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Your Pregnancy Guide
for choosing us for choosing us to care for you through your to care for you through your pregnancy and baby's birth.
pregnancy and baby's birth.
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We've created this guide to answer your questions about everything from healthy nutrition to the signs and prepare. That's where this book comes in.
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Of course, the infor mation you'll find in this book is not a substitute for consulting with . As a comprehensive overview, we hope it will help you learn the basics y healthcare ou need to know – and encourage you to ask more questions during your regular visits and in-between. We're here to help you , the information y . As a comprehensiv ou'll fi view, w his book is not a subst e hope it will help y ou lear e for consult n the basics y ing with ou need to know – e you to ask more questions during y e a smooth pregnancy and rewarding bir our regular visits and in-betw th experience every step of the wa een. W e're here to help you healthcare professionals. As a comprehensive overview, we hope it will help you learn the have a smooth pregnancy and rewarding birth experience every step of the way! basics you need to know – and encourage you to ask more questions during your regular visits and in-between. We're here to help you have a smooth pregnancy and rewarding birth s Birth Center Team experience every step of the way! Monroe Clinic's Birth Center Team Freeport Highland W Monr t Highland W enter (appointment desk -2241 815-233-0999 Family Birth and Women's C (nurses (when Clinic is closed) ednesda nroe Women' y: 7 am to 4 pm s Health Closed daily: 11:30 am to 12:30 pm Center (appointment desk) 608-324-2250 Family Birth and Women's Center (when Clinic is closed) Closed daily: 11:30 am to 12:30 pm oe Women's Health Center: 32 s'4 de - sk) 608-324-2241 y - Frida s Health Center: rida irth and Wome n's Center (when Clinic is closed) 608-324-1291 Monroe Birthing Unit (when Clinic is closed): Monroe Birthing Unit (when Clinic is closed BABY STEPS Your Pregnancy Guide Table of Contents

Chapter 1
1. Taking Good CareAs you head down the "pregnancy path," we're with you every step of the way – offering education and care that helps you plan, prepare and make the best choices for your growing family.
FREE MONROE CLINIC CLASSESClasses are a great way to prepare yourself and your family for childbirth. Plus you'll have a chance to meet other expectant moms as eager for knowledge and support as you are.
Register for the following classes online at or by calling 608-324-1725 or 800-337-0785.
A spouse, partner, friend or family member is welcome to attend classes with you.
§ Childbirth Preparation. An enlightening and realistic look at pregnancy, childbirth and
parenting taught by childbirth educators. This class helps parents prepare for and make informed decisions during the journey ahead.
§ Breastfeeding Classes. Strategies for a successful start, plus facts about the physical and emotional
impact of breastfeeding on moms and babies. Monroe Clinic lactation educators also address "working mother" concerns like breast pumping and milk storage.
§ Big Brothers and Sisters. Welcoming a new sibling isn't always easy on big brothers or sisters.
Teach children age 3 and older how to be part of the fun by helping out and practicing safe care and handling techniques.
§ Lifesaver Baby Class. Emergency training for caretakers, relatives, siblings, babysitters and daycare
workers. This program shows participants what to do in emergency situations, including resuscitation techniques for infants less than one year of age.
BABY STEPS Your Pregnancy Guide EXPECTANT MOM SCREENINGS BY TRIMESTER The following are health tests and screenings commonly offered during your pregnancy.
§ Cysticfibrosiscarrierscreen.This genetic test
§ Urine test. A routine test throughout your
is for parents concerned about passing a cystic pregnancy to check for signs of infection, fibrosis gene on to their child. If one parent's test diabetes, dehydration and other potential is positive, the other parent will need a screening complications. Notify a nurse if you are test to best determine their child's risk.
experiencing painful and/or frequent urination. § First trimester combined screening.
These could be signs of a urinary tract infection.
This optional test is offered between 12 and 14 § Blood count. This test may be repeated
weeks of pregnancy. It consists of an ultrasound occasionally throughout your pregnancy to and finger-stick blood test that checks for monitor blood cell counts and check for anemia. possible chromosomal abnormalities and the If your blood count is low, your provider may need for further testing.
want you to take an iron supplement.
§ Private well water testing. Families with well
§ Rubella (German measles) immunity. This test
water (not city water) should have their water shows if you are immune to rubella. If not, you tested for nitrates, lead and bacteria. Sampling should be immunized following delivery and kits are available through Monroe Clinic's should not get pregnant again for three months laboratory. Testing is also offered through your after your rubella shot.
county health department.
§ Toxoplasmosis titer. This optional test is
for patients concerned about exposure to an § One-hour glucola. This screening test
organism found in raw meat or passed on from checks for gestational diabetes at 28 weeks, as the feces of small animals, including cats.
pregnancy occasionally causes an imbalance § Blood type and Rh factor. This test will help
between your body's sugar and insulin supplies.
determine if your blood type is Rh negative. If § Ultrasound. This technology uses high-
so, and your baby's blood type is Rh positive, frequency sound waves to evaluate the placenta, the antibodies already in your blood could attack the amniotic fluid and the gestational age, growth your baby's red blood cells, leading to anemia, and anatomy of your baby. A routine ultrasound jaundice or more serious problems. If needed, is usually offered around week 20 and may be you'll receive a RhoGAM injection (Rh immune recommended at other times for various reasons. globulin) to help prevent these health problems.
A vaginal ultrasound requires no preparation § STD screening. This routine test checks for
and is usually performed up until the 14th week various sexually transmitted diseases.
of pregnancy. An abdominal ultrasound requires a full bladder and is performed from 14 weeks § Hepatitis B test. This test shows if you have
through full-term pregnancy.
been exposed to or are a carrier of Hepatitis B.
§ HIV test. This test shows if you have been
infected with the human immunodeficiency virus.
§ Kick counts. To monitor your baby's activity,
you can do "kick counts" at home by following § Group B streptococcus culture. A cervical
culture is obtained around 35 weeks to check w Plan to do kick counts when you know for group B streptococci (strep B). If strep B is the baby is usually active.
present, you will be given an antibiotic when you are in labor so your newborn won't get infected.
w Get comfortable in a recliner on the sofa or in bed.
§ Multidrug-resistantorganisms(MRSA). If
you have tested positive for MRSA in the past, a w Note the time you start the kick counts culture (nasal or open wound) must be obtained using a clock/watch, pencil and paper.
a month prior to delivery. If you are infected w Lie on your side for the counting period.
with MRSA, special precautions will be taken when you come to the hospital birthing unit.
w Place your hands on you oup B streptococcus culture. A cervical culture is obtained around 35 weeks to check for group over the baby.
B streptococci (strep B). If strep B is present, you will be given an antibiotic when you are in labor so SKILLED PROVIDERS your newborn won't get infected. w Count each time the baby moves, including kicks, rolls, pu • nches, turns Multidrug-resistant Organisms (MRSA). If you have tested positive for MRSA in the past, a Physician coverage for delivery. Our team of
and stretches. Do not count hiccups or culture (nasal or open wound) must be obtained a month prior to delivery. If you are infected with skilled obstetricians take turns being on call, so movements the baby makes as you push MRSA, special precautions will be taken when you come to the hospital birthing unit. we encourage you to see all our physicians for your against him or her.
prenatal care. You can view all of our obstetricians w When you have counted eight profiles at or on the brochures movements, note the time and SKILLED PRO clinic waiting r FOR . YOU AND BABY how long it took.
Selecting your child's healthcare provider. To
Physician coverage for delivery. Our team of skilled obstetricians take turns being on call during w Your baby is showing good activity if choose your child's primary care provider, you can non-office hours, so there is a possibility that the provider you have been seeing for prenatal care may not there are eight movements in two hours.
browse our pediatric or family practice profiles be available for your delivery. You can view all of our obstetricians profiles at or on the at or ask for information in our w If your baby does not mov broce eight times hures located in the clinic waiting rooms. pediatric or family practice departments. Before your in two hours, call your healthcare baby is born, we invite you to schedule a checkup provider as soon as poss electing y uss.
our child's healthcare provider. To choose your child's primary care provider, you can consultation with a provider to discuss newborn browse our pediatric or family practice profiles at or ask for information in our pediatric § Biophysicalprofile(BPP).This evaluates you
or family practice de r care, immunizations, circumcision and any other partments. Before your baby is born, we invite you to schedule a checkup consultation baby's wellness by using ultr questions you may have.
o discuss newborn care, immunizations, circumcision and any other questions you may have.
movement, breathing, muscle tone and the We recommend preventive health examinations for amount of amniotic fluid pre e recommend preventiv your baby that may include e health examinations for y rout our babine immunizat y include routine immunizations and § Non-stress test. This test is done with a
screenings at the follo wing ages of reenings at t he following ages of infancy: monitor placed on your abdomen to help detect and evaluate your baby's heart rate and movements. It's also used to monitor uterine contractions lasting a minimum of 20 minutes.
§ Maternal Serum Alpha-Fetoprotein
(MSAFP).This blood test is performed to
screen for open neural tube defects, such as Spina Bifida.
BABY STEPS Your Pregnancy Guide Chapter 2
2. A Healthy Start for Two NUTRITION: "EATING RIGHT" TIPS Evaluating what you eat is important to your body's changing nutritional demands and the needs of your baby. You are your baby's only source of nourishment – pregnancy is not a time to "diet" by restricting or limiting foods that provide important nutrients. Use the table below to help you develop your daily menu. If you have concerns about getting the proper nutrition, please discuss your diet with your healthcare provider or ask for a referral to a registered dietitian.
"EATING RIGHT" TIPS w Add peanut butter to apples, carrots, celery w Use milk instead of water in recipes w Use peanut butter instead of margarine on toast w Add 5 tablespoons powdered milk to 8 ounces w Swirl peanut butter through ice cream or yogurt liquid milk when making soup, mashed potatoes, w Snack on nuts or seeds hot cereal, pudding, etc.
w Add chopped eggs to tuna or ham salad w Freeze fruit juice for juice pops w Add extra kidney beans to chili w Add pineapple to pizza or stir-fry w Serve beans mixed with ground beef w Add fruit to cereal or cottage cheese w Add mashed tofu to pasta dishes w Add vegetables to recipes w Add sliced or melted cheese on sandwiches w Make non-fat dips for vegetables w Snack on dried fruits or raw vegetables w Put cheese on vegetables w Make fruit-based desserts w Use non-fat yogurt in place of sour cream w Add rice or pasta as a side dish to meals w Mix yogurt with fruit juice and freeze w Add rice or pasta to casseroles and soups w Blend fruit with yogurt w Add bran to cereal or casseroles w Drink fruit or vegetable juice w Add a muffin or bagel to meals "EATING RIGHT" TABLE
Note: Suggested servings are minimum daily requirements and can be increased to achieve proper weight gain
FOOD GROUP AND KEY INGREDIENTS FOOD SOURCE AND SERVING SIZE One serving equals: w ½ cup cottage cheese w Supplies protein, niacin, thiamine (B-1) and iron w 1 cup cooked dried beans w Helps build new body tissue, prevents anemia w 4 tablespoons peanut butter w Meat, fish, poultry, eggs and cheese are sources of complete protein. (All needed building blocks are present. The protein in dried beans or peas, peanut butter and tofu need to combine with protein w 2 ounces of cooked meat, poultry or fish building blocks from meat, dairy food, grains and vegetables to form complete protein.) One serving equals: Milk and Milk Products
w 1 cup whole, 2%, 1% or skim milk w Supplies calcium, protein, vitamins A, D w 1-½ ounces cheese and riboflavin (B-2) w 2 cups cottage cheese w Builds bones and teeth w 1-¾ cups ice cream w Protein builds body tissue w 1 cup yogurt, custard, cocoa or pudding 3-5 SERVINGS Vegetables One serving equals: 2-4 SERVINGS Fruit w ½ cup cooked, chopped raw w Supplies vitamins A and C, folic acid, and many or canned vegetables/fruits vitamins and minerals w Promotes healthy skin, teeth, bones and eyes w 1 cup raw leafy vegetables w Provides fiber to avoid constipation VITAMIN C-RICH FOODS: Oranges, berries,
grapefruit, melons, tomatoes, asparagus, broccoli, brussels sprouts, cabbage, greens, potatoes VITAMIN A-RICH FOODS: Broccoli, carrots,
greens, sweet potatoes, winter squash, cantaloupe, peaches, apricots FOLIC ACID-RICH FOODS: Dark greens,
broccoli, asparagus, orange juice, liver, dried beans. It is
recommended to have at least 600 mg when pregnant,
and it may be taken as a daily vitamin supplement
One serving equals: w 1 slice bread, roll, muffin, waffle w Supplies complex carbohydrates, w ¾ cup dry cereal thiamine (B-1), iron, niacin (B-3) w ½ English muffin, bagel, hamburger bun w Provides energy and proteinw Provides fiber and select whole grains w ½ cup cooked cereal, rice, pasta, grits w Promotes healthy skin, nervous system 8 (8 OZ) SERVINGS Fluids Suggested fluids: w Supports an increasing blood volume in pregnancy w Milk w Water w Juice w Helps maintain a fluid balance BABY STEPS Your Pregnancy Guide AVOIDING UNNECESSARY RISKS: Effects of Alcohol, Tobacco and Drug Use
Alcohol, tobacco and drug use can put you and your Marijuana deprives the baby of vital nutrients and baby at risk. From birth defects to life-threatening oxygen and remains in the baby's fat cells for seven conditions, substance abuse can have serious long-term effects. If you need help with abuse or addiction, talk to your provider immediately. Support Health risks include miscarriage, stillbirth, and resources are available to get you on a safe and difficult or long labor, hyperactivity and irritability healthy management program. in the newborn, premature labor, low birth weight, attention deficit and learning disabilities.
Alcohol passes through the placenta, where it is broken down more slowly and leads to higher blood Cocaine, crack, heroin and methadone alcohol levels for longer time periods in the baby's are highly addictive for moms and babies. These body. No amount of alcohol use during pregnancy drugs attack the central nervous system and cause has been proven safe.
a decrease in the baby's blood flow, ultimately depriving him or her of nutrients and oxygen.
Health risks include miscarriage, stillbirth, low birth weight, mental retardation, birth Health risks include miscarriage, premature defects (especially in the heart and brain), birth, bleeding, death, fetal strokes, placenta behavioral problems, learning disabilities and abruption, low birth weight, brain damage, physical deformities like small eyes, short nose birth defects, Sudden Infant Death Syndrome and flat cheeks.
(SIDS) and serious withdrawal symptoms for baby after birth. Behavioral problems, feeding Smoking exposes you and your baby to chemicals and sleeping difficulties, and increased irritability in tobacco (nicotine, tar, carbon monoxide, cyanide, are also common.
etc.) that interfere with your baby receiving proper nutrients, blood flow and oxygen.
Methamphetamines or "speed" used during pregnancy deprives unborn babies of nutrients Health risks include preterm labor, placenta previa, low birth weight, Sudden Infant Death Syndrome (SIDS), chronic respiratory illness Health risks include decreased weight, length and throughout childhood, problems with physical head size, stroke, bleeding into the brain, premature growth, impairments and learning disabilities.
labor, miscarriage, placental abruption, withdrawal symptoms and learning difficulties.
EXERCISE AND PHYSICAL ACTIVITY GUIDELINESBenefits: Regular exercise and physical activity during pregnancy can enhance your mood and ease some of the discomforts of pregnancy. In addition, physical activity and certain exercises can help prepare you for childbirth. (See page 16 to learn more about these exercises.) Your goal should be to maintain a general level of fitness.
Concerns: Because of hormonal changes during pregnancy, your ligaments become easier to stretch, making it easier to sprain a ligament or pull a muscle. It may also be harder to catch your breath (get enough oxygen) during exercise, sometimes causing a dizzy or weak feeling.
Good body mechanics in daily activities: § Use good posture.
§ When standing, keep one foot up on a box placed in front of you.
§ When using a vacuum, etc., place one foot forward, allowing you to shift your weight without twisting.
§ When picking up an object, face it and use your arms and legs to lift. Bend your knees and lower yourself slowly to a squatting position with feet well apart and your back straight.
§ When picking up a toddler, place one foot forward and lower yourself slowly to the other knee. The front foot/leg should be used for lifting yourself up, the rear foot/leg for pushing and balance. Draw the toddler close to your body from this position or have the toddler climb onto your lap from a chair or couch.
SAFE EXERCISE TIPS w Drink plenty of fluids before exercising.
w Exercise during hot, humid weather w Warm up slowly for at least five minutes.
or at higher altitudes.
w Stretch gently and not to your limit to w Perform routines that are strenuous, prevent ligament injury.
high-impact (jerky or bounding) or w Use a stable floor (no loose rugs).
new to your body.
w Exercise at least three times a week.
w Work out when you are ill.
w Increase calories and fluids to replenish your w Do sit-ups, deep knee bends, straight body after exercise.
toe touches, weight lifting or activities w Wear comfortable clothes and a supportive, where you hold your breath and strain.
well-fitting bra. Consider support stockings w Use hot tubs, saunas or expose yourself for leg comfort.
to any environment/activity that raises w Rise from the floor slowly after exercise to your body temperature above 101 avoid dizziness or fainting.
degrees Fahrenheit.
IMMUNIZATION AND PREGNANCYYour immunity is passed along to your baby during pregnancy. Receiving recommended vaccines will protect your baby from some diseases during the first few months of your baby's life until he or she may be vaccinated.
Flu vaccine: Pregnant women are at serious risk for complications and hospitalization when infected with the flu. It is important to receive the flu vaccine when you are pregnant to reduce risk for serious complications Tdap vaccine: Tetanus, diphtheria, and acellular pertussis vaccine is recommended to pregnant women after 20 weeks. The Tdap vaccine helps protect your baby from pertussis (whooping cough) until your baby is able to be vaccinated. It is also recommended for all close contacts of the baby (fathers, grandparents, siblings, caregivers, etc.) to receive the Tdap vaccine at least 2 weeks prior to the baby's arrival.
BABY STEPS Your Pregnancy Guide Chapter 3
3. Common Discomforts and Relief Measures COMMON DISCOMFORTS OF PREGNANCY POSSIBLE CAUSE(S) RELIEF MEASURE(S) Fatigue or tiredness Physical demands of pregnancy, including Try to increase rest. Plan extra help changes in processing foods and nutrients. during the first three months of Greater blood volume makes heart and other pregnancy and the last month. Go to organs work harder. Hormonal changes can bed early and try to avoid getting up make you feel sluggish or sleepy.
at night. Exercise moderately.
Breast tenderness; Change in hormones Wear a supportive bra. Avoid Nausea and vomiting Change in hormones Eat small, frequent meals. Don't let stomach become empty. After sleeping, eat dry crackers before rising. Get up slowly. Avoid odors. Call your healthcare provider if severe.
Pressure of the uterus on large blood Don't lie on your back or stand for long vessels. Anemia or decreased blood sugar.
periods of time. Get up slowly and avoid sudden changes in position. Don't skip meals.
Stuffy nose or nose bleeds Increased blood volume.
Use humidifier. Lubricate nasal passages with petroleum jelly. If severe, report to your healthcare provider.
COMMON DISCOMFORTS OF PREGNANCY POSSIBLE CAUSE(S) RELIEF MEASURE(S) Stomach displaced by growing uterus. Eat small, frequent meals. Avoid fatty Hormones relax the stomach opening, or spicy foods. Stay in upright position allowing acid to enter the esophagus. after eating. Eat slowly. Prop yourself Delayed stomach-emptying time.
up in bed with pillows if heartburn occurs when sleeping.
Frequent urination Pressure of uterus on bladder. Possible Use bathroom frequently. Drink plenty urinary tract infection if accompanied of fluids. Do Kegel exercises (see page by burning, urgency to go.
17) to help tone. Check with doctor about possible infection. Be patient, as birth of baby will provide relief.
Slower movement of food through Drink six to eight glasses of water a the digestive tract due to the hormone day. Increase roughage in diet: fruits, progesterone, resulting in increased water vegetables, whole grains. Increase physical absorption from the colon. Pressure on activity. Find a bathroom when the need the intestines as the uterus becomes first comes, don't wait. If problem persists, larger. Decreased physical activity.
talk to your healthcare provider.
Softening of ligaments and joints due Practice good body mechanics and to hormones. Posture changes due to posture. Don't bend over to lift; squat increased weight of uterus. Standing or instead. If standing for long periods, put sitting for long periods.
one foot on box or stool. Change position frequently. Perform pelvic tilt or rock, knee-chest position (see page 17). Wear low-heeled shoes.
Groin pain/round Round ligaments that hold uterus in Use good posture. In bed, draw knees up place are stretched. Poor posture. then roll to side. Do not twist-move body Standing too long.
all at once. Bend forward when laughing, coughing or sneezing.
Fatigue or chilling. Sitting or standing Never point your toes to stretch. Bring for prolonged time that causes pooling toes toward head. Increase calcium intake. of blood in legs. Pressure of enlarged Eat bananas. Get adequate rest.
uterus on nerves and blood vessels. Pointing of toes. Lack of calcium.
Vaginal discharge Thickening of lining increases secretions. Call your healthcare provider if discharge Plays a role in preventing infection.
becomes foul smelling, causes burning or itching or becomes watery in the second half of pregnancy. Wear cotton panties.
Pressure of enlarged uterus on blood Drink six to eight glasses of water daily. vessels. Standing or sitting for long Elevate legs. Rest more. Avoid canned, periods. (Minor swelling is normal.) processed, high-sodium foods. Wear support hose. Call your healthcare provider if swelling is in face or becomes severe.
BABY STEPS Your Pregnancy Guide COMMON DISCOMFORTS OF PREGNANCY POSSIBLE CAUSE(S) RELIEF MEASURE(S) Constipation. Increased pressure on blood Avoid constipation; perform Kegel exercises vessels and pressure of uterus on bowel. to increase circulation. Avoid straining to Straining to move bowels.
move bowels. Use Tucks pads for cleansing. If inflamed, apply hydrocortisone cream sparingly.
Arms/wrist: possible carpal tunnel syndrome. Place hands on shoulders or elbows. Hold or Legs/thigh: uterus increases in size, placing hug pillow while sleeping.
pressure on nerves.
If non-medicine measures don't provide relief, you may use the following over-the-counter medications after your 12th week of pregnancy. Please follow directions and use in moderation. Call your healthcare provider if you have any questions or if symptoms don't improve.
NON-PRESCRIPTION MEDICATIONS OKAY TO USE DURING PREGNANCY NON-MEDICINE TREATMENT OVER-THE-COUNTER Bed rest, cool cloth on forehead, increased Lozenges, Vicks VapoRub, Sudafed, Tylenol fluids (vitamin C juices), humidifier or cool Cold, Robitussin Cough, Dristan Nasal Spray mist vaporizer. Call your healthcare provider (use only three days), Vicks Dayquil.
if you have a fever over 100 degrees.
Increase fluids and fiber in diet. Increase Metamucil, Citrucel, Colace exercise, walking.
Maintain fluids. May need to limit solids, Imodium, Kaopectate. Do not use especially fresh raw fruits and vegetables.
Pepto-Bismol; contains aspirin.
Headache, fever, Bed rest, cool cloth to forehead, increased Tylenol (Acetaminophen). Do not use aspirin general body aches fluids (vitamin C juices). Call your healthcare products or ibuprofen.
provider if fever over 100 degrees.
Sit after eating. Do not lie down right away. Gaviscon, Maalox, Mylanta, Tums Prop back up with pillows. Small, frequent liquid or tablets.
meals. Avoid spicy foods.
Prevent constipation. Constipation aggravates Tucks pads, Annusol, Preparation H, hemorrhoids. Sit in warm tub.
hydrocortisone cream (sparingly).
Take a warm bath with 2 cups oatmeal, apply Aveeno lotion, Benadryl cream.
vitamin E oil to affected area.
Wear cotton underwear. Call your healthcare Gyne-Lotrimin, Monistat vaginal cream.
provider if not relieved by medication.
Avoid allergen if possible.
Zyrtec or Claritin.
Chapter 4
4. Warning Signs and ComplicationsWhile most women enjoy a normal, healthy pregnancy, it's important to recognize possible warning signs and seek prompt medical evaluation.
EARLY PREGNANCY WARNING SIGNS AND COMPLICATIONS § Cramping and/or bleeding from the vagina.
While more than half of women who experience bleeding early in pregnancy continue with a normal pregnancy, this condition is not normal and should be evaluated immediately. Vaginal bleeding and cramping could be signs of a miscarriage.
and occasionally, shoulder pain.
These are possible signs of an ectopic (tubal) pregnancy growing outside the uterus, usually in the fallopian tube. If untreated, a tubal pregnancy can be life threatening. Contact your healthcare provider immediately if you have any of these warning signs.
BABY STEPS Your Pregnancy Guide (premature labor before 37 § Abdominal pain, continuous or severe weeks of gestation) § Regular contractions or tightening of the § Vaginal discharge - change in type (watery, uterus before 36 weeks mucous, bloody) or increase in the amount § Chills and fever over 100 degrees Fahrenheit § Lower abdominal or pelvic pressure § Vaginal bleeding. (You can expect light, painless vaginal bleeding for a day following a pelvic § Low, dull backache exam in late pregnancy.) § Abdominal cramps, with or without diarrhea § Major decrease in baby's movement. (Perform § Regular contractions or tightening of the uterus kick counts as explained in Chapter 1.) If you have any of these warning signs, contact § Sudden increase of vaginal discharge your healthcare provider without delay. It is often § Bag of waters leaking or gushing possible to prevent premature birth when the signs are recognized and treated promptly.
§ Headaches, severe or continuous § Blurred vision or spots before your eyes § Rapid weight gain – more than 1 pound per day § Swelling, especially in the face, that does not go away after lying down § Vomiting that does not get better, especially if you are unable to hold fluids down for 24 hours § Burning with urination or trouble passing urine If you experience any of the above, call your healthcare provider immediately. For questions regarding any signs or symptoms, contact your physician's office during clinic hours. If the clinic is closed, call the hospital birthing unit at 608-324-1291.
Chapter 5
5. Preparing for Childbirth CONDITIONING YOUR BODY These exercises, done prenatally, strengthen, stretch and limber muscles used for childbirth -
§ Use to strengthen and stretch inner thighs and relieve low backache.
§ Sit cross-legged on the floor with soles of feet together and drawn toward the perineum.
§ Place hands on ankles, keep back straight and lean forward with chest while keeping chin up.
HEAD ROLLS/SHOULDER ROLLS § Tailor sit or stand with feet comfortably apart.
§ Slowly roll head in a half circle from one side to the front and to other side.
§ Raise shoulders up and roll forward.
§ Lower shoulders and push back.
§ Repeat rolling backwards.
BABY STEPS Your Pregnancy Guide § Use to increase flexibility of thighs.
§ Use to increase flexibility of calf muscles to prevent leg cramps.
§ Stand with feet comfortably apart, toes pointed outward. Squat down keeping feet flat on the § Stand with one foot forward and one foot back. floor and knees wide apart.
Lean forward, bending the forward knee until it is directly over your foot. Keep both heels firmly § To stand up, place hands on floor and slowly stand up the way toddlers do - bottom up first on the floor. Hold for 20 to 30 seconds. Repeat using thigh muscles, not back muscles.
with other foot forward.
§ Squat rather than stoop to pick things up.
PLANNING YOUR HOSPITAL VISIT Packing your bags: Be ready to go to the hospital § Use to relieve backache and strengthen at least two weeks before you are due so there will be no last-minute rush. Use the following list for § Stand with shoulders against the wall and reference as you pack.
heels an inch or so away from wall.
§ Toiletries, like your toothbrush, toothpaste, § Press the small of your back against the wall shampoo, conditioner, make-up, brush, comb, and hold five seconds. Release.
curling iron and hair dryer § Also can be done on hands and knees. Keep § Camera and extra batteries hands shoulder-width apart and do not allow your back to sag. Press lower back up toward ceiling (keep looking at floor). Hold two or § Suckers or hard candy three seconds and release. (Picture a spooked § Robe and slippers cat with its back arched.) § Your own night gowns (optional) § Practice either position 20 times, two or three times daily.
§ Relaxation aides, like music (iPod® doc and PELVIC FLOOR EXERCISES (Kegel Squeeze) DVD player are available), lotions/oils for § Use to maintain tone and elasticity of perineal massage, games, cards, books, inspiring photos muscles. Develops your ability to consciously relax those muscles during birth to shorten § Cell phone and charger and ease the second stage of labor.
§ Nursing or supportive bra § Inhale and tighten the muscles of your perineum § Underwear (disposables provided) and vagina. Visualize a string pulling the vaginal muscles upward. Hold and relax.
§ Loose-fitting outfit to wear home § Do this slowly and work up to 50-100 § Baby book, announcements repetitions daily.
§ Infant car seat § Outfit, undershirt and socks for the baby for pictures and to wear home We provide the following items for use while INCLUDE YOUR PARTNER IN THE BIRTH you and your baby are in the hospital: PROCESS, WHO CAN: § Help you with relaxation, breathing, position changes, walking, massage, etc.
w Diapers and baby wipes § Wipe your brow with a cold washcloth.
w Shampoo, conditioner, § Offer a spoonful of ice chips after each lotion, comb, soap, Pads and disposable § Cut the umbilical cord.
§ Give your baby's first bath with the assistance Note: Please ask your support people to bring
their own personal care items. § Help you with feeding your baby (Breastfeeding Class is highly recommended for dads or birth DURING YOUR LABOR, YOU MAY: partners, too).
§ Include the support people you choose - one or two family members or friends and your other AFTER DELIVERY, WE INVITE YOU TO: children, if desired.
§ Have your baby with you in your room.
§ Dim room lights and bring music for relaxation.
§ Have the baby's father, siblings and grandparents visit you, and touch and hold the new baby.
§ Walk and change positions often.
§ Watch our newborn channel for helpful education.
§ Use the whirlpool tub or shower for pain relief.
§ Bathe your baby.
§ Consume clear liquids, popsicles, Jell-0 § Consider your pain control options, choose no The Family Birth and Women's Center is a family- pain medication or request pain medication or centered environment and visiting by family and friends is encouraged. However, for the safety of you and your baby, only two support people will be § Choose your own position for pushing al owed in the room during your labor and delivery and delivery.
(your visitors may take turns to come in and see you). Other support people will be able to wait in the MORE OPTIONS TO CONSIDER: designated waiting area. Visitation may be limited § Have a support person with you during at your doctor's or nurse's discretion, taking into surgery if a Cesarean delivery is needed consideration your condition and preference. After the and during your recovery room time.
birth of your baby, two visitors at any one time wil still be in effect until after your two-hour recovery § View your baby's birth with a mirror.
time. After that, you are able to have as many visitors as you would like.
§ Touch your baby's head while pushing.
After your baby is born, your birth partner, siblings § Photograph or videotape your baby after birth.
and parents/grandparents will be welcome to visit any § Nurse your baby soon after birth.
time, day or night. Friends and other family members are welcome during visiting hours, which are until § Have immediate skin-to-skin contact 9:00 p.m. daily. with your baby.
To protect the health of the baby, persons with colds or other infections should not visit. Your baby does not have immunities to colds and other viruses.
BABY STEPS Your Pregnancy Guide Chapter 6
6. Labor and DeliveryChildbirth is a natural process that each woman handles differently. The more you understand the childbirth process, the more relaxed and effective you will be during labor and delivery.
SIGNS OF LABORThe labor experience varies by individual. You may experience one, two or all of the common signs listed below: § Bloody show. A thick, blood-tinged vaginal discharge is the result of the cervix thinning and dilating or
opening. It can happen at the beginning of labor or up to one week prior to labor. If you experience any bright red bleeding, call your physician for evaluation.
§ Loss of mucus plug. The thick, gelatin-like mucus sealing the cervix and uterus can be dislodged as
labor approaches. However, passing the mucus plug does not mean you are in labor or even that you'll go into labor in the next few hours.
§ Ruptured membranes. Your water may break as a sudden gush or slow trickle of amniotic fluid that
you cannot control. This amniotic fluid may be clear, yellow-, green- or pink-tinged in color. Please call the hospital birthing unit when your water breaks.
§ Contractions. This tightening or cramping sensation spreads across your entire belly, though some
women feel contractions in their lower back. Timing your contractions – from the beginning of one contraction to the beginning of the next – can indicate your labor progression.
§ Diarrhea. Contractions may irritate your bowel, causing loose stools.
IS IT PRE-LABOR OR TRUE LABOR?At times you may feel tightening, contractions or cramps, but it isn't true labor until your cervix begins to dilate (stretch and thin). A few of the differences between pre-labor contractions (false labor) and true labor contractions are: TRUE LABOR CONTRACTIONS PRE-LABOR CONTRACTIONS (False Labor) w Grow regular and closer in timing w Remain irregular and do not get closer together w Become increasingly intense w Do not increase in intensity w Grow progressively longer (up to 60 seconds) w Are short in duration (15 to 45 seconds) w Do not stop with activity or position changes w May stop with activity or position changes w Cause cervix to thin and dilate w Cause no cervical change IT'S TIME TO LEAVE FOR THE HOSPITAL IF: § Your water breaks.
§ If it's your first baby, when your contractions are five minutes apart for at least one hour and are gradually becoming stronger.
§ If you've had a baby before, when your contractions are six to eight minutes apart for one hour.
Please call us before you come so we can prepare for your arrival. If you are unsure if it's time to come to the hospital, call and speak with a nurse who can help you decide. During regular business hours, please call your clinic. After hours, please call the hospital birthing unit at 608-324-1291.
WHEN YOU ARRIVE AT THE HOSPITAL: § Between 6 a.m. and 8 p.m., go directly to the birthing unit.
§ Between 8 p.m. and 6 a.m., enter through the emergency department and a Monroe Clinic employee will accompany you to the birthing unit.
After arrival, the nursing staff will evaluate your labor and notify your physician. A fetal monitor will be used to evaluate your labor contractions and baby's heart rate. A vaginal exam will be done to determine BABY STEPS Your Pregnancy Guide LABOR DURATION, STAGES AND STRATEGIES It is impossible to predict how long your labor will last, as the experience is unique to each
woman who has already had one or two children will probably have a shorter labor.
§ What it feels like: strong contractions, intense
The first stage of labor begins with the onset of rectal pressure, lower backache, urge to push, active labor and ends when the cervix is fully dilated nausea or vomiting, aching thighs, leg cramps, (10 centimeters) and 100 percent effaced, or thinned. tired, irritable, ready to give up.
The first stage of labor is divided into three phases: § What to do: try to remain focused, take one
early, active and transition.
contraction at a time, find your most comfortable position, rest between contractions, visualize The cervix dilates, or opens to 3 to 4 centimeters cervix opening and baby descending down, and begins to efface or thin.
remember this is the shortest phase of labor.
§ What it feels like: mild contractions,
§ What your partner can do: help you focus,
"crampy" feeling, diarrhea, excitement, offer encouragement, place cool cloth on forehead, keep lips and mouth moist, tell you the baby is almost here and you are doing great.
§ What to do: rest and relax to conserve energy,
eat and drink lightly, take a warm bath or shower, change positions for comfort and The cervix is fully open and you will push the baby time contractions.
down and out of the birth canal. Pushing can last from several minutes to several hours, depending § What your partner can do: offer a massage,
on the baby's position and size, the effectiveness of encourage rest, listen to music or get some sleep.
pushes and if you've given birth before.
§ What it feels like: contractions every 3 to 5
The cervix will dilate to 4 to 7 centimeters and minutes, lasting 60 to 90 seconds, overwhelming efface/thin more.
urge to push, increased perineal pressure, § What it feels like: stronger, longer contractions,
energized and empowered.
increased perineal pressure, more serious, more § What to do: find comfortable and effective
concentration needed to relax.
pushing position (semi-upright holding knees, § What to do: use slow or shallow breathing,
side-lying, squatting or on all fours), push when change positions frequently, walk if comfortable, you feel the urge.
use hospital's whirlpool or shower, request pain § What your partner can do: help you position
medication or epidural.
yourself, support your legs, remind you to relax § What your partner can do: help you
between pushes, cheer you on and share in the focus, assist with position changes, offer miracle of birth.
encouragement or affirmations, provide comfort with pillows, dimmed lights or cool cloth.
The placenta (or afterbirth) is expelled. Your uterus will continue to contract mildly until the placenta The cervix will dilate to 8 to 10 centimeters and be is completely out. This occurs between five and 20 100 percent effaced.
minutes after the birth of your baby.
LABOR AND DELIVERY INTERVENTIONS Labor pain is a sign that your body is working well and working hard to deliver successfully. Women experience different degrees of labor pain. While you may have heard stories and advice from friends and family, be sure to choose pain relief options based on your own needs and preferences.
§ Deep breathing helps you manage contractions.
Begin each contraction with a deep cleansing breath (a slow deep breath in through the nose § Whirlpool bath or warm shower.
and a full exhale out through the mouth). Try to do six to nine breaths per minute, ending with a full, cleansing breath. Breathing should be slow, § Apply ice or warm packs to your back.
steady and controlled.
§ Conscious relaxation decreases labor discomfort, § Modifiedbreathing stills the diaphragm
enhances labor progress and conserves precious through shallow breathing. With open mouth, energy. The ability to focus on relaxing take a light, shallow breath and exhale with the contributes to a calm frame of mind. sound "hee". Increase and decrease your rate of § Visualization uses your mind to access the breathing as contractions get stronger or lessen autonomic nervous system. It usually begins in intensity. Ending with a cleansing breath.
with a relaxation exercise and then progresses § Transition breathing helps you work through
to a deeper level by imagining sights, sounds, the urge to hold your breath or push during smells, sensations or tastes connected to strong contractions. Begin with a quick personal memories.
cleansing breath and take four to eight shallow § Breathing techniques ease discomfort caused breaths followed by a short sharp blow (sounds by tightened muscles that can slow the labor like "he-he-he-he-whoo-he-he-he-he-whoo"). process. They are best used when you can no Continue this pattern through each contraction.
longer walk or talk during contractions.
PAIN-RELIEF MEDICATION § Intravenous(IV)medications typically
"take the edge off" the pain and help you relax, though you may still experience pain with contractions.
§ Labor epidural anesthetic almost eliminates
labor pain. An anesthesiologist will place a thin plastic tube into your lower back next to the membrane that covers the spinal cord. Numbing medicine is delivered to your nerves through the tube.
BABY STEPS Your Pregnancy Guide LABOR INDUCTION (inducing labor) Induction starts the labor before it happens naturally. A Cesarean section (C-section) is a surgery to deliver One of the main reasons to induce labor is mom or your baby. Many C-sections are scheduled prior to baby would be healthier if the baby were delivered hospitalization, but there are times when they are sooner. Several methods are used to induce labor: unexpected and need to be performed. Common reasons for an unplanned C-section include: § Amniotomy breaks the bag of water that
holds the baby to offer the uterus natural § Fetal distress.
chemical signals to start labor. This option § Labor fails to progress.
depends on cervical dilatation, effacement and the baby's position.
§ The baby is positioned inappropriately for vaginal delivery (malpresentation).
§ Cervidil is a medication with prostaglandins
that softens the cervix and stimulates the § The baby cannot fit through the pelvic bones uterus. A vaginal insert is placed near the cervix by your physician and is typically § Other health complications that make a removed within 12 hours. Continuous C-section the safer option.
electronic fetal monitoring is required.
§ Mistoprostel(Cytotec) is a tablet medication
placed near the cervix to soften the cervix and AFTER CESAREAN (VBAC) stimulate the uterus. Continuous electronic fetal In some cases, women who have delivered a baby by monitoring is required.
C-section may have the option to attempt vaginal birth. However, it is not the right choice for all § Pitocin is an IV drug used to stimulate
women. If you've had a C-section in the past and uterine contractions. Continuous electronic are interested in attempting VBAC, discuss the risks fetal monitoring is required.
and benefits of VBAC and repeat C-section with ASSISTED DELIVERY your physician.
Certain situations require healthcare providers to help with a baby's delivery. These situations include the inability to push effectively due to anesthesia, exhaustion or the baby's size. These instruments § Forceps is a sterile tong-like instrument placed on either side of the baby's head to assist with delivery.
§ Vacuum device is a small cone-like cup placed on the top of baby's head to assist the delivery with suction.
Chapter 7
7. Getting AcquaintedGETTING ACQUAINTED WITH YOUR BABYWith the arrival of your baby, your days (and nights) will revolve around feeding, changing, burping and cuddling your baby. This is an intense, amazing and sometimes overwhelming time when you and your baby begin your new life together. Within a few weeks, you'll establish manageable routines, gain skills and feel comfortable in your new mothering role. Please be patient with yourself and your new baby as you both adjust to a new world.
As you get better acquainted with your little one, remember that all babies are unique and vary in appearance and behavior. However, typical newborns have many of the following characteristics: § Color varies from pale to a deep color and can grow deep red when the baby cries.
§ Feet and hands may look bluish until the baby's circulation is established a few days after birth.
§ Expect a white, waxy, protective skin coating called vernix when your baby is born. It usually washes off with the first bath or is gradually absorbed through the baby's skin.
§ Fine, downy hair on your baby's back, arms and ears is typical.
§ Areas of peeling or cracking, particularly around the wrists or ankles are most common in babies born after their due dates.
§ Rashes including neonatal urticaria (red blotches with tiny red centers or fluid-filled dots) or milia (tiny white spots often on the nose) will soon disappear.
BABY STEPS Your Pregnancy Guide § Large in relation to the rest of the baby's body.
§ First stools will contain meconium, a greenish-black, tar-like substance in a § Elongated shape for fitting through the birth canal will return to normal in a few days.
newborn's intestines. Stools will become greenish-brown, then yellowish with a § Soft spots, known as fontanelles, where the loose consistency.
bones of the skull will continue growing together until age two. (Fontanelles are covered § Expect five to six stools daily for the by a tough membrane, so don't worry about first few weeks.
harming your infant with normal handling.) § Your baby should produce six to eight wet diapers per day if eating properly.
§ Puffiness of eyelids will disappear within a few days of birth.
§ Urine is water-like during the first few weeks, then becomes yellow-amber.
§ While your baby can see at birth, the ability to focus is limited to objects within 12 inches. Eyes may also wander or appear crossed until the eye muscles strengthen.
Babies who are provided with skin to skin contact adjust to the outside world easier than babies who are swaddled and placed in a crib. This is done simply by placing your baby belly-down, directly § Often irregular, but not a cause for concern.
onto your chest just after birth for at least 60 § Frequently stuffy during the first days of life, uninterrupted minutes. This offers you and your baby relieved by sneezing.
the opportunity to bond and get to know each other. It also helps to get breastfeeding off to a good start.
Skin to skin contact has multiple benefits to mothers § Account for much of baby's activity.
§ Touching lips stimulates sucking and swallowing reflexes.
§ Rooting reflex is tied to sucking reflex.
§ Touching a cheek will cause your baby w Reduces crying w Stimulates milk to root or turn with an open mouth.
w Reduced risk of § Frequent yawning brings in oxygen.
postpartum depression w Speeds recovery time § Coughs and sneezes help clear the w Stable heartbeat throat and nose.
Promotes relaxation w Accelerates brain w Reduces postpartum w Stimulates breastfeeding § Babies are born with extra fluid and fat.
w Increases pain tolerance § A loss of a few ounces is normal after birth.
Skin to skin contact should not be limited to the § Established eating patterns will increase period following the birth. Skin to skin is beneficial weight by 4 to 6 ounces per week during during your hospital stay and at home. Dads can the first months of life.
provide skin to skin too! BEFORE LEAVING THE HOSPITAL Screenings and procedures
Before you and your baby leave the hospital, you'll IMPORTANT DOCUMENTS be offered the following screenings and procedures: The following documents will be available for § Newborn screening. Wisconsin law requires
completion during your hospital stay.
that babies born in Wisconsin are tested for § BirthCertificate. Parents will receive a Birth
congenital and metabolic disorders. After 24 Certificate worksheet. To complete it, you will hours of age, the baby's heel is pricked and need to know your township if you don't live several drops of blood are collected for testing within city or village limits, your social security at the State Laboratory. The results are generally number and your husband's social security available in five days. A written report is sent to number if you're married. You'll receive a birth your baby's physician.
record registration letter from the State Vital § Hearing screening. All babies born at Monroe
Statistics Office within six weeks.
Clinic will have their hearing screened prior to § Wisconsin Voluntary Paternity
leaving the hospital using Automated Auditory Acknowledgment. According to Wisconsin
Brainstem Response - technology that senses law, if you are not married at any time from how your baby's brain responds to soft clicking conception to the birth of your baby, you sounds. It is a painless and brief screening.
may not enter the name of a father on the § Heart screening. This screening is a painless,
Birth Certificate. The nurse will provide noninvasive test to screen for heart defects. A you with a Wisconsin Voluntary Paternity small sensor with a light source is attached to Acknowledgment form. This document will your baby's foot and hand to measure the oxygen allow you to identify the legal father for your level in your baby's blood. Low oxygen levels child's birth record. The baby's biological signal the need for further testing to look for parents should fill out the form and sign it in a heart-related problem. This test is performed the presence of a Notary Public. Monroe Clinic after your baby is 24 hours old.
has a Notary Public available to notarize this form if completed while in the hospital.
§ Circumcision. Parents of boy babies can elect
to have this optional procedure, where your SCHEDULING A FOLLOW-UP VISIT physician surgically removes the foreskin - a skin flap that covers the tip of the penis.
Before leaving the hospital, we invite you to schedule a return visit in two or three days at no additional § Hepatitis B Vaccine. Hepatitis B is a serious
charge. During this visit, a nurse will check to see disease that affects the liver. It is caused by how you and your baby are doing and address any the Hepatitis B (HBV) virus. Children aren't concerns. Dads or birth partners are also welcome at particularly high risk, but vaccinating your to come along. If you prefer a phone consultation baby is a practical way to ensure they will be instead, please let us know. For your convenience, we protected later in life when they could be at risk. offer valet parking service at the hospital entrance.
It is recommended that all children get their first dose of Hepatitis B vaccine at birth and complete the vaccine series by 6-18 months of age. If you have questions or concerns about this vaccine, please talk to your baby's physician.
BABY STEPS Your Pregnancy Guide 8. Preparing for BreastfeedingThere are a few things you can do before your baby arrives to help get off to a good start breastfeeding. It may be helpful to figure out how graspable your nipples are. You can do this by placing your thumb on top and fingers below your nipple about an inch from the base and gently closing them together. If your nipple protrudes when gently pinched this way, it is "everted" and will be easier for your baby to latch on. There are all sorts of nipple variations, however. Some nipples are "inverted" or sink down into the breast rather than protrude outward when pinched. Sometimes a nipple protrudes but the tip "dimples" inward. And many nipples are flat or "short stemmed". They aren't inverted but they don't protrude either. If you think one or both of your nipples may be a challenge for your baby to latch on, you might purchase breast shells to wear prenatally inside your bra. They are designed to gently put pressure on the base of the nipple, gradually helping it to stretch and become more graspable. You could also try the Hoffman Technique. Place your thumbs on each side of your nipple and gently stretch the areola sideways. Reposition your thumbs to top and bottom of your nipple and again stretch up and down. Do this a couple times every day. Some women purchase an Avent Niplette to use the first two trimesters or an Evert-It Nipple Enhancer to help pull out their nipples just before feeding their baby. You can also use a breast pump to do this. Sometimes flat nipples change as pregnancy progresses and naturally become graspable by the time baby arrives. No matter what type of nipples and breasts you have, the most important thing you can do to prepare for breastfeeding is to learn as much as you can, especially about latching on and newborn behavior. Reading, attending classes, WIC clinics, or breastfeeding support groups (like La Leche League), watching YouTube videos, spending time with other breastfeeding mothers - however you learn best - will help you feel comfortable and confident when baby arrives and you breastfeed for the very first time! 9. Your Emotions as a New Mom BABY BLUES AND POSTPARTUM DEPRESSION commonly referred to as "baby blues". This includes:
§ Feelings of depression, anxiety and anger that usually begin approximately three days after birth.
§ Feeling fragile, alone and overwhelmed.
§ Feelings that don't seem to match expectations.
§ Guilt about feeling depressed.
§ Unexpected anger toward the new baby, partner or other children.
§ Sudden bouts of crying.
§ Difficulty sleeping, eating and making decisions.
§ Insecurity about handling the responsibility of a baby.
BABY STEPS Your Pregnancy Guide As bewildering and frightening as these thoughts and POSTPARTUM DEPRESSION feelings seem at the time, the baby blues usually only This is a different and more serious condition. last a short time - from a few hours to a week or so. The difficult feelings last longer, are more intense To ease these feelings: and may require special support, counseling and § Be kind to yourself – eat right, sleep, medical treatment. About one in 10 new mothers rest and exercise.
feel depressed for more than a couple of weeks. The depression may begin soon after birth or § Ask for and accept help from others.
anytime in the first year. Proper treatment is § Express your feelings, both positive essential to a successful recovery.
and negative. It's OK to cry.
Common warning signs include: § Talk to a supportive person.
§ Feeling tired, overwhelmed, § Do something just for you every day.
anxious or irritable.
§ Get a trusted caregiver or your partner § Sleeplessness.
to watch the baby so you can enjoy some fresh air or a little "me time".
§ Feeling hopeless or unable to cope.
§ Set realistic expectations. Baby care § Crying for no reason.
takes a lot of time and energy.
§ Having thoughts about harming § Look for humor. Have fun and a yourself or your baby.
good laugh when possible! § Little or no interest in caring for your baby.
§ Postpone major life changes and If you have any of these warning signs, contact decisions until you have adjusted your healthcare provider. He or she can help you to life with your new baby.
recover from postpartum depression in several ways, which may include medication, counseling, connecting you to community resources, and other effective treatments.
for choosing us to care for you through your We hope this guide is a helpful resource that you'll tur pregnancy and bab n t y' o again and ag s birth. ain during your pregnancy and in the weeks after your baby is born. We consider it a privilege to share in your experience and hope we can help make every "baby step" a healthy and rewarding one. Please feel free to contact us any time with questions or concerns. We're here to take good care of you and your baby.
y expectant mom experiences pregnancy and birth differently, but there's one thing all moms-to-be have in common: Questions – lots of them. About how to give your baby a healthy start in life. What kind of food and exercise you need. What to expect and how to prepare. That's where this book comes in.
e created this guide to answer your questions about everything from healthy nutrition to the signs and labor unicate with your physic . Be sure to bring it with yian by sending a secure message via y ou to classes and the hospital when y our My k reference. stion will be addressed, usually within the hour, during clinic business hours.
Of course, the information you'll find in this book is not a substitute for consulting with healthcare professionals. As a comprehensive overview, we hope it will help you learn the basics you need to know –and encourage you to ask more questions during your regular visits and in-between. We're here to help you have a smooth pregnancy and rewarding birth experience every step of the way! Freeport Highland Women's Care Monroe Women's Health Center (appointment desk) 608-324-2250 Monroe Clinic's Birth Center Team (nurses' desk) 608-324-2241 Highland W ily Bir 233 s- c 233 l-osed) y & F (appointment desk Wednesday: 7 am to 4 pm Family Birth and Women's Center (when Clinic is closed) Closed daily: 11:30 am to 12:30 pm Monroe Women's Health Center: Monday - Friday: 8 am to 5 pm Monroe Birthing Unit (when Clinic is closed): BABY STEPS Your Pregnancy Guide Sponsored by the Congregation of Sisters of St. Agnes


(1) Wal ace RB, Gryzlak BM, Zimmerman MB, Nisly NL. Application of FDA adverse event report data to the surveillance of dietary botanical supplements. Ann Pharmacother 2008; 42(5):653-660.Abstract: BACKGROUND: Concerns have been raised about the sufficiency of dietary botanical supplement (DBS) surveillance in the US. The Food and Drug Administration's Center for Food Safety and Applied Nutrition's Adverse Event Reporting System (CAERS) represents one of the few existing surveil ance mechanisms, but it has not been wel characterized with respect to DBS adverse effects. OBJECTIVE: To characterize data on DBSs associated with adverse event reports submitted to CAERS. METHODS: We requested and obtained CAERS data from 1999 to 2003 involving adverse effects associated with the 6 most frequently used DBSs: Echinacea, ginseng, garlic, Ginkgo biloba, St. John's wort, and peppermint. We summarized and characterized the adverse event reports received, focusing on the composition of the DBSs and the nature of associated adverse events. We also cross-referenced reported single-ingredient DBSs with corresponding available product information. A sample of CAERS cases associated with signal DBSs was also characterized in detail. RESULTS: CAERS reports involving ginseng DBSs were most frequently reported during the study period, whereas reports involving St. John's wort were the least frequently reported. Most CAERS reports involved multiple-ingredient DBSs, and 3-13% of reports involved multiple DBSs. Gastrointestinal and neurologic problems were the most common clinical outcomes among single-ingredient DBS-associated adverse events. CONCLUSIONS: CAERS surveil ance of DBS adverse effects is potential y as effective as other passive surveil ance methods, but the number of reports is relatively smal , validation is incomplete, and some inconsistencies within reports were found. Reports in CAERS may underrepresent DBS adverse events associated with DBS consumption

Drug-Induced Acneform Eruptions: Definitions and Causes saira Momin, do; Aaron Peterson, do; James Q. del rosso, do Several drugs are capable of producing eruptions that may simulate acne vulgaris, clinically, histologi-cally, or both. These include corticosteroids, epidermal growth factor receptor inhibitors, cyclosporine, anabolic steroids, danazol, anticonvulsants, amineptine, lithium, isotretinoin, antituberculosis drugs, quinidine, azathioprine, infliximab, and testosterone. In some cases, the eruption is clinically and his-tologically similar to acne vulgaris; in other cases, the eruption is clinically suggestive of acne vulgaris without histologic information, and in still others, despite some clinical resemblance, histology is not consistent with acne vulgaris.