Download the labor instructions (pdf format)

Download the medication list (pdf format)

No, your prenatal vitamins should be the only supplement used during pregnancy unless your provider specifically directs you to use an additional product.

It is not uncommon to develop a yeast infection during pregnancy. If such an infection does occur, it is safe for you to use over-the-counter products, such as Monistat. These are readily available at stores. However, if you are early in your pregnancy, before 12 weeks, it is important that the cream be used externally only. After 12 weeks, it is safe to gently use the applicator internally.

Very often pregnant women who are constipated also have hemorrhoids. Hemorrhoids are varicose (or swollen) veins of the rectum. They are often painful. Straining during bowel movements and having very hard stools may make hemorrhoids worse and can sometimes cause them to protrude from the rectum. Do not take drugstore cures while you are pregnant without first checking with your doctor or nurse. Hemorrhoids usually improve after the baby is born. Several things can help give relief or avoid the problem in the first place.

• Avoid getting constipated
• Eat a high-fiber diet
• Drink plenty of liquids

• Eat five or six small meals a day instead of two or three large ones. (A glass of fluid may be equal in volume to a small meal, so avoid drinking large amounts of fluids with meals.)
• Avoid foods that cause gas, such as spicy or greasy foods.
Do not eat or drink several hours before bedtime.
• Wait two hours after eating before exercising.
• Antacids may be helpful, such as Maalox, Tums, or Zantac. Liquid will be more effective than tablets. If the problem is frequent and only briefly relieved by antacids, speak with your doctor or midwife.

Indigestion is commonly called heartburn, but it does not mean that anything is wrong with your heart. It is a burning feeling that starts in the stomach and seems to rise into the throat. It occurs when digested food from your stomach, which contains acid, is pushed up into your esophagus (the tube leading from the throat to the stomach). Liquids that you drink also take up space in your stomach, so they may also add to the problem. Changes that take place in your body during pregnancy may worsen indigestion. Changes in your hormone levels slow digestion and relax the muscle that normally prevents the digested food and acids in your stomach from entering the esophagus. In addition, your growing uterus presses up on your stomach.

Some people worry about having intercourse during pregnancy. They may be afraid it will cause a miscarriage. For a healthy woman with a normal pregnancy, intercourse is safe into the last weeks of pregnancy. For your comfort, you and your partner may want to try different positions. Your doctor or midwife may advise you to limit or avoid sex if there are signs of problems in your pregnancy.

Latex paints manufactured before 1991 used small amounts of mercury as a preservative. There was some concern that this mercury could present a health hazard, so mercury is no longer used in latex paints. The fumes from latex paints are not felt to be a specific risk to a developing baby, but it is always wise to paint in a well-ventilated area. The fumes from oil based paints, turpentine, paint thinner, etc., are best avoided by pregnant women. Also, remember when painting to avoid use of a ladder to reduce the risk of injuries due to a fall.

In the last three months of pregnancy, you may find that you have more leg cramps. Get plenty of calcium (three glasses of milk or supplement) and potassium (oranges or bananas). Stretching your legs before going to bed can help relieve cramps. Avoid pointing your toes when stretching or exercising.

At least half of all pregnant women seem to have problems with constipation. One reason for this may be changes in hormones that slow the movement of food through the digestive tract. Sometimes iron supplements may also cause constipation. During the last part of pregnancy, pressure on your rectum from your uterus may add to the problem. Here are some suggestions that may help:

• Drink plenty of liquids – at least 6-8 glasses of water each day, including 1-2 glasses of fruit juice such as prune juice. Liquids (such as coffee, tea and cola) which make you go to the bathroom should not be drunk. They will tend to create a negative water balance in your body and thus make your stools harder and more difficult to pass. Each food high in fiber, such as raw fruits and vegetables and bran cereals.
• Exercise daily – walking is a good form of exercise.

Headaches are common during pregnancy. Usually headaches do not signal a serious problem. How often they occur and how bad they are may vary. It is important to discuss with your healthcare provider which medications you can use for the headache. You should contact your doctor if your headache does not go away, returns very often, is very severe, causes blurry vision or spots in front of your eyes, or is accompanied by nausea. You may use Tylenol (acetaminophen) two regular tablets or one extra-strength tablet for headaches.

Pregnant women exposed to, or who develop symptoms of the Parvovirus B19 infection should be tested to see if they are susceptible to infection (nonimmune) or if they have a current infection. You will need to contact your doctor to check your immunity by having a blood test performed. If the Parvovirus B19 IgG is present and the IgM is negative, both you and the baby will not develop the infection. If both of the tests are negative, it means you are not immune and have not developed the infection. You may want to minimize further exposure by staying away from the person who does have the infection. If you have been exposed to the virus, your doctor should counsel you regarding risks and any treatment that may be recommended.

Most adults are immune to chickenpox, either from having the disease or by forming immunity from a mild exposure. If you have had chickenpox in the past, you and your baby are protected. If you are not sure, ask your doctor to check your immunity with a blood test. If this shows positive immunity, you are both protected. If it shows no immunity, an injection of a medicine called Varicella Immune Globulin (VZIG) may be given to prevent chickenpox. In order to be effective, this injection must be given within 72 hours of exposure.

A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer. Let your doctor or nurse know if you have swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed for you.

• Elevate your legs when possible.
Rest in bed on your left side.
• Lie down with your legs raised on a small footstool or several pillows.
• Do not wear stockings or socks that have a tight band of elastic around the legs.
• If you must sit a lot on the job, stand up and move around from time to time.
• Try not to stand still for long periods of time.

Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant. This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good “rule of thumb” is to limit exertion to about 2/3 of what you could do before pregnancy. Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments. Your family should be able to help you at home as fatigue increases at the end of your pregnancy.

The following suggestions may be useful in relieving nausea and vomiting:

• Remember, “any calorie is a good calorie” so eat what stays down for you.
• These foods may not be well tolerated:
  • Greasy or fried foods, as they take longer to leave the stomach
  • Very sweet foods
  • Spicy hot foods
  • Foods with strong odors
• Eat smaller, more frequent meals, that are six small meals and snacks.
• Drink fluids between meals, not with meals.
• Eat foods that are at room temperature or cooler. Hot foods may trigger nausea.
• Drink beverages chilled or cold. Decaffeinated soda is often well tolerated. Don’t opt for diet soda; you need the calories right now.
• Eat slowly and rest after meals. It is best to rest sitting in an upright position for about one hour after eating.
• Dry toast, soda crackers or dry pre-sweetened cereals may relieve periods of nausea.
• Keep track of when you feel nausea and what causes it.
• If continued vomiting occurs, do not eat or drink anything until the vomiting has stopped. As you feel better, try some small amounts of clear liquids (broth, Jell-O, apple, grape, or cranberry juice and/or popsicles.)
• Tart or salty foods such as lemons or pickles may help decrease nausea.
• Avoid mixing hot and cold foods at a meal, as it may stimulate nausea.
• Ask your doctor about medicine to control nausea.
• Avoid eating in a room that is stuffy, too warm, or has cooking smells/odors that may disagree with you.
• Wear loose fitting clothing.
• To avoid the sight/smell of foods, eat meals out or have others bring prepared food to you.
• These are signs that you need to call your doctor:
  • Unable to keep anything down for more than two days
  • Fainting
  • Vomiting blood
  • Rib pain
  • Jaundice (skin is greenish or yellow)
  • Your weight drops more than five pounds within a week

The use of saunas, hot tubs and tanning booths is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100° Fahrenheit.

Often pregnant women have concerns about the safety of hair dyes and permanents during pregnancy. There is no scientific data on this question, but it seems unlikely that these types of exposures are harmful.

Colds are miserable things, even at the best of times, but there are increased concerns during pregnancy. Many things can relieve symptoms at home, sometimes eliminating the need for an office visit.

• Use a cool mist vaporizer/humidifier at night. This moistens the air you breathe to keep secretions flowing.
• Saline gargles (one teaspoon of salt in ½ cup warm water) every four hours while awake will cut the mucous in the back of the throat and relieves mild soreness.
• Any brand of saline nose drops (NOT regular Afrin or Neo-Synephrine) at bedtime and on arising in the morning will help moisten secretions.
• Tylenol (plain) and/or Extra Strength Tylenol, two tablets, as directed if necessary for aches.
• Take your temperature, orally, if needed – call us if your temperature is greater than 101° Fahrenheit.
• Coughing can be relieved with one teaspoon of honey and 2-3 drops of lemon juice. Hold this in your mouth until the honey thins and then swallow. If coughing interrupts sleep or causes vomiting, call your doctor. You may try Robitussion DM, an over-the-counter cough medication.
• Increase fluids (especially water) to two quarts a day.
• Get extra rest, if possible.
• Actifed, Sudafed or Mucinex may also be used for symptoms of congestion when taken as directed on the package. It is preferable that you not take this in your first trimester of pregnancy.

Most women can travel safely until close to their due date. For most women, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. During pregnancy, many women have concerns about seat belts. There is no question that you are much better off wearing your seat belt during pregnancy. The baby is very well protected in the uterus from trauma, but car accidents are the most common source of trauma during pregnancy. The most common reason for fetal death is maternal death, and maternal death is much less likely in mothers who wear seat belts. Both lap and shoulder belts should be worn at all times. The lap belt should be worn low on the hips, not over the uterus. Also, remember that after delivery, an approved car seat must be in your car in order to take your baby home from the hospital. We recommend you not sit with your legs crossed and that you get out and walk every two hours. People also have concerns about flying during pregnancy. In general, there does not seem to be an increased risk for women who fly during pregnancy. Any woman who sits for long periods of time without getting up for a walk is at risk for developing a blood clot in her legs. For this reason, on flights over two hours, you should get up, stretch your legs and take a walk up and down the aisle. Because of this, an aisle seat is usually advisable. Our office recommends that patients do not travel after 35 weeks and restrict travel to within one hour from home during their last month.