Obstetrics

Congratulations on your Pregnancy!
You’ve started out well – seeking out the finest prenatal care during your pregnancy. Our staff has over 60 years of combined experience in caring for women! We are excited to do everything we can to make your experience with us as pleasant as possible, utilizing a combination of state of the art equipment, modern techniques, natural approaches and old-fashioned concern for your well-being.

Marisol Health is committed to promoting healthy living while affirming the dignity of women and of life. We are a pro-life office, and do not perform or refer for abortions. Therefore, we do not routinely order genetic tests on your baby, which may lead to the consideration of an abortion. If you have reason to believe that such testing is indicated in your situation, please discuss this with our staff.

Care in the Office
Typically, a pregnancy lasts 40 weeks. The pregnant women without complications see their obstetrician every month through week 28, then every two weeks from weeks 28 to 36. Finally, you will be seen every week from weeks 36 to 40.

Care in the Hospital
Although our primary delivery hospital is Swedish Medical Center- a HealthOne facility in Englewood Colorado, we also have privileges at Centura’s Littleton Adventist Hospital in Littleton.

Emergencies and Serious Concerns
Our office is open from 9-5 Monday through Friday, and closed for lunch from 12-1. Our staff will assist you with any concerns during those hours. If you have a serious concern during your pregnancy or think you may be in labor after hours you may call our main number to reach the on-call provider.

In order to receive the best care, you should be able to recognize an emergency and know what to do about it. Any of the following should be considered emergencies, and you should seek medical help immediately.

• Any vaginal bleeding
• Sharp or persistent abdominal pain or cramps
• Persistent headaches
• Extreme nausea and vomiting, or vomiting after the fifth month of pregnancy
• Blurred vision
• Unusual swelling of hands, feet, or face
• Sudden weight gain (a gain of 1 lb per day over 3+ days in the 7th to 9th month)
• Loss of fluid from the vagina
• Infection, fever, chills or flu like symptoms
• Fainting
• Pain or difficulty with urination
• Hard or regular contractions prior to 36 weeks
• Any concerns about fetal movement

Bleeding
Twenty-five percent of all pregnant women have bleeding problems during the first three months of pregnancy. Many things can cause this, and it may be harmless, but it may also signal a miscarriage. Bleeding during the later months is unusual and serious. If you have ANY bleeding, call for assistance. If possible, save any clots so that they may be examined.

A Healthy Beginning
We are very concerned about the best possible start for your baby. Here are a few necessary and important ways you can take charge of your health and contribute to your baby’s good health as well.

• Abstain from ANY tobacco use, and also avoid second-hand smoke.
• Abstain from consuming alcoholic beverages.
• Do not use over-the-counter medications without contacting us.
• Do not change kitty litter.
• Limit your use of caffeine to two servings or less per day.
• Take prenatal vitamins as prescribed.
• Avoid saunas and whirlpool hot tubs.
• Avoid undercooked meat, and try to eat as much healthy fresh food as possible.
• Wear your seatbelt at all times.

Baby Movement
Most women begin to notice their baby moving around 20 weeks. At about 24 weeks a baby will begin to have more regular and consistent movements. By 26 weeks a woman should be able to do “Kick Counts.”

When: During your baby’s active times of the day, After eating or drinking something cold, After a walk, while you are feeling for contractions. It is good to do kick counts every day.

How: Sit down, put your feet up, place your hands on your belly and begin counting each time your baby gives you a nudge, kick or movement.

Why: Baby movement give insight into life on the inside. A baby should move 5-10 times in 1-2 hours. If your baby is not moving this much or if it is moving less than normal for you this may indicate something is going on. Please call if you are ever concerned about how much the baby is moving or if your baby is not moving.

Medications
Do not use any over-the-counter medications during your pregnancy without first consulting with our staff. The following is a list of commonly needed over-the-counter medications which have been proven to be safe to use at any time during your pregnancy:

• Tylenol (Acetaminophen) 325-650mg every 4 hours, or 1000 every 6 hours, for fever, pain or headache
• Sudafed (Pseudoephedrine) 30-60mg every 6 hours for nasal congestion
• Robitussin (Guaifenesin Syrup) 2-4 teaspoons per package directions for cough
• Robitussin DM (Guaifenesin and Dextromethorphan Hydrobromide) 2 teaspoons every 4 hours for cough and as an expectorant to loosen phlegm, making cough more productive
• Tums, Maalox, Mylanta or Gaviscon per package directions for indigestion or heartburn

Be aware that Tylenol, Sudafed and Robitussin come in combination formulas, such as Tylenol PM, Sudafed Cough and Cold, Robitussin CF, etc. and some of these are not safe to use unless their other ingredients have been approved by our staff. Always read the “active ingredients” on the medication and do not use unless they are specified in the list above.

Emotions
In our aim to provide complete care for our patients, we recognize the importance of the emotions you may experience during pregnancy. It is not uncommon for you and your family to experience additional tension and stress during this time. Pregnancy and/or birth of a baby can strain relationships with loved ones, create budget problems, hamper careers, or force changes in identity and body image. Please remember, we are here to help. Feel free to discuss these problems with us any time. We can also make arrangements for you to visit with a counselor to help you and your family adjust to the many changes pregnancy may create in your life.

Exercise
Exercising during your pregnancy is not only safe but also important. Exercise helps to keep a balance between the fuel your body gets and the use of that fuel, to avoid problems associated with gestational diabetes and other disorders.

However, it is necessary to follow some general guidelines for a healthy workout. Please check with our staff before starting an exercise program.

• Drink fluids before and during exercise – even in winter.
• Follow a slow warm-up routine for at least 15 minutes before starting.
• Follow a mild stretching routine before exercise (But not to your limit).
• Remember, your ligaments are looser now and can be more easily injured.
• Avoid exercises with jerky or bouncing motions.
• Be sure your exercise area is clear (avoid rugs that may slide), adequate in size, and has a stable floor.
• Exercise regularly (3 or 4 days a week) not just once in a while.
• This is not the time to be competitive! Exercise at your own pace and comfort level.
• Do not exercise during hot, humid weather or if you have a fever.
• After the fourth month, do not exercise lying down on your back.
• Do not take part in any exercise including lifting weights where you hold your breath and strain. Lifting weights is good, just remember to breathe!
• Adjust caloric intake to your level of activity. But remember, during pregnancy, calorie levels need to be over and above your usual amount.
• Avoid strenuous exercise at higher levels of altitude than you are accustomed to.
• Monitor your activity so your pulse does not exceed 140 beats per minute.

Breast vs. Bottle Feeding
Breastfeeding has been proven to be the best choice for both the mother and the child’s health and well-being. As a new mother, you know that proper nutrition is vital to your baby’s proper growth and development. By breastfeeding, you will be joining billions of women throughout the history of the world who find it simply ideal.

It is an amazing thing to be a woman, especially a new mother whose body is producing food for her growing child. Along with the perfect combination of nutrients, nature has provided breastmilk as an excellent source of antibodies which will protect your child from illness. It is perfectly matched for your baby’s needs. It is convenient, and free! Also, the contact made by the act of breastfeeding will contribute to your infant’s emotional well-being. As long as you choose to breastfeed, your body will benefit as well. It has been shown to reduce the incidence of breast cancer and will help your body resume your pro-pregnancy weight.

Confirmation of Pregnancy

• Usually around 6 weeks or after the first missed period or first positive home pregnancy test.
• An ultrasound is done to confirm the pregnancy.

8-10 Weeks

• This is an information gathering visit and takes about an hour!
• It includes orientation to the practice, lab work, brief ultrasound and a complete physical exam.
• Visits after this will usually be every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and then every week until delivery depending on your particular history and pregnancy.

11-14 Weeks

• Consisder a flu shot.
• Discuss exercise.
• For at risk moms: First trimester/Sequential screen: Includes a Nuchal Translucency screening ultrasound and blood test providing your specific risks for Down’s syndrome and Trisomy 13 & 18.

15 Weeks

• MSAFP (maternal serum alpha-feto protein) is a blood test that screens for neural tube defects and placental problems and is recommended even if genetic screening is declined.
• For High Risk moms a Quad-screen can be done if first trimester screening is declined.

18-20 Weeks

• A review of systems ultrasound is done- your baby is big enough to see the major anatomy!

20-24 Weeks

• This is a great time to begin thinking about pregnancy and birthing classes and to pre-register and schedule a tour at the hospital.
• Local classes can be found online or by calling 1-877-Healthone.
• Discuss Baby Kick Counts.

24-28 Weeks

• The one hour glucose tolerance test is done to screen for gestational diabetes.
• A complete blood blood count is also checked to screen for anemia.
• If you are RH negative, an antibody screen blood test is also done and you will receive a RHOGAM shot.
• Discuss Preterm labor symptoms.
• Visits begin every two weeks.

30-36 Weeks

• Begin thinking about labor desires, breastfeeding needs, your pediatrician, plans for circumcision and future family plans after delivery.

35-37 Weeks

• GBS (Group Beta Strep) is a common vaginal bacteria and a culture is done during this time.
• If you are positive you will receive antibiotics during labor.
• Weekly visits begin.

37-41 Weeks

• Its time to have a baby!

Every pregnancy is different! This is a guide and additional ultrasounds or visits may be recommended.

YOUR BABY’S ACTIVITY RECORD

A guide to counting your baby’s movements

What is Fetal Movement Counting?
Healthy babies are usually active. Unborn babies sleep for short periods of time, but most of the time they will kick, roll, twist and turn. Counting your baby’s movements is a way to tell how your baby is doing. During the time he is awake, a healthy baby usually moves at least 10 times in 1 hour.

Doctors and midwives usually recommend that you begin counting movements around the 7th month of pregnancy (about 28 weeks). As you get to know your baby’s movement pattern, you will be able t o report any changes to your care provider. Most healthy babies will be awake and active at least 3 times each day. If at the end of the day you have noticed a significant decrease in your baby’s normal movement pattern, please contact Marisol - Bella Office.

There are different ways to monitor a baby’s movement. You may wish to ask your prenatal care provider which method he or she prefers.

How do I Count My Baby’s Movements?

1. Choose a time of day that your baby is usually active. Try to count around the same time each day.
(It may be best to count after a meal.)
2. Get in a comfortable position. You can lie down or sit in a chair with your feet up.
3. Write down the date and time that you begin counting your baby’s movements.
4. Continue counting until your baby has moved 10 times. Count any movements including kicks, rolls, swishes, or flutters.
5. After your baby has moved 10 times, write down the time on your chart.
6. If you can’t feel your baby move, try to wake the baby by drinking a glass of juice or walking around for few minutes. You may even nudge the baby gently on your abdomen. Then start counting again.

What Should I do if My Baby Doesn’t Move?
If at the end of the day you have noticed a significant drop in your baby’s activity, please call Marisol -- Bella Office

Example of Charting Baby Movements: