BASIC GUIDELINES TO PREGNANCY

Congratulations on your pregnancy! This is a very exciting time in your life. In the coming months your body will go through many physical and emotional changes as the life inside you grows and develops. This brochure is designed to answer some of the first questions you may have about your prenatal care.

The Office Routine
A team of physicians, advanced care practitioners (nurse practitioner and physician assistant), and sonographers will provide your health care. The physicians will attend your labor and delivery and any hospital care necessary. You are welcome to select one physician as your primary provider, but may wish to visit with a number of the providers over the course of your prenatal care so that you are more likely to be familiar with the doctor who will ultimately care for you during labor.

Appointments
•Average number of appointments is 13 total.
•Schedule your first appointment at 6–10 weeks from the start of your last period.
•Visit every 4 weeks until 28 weeks.
•Visit every 2 weeks from 28-36 weeks.
•Visit every week after 36 weeks until delivery.∞
•The visit between 24 and 28 weeks includes a screen for diabetes.

Postpartum visits are scheduled with the physician who performed the delivery at 6 weeks for vaginal births and at 2 and 6 weeks for Cesarean births.

All deliveries are at Sibley Memorial Hospital. COVID-19 FAQs: Preparing for Childbirth at Sibley Memorial Hospital

Very high-risk pregnancies will be managed by, or in concert with, a Maternal Fetal Medicine specialist. Premature (less than 32 weeks) deliveries will be managed by Maternal Fetal Medicine at Georgetown.

Weight Gain
You can anticipate an average of 25 – 35 pounds if you have a normal, healthy body weight at the beginning of the pregnancy. During the first trimester, weight gain varies considerably. The main goal in not to lose weight especially more than 5 pounds. Then expect about 4 pounds per month from 12 – 36 weeks. At 36 – 40 weeks, monitor for rapid or excessive weight gain and/or fluid retention with excessive swelling. Women with higher pre-pregnancy body mass indexes (BMIs) do not need to gain the same amount of weight as women with normal or low BMIs.

Childbirth, Newborn, and Breastfeeding Educational Classes
Our doctors recommend Nested for childbirth and newborn care classes because they are specifically catered toward Reiter & Hill clients and Sibley Hospital. The Nested educational team include some of our very own providers and local experts in the area. The Nested classes promote a casual, non-judgmental evidence based learning environment that is interactive and will prepare parents for labor and delivery, newborn care, and infant CPR skills. Please refer to the Nested website for early registration discounts.

Diet
Work toward just a 300 cal/day increase over your baseline. This is all that is required to gain a healthy 25 – 35 pounds.Your diet should be well-balance and consist of lean protein sources, complex carbohydrates and plenty of fruits and vegetables. You also should avoid large amounts of simple sugars. In addition, you can also include the following supplements:

•Folic acid, at least 0.4 mg/day (contained in all prenatal & multi vitamins) in the first two months to decrease the risk for neural tube defects.
•Calcium 1200 – 1500 mg per day. This requires four or more servings of dairy products (low fat or skim) a day. Most women do not consume this much and will need to supplement. Prenatal vitamins do not contain enough to meet the daily requirement. Calcium carbonate –Tums, Oscal, Rolaids, Viactive, Caltrate – are good sources as well as calcium fortified orange juices.
•Iron supplements are available in prenatal vitamins. Many women will need to add additional iron at about 20 weeks.
•Iron and calcium taken alone together will bind with each other and not be absorbed. Take with meals or separately.
•Iron is better absorbed when taken with Vitamin C-rich foods.

Foods to Avoid
•Under or uncooked meat, fish, or poultry.
•Although current recommendations state women should generally avoid undercooked fish, sushi prepared in a clean and reputable establishment is unlikely to pose a risk to the pregnancy.
•No swordfish, shark, mackerel, or tilefish – these fish may contain excessive amounts of mercury.
•Soft cheeses such as brie, feta, Camembert, or Roquefort made from unpasteurized milk.
•Unpasteurized milk or juices or products made from these items.
•Pregnant women should wash their fruits and vegetables before eating them.
•If consumed, deli meats and hot dogs should be reheated before eating.

Foods to Include
•Consume 2-3 servings per week of low mercury fish
•Aim for 8 ounces of protein per day (this can include the protein in dairy products).
•6+ glasses of liquids per day.
•Increase fruits and vegetables as well as bran to combat constipation.
List of calcium sources

10 Things to Avoid
•Smoking, including second hand smoke. Women who are unable to quit entirely should reduce it as much as possible and can try nicotine replacement (gum and patches) as part of a smoke cessation strategy. However, these products may also have possible associate with IUGR due to vasoconstriction.
•Alcohol, to avoid the risk of fetal alcohol syndrome.
•Recreational drugs.
•Limit caffeine to less than 300 mg per day
•Low consumption of artificial sweeteners is fine, but limit saccharin to two packets per day.
•Over the counter herbs and medicinals. We know little to nothing about the effects of these products on babies.
•Excessive heat: saunas, hot tubs, over exercising, temperature 100.4 or higher (treat with Tylenol).
•Changing kitty litter or exposure to cat feces, i.e. gardening without gloves, or playing in sandboxes
•Lying flat on your back for extended periods of time. This decreases the return of blood to the heart and can cause a drop in blood pressure and flow to the uterus.
•Consider avoiding hair dyes, perms, or relaxers, at least in the first trimester. Although data is limited, hair dye is presumed to be safe in pregnancy because systemic absorption is limited

Exercise
Unless otherwise instructed, plan to exercise 20 – 30 minutes 3 – 5 times a week. Walking, jogging, swimming, low impact aerobics, treadmill, and Stairmaster are generally well tolerated. Avoid potentially harmful sports (e.g. horseback riding, downhill skiing, and anything that requires you to use or wear protective equipment). Weights are ok, but decrease the amount of weight and increase the repetitions to maintain tone. Hydrate thoroughly before, during (if possible) and after exercise. Stop if you experience contractions, bleeding, excessive fatigue, or shortness of breath.

Sexual Intercourse
Pregnant women without complications should not have any restrictions regarding sexual intercourse. Pregnant women with bleeding, placenta previa, ruptured membranes or other risk factors will be asked to abstain from intercourse until further evaluation eliminates their risk.

Approved Medications
Following is a list of approved medications during pregnancy. If possible, it is best to avoid any nonessential medication in the first trimester.

Approved Medications during Pregnancy

Travel
In general, travel during pregnancy is safe. You may wish to consider limiting out of town travel before 12 weeks or until a heartbeat is heard or seen as this is the most likely time for miscarriage, and medical attention will be required. Travel plans in the second and third trimesters should take into account current and past obstetrical and medical histories, destination, length of time away from home, and medical facilities available during travel. Wear seat belts at all times. The belt should rest between your breasts and underneath your stomach. On long trips, walk around every couple of hours to decrease the risk of blood clot formation. Topical insect repellants (including DEET) can be used in pregnancy and should be used in areas with high risk for insect-borne illnesses.
**See Zika Warning Section**

Morning Sickness Suggestions
(To avoid dehydration and/or weight loss):

•Small frequent meals
•Avoid spicy and greasy foods and strong odors
•Wet/dry regimen – alternate solids and fluid intake
•Emetrol – follow label directions
•Vitamin B6 50 mg three times per day
•Ginger tea
•Lemon drops
•Sea bands – acupressure wrist bands
•Acupuncture
•Call if you are unable to hold down liquids, are dizzy, notice a decrease in urine output, or weight loss greater than 3 – 5 pounds.

Laboratory tests

1st visit
•Complete Blood Count (anemia screen)
•Blood Type and Antibody Screen
•Rubella – German Measles – Titer
•Varicella – Chicken Pox – Titer
•Urinalysis
•Urine Culture (Asymptomatic urinary tract infections are common in pregnancy and have been associated with pre-term labor and/or the development of pyelonephritis or kidney infection)
•Pap smear
•Sexually Transmitted Diseases

      • Syphilis (RPR) – Required by law
      • Gonorrhea – Required by law
      • Chlamydia – Required by law
      • Hepatitis B – Recommended by the American Academy of Pediatricians
      • HIV (AIDS) – Recommended by the American College of Obstetricians and Gynecologistsand the CDC

24–28 weeks
•One hour Glucola to screen for diabetes
•Complete Blood Count
•Antibody Screen and Rhogam (if Rh negative)
•Syphilis (RPR)

36 weeks
•Beta Strep vaginal and rectal culture (Approximately 10 – 30% of the population are carriers of this bacteria which has been associated with serious infections in the newborn. Mothers who test positive at any time will be treated in labor with intravenous antibiotics
•Gonorrhea culture
•Chlamydia culture
•Syphilis (RPR)
•Complete Blood Count
•HIV

Ultrasounds
•First trimester to confirm dates
•18 – 20 weeks for anatomy screen
•Additional ultrasound screening for high risk pregnancies and maternal age greater than 35 at delivery
•Fetal Echo at 20-22 weeks for IVF pregnancies

Optional Labs and Tests (recommended only if you fit the appropriate high-risk profile, please discuss with your health care provider)

•Parvovirus – Fifth Disease – screen: High-risk individuals include daycare providers, nursery and elementary school teachers and volunteers, and those who work or volunteer at children’s hospitals.
•Toxoplasmosis screen for cat owners.
•NIPT at 10 weeks to screen for Down Syndrome, Trisomy 13 and Trisomy 18
•Ultrascreen First Trimester Screen (Nuchal Translucency) at 11 and 1 to 13 and 6 weeks for Down Syndrome, Trisomy 13 and Trisomy 18.
•Sequential Second Trimester Screen at 16 weeks to be combined with the Ultrascreen to screen for open neural tube defects, as well as Down Syndrome, Trisomy 13 and Trisomy 18
•AFP only at 16 weeks to screen for open neural tube defects
•AFP Tetra Screen at 16 weeks to screen for open neural tube defects, as well as Down Syndrome, Trisomy 13 and Trisomy 18
•Genetic Carrier Screen to include, but not limited to: Fragile X, Spinal Muscular Atrophy, Cystic Fibrosis, Jewish carrier screening, Alpha/Beta Thalassemia, G6PD, and Sickle Cell screening
•Hemoglobinopathy screening
•Amniocentesis at 16 weeks (This is an invasive procedure with approximately 0.3% miscarriage rate.)
•Chorionic Villus Sampling (CVS) at 10 – 12 weeks (This is an invasive procedure with approximately 1% miscarriage rate.)

Suggested Reading
What they don’t tell you about having a baby by Heather L. Johnson, MD
Dos and Don’ts in Pregnancy Truths and Myths.pdf by Nathan Fox, MD
What to Expect When You’re Expecting by Heidi Murkoff
Girlfriend’s Guide to Pregnancy by Vicki Iovine
Postpartum Survival Guide by Ann Dunnewold
The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger
Today’s Mothers-to-Be
Relieving Pelvic Pain During and After Pregnancy: How Women Can Heal Chronic Pelvic Instability by Cecile Röst
Twin Set: Moms of Multiples Share Survive and Thrive Secret by Christina Boyle