Your Guide to a Healthy Pregnancy - Cleveland Clinic

YOUR GUIDE TO

Healthy Pregnancy

12th edition

Your Guide to a Healthy Pregnancy

Dear Parents-to-Be,

Thank you for choosing Cleveland Clinic for your obstetrics care and allowing us to help bring your new little one(s) into the world! This is an exciting time for you, and we are here to assist in making your experience the best it can be.

designation every five years. The Baby Friendly Hospital Initiative () is an international program of the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF).

Deciding to become a parent is one of the most important decisions you will make in your life. As babies don't come with instruction manuals, you rely on healthcare professionals for education and guidance. Our goal is to provide you with the best possible information to make knowledgeable decisions.

Our highly trained obstetricians, maternalfetal medicine specialists, and certified nurse midwives deliver more than 13,000 babies a year at three hospital locations. We are excited to be a part of your team and hope that you will continue to rely on us for all your healthcare needs. For more information about our physicians and services, go to obstetrics.

For birthing patients who have experienced previous sexual violence or other trauma, Cleveland Clinic has developed its M-Power Program to provide trauma-informed care that puts your needs first. This compassionate, holistic approach ensures that you feel prepared for labor, delivery and the postpartum period.

Cleveland Clinic has partnered with the Ohio Department of Health to promote safe sleep, while proactively working to reduce the infant mortality rate. This includes the ABCs of safe sleep. Always place your baby alone on their back in their crib with only a firm mattress and a fitted sheet.

How you will feed your baby is a choice that all parents must face. Cleveland Clinic birthing hospitals support exclusive breast milk feeding for the first six months of life and are taking special steps to create the best possible environment for successful breastfeeding. We strive to renew our Baby Friendly Hospital

Breastfeeding offers an unmatched beginning for babies and is recommended by the American Academy of Pediatrics (AAP) as the primary source of nutrition for the first year of life. Scientific studies have shown that breastfed babies are healthier, have reduced risk of sudden infant death syndrome (SIDS), and have fewer cases of childhood cancers and diabetes.

In addition to breastfeeding and birthing assistance, Cleveland Clinic can help you prepare for the big day through classes like "Baby Basics" and "Boot Camp for New Dads." We also offer lactation consultations, informative materials and support groups. Cleveland Clinic pediatricians and family medicine specialists offer assistance in well-baby care at our nearby family health center and hospitals. You can see a schedule of the many prenatal classes we offer at childbirthed. This book can be accessed at healthypregnancyguide.

For more information about making an informed decision about your baby's nutrition, we encourage you to speak to your healthcare provider.

Sincerely,

Your Women's Health Team

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CONTENTS

1. Mother Care | 7

> Prenatal care > Prenatal vitamins > Medicine guidelines during pregnancy > Good nutrition during pregnancy > Dental care during pregnancy > Global obstetrical care > HIV testing > Vaccination during pregnancy > Sexually transmitted diseases and pregnancy > How smoking affects you and your baby > High blood pressure > Gestational diabetes > Toxoplasmosis and pregnancy > Coping with the physical changes

of pregnancy

> Finding a comfortable position > Exercise during pregnancy > Pregnancy childbirth and bladder control > Sex during pregnancy > Sleep during pregnancy > Travel during pregnancy > Depression during pregnancy

2. First Trimester | 66

> Your first trimester of pregnancy > When to call your provider > Prenatal ultrasonography > Ultrasound appointment guidelines > Screening for chromosome abnormalities > CPT codes for genetic tests

3. Second Trimester | 76

> Your second trimester of pregnancy > Welcome to the second trimester > When to call your provider > Oral glucose challenge test

4. Third Trimester | 80

> Your third trimester of pregnancy > When to call your provider during the

third trimester

> Counting your baby kicks > Non-stress test > Group B streptococcus and pregnancy > True vs. false labor > Premature labor > What to pack for the hospital > Your birth day > Types of delivery > Pain relief options during childbirth

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5. After Delivery | 104

> What to expect after delivery > Physical changes after delivery > Vaginal tears > Long-acting reversible contraception > Depression after the birth of a child > Exercise after delivery

6. Breastfeeding | 118

> The benefits of breastfeeding > 24-hour rooming-in > Skin-to-skin contact for you and your baby > Breastfeeding the first weeks > Over-the-counter medications and

breastfeeding

> Contraception during breastfeeding

7. Baby Care | 136

> Safe sleep > Newborn care in hospital > Newborn appearance > Newborn behavior > When to call the doctor > Umbilical cord appearance and care > Circumcision > Childhood immunizations > Adding your baby to your insurance policy > Are you looking for a pediatrician? > Choosing a car seat

CLEVEL AND CLINIC | WOMEN'S HEALTH - PREGNANCY | 4

TYPES OF REMEDY Allergy Cold and flu

Diarrhea Constipation

First aid ointment Headache Heartburn

Hemorrhoids

SAFE MEDICATIONS TO TAKE DURING PREGNANCY

Diphenhydramine (Benadryl?) Loratidine (Claritin?) Cetirizine (Zyrtec?) Diphenhydramine (Benadryl)* Dextromethorphan (Robitussin?)* Guaifenesin (Mucinex? [plain])* Vicks Vapor Rub? mentholated cream

Mentholated or non-mentholated cough drops

(Sugar-free cough drops for gestational diabetes should not contain blends of herbs or aspartame) pseudoephedrine ([Sudafed?] after 1st trimester) acetaminophen (Tylenol?)*

Saline nasal drops or spray

Warm salt water gargle

*Note: Do not take the "SA" (sustained action) form of these drugs or the "multi-symptom" form of these drugs.

Do not use Nyquil?, or a generic version, due to its high alcohol content. Loperamide ([Imodium?] after 1st trimester, for 24 hours only) Methylcellulose fiber (Citrucel?) Docusate (Colace?) Psyllium (Fiberall?, Metamucil?) Polycarbophil (FiberCon?) Polyethylene glycol (MiraLAX?)*

*Occasional use only Bacitracin

Neomycin/polymyxin B/bacitracin (Neosporin?) Acetaminophen (Tylenol) Aluminum hydroxide/magnesium carbonate (Gaviscon?)* Famotidine (Pepcid AC?)

Aluminum hydroxide/magnesium hydroxide (Maalox?) Calcium carbonate/magnesium carbonate (Mylanta?) Calcium carbonate (Titralac?, Tums?)

*Occasional use only Phenylephrine/mineral oil/petrolatum (Preparation H?) Witch hazel (Tucks? pads or ointment)

Return to Table of Contents

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TYPES OF REMEDY

SAFE MEDICATIONS TO TAKE DURING PREGNANCY

Insect repellant Nausea and vomiting

Rashes

Sleep Yeast infection

N,N-diethyl-meta-toluamide (DEET?) Doxylamine (Unisom Sleeptab)

Vitamin B6 25mg three times per day in combination with doxylamine 12.5mg at bedtime to prevent nausea.

Ginger extract 125-250mg every six hours. Diphenhydramine cream (Benadryl)

Hydrocortisone cream or ointment

Oatmeal bath (Aveeno?) Diphenhydramine (Unisom SleepGels?, Benadryl) Miconazole (Monistat? 7-Day)

*Please note: No drug can be considered 100% safe to use during pregnancy.

Return to Table of Contents

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1. Mother Care

> Prenatal care > Prenatal vitamins > Medicine guidelines during pregnancy > Good nutrition during pregnancy > Dental care during pregnancy > Global obstetrical care > HIV testing > Vaccination during pregnancy > Sexually transmitted diseases and pregnancy > How smoking affects you and your baby > High blood pressure > Gestational diabetes > Toxoplasmosis and pregnancy > Coping with the physical changes

of pregnancy

> Finding a comfortable position > Exercise during pregnancy > Pregnancy childbirth and bladder control > Sex during pregnancy > Sleep during pregnancy > Travel during pregnancy > Depression during pregnancy

Return to Table of Contents

CLEVEL AND CLINIC | WOMEN'S HEALTH - PREGNANCY |7

Prenatal Care: Your First Visit

Why is prenatal care important?

Regular appointments with your healthcare provider throughout your pregnancy are important to ensure the health of you and your baby. In addition to medical care, prenatal care includes education on pregnancy and childbirth, plus counseling and support.

Frequent visits with your healthcare provider allow you to follow the progress of your baby's development. Visits also give you the opportunity to ask questions. Most healthcare providers welcome your partner at each visit, as well as interested family members.

What happens on my first medical visit?

The first visit is designed to determine your general health and give your healthcare provider clues to the risk factors that might affect your pregnancy. It will typically be longer than future visits. The purpose of the initial visit is to:

? Determine your due date.

? Find out your health history.

Physical exam

A thorough physical exam is also part of the first visit. You are weighed, and your blood pressure, heart, lungs and breasts are checked. The first visit also includes a pelvic exam by your healthcare provider.

Pelvic exam

During the pelvic exam, a bimanual internal exam (with two fingers inside the vagina and one hand on the abdomen) will be performed to determine the size of your uterus and pelvis. Your healthcare provider might listen for the baby's heartbeat with a special instrument called a doppler, which uses ultrasound (high frequency sound waves). A doppler usually cannot detect a baby's heartbeat before the 10th to 12th week of pregnancy.

Lab tests

Many lab tests are ordered in your first trimester, including:

? Complete blood count (CBC) screens for blood problems, such as anemia (low iron).

? Explore the medical history of family members.

? Determine if you have any pregnancy risk factors based on your age, health, and/or personal and family history.

You will be asked about previous pregnancies and surgeries, medical conditions, and exposure to any contagious diseases. Also, notify your healthcare provider about any medications (prescription or over-the-counter) you have taken or are currently taking. We ask some very personal questions, but be assured that any information you give is strictly confidential.

? Hepatitis C.

? RPR screens for syphilis (a sexually transmitted disease).

? Rubella: Tests for immunity (protection) against German measles.

? HBSAG: Tests for hepatitis B (a liver infection).

? Urinalysis: Tests for kidney infection and bladder infection.

? HIV: Screens for antibodies in your blood.

? Cystic Fibrosis: Screens for the presence of the CF gene.

Return to Table of Contents

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