Dear Expecting Patient:
Our providers will be first seeing you between 8-10 weeks of your pregnancy. This is due to being able to detect fetal heart tones for the first time. Following is information which may answer some of your questions and put you at ease until we see you for your initial OB visit. This covers a variety of topics which are often asked early in pregnancy. Please review this information and bring it with you to your initial visit. Of course we would be happy to answer any questions you may have. Information is also available on our website for your convenience: www.boulderwomenscare.com

Schedule of visits:

You will see all providers (5 Doctors and our Nurse Practitioner)
Initially every 4 weeks
At 28 weeks every 2 weeks
At 36 weeks every week
Cervix checked for dilation starting at 37-38 weeks

Lab work:

Required tests:

A lab order for prenatal lab work will be given at the 1st OB visit. These prenatal tests will include blood typing, antibody screen, HIV, Rubella and Hepatitis B immunity status, VDRL, CBC, and Urinalysis. A pap smear and GC/Chlamydia will also be done at your initial visit.
A glucose test will be done at 28 weeks to make sure you have no symptoms of diabetes during your pregnancy. We will also do a hemoglobin and hematocrit to make sure you are not low on iron at this time.
A culture will be done at 36 weeks to check for Group B Strep.

Optional tests:

An Ultrasound will be done around 20 weeks to check for growth and anatomy. If you would like to know the sex of the baby, and it can be identified at this time you will be told. (If you do not wish to know the sex please let the sonographer know and nothing will be said.) *Please be aware that the 22 week ultrasound is a diagnostic tool that we use to check the anatomy of the fetus. We do not video tape, and we ask that you do not use cameras, or picture phones. We also ask that you limit the number of people you bring with you. The room is small and is set up for the mom and dad and maybe one other person. You will be given a picture of the fetus to take with you. Thank you in advance for your cooperation.
Genetic Screening:

The First Trimester Integrated Test will be offered and is done between 9-14 weeks. A high resolution U.S is done to measure the Nuchal Translucency of the baby’s spinal cord this measures the area between the spinal column and the skin of the baby’s neck. The First trimester screening also includes blood work done in 2 stages.
Quad screen will be offered at 16-18 weeks. This is a blood test to see if you have any risk factors to have a baby with Downs Syndrome or a neural tube defect like Spina Bifida.
Amniocentesis-details as needed or requested.
CVS-details as needed or requested.

Diet:

Balanced diet – small frequent meals throughout the day. *You only need an extra 300 calories per day as optimal weight gain is 25-35 lbs.
Lots of water - at least two liters per day!
Calcium requirements of 1200-1500 mg daily.
Folic Acid 1000mcg (1mg) per day.
Moderate caffeine – 1-2 servings a day is okay.
NutraSweet and Splenda 1-2 servings a day is okay.
No unpasturized juices or cheeses of any kind! All cheese sold in the United States must be pasteurized, but some stores can import cheese that may not be pasteurized, so please read labels!
Cream and cottage cheeses are okay.
No undercooked meats or fish.
No Swordfish, Shark, King Mackerel or Tilefish and Albacore Tuna due to large amounts of Mercury.
The other tuna’s like chunk and light are ok.
Fish in a restaurant or market – 12 oz per week or fish caught in local waters - 6 oz per week. All farm raised fish is ok up to 6 oz per week.
Shellfish is ok.

Exercise:

We encourage you to exercise during your pregnancy but try to keep your heart rate below 140-150 beats per minute.
Watch for signs of overexertion-flushing, out of breath, unable to talk during exercise.
Avoid heavy straining, high impact or jarring activities such as kickboxing, mountain biking or horseback riding.
Avoid walks/hiking above 11,000 feet in elevation.
WE CONSIDER SKIING AND SNOWBOARDING RISKY DURING PREGNANCY! (X-country or snowshoeing is ok as long as not above 11,000 feet)
Walking and swimming is healthy for everyone and we encourage you to make this a part of your daily routine.

DRINK PLENTY OF FLUIDS TO PREVENT DEHYDRATION

Fetal Activity:

Usually start feeling baby move around 20th week.

Uterine Growth and Ligament Stretching:

May produce some uterine cramping which is very normal in the absence of bleeding.
You may experience some stretching in the pelvic area, again this is normal.
We encourage you to get massages during your pregnancy and to do some stretching exercises.
We also feel that chiropractic, acupuncture and acupressure are safe during pregnancy, as long as the practitioners are licensed and comfortable working with pregnancy.

Overheating

Hot tubs at 102 degrees or less are ok for short periods of time. Ten to fifteen minutes at the most and make sure you are hydrating while you are in. Please do not use tanning beds, spray tans or saunas.

Dental care:

This is important to maintain during pregnancy.
Let dentist know that you are pregnant, so he/she can limit x-rays to involved tooth.
It is safe to have local numbing injections for dental procedures.

Travel:

We do not recommend travel after 36 weeks gestation or 34 weeks for repeat c-section deliveries.
When traveling, it is important to get out of the car and stretch every couple of hours.
If flying, get up and stretch your legs as often as possible. If flying later into your pregnancy, we have a form letter that states you are under our care, and we give permission to fly. Make sure you are also drinking lots of water or juice. If you must travel in an emergency situation, we will send a copy of your records with you.

Hair dyes and perms:

These are ok, please be sure that the room is well ventilated to avoid breathing in fumes. If you are having this done in a salon, please try and get the first appointment of the day to avoid being in the room with other patrons getting perms, etc.

Additional information:

Please use sunscreen with at least 30% protection.
Use insect sprays with at least 18-21% deet make sure it is in lotion form not a spray.
You may spot a small amount after intercourse. Nothing to worry about unless it becomes heavy like a period.

Again, please bring this information with you to your first appointment so we may review any questions/concerns you may have.

Over the Counter Medications

The following is a list of over the counter medications that are acceptable for use throughout your pregnancy. Please keep this information as a convenient reference guide.

Symptoms Headache /Fever	Medication Tylenol Do not use Advil, aspirin, Ibuprofen, or Aleve unless ok’d by the Dr.*	Dosage 2 regular or 1 extra strength every 4 hr
Sinus Congestion	Sudafed, Claritin Tylenol Cold & Sinus Benadryl, Chlor-trimeton	As Directed
Cough	Robitussin DM	As Directed
Nausea	Vitamin B6 Unisom Emetrol, Preggie Pops Dramanine (non-drowsy) Morning Sickness Magic	50mg (2-3 times a day) ½ tab every 6 hrs As Directed As Directed
Sore Throat (without Zinc)	Throat Lozenges	As Directed
Yeast Infection	Monistat, Gyne-Lotrimin	As Directed
Gas Pain	Gas-Ex , Phazyme Maalox, Mylanta, Gaviscon	As Directed As Directed
Heartburn	Tums, Zantac 75, Pepcid AC Avoid Pepto-Bismol	As Directed
Constipation	Colace, Metamucil Citracil, Fibercon	As Directed As Directed
Diarrhea	Immodium AD	As Directed
Sleep Problems	Tylenol PM Unisom	2 tabs at bedtime 1 tab at bedtime

Boulder Women's Care Pregnancy Handout