Mommy To Be Guide



Mommy To Be Guide2013By Michael Yuzefovich, MDMillennium GynecologyPrenatal Care Packet 703-224-9999 t571-384-6702 fright3143250Dear Millennium Mommy,Congratulations! You are a Millennium-Mommy-to-Be! Thank you for choosing Millennium Gynecology. We are honored to have your trust and for allowing us to take care of you and your baby. Pregnancy is an exciting period in your life and we are dedicated to make it the most beautiful experience. Let’s begin. The first step is to review this packet. It contains important information related to your experience with us. It is written by Michael Yuzefovich, MD, FACOG (known by patients as “Dr. Mike”) – medical director of Millennium Gynecology. You should use this packet as a guide to help you become familiar with our practice. Keep in mind that the information presented is not a substitute for medical advice, as all medical decisions should be made between you and one of our health care providers. In this folder, you will notice our exclusive programs – offered only to Millennium Mommy’s to be. When you read through this guide, there will be references to the folder or packet. This refers to several programs that we have put together to help you through your pregnancy and after you have delivered. This packet is divided into 3 main sections corresponding to the 3 major phases during your pregnancy: Ante-Partum Intra-Partum Post-PartumEach section contains relevant information we would like you to become familiarized with. The more you know, the greater will be your experience. So relax and feel at ease, you are a Millennium Mommy to be.We are always here to help with any questions or concerns you may have.Sincerely,Michael (“Dr. Mike”) Yuzefovich, MDOB/GYN | Medical DirectorMillennium GynecologyTable of Contents TOC \o "1-3" \h \z \u Disclaimers PAGEREF _Toc281227003 \h 21.Ante-Partum Period PAGEREF _Toc281227004 \h 2General PAGEREF _Toc281227005 \h 21st Trimester PAGEREF _Toc281227006 \h 22nd Trimester PAGEREF _Toc281227007 \h 23rd Trimester PAGEREF _Toc281227008 \h 2What’s expected of you? PAGEREF _Toc281227009 \h 2What Activities Can I Do? PAGEREF _Toc281227010 \h 2Who will take care of me during my prenatal period? PAGEREF _Toc281227011 \h 2When Should I call? PAGEREF _Toc281227012 \h 2Going to the hospital PAGEREF _Toc281227013 \h 2Your visits to the office PAGEREF _Toc281227014 \h 2Resources PAGEREF _Toc281227015 \h 22.Intra-Partum Care PAGEREF _Toc281227016 \h 2How do I know that I am ready? PAGEREF _Toc281227017 \h 2What does it mean that I am ready for delivery? PAGEREF _Toc281227018 \h 2How should I deliver? PAGEREF _Toc281227019 \h 2Where will I deliver? PAGEREF _Toc281227020 \h 2Who will deliver my baby? PAGEREF _Toc281227021 \h 2What should I bring? PAGEREF _Toc281227022 \h 2Do I need anesthesia in labor? PAGEREF _Toc281227023 \h 2Neonatal Care PAGEREF _Toc281227024 \h 23.Post Partum Care: PAGEREF _Toc281227025 \h 2General PAGEREF _Toc281227026 \h 2Discharge Instructions PAGEREF _Toc281227027 \h 2Activity & Exercise PAGEREF _Toc281227028 \h 2Medications PAGEREF _Toc281227029 \h 2Follow-Up PAGEREF _Toc281227030 \h 2Emergency Reasons to Call and Get Help PAGEREF _Toc281227031 \h 2Birth Control PAGEREF _Toc281227032 \h 2Getting My Body Back PAGEREF _Toc281227033 \h 2Annex A PAGEREF _Toc281227034 \h 2Which Medications Are Safe During Pregnancy? PAGEREF _Toc281227035 \h 2Annex B PAGEREF _Toc281227036 \h 2Your Diet during Pregnancy PAGEREF _Toc281227037 \h 2DisclaimersGeneral DisclosuresThe information presented in this packet is for general public information. It should not be misunderstood as medical advice, in any context, and the reader will hold Millennium Gynecology PLLC harmless, in the event of any such misrepresentations. It is the absolute responsibility of the patient, to consult the Physician regarding any portion of this informational packet prior to any medical decision making. Disability PolicyWhile we truly understand the hardships associated with pregnancy, we cannot justify unwarranted disability requests, as it is against the law. It is recommended that patients follow the disability policies established by their employers, unless medical circumstances warrant otherwise.Intellectual PropertyThese materials are property of Millennium Gynecology and their patients; any dissemination or copying will be fully prosecutedAnte-Partum PeriodGeneralThe Ante-partum (also known as the Prenatal) period occurs from when you are first diagnosed as being pregnant to the time just before you go to the hospital to deliver your baby. There are generally 9 months in this period. However, clinicians prefer to count weeks, as weeks are much more precise. There are approximately 40 weeks that a woman is pregnant. As a reference, this 40 week mark is designated as your due date. You will be assigned a due date, and it is important that you remember it. My Due Date is _________________________________________________________The reality is that most babies are not born exactly on the due date. Actually no one can truly predict the day your baby is born. You may also hear the term trimester, which spans about 14 weeks in length. There are 3 trimesters in total spanning the 40 weeks. A full term pregnancy is defined as a pregnancy 37 weeks and beyond. If your pregnancy extends into 40 weeks then you are considered Post Dates, and specialized testing becomes necessary to make sure that everything is fine. Below are common symptoms experienced in each trimester. 1st TrimesterNausea and Vomiting: It is common to feel morning sickness. As long as you are able to function throughout the day and tolerate some foods and most liquids, this will usually improve in several weeks. If your symptoms are more severe, you need to tell us immediately. Safe ways to help alleviate such symptoms are ginger supplementation and vitamin b6 which can be found in organic and health food stores.Breast Tenderness: Increasing levels of progesterone produced by your ovary and newly forming placenta contribute to this effect. Safe ways to help alleviate this is by using evening primrose oil which can be purchased in most pharmacies.2nd TrimesterRound Ligament Pain: This pain is usually noticed in the creases of your hips known as the inguinal area. This pain occurs with walking as a result of your ligaments stretching as your uterus grows. If the pain is mild and only occurs when walking and resolves completely with rest- don’t worry! We encourage stretching exercises and periodic rest when pain occurs.Physiologic Dyspneaa: This refers to a difficulty in taking a deep breath when laying flat in bed. This occurs when the uterus presses up on the diaphragm, which is a large muscle responsible for the movement of air in our lungs, and limits the amount the diaphragm can move. We recommend that you use 1-3 pillows at night to elevate your upper body so the uterus doesn’t push so much on the diaphragm. If you still continue to feel short of breath, after such maneuvers, then seek medical attention. Fetal Movements: Women experiencing their first pregnancy (aka Prima-Gravida) usually start feeling movements around 21 weeks. Women who’ve had kids before (Multi-Gravida) usually begin to feel movements around 19 weeks. It’s common that the baby will not begin moving vigorously until 4 weeks after you first feel baby movements. After that, fetal movements must be felt on a frequent basis. Extreme movements by the baby are highly reassuring and do not suggest trouble. Baby’s can’t keep moving all the time however, as they need their sleep as well. Most babies sleep for about 40 minutes to 1 hour. At that time you may experience little movement, which is ok as long as they return to their baseline activity afterwards. If for some reason you aren’t feeling the baby move as usual, you are expected to do the following: Kick Counts. This is a very valuable test that you can do to ensure fetal well being. Drink a glass of orange juice or milk, lie down on your left side, put both hands firmly on your belly, and feel for the baby to move. If you feel 10 movements in 2 hours, then be reassured. If there are less than 10 movements in 2 hours, call us immediately.Again, it is common that the baby is not moving vigorously until 4 weeks after you first notice a movement. Also, as you approach full term, your baby will start having limited space to move. So the amount of movement may be slightly diminished, however the frequency of movements must be maintained. 3rd TrimesterBraxton Hicks Contractions: A tightening of the abdomen, lasting 20-45 seconds, followed by complete resolution, is a contraction. If these contractions occur a few times/ day, they are not dangerous as they are simply Braxton Hicks. They are not associated with labor. It’s the way that your uterus begins its preparation for the real thing that may occur in the future. Discharge 3rd trimester: Further along in pregnancy you may begin to experience a slight, white, thick, non odorous, mucous discharge, on your panty liner a few times per day. This is secondary to increased cervical secretions. If you experience anything other than what is mentioned, you must let us know. Bloody Show is a term used to describe another discharge that occurs after the minor dilation of your cervix. This slight discharge is blood tinged and mixed with mucous. If this occurs at or near Term, don’t worry as long as the baby continues to move appropriately. Bloody Show is normal; however, if you experience any active bleeding, you must inform us immediately. Back Pain: It is common for women to start experiencing mild generalized back pain. This is mainly from the weight of the pregnancy and compression of the nerve roots that exit through your vertebral column. This pain may occasionally radiate down the back of your thigh called Sciatic Nerve pain. If you experience these symptoms, it is advised to bed rest with a heating pad. If your symptoms are severe at any point, please contact us. Swelling in your legs: You may begin to experience swelling in both of your legs that changes throughout the day. This is secondary to the increased volume of fluid collected in your body and gravity that causes that fluid to collect mainly in the lowest part of your body- your legs. It’s important to use a pillow to elevate your legs at night. If the swelling occurs in only 1 leg, you must contact us immediately. What’s expected of you?Staying safe: It is important that you avoid any situations that may cause you harm. It is best that you apply a common sense approach to this recommendation. If you feel that you are under the threat of someone or in a dangerous situation, please call 911. Staying positive: Babies can handle an enormous amount of stress, however its always best to maintain positive emotions, by securing an environment around you that will inspire serenity and good feelings. If you require stress reduction, we recommend exercise, support groups, and even Yoga. Remember, this is your pregnancy, don’t let anyone spoil it for you. Prenatal Vitamins: If you consume a well balanced diet, you will most likely fulfill all your nutritional needs for your pregnancy. Nevertheless, supplementation is encouraged especially for Iron, Folic Acid, Calcium, and DHA Omega 3 fatty acids, so make sure your pre-natal vitamin has these. In general, pre natal vitamins, regardless if brand named or over the counter, have similar nutrients. Sure, little differences exist, but these subtle differences are usually not clinically significant. So don’t go broke trying to buy a fancy vitamin such as Neevo or Ob Complete One, because a generic over the counter brand is nearly as good. For those moms who are too nauseous for a big pill, try a chewable Flinstones vitamin, but don’t tell Wilma or Fred!Hydration: It is important to drink 8-10 glasses of water each day. Dehydration can lead to premature contractions. What Activities Can I Do?Sex: Sex is safe in pregnancy. You won’t give the baby a headache. However, if you have a high risk condition, your doctor may advise otherwise. Travel: It is safe to travel by plane and car. If you do, we recommend you get up from the seat every 1-2 hours for 15 minutes to increase the blood circulation in your legs. Some airlines restrict flight overseas at 34 weeks and beyond. Most domestic airlines restrict flights 36 weeks and beyond. This is not because it is dangerous to the baby; simply the airlines do not want to take a chance that someone will deliver on their flight. It is best to check with the particular airline regarding their flight rules.Exercise: Exercise is safe and encouraged in pregnancy. Yes, avoid starting an intense workout your body has never been exposed to. Again, exercise your common sense first. We also advise against activities with a high risk of falling or trauma, or require a significant time laying flat on your back. Who will take care of me during my prenatal period?The Millennium team is a group of highly trained obstetric providers. Everyone, from our receptionist to the doctor, is responsible for your well-being. We all work together to ensure the best medical care is being delivered to you and your baby.Standard Business Hours- In the office you will be examined by either Dr. Mike, Taryn Thibeault NP, or Rupali Singh MD. If a situation requires hospitalized care then Dr. Mike or Dr. Singh will manage the situation. Afterhours during the work week- Dr Mike or Dr Singh will most often manage the critical emergency in the hospital after initial assessment by the nurses and Hospitalist Group. Hospitalist Group- As a service to our patients, Millennium Gynecology ensures that a Board Certified Doctor is present in the hospital 24 hrs a day/ 7 days a week to take care of any Millennium Mom who needs urgent medical care. It is an enormous benefit to know that a trusted Millennium affiliated physician is always in the hospital in case a critical situation occurs that needs to be dealt with that second. The Hospitalist Group is composed of 5 physicians: Dr. Thomas/Rasul/Martinez/Duncan/Josephs that alternate each 24hr shift. Most often, after their initial assessment, will contact Dr. Mike or Dr Singh, so they can safely take control of the situation. Millennium is affiliated with the Georgetown School of Medicine and George Washington School of Medicine so resident physicians and medical students may be present to learn and observe. When Should I call?If you experience:painful contractions lasting 1 hourleakage of fluidunexpected vaginal bleedingif the baby is not moving wellanything else that you consider an emergency CALL US: 703-224-9999 During business hours- a staff member in the office will advise you.Afterhours- a representative from our answering service will advise you to go directly to the hospital. For afterhour non-emergency phone calls- a representative from our answering service will take a message so that a member from the office will contact you the very next business day.Please commit our number to memory. Sometimes there may be an interruption in the answering service, mainly due to telecommunication issues. Again, if is a medical emergency – Do NOT Wait, just proceed directly to the Virginia Hospital Center. Going to the hospitalIf it is an emergency, you need to go to the Virginia Hospital Center (formally known as Arlington Hospital.) Virginia Hospital Center is the exclusive choice hospital for Millennium Gynecology, chosen for its excellence in patient care and outstanding patient satisfaction. For directions to the Virginia Hospital Center, refer to your folder. These are the steps to take:10 minutes away from the hospital, call labor and delivery 703-558-5000 and tell them you are 10 minutes away and may need a wheelchair and that you will be dropped off at the lobby.Once you arrive at the hospital, we encourage that you be dropped off at the front of the Women’s and Children’s lobbyTell the security person I am a Millennium Gynecology patient and have an emergencyIf you are less than 20 weeks pregnant, they sometimes will send you to the Emergency Room. If you are > 20weeks, then you will be sent to the 3rd floor to an area called Triage. Triage is an area where pregnant women are evaluated to determine if they need to truly be hospitalized or it’s just a false alarm. In Triage, the nurses will assess you and get in touch with the doctor for further instructions. Your visits to the officeWelcome Visit: Your first visit will begin with our nurse supervisor. She will review your history and introduce you to our practice as a Millennium Mommy to Be. Please refer to Annex A for a list of safe medications and Annex B for nutrition recommendations, at the end of this document.The First Medical Visit: The Clinician will review your history and address any issues that you may have. You may have a Pap Smear and Genital cultures performedYour due date will be assignedWeeks 11-22 genetics: Within this period you have to decide on the level of genetic screening you would like done. Below are the options:Non-Invasive testing: These tests are not invasive and do not pose any risk to the fetus.First Trimester Screening. This non-invasive test is performed by a specialist sonographer in an outside radiology center between 11.0 - 13.6 weeks. Ultrasound is used to measure something called the Nuchal Translucency, which correlates with the risk of chromosomal abnormalities such as down syndrome. This test is about 93% accurate.The location will mainly be based on your preference and the complexity of your pregnancy. Antenatal testing center (ATC): 703-776-6654 Dr Reyes of Virginia Hospital Center: 703-558-6077For a list of the locations and contact information for all testing locations, please refer to the folder- Antenatal Testing CenterQuad Screen. This is a simple blood test performed 15.0 - 22.0 weeks. This test will be performed at the same blood testing center you will be having all your blood work done. The circulating level of certain proteins in your blood correlates with the risk of chromosomal abnormalities. This test is about 87% accurate.Invasive Testing: These tests are associated with a minor risk to the fetus, however they are >99% accurateCVS Test. Performed at 11.0 weeks where cells from the placenta are retrieved for chromosomal analysisAmniocentesis. Performed at 15.0 weeks and beyond where cells from the amniotic fluid are retrieved for karyotype analysis. Invasive testing will be performed by a Perinatologist, usually by Dr. Reyes at the Virginia Hopsital Center or by your own designated Perinatologist. Such testing is optional for all pregnant women and it is your choice to accept or decline such testing. Weeks 18-22: Level-2 Ultrasound: This test is ideally performed between 18-22wks and evaluates the major structural anatomy of the baby. It is performed at a radiology center and often will also identify the gender of the baby if you prefer. While ultrasound is an excellent means of looking at your baby, it cannot detect genetic disorders or small anatomical abnormalities. However, a normal ultrasound is usually very reassuring. In the office, you will receive a prescription for a Level-2 ultrasound which will have a phone number for you to call to schedule your appointment. Most of our patients receive ultrasounds at any of the 3 locations:Mount Vernon Hospital: To schedule 703-750-8200. Antenatal testing center (ATC): To schedule 703-776-6654 Dr. Ramsey of Woodbridge: 703-494-0064Dr. Reyes of Virginia Hospital Center: 703-558-6077Hospital Tour: This is a good time to think about arranging a tour of the hospital. Visit Click on Programs & ClassesOn the left side column click on Women & Infant HealthSearch for Expectant Parent TourClick on Add to my classes, and fill out all necessary questions.If you do not have internet available, a Millennium Team Member will more than happy to do it for you.c.Cord blood: Cord blood is the collection and saving of blood from the umbilical cord, instead of simply discarding it after birth. It is understood that this blood contains stem cells which are used today to treat blood cancers. It is theorized that in the future, stem cells may even treat other diseases as well. Cord blood can be collected for private use or for public use as a donation. If you choose private collection, this means that your baby’s cord blood will be stored for your family only. There are 2 major companies that store private cord blood and they both are very good. Their promotions vary so it is a good idea to shop around.Millennium has the most experience with Cord Blood Registry? (CBR) and tries to obtain the best promotions for our patients. Week 28-30: Glucose Testing: you will be asked to drink a sugar based beverage and your blood will be tested 1 hour afterwards. This test is used to check for pregnancy induced diabetes. It is best to be fasting and then drink the beverage 30minutes before arriving for your blood drawYour blood count will be checkedNow is the best time to pre- register at the hospital! This is not mandatory, however when you are ready to deliver, there will be less paperwork to fill out so this step is recommended. To pre-register you must visit the hospital websiteClick on Medical ServicesClick on Women & Infant HealthOn the left column click on Obstetrics Pre-Admin. Form, and fill out all the following questions.If you do not have internet available, a Millennium Team Member will be more than happy to do it for you.Become familiar with the best way to the hospital. Pick a day when your free and take a trip to the hospital so you know where to go when your ready.Consider a pediatrician. This process is encouraged but not absolutely necessary. Make sure the pediatrician has an office close to your home. If you do not have a pediatrician when you have your baby, don’t worry, your baby will be assessed by a top pediatrician at the hospital. Rhogam - This is a required injection for women with Rhesus or "Rh(D)" negative blood type. The doctor will inform you when this is needed. If you are Rh negative you will receive an order from the Doctor and have to go to Inova Outpaitent Center located at 8503 Arlington Blvd. Suite 200, Fairfax VA 22032, you can reach them at 703-970-3101.Here are a few Pediatricians to consider:Potomac Pediatric located in Woodbridge, VA 703-730-5437Sherwood Hall Pediatrics located in Alexandria, VA 703-360-0300Vienna Pediatrics located in Vienna, VA 703-938-2244 It is always BEST to call your insurance company to ensure that a Pediatrician participates with your insurance. If you do not have a pediatricians before you deliver, DO NOT WORRY a Virginia Hospital Center Pediatrician will be present at your baby’s birth & to take care of your child during your hospital stay. Week 34-36: You will be asked to undress so a culture can be taken from your external vagina. This test looks for bacteria called GBS. We all have this bacteria in our colon, however in 30% of women, this bacteria migrates to the outside vagina during pregnancy. If it returns positive, you will be required to take antibiotics during labor, if you are having a vaginal delivery, to prevent passage of this bacteria to the baby. Transportation to the hospital- If you are a mom with significant transportation limitations and need help, Millennium Gynecology will pay for your ride to the Virginia Hospital Center. Ask a Millennium team member and they will give you a free pass to VHC. When ready to deliver and use your pass- call Yellow Cab 703-491-2222 and a tell them you are a Millennium patient and need to be taken to the Virginia Hospital Center.Conditions- This pass is only given once when you are ready to deliver. This pass can only be used to go to the Virginia Hospital Center, and for all other locations, you will be charged. By using this pass, you indemnify Millennium Gynecology completely and assume all responsibility for any harm that occurs to you and your fetus during your transport to the hospital. If you do not agree to these conditions, you should absolutely not use this service. If this pass is used for any other destination other than VHC, Millennium reserves the right to bill you for the cost of card.Weeks 38+:If you make it this far, you will be asked to disrobe so a gentle cervical exam can be performed. ResourcesPrepared childbirth classes- these classes are optional and not necessary, however patients highly recommend them.Dental Care. We are affiliated with Tysons-Dental. They offer our patients a complimentary discount and are available for emergency care. Go to Tysons-Diabetes Center- For Moms diagnosed with Diabetes in pregnancy. The Diabetes Center will teach Moms how to check their blood sugars, and improve their diet. To contact the Diabetes Center Call 703-558-5718 for VHC or Call 703-698-2500 for other locations. Genetic Counseling- for moms with a genetic disorder, and require counseling and risk assessment. Reading ListThe following is our recommended reading list which can be purchased at any major book store or on-line. What to Expect When Your Expecting by Heidi MurkoffQue Peude esperar cuando esta esperando by Heidi MurkoffYour Pregnancy Week by Week by Glade B Curtis, M.D.Baby Names: The Complete Book of Baby Names by Leslie BoltonWhat to Expect the First Year by Heidi Murkoff Your Baby’s First Year Week by Week by Glade B. CurtisIntra-Partum CareThis section pertains to the time you are going to the hospital to deliver your baby. How do I know that I am ready? In most instances, you know that you are ready to have your baby when:Your water breaksYour contractions occur every 5 minutes apart for 1 hour.Sometimes, however, less obvious medical reasons necessitate having your baby delivered. What does it mean that I am ready for delivery?By ready, we mean that you are in labor. Labor is the process where your body produces contractions with enough force to cause your cervix to dilate. If you are pre-term (less than 37 weeks) we may need to medically stop the labor process. However, if you are 37 weeks or above- then you are ready. How should I deliver?At Millennium, we believe in personal choice. Of course, certain medical factors may dictate which route of delivery is better, however assuming all things equal, a woman can elect a vaginal or cesarean delivery. Vaginal Delivery: In a vaginal delivery, a women’s cervix must dilate a certain amount of centimeters per hour. Once the cervix is 10 cm, then you can start pushing, a process which may take 10 minutes to 2 hours of time. Most patients go home 1-2 days after a vaginal delivery.Pros - Vaginal delivery is associated with faster recovery, lack of an incision, less blood loss. Cons - Risk of failure to dilate, the baby shoulders becoming stuck in the birth canal, the baby lacerates the vagina and nearby organs requiring extensive repair.What if I wish to have a vaginal delivery but do not go into labor by myself?Don’t worry! If you do not go into labor by yourself, your labor can usually be induced. This means that on a certain date, you will arrive to the hospital, and a medication will be gently placed by a nurse or resident in the vagina to soften your cervix. This process is usually done overnight so you can sleep through this softening process. The following day, Dr. Mike or a designated Physician will arrive and break your water (rupture the amniotic sac), which will stimulate your body to start contracting. Sometimes, supplemental medication is used called Pitocin, which mimics our own body’s natural hormone oxytocin, which will increase the strength of the contractions. If you continue to dilate your cervix at an appropriate rate, you will likely have a successful vaginal delivery. Inductions may be fast or slow, so prepare yourself mentally that it may take a while. Once you are ready then the doctor will arrive. Planned C-Section: In a planned c-section, a patient arrives to the hospital at a scheduled time, a spinal anesthetic is provided for pain relief, and the baby is delivered in a few minutes after starting. We pride ourselves on performing beautiful incisions that are very low and usually in the hair line. The average c/section time is 45 minutes long. You can bring only 1 special person with you into the section room. Most patients go home 2-3 days after a c/section. Pros- No risk of vaginal injury, less chance for trauma to the baby, smaller likelihood of pelvic organ prolapsed in the future possibly.Cons- An incision is made, it is recommended to have future deliveries by c-section, risks of adhesions with having many c-sections.The day of your c-section, you will be asked to follow these following instructions which are mandatory.BLOODWORKYou are REQUIRED to go to Virginia Hospital Center at least 24 hours prior to your scheduled delivery for Mandatory Blood work. Failure to do so will result in a delay of your scheduled delivery. While at the hospital you must go to the Outpatient Laboratory located on the 1st floor of the hospital. For Further directions please call 703-558-6489.Patients with scheduling or transportation issues must notify the hospital and our office at least 24 hours in advance if you are unable to obtain blood work.Eating/DrinkingPlease do not eat or drink anything, at least 8 hours prior to your c-section. Failure to comply will result in an automatic Cancellation to your delivery.Hospital ArrivalOn the day of your delivery you are required to arrive to Virginia Hospital Center; Labor & Delivery (3rd floor) at least 2hours prior to your scheduled C-Section. Lateness to your C-section may result in postponement or cancellation. Where will I deliver?If you’re a Millennium Mommy to Be, you will deliver at the Virginia Hospital Center. All the rooms are private, you may have an unlimited number of guests with you, wine is allowable in the delivery room for those that wish to say cheers, and the hospital has a level 3 nursery to take care of any urgent neonatal issues with a pediatric subspecialist in house 24 hours a day. If you accidently go to another hospital, care will not be provided by Millennium and it is very disheartening that we cannot care for our patients. These are the steps to take:1.10 minutes away from the hospital, call labor and delivery 703-558-5000 and tell them you are 10 minutes away and may need a wheelchair and that you will be dropped off at the lobby.2.Once you arrive at the hospital, we encourage that you be dropped off at the front of the Women’s and Children’s lobby3.Tell the security person I am a Millennium Gynecology patient and have an emergency4. Your driver, if they will stay, can park in the Green Parking LotWho will deliver my baby?Another advantage of being a Millennium patient is that Dr. Mike or Dr. Singh will most likely be taking care of you during your delivery. On rare occasions, when Dr. Mike or Dr Singh are not readily available, Millennium Gynecology entrusts a select group of Physicians at the Virginia Hospital Center to take his place. There is always a Physician at the hospital ready to take care of our patients. What should I bring?Bring to the hospital whatever makes you feel comfortable. We are referring to small items which comfort you. The items we strongly recommend are:CameraMusic to play during your deliverySmall radioSlippersFavorite pillowDo I need anesthesia in labor?Anesthesia in labor is not mandatory. However, the far majority of women do prefer to receive anesthesia, most often in the form of an epidural. This anesthetic is infused via a small catheter in the back which is very safe. After an optimal epidural, patients may dilate while talking on the phone or even sleeping. It is highly effective. If given at the appropriate time, it may even help facilitate the labor process. Again, the decision for an anesthetic is your choice. Neonatal CareDon’t worry if you didn’t make arrangements with a pediatrician prior to delivery. The Virginia Hospital Center has an excellent team of house pediatricians that will take care of your newborn until you can comfortably transition to one. Sometimes babies require more intensive care; in that case a baby might be transferred to the NICU (Neonatal Intensive Care Unit.) This unit is located on the second floor of the hospital. Otherwise the well baby nursery is located on the same floor that you will be located.3. Post Partum Care:GeneralThis refers to the period after your baby is born. After you deliver, you will be transferred out of L+D to a Post Partum area for moms that are recovering from their delivery. At the Virginia Hospital Center, you are assured a private room. Breast Feeding: Breastfeeding is always encouraged, unless medical factors deem otherwise. If you are having trouble breastfeeding, you can request that your nurse provide you with a lactation consultant while in the hospital. Breastfeeding information- The Hospital will provide you with significant reading material if you so request it. If you did not have a chance to review the material while in the hospital and still wish to, we recommend going online to the following web address: . If you do not have computer services then our office will be glad to print the forms for youBreast Pump Rental - Maintaining adequate milk supplies without an electric or a hand-held pump is very difficult. The breast has to be stimulated to produce milk every 2-3 hours or else the quantity of milk will diminish. The nurses in the hospital will help arrange a breast pump if you choose. Circumcision. Circumcision is a controversial process. It is mainly performed for religious and cultural reasons. It is not absolutely necessary. However, some studies have shown that circumcision decreases the incidence of HPV and HIV-2 transmission. Our philosophy- it’s your decision! Dr. Mike or Dr Singh will likely be performing this procedure on your baby boy, the next day after his birth. Discharge InstructionsCongratulations, you are almost home!Wound Care:Vaginal delivery- If you had a vaginal delivery and a repair was performed, you must take care of your genital area. Don’t worry, any suturing that was performed will dissolve on its own.Rule #1 No sex for 6 weeksRule #2 No straining to obtain a bowel movement. Take laxatives such as Colace 2x/day if necessary and consume lots of fruits, vegetables, prunes, and fiber. Continue to drink plenty of water.Rule #3 Keep the vaginal area clean with warm water rinses and soap applied externally. Don’t scrub the area or clean inside your vagina. Sitz baths are nice with Epsom salt, which you can purchase in any pharmacy, but they are not necessary.Rule #4 No Douching/ Tampons/Baths for minimum of 6 weeksC-section Incision. Skin closure is almost always performed on the inside, and the suture will dissolve on its own. However, if staples were required, we ask that you return to the office 5-7days after delivery for removal. Staples are sometimes medically superior so do not feel alarmed if they were used, I assure you they are there for your best interest.Rule#1 Keep the incision very dry. Use a hair dryer after the shower if you must. For patients with a larger belly that tends to cover the incision, I recommend purchasing an ABD Pad in the pharmacy and applying it to the incision 2-3 x/day so it can soak up the moisture. The ABD Pad must lay directly on the incision to keep it dry.Rule#2 Keep the incision clean with a shower 1x/day. Yes, gently apply soap to the incision and rinse off with water. You can take a shower the first or second day after your c-section. After the shower, remember to apply Rule#1. The secret to a beautiful incision is to keep it clean and dry, even if someone accidentlay tells you otherwise, I can’t stress enough how important clean and dry is to your success. Rule #3 No sex for 6 weeksActivity & ExerciseThe general principal is simple: do as much as you can and when you start becoming sore or tired, stop and take a break. You will not hurt anything as long as you don’t do anything ridiculous. I strongly encourage walking the very next day after you deliver and being as active as possible.Driving is permissible if you feel you can be safe on the road, able to turn the wheel and press on the brake, and are not relying on narcotic medication. If driving is not absolutely necessary, it’s preferable that you stay home and get some rest, you deserve it!ExerciseVaginal Delivery: You can resume mild exercise after 2 weeks and gradually return to full activity at 6weeksC-Section: You can resume mild exercise at 4 weeks and gradually return to full activity by 8 weeksMedicationsIt is recommended that you continue taking medications that were prescribed for any specific medical conditions, unless told otherwise. The doctor may need to tailor your medications after delivery depending on medical circumstances. Pain: Vaginal: Most patients will only require over-the-counter Motrin 600-800 mg every 8 hours as needed. C-section: If you had a c-section, you will be prescribed Percocet. Take 1-2 pills every 4-6 hours as needed for pain. You will also be recommended to take over the counter Motrin 600-800 mg every 8 hours as needed for pain. Try to transition away from Percocet to Motrin when ready. Your body will tell you when you are ready Constipation: It is recommended to continue taking Colace 100 mg 2 times per day for 6 weeks. Pre -natal vitamins are encouraged for at least 6 weeks after delivery.Follow-UpC-Section: You are recommended to make an appointment and return to the office in 1 week after having the baby and then 6 weeks after that visitVaginal Delivery: You are recommended to make an appointment at the office 6 weeks after having the baby. Emergency Reasons to Call and Get HelpContinued bleeding greater than a periodPain that is not improved with your standard pain medicationsInability to urinate > 6 hoursFever >100.4Foul odor from the vaginaFeelings of persistent sadness or hurting yourself or othersAnything else that you consider significant and out of the ordinaryThe Emergency line is always the same as the office line: 703-224-9999. If you cannot get through for some unusual reason then go to the Virginia Hospital Center Emergency Room or your closest Emergency Room. Birth ControlBecause we recommend no sexual vaginal activity for 6 weeks, we prefer to discuss birth control at your 6 week post partum appointment. Prior to this date, you are recommended to consider whether you want a reversible form of birth control (ex. Pills/Patch/ Ring/Implenon/IUD/Condoms) or Permanent Birth Control (Essure In-Office Sterilization or Classic Surgical Sterilization)Getting My Body BackWomen often ask for ways to reshape their bodies after delivery. Abdominal binders may hide excess bulges, in case you need a temporary fix. Breast feeding is a terrific calorie burner.Coco Butter/ Mederma cream/ Bio Oil for stretch marks and c-section scarsExercise and a well balanced diet is always the fundamental root to success. Please bring this folder with you to the hospital so it can guide you.WE WISH YOU SUCCESS AND A WONDERFUL EXPERIENCE!The Millennium Gynecology TeamAnnex AWhich Medications Are Safe During Pregnancy?Below, you will find a list of medications which are deemed SAFE to use during your pregnancy. These medications have been tested in clinical trials and have not shown any risk to the fetus. ConditionSafe Medications to Take During Pregnancy* AllergyBenadrylCold and FluTylenol (acetaminophen) or Tylenol ColdWarm salt/water gargleSaline nasal drops or spraySudafed, Actifed, Dristan, Neosynephrine*Robitussin DM, Trind-DM, Vicks Cough Syrup, Romilar, Halls**Do not take "SA" (sustained action) forms of these drugs or the "Multi-Symptom" forms of these drugs.ConstipationMetamucilCitrucilFiberall/FiberconColaceMilk of MagnesiaSenekotDiarrheaFor 24 hours, only after 12 weeks of pregnancy:KaopectateImodiumParepectolinFirst Aid OintmentJ & JBacitracinNeosporinGasSimethicone (Gas-X ?, Mylicon ?, Phazyme ?)HeadacheTylenol (acetaminophen)- extra strength is safeHeartburnMaaloxMylantaTumsPepcidZantacHemorrhoidsPreparation HAnusolTucksWitch hazelInfectionAcyclovir (Zovirax ?) Azthitromycin (Zithromax ?) Cepaholosporins. Examples: Cephalexin (Keflex?), ??? Cefazolin (Ancef ?), cefaclor (Ceclor?) Clindamycin (Cleocin?) Erythromycin Penicillins. Example: Amoxicillin (Amoxil?), Amoxicillin Clavulanate (Augmentin?), methicillin, carbenicillin. Metronidazole (Flagyl?)InsomniaDoxylamine (Unisom Sleep Tabs?)MotionSicknessDimenhydrinate (Dramamine ?)Nausea and VomitingVitamin B6 100 mg tabletGingerSea bandsNasal CongestionPseudoephedrine (Sudafed ?): Avoid in first trimester. Avoid if you have high blood pressureRashesHydrocortisone cream or ointmentCaladryl lotion or creamBenadryl creamOatmeal bath (Aveeno) *Please Note: No drug can be considered 100% safe to use during pregnancy.It is recommended that you avoid herbal medications as they have not been tested in formal clinical trials. We strongly recommend that you avoid the following herbal supplements: Avoid these oral supplements: Arbor vitae, Beth root, Black cohosh, Blue cohosh, Cascara, Chaste tree berry, Chinese angelica (Dong Quai), Cinchona, Cotton root bark, Feverfew, Ginseng, Golden seal, Juniper, Kava kava, Licorice, Meadow saffron, Pennyroyal, Poke root, Rue, Sage, St. John's wart, Senna, Tansy, White peony, Wormwood, Yarrow, Yellow dock, vitamin A (large doses can cause birth defects). Annex BYour Diet during PregnancyYou should consume about 300 more calories per day than you did before you became pregnant. Eat a variety of foods to get all the nutrients you need.Foods to Eat:Seafood: Seafood can be a great source of protein and iron, and the omega-3 fatty acids in many fish can help promote your baby's brain development. Try to eat 1-2 average sized portions per week of any of the fish listed below:Canned light tuna (limit albacore tuna and tuna steak to no more than 6 ounces or 170 grams a week) Salmon Pollock Cod Dairy: Eat and drink at least four servings of dairy products and calcium-rich foods a day to help ensure that you are getting 1000-1300 mg of calcium in your daily diet during pregnancy. The best sources of calcium are dairy products including milk, cheese, yogurt, cream soups, and pudding. Calcium is also found in foods including green vegetables (broccoli, spinach, and greens), seafood, dried peas, and beans. Vitamin D will help your body use calcium. Adequate amounts of vitamin D can be obtained through exposure to the sun and in fortified milk, eggs, and fish. Iron: Eat at least three servings of iron-rich foods per day to ensure you are getting 27 mg of iron daily.The best sources of iron include enriched grain products, lean meat, poultry, fish, and leafy green vegetables. Total brand cereal has 18mg of Iron Foods to LimitCaffeine: Limit caffeine to no more than 300 mg per day. The caffeine content in various drinks depends on the beans or leaves used and how it was prepared. An 8-ounce cup of coffee has about 150 mg of caffeine on average while black tea has typically about 80 mg. A 12-ounce glass of caffeinated soda contains anywhere from 30-60 mg of caffeine. Remember, chocolate contains caffeine -- the amount of caffeine in a chocolate bar is equal to 1/4 cup of coffee. Artificial Sweeteners: The use of saccharin is strongly discouraged during pregnancy because it can cross the placenta and may remain in fetal tissues. But, the use of other non-nutritive or artificial sweeteners approved by the FDA is acceptable during pregnancy. These FDA-approved sweeteners include aspartame (Equal or NutraSweet), acesulfame-K (Sunett), and sucralose (Splenda). These sweeteners are considered safe in moderationFoods to Avoid Do not eat shark, swordfish, king mackerel, or tilefish (also called white snapper), because they contain high levels of mercury. Avoid soft cheeses: such as feta, Brie, Camembert, blue-veined, and Mexican-style cheese. These cheeses are often unpasteurized and may cause Listeria infection. There’s no need to avoid hard cheese, processed cheese, cream cheese, cottage cheese, or yogurt.? All soft non-imported cheeses made with pasteurized milk are safe to eat. Unpasteurized Milk: Unpasteurized milk may contain bacteria called listeria, which can cause miscarriage. Listeria has the ability to cross the placenta and may infect the baby leading to infection or blood poisoning, which can be life-threatening. Make sure that any milk you drink is pasteurized.In addition, during pregnancy, some women feel strong urges to eat non-food items such as ice, laundry starch, dirt, clay, chalk, ashes, or paint chips. This is called pica, and it may be associated with an iron deficiency such as anemia. Do not give in to these non-food cravings -- they can be harmful to both you and your baby. Tell your health care provider if you have these non-food cravings.Raw Meat: Uncooked seafood and rare or undercooked beef or poultry should be avoided because of the risk of contamination with coliform bacteria, toxoplasmosis, and salmonella. Avoid deli meats (“cold cuts”) as well or warm them until they are hot before you eat them.Avoid raw fish, especially shellfish like oysters and clams. Fish that contain high levels of mercury should be avoided as well. Mercury consumed during pregnancy has been linked to developmental delays and brain damage. A sample of these types of fish include: shark, swordfish, king mackerel, and tilefish. Canned, chunk light tuna generally has a lower amount of mercury than other tuna, but still should only be eaten in moderation in proportions as written above. Certain types of fish used in sushi should also be avoided due to high levels of mercury. ................
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