Prenatal care and policy

Scheduling:

Never leave the office without an appointment to return! If the computer is down please call the office the next day for your appointment or our staff will call you to schedule. Have a plan of who is going to call whom before leaving the office!

You will rotate between all the providers once then you may follow with the provider of choice. It is necessary that we are all familiar with all of our patients.

Fees and Payments:

The fees are best handled on a pay-as-you- go basis. If you have partial or complete insurance coverage, the billing staff will assist you in determining what your insurance will cover, and help you make arrangements so that the portion of our bill that your insurance does not cover will be paid by the time you are 28 weeks pregnant. Insurance claims will be submitted after the delivery for the remainder of the bill. If you should leave our care before delivery, you will be charged for each office visit, laboratory tests, and any other services performed. Any overpayment will be refunded to you. Please contact our office manager if you have any questions.

Our Fees Include:

• Office visits during your pregnancy for pregnancy related issues.
• Complete care of the mother at the time of delivery.
• Your six week postpartum check up.

There are additional fees for the following:

• Laboratory and other tests (i.e. pap smears, cultures, non-stress tests, ultrasounds, etc...)
• Injections such as the flu shot.
• Cesarean Section and/or other surgery (i.e. Tubal Ligation)
• Circumcision of male infant (consent form included with hospital registration forms)
• If you are seen for a primary care issue during your pregnancy your co-pay will be collected. Examples are sinus infection, strep throat, etc…
• Non-routine care (i.e. hospitalization)
• Cord Blood Collection
• Some insurances do not cover the blood work for the Ultrascreen testing
• FMLA paperwork or other paperwork required by your employer or disability insurance.

Hospital information and charges:

All of our obstetrics patients deliver at Baptist Hospital. For information on hospital charges, please contact them directly. To find out more information about Baptist Hospital go to www.baptisthealth.net.

Please make arrangements beforehand for your pediatrician to examine your newborn baby. If you need some help choosing a pediatrician, we will be happy to discuss it with you. Also, if there are other children at home in your care, please make arrangements for childcare well before your due date. Children are not allowed in the labor room. In addition to mom, up to 3 people are allowed in the delivery room. Photographs are allowed, but videotaping the delivery is prohibited.

Maternity Pre-Registration Forms:

Pre-admitting with Baptist Hospital at 24-28 weeks of pregnancy will ensure that your records are ready when it is time to have your baby. Go to www.baptisthealth.net then click on “pt and visitor guide”, then click on “maternity pre-registration”, this site contains the forms and accompanying information to register for your maternity stay at Baptist Hospital. Please complete the maternity pre-registration forms and click send. Please print and keep a copy for your records.

If you have any questions, please call the Maternity Pre-Admissions Coordinator at: Baptist Hospital: 786-595-5959

DO NOT go to any other hospital beside Baptist on Kendall Drive, or else we will not be able to care for you. Do not go to South Miami, West Kendall Baptist, or Homestead Baptist Hospitals!

Blood Transfusions:

While we do not expect to have to give you a blood transfusion during your delivery, there are circumstances and emergencies that may occur requiring it. In other countries, blood loss is the most common cause of maternal death. Fortunately, the need for blood transfusion is rare. Your doctor is the only person who can order a blood transfusion for you and only in a true emergency, when you life depends on it. We recommend that you sign the hospital papers allowing blood transfusion if it is necessary. If you wish to arrange for “designated donors” to give blood in your name prior to your delivery, please call the blood bank at Baptist Hospital. We do not allow pregnant women to donate their own blood. Checking “no” in the hospital’s papers indicates you would rather die than receive a life saving transfusion. If you have any questions or you are not planning to sign “yes” for transfusions, Please discuss this with us. Please do not check no!

Some Important Recommendations During Your Pregnancy:

• For most people, ideal weight gain in pregnancy is about 25-30 lbs. from your pre-pregnancy weight. Pregnancy is not a time to diet and yet it is also not at time to go “wild” with eating. Try to eat a balanced diet and stay away from “junk food”.
• Do not consume any caffeine (drink caffeine-free sodas, coffee and tea). Bear in mind that most of the weight gained is during the second half of the pregnancy.
• It is also important for you to have a diet low in salt. Please see the enclosed diet sheet. A diet low in salt may help control the swelling that all pregnant women experience.
• In general, you should not drink alcohol during pregnancy, as it can be dangerous for your baby.
• DO NOT TAKE ASPIRIN or IBUPROFEN (Advil), or any medications containing these ingredients. Tylenol is okay to take for pain, headaches, or fever (you may take 2 extra-strength every 4-6 hours as needed).
• Indigestion/heartburn: Maalox, Mylanta, Tums, and over the counter Zantac or Pepcid.
• Cold/Flu Symptoms: Tylenol Cold, Robitussin, Mucinex, Benadryl, Claritin, and Zycam (if started at the beginning of symptoms). Please get the flu shot if in season, as pregnant women are at risk for pneumonia that contract the flu. If you suspect the flu or are not feeling better with your cold, please make an appointment with your Primary Care doctor.
• “Stomach Bug”: You may take Imodium AD for diarrhea. Take 2 tablets with the first episode of diarrhea, then one tablet with each loose stool thereafter, to a maximum of 8 pills in a 24 hour period. Increase your fluids as diarrhea puts you at risk for dehydration.
• Constipation and Hemorrhoids: Increase the fiber in your diet by using Metamucil or Benafiber powder, or taking Fibercon tablets. You may also use a stool softener such as Senakot. You may use Preparation H for hemorrhoids, but also talk to Dr. Fink because there may be an excellent, painless treatment that will rid you of hemorrhoids- but it can only be done after your pregnancy.
• Nausea: Please remember that most pregnancy related nausea usually subsides by 12-14 weeks for pregnancy, so hang in there!.
• Smoking: Please use this as an opportunity to quit or at least cut way down. Smoking hurts your baby! There are 80 known carcinogens in Tobacco, don’t risk it!
• Exercise: Keep doing what you have been doing! Unless you play a contact sport. We do not recommend high impact aerobics, mountain biking or horse-back riding. Swimming, floor exercises, and walking/jogging, are excellent forms of exercise. Keep your heart rate below 140. Stay well hydrated.
• Sexual intercourse is fine during pregnancy as long as you are not having any complications such as vaginal bleeding, cramping, and infections or suspect that your “bag of water” has broken.
• Douching is not recommended at all, as well as hot tubing or applying heat to your abdomen.
• Please take a prenatal vitamin with DHA and get at least 1200-1500mg of calcium daily. Your prenatal does not have near enough calcium. We will prescribe you an iron pill if you need it.
• Vacationing is okay when pregnant. You may fly, drive, cruise or travel as you wish. Make sure you do not sit in one place for extended periods of time. You must “keep your blood circulating”. Travel is not recommended after 36 weeks.
• You do not need to get rid of your dog or cat family member! If you are pregnant and have a cat, someone else should change the cat litter. Please see the Toxoplasmosis information sheet.
• Avoid painting a room during pregnancy; your partner can do this. Make sure to well ventilate the area and use low VOC paint. Try to avoid using aerosol cans or industrial strength cleaners when cleaning your home.

Blood work:

Your “New OB” blood work is typically performed in our office at 10 weeks as we send the first part of a genetic test called the Ultra-screen at this visit. We also perform your routine blood work for pregnancy. If your blood type is Rh negative, you will undergo some extra tests and receive an injection of a medication call Rho-gam at about 28 weeks of pregnancy. This medicine helps to protect pregnancies from blood-related immune problems. We screen all of our obstetrical patients for gestational diabetes between 24-28 weeks.

Ultrasounds:

While having a sonogram is a fun and exciting way to see your baby, your insurance company limits the sonograms you can have. Unless there is a specific medical reason, your insurance generally pays for only one or two ultrasounds. Your “anatomy” ultrasound is performed between 16-20 weeks, and is looking to be sure your baby’s anatomy is normal. This is the time at which you may also be able to find out the gender of your baby! We do provide 3D/4D ultrasounds in our office between 28-31 weeks; this type of ultrasound is not covered by insurance. We have affordable packages and you go home with pictures of your baby and a DVD.

Labor:

Enclosed in this packet are written instructions for labor at your 36 week visit. Please make arrangements beforehand for your pediatrician to examine your newborn baby. If you need some help choosing a pediatrician, we will be happy to discuss it with you. Also, if there are other children at home in your care, please make arrangements for childcare well before your due date. Children are not allowed in the labor room. In addition to mom, up to 3 people are allowed in the delivery room. Photographs are allowed, but videotaping the delivery is prohibited.

After the hospital:

If you had a cesarean section, you will need to come in for a wound check 7-10 days after you leave the hospital and then again at 6 weeks for your postpartum visit. If you had a vaginal delivery call for your postpartum 6 weeks after you get home. Your obstetric fee includes a wound check and a six-week postpartum examination. Your first annual exam after having the baby is performed 3-6 months after your postpartum visit. Please call the office with any concerns or problems you may be experiencing once you get home. Congratulations on the new addition to your family!

Reasons to contact the office post partum:

• Feeling depressed for 2 weeks or more, or thoughts of hurting yourself or the baby.
• Soaking more than one pad an hour for over 3 hours.
• Fever 100.4 or higher
• Suspected breast infection
• Foul odor from vagina
• Suspected wound infection

For breastfeeding challenges please contact: Lactation services at Baptist Hospital: 786-596-2671 Mon-Fri or email them at [email protected]

• Private consultations
• Support groups
• Breast pump rentals and sales
• Breastfeeding accessories

in Pregnancy

• Eat small frequent meals
• Eat before you are hungry
• Eat a substantial bedtime snack including protein
• Try eating before getting out of bed in the morning then take it slowly
• Separate liquids from your meals; be sure to get enough liquids!
• Avoid foods that make you feel sick
• Sea bands or motion sickness bands may help, they are available at the pharmacy for $10
• Ginger gum, ginger pops (by RX), ginger ale, sprite and crackers
• B.R.A.T. diet: bananas, rice, apple sauce, and toast
• Mints such as peppermint candy or aromatherapy with peppermint.
• 25-50mg tablets of vitamin B6 cut in half and then take 3 times daily. At night take ½ to 1/4th a tab of Unisom. Only take Unisom when you are ready to go to bed, it will help you sleep.
• Take your prenatal with food at night.
• Acupuncture from a certified acupuncture physician may work for some
• Emetrol is available over the counter, it can make you drowsy
• Call our office with your pharmacy number if the above suggestions do not help.
  • Remember medications such as Phenergan can cause drowsiness
  • If we call in Zofran for you, some insurance companies will not cover this medication or will not cover refills. You are only allowed 12 tablets every 30 days.
• Do not drive your car when drowsy
• Please remember that most pregnancy related nausea usually subsides by 12-14 weeks for pregnancy, so hang in there!

Pregnancy and Exercise

• Basic rule of thumb is to keep you heart rate at or below 140 beats per minute.
• Continue exercises you are currently performing unless we instruct you otherwise or if there is a risk of falling or getting “hit”.
• You are responsible for protecting yourself from injury to yourself and your baby. Please discuss any form of exercise with us or consult with us prior to starting a new regimen.
• For more detailed information about exercise please ask us for a copy of the American College of Gynecologist guidelines for exercise. Especially if your trainer is requesting or needs it.

DIET

Protein: During pregnancy you will need to consume approximately 70 grams of protein daily. You may find that you do not like meat products while pregnant. No worries, many other types of foods have protein.

Calcium: Your prenatal will not have enough calcium for your pregnancy. You will need 1200 mg to 1500 mg in divided doses daily. You may buy pills, chocolate chews, Tums or Maalox for your calcium needs. You will need to continue 1500mg of calcium while you are breastfeeding postpartum.

Food high in Salt: A pregnant women tends to “retain water”, so it is important to limit your salt intake. Watch out for processed, canned, fried, condiments and eating out. We will restrict your salt intake if you have high blood pressure during pregnancy.

Please wash all fruits and vegetables prior to consuming!

LIMIT THE AMOUNT OF RICE, PASTA, and BREAD & CARBS! These cause you to put on unnecessary weight. Whole wheat and whole grains should be substituted for “white” rice, pasta, and bread! These types of carbs are better for you and should be a part of your diet in moderation.

You should not consume or need to limit:

• Fast Food…
• Soda: unless it is ginger ale, caffeine free, and artificial sweetener free. La Croix sparkling water is a great substitute. You can find this at Publix.
• Caffeine: Decaffeinated products are okay. At 200mg or higher of caffeine consumption there was an increase in miscarriages in the first trimester in one study. This could be one cup of coffee from Starbucks, so be careful!
• Artificial sweeteners: Splenda is okay, Stevia has not been studied in pregnant women. No pink or blue packets please.
• Green Tea: May decrease your absorption of folic acid and contains caffeine.
• Deli meats or “cold cuts”: May be contaminated with Lysteria which can cause preterm labor and maternal illness.
• Unpasteurized milks or cheeses
• Limit peanut butter to twice a week
• Any of the following fish: Shark, Swordfish, King Mackerel, Tilefish. These fish contain high levels of mercury, which can be harmful to your baby.
• Foods deemed unsafe or tainted by the CDC: keep up to date with news releases. You may follow us on FaceBook at Miami Center of Excellence for Obstetrics & Gynecology, as we will post news updates here. We will not call you to warn you about food alerts.
• No raw or under cooked meats
• Do not consume more than 6 to 8 ounces of fruit juice daily! Eat your fruit do not drink it.

A note about Fish:

You may eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are low in mercury. Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, sea bass, and catfish. Albacore or canned “white tuna” has higher Mercury levels than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week. The same holds true for tuna steaks; do not eat more than 6 ounces per week. For more information about the risks of mercury in seafood, call the U.S. Food and Drug Administration’s food information hotline at 1-888-SAFEFOOD or visit FDA’s Food Safety website.

The Dentist!

Did you know that women who received routine dental care were less likely to have preterm labor vs. those who did not? Please see your dentist for cleanings at least every 6 months or as recommended by your dentist. You can request to not have x-rays at this time, but it is safe to do so if shielded. We can fax a dental release to your provider if necessary! Do not wait to address a dental issue till you have had the baby. If you have tooth or mouth pain during pregnancy please consult with your dentist. If your dentist will not see you during your pregnancy we can refer you to a dentist who will.

Common Complaints of Pregnancy

• Extreme fatigue, especially in the 1st trimester. This should get better by 14 weeks.
• If you are having difficulty getting a deep breath, just relax and lay down if necessary. Severe chest pain and not being able to breathe is an emergency. Proceed to the ER.
• Breast tenderness, breasts getting larger. Some women experience nipple discharge during pregnancy. If bloody or an unusual color call the office.
• Gums and nose may bleed easily.
• Increase in milky white vaginal discharge.
• Feeling of heart palpitations occasionally, again chest pain is not normal. If you are having a lot of palpitations let us know.
• Heart burn: do not lie down after eating for 2 hours, decrease spicy foods. Sleep with two pillows. See medications for common conditions for recommended medications.
• Cramping like your period is very common early on as the uterus is enlarging.

When to Call the Office for a Non-emergency

• Abnormal discharge: itching, odor, green, or unusual for you
• Bladder infection, painful urination or urine odor
• Vomiting without relief from nausea medication
• If your primary care doctor will not see you for a cold or other primary care issue.

Scheduling

• Never leave the office without an appointment to return! If the computer is down please call the office the next day for your appointment or our staff will call you to schedule. Have a plan of who is going to call who before leaving the office.
• You will rotate between all the providers once then you may follow with the provider of choice. It is necessary that we are all familiar with all of our patients.

Emergency Warnings First and Early Second Trimester

• Bleeding
• Severe pelvic pain
• Continually cramping after 20 weeks
• Contractions that do not go away after 20 weeks
• Fever 100.4
• OB patients 18 weeks and under will be seen in the ER

Always call the office during office hours if possible. We are better able to manage your calls this way. Only call after hours with true emergencies, sometimes if you are stable the physician or midwife will ask that you come to the office first thing in the mornings instead of going to the ER. You could be in the Baptist ER for 30 hours before being seen. We cannot meet you there to see you; you must be cleared by the ER first. In most cases it is safe to wait until we are open to see you, if in doubt call us. Occasionally the physician may send you to the ER.

Emergency Warnings 28 Weeks till Delivery

• Ob patients 18 weeks or greater will proceed to Triage in emergency if pregnancy related.
• Decreased fetal movement (refer to kick count sheet)
• Vaginal bleeding
• You think your “water” has broken
• Severe headaches unrelieved with Tylenol and rest
• Unusual vision changes
• Severe abdominal changes
• Severe abdominal pain
• If you think you are in labor or pre-term labor
• Fever 100.4

Labor Precautions

PLEASE CALL US IF ANY OF THE FOLLOWING OCCUR DURING THE HOURS OF 8:00 AM TILL 10:00 PM

IF THESE OCCUR BETWEEN THE HOURS OF 10:00 PM-8:00 AM, PLEASE GO DIRECTLY TO LABOR & DELIVRY AT BAPTIST HOSPITAL. YOU DO NOT NEED TO CALL, AS THE HOSPITAL WILL CONTACT US UPON YOUR ARRIVAL.

1. Strong, regular contractions.
2. Heavy bleeding. Some bleeding mixed with mucous substances usually represents your “bloody show” and is normal but call if you are not sure. This is especially normal after being examined in the office.
3. If you think your “bag of water” (amniotic fluid) has broken or is leaking. Call immediately, day or night, even is you are not having any contractions.
4. If there is a decrease in the amount of fetal activity or movements.

Remember, if you think you are in labor or your bag of water has broken, do not eat or drink anything.

The office phones are answered 24 hours a day, either by the office staff or an automated answering service.

Kick Count Instructions

FETAL KICK COUNTS

Fetal kick counts are an important way a mother can assist your OB/GYN to determine if the baby is healthy. If the number of fetal kicks is too low, other tests may need to be done. Follow these steps to count the baby’s movements:

1. Count kicks for 30 minutes three times a day: morning, afternoon, and evening.
2. Lie down while counting, preferably on your left side with feel and legs propped up or supported.
3. Count either “kicks” or “rolling” or “turning” type movements. If the baby has hiccoughs, stop counting until they stop, then start over.
4. If you count 5-6 movements in 30 minutes, stop counting.
5. If the movements are less than 3 in 30 minutes, count for one hour. If still less than 3 movements, count for 6-8 hours.

WARNING SIGNS FOR DECREASED MOVEMENT

Go to Triage if you have any of these signs:

1. If you count less than 3 movements in 6-8 hours or less than 10 movements in 12 hours.
2. If no movement is felt in the first 2 hours after arising in the morning. Make sure you have eaten breakfast!
3. If the number of movements are much less than usual!
4. If movements change from strong and rolling to weak OR if they suddenly become more intense than usual.
5. Try to call the office during business hours. If after hours please leave a message on the emergency voicemail. Leave your name twice and phone number twice in English. (305) 515-5425

Banking Your Cord Blood

It is important for you to be aware of the potential value of the stem cells found in your newborn’s umbilical cord. Because you only have one chance to collect your newborn’s stem cells, we believe it is very important for you to be fully educated so you can make an informed choice regarding your banking options.

Cord blood is the blood that remains in the umbilical cord after your baby has been delivered. Like bone marrow, this blood is a rich source of stem cells that are used in many lifesaving medical treatments today, and are showing promise in the treatment of conditions such as brain injury and juvenile diabetes.

Your cord blood counseling session in the office will occur between 24-28 weeks. You will receive hand outs and general information.

It is then your responsibility to sign up with the cord blood banking company of your choice by 36 weeks gestation or earlier if we suspect you to deliver early. Baptist Hospital does not stock cord blood kits, so if you forget your kit, you cannot save your baby’s cord blood.

What to Pack!

We suggest that you start packing your bags at 36 weeks.

List for the Hospital By Stephanie Fink, MSN, NP & MOM

• Paper/pen to keep a list of flowers and gifts sent for thank you notes later.
• List of phone numbers and email addresses to call/email family members.
• CD player with CD’s (or Ipod with player) of restful relaxing music to play in the delivery room.
• Camera with extra film/memory cards, video recorder. Note that at Baptist, you cannot videotape until after the delivery.
• Diversions for labor: playing cards, magazines.
• Favorite hand lotions, massage lotions for labor if desired.
• Fragrant room spray or plug-in air-freshener to give that aromatherapy touch! Candles are not allowed!
• Birthing ball if going all natural or any natural birthing aid.
• Your favorite pillow and blanket! I brought a blanket that my grandmother made me when I was born; it was very special to have. Remember: hospitals are usually cold.
• Snacks for your labor coach and for postpartum time. I had friends bring me Gatorade and diet coke to have in the room after I delivered. It was great for everyone to have snacks.
• Socks, slippers.
• Toothbrush, toothpaste, toiletries (shampoo, conditioner, hair dryer, etc.).
• Hairbrush, clips and hair bands.
• 2-3 pairs of night gowns or PJ’s. Pajamas with front buttons are good for breast feeding.
• Robe
• Favorite brand of maxi-pads, as you won’t like the hospital’s..
• Lanolin cream for sore nipples, Soothies pads are great too!
• Antibacterial hand gel. Have your guests use it or wash their hands before they hold your baby.
• 5 changes of underwear.
• Nursing Bra (2).
• Going home outfit (could be a nice set of PJ’s, keep in mind you will still have a tummy!)
• Infant car seat already in place and ready to go.
• Any cute signs for the postpartum room door you want (or have a friend be in charge of this).
• Your boppy/infant support device for breast feeding (optional, I just used pillows).
• Unless you live far away, someone can go home and get what you need if you leave in a hurry and forget something.
• Drive safely to the hospital!
• If you are banking cord blood, don’t forget your kit. Do not store it in your car.

Baby clothes/supplies

• Onesies (2-3)
• Mittens
• Going home outfit
• Outfit for hospital picture
• Infant care kit
• Receiving blankets (2-3)
• Diaper cream/ointment
• Diaper bag with a few diapers for the way home in case
• Pacifier (optional)

Congratulations on the new addition to your family!