Welcome to our practice! Thank you for choosing us to care for you during this very important and precious time in your life! Please take the time to read this introduction to your pregnancy and the details within. Together we can be proactive in your care to ensure all the appropriate testing and visits are performed. We are a team and look forward to developing a rewarding relationship with you!
Milestones
Your pregnancy is divided into three trimesters. The first trimester begins at conception and continues until the 14th week. The second trimester is between the 14th week until the end of the 28th week. During the first and second trimester you are seen once a month. These first two trimesters are critical for the genetic screening and general maternal screening. In addition, we will routinely check your weight, blood pressure, the baby’s heartbeat, and your urine for protein and glucose. In addition after 20 weeks we will begin to measure your uterus externally (this is called “fundal height”) to ensure the baby is growing appropriately. The third trimester is between the 29thweek until delivery. This time is also important as you begin to come every two weeks until 35 weeks and then weekly. We are watching more closely for many things during this time, including preeclampsia and labor symptoms. Your due date is when you reach 40 weeks; however, term is considered 37 weeks or more.
Our Practice
We are pleased to offer you compassionate and comprehensive obstetrical care. Our training and experience allows us to welcome patients with high-risk pregnancies or to continue to manage those patients whom have medical complications arise along the course of the pregnancy. Through our affiliation with Hoag, we are able to provide additional prenatal services including: perinatal and genetic referrals, medical consultations, Hoag based exercise and nutrition counseling, prepared childbirth classes, and lactation classes.
Dr. Howe and Dr. Maslovaric share coverage with Dr. Illeck. This coverage allows us to be available 24/7 for emergencies and deliveries after hours. Simply calling the office number you will be directed to the Exchange which will connect you to one of us. On occasion we may have an equal qualified colleague cover when needed.
The Hospital
Hoag Memorial Hospital Presbyterian offers a highly sophisticated Perinatal Unit including elegant labor, delivery and recovery rooms (LDR’s). Hoag also has highly qualified neonatologists and perinatologists. Maternity services will assist you with lactation consultations, assistance in newborn care and attention to your healthcare needs. Our office will provide information regarding pre-registration, which typically occurs around 28 weeks, and access to these services. See Hoag’s website www.Hoag.org for more details. We strongly encourage you to take all the classes you desire from the Hoag Hospital OB Education Department, these include birthing classes, breast feeding, newborn care and newborn resuscitation.
PREREGISTER TO HAVE A BABY AT HOAG
Routine pregnancy visit schedule
0-28 weeks of pregnancy — every 4 weeks
28-36 weeks — every 2-3 weeks
36 weeks until delivery — weekly
After 40 weeks = twice a week until delivery
| Week 5-10 |
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| Week 10-14 |
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| Week 15-20 |
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| Week 18-21 |
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| Week 24-26 |
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| Week 28-30 |
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| Week 32-34 |
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| Week 34-36 |
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| Week 36-40 |
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| Week 41 |
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Labor
Contractions can begin days to weeks before actual labor begins. If you experience regular contractions, especially if they last for more than 2 hours and progressively worse, before 35 weeks, please call the office to discuss your individual situation. If you are at 35 weeks of pregnancy or more, and this is your first baby, observe your contraction pattern and call when your contractions are every 5 to 10 minutes apart, lasting for at least 60 seconds and are strong enough that you cannot walk or talk through them. If you have already delivered a baby, then call when your contractions are less than 10 to 15 minutes apart and are increasing in strength. Call if you have vaginal leakage of fluid that does not resolve with emptying your bladder, if you have vaginal bleeding like a light menstrual flow or heavier, you feel the baby is not moving as it normally does, or for any perceived emergency situation.
If a physician does not return your call in a reasonable length of time, please call Hoag Hospital Labor and Delivery at 949-764-5789 or go directly to the hospital if you feel it is indicated.
Delivery
Our purpose is to make this a memorable and rewarding experience. Husbands and partners are encouraged to participate. Epidurals are available upon request. IV’s are a necessary part of your care, for hydration and in case of an emergency. Internal monitors and Pitocin are reserved for specific indications as needed to prevent complications. Episiotomies and enemas are not routinely performed. If a cesarean section delivery is required the indications, risks, and benefits will be fully discussed with you unless a true life-threatening emergency precludes this.
Cord Blood Banking
All parents should consider storing cord blood after the infant is delivered in the chance there is a need for stem cells later in life. There are many new uses for stem cells in modern medicine and the field/opportunities is growing.
There are many companies to choose from. They each have potential benefits. There are private and public banks. Please research this if you are interested.
Stemcyte 1-866-389-4659 www.stemcyte.com
Cryobanks International, Inc. 1-800-869-8608 www.cryo-intl.com
CariCord 1-844-227-4267 www.caricord.com
Viacord 1-877-247-0753 www.viacord.com
Cord Blood Registry 1-888-CORDBLOOD www.cordblood.com
Common Pregnancy Issues and Guidelines
Detailed pregnancy guidelines and information can be found at ACOG patient page. http://www.acog.org/Patients
Nutrition for Nausea and Vomiting During Pregnancy
Nausea and vomiting symptoms are extremely common during the 1st three months of pregnancy due to changing hormones. Following are some suggestions to help with these symptoms.
- Symptoms seemed more pronounced when the stomach is empty. Eating frequently (every 1 ½ – 2 hours) in small amounts will keep the nausea to a minimum.
- Separate liquids from solid foods – if you drink something, don’t eat for at least 30 minutes.
- Carbohydrates and starches are the most popular foods.
- High fat, spicy, or gaseous foods are not tolerated well.
- Citrus fruits and drinks usually have too much acid.
- Vitamins are important. If you can tolerate prenatal vitamins, they should be taken daily with solid foods.
- Folic acid (0.4-1mg average) is recommended daily. This is available in the prenatal vitamins or may be taken separately.
- Chewable vitamins may be taken daily if other vitamins cannot be tolerated.
- Vitamin B-6, 50-100mg twice daily or vitamin B-6, 25mg four times every day can decrease nausea (must take 2 times every day).
- Motion sickness or sea sick bands can be purchased at drug stores and dive shops.
- Keep some type of dry food next to your bed if you get up during the night or when you wake up in the morning.
- Try eating lemon drops, mints, and foods and drinks containing ginger (i.e. ginger ale, ginger snaps).
Some women require prescription medication or hospitalization if symptoms are severe. Please feel free to call if vomiting is excessive.
Caffeine – Limit caffeine intake to 200 mg of caffeine per day. This is typically about 2 cups of regular coffee.
Artificial sugars – Nutrasweet (Equal, Aspartame) is allowed occasionally but Saccharin (SweetNLow, Sugar Twin) is no recommended.
Fish –Do not ingest shark, swordfish, tile fish or albacore tuna steak during pregnancy due to high levels of mercury which has been found to be neurologically toxic. You may eat up to 12 ounces (2 average meals) per week of fish low in mercury (e.g. salmon, shrimp.) Canned light tuna has less mercury than albacore. Please refer to the www.cdc.gov, www.cfsan.fda.gov, www.otispregnancy.org/pdf/methylmercury.pdf, and www.ajc.com/health/content/shared-auto/healthnews/govt/516856.html for more information.
Listeria – Avoid foods that are high risk for listeria infection including hot dogs, deli meats (okay if reheated to steaming), soft cheeses, pates or meat spreads, unpasteurized milk or milk products, raw or undercooked meats. Clean your fruits and vegetables well. Order soups and cooked vegetables when eating out if possible.
Toxoplasmosis– we recommend that women do not change the cat box from the time they start trying to become pregnant until the pregnancy is complete. You may handle your cat but we recommend that you do not kiss it as a Toxoplasmosis enters your body through your mouth, not your skin. Raw and rare beef can also contain Toxoplasmosis. Therefore we recommend that you only eat beef that is been cooked well.
Prenatal vitamins with 1 mg of folic acid and DHA or Omega 3 fatty acids are recommended. Iron supplementation is often recommended and is also important later with breast feeding. Add Citrucel or Metamucil to help with the constipation frequently found with iron supplementation. Avoid calcium and dairy products within two hours of taking iron to maximize its absorption. Add a stool softener, such as Colace if additional help is needed. This is often found in prenatal vitamins too.
Environmental/Work Hazards
Avoid contact with oil based paint, petroleum distillates such as paint thinner and toxic chemicals. Climbing tall ladders, heavy lifting over forty pounds, and working over forty hours per week is not recommended.
Exercise
Exercise is important in pregnancy. Labor is improved when you are physically fit. It is recommended that pregnant patients get moderate cardiovascular exercise/activity for at least 30 minutes, 5 times per week. Please let instructors know you are pregnant in classes and consider slowing down the pace if you are out of breath, such that you cannot speak, or your heart beat is more than 140 beats per minute.
Travel
Pregnancy increases the risk that with long drives or flights blood clots may form; in addition, unexpected complications can arise at any time in pregnancy, so we recommend that you limit travel after 30 weeks of pregnancy. After 36 weeks we ask that you stay approximately one hour of Hoag Hospital.
Check with your airline to determine if you need a note from your doctor before your flight. You may go to the mountains during your pregnancy, but try to limit your activity to below 10,000 feet due to the decreased oxygen at higher elevations. As always, stay hydrated and use plenty of sunscreen.
Constipation
Constipation is common throughout pregnancy. It can be a result of hormonal effects and/or mechanical pressure. Start by increasing the fiber in your diet (fresh fruit, vegetables, whole grain breads, high fiber cereals.) Increase your water intake to 2-3 quarts daily. Begin a stool softener (see enclosed list.) Avoid laxatives. Calcium carbonate (like Tums) can make constipation worse. Blood in your stool may be a sign of straining or hemorrhoids- notify us at your next visit or sooner if symptoms worsen.
Headaches: Headaches are fairly common in pregnancy. You may take 2 plain or 1 extra-strength Tylenol every 6 hours. If your headaches are one-sided or associated with blurred vision, please call the office.
Side pain: Many women experience side pain during pregnancy, especially when exercising, stretching or lifting. This is usually ligament pain caused by a growing uterus pulling on the ligaments. For relief, you may use heat, rest, Tylenol or massage.
Heartburn: Indigestion and heartburn are very common in pregnancy. Please see the list of OTC medications.
Vaginal Discharge: It is normal to have thicker vaginal discharge. Do not douche in pregnancy. If you leak clear watery fluid, call the office.
Fetal Movement: Expect fetal movement around 20-24 weeks. After 28 weeks, make a “mental note” of daily fetal movement. You should feel your baby move at least 12 movements a day. Easy times to monitor for movement are at bedtime (lying on your left side) or just after a meal. If you feel less than 12 movements in a day, please call the office.
Hot Tubs: Avoid saunas, steam baths, hot tubs (>100 degrees), and electric blankets as they may be harmful to the fetus’ neurological development.
Hair Dye: There is no evidence suggests any fetal effects, however avoid in first trimester if possible.
Medications and Toxins
Most medications and toxins cross the placenta and are transferred to the fetus in variable amounts. Exercise caution before taking any medications. Always try to use natural remedies such as fluids, high fiber diets, bed rest, etc… This is most critical during the organ formation that occurs within the first 12 weeks of pregnancy.
Acceptable over-the-counter (OTC) medications during pregnancy:
It is a general rule that medications should be avoided during pregnancy. But if you are ill, there are various medications that have been widely used for years and have been demonstrated to have a wide margin of safety.
| ALLERGIC REACTION | Benadryl (diphenhydramine) or Claritin (loratadine) |
| ANTACID/ HEARTBURN | Maalox, Rolaids, Tums, Mylanta, Gaviscon, Pepcid, Tagament |
| CONGESTION/ SINUSITIS | Afrin, saline spray, sudafed, actifed, Tylenol sinus, chlortrieton, vaporizer |
| CONSTIPATION | Metamucil, Fibercon, Citracal, Colace, Senokot Plain, Milk of Magnesia. |
| COUGH | Robitussin DM, warm salt water gargles, Cepacol throat spray, lozenges, tylenol cold products, Vick’s products |
| DIARRHEA | Immodium, donnagel, avoid dairy / caffeine |
| ENEMA | Fleets (contact your doctor first) |
| FEVER | Tylenol 325mg–2 pills every 6 hours, tylenol 500mg-1 pill every 4 hours |
| GAS | Phazyme 125, Mylicon 80 |
| HEADACHE | Tylenol 325mg–2 pills every 6 hours, tylenol 500mg-1 pill every 4 hours |
| HEMORRHOIDS | Anusol HC cream, Tucks pads, Preparation H |
| MOTION SICKNESS | Benadryl |
| NAUSEA | Vitamin B6 (25 mg 3 times a day), Ginger, motion sickness wrist bands |
| PAIN | Extra-strength Tylenol (2 every 6 hours), bengay, Abdominal binder |
| SORE THROAT | Chloroseptic spray or drops, Cepacol lozenges, Gargle with warm salt water |
| YEAST INFECTION | Monistat, Gynelotrimin, Mycelex |
Follow the directions on the package for all medications unless we instruct you otherwise.
Physical and Emotional Abuse
Physical and emotional abuse, unfortunately, occur in some relationships before, during and/or after pregnancy. The increased stress of pregnancy and parenting can increase the rates of domestic violence and emotional abuse. Please let us know if you have any concerns for your safety, for the safety of your baby, or for your other children. Call 911 if the concern is urgent.
Domestic Violence; Violence against family members is a generational problem. If you have been subjected to violence in any form, please discuss it with your physician. If you have not yet had counseling regarding this problem, we can assist you to obtain some. Without proper treatment, domestic violence can continue from generation to generation.
Seat Belt Use
Trauma to you or your unborn baby as a result of an automobile accident can be very serious and life threatening. Wearing your seat belt properly is your best defense against trauma during an accident. Place the shoulder strap above your abdomen and the lap belt across your hips.
IMPORTANT SYMPTOMS
PLEASE CALL RIGHT AWAY (EVEN AT NIGHT OR WEEKENDS) IF YOU HAVE ANY OF THE BELOW:
Early in pregnancy:
- Heavy vaginal bleeding.
- Vomiting that does not subside, especially if unable to keep fluids down.
- Burning or painful urination.
- Severe pelvic or abdominal pain.
In last month of pregnancy:
- 5-1-1 Rule: Contractions which occur every 5 minutes, last 1 minute, having continued for 1 hour.
- Heavy vaginal bleeding (like a period.)
- Ruptured membranes/ break the “bag of water,” even if you do not have any contractions.
- Decreased fetal movement.
You do not need to call if you pass your “mucous plug”
POST PARTUM CARE
Instructions/Activity:
- Pelvic rest for 6 weeks. (No douching, tampons, or sexual intercourse.)
- No vigorous exercise for 6 weeks.
- If you have had a C-section, no heavy lifting greater than 20 lbs. for 6 weeks.
- No driving for 1-2 weeks (if you have had a C-section) or while taking NARCOTICS.
- If you have had a 4th degree tear, nothing in the rectum (suppositories, etc.) for 6 weeks. Also, please use a stool softener for ~2-3 weeks after your delivery, such as Colace (which is sold over the counter).
- For C-section patients, keep your incision clean and dry. Let the water/soap run down on the incision in the shower. Do not apply soap on a towel and directly scrub your incision. Do not apply any creams/lotions/Neosporin to your incision. Your steri-strips may fall off on their own, otherwise we will inspect and/or remove them at your 2 week appointment.
- Your next appointment should be:
- In six weeks for a vaginal delivery, unless otherwise specified at the time of discharge.
- In two weeks, if you had a C-section, for an incision check. You will then have another appointment 4 weeks later for your 6 week post partum exam.
Call the office if you have…
- Signs of mastitis including: reddened, hard, and exquisitely tender areas to the breast accompanied by a fever greater than 100.4.
- Excessive vaginal bleeding greater than 1 soaked pad per hour. (You will have vaginal bleeding for 4-6 weeks after delivery. This may slightly increase 2-3 weeks after delivery, but will then taper off.)
- An exquisitely tender abdomen accompanied by a fever greater than 100.4.
- Any signs or symptoms of post partum depression.
- For C section patients
- Any opening of your incision.
- Any drainage from your incision that is excessive, or any pus coming from the incision.
Medications:
- Norco (or another Tylenol/codeine derivative), 1-2 tablets every 4-6 hours as needed for pain.
- Ibuprofen 600 mg every 6 hours as needed for pain.
- For constipation: Colace, Milk of Magnesia.
- Continue your prenatal vitamins as long as you are breast feeding or for 30 days after delivery.
- For hemorrhoids, use Tucks pads, Preparation H, Proctofoam as needed.
- For cracked/sore nipples you may use Lanolin cream.
GYNECOLOGY
- ANNUAL EXAM – WELL WOMAN ASSEMENT
- ABNORMAL PAP SMEAR
- UTERINE FIBROIDS
- POLYCYSTIC OVARIAN SYNDROME
- ENDOMETRIOSIS
- INFERTILITY
SURGERY
- GENERAL INFORMATION
- PREOP INSTRUCTIONS
- POST OP INSTRUCTIONS HYSTEROSCOPY
- POST OP INSTRUCTIONS LAPAROSCOPY
- POST OP INSTRUCTIONS HYSTERECTOMY
- POST OP INSTURCTIONS VAGINAL PROLAPSE SURGERY
- POST OP INSTRUCTIONS URINARY INCONTENCE SURGERY
- POST OP INSTRUCTIONS GYNECOLOGIC COSMETIC SURGERY