• We encourage you to eat a good variety of food including proteins, vegetables, and fruits.
• Please take your prenatal vitamin daily. If you are unable to tolerate your vitamin, please let us know so that we can discuss additional options. Your vitamin should have folic acid included and based on your personal or family history we may give you a folic acid supplement to take in addition to your prenatal vitamin. You should consume the following every day through diet or supplements:
• Folic Acid 400-800 micrograms (until the end of the first trimester)- however we may recommend increased folic acid if you have certain medical conditions or on certain medications
• Iron 30mg (we will also be screening you throughout your pregnancy for anemia and may encourage you to take additional iron)
• Vitamin D 600 international units
• Calcium 1000mg
• Stay away from un-pasteurized cheeses. Pasteurized cheeses are good sources of protein so we encourage you to eat these. Unpasteurized cheeses often include feta, goat, blue cheese, and queso cheese. If it says pasteurized on the package you may eat it.
• You may eat seafood and we encourage you to eat 2-3 servings per week. However, you should avoid large fish, fish that eat other fish or raw fish (examples to avoid include Mackerel, Ahi Tuna, shark, swordfish). If you wish for a more complete list of fish you can and cannot eat please visit: https://www.fda.gov/food/consumers/advice-about-eating-fish
• You may eat deli or sandwich meat and hotdogs however you should make sure that they have been cooked enough that the meat steams.
• There is conflicting data regarding artificial sweeteners in pregnancy- at this time low (or typical) intake is likely safe
• Caffeine less than 200mg/day does not appear to be associated with adverse affects on the pregnancy There is a study showing decreased height of children with maternal caffeine intake during pregnancy.
• You should also avoid raw or undercooked meat during pregnancy and should wash all fruits and vegetables prior to eating them.
• We will talk with you about your overall weight gain recommendations for pregnancy. This recommendation is based on your BMI (body mass index) as well as if you have a single or multiple gestation. Increased or decreased weight gain can have a negative impact on your pregnancy and infant.

• If you currently exercise, you may continue your current regimen however as you get further along you may need to adjust your exercises to accommodate your changing body. We also encourage you to only exercise to maintain fitness not for body building or weight loss.
• If you are not currently exercising, we encourage you to start walking 4-5 days a week for 30-45 minutes per day.

• During pregnancy our mood and emotions can sometimes go up and down. If you find that you are struggling with your emotions and may be experiencing depression, please talk with us so that we can assist you or find someone to assist you.
• Please keep us informed of work or home stressors that you may be experiencing during your pregnancy.

• We recommend all pregnant women or women trying to get pregnant be vaccinated against COVID-19 with one of the FDA approved vaccinations as well as any applicable boosters. These vaccinations have been found to be safe in pregnancy and not cause complications with your pregnancy.
• We recommend all pregnant women to get the flu vaccine during your pregnancy. It is not a live vaccination and therefore you cannot get the flu from the vaccine. It does take 2 weeks to build up in your system therefore if you are exposed during those 2 weeks you can still get the flu. Women who get the flu during pregnancy are more likely to be sicker for longer and are more likely to need hospitalization than women who are not pregnant.
• The CDC recommends all pregnant women get the Tdap vaccine during their 3rd trimester of pregnancy every pregnancy. This is to help pass some immunity to the infant for pertussis (whooping cough) which is still present in the US and can cause severe respiratory problems in infants.
• We evaluate if you have built up immunity to Rubella (German Measles) and Varicella (Chickenpox) at the beginning of your pregnancy. If you are not immune to either of these and are exposed during your pregnancy, please let us know as soon as possible (please call us). If you are not immune we recommend you getting the vaccines postpartum prior to leaving the hospital.

• COVID-19: COVID-19 during pregnancy has been shown to increase your risk for preterm labor, and stillbirth or miscarriage. Women who are pregnant are at an increased risk for severe respiratory symptoms from COVID and those who have other co-morbidities such as diabetes or obesity are at an even higher risk. There may be other complications that are unknown at this time since this is a continually developing situation.
• Toxoplasmosis: If you have cats, make sure that someone else changes the cat litter or if you must change the litter that you wear gloves. If you garden outside you should wear gloves.
• Zika: Make sure if you or your partner are traveling to areas with Zika outbreak that you use insect repellent with DEET. You should also let us know so that we can monitor for symptoms on your return.
• Parvovirus: (Also known as fifths disease). Please let us know if you are exposed to someone with the Parvovirus. We will need to draw labs to determine if you have immunity.
• Flu: Even if you have had the flu vaccine during the current season you can still get the flu, therefore you should try to stay away from anyone diagnosed with the flu. If you must be in contact with someone who has the flu, please let us know and we can determine if Tamiflu would benefit you.

• Unless we specifically tell you that you should avoid sex, you may continue to have sex. If you are concerned that your water is broken, it is best to avoid sex until we have evaluated you.
• Travel: If you are traveling more than 1-2 hours away you may be at an increased of blood clots. It is important for you to get out of the car and walk for 10-15 minutes every 1-2 hours. If you are in a plane, bus, or train and it is safe, we recommend walking around every 1-2 hours. There is not a specific gestational age in which you should not travel, however talk to your provider about specific considerations for you during your pregnancy.
• Seat Belts: It is important to wear seatbelts when traveling in the car. As your belly gets bigger it is important to wear the seatbelt under your abdomen and not across the front of you belly.
• Hot Tubs/Saunas: You should not use hot tubs or saunas while you are pregnant. You may baths/showers, as well as swim. Your water should not be so hot that you feel hot.
• Sleep: It is important to try and get 8-10 hours of sleep per night. It is often uncomfortable to lay in bed. Pillows placed between your knees, as well as under your belly and behind your back may help you feel more comfortable. It is also important to not sleep flat on your back. Side lying when sleeping is the best position and it does not matter which side.
• We encourage all pregnant women to get at least one dental cleaning during pregnancy. This can help with early detection of tooth or gum disease. There are a lot of dental procedures that can be done during pregnancy including filling of cavities. If you need a note for your dental office, please let our front desk know.
• Hair dye is presumed to be safe during pregnancy due to low absorption through the skin. This should be done in a well ventilated area to decrease fumes inhaled.

• Exposure to gardening pesticides or other Pesticides should be avoided during pregnancy
• If there is concern regarding contaminated water in your area it is best to use bottled water or boil your water per the recommended guidelines.
• Please talk with us about any potential chemicals you may come in contact with at work or at home.
• It is best to not smoke or use tobacco products including vaping. This also includes exposure to secondhand smoke. If you must smoke, it is best to smoke outside and to wear a coat dedicated to smoking (even in summer) so that when you come inside you can remove the coat and limit your continued exposure. We also do not recommend vaping or using vape products during pregnancy.
• Avoid alcohol during pregnancy. There has not been a determination of a quantity of alcohol that is safe during pregnancy.
• Marijuana has not been shown to be safe in any amount in pregnancy. There is possible increased risks of disruption in brain development prior to birth, smaller sized babies at birth, stillbirth, preterm birth and increased risk of the child having behavioral problems and trouble paying attention in school. These risks are possible even with second hand smoke. There are also increased maternal risks from smoking marijuana including permanent lung injury, dizziness which puts you at increased risk for falls, impairs judgement putting you at risk of injury, and decreased levels of oxygen in your body which can lead to breathing problems.
• Avoid street drugs and narcotics. If you take prescribed narcotics it is best to use the lowest dose that is effective. Please talk with us if you need assistance with quitting.
• Please let us know any medications that you are taking- prescribed or over the counter. Many medications are not safe or can affect the pregnancy. We can talk with you about whether they are safe or if they are not safe, alternatives that can be used. Please talk with us or your prescribing providers before abruptly stopping medications that you were taking prior to pregnancy.

• Initial ultrasound to determine your due date, evaluate fetal heart beat/viability and determine number of fetuses
• Anatomy Ultrasound: Approx. 18 weeks and evaluates fetal anatomy including gender if the fetus cooperates
• Additional ultrasounds may be done for fetal heart rate, growth, evaluation of fluid, and placenta
• Non-medical/3D ultrasounds may be done if made by personal arrangements and at your own cost- these are not done for medical indications and insurance will not cover them. Make sure that when you are having a 3D or 4D ultrasound, you drink plenty of water for the few days leading up to your ultrasound.

• Blood type and assess for antibodies
• Blood count for anemia, platelets, and white blood cells
• Glucose screening
• HIV, syphilis, gonorrhea, and chlamydia which is NC state law
• Urine culture
• Rubella (German measles) and varicella (chickenpox) immunity screening
• Pap smear if indicated

• Cell-free DNA testing (cfDNA- MaterniT 21) is done at 12 weeks or more and screens for Down Syndrome, Trisomy 13 and 18 and if desires can give gender. (this testing may not be covered by insurance if you are low risk however you can answer a questionnaire through LabCorp to get the testing for $299). This is a blood test which looks at the fetal DNA in the maternal blood. It is around 98% accurate. http://womenshealth.labcorp.com/patients/pregnancy/maternity21plus
• AFP-Tetra Screening is a blood test that screens for Down Syndrome, Trisomy 18 and open neural tube defects or if cfDNA testing was done AFP- for open neural tube defects and this is done between 16 weeks and 20 weeks gestation.
• Cystic Fibrosis and Spinal Muscular Atrophy (Inheritest) is done with initial prenatal labs or at 16 weeks. These are only done once in your lifetime, therefore if you have already had these tested you do not need them again. These can also be done prior to pregnancy, if you are planning pregnancy in the future. http://womenshealth.labcorp.com/patients/pre-pregnancy
• Additional testing may be done based on family risk factors.
• For the MaterniT21 and Inheritest screenings you may call LabCorp at 844-799-3243 to talk with them about whether your insurance will cover the screenings.

• Gestational diabetes screening and syphilis screening at 26-28 weeks
• A complete blood count looking for anemia and low platelets will also be done at 26-28 weeks
• Group B strep screening and if indicated Gonorrhea and Chlamydia screening at 36 weeks
• Anemia screening at least 1 time a trimester and additionally as indicated
• Additional labs may be recommended at other times of your pregnancy based on symptoms or medical issues in pregnancy

• If you are having vomiting and are unable to keep liquids down for 24 hours or have not been able to pee in 12 hours.
• If you are less than 37 weeks and having more than 4-6 contractions in 1 hour and have tried drinking water and taking Tylenol and they are continuing.
• If you are having leaking of fluid and despite changing your underwear or wearing a pad you are wet again within 1 hour.
• If you are more than 28 weeks and are not feeling your baby move at least 10 times in 2 hours 1 time during the day. If you have questions about fetal movement, we will be glad to talk with you.
• If you have a headache or have severe pain under you right breast that does not go away with Tylenol or if you have sudden onset blurred vision or seeing spots in your vision

(You may always call our office and let us know you are going, but you should not delay going to the hospital waiting to talk with us)

• If you are less than 20 weeks and are having vaginal bleeding and are soaking a pad in an hour or severe pain
• If you are 20 weeks or more and are having vaginal bleeding more than when you wipe or if you are having severe pain that is not going
• Shortness of breath or difficulty breathing

Initial appointment:

• Ultrasound
• Labs
• Pap smear
• GC/Chlamydia
• Flu shot
• Go over any issues patient may have
• Referral (If needed)
• BMI (Body Mass Index)
• Recommended weight gain

Tetra for genetic/spine defects / Cystic Fibrosis (both optional

Anatomic Ultrasound (Gender Id if possible)

• OSS diabetic screen
• Rhogam (If Rh negative)
• Tdap vaccine info
• contraception and breastfeeding plans
• Prenatal classes: Wayne Memorial / Partnership for Children

non-medical 3D ultrasound (optional)

hospital preregistration and birth plans (optional)

• Group B Streptococcus
• GC/Chlamydia (25 years old or less)
• Cervix check (optional)

Cervical Check and planned Cesarean section (If applicable)

Appointment will be mailed

Your “due date” was established earlier in the pregnancy, and is not affected by the baby’s future growth or later ultrasound measurements. Labor will usually come naturally at full term, between37 and 42 weeks gestation.

False labor or Braxton-Hicks contractions are not uncommon. These contractions will be irregularly spaced, and eventually ease off. True labor contractions usually develop a more regular pattern, with decreasing intervals between them. Usually the contractions will progress to at least every 5 minutes for more than an hour.

Mild and limited vaginal spotting may occur at times, especially after intercourse or a recent exam. If you have heavier or more persistent bright red bleeding, especially if it is accompanied by pain or decreased fetal movement, do not hesitate to call.

At times, the bag of water may break before labor. If you experience heavy, persistent, or recurrent leakage of fluid, make sure you call. You may lose your mucous plug 1-4 weeks prior to labor.

Although it is not unusual for the nature of the baby’s activity to change in late pregnancy, you should remain reassured by the activity level. If there are any questions about this, lay on your left side following some liquid and food intake, and pay attention. You should feel at least 6 movements in an hour. Call us at any time you are not reassured.

Your plan for labor management is personal and individual. This may involve your desire for supporters, use of cameras or video, the ability to ambulate, your confidentiality, etc. If you have questions, requests or a birth plan please let us know. We would like to review it and discuss options or limitations if they exist. Similarly, your desire for pain management is individual, and we will try to accommodate your choices as best as the labor allows.

If you have questions or concerns about your pregnancy or symptoms, please call. Questions or problems that are not urgent should be managed during office hours. After hours you may call labor and delivery at 919-731-6200 if you think you are in labor or your water has broken, or if you need to speak with a doctor, calling the office number at 919-734-3344 will put you in contact with the doctor on call.