Camelback Women's Health Prenatal Handbook
Our philosophy of prenatal care centers around individualized one-on-one care with your doctor. Your physician will oversee the special considerations of your pregnancy personally at each visit. We make a special point to have the doctor that you've chosen, whenever possible, available for your delivery. Continuity of care throughout the pregnancy and with each subsequent pregnancy is as important to us as it is to you.
Our goal is to promote a healthy pregnancy through education, early prenatal counseling, appropriate laboratory testing, proper diet and exercise. Since your unborn baby is entirely dependent on you, your health should be your most important consideration for the duration of the pregnancy. We encourage you take advantage of this exciting time in you and your new baby's life to ask questions, read, and improve your lifestyle wherever possible.
This guide is intended to serve as a reference for expectant parents at Camelback Women's Health. We encourage you to read available prenatal books and literature throughout your pregnancy and bring questions that may arise to each of your prenatal visits.
About Our Medical Staff
About our Medical Staff Gregory DeSanto M.D.
Steven Nelson, M.D., J.D.
Erin O'Sullivan, M.D.
Kathleen Schwartz, M.D.
1111 E. McDowell Rd; 1 mile west of the Squaw Peak Freeway The Department of Obstetrics and Gynecology at Banner Good Samaritan Medical Center is the regional referral center for high risk pregnancies for most of Arizona and is known for its quality of care and expertise for both high risk and low risk pregnancies throughout the valley. The neonatal unit of Phoenix Children's Hospital is integrated with labor and delivery and is renown nationally for its care of premature newborns. The Birthing Centre features newly remodeled, family oriented LDRPN private rooms where labor, delivery and the entire postpartum period can be managed in one comfortable Labor-Delivery-Recovery-Post Natal suite. This allows for rooming in for the newborn baby and the father. Good Samaritan offers 24 hour in house Ob anesthesia services and has a well respected Ob/Gyn graduate medical education program.
7700 E. Shea Blvd; 2 blocks east of Pima and Shea Scottsdale Healthcare-Shea offers a more community oriented experience with LDR rooms which allow for labor and delivery in a private labor room. The post partum unit features all private rooms and a level 2 nursery. Scottsdale Healthcare-Shea is well known for its prenatal classes and encourages family involvement through its Stork Stories program for siblings. Anesthesia is on call and available 24 hours a day. The hospital invites new mothers and their babies back 2-3 days after delivery for follow-up on infant care or post partum questions.
Emergencies
If an emergency situation occurs, please call the office at the telephone number listed below for the office that you normally visit. During business hours, a doctor or nurse practitioner should be available at the office. After hours, the answering service will receive your call and the on call physician will return your call. Please identify yourself and your physician, the nature of your problem and give a phone number that we can call and stay by your phone. If the on call physician is involved with a delivery or another patients call, he or she will return your call as soon as possible.
We want to know immediately about any heavy or bright red bleeding. Dark red or brown discharges generally do not imply active bleeding, but should be reported when the office opens the next morning. Notify a doctor of any bleeding associated with pain.
During your pregnancy, if contractions ever develop a timeable pattern or involve severe pain, notify a physician. Contractions can occur irregularly throughout the pregnancy and generally do not present a problem, but regular, timeable contractions can suggest preterm labor. Report any large gushes of fluid or continuous leaking of clear liquid immediately. Most other vaginal discharges can be discussed during office hours.
Temperatures for whatever reason over 101 (38 degrees Celsius) should be reported. If you think that you have a fever but you are not sure, please check your temperature with a thermometer before calling. For women past 24 weeks, please report any absence of fetal movement for more than 4 hours. If you are concerned about your baby's level of activity, it is best to monitor movements immediately after a meal while lying down. Movements during the last month of the pregnancy will involve more rolling and turning and therefore will require more attention on your part. Remember, it will be the frequency of movement that is more important, not the type of movement.
If you believe you have an emergency that requires a visit to an emergency room, please call us first. Many insurance plans require preauthorization before a visit, and an unauthorized visit can result in bills becoming your responsibility. Most other problems of a more routine nature can be directed to the office during business hours. On weekends, please call when possible between 8am and 6pm. Many simple questions will be answered in your prenatal books; please look there first or bring them to your next visit. If you call during the business day, please be patient. Calls are returned throughout the day and after the last patients are seen. Important Phone Numbers Camelback Women's Health
Scottsdale Healthcare-Shea
Appointments
Appointments are made from 8:30 to 4:40 Monday through Friday at both the Paradise Valley and Biltmore offices. Appointment times may vary from doctor to doctor. Because of the nature of obstetric practices, it is possible that your appointment may need to be rescheduled or delayed due to a delivery or an emergency. As you can understand, the physicians must attend to these cases when they occur, as they will when your special moment arrives. A nurse practitioner is also available to provide routine OB exams. When making future appointments, please leave us a phone number where you think you will reachable just before the visit. The office staff, if necessary, will make every effort to help you reschedule your appointment to suit your needs. We thank you in advance for your patience and understanding.
At your first visit your doctor will discuss with you your family and previous obstetric history to identify if you are a candidate for early prenatal diagnostic testing or genetic counseling. You should be able tell us if any serious birth defects or hereditary diseases affect you, the baby's father, close relatives or a previous pregnancy. Great strides are being made in science of prenatal diagnosis everyday and these can sometimes be applied to your pregnancy.
Alpha-fetoprotein screening is a blood test offered all pregnant women and is drawn between 14-20 weeks gestation. The test is intended as a screening study for a group of disorders called neural tube defects. These include spina bifida, myelomenigoceles and anencephaly, serious conditions that affect the brain and nervous system. The test has been improved and refined in recent years using two additional markers (now called the triple screen or AFP+) and now can serve also as a screening test for Down's Syndrome (Trisomy-21) and Trisomy 18.
It is very important to understand that the AFP triple screen is exactly that, a screening test that has both the risk of being falsely positive or falsely negative. An abnormal test does not necessarily mean that there is something wrong with the pregnancy, but gives you and your doctor the chance to more carefully evaluate your situation. The screen for neural tube defects is based on elevated AFP levels, but a positive screen results in an affected child in only 3% of cases.
The screen for chromosomal problems is based on low AFP levels and two other markers, combined with your age. The very important limitation of this test is that it will still miss up to 30% of those pregnancies affected with Down's Syndrome in patients over 35 and up to 60% in younger patients. The test is useful as a guide for further evaluation for most patients and can, taking into account your age, give you a revised risk of your pregnancy being affected with a chromosomal problem.
Genetic amniocentesis is a procedure usually done between 14 1/2 and 16 weeks gestation in patients at risk for chromosomal abnormalities. The test involves taking a small amount of fluid from around the sac of the baby under ultrasound guidance and sending the fluid for cell culture. The test takes about 7-10 days for reporting since it involves a culture and has a risk of about 1 in 250 of resulting miscarriage or rupture of membranes. This test is done in our offices and is very accurate in evaluating pregnancies at risk for chromosomal problems.
Chorionic villus sampling is a test available for early prenatal diagnosis of chromosomal problems and can be done between 9 and 11 weeks gestation. It involves sampling the early placental tissue (chorionic villi) and has a higher risk of miscarriage. Referral to a specialist trained in this procedure is necessary.
HIV Testing The American Medical Association, the American College of Obstetrics and Gynecology, the American Academy of Pediatrics and the National Institute of Health have all passed resolutions to advise all pregnant women to have HIV testing during their pregnancy, since newer medical therapies are able to significantly reduce to transmission rate and subsequent infection rate to babies if the treatment is started before delivery. HIV occurrence rates are relatively low in Arizona.
Cycstic Fibrosis Testing Beginning this year, the American College of Obstetrics and Gynecology and the American Academy of Pediatrics is recommending offering cystic fibrosis testing to all pregnant and prospective pregnant women. Newer testing is now able to detect approximately 85% of the carriers of cystic fibrosis. The gene is present in approximately 1 in 40 men and women and requires both parents to carry the gene in order for a child to be affected. Therefore, approximately 1 in 1600 children is affected by cystic fibrosis, a serious and debilitating lung condition. Certain ethnicities have higher carrier rates.
Diet
Your diet during your pregnancy is perhaps the most important element of having a healthy pregnancy and newborn. You are solely responsible for providing the nutrients for your growing baby. This is also the perfect time in your life to begin better eating habits that can carry on with you through your lifetime. During early pregnancy, calorie content is not nearly as important as the quality of your diet. Please spend an extra few minutes to read about how to eat right during your pregnancy in one of your prenatal books.
If you are having difficulty keeping meals in due to morning sickness, look for ways to maintain hydration, by taking fluids during those portions of the day that you feel better. Morning sickness is thought to be worse when the stomach is empty for prolonged periods of time, hence morning sickness is more troublesome in the morning. If your having difficulties, try keeping your stomach busy with hard candies or gum during the day or try a small snack before bedtime to avoid difficulties the next morning. Many times vitamins during this portion of the pregnancy irritate stomach. Try taking the vitamins with food or just before bed. If this isn't possible, stop the vitamins for week or two before resuming them and look for natural sources of vitamins in fruits and vegetables. Most women who eat a nutritionally sound diet actually do not need additional vitamins. If morning sickness is worsening to the point you cannot keep even liquids in, call your doctor.
Many women, particularly in early pregnancy can feel lightheaded due to low blood sugars, so be sure to eat regularly. In general however, pregnancy tends to be a state when a woman's blood sugar levels run higher than normal, sometimes to the point that diabetes can be a problem. This form of diabetes usually resolves after delivery. Perhaps one the most important goals during your pregnancy therefore should be to reduce or eliminate sugar and processed sugar whenever possible.
Read the labels of prepackaged foods for sugar content. Fruit juices have high fructose concentrations ( translation => sugar) and therefore, although there are beneficial nutrients in fruit juices, limit your daily intake. The sugar substitute Nutrasweet is a very simple protein, and therefore is a safe substitute for sugar, despite what some older prenatal books suggest. Therefore, try diet sodas whenever possible. Avoid saccharin as a sugar substitute. One or two servings of colas or coffee with caffeine should be safe, however it would be best to try decaffeinated products whenever possible.
Calorie requirements go up modestly during pregnancy and weight should occur naturally without making special efforts to eat more. One of the easiest ways to gain more weight than is needed is to begin purposely eating for your baby and yourself. If you are near your optimal body weight before your pregnancy, you should gain 22-30 pounds over the course of the pregnancy. If you are overweight before the pregnancy, this weight requirement will be less. Discuss the optimal weight gain for your particular pregnancy and never begin a new diet, particularly weight loss diets, without consulting your doctor.
Emphasis leaner meats, particularly skinless chicken or fish during pregnancy. Reduce the fat in your diet by reading labels whenever possible. Green vegetables are a good source of vitamins, iron and even calcium. Higher fiber foods will help you avoid problems with constipation. Metamucil, citracel and colace, an over the counter stool softener, can be used to naturally supplement fiber content in your diet.
Iron will be important to help increase the blood supply during your pregnancy, but in general iron supplements are not needed if you eat iron-rich foods. Again lean red meats, and green vegetables are good sources of iron. If you doctor suggests an iron supplement, be sure to increase the fiber in your diet as well, since iron supplements can be constipating.
Heartburn can be a problem in pregnancy, particularly as you approach your due date. This is often caused by passage of food back towards the esophagus due to the relaxed nature of the stomach during pregnancy. To avoid this, reduce the portions of food during a single meal. Try smaller meals 4-5 times a day to allow the stomach to empty better. Also try not to lie down for an hour or two after eating, particularly at night. Avoid spicy and fatty foods, particularly deep fried foods and stop the use of caffeine, chocolate, and cigarettes. Tums and Rolaids are safe to use and if symptoms persist Maalox or Mylanta may help. Medications are available if more conservative measures fail to relieve the problem. Before using any other over the counter medications, discuss this with your doctor.
Exercise
In recent years, there has been more and more information available about the beneficial effects of aerobic exercise in pregnancy. Both the mother and baby benefit directly. Babies of mothers who exercise regularly are generally leaner and more vigorous at birth. Exercise promotes a sense of well being in expectant mothers and labors tend to be better tolerated and faster in well conditioned mothers. The post partum recovery is also generally easier.
Make it a special point to discuss with your doctor what exercises that you normally do and whether these are safe and appropriate for your particular pregnancy. Brisk walks, light jogging, swimming, bicycle riding or low impact aerobics are all good forms or aerobic exercise. Slow walks and working around the house all day do not qualify as aerobic exercise, since your heart rate generally remains low. At the gym, stair steppers, exercise bikes or Nordic Track machines will give you a good workout. Avoid vertical impact movements such as high impact aerobics or horseback riding during your pregnancy. Your target heart rate should be between 110-120 beats per minute, sustained for 20-30 minutes. Do not exceed 140 beats per minute, as this has been shown to be the heart rate where blood flow begins to drop to the placenta and baby. You should try to do this exercise at least 3 times a week throughout your pregnancy. Start out slowly if you haven't been on an exercise program recently. Particularly in Arizona, its important to stay hydrated both during and after your workout. Bring plenty of fluids with you on walks or hikes.
You may continue using weights in your exercises, but try to work on repetitions and avoid straining movements. Avoid bearing weight over your head. Sit-ups are fine, but you'll obviously note that they become harder and less beneficial as the pregnancy progresses.
Sex is generally healthy and safe during pregnancy. Avoid positions that involve direct impact to the stomach. Report any bright red bleeding. Mild contractions frequently occur for the first hour or so after intercourse and generally are not a problem. If you are at high risk for preterm labor, discuss whether intercourse is advisable during your particular pregnancy.
If you have had any problems with bleeding, preterm contractions or have other medical problems with either this or previous pregnancies, please be sure that you discuss with your doctor what type of exercise is right for you for this pregnancy.
Colds And Flus
Perhaps the most common questions that come up during pregnancy relate to colds and flus during your pregnancy. Unfortunately, during pregnancy, your immune system is not as responsive to the troublesome viruses and sometimes bacteria that cause flus and colds.
Its important to do what you can to avoid this problem whenever possible by getting plenty of rest, exercise and eating healthy. Be assured that generally your baby is aided by the antibodies that your immune system makes to ward off these infections, but is also therefore most important that you devote yourself to getting better when your feeling ill. You should direct any cold medications that you may need to the particular symptoms of your illness at the time, as many times flus over their course migrate from the sinuses, the throat and the chest. If your experiencing fevers, chills, headaches or muscle aches, 2 Tylenol (regular or extra strength) every 4 hours should help with these symptoms. Avoid ibuprofen (Advil, Motrin, Nuprin) when possible during pregnancy. Aspirin has a role in certain conditions related to pregnancy, but should generally not be used for colds or flus regularly.
If sinus congestion is a problem, try Sudafed or Actifed during daytime hours and Benadryl before bedtime (as this will also help you sleep). Robitussin DM or similar generic cough syrups with dextromethorphan are preferred for coughs. If you begin coughing up excessive sputum or continue to incur fevers, notify your doctor. Antibiotics are only occasionally needed for colds or sore throats.
Although all medications have potential risks, the medications mentioned have been in long-standing use without reported safety concerns and therefore should be safe for pregnancy. Consult your doctor before trying other over the counter or prescription medications. Oral or nasal inhalers may be needed for more troublesome colds and asthma and are generally quite safe. Influenza vaccines are available between October and January both through your primary care physician and our department. The vaccines are considered safe in pregnancy and are very useful in protecting you from what are considered to be the most common flu viruses for the coming flu season. Experts suggest you consider getting a flu vaccine either before or during your pregnancy , since women are particularly prone colds and flus during pregnancy.
Both Camelback Women's Health offices offer on-site ultrasound, which is advantageous in sorting out problems quickly and conveniently for our patients. In most instances, an ultrasound will be performed by your physician at your first visit to establish that your due date is correct, make sure the pregnancy is progressing normally and confirm that there are not twins, triplets,... etc! Due to the small size of the fetus, this generally is a limited ultrasound that will not identify problems with the baby's anatomy.
A second ultrasound will be obtained at 18-20 weeks gestation to survey fetal anatomy. A normal ultrasound report does not guarantee the baby is anatomically perfect, but it is intended to try to identify potential problems. The spouse or one other close relative is encouraged to attend this ultrasound, but please don't have other family members, friends or children attend. A full bladder will be necessary and therefore if your bladder is not approaching full, drink 32 oz of water an hour prior to the ultrasound.
The ultrasound technician has responsibilities for obtaining accurate film records, and please therefore allow her the time needed to do her work. A short video of the ultrasound can be obtained after the film records are completed if you bring a blank VHS tape with you. It is sometimes possible to identify the sex of the baby, but guarantees are not given.
Travel
Travel during pregnancy is generally safe, but there are some important guidelines to follow when planning a trip. It is important to check the limitations of your insurance, since many insurance plans have restrictions in coverage for medical costs incurred out of state.
As a general rule, don't schedule trips out of town after 32 weeks gestation (ie. 8 weeks before your due date). If your planning on flying, check on any restrictions the airlines have on flying and whether a letter will be necessary to board your airplane. Plan ahead by getting to the airport in plenty of time and have someone help with luggage. Airline flight is in itself quite safe in pregnancy, but troubles arise with the stress of travel (chasing luggage, time zone changes, etc). Be sure to get extra rest during your trip.
If you are traveling by car, make plans to get out of the car every 2-3 hours, since pregnancy is a condition that makes women susceptible to blood clots in the legs. Always wear a seat belt and bring extra fluids to keep yourself hydrated during the trip.
If you plan on foreign travel during pregnancy, make every effort to do this early in the pregnancy. Check with your travel agent about illnesses endemic to the countries that your planning on traveling in and what vaccines are necessary. Ideally, vaccines should be given before you become pregnant, however your doctor and you may need to decide whether the risks of a disease are greater than the risk of the vaccine. Particularly when traveling in Mexico, avoid contaminated water by drinking bottled water or soft drinks without ice.
Prenatal Classes
Prenatal labor classes at all of the local hospitals, usually beginning the first week of the month and lasting three to four weeks. First time mothers and their husbands or significant others are strongly encouraged to attend these classes to learn more about labor and what to expect in the hospital. A single refresher class is also available for mothers who feel that an update on labor would be useful.
These classes provide an excellent opportunity to ask questions and learn more about the process of labor in a comfortable and informal setting. Relaxation and breathing techniques are reviewed and a film is shown both of natural childbirth and cesarean section.
Tours of the hospitals are generally provided with the classes. These can also be arranged for separately for those not taking the classes. Classes can be scheduled by calling the phone numbers listed above. Try to have the classes completed before the 36th week of the pregnancy.
Labor: When to go to the Hospital and What to Bring
The last few weeks prior to your labor can be both the most exciting and yet most anxious time in your pregnancy. Your visits will be weekly with your doctor after 36 weeks, so you should have plenty of opportunity to ask questions or discuss your concerns or feelings at these visits. Despite all the aches, pains and emotions that occur during the last weeks of your pregnancy, try to enjoy this time, since you and your baby will never be this close again.
Your spouse or significant other should plan on attending the visit at 36 weeks where labor will be reviewed. We will discuss when to call us, our approach to labor management and try to accommodate your special requests. We will also discuss pain management options available to you. Our office will generally check for cervical dilation between 37 and 38 weeks, at which point we will be able to give you an idea about how close to delivery you are.
In general, try to approach your labor with a very open mind. Breathing techniques, walking in the halls, showers and other relaxation methods are all intended to keep your focus on the short term goal of remaining as comfortable and in control as possible while keeping in focus the broader objective of a safe and healthy delivery. Friends and relatives like to recount stories of their labors, but remember, every labor and every pregnancy is different. Its far more likely that your labor will be much more different than anyone else's than it will be the same.
When you think that you are in labor, talk first with your spouse or labor coach and then inform our office. You should have plans for a ride to the hospital well in advance of labor. If your contractions are regular, timeable, lasting more than 40 seconds and you are unable to walk or talk through the contractions, call our office. Your doctor should talk with you at your 36 week visit, for your particular pregnancy, about what the frequency of contractions should be before leaving for the hospital. If your water breaks first, which occurs in about 20% of pregnancies, call us first to discuss when you should go to the hospital.
Pack only a small bag of clothing and personal items for your stay and leave jewelry or other valuable items at home. Be sure your camera or VCR has fresh batteries. In most instances, it will possible to tape the delivery and first minutes after your child's birth. Bring a comfortable robe and slippers and one set of clothes for your baby. Formula and diapers will be provided by the hospital. A car seat is mandatory before the discharge of your baby. Discuss in advance with your doctor if it will be possible for anyone other than your spouse or labor coach to be able to attend the actual delivery. One Last Thing
The anticipation of labor can be very exciting, but sometimes frightening. Friends, neighbors and even strangers seem to relate their labor stories to pregnant women. What is certain is that your labor experience will be unique. There are risks to childbirth and we have chosen to work at hospitals that provide the very best in obstetric care.
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Congratulations on the news of your pregnancy. In order to promote healthy pregnancies for all of our patients, the physicians and staff of Camelback Women's Health dedicate ourselves to maintaining the highest quality and most up to date prenatal care available today. We are excited that you've chosen our doctors and staff to provide for you and your expectant child's care.
Banner Good Samaritan Medical Center
Scottsdale Healthcare-Shea 
Aerobic exercise involves stimulating your heart to a higher heart rate, which results in improved blood flow to organs such as muscles that normally don't require high blood flow. The placenta, which serves as the filter and nutritional bridge between you and your baby also receives improved blood flow during moderate exercise. Essentially, your baby gets a modest workout with you.