Congratulations AND Welcome to !

Whether this is your first, third, or thirteenth (yikes!) baby, each pregnancy is always a brand new experience. With each baby you become a new parent. Pregnancy can be an exciting, fulfilling, delightful time. It can also be a time of uncertainty and change.

As a team, we will work together to make your pregnancy as healthy and as enjoyable as possible. This is YOUR handbook—print it out or download it to your phone or computer. Jot notes. Please take the time to read this handbook!

Thank you for choosing Be. Women’s Health & Wellness for your . Our practice is committed to providing the highest quality of women’s health care with special personal attention.

About our office…

Appointments Call our office at 940-365-9001 or make subsequent appointments while checking out after your office visits. Our providers are very dedicated to their patients, therefore, we ask for your understanding if we are not able to see you at your scheduled appointment time. Many deliveries and surgical emergencies can arise during office hours. One of the other providers may be able to see you or we will attempt to notify you in advance when possible to reschedule your appointment.

Telephone Calls If, between visits, you have questions, please do not hesitate to call the office. Our nurses are experts at handling many women’s health problems. Occasionally, you may need to leave a message. Please be patient and remember we will always return your call the same day if we can reach you. If your voice mail does not indicate your name, we won’t be able to leave detailed information when we call you.

We request that you limit your after hour calls except for true emergencies. If you need to contact us after hours the answering service will notify us to call you. If you ever have problems reaching the answering service, please call labor and delivery at the Texas Health Presbyterian Denton at (940-323-3600) or Denton Regional Medical Center and they will forward your call to us. There may be a charge for non-emergent calls.

Billing, Insurance, Pre-Certification, Self-Pay Our charge for a normal vaginal delivery includes the routine care of the mother during the months of pregnancy, delivery and subsequent hospital care, including one 4 to 6-week postpartum examination. If you should require a C-section there could be an additional fee for an assistant surgeon. Blood work, ultrasounds, non-stress tests and any other special examinations, if necessary, are not included in this fee. Please keep in mind that you will receive separate billings from the hospital, anesthesia, laboratory, etc.

We make every effort to work with you and your insurance company. Our staff will discuss your benefits Most insurance as provided by your insurance company. Any deductibles, co-pays, or coinsurance is the patient’s companies allow 30 responsibility. Precertification involves notifying the insurance company of your pregnancy and future days from the date of hospitalization. It is NOT a guarantee of benefits. birth to add a baby to If you do not have insurance, you will be placed on a “Self Pay” status. A deposit will be required at your first your insurance policy. OB visit with monthly payments to be made and the entire balance paid by your seventh month of pregnancy.

About Your Care Subsequent Visits On follow-up visits, we will check your weight Prenatal Visits and blood pressure.

First Visit A doppler will be used to hear the baby’s heart Your first OB visit is very important. We will tones. Fetal activity and the size and growth of obtain a thorough medical history on you and the baby will be checked. the father-to-be. Your weight and blood pressure will be taken. A urinalysis will be Around 20 weeks, a routine ultrasound is performed. scheduled in our office. An ultrasound uses sound waves to make a picture of the baby We will calculate your due date. This date moving inside your uterus. Ultrasound tests becomes a “monitoring progress” date. Your are used to determine if the baby is pregnancy is measured in weeks and an developing properly, check the baby’s heart average term pregnancy is 280 days or 40 rate, and confirm the baby’s and size. weeks from the first day of your last menstrual period. It is important to remember that only Between twenty-four to twenty-eight weeks 5% of babies are delivered on their due date, you will be screened for gestational diabetes. although most are born within two weeks of the expected day. [Science moment: Diabetes occurs when there is a problem with the way the body uses Due Date = Last Period (1st Day) minus 3 insulin. When insulin is not used properly, the months plus 1 week level of glucose (sugar) in the blood becomes (Example: Last Period 10-12 = Due Date 7-19) too high. Because the hormones of pregnancy increase the body’s resistance to insulin, You will be given an order to have your blood approximately 3% of pregnant women will drawn for prenatal laboratory work. These develop diabetes during pregnancy. This routine-screening labs will check for hepatitis condition usually subsides after pregnancy, but B and C (a virus transmitted by bodily women who have had gestational diabetes are secretions), HIV, reactive plasma reagent more likely to develop diabetes later in life.] (screens for syphilis), immunity to rubella (German measles), blood type and screen, and The 1-hour glucose tolerance test involves complete blood count. You will also be drinking a SUPER sugary drink and having your offered cystic fibrosis screening. blood drawn one hour later. This will measure your blood sugar level. If the test reveals a high level of glucose in your blood, a more We do offer gender scans extensive three-hour glucose test will be conducted. Your blood will also be drawn starting at 16 weeks. again to check for anemia and a state-required HIV. These are not covered by If your blood type is Rh negative, you will insurance, but are great receive an Rh injection after 28 weeks. Only 15% of women are Rh negative. This means if for gender reveal parties! your baby is Rh positive, you may form antibodies that fight against your baby’s blood. The injection can prevent sensitization for Down Syndrome as well as certain spinal for up to twelve weeks. You will have this cord defects. This testing will identify 95% of injection again after delivery if your baby is Rh babies with spinal cord defects and 85% of positive. babies with Down Syndrome. If the testing is abnormal, patients are often referred to a The Internet can be a source of excellent high-risk specialist for further testing. pregnancy related information. When reviewing information on your computer, DO is a procedure in which a consider the source. Try to avoid unknown needle is introduced into the uterus through sites, and sites trying to sell you products. the skin under ultrasound guidance. This is done to obtain for testing. Women over 35 years old are offered this routinely because of their increased risk for a baby with Down Syndrome. Other genetic Websites that you may diseases can also be evaluated using this technique. find useful include: www.cdc.gov, Cystic Fibrosis is a genetic condition that affects the respiratory and digestive system. 1 www.marchofdimes.com, in 29 Caucasians, 1 in 45 Hispanics and 1 in 65 www.mayoclinic.com, African-Americans carry a gene for this disease. Parents can be tested for this and www.acog.org (click on condition at any time with a blood test. ACOG patient page.) Sickle Cell Anemia is common in the African- American population and can be tested for with a blood test.

Genetic Testing Other genetic testing would be recommended Genetic testing is offered to every patient and based upon family history and could include can be general screening offered to all genetic counseling, ultrasound or patients, or more specific testing based on a amniocentesis. patient’s personal, or family history.

Down’s Syndrome screening is offered to all pregnant patients and comes in several forms. Early screening consists of an ultrasound to measure the thickness of the skin on a baby’s neck and several blood tests. This testing is usually performed at about 12 to 14 weeks of pregnancy. Currently, this testing approaches 95% predictive value. This testing is referred to high-risk pregnancy specialists due to the nature of the ultrasound.

Quad testing is a set of blood tests performed between 15-20 weeks to assess a baby’s risk Sexual Relations Everyday Information For healthy pregnant women without (aka Survival Guide!) complications, sex is safe up to delivery.

Travel Dental Care Travel during pregnancy is not considered Caring for your teeth during pregnancy is very harmful for a normal pregnancy, but long, important and routine dental examination and tiresome trips should be avoided. The Federal treatment is encouraged. Due to hormonal Aviation Administration (FAA) We recommend changes, you are more susceptible to cavities, that you do not fly after 36 weeks of bleeding gums, and gum infections. Tell your pregnancy. When you travel by car, wear your dentist that you are pregnant. Local anesthesia seatbelt low over your hips. Stay within an injections are safe, but avoid general hour of the hospital during your last month. anesthesia/nitrous oxide IF possible. Use a lead apron if x-rays are necessary. Teeth Tanning whitening products are also safe. Tanning beds are not healthy for you anytime, but should be avoided in pregnancy. Seafood Seafood is a great source of DHA, which helps Toxoplasmosis build your baby’s brain and eyes. You should You should avoid cleaning cat litter boxes and limit yourself to 2-3 servings of seafood each eating undercooked meat due to the risk of week. The only fish to avoid are shark, exposure to toxoplasmosis. This is a potentially swordfish, king mackerel and tilefish. harmful infection, which could cause your unborn baby to suffer permanent eye and Nails neurological damage. You may paint or have a pro manicure. Hot tubs/Saunas/Whirlpools Exercise Please avoid these due to the risk of Common sense should guide you. When an overheating. However, warm baths are safe activity, especially in late pregnancy, is during pregnancy. associated with significant discomfort, it should be discontinued. Your heart rate should Painting/Cleaning remain below 140 beats per minute. If you are We recommend that you use only latex paint not used to exercise, increase your level and that you avoid paint strippers. Keep the gradually. Planks are a good exercise to help area well ventilated where you are cleaning or prevent low back pain. painting.

Swimming Smoking Swimming is fine, and may be helpful for sore Please DO NOT smoke during pregnancy. muscles, back pain, and swelling. Sunburn can Tobacco smoke is a major source of carbon make you feel terrible during pregnancy. Use monoxide, which can interfere with the sunscreen. Swimming in a lake, ocean, or pool oxygen supply to the fetus. Your baby will have is safe. twice the level of carbon monoxide that you have. Smoking increases the risk of premature delivery, stillborn infants and . Smoking even results in a ten times increased risk for SIDS (Sudden Infant Death Syndrome). have been known to have a higher incidence of or to deliver Discomforts and babies with congenital malformations. If you have not had chickenpox, avoid contact with Illnesses During anyone who has chickenpox or shingles. If you become infected, there is a drug called varicella-zoster immunoglobulin (VZIG) that Pregnancy can be given and may help prevent you from developing a severe form of the disease if it is Backache given within 96 hours of exposure. It may not Apply heat to your lower back, back massage, however, protect the fetus from infection. and the use of a firm mattress may offer relief. Avoid lifting and bending. Wear a supportive Colds/Sinus Infections bra, try stretching, pelvic rocking, wearing an Antibiotics are drugs that fight bacteria, but external abdominal binder, Tylenol or viruses cause colds. A decongestant (Sudafed, crunches. Wear supportive shoes with low Afrin Nasal Spray) can help you breathe if your heels. nose is blocked. Nose sprays are more effective but shouldn’t be used more than a Bleeding gums week. A steam vaporizer may make you feel Practice good oral hygiene. Use a soft better. An expectorant (plain Robitussin) can toothbrush and floss regularly. Try warm saline help your cough and your chest congestion. mouthwash. Lots of water helps loosen secretions. Tylenol can help aches, sore throat, and feverish Braxton-Hicks contractions feelings. Throat spray and lozenges can soothe Rest on your left side and relax. Empty your your throat. So can frequent sips of warm bladder frequently. Drink at least three glasses liquids and saltwater gargles. You can take an of fluids for possible dehydration. Call the antihistamine if you need something to help office if they are regular and/or intense. you sleep, but otherwise they are for allergies. There is no good medicine to stop a runny Breast pain nose – that’s your immune system trying to Perform a breast exam, avoid caffeine, and try flush out the virus. Vitamin E 800 IU. Wear a supportive bra Constipation constantly.

Carpal Tunnel Syndrome No medications will cure a cold, so Increase your water intake and decrease your take medications to help symptoms salt intake. Wear a wrist splint while sleeping. This usually disappears post-partum. if you want.

Chickenpox Drink at least eight glasses of water daily. A virus called varicella-zoster causes Eating more roughage (fresh fruits and chickenpox and it can be transmitted across vegetables) and whole grain foods may help the to the fetus. If you have had prevent constipation. Maintain a regular chickenpox, you don’t have to worry about exercise program. Try Miralax—it’s our being exposed as you have life-long immunity. favorite!! Flax meal is a natural product Women who contract chickenpox between the available by Bob’s Red Mill at supermarkets, 1 second and fourth months of their Tbsp. a day should do it—don’t think that Head Lice or Scabies more is better! Nix (over the counter) is ok to use. Wash all sheets and clothes in HOT water. Diarrhea Drink liquids to avoid dehydration. Avoid dairy Headaches products. Try rice, bananas, toast, or Rest in a dark room and drink fluids, try Kaopectate. Call our office if it is severe. relaxation techniques, massage, and or hot/cold compresses. Try Tylenol 325-650mg Difficulty breathing every four to six hours or Excedrin without Avoid restrictive clothing. Use pillows to aspirin. A cold coke or Dr. Pepper can elevate your back and rest. sometimes help as well.

Dizzy spells Heartburn Avoid rapid breathing. Get up slowly – sit first. Eat small frequent meals and less at a time. Lie on your side. Eat small frequent meals. Try Limit beverages with meals. Do not eat before calf raises. Squeeze your leg muscles to bed. Raise the head of your bed. Don’t smoke. prevent blood from pooling in your legs. Try Maalox, Pepcid or Zantac.

Fatigue Hemorrhoids Take frequent rest periods. Avoid exercise and Eat a high fiber diet. Try cold compresses or caffeine before bed. Try warm milk and warm baths. Take Metamucil. Try Tucks or relaxation. Lavender oil rubbed on pulse Anusol. Hydrocortisone cream works well, points (such as wrist and neck) may help relax too. You can also take an ice cube tray fill each you. one with witch hazel and freeze them. They make great “popsicles” for that area to Fifth’s Disease soothe! Parvovirus B19 causes a common childhood disease that in rare cases could cause Itching miscarriage. If you have been exposed (the risk Try an Aveeno bath, moisturizing lotion, and is highest from your own children), a blood drink fluids. Try Benadryl cream, Caladryl, test can determine whether you are protected Calamine lotion or Aveeno anti-itch cream. because you already had the disease. A later blood test can determine whether you Leg cramps developed the disease during pregnancy, since Wear comfortable flat-heeled shoes. Avoid symptoms are minimal. If you have been crossing your legs and elevate them whenever infected, we may need to follow your baby possible. If you experience a leg cramp, flex with ultrasound examinations. your foot back and pull your toes toward your head. Take extra calcium. Soak your legs in a Flatulence warm tub before bed. Avoid gas-forming foods and straws. Try taking Mylicon liquids 40-80mg. Listeriosis Listeriosis is an infectious disease caused by Flu vaccine bacteria that is transmitted by some foods. We recommend flu vaccination during Symptoms include sudden onset of fever, pregnancy. headache, muscle cramps, abdominal pain, nausea, diarrhea, and vomiting. The listeria bacteria can infect the fetus during pregnancy, causing a spontaneous , stillbirth, or every one to two hours. Drink at least eight an infected newborn. Avoid Mexican style or glasses of water daily. Limit sodium intake. goat cheese, Brie, Camembert, and blue- Sometimes a glass of green tea will help but veined cheeses UNLESS THEY SAY only after the first trimester. “PASTEURIZED”. Remember, over the past few years, fruit has been the highest culprit of TB test listeria. So wash fruits and veggies well. FINE!!

Nasal congestion Tetanus Vaccine Some increased stuffiness is usual with SAFE!! pregnancy. Use a humidifier, drink fluids, try saline nasal drops or spray and gargle with salt Vaginal discharge water. Sudafed may help. Afrin nasal spray Cervical mucous increases as pregnancy should not be used for more than a week, so it progresses. Wear cotton underwear and is best reserved for colds. Eucalyptus oil or pantiliners. Avoid tight pants or jeans. Call the Vicks vapor rub in your “scentsy” works great, office if you have a foul odor or itch, change in as do “breathe right strips”. color or consistency. Using diaper cream “down below” can help protect your fragile Nose bleeds skin from irritation. Avoid overheated air, excessive exertion and medicated nasal sprays. Blow your nose Varicose Veins gently. Saline spray and Vaseline or Vicks are Avoid long periods of standing and crossing fine. Use a room humidifier (cool mist) to help legs. Wear support hose. Elevate legs. as well. Walk. Take rest periods.

Rubella (German Measles) This disease can cause birth defects, but you Warning Signs would have to have it during pregnancy for your baby to have any risk. We test for Preterm Labor: Warning signs for preterm immunity routinely with your first lab tests in labor includes an increase or change in vaginal pregnancy. If your immunity is low, we suggest discharge especially with bleeding, pelvic or you receive the vaccine just after delivery. If low abdominal pressure, abdominal cramps you are not immune and you have been with or without diarrhea and regular exposed, you should talk with your doctor. contractions that do not subside with rest. Fever, rash, and swollen glands would not show up for two weeks or more if you did get High Blood Pressure: High blood pressure, also sick. The risk is higher to your baby if you known as toxemia or preeclampsia develops in develop the disease in the first trimester. fewer than 10% of pregnant women. The cause of this potentially serious condition is Stretch marks unknown. Warning Signs of Preeclampsia are Apply moisturizers daily. They are not raising blood pressure, right upper quadrant preventable but usually will fade. pain, blurred vision, persistent headaches, and significant swelling of hands, feet, and face. Swollen hands/feet Avoid restrictive clothes and long periods of standing. Elevate your legs throughout the day. Wear support hose. Walk for ten minutes Dr. B’s Tips to Help Prevent Nausea During Pregnancy Safe Medications in • Before getting out of bed in the morning, eat a few crackers, a handful Pregnancy of dry cereal, or a piece of toast or dry bread. Put these within reach of your Aches/Fever/Pains – Tylenol bed the night before. Allergies – Tylenol Allergy/Sinus, Benadryl, • Get up slowly in the morning and sit on Claritin, Zyrtec the side of the bed for a few moments before standing up. Cold/Sinuses – Tylenol Cold, Sudafed, Saline Nasal Spray, Afrin Nasal Spray, • Avoid any sudden movements. Mucinex, Neti-Pot, Breathe-right strips with menthol, eucalyptus essential oil. • Eat six to eight small meals during the day. Never go for long periods of time Constipation – Colace, Metamucil, Milk of without food. Eat foods that are high in Magnesia, Miralax, Flax meal (1 T each day) long acting proteins such as milk, yogurt, cheese, peanut butter, and Cough – Robitussin DM nuts. Diarrhea – Kaopectate, Imodium AD • Avoid greasy, highly seasoned, and fried foods. These include butter, Headache – Tylenol, Aspirin-free Excedrin margarine, bacon, gravies, piecrust, pastries, fried meats, and 9rench fries. Heartburn – Mylanta, Maalox, Riopan, Zantac, Pepcid, Prilosec, Prevacid • Always eat a snack high in protein before bedtime. Hemorrhoids – Preparation H, Nupercainal, Anusol, Proctofoam, Tucks • If the nausea is severe, avoid drinking citrus juice, coffee, and tea. Coke or Indigestion – Tums/Rolaids, Mylanta, Gas-x, Dr. Pepper may help. Simethicone

Insomnia – Tylenol PM, Benadryl, Unisom • Lemonhead or ginger candies-keep in your purse for a quick fix. Oyster crackers are a good choice also. Nausea – Vitamin B6, Emetrol, Unisom (see page 19)

• Lavender oil on the inside of the wrists Sore Throat – Halls drops, Cepacol, Sucrets, and under the jawbone can also help. Chloraseptic Spray and lozenges,

Tylenol • Doxylamine 25 mg tablet (Unisom

tablet) one at bedtime combined with Yeast Infections – Monistat 7 and Gyne- vitamin B6–25 to 50 mg twice a day Lotrimin This combination works best as a

preventive, so take it routinely.

Development of the Baby By the end of the sixth month the baby will be eleven to fourteen inches in length and weigh A baby starts out as a fertilized egg no bigger about one to one and one-half pounds. The than the period at the end of this sentence. baby can open and close its eyes and cough The baby will change and grow every single and hiccup. day. It will take 280 days (or 40 weeks) before the baby is fully developed. Pregnancy is often Third Trimester (29-40 weeks) divided into three periods called trimesters. By the end of the seventh month the baby will Each is about three months long. be fifteen inches in length and weigh about two and one-half to three pounds. The baby’s First Trimester (0 to 13 weeks) skin is red and wrinkled because there is By the end of the first month the baby will be practically no fat under it and the baby can one-half inch in length and weigh less than respond to stimuli (pain, light, and sound). one ounce. Organs such as the heart, brain, and lungs are beginning to form. The placenta By the end of the eighth month the baby will and umbilical cord are developing. The be sixteen and one-half to eighteen inches in umbilical cord carries nourishment to and length and weigh four and one-half to six waste away from the baby. pounds. The bones continue to harden as the baby develops and the baby can hear sounds By the end of the second month the baby will outside your body. be one and one-eighth inch in length and weigh less than one ounce. The arms and legs By the end of the ninth month the baby will be are starting to form. The head is large in twenty to twenty-two inches in length and proportion to the rest of the body because the weigh six to eight pounds. The baby will have brain is developing rapidly. Facial features smooth skin and the bones of the head will be become more pronounced. soft and flexible for delivery.

By the end of the third month the baby will be Labor and Delivery four inches in length and weigh one ounce. Bloody Show: A discharge increases late in The baby is called a fetus and teeth and lips pregnancy, and sometimes mucous is mixed begin to develop. The kidneys produce urine with blood. The show may happen as and tooth buds appear. contractions start or may happen many days earlier as the cervix starts to thin. Second Trimester (13-28 weeks) By the end of the fourth month the baby will False Labor be seven inches in length and weigh five • There is no bloody show. ounces. Eyelashes, fingernails, and toenails are • Contractions are irregular and not forming. The baby has vocal cords and taste progressively closer together. Walking, buds and can suck its thumb. changing activity or positions may relieve or stop the contractions. By the end of the fifth month the baby will be • There is no change in cervix. eight to twelve inches in length and weigh about one-half to one pound. Hair begins to grow and a protective coating of vernix (a white, greasy substance) covers the baby. numbs the lower abdomen, legs and birth canal. When do I go to the Hospital ?? • IV Narcotics – pain medications that (DON’T CALL---- only checking your are given through your IV. cervix will tell us if labor is starting).

First pregnancy-- wait until your Ways to Give Birth contractions have been five minutes Vaginal Birth apart for two hours. The first stage of labor starts with the onset of labor and is completed when the cervix is If you have already delivered a child, completely dilated to 10 centimeters. The first go to the hospital when contractions stage of labor can take quite a long time, are regular (equally spaced) and especially with a first baby. This stage of labor painful for at least 1 hour. could last twelve to fourteen hours. The second stage of labor starts with the

cervix becoming fully dilated and is completed with the delivery of the infant. The second stage of labor is much shorter than the first If Your Water Breaks stage. The contractions are now very close • Wear a pad or towel for two hours together and the baby is being pushed out. around the house—if when you check it it’s wet, then you need to come on The third stage of labor begins after the in. delivery of the infant and is completed with the delivery of the placenta or afterbirth – that Actual Labor material which was developed to create the • A “bloody show” may be the first sign. baby’s incubator inside of you. This stage lasts It is usually associated with cramp-like only a few minutes and minimal pushing is pains. needed. • Contractions get stronger, occur more frequently and last longer. Cesarean Birth (C-Section) • Walking, changing activity or position Cesarean birth involves removal of the baby doesn’t affect intensity or frequency of through the mother’s abdominal wall. There contractions. are numerous reasons for cesarean deliveries. • Cervix dilates. Some are known prior to labor, but many aren’t identified until after labor begins and Labor with the first baby varies with different progresses. Any one or a combination of the patients, but on average lasts 12-14 hours. following conditions can lead to a cesarean After the first baby, labor averages 5-6 hours. birth.

Pain Relief Options * Abnormal Presentations – The baby’s • Natural – no use of medications during position prevents a normal head-first delivery. labor. Used in conjunction with The passage of a baby’s legs or buttocks relaxation and breathing techniques. (), or arm or side (transverse-lie • Epidural – anesthetic injected through birth) creates a great risk to the baby’s well a catheter in the lower back which being.

* Cephalopelvic Disproportion – The baby’s head or body is too large to pass through the birth canal. Post Partum

* Fetal Distress – The baby’s heartbeat Most women spend 24-36 hours in the may appear abnormal during labor, hospital after a vaginal birth. If you have had a indicating possible trouble for the cesarean birth or any complications, you will baby. probably stay a full 2 days. You will be monitored for bleeding and fever. * Maternal Bleeding – The placenta can separate from the uterus prematurely Post Partum Discomforts and disturb the oxygen supply to the baby. Additionally, the placenta can * Afterbirth pains/Cramping – These become positioned over the cervix and are due to the uterus contracting as it returns prevent passage of the baby. to normal size. These may be increased with breastfeeding. They usually only last a few * Maternal Medical Condition – days. We recommend changing your position Toxemia, genital herpes, diabetes, often, emptying your bladder frequently, using heart disease and certain other medical a heating pad, and/or taking ibuprofen. conditions in the mother can lead to a Cesarean birth in some situations. * Bleeding – Called “lochia,” it occurs in 3 stages. The first stage is bright red, lasting * Previous Cesarean Birth – The for about 3 days. The second is medium red, previous scar in the uterus may be lasting 1-3 weeks, and the third is brownish weak and allow rupture of the uterus lasting invariably. during labor. A trial of labor may be allowed. * Constipation – The pressure exerted during labor can cause the rectum to become • Prolapsed Cord – The baby’s umbilical numb and the muscles that push the bowel cord drops out of the ahead of movements are sluggish. Try increasing your the baby and can endanger it by fluid intake, fiber, or using stool softeners such cutting off its oxygen supply. as Metamucil twice a day and Colace two or three times a day. Vaginal Birth After Cesarean (VBAC) Today, an effort is being made to allow certain * Emotional Changes – It is normal to women to deliver vaginally after a previous feel exhausted, overwhelmed, and sleep cesarean birth. This option is obviously not for deprived. Your lifestyle has changed and everyone, but can be accomplished in more fluctuating hormones might cause anxiety and than 60% of the instances where it is feelings of helplessness. These “baby blues” attempted. are common, so expect them. Usually, though, postpartum depression doesn’t last longer The advantages of a vaginal birth after than a few days. If you find yourself unable to cesarean are a less costly and shorter hospital function, you have no interest in your baby, or stay. It also allows for a quicker recovery and can’t sleep or eat please call the office. resumption of normal activities. * Episiotomy – Try using cold packs immediately, then dry heat, sitz baths, or a rubber ring. A sitz bath is a clear, comfortably hot bath over your waist that promotes healing and comfort.

* Loss of bladder function or leakage of urine – This is often from decreased perineal muscle tone. Try doing Kegel’s exercises. In Kegel exercises, you tighten the pelvic floor muscles the way you would to stop the flow of urine or feces in midstream. The muscles will pull in together in the form of a figure 8, and the pelvic floor will lift slightly. You should hold these muscles tightly for two or three seconds and then release them. Repeat for several minutes twice a day.

• Swollen Breasts – If you are not breastfeeding, try ice packs, wearing a tight-fitting bra 24 hours a day and avoid stimulation.

Signs and Symptoms to Report after Delivery * Fever over 100.4F * Bleeding heavier than a menstrual period. * Swelling and tenderness in your legs * Chest pain and/or cough * Nausea and vomiting * Burning, pain, urgency (frequent, strong desire to void) on urination * Painful hot and tender breasts * Perineal pain and tenderness that does not subside.

Post Partum Check – At your 4-6-week post partum visit your uterus will be evaluated to ensure that it has returned to normal size, any vaginal stitches have dissolved, and the cervix has healed. This is the time we will discuss your options.

We will then inform you of your next well- woman appointment. But you better keep sending us pictures of your little one!! J