Wellcome to your Pregnancy

This letter contains important information we recommend you to review early in your pregnancy. It includes a schedule of your routine visits and lab tests. This is followed by a Question and Answer section, which covers most of the common questions that come up during the pregnancy as well as information regarding prenatal classes and breastfeeding. At the end of this letter is a list of suggested books that cover pregnancy and the postpartum period.

We look forward to working with you throughout your pregnancy and providing you with excellent prenatal care. During the first few prenatal visits, your Obstetrician and Nurse Practitioner will review your medical history and often perform one or several ultrasounds.

Your Obstetrician will be responsible for your prenatal care. There are two Obstetricians and two Nurse Practitioner in the office, Dr. Rydfors, Dr. Schuftan, Mary Lynn Sepkowitz and Beverly Richardson.. They all share the same philosophy of individualized care. If you wish, during the course of your pregnancy you will have the opportunity to meet the other Obstetrician. Occasionally, your Obstetrician may be called away for a delivery or surgery on the day you have your appointment. On these occasions, the other providers will be happy to see you for your visit.

Your delivery will be at Sequoia Hospital which has an excellent reputation. Everybody gets a private room during their stay. It is known as being the best hospital in the whole bay area to deliver a baby at. During your pregnancy you can expect to experience changes in your emotional and physical states. Some of the physical changes that you may experience are nausea, frequent urination, breast tenderness, fatigue, bloating and constipation. You can alleviate some of these symptoms by increasing rest periods during the day, eating several small meals (instead of three larger ones) and increasing your intake of fluid and fiber. Your body will also undergo hormonal changes, which may cause mood fluctuations. Fear and ambivalence are as common as excitement and joy in the early months.

Having covered what is normal in pregnancy brings us to what is not normal: bleeding and severe cramping can be signs of a miscarriage. Call to report any bleeding or cramping.

Below, we offer you some practical information and answers to commonly asked questions:

Prenatal visits

During you first few visits, your Obstetrician and Nurse practitioner will perform a history and physical exam as well as go over many pregnancy issues. You will be seen initially on a monthly basis up until your eight month of pregnancy when you will be seen every two weeks. On the ninth month, due to the impending delivery, the visits will be weekly.

Routine tests during pregnancy

During your pregnancy several tests will be recommended. Below is a list of what the usual ones are and when they are going to be done:

First trimester

In the first trimester you will have the Ob panel blood test. This will look at the following: Blood type, Rh, blood count, Hepatitis B, HIV, Rubella, Chicken Pox, Parvo Virus, Syphilis and Cystic Fibrosis status.

integrated sequential testing for down syndrome consisting of one ultrasound and two blood tests will be done (please see below).

Quad - AFP test is done. It looks for structural abnormalities in the fetus such as neural tube defects and abdominal wall defects. The test also picks up slightly more than half of Down Syndrome pregnancies. Patients who chose to do the integrated sequential testing for Down syndrome will have this test as a component of the whole test sequence (please see below).

18-22 wks

An ultrasound will be done in order to look for gross abnormalities and to ensure normal growth of the baby. We will send you to an ultrasound specialist for this ultrasound.

24-28 wks

A glucose test will be done in order to look for gestational diabetes. The test involves drinking a sugar drink one hour prior to the blood test. You do not need to be fasting for the test. We will also check your blood for anemia.

34-38 wks

GBS testing. A cotton swab test will be done of the recto-vaginal region to look for the presence of Group B Strep, a very common bacteria that can be present in the birth canal at the time of delivery and can cause severe infections in the newborn. If you have the bacteria, we will offer antibiotics during labor.

The State of California updated its non-invasive screening for Down syndrome in 2009. It will now consist of an ultrasound of the fetal nuchal thickness ( a.k.a the “the NT test”), and two separate blood tests, a first trimester (blue border lab slip) and a second trimester one (green border lab slip).

Both blood tests can be done at your local lab (e.g. QUEST). The timing of the tests is important:

The results are given as a probability; meaning that you results will not say if your fetus has or does not have a genetic issue. Instead the results will tell you the chance of your fetus having a specific genetic issue. You will get a first number after the NT ultrasound and first trimester blood test results have been combined. You will then get a second number after the second trimester blood test results have come back. This second and last number will have incorporated the results of all three tests and is the final and most accurate number. This is the number you should use to decide if you want to have an amniocentesis or not. We will discuss the results with you to help you make a decision.

Please note that if you are able to do your first trimester blood test 7-10 days before your do your NT ultrasound, you might be able to get your first result at the time the NT is being done.

The second blood test will also look at the chance of your fetus having a rare neural tube defect and other rare conditions.

Should I take vitamins or iron supplement during pregnancy?

We recommend that you take a prenatal vitamin and a supplemental iron pill each day. Over the counter brands of prenatal vitamins that supply at least 0.4 mg folic acid should be taken (most contain 0.8 or 1.0mg). If you are anemic, we suggest that you also take an iron tablet each day which contain at least 50 mg of elemental iron (e.g. Ferrous Sulfate 325 mg). Docusate sodium (DSS), which is an over the counter stool softener, 100mg after breakfast and dinner is a good and safe way to help constipation. Increasing your daily water and fiber intake will also help prevent constipation. Be aware that the iron pills may turn your stools a dark color and may occasionally cause an upset stomach. It is best to take iron with juice or water. Avoid taking it with milk. If you have severe nausea during the beginning of your pregnancy, it is fine to skip the iron tablets and to substitute the prenatal vitamin for a regular multivitamin until you feel better. Over the counter 25mg of Vitamin B6 by mouth 3 times per day can also significantly help nausea. A new all-natural fortified snack bar called the "Belly-bar" has recently been introduced. It is designed to meet the nutritional needs of women during pregnancy as well as during the breastfeeding period. it is an excellent alternative for women who have difficulties taking the prenatal vitamin during and after the pregnancy.

Should I take additional calcium during pregnancy?

We recommend that you increase your calcium-containing foods during pregnancy in order to achieve the recommended dose of 1500mg of elemental calcium. You can do this by increasing you milk product intake (8 oz milk = 250 mg, 8 oz yogurt = 400mg, 1oz cheese = 200mg). If you have difficulty taking milk products, Calcium Carbonate tablets (e.g. Tums) can be taken ( 1 regular Tums tablet = 200 mg elemental Calcium).

Is exercising safe during pregnancy?

Exercising during pregnancy is generally safe. Be careful, however, not to over-exert yourself. Keep you heart rate under 140 beats per minute or exercise at an intensity level where you are still able to maintain a normal conversation. Drink plenty of fluids before, during and after a workout because pregnancy makes you more susceptible to dehydration. Also be aware that your joints “soften” when pregnant; this along with a change in the way your weight is distributed increases the chance of loosing your balance. If you do not exercise much, a daily walk (20-30 minutes) is an excellent way to stay in shape.

If I have a low grade fever, a head ache or other muscle/joint ache, what can I take?

For low grade fever or head ache relief, you can safely take Tylenol . If you have a temperature greater than 101, please contact us. Do not take Advil or aspirin while pregnant.

Can I take saunas or use hot tubes during pregnancy?

We recommend that you do not use hot tubs or saunas during pregnancy. High heat can cause malformations. Warm showers and baths less than 100 degrees are fine.

How much fish can I eat during pregnancy?

Fish contain mercury that can affect part of the fetal development. Certain fish should be limited or avoided altogether. Avoid altogether the following: Shark, swordfish, tilefish (a.k.a. golden bass), and king mackerel. No more than 2 meals per week of the following: Shrimp, salmon, catfish, Pollock and canned light tuna. (Note that for tuna eaters this is equivalent to 6 tuna sandwiches or 3 tuna salad servings per week.) No more than 1 meal per week of the following: Tuna Steak, albacore (white tuna). Please note that these recommendations apply to breastfeeding women as well.

Should I avoid Aspartame (Nutrasweet) during the pregnancy?

Aspartame breaks down into Phenylalanine, which can be toxic at very high doses to the fetus. With normal amounts of Aspartame ingestion, the levels in the placenta are insignificant and don't come close to the levels needed to cause any fetal brain damage. No “safe cut-off point” has been determined, but Aspartame ingestion within moderation (e.g. 1-2 cans of soda per day) is according to most medical authorities not a problem for the developing fetus.

Is Caffeine safe in pregnancy?

Large doses of caffeine have been shown in some studies to increase the risk for miscarriages and low birth weight babies. To be on the safe side, decrease your caffeine consumption to less than 150 mg per day. This is equivalent to 1-2 cups of coffee a day.

Should I avoid peanuts and peanut containing foods during my pregnancy?

Many experts think that eating peanut containing foods during the pregnancy or during breastfeeding can lead to an increase in fetal allergies, eczema, and asthma.

In England a government report in 1998 advised women with a family history of such conditions to avoid peanut contain products during the pregnancy and breastfeeding.

Should I avoid soft cheeses and deli meats during my pregnancy?

Unpasteurized soft and semi-soft cheeses can contain a deadly bacteria called Listeria. Several weeks after exposure, a flu-like illness can occur in the pregnant mother. The infection, if not treated with antibiotics, can occasionally spread to the fetus and cause a miscarriage or still birth.

Deli meats that are not reheated can also contain Listeria and should be avoided.

The American College of Obstetricians and Gynecologists (ACOG) and the FDA both advise pregnant women against eating unpasteurized soft and semi-soft cheeses.

What If I live with a cat?

Have someone else change the litter box. Wear gloves when gardening outside since toxoplasmosis can be spread from dirt.

How do I treat a cold in pregnancy?

If you get a cold during your pregnancy, the best treatment is rest and plenty of fluids. Take Tylenol for aches and fever. Throat lozenges and saline nasal drops (“Ocean mist”) for other cold symptoms are fine too. If your symptoms are still very bothersome and you are past the first trimester (13 + weeks), you may take other over the counter medicines such as Benadryl, Chlortrimeton, Sudafed and Robitussin. If your symptoms persist and or worsen please contact us.

What if I get diarrhea, constipation or heartburn during pregnancy?

If you get diarrhea, replace the fluids and electrolytes by drinking a lot of fluids and fluid replacement beverages such as Gatorade. If the diarrhea is severe you can use over the counter Kaopectate and Imodium which are both safe during pregnancy. If the diarrhea persists or worsens, please contact us.

Constipation is very common and can often be alleviated by drinking more fluids and eating more fiber. Over the counter Metamucil and DSS are safe to use for more difficult cases. Prune juice also helps.

Heartburn is also very common. Try to eat slowly and try to not lie down for at least an hour after you have eaten. Avoid spicy foods. Over the counter Tums can be helpful. For more persistent cases, over the counter Zantac (1to 2 a day) is safe.

Can I travel during pregnancy?

Yes, as long as your pregnancy is going well and you do not have any risk factors, you can safely travel up until 34 weeks of your pregnancy. Make sure you stay well-hydrated before, during and after the trip and do expect more-than-usual foot swelling if you are flying. For both car and flight travel, it is important to stretch your legs every hour to ensure good circulation. Please discuss potential travel plans with your Obstetrician.

Should I take a flu shot during pregnancy?

The influenza vaccine is considered safe in pregnancy. We recommend you take a flu shot if you are in your second or third trimester. Flu symptoms are usually more severe when pregnant and there is a greater chance of developing pneumonia.

Can I go to the dentist during pregnancy?

You can go to the dentist to have routine dental work and cleaning done. Avoid x-rays. If your dentist needs to give you a local anesthetic, have your dentist use a local anesthetic without Epinephrine. If there is any doubt, have your dentist call us.

Can I get my hair colored or permed during pregnancy?

It is safe to treat your hair, but we recommend you wait until after the first trimester (13+weeks) and that it is done in a well-ventilated area.

Should I take prenatal classes?

We highly recommend these classes. Many classes are available (including baby care and lactation classes) and they will give you a lot of information as well as to ease your fears about your upcoming delivery. You will also meet other pregnant women with whom you can share your experiences. The classes are often fun and very few regret they took them. Intensive weekend classes can also be found. Please sign up early for the classes since they fill up fast! A list of the places classes can be found at PRENATAL CLASSES.

Where can I get support and help with breast-feeding after the baby is born?

We strongly encourage breast-feeding. The American Academy of Pediatrics recommends breast-feeding as the preferred method for the first year. Since breastfeeding can be very challenging for many women at first, we have listed several available resources below. If you have concerns or questions while still pregnant you can contact them:

Welcome to your pregnancy