with the physical changes 4. Third Trimester | 79 of pregnancy › Your third trimester of pregnancy › Finding a comfortable position › When to call your provider during the › Exercise during pregnancy third trimester › Pregnancy childbirth and bladder control › Counting your baby kicks › Sex during pregnancy › Non stress test › Sleep during pregnancy › Group B streptococcus and pregnancy › Travel during pregnancy › True vs. false labor › Depression during pregnancy › Premature labor › What to pack for the hospital › Your birth day › Types of delivery › Pain relief options during childbirth CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 3 5. After Delivery | 101 7. Baby Care | 131 › What to expect after delivery › Safe sleep › Physical changes after delivery › Newborn care in hospital › Vaginal tears › Newborn appearance › Long acting reversible contraception › Newborn behavior › Depression after the birth of a child › Your baby and when to call doctor › Exercise after delivery › Umbilical cord appearance and care › Circumcision 6. Breastfeeding | 115 › Childhood immunizations › The 10 steps to a successful breastfeeding › Adding your baby to your insurance policy program › Are you looking for a pediatrician › The benefits of breastfeeding › Choosing a car seat › 24 hour rooming-in › Skin-to-skin contact for you and your baby › Breastfeeding the first weeks › Over the counter meds and breastfeeding › Contraception during breastfeeding CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 4 TYPES OF REMEDY SAFE MEDICATIONS TO TAKE DURING PREGNANCY Allergy Diphenhydramine (Benadryl®) Loratidine (Claritin®) Cetirizine (Zyrtec®) Cold and flu Diphenhydramine (Benadryl)* Dextromethorphan (Robitussin®)* Guaifenesin (Mucinex® [plain])* Vicks Vapor Rub® mentholated cream Mentholated or non-mentholated cough drops (Sugar-free cough drops for gestational diabetes should not contain blends of herbs or aspartame) Pseudoephedrine ([Sudafed®] after 1st trimester) Acetaminophen (Tylenol®)* Saline nasal drops or spray Warm salt/water gargle *Note: Do not take the “SA” (Sustained Action) form of these drugs or the “Multi-Symptom” form of these drugs. Do not use Nyquil®, or a generic version, due to its high alcohol content. Diarrhea Loperamide ([Imodium®] after 1st trimester, for 24 hours only) Constipation Methylcellulose fiber (Citrucel®) Docusate (Colace®) Psyllium (Fiberall®, Metamucil®) Polycarbophil (FiberCon®) Polyethylene glycol (MiraLAX®)* *Occasional use only First aid ointment Bacitracin Neomycin/polymyxin B/bacitracin (Neosporin®) Headache Acetaminophen (Tylenol) Heartburn Aluminum hydroxide/magnesium carbonate (Gaviscon®)* Famotidine (Pepcid AC®) Aluminum hydroxide/magnesium hydroxide (Maalox®) Calcium carbonate/magnesium carbonate (Mylanta®) Calcium carbonate (Titralac®, Tums®) *Occasional use only Hemorrhoids Phenylephrine/mineral oil/petrolatum (Preparation H®) Witch hazel (Tucks® pads or ointment) Return to Table of Contents CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 5 TYPES OF REMEDY SAFE MEDICATIONS TO TAKE DURING PREGNANCY Insect repellant N,N-diethyl-meta-toluamide (DEET®) Nausea and vomiting Doxylamine (Unisom Sleeptab) Vitamin B6 25mg three times per day in combination with doxylamine 12.5mg at bedtime to prevent nausea. Ginger extract 125-250mg every six hours. Rashes Diphenhydramine cream (Benadryl) Hydrocortisone cream or ointment Oatmeal bath (Aveeno®) Sleep Diphenhydramine (Unisom SleepGels®, Benadryl) Yeast infection Miconazole (Monistat® 7-Day) *Please note: No drug can be considered 100% safe to use during pregnancy. Return to Table of Contents CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 6 1. Mother Care › Prenatal care › Prenatal vitamins › Medicine guidelines during pregnancy › Good nutrition during pregnancy › Dental care during pregnancy › Global obstetrical care › HIV testing › Vaccination during pregnancy › Sexually transmitted diseases and pregnancy › How smoking affect you and your baby › High blood pressure › Gestational diabetes › Toxoplasmosis and pregnancy › Coping with the physical changes of pregnancy › Finding a comfortable position › Exercise during pregnancy › Pregnancy childbirth and bladder control › Sex during pregnancy › Sleep during pregnancy › Strengthening your pelvic floor muscles › Travel during pregnancy › Depression during pregnancy Return to Table of Contents CLEVELAND CLINIC | WOMEN’S HEALTH - PREGNANCY | 7 Prenatal Care: Your First Visit Why is prenatal care important? Physical exam Regular appointments with your healthcare A thorough physical exam is also part of provider throughout your pregnancy are the first visit. You are weighed, and your important to ensure the health of you and your blood pressure, heart, lungs, and breasts are baby. In addition to medical care, prenatal checked. The first visit also includes a pelvic care includes education on pregnancy and exam by your healthcare provider. childbirth, plus counseling and support. Pelvic exam Frequent visits with your healthcare provider During the pelvic exam, a bimanual internal allow you to follow the progress of your exam (with two fingers inside the vagina and baby’s development. Visits also give you the one hand on the abdomen) will be performed opportunity to ask questions. Most healthcare to determine the size of your uterus and pelvis. providers welcome your partner at each visit, Your healthcare provider might listen for the as well as interested family members. baby’s heartbeat with a special instrument What happens on my first medical visit? called a doppler, which uses ultrasound (high frequency sound waves). A doppler usually The first visit is designed to determine your