You and Your Pregnancy Congratulations You’re Having A Baby!

1 Table of Contents Welcome 3 Your Pregnancy Timeline 4

Financial Breakdown 5

Frequently Asked Questions 6 Warnings: Things to Avoid 9 When to Call Your Doctor 9 Vaccines 9 Traveling while Pregnant 10 Managing Morning Sickness 10 Dental Care in Pregnancy 11 Prenatal Testing Information 11 How Big is Your Baby? 13 Cervical Dilation 13 Postpartum Care 15 Community Resource Line 17 Health and Welfare Child 17 Protection

Safe Haven Idaho Law 17 Childcare and Breastfeeding 18 Classes and Support

Parenting Classes 18 Family Nurse Partnership 18

2 We are so grateful you chose us to partner with you Welcome to and your family on this new journey. We hope this packet answers some questions you may have on prenatal care how to have a healthy pregnancy. Our promise to you - With integrated medical, dental and behavioral health with Terry Reilly services, our healthcare professionals work together to make sure that you and your health concerns never go unnoticed. We see success when you and your family are healthy and thriving. In order to provide the best care and experience, we strive to ensure that you are informed about services, appointments, financial responsibilities, payment options, and have access to your health information.

3 WEEKS 6-12 Your Pregnancy Timeline

• Confirm pregnancy • Lab tests • Optional blood screening tests • Hospital preregistration • First visit with your clinician • Confirm genetic testing • Discuss genetic testing options • Review lab results • Educational & diet information • Schedule ultrasound • Physical exam WEEKS 13-16 WEEKS 17-20

WEEKS 21-24 WEEKS 25-28 • Discuss circumcision • Learn baby kick counts • Discuss ultrasound results WEEKS 29-32 • Diabetes screening (24-28 weeks) • Confirm estimated due date • Blood count test, syphilis screening • Schedule childbirth class (recommended by public health • Schedule hospital tour department), vitamin B12 as needed • Discuss breastfeeding • Start birth preferences discussion • Discuss newborn • Tdap vaccination (27-36 weeks) information • Discuss Tho(D) immune globulin if Rh negative (28 weeks)

WEEKS 33-36 WEEKS 37-38 • Confirm birth preferences • Discuss signs and symptoms of preeclampsia • Discuss readiness for • Group B strep test (25 weeks or later) labor and delivery • Confirm baby’s position (35 weeks or later) • Schedule postpartum visit

WEEK 40

• Discuss past-dates plan

4-6 WEEKS AFTER DELIVERY • Discuss birth control, feeding, return to work • Depression/anxiety screening

4 Our package does NOT include: • Charges from the hospital Financial • Office visits due to injury or illness or other conditions not related to pregnancy Breakdown • Blood tests, pap smear, urine culture or STD testing, which we routinely recommend as part of your care for prenatal care at • Inpatient newborn care or circumcision • Medications, vitamins, or iron Terry Reilly • Hospital observation for pre-term contractions and other possible complications It is important that this journey of adding to your family • Additional or outside ultrasound testing is affordable. Read below for a breakdown of costs for • Delivery prenatal care at Terry Reilly. Payment plan options: Our prenatal package may include any combination of • Your payment plan will be finalized at your first the following services for prenatal care: scheduled prenatal visit. • A discount is available for patients who qualify. • Prenatal Visits Please fill out a sliding fee application to apply. • 1 visit each month up to 28 weeks • 1 visit every other week up to 36 weeks • The payments for obstetrical services are due in • 1 visit per week up to delivery full one month prior to delivery • Your clinician may choose to see you more often • Please note - it is your responsibility to provide than outlined above billing information if you apply for an emergency • Routine urinalysis at each prenatal visit, as Medicaid card. The emergency Medicaid card will indicated by clinician only pay for your delivery and hospital stay when • One Ultrasound the baby is born. It will not cover your prenatal • One Dental screening visit care. • Two postpartum visits for the mother up to six • If you currently have Medicaid, please give your weeks after delivery (recommended at 2 and 6 card to the receptionist. This will insure your visits weeks after birth). If you deliver cesarean at Saint are billed correctly. Alphonsus in Boise, your 2 week check may be • If you carry private insurance, please provide with your surgeon if they work outside Terry Reilly. us with your card. Our staff will work with you to Hospital fees are separate: determine your benefits and arrange a payment • Please contact the hospital where you plan to plan. deliver for hospital charges and pre-admission The sliding fees for our OB Packages are included below. instructions. If you are delivering at: • St. Alphonsus Boise, Obstetrics Package, including prenatal please call 208-367-2130 and postpartum - 7 visits or more • St. Alphonsus Birkeland Maternity Full Fee Plan A Fee Plan B Fee Plan C Fee Plan D Fee Nampa, please call 208-367-3514 $2092 $425 $850 $1275 $1700

You are able to make payments at any of our clinics, online, or over the phone by calling Patient Financial Services at (208) 461-7149.

5 What should I eat during my Frequently Asked pregnancy? Eating a balanced diet is one of the most important things you can do for yourself and your baby. Try to Questions eat four or more servings of dairy foods daily. This will help make sure you and your growing baby What will happen during prenatal have enough calcium. Foods with a lot of fiber (fruits visits? such as figs, papaya, pear, peach, prune, pineapple and vegetables, bran cereal/oatmeal) can help with After discovering you’re pregnant, make an constipation or hard stools. appointment with your doctor, physician assistant or nurse practitioner at Terry Reilly. The goal of your Nearly 30% of women may experience anemia and first visit is to see how you’re feeling so far, identify are often low in iron at the start of pregnancy. any early concerns or risks of your pregnancy and Here are some foods high and moderately establish a due date. During your first visit, we will high in iron that can help prevent and speak with you about your medical and pregnancy improve iron deficiency anemia: history. You will have your weight checked, and we will set a goal with you about how much weight is • Foods high in iron: Beef, chicken, kidney or pinto appropriate to gain during pregnancy. Your weight beans, liver, rice, bran, beet greens, mustard greens, and blood pressure will be taken each visit. During lentils, peaches, prune juice, plums, asparagus, the first visit urine and blood tests will also be taken. broccoli, raisins, okra, kelp, parsley. Urine tests check for infection in the urine. Blood • Foods moderately high in iron: Lean meats (lamb, tests are recommended for all women and can help turkey, veal), cooked beet greens, dried apricots, identify your blood type, anemia and infections dates, lima beans, chili, cooked spinach, dry and (hepatitis B, HIV, syphilis). fresh peas, apples, whole grains, turnip greens, yams, Follow up care is a key part of your treatment bananas, egg yolks. and safety. Be sure to schedule and go to all To help your body absorb iron, take an iron appointments, and call your provider if you’re having supplement with orange juice or vitamin C. Do not problems. It’s also a good idea to know your test drink milk or dairy at the same time that you take results and keep a list of any medications you take. your iron. Traditional schedule of prenatal care visits is every Here are a few foods to avoid during month until 28 weeks, then every 2 weeks until 36 pregnancy: weeks, then weekly until delivery. 1. Shark, swordfish, king mackerel, tile fish- due to Here is information on routine testing and higher levels of mercury. timing in pregnancy: 2. Tuna - You can eat canned tuna, but avoid more 15 to 21 weeks: Genetic screening with the QUAD than 6 ounces of canned tuna a week. screen (blood test, see page 11) - this is an optional 3. Unwashed fruits/vegetables test 4. Unpasteurized milk or milk products 18 to 21 weeks: Anatomy ultrasound (performed at outside facility, e.g. Imaging Center of Idaho, Saint 5. Undercooked meat, fish, shellfish Luke’s or St. Alphonsus) 6. Soft cheeses - brie, feta, camembert, blue cheese, 24 to 28 weeks: Gestational diabetes and anemia queso fresco. These may have bacteria which can screening (blood test) cause infections. After 27 weeks: Whooping cough vaccine (i.e. Tdap) 7. Coffee - You can drink coffee or caffeinated drinks recommended but avoid more than 2 cups a day. 36 weeks: Group B Streptococcal screening (cotton You do not need to “eat for two” during your swab) pregnancy. 37-39 weeks: Delivery discussion and planning 6 Frequently Asked Questions cont. How much weight should I gain in Recommended weight pregnancy? gain in the second and Prepregnancy weight Recommended third trimesters (lb) Speak with your medical provider about how category weight gain (mean range [lb/wk]) much weight to gain and about strategies for Underweight 28-40 lbs 1 (1-1.3) lbs not gaining too much weight in pregnancy. Excessive weight gain leads to higher risk Normal Weight 25-35 lbs 1 (0.8-1) lbs of problems or issues in pregnancy such as Overweight 15-25 lbs .6 (0.5-0.7) lbs preeclampsia, diabetes, c-section (cesarean), Obese 11-20 lbs 0.5 (0.4-0.6) lbs or difficulty losing weight postpartum.The recommendation for weight gain is based off your height and weight balance (or body mass index (BMI)) at the start of pregnancy. Generally, the Institute of Medicine recommends the above guide for weight gain throughout your pregnancy. Where should I deliver? Is it ok to take medicine? You have the option to deliver at the hospital of your Check with your doctor or provider before taking any choice. Our Terry Reilly group traditionally delivers medication, including over the counter pain relievers. at St. Alphonsus Nampa Birkland Maternity Center. Here is a safe to use medication list: There is always a Terry Reilly group physician on call Allergy: Benadryl, Claritin, Steroid Nasal Spray 24 hours a day, 7 days a week at that hospital. Speak Cold and Flu: Vicks Cough Syrup, Saline Nasal Drops with your provider about which hospital you plan or Spray, Actifed, Tylenol, Tylenol Cold to go to for delivery. We will make sure your records Constipation: Milk of Magnesia, Metamucil, Colace arrive at the hospital of your choice. Diarrhea: For 24 hours only after 12 weeks of Canyon County: pregnancy - Imodium, Kaopectate St. Alphonsus Nampa Birkland Maternity: First Aid: Neosporin, Bacitracin 208-205-0300 Headache: Tylenol (acetaminophen) St. Luke’s Nampa Labor and Delivery: 208-205-7320 Heartburn: Gaviscon, Maalox, Mylanta, TUMs West Valley Medical Center Labor and Delivery: Hemorrhoids: Witch Hazel, Tucks, Anusol 208-459-4641 Nausea and Vomiting: Dramamine, Sea Bands, Ada County: Vitamin B6 (100 mg tablet) St. Luke’s Meridian Labor and Delivery: 208-706-3115 Rashes: Benadryl cream, Hydrocortisone, Caladryl St. Luke’s Boise Labor and Delivery: 208-381-2652 Yeast Infection: Monistat St. Alphonsus Boise Family Maternity Center: How can I sleep more successfully? 208-367-4555 • Reduce or eliminate caffeinated drinks like Should I take vitamins? soda or coffee from your diet, or restrict them to Yes! It’s recommended that all women of morning or early afternoon. reproductive age take one prenatal vitamin a day. • Avoid drinking a lot of fluids or eating a full meal Look for a prenatal vitamin that has at least 400mcg within 2-3 hours of going to bed. Get plenty of folic acid. Talk with your provider before taking any of fluids and nutrients during the day. If you other over the counter vitamins or minerals. experience nausea, try eating a few crackers. • Go to bed and wake up at the same time each Is it ok to have sex? day. Yes, unless your doctor believes you’re at risk for • Avoid rigorous exercise right before bed. problems (e.g. placenta previa). You may be less or • Do something relaxing before bed like soaking in more interested in sex while you are pregnant. a bath. • Take a class for relaxation techniques. • If fear and anxiety are keeping you awake, talk 7 with your doctor. What about exercise? Bleeding gums: Brush your teeth and floss regularly. Exercise is recommended throughout your See your dentist for cleanings every six months. pregnancy. It can help ease discomfort, prevent Varicose veins: Avoid clothing that is tight around excessive weight gain and improve your overall your legs or waist. Rest and put your feet up as much physical and mental health. Some women say as you can. Move around if you must stand for long exercising during pregnancy makes labor and periods (such as at work). Ask your provider about delivery easier. Walking, swimming, and yoga are support hose or compression stockings. great choices. Try to get at least thirty minutes of Moodiness: Changes in mood are normal and exercise each day. common. If you feel sad or are thinking about How long can I keep working? hurting yourself, talk to your doctor. Regular exercise, This depends on the type of work you do (ex. a healthy diet and rest can help prevent depression. radiation, lead, heavy metal exposure may be Heartburn: Eat frequent, small meals. Avoid spicy or harmful). Generally, you can continue working greasy foods. Wait 1-2 hours to lie down after eating. throughout pregnancy. When considering work Ask your provider about approved antacids. leave, see if you qualify for the Family Medical Leave Yeast infections: Vaginal discharge changes Act (FMLA). If you have worked for a company for throughout pregnancy. Signs of yeast infection are 12 months, you may qualify for up to 12 weeks of itching and clumpy white discharge. Speak with your unpaid leave. doctor about your symptoms if you are concerned. What can I do to feel better? Stuffy nose:This is related to the changes in estrogen Nausea or vomiting: Try frequent, small meals and level in pregnancy. avoid greasy foods. Keep crackers by your bed to eat Edema (retaining fluid): Drink plenty of water and before getting up. Consider taking prenatal vitamins rest with your legs up. Lie on your left side while at night. Drink plenty of water (2 liters) daily. sleeping so blood flows from your legs back to your Tiredness: Sometimes this can be caused by anemia heart better. Talk with your doctor before changing so mention screening for this to your doctor. the amount of salt you eat - normal dietary salt is Otherwise, make sure to get enough rest - naps are important to maintain balance of fluid. If you have okay. Tiredness is common in early pregnancy, and puffiness with headaches, blurred vision or belly pain energy will most likely return in the second trimester. call your doctor. These may be signs of a high blood Leg cramps: Gently stretch the calf of your leg by pressure condition called preeclampsia which could curling your toes upward toward your knee. Drink be harmful to yourself or your baby. plenty of water. Call the clinic immediately if you Skin changes: Stretch marks appear as red marks on notice more swelling or redness in one leg than the your skin. Lotion with shea or cocoa butter can help other - this could be signs of a blood clot. keep your skin moist and may help reduce itchiness, Constipation: Drink plenty of water. Eat foods with but studies have shown there is no one way to avoid lots of fiber like fruits (pear, peach, papaya, prune, them. Other skin changes include darkening of the pineapple, figs, apple), vegetables, bran cereal/ skin on your face, around your nipples and a dark line oatmeal. Don’t take laxatives without talking with below your belly button. Staying out of the sun or your provider first. Stool softeners (polyethylene using sunscreen may help lessen these marks. Most glycol, docusate sodium) may be safer than laxatives. marks will likely fade after pregnancy. Hemorrhoids: Don’t strain during bowel movements. Aches and pains in back, pelvis, and hips: This is Clean yourself well after a bowel movement (wet common in the second trimester and beyond. wipes or something with witch hazel may be less Supporting your growing belly may strain your irritating than toilet paper). Take warm soaks in the back. Your hips and pelvic area may begin to ache bath if necessary. as pregnancy hormones (called Relaxin) relax the ligaments (tough, rope-like bands of tissue) which Urinating more often: This is very common. As the hold bones together. The bones begin shifting baby grows, more pressure is put on your bladder. slightly in preparation for childbirth. Regular exercise, Don’t cut back on water to avoid this as it can lead to not gaining too much weight, stretching and swelling in your legs, constipation, or nausea. swimming may help relieve and/or prevent these aches and pains. 8 Don’t drink alcohol. Warnings: Drinking alcohol during pregnancy is a major cause of preventable birth defects including fetal alcohol Things to Avoid syndrome (long term issues for the child’s life). Don’t smoke. Don’t clean your cat’s litter box or eat raw/ Smoking raises risk for miscarriage, premature birth, undercooked red meat or fish. low birth weight, and many other problems. These are risks for toxoplasmosis, a disease that can Don’t use drugs. cause birth defects. Cocaine, heroin, marijuana and other drugs increase Don’t sit in a sauna or hot tub longer than risk of miscarriage, premature birth and birth defects. 10-15 minutes at a time. Your baby could also be born addicted to the drug High heat in early pregnancy may cause miscarriage. you’ve been abusing, which can cause serious health Later in pregnancy, the risk is dehydration. problems. If you have concern about drug use, Don’t douche. your team at Terry Reilly can absolutely help you This could cause problems with forced air or an with recovery to promote a healthy pregnancy. We abnormal change in the helpful bacteria to keep the also have providers available to help you with any vagina clean. addiction issues. Call your doctor now or seek immediate care if When to • You have vaginal bleeding less than a period • You have belly pain Call Your Doctor • Fever (temperature more than 100.4 F) Before 20 weeks • Symptoms of preeclampsia (sudden swelling of face, hands, feet, new vision problems, severe • Fever (100.4 F) headache, severe right sided pain under your • Vaginal bleeding ribs not associated with fetal movement) • Dizziness or lightheadedness, or you feel • Sudden release of fluid from your vagina (you you may faint think your water broke) • Symptoms of a bladder infection (pain or • You think you may be in labor (more than 8 burning, frequent need to urinate, pain in contractions in an hour for more than 2 hours) either side of back, blood in your urine) • You notice your baby has stopped moving or is • Belly pain moving much less than 10 times in 2 hours • You think you’re having contractions • You have symptoms of a bladder infection (pain, • Sudden release of fluid from your vagina frequency, or burning with urination, or blood in • Foul smelling vaginal discharge you urine) • Other concerns about your pregnancy • You have other concerns about your pregnancy • Call 911 if you think you may need (itching, a rash, skin changes or new vaginal emergency care discharge)

After 20 weeks Vaccines The CDC has guidelines for the vaccines you need Call 911 if before, during, and after pregnancy. Some vaccines • You have vaginal bleeding like a period such as the measles, mumps, rubella (MMR) vaccine • You have sudden, severe pain in your belly should be given a month or more before pregnancy. • You passed out You should get the Tdap vaccine (to help protect • You had a seizure against whooping cough) during your pregnancy. • You see or feel the umbilical cord Other vaccines like the flu shot can be given before • You think you are about to deliver and you or during pregnancy depending on whether or not cannot make it safely to the hospital it is flu season when you’re pregnant. It is safe for you to receive vaccines right after giving birth, even while you are breastfeeding. Be sure to discuss each vaccine with your healthcare professional before 9 getting vaccinated. Traveling while Pregnant 1 Pregnant women can generally travel Staying healthy while traveling: safely with little preparation. Follow these • Pregnancy makes blood clots during travel more tips: likely. To reduce this risk, stand up for a short • Make an appointment with your provider 4-6 walk every couple hours or wear compression weeks before traveling internationally to discuss stockings. where you are going and any potential risks. • Wear a seat belt while traveling in a car. • Consider where you will get medical care in case • Eat only food that’s cooked and served hot. of an emergency. • Do not eat cold food or food sitting at room • Consider supplemental travel health insurance. temperature (such as food from a buffet). • If flying, check how late in your pregnancy the • Do not eat raw/undercooked meat or fish. airline will let you fly. Most allow until 36 weeks. • Eat fresh fruits and vegetables only if you can • If cruising, check how late they’ll allow you to peel them or wash them in clean water. travel. Most allow until 24-28 weeks. • Do not eat unpasteurized dairy products. • Do not travel to an area with zika or malaria. • Avoid drinks that are not canned or bottled and • If you do go to an area with zika, take sealed. precautions to prevent mosquito bites & avoid • Do not drink anything with ice in it. sexual transmission. • Talk with your doctor before taking any over the • If you’re traveling to an area with malaria risk, counter medications and stay hydrated. talk to your doctor about taking a drug to prevent malaria. Managing Morning Sickness For many women, the toughest part of early • Eat more protein such as chicken, fish, lean meat, pregnancy can be morning sickness. It can range beans, nuts, and seeds. from mild nausea to severe with bouts of vomiting. • Avoid smells and foods that make you nauseous. Symptoms can be in the morning or any time of the • Spicy or high-fat foods, citrus juice, milk, coffee, day or night. and tea with caffeine can make nausea worse. Here are some things that you can do to • Do not drink alcohol or smoke. care for yourself at home: • If taking iron supplements, ask your doctor if • Follow up is key - be sure to schedule and go to they are necessary. Iron can make nausea worse. all of your appointments and call your doctor if • Get lots of rest. Stress and fatigue can make you’re having problems. Keep a list of morning sickness worse. medications you take and things that you’ve • Ask your doctor about over the counter products done that have helped. such as doxylamine (Unisom), vitamin B6. • Keep food in your stomach, but not too much • Take your prenatal vitamins at night on a full at once. Nausea may also worsen if stomach is stomach. completely empty. Eat five or six small meals a day instead of three large meals. When to call for help: • Drink plenty of fluids, so urine is light yellow or • Muscles feel weak clear like water. If you have a medical reason to limit fluids, talk with your doctor before you • Vomiting more than three times a day increase the amount of fluids you drink. • Pain with vomiting, fever or both • Drink peppermint, chamomile, or ginger root tea. • You lose weight • Consider flavors of mint, lemon, or ginger in the • You’re not getting better as expected form of hard or dried candies/fruit. • Morning sickness continues in your second trimester 1 https://wwwnc.cdc.gov/travel/page/pregnant-travelers 10 Dental Care in Pregnancy All pregnant women should see a dentist during and may lead to more significant gum disease. To their pregnancy, especially if it has been more than reduce gingivitis and prevent cavities, it is important 6 months since the last dental cleaning, or if there to brush your teeth at least twice per day with a are any oral health concerns. A dental screening is fluoridated toothpaste and floss once per day. included at no additional cost with the Terry Reilly Keeping your mouth healthy is important for you and OB Package. Dental treatment including x-rays, local your baby. If you cannot brush because you feel sick, anesthesia, and most dental procedures are safe in rinse your mouth with water or a mouth rinse that pregnancy. has fluoride. If you vomit, rinse your mouth out with The changes that occur in pregnancy can make your water to neutralize the stomach acid. Speak with gums feel sore, puffy and red. This is called gingivitis your dentist and pregnancy provider about how to keep good oral health during your pregnancy. Prenatal Testing Information Most babies are born healthy, but problems can Why do we use ultrasound? happen and testing can be done to look for birth Ultrasound looks at the growth and organs of your defects before the baby is born. No test can find all baby. Usually ultrasound is done around 20 weeks birth defects, but testing can be done for conditions of pregnancy. Many birth defects can be seen on called Down syndrome (trisomy 21), spina bifida, and ultrasound, but not all birth defects are visible on trisomy 18 and 13. ultrasound. For example, only half of babies with No test guarantees a healthy baby. The tests show if Down syndrome will have abnormal ultrasound there is a higher or lower risk for a birth defect. If the findings. This is why we use other tests as well as test finds that your baby has a higher risk for birth ultrasound to look for birth defects. defect, we will work with you and your family to find the right care for you and your baby. Quad screening: This is a blood draw done in our clinic. There is an Why should I have the testing? additional cost for this test - around $80. It tests for Testing for birth defects is OPTIONAL. Some families Down syndrome, spina bifida, and trisomy 18. It decide to have testing because they want to have measures the levels of chemicals in your blood made time to prepare for a baby with a birth defect. It by baby and placenta. Abnormal levels of these is important to know that birth defects cannot be chemicals show higher change of birth defects. It can cured. find about 80% of babies with birth defects, however The birth defects in the tests are not inherited in about 5% of women who had the test will get a “high- families; they happen because of chance. risk” result, and their babies will be born healthy. If the test is a “high-risk” result, you will have the option What testing options are available to me? to be referred to a genetic counselor who will discuss Three tests are available to test for birth defects. One diagnostic testing (called amniocentesis) or non- test is a blood test that can be done in your doctor’s invasive prenatal testing (NIPT). office (called Quad Screening). If that test is abnormal, The quad screen is less helpful in women who will be we will offer an appointment to meet with a genetics 35 years old or older when their baby is born. These counselor at an outside clinic who can help you women already have a higher chance for a baby with decide if you need one of another two tests. There birth defects. So, if you are over age 35 and want is also an ultrasound done to look for signs of birth testing, it is better to have non-invasive prenatal defects. testing or diagnostic testing.

11 Noninvasive prenatal testing (NIPT) Further information Noninvasive prenatal testing (sometimes also What is Down syndrome (trisomy 21)? called cell free DNA testing), is a very good test for Down syndrome is the most common form of conditions like Down syndrome. It is not as good as intellectual disability. Children with Down syndrome diagnostic testing, but many women choose to have usually develop more slowly than other children. this test because there is no risk of miscarriage. This There is a 30-40% risk of heart defect at birth which can be done any time after ten weeks of pregnancy. could require surgery. They also have a higher chance This test can only be ordered after a visit with a to develop intestinal problems, childhood blood genetic counselor. Many types of insurance will cover cancer, and Alzheimer’s disease later in life. this, and out of pocket cost otherwise is around $100- $200. If you wish to have NIPT, we will schedule a What are trisomy 18 and 13? genetic counselor appointment for you with St. Luke’s These disorders are much more severe than Down or St. Alphonsus. Results take approximately 7-10 syndrome. These babies have multiple birth defects, days to return. usually involving the heart and brain. These birth defects can often be seen with ultrasound. The This test currently tests for Down syndrome, trisomy majority of children with trisomy 18 or 13 do not 18, and trisomy 13. It can also tell if you’re having a survive past 3 months old. boy or a girl. In your blood, there are pieces of genetic material (chromosomes) from you and from the What causes these conditions? pregnancy. The lab checks for extra chromosomes in These conditions are not caused by the mother your pregnancy. Babies with Down syndrome, trisomy during the pregnancy and are usually not inherited in 18 and 13 have an extra chromosome and this causes families. their birth defects. NIPT is 99% or more accurate in All of the cells in a person’s body have chromosomes its results. Since false positive results are unlikely, but (our genetics). The chromosomes are instructions for still possible, it’s not a diagnostic test. Women who our bodies to grow and stay alive and healthy. Babies get a high risk result will be offered a diagnostic test with trisomy 21, 18 or 13 have an extra chromosome (amniocentesis). and with too many chromosomes, this causes problems with development. Diagnostic testing What are neural tube defects? Diagnostic testing means the results are very close These conditions are very likely to be found by the to 100% accurate. These tests are called CVS and Quad screen and an ultrasound of the baby. amniocentesis. These tests are performed only through Maternal Fetal Medicine specialists. To do In babies with neural tube defects (spina bifida), this test, an ultrasound is used to place a long needle part of the skin and bone covering the spinal cord is into your womb and take some of the amniotic fluid missing. This occurs in 1 out of 1,000 pregnancies in or placenta. The lab looks at the sample to find if the United States. The effect on thebaby depends on there is a birth defect like down syndrome, trisomy 18 the size and location of the defect but usually causes or trisomy 13. If you have a family history of another problems with moving the legs and with control of genetic condition, you may also be able to have stool and urine. testing for that condition done with this test. There What are abdominal wall defects? is a small risk to cause a miscarriage with this test - it Open abdominal wall defects occur when part of the happens only 1 out of 500 times. Diagnostic testing is abdominal wall develops incorrectly and some of the ALWAYS your choice and optional. baby’s intestines are outside of the body. This can usually be corrected with surgery after birth. Where can I find more information? National Down Syndrome Society: 1-800-221-4602; www.ndss.org/resources Spina Bifida Association of America: 1-800-621-3141; spinabifidaassociation.org Support Organization for Trisomy 18, 13, and related disorders: 1-800-716-7638; trisomy.org 12 How Big is Your Baby? A Month-by-Month Guide

Poppy Seed Raspberry Lime Month One Month Two Month Three

Avocado Banana Mango Month Four Month Five Month Six

Eggplant Pineapple Watermelon Month Seven Month Eight Month Nine

Cervical Dilation The cervix, which is the bottom portion of the uterus, opens when a woman has a baby, through a process called cervical dilation. The process of the cervix opening (dilating) is one way that healthcare staff track how a woman’s labor is progressing.

During labor, the cervix opens to accommodate the passage of baby’s head into the vagina, which is around 10 centimeters (cm) dilated for most term babies.

1 cm 3 cm 5 cm 7 cm 10 cm

13 14 Postpartum Care 2 • Use a peribottle (water bottle or spray water The first few weeks after childbirth are called the bottle) filled with warm water for about a postpartum period. During this time your body goes week, rinsing your perineum during and after through many changes. Here is some information urination. Some stinging is normal. to help guide you through the normal and many • Try putting Tucks pads directly on painful areas changes of what many people may call the fourth to cool and sooth them. These pads can also trimester. help pain from hemorrhoids. Uterus • Place a small amount of aloe on a pad and freeze. Right after delivery, your uterus goes from Use as needed. watermelon to grapefruit size (it can be felt below • If you still have pain after trying the above tips, your belly button) and gets smaller each day. Ten days keep your doctor informed. after delivery, you won’t be able to feel it. Cramping in this area is normal after delivery, especially while Diet breastfeeding. Cramping gets better after the first few Follow these guidelines for a healthy diet throughout days but your provider may recommend ibuprofen to your pregnancy: help with the pain. • Eat a variety of healthy foods - including high fiber and iron (see list above). Vaginal bleeding Bleeding after delivery for a few weeks is normal, • Eat high fiber foods. and it’s called lochia (or flow). It’s similar to a period • Most women need 300-500 calories per day for the first few days, then becomes lighter in color more while breastfeeding. and less in amount with spotting off and on for a few • When breastfeeding, you don’t need to avoid weeks. If you have bright red bleeding soaking a pad foods you normally eat because they are spicy. an hour for more than two hours, call your provider Amniotic fluid (fluid around your baby in right away. the womb) takes on the flavors of the food the Perineum and pain (or caring for your mother eats, such as garlic and spices. After your bottom) baby is born, he or she will continue to enjoy a The perineum’s the area between your anus and variety of flavors in your breast milk. vagina. This area may tear or be cut (rarely) during • Drink enough liquids so that you don’t feel delivery. If you have stitches, they will be absorbed by thirsty and your urine is light yellow in color. your body and do not need to be removed. Here are Anemia some tips to help with healing and pain: Your doctor may recommend starting an iron • Take medications as needed. Usual medications supplement for anemia after your first bowel are a stool softener (polyethylene glycol - movement after delivery. See the previous list in the commonly seen as “Miralax” or “GentleLax” packet about foods high in iron content. - 1 spoonful in water or juice 1-4 times daily, or Vaccines docusate sodium 100mg twice daily), ibuprofen Before leaving the hospital, your baby receives the (200mg, three tablets 3-4 times a day) and first of three doses of the Hepatitis B vaccine. It’s Tylenol (max dose 4,000mg in 24 hours). Rarely, important to protect infants from hepatitis B because women may need a stronger pain medication for they are more likely than adults to develop incurable the first few days after delivery prescribed by chronic (long term) infection. Your Terry Reilly their doctor. provider may recommend you receive some vaccines • Warm baths (called “Sitz” baths) and ice packs can right after giving birth. Postpartum vaccination will bring down pain and swelling. Adding rosemary help protect you from getting sick and will pass some tea or Epsom salt to a warm bath may be helpful. antibodies to your baby through your breastmilk.

2 https://wa.kaiserpermanente.org/healthAndWellness/index. 15 Activity and exercise Mastitis: This is a breast infection. You may see a hard, red and tender area on the breast. This may happen Walking is a great exercise after childbirth. It can help without having a fever. You may have chills. Call your with mood, self-image, and building up energy. A provider if this happens. mother who had a vaginal delivery can begin mild exercise two weeks after delivery. If a c-section was If you are bottle feeding: Wear supportive bra for done, wait 4-6 weeks before any abdominal exercises. comfort. Apply ice packs to engorged breasts to help For everyone, start Kegel exercises the day after with pain, and take ibuprofen. Avoid any stimulation delivery to improve vaginal and perineal muscle tone of breasts such as hot showers or washing the chest. and shape. To do Kegels, tighten the muscle that Engorgement will get better after a few days on its starts and stops the flow of urine. Hold this position own. Other medication is not needed or helpful. for 10 seconds, then rest. Repeat a few times and do When to call this several times a day. This will help tone your entire Warning signs for mom after going home: pelvic floor muscles and help prevent any issues • Severe pain anywhere that is getting worse with incontinence (losing urine with coughing or • Vaginal bleeding that soaks one pad per hour for sneezing) in the future. more than two hours Contraception • Vaginal discharge with foul odor • Temperature higher than 100.4 F (this is a fever) It is ok to start having sexual intercourse when longer than four hours. vaginal bleeding stops (six weeks), and you feel • Increased warmth, redness, swelling, tenderness comfortable resuming sexual activity. Feeling of breasts, legs, stitches, or abdominal incision (if comfortable can vary from person to person. Water- you had a c-section) soluble or silicone based lubricants may help with any • Drainage more than a small amount from discomfort. If you are breastfeeding, you may have abdominal incision decreased sex drive and increased vaginal dryness. • Severe headache, blurred vision This is normal. If you start having sexual intercourse • Difficulty breathing and are not hoping for another pregnancy right • Pain, frequency or urgency with urination that away (an interval of 18 months between pregnancies doesn’t get better in two days recommended) - talk to your provider about birth • Red, warm, or swollen area on your leg, or pain in control options. your call when you step down Breast care, engorgement, and mastitis • Severe mood swings; thoughts of harming yourself or your baby Your doctor may recommend starting an iron Call your doctor’s office if your baby: supplement for anemia after your first bowel • Refuses to feed for multiple feedings in a row movement after delivery. • Has diarrhea and vomits more than usual If you are breastfeeding: Your milk will usually “come • Has a cold that doesn’t improve or gets worse in” at about 72 hours after delivery. Your breasts may • Has a rash feel full, warm, and sometimes tender. This is normal. • Has ear drainage It’s important to empty breasts by feeding baby 8 to • Will not stop crying 12 times a day or by pumping. Start breast feeding Call your doctor immediately or go to the shortly after giving birth. emergency room if your baby: • Has blood in his or her vomit or stool Nipple soreness: This is very common and usually • Has difficulty breathing improves after two weeks. If cracks or scabs occur, • Has a seizure apply warm compresses. After feeding, apply • Has signs of dehydration colostrum, breast milk, vegetable (or olive or mineral) • Has any type of poisoning oil, Crisco, or medical-grade lanolin to the nipple. • Has bleeding that you cannot stop Moistened black tea bags may also help. • Is not able to move Engorgement: Feeding will help relieve pressure and • Has a rectal temperature of 100.4 degree tenderness. Consider a warm compress 5 minute fahrenheit or higher before a feed to help. Or apply a leaf of green • Has yellow skin or eyes cabbage to help relieve some pressure without • Sleeps more than usual or will not wake up 16 changing milk supply. • Is limp Community Resource Line 211 Call 2-1-1 or 1-800-926-2588

Health and Welfare Child Protection 208-334-5700 If you suspect a child is experiencing abuse, neglect, or abandonment, please contact Health and Welfare.

Safe Haven Idaho Law The Idaho Safe Haven Act protects abandoned infants. A parent is not required to provide any information to the safe haven but may provide medical or other information. The parent remains anonymous and will not be prosecuted for child neglect or abandonment. Safe havens include calling 911 and requesting safe haven, licensed physicians and staff in a clinic, hospitals licensed in Idaho.

17 Childbirth and Breastfeeding Classes and Support St. Lukes System West Valley Medical Center Register by phone: 208-381-9000 Free classes to those delivering at WVMC Class pricing varies ($10-$60) Register by phone: 208-455-6565 • Intuitive Birth • Childbirth Preparation: Second Saturday • Childbirth Preparation every month 9am-4pm • Breastfeeding Support • Breastfeeding 101: 2nd Tuesday 6:30-9pm Saint Alphonsus WIC (Must be a participant in WIC) Register by phone: 208-367-5454 or Canyon County: 208-455-5330 Facebook: www.facebook.com/saintalsbaby Ada County: 208-327-7488 • Baby Support Group (Nampa): Free, Owyhee County: 208-455-5330 Thursdays 10-11am BabySteps (Ada) • Breastfeeding Support Group (Nampa): Free, 208-342-5601 ext. 212 or Thursdays 11am-12pm [email protected] • Breastfeeding for Beginners: Free • Programs on Tuesday/Thursday for mothers. • Childbirth, Lamaze: $60 (financial Earn ‘points’ redeemable for baby items. scholarship available, 6 week course) • CPR: $20 Baby Haven - Caldwell Corps • Happiest baby on the Block: $20 Salvation Army (Canyon) • Newborn Care and Parenting: $20 Apply in person: 1015 E. Chicago St. Caldwell • Sibling Preparation: $15 (every other month) or call: 208-459-2011 Building Villages • Programs on building healthy families (nutrition, infant care, group parent support), baby items Peer support in childbirth, parenting available. buildingvillages.org • English: Tuesday Spanish: Thursday Parenting Classes Building Villages www.buildingvillages.org/positive-parenting- Idaho Youth Ranch classes www.youthranch.org/parenting-classes Boise Schools Parent Education St Luke’s Mom’s Meet Up 208-334-5437 208-381-9000 or 208-381-1510 www.stlukesonline.org/communities-locations/ Saint Alphonsus support-groups www.saintalphonsus.org/services/womens- health/maternity/classes-events Family Nurse Your nurse can also help make sure you’re connected Partnership to community recourses as well as providing general This is a program for first time moms - offering home support. This program is free. Must register before 28 visits and phone support from a registered nurse weeks of pregnancy. from pregnancy until your child is two years old! Talk to us or call: Southwest District Health (208-455-5433). 18 Clinic Locations

Boise - 23rd Street Boise - Dental Boise - Latah 300 S. 23rd St. 2301 N. 36th St., STE 102 848 La Cassia St. Boise, ID 83702 Boise, ID 83703 Boise, ID 83705 (208) 344-3512 (208) 336-8801 (208) 344-0086

Caldwell - Arlington Homedale - Dental Homedale - Medical 2005 Arlington Ave. Eight 2nd St. West 108 E. Idaho Ave. Caldwell, ID 83605 Homedale, ID 83628 Homedale, ID 83628 (208) 459-1025 (208) 337-6101 (208) 337-3189

Marsing Melba Middleton 201 Main St. 150 2nd St . 201 S. Paradise Ave. Marsing, ID 83639 Melba, ID 83641 Middleton, ID 83644 (208) 896-4159 (208) 495-1011 (208) 585-0048

Canyon - Dental Nampa - 1st Street Nampa - 16th Ave. 11136 Moss Lane 207 1st St. South 223 16th Ave. North Nampa, ID 83651 Nampa, ID 83651 Nampa, ID 83687 (208) 466-0515 (208) 466-7869 (208) 467-7654

Medical Dental Behavioral Health

Pharmacy Urgent Care

(208) 467-4431 trhs.org