Pregnancy & Childbirth Pregnancy & Childbirth

Version 4.0 March 2019

Pregnancy

& Childbirth

Pregnancy

& Childbirth

A Goal Oriented Guide to Prenatal Care

Congratulations on Your Pregnancy

The Department of Defense and the Department of Veterans Affairs are proud

to welcome you to our Obstetrical Services. We will do everything possible

to help you receive the best prenatal care for you and your baby. That’s

why we have implemented Goal-Oriented Prenatal Care. If you have any

complications in your pregnancy, you may need additional visits and testing.

Visits and testing outlined here form the basis of care for all pregnant women.

With goal-oriented care, we design each visit to cover precise goals

that are most appropriate to that specific time in your pregnancy. So

no matter where you are located you will receive all critical aspects of

prenatal care at the appropriate time. We have eliminated practices that

do not have sound scientific backing (such as taking urine at each visit

and early pregnancy cervical checks) and have added practices that have

been shown to help promote a healthy pregnancy. With this approach,

you will know what to expect and when to expect it. When possible, we

encourage you to involve your baby’s father or support person in your care.

This book will guide you each step of the way through your pregnancy.

Please bring it to every visit. We have divided the contents by visits

with additional material in the Resource Section. Each visit section will

include what to expect at your visit, signs to report, patient education,

and a space to record related information. We encourage you to read

each visit section carefully prior to each appointment. Please ask your

healthcare provider if you have any questions or concerns. In this way,

you will be well prepared for each step in this very special journey!

Thank you for allowing us to take this journey with you!

ii Prenatal Information Sheet: Introduction

Important Information

Hospital Name

Healthcare Provider

Important Telephone Numbers

OB Clinic

Labor & Delivery (L&D)

Labor & Delivery Triage Line

Emergency Department

My Childcare Provider

Appointment List

DATE TIME PROVIDER LOCATION

Prenatal Information Sheet: Introduction iii

Table of Contents

Visit Information

This section provides detailed information for each visit. Each visit section includes what to

expect in your pregnancy, what to expect at your visit, and general pregnancy education.

We suggest you be cautious about information and advice you may receive from family

members, friends, the Internet or other outside sources. While most of these sources are

well-meaning and may provide important support, bad advice and inaccurate information

are common. Please make sure to discuss your specific concerns with your provider.

Week 6 - 8 . . . . . 1 Week 24 . . . . . .33 Week 36 . . . . . .63

Week 10 - 12 . . 13 Week 28 . . . . . .43 Week 38 - 41 . . 73

Week 16 - 20 . . 23 Week 32 . . . . . .53 After Delivery . . 87

Resource Section:

• Pregnancy Information

• Common Terms ........................................................................................ 213

• Types of Providers ..................................................................................... 220

• Depression Screen (28 Week and Postpartum) ............................................ 223

- Active Duty Information ...................................................................... 95

- Veteran’s Information ....................................................................... 102

- Partner’s Information ....................................................................... 104

- Anatomy (front & side views) ........................................................... 106

- Common Discomforts and Annoyances of Pregnancy ......................... 109

- Exercise .......................................................................................... 117

- Travel During Pregnancy ................................................................. 118

- Having Twins, Triplets or More ......................................................... 119

- Fetal Movement Count Charts ........................................................... 120

- Immunizations ................................................................................ 125

- Nutrition in Pregnancy ..................................................................... 127

- Weight Gain Chart ......................................................................... 137

- Dental Care .................................................................................... 138

- Tobacco, Alcohol, and Drug Use in Pregnancy .................................. 139

- Sexually Transmitted and Other Infections in Pregnancy ..................... 141

- Genetic Screening ........................................................................... 144

- Specific Genetic Testing ................................................................... 151

- Depression Screen - 28 Week .......................................................... 153

- Testing and Monitoring During Pregnancy ........................................ 155

- True versus False Labor .................................................................... 157

- Preterm Labor ................................................................................. 158

- Labor and Delivery Procedures ......................................................... 160

- Labor and Delivery Basics ................................................................ 162

- Cesarean Delivery ........................................................................... 179

- Birth Plan ........................................................................................ 184

- Baby Supplies ................................................................................. 187

- Family Planning .............................................................................. 189

- Breastfeeding .................................................................................. 199

- Bottle Feeding ................................................................................. 209

- Safety Tips for Baby ........................................................................ 211

The Birth of a Mother ................................................................................. v

Visit Summary Pages ............................................................................... vii

This section provides a quick overview of goals and expectations for each visit.

Keeping You and Your Baby Safe ........................................................... x

iv Prenatal Information Sheet: Introduction

Suggested Additional Reading (available in your clinic):

- Prenatal Fitness and Exercise

WEB SITE INFORMATION: Links to non-federal organizations in this book are

provided solely as a service to our users and are not an all inclusive list of non-

federal organizations. Links do not constitute an endorsement of any organization

by the Department of Defense or the Department of Veterans Affairs and none

should be inferred. The Department of Defense and the Department of Veterans

Affairs are not responsible for the content of the individual organizations web

pages found via these links.

General Pregnancy and Childbirth

http://www.nlm.nih.gov/medlineplus

http://www.healthfinder.gov

http://marchofdimes.com

http://www.childbirth.org

http://www.text4baby.org (text messages about baby)

http://www.dodparenting.org (Parent Review)

Baby/Child Care

http://www.aap.org

http://www.dodparenting.org (Parent Review)

Breastfeeding

http://www.lalecheleague.org

General

http://www.militaryonesource.com

Prenatal Information Sheet: Introduction v

The Birth of a Mother

In this book, you are asked questions focused on how you feel about your

pregnancy and your relationship with your mother, or the primary person who

raised you, and your partner. There is space provided to record your thoughts. As

you go through your pregnancy and adapt to being the mother of a new baby,

it is important that you realize you are being “born” or reborn into your role as

a mother to this baby. Even if this is not your first baby, the transition to being

a mother is a process that involves feelings, behaviors, attitudes, and character

developed from life experiences and expectations.

While responses to being a mother may come from life experiences, maternal

attitudes and behaviors change in relation to the age, condition, and situation of

one’s child. Each mother-child relationship, each pregnancy, each delivery, and

each childbirth experience are different for each woman. This is true even if you

already have children. Each pregnancy, labor, and delivery is unique.

Supportive sharing from significant persons, especially your family, balances the

process of becoming a mother. The support you receive from your mother, or other

key support person, and your partner assists you in the changes you go through

to become a mother. For you and your partner, mutual sharing provides the best

foundation for adapting to your roles as new parents. The ability to see yourself

as a mother and expand on the idea that the new child will impact your dreams

and fantasies is a building process that occurs throughout pregnancy. It happens

best with the support and help of your partner. Some of the questions raised in this

book are to help include your partner in this important process.

The ability to imagine and think about being a mother depends on your life

experiences. Good “mothering” role models, whether your own mother or another

loving person you respect, will help you be confident and identify with being a

mother. Many women feel a tremendous sense of relief in having a female friend

or mentor with whom they can share feelings about their pregnancies. Regardless

of the relationship you have with your partner, you may feel unable to express

certain feelings or fears with him or her. This is normal. Women often say that

they recognize their husband or partner “kind of understands”, but worry about

discussing their fears, thoughts, hopes and dreams. Sometimes it is helpful to have

a friend other than your partner to discuss your hopes, dreams and fears with.

Keep in mind that it is natural to have doubts and conflicts about this immense

role change. This usually happens every time you have a baby. Becoming a

mother affects your sense of self. If you are expecting your first child, you are truly

between roles. Often there is fear of the impact the baby will have on marriage,

family, and career. Generally, a vision of your image as a mother becomes

clearer as pregnancy continues. The questions throughout this book are to help

you define your idea of motherhood. Being able to picture or express your idea

of motherhood takes place by rehearsing or imagining yourself in the role of a

mother. It is normal to dream of yourself as a mother.

vi Prenatal Information Sheet: Introduction

This process helps you identify the characteristics of a good mother. The ongoing

process of the “birth of a mother” requires you to accept the loss of a former part

of yourself. It is important to recognize your new role, with all its responsibilities,

has many rewards. In other words, any losses you might have are balanced by

rewards you will receive.

Preparing for any role change requires a desire to learn. During the process of

becoming a mother, you will seek out information or models of your new role.

Various confidants, whether your mother, a close friend, or your partner can all

help provide information and act as role models. Watching other mothers with

their children and attending birthing and prenatal classes are sources of informa-

tion to help you through this process.

At many military installations, the DoD provides assistance through the New

Parent Support Program. This program employs nurses, social workers and other

individuals who can provide you access to many education programs. They can

provide you written or video educational information and sometimes they can even

come to your home to help you adapt to your role of becoming a new mother. For

women veterans receiving services through the Department of Veterans Affairs,

each facility has a Women Veterans Program Manager who can assist you with

finding the resources you need during your pregnancy and after delivery.

This book will provide you with a lot of valuable information and should help

answer many of your questions but it is no substitute for a wise and supportive

mentor. Some places have support groups for women whose spouses are

deployed. Other places have groups where experienced women volunteer to

provide guidance to new mothers. We encourage you to take advantage of these

kinds of opportunities. We wish you the very best in your own birth as a mother!

Prenatal Information Sheet: Introduction vii

Visit Summary Information

Goal-oriented visits:

6–8 Week Visit Goal: Exchange information and identify existing risk factors

that may impact your pregnancy

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions you may have.

2. Ask your family about any medical problems that exist in your

family members such as diabetes, cancer, hypertension, and genetic

problems.

3. Fill out questionnaire, if provided prior to your appointment, in

preparation for this visit.

4. Suggested reading in Resource Section: Common Discomforts

and Annoyances of Pregnancy, Travel and Pregnancy, Tobacco,

Alcohol and Drug Use in Pregnancy, Specific Genetic Testing, Nutrition,

Dental Care, and Genetic Screening. Think about whether you wish to

have blood tests to screen for birth defects.

10–12 Week Visit Goal: Determine current health status and work toward a

healthy pregnancy

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions you may have.

2. Wear clothing easy to change out of for a physical exam.

3. Suggested reading in Resource Section: Common Discomforts

and Annoyances of Pregnancy, Genetic Screening, Breastfeeding,

Exercise, Immunizations, and Sexually Transmitted and Other Infections.

4. Review Prenatal Fitness and Exercise brochure.

viii Prenatal Information Sheet: Introduction

16–20 Week Visit Goal: Work toward a comfortable and safe pregnancy

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions you may have.

2. After visit, schedule your appointment for an ultrasound if not already

scheduled.

3. Suggested reading in Resource Section: Breastfeeding and Testing and

Monitoring during Pregnancy.

24-Week Visit Goal: Prevent preterm labor for a safe and healthy baby

To Do:

1. Read the visit information and any additional related information prior

to your visit. Write down any questions or concerns you may have.

2. Suggested reading in Resource Section: Preterm Labor and Fetal

Movement Counting Chart. Check out available prenatal classes at

your hospital.

28-Week Visit Goal: Monitor your baby and your progress and learn to

count fetal movements

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions or concerns you may have.

2. Follow instructions given to you for your one hour glucose beverage

test.

3. Suggested reading in Resource Section: Fetal Movement Count Chart,

Testing and Monitoring during Pregnancy, and True versus False Labor.

4. Fill out Fetal Movement Chart and bring with you to visit.

32-Week Visit Goal: Prepare for your baby’s arrival

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions or concerns you may have.

2. Fill out Fetal Movement Chart and bring with you to visit.

3. Suggested reading in Resource Section: Labor and Delivery Basics,

Labor and Delivery Procedures, Family Planning, Birth Planning,

Breastfeeding, and Bottle Feeding.

Prenatal Information Sheet: Introduction ix

36-Week Visit Goal: Begin preparations for your hospital experience

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions or concerns you may have.

2. Fill out Fetal Movement Chart and bring with you to visit.

3. Suggested reading in Resource Section: Labor and Delivery Basics,

Labor and Delivery Procedures, Birth Plan, Promoting Safety in

Childbirth, Baby Supplies for First Week, and Safety Tips for Babies.

38–41 Week Visit Goal: Preparing for birth and baby’s arrival at home

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions or concerns you may have.

2. Fill out Fetal Movement Chart and bring with you to visit.

3. Suggested reading in Resource Section: Labor and Delivery Basics,

Labor and Delivery Procedures, Birth Plan, Promoting Safety in

Childbirth, Baby Supplies for First Week, Safety Tips for Babies,

Breastfeeding, and Bottle Feeding.

Post Delivery Visit 6-8 Weeks after Delivery: Determine health status

and promote adjustment to being a mother

To Do:

1. Read the visit information and any additional related topics prior to

your visit. Write down any questions or concerns you may have.

2. Think about family planning needs if that has not already been decided.

3. Call the clinic to confirm whether or not you may bring baby with you

for this appointment.

x Prenatal Information Sheet: Introduction

Keeping You and Your Baby Safe

The VA and DoD have created Guidelines for Pregnancy that form the basis for the

care outlined in this book. We have created the Resource Section to provide you

further information that will help in your pregnancy. It is important that you be a

partner with the providers in your pregnancy care. To help with this we have a few

tips and recommendations for you.

The information in this book is helpful but it is not a substitute for your obstetric

care provider. He or she will have specific information about you and will be

able to help tailor your prenatal care for your personal circumstances. These are

guidelines and the best care will sometimes mean doing things different than or in

addition to what is outlined here.

Help keep track of your key pregnancy information. The VA/DoD Pregnancy

Passport contains most of the information that is essential for good prenatal care.

Take it to your visits and keep it with you at all times. This will help if your records

are misplaced or computer systems are down. It will also be useful if you have an

emergency and need to get care away from your hospital or clinic.

Help us assure that your due date is well established by 20 weeks of pregnancy. It

is very hard to establish a firm due date after mid-pregnancy. Firm due dates are

always estimates but the due date affects many of the decisions that could need to

be made for your care. If there is any uncertainty in your due date your provider

will usually order an ultrasound to help establish the due date.

Remember, your due date is an estimate. Normal pregnancies usually end

between 37 and 42 weeks by you going into labor all on your own. In a normal

pregnancy, the baby and placenta help prevent you from going into labor too

soon. Usually, when the baby is mature, the baby will stop preventing labor and

allow it to happen.

Try not to be too anxious to deliver before it happens on its own. There are many

reasons why your provider might recommend giving birth before your due date.

Sometimes it is critical for you or the baby’s health to be delivered early. There will

always be a good medical reason if it is recommended you give birth before 39

weeks. Be sure you understand why this recommendation is being made. If your

cervix is not ripe, labor induction can be long and hard and can increase your

chances of a cesarean delivery especially if this is your first baby. Even babies

born at 37 to 38 weeks can have problems from prematurity such as difficulty

breathing and eating or jaundice.

If you have questions or concerns, ask or arrange to go to the hospital to be seen.

This book can give you answers to many questions. Your provider will also answer

your questions and address your concerns. It is important that you help us take

care of you by making sure we understand your needs.

6–8 Week Visit

Prenatal Information Sheet

Goal: Exchange information and identify existing

risk factors that may impact the pregnancy

6-8 Week Visit

Prenatal Information Sheet: 6–8 Week Visit 3

Prenatal Information Sheet: 6–8 Week Visit

Goal: Exchange information and identify existing

risk factors that may impact the pregnancy

Your baby’s growth

• Your baby (embryo) is probably an inch long and likely weighs

1/30 of an ounce.

• Your baby’s face and body are fairly well formed.

• Your baby’s bones have appeared. Internal organs are beginning

to work and the baby’s heart has been beating since the third

week.

• The placenta is attached to the uterine (womb) wall on the mother’s

side and the umbilical cord going to the baby on the other. The placenta

acts as an “almost” perfect filtering system between mother’s blood and

baby’s blood. The placenta has a fetal (baby) circulation side and a maternal

circulation side. A membrane barrier separates these sides. The placenta and

umbilical cord provide the way for nutrients (food and oxygen) to get to your

baby and for waste products to be removed. Unfortunately, it also allows some

harmful substances, such as alcohol and drugs, if in the mother’s blood, to get

to the baby.

Your body’s changes

• Your uterus has grown from the size of a pear to the size of a

large orange.

• You are probably beginning to notice changes in your body as a

result of your pregnancy.

• Your breasts may become larger and tender.

• The area around your nipples may darken.

• You may have to go to the bathroom more frequently to urinate.

• You may have “morning sickness” that may last beyond the

morning.

• Your bowel habits may change. You may be more constipated.

Your family’s changes

• The hormone changes that affect your body may also affect

your emotions, causing mood swings.

• Your partner may have concerns about your health, the baby,

and your family’s financial state.

• Coping with the discomforts of pregnancy may change

household and work routines.

• You and your partner both need time to adjust and accept your

upcoming role as new or repeat parents.

• It is important to share these feelings with someone you trust.

• Talk with your spouse/partner regarding any feelings about the pregnancy.

Your baby’s

growth

Your body’s

changes

Your family’s

changes

4 Prenatal Information Sheet: 6–8 Week Visit

Your thoughts and feelings

• You may have some new feelings - maybe you stopped doing

things you enjoy or felt sad some days in the past couple weeks.

• Accept how you are feeling, even if it is that you are very tired,

and remember that these changes are temporary.

• Discuss your feelings with someone you trust and your healthcare

provider, especially if you have been very sad or depressed.

• If you have experienced depression at another point in your life,

you are at much higher risk for pregnancy-related depression.

In fact, one in three mothers with a history of Major Depressive

Disorder will experience depression during or after pregnancy.

Please discuss any history of depression, thoughts of hurting

yourself or others, or any mental health concerns with your

provider as soon as possible.

• In early pregnancy you may find that your desire for sexual

intercourse changes especially if you have nausea, vomiting,

fatigue and/or breast tenderness. Since the amniotic sac protects

and cushions the fetus, intercourse normally does not hurt the

developing baby or cause a miscarriage. Ask your healthcare

provider if you have concerns.

• Hormone changes and weight gain can make it easy to become

frustrated with yourself and others. Physical discomforts, like not

sleeping well, nausea and fatigue, can make it hard to deal with

the demands of life even when you are not pregnant! If you are

already a parent, your challenge may be even greater.

• Pregnancy is both exciting and scary. Adapting to a new

pregnancy as a Veteran transitioning to civilian life, as an Active

Duty member or as a military spouse can be challenging. For

pregnant spouses of deployed military members or for pregnant

active duty service members, there may be anxiety about the

timing of the pregnancy and birth. Planning an upcoming

Permanent Change of Station (PCS)/move can be especially

challenging when you are pregnant. A strong support system

helps decrease anxiety that may come with pregnancy and

military/veteran transitions.

Signs to report

immediately

Signs to report immediately

• When in doubt, call the clinic or your healthcare provider or go

to the Emergency Department!

• Bright red vaginal bleeding or painful cramping.

• Persistent severe headaches.

• Fever at or over 100.4° F or 38° C.

• Persistent nausea and vomiting.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Thoughts

feelings

Prenatal Information Sheet: 6–8 Week Visit 5

Today’s visit

Today’s visit (typical topics)

• Fill out the questionnaire, if received prior to this visit, about any

history that is relevant to this pregnancy.

• You will be screened for potential risk factors such as:

– Social risks: alcohol/drug/tobacco/intimate partner violence.

– Medical risks: immunization status, exposure to sexually

transmitted infections, current health status, and family history

of specific diseases.

– Nutritional risks: weight and dietary intake.

– Obstetrical risks: problems in previous pregnancies and risks for preterm

labor.

– Mental health concerns.

• If you are struggling with nausea and vomiting, refer to Common Discomforts &

Annoyances of Pregnancy in the Resource Section for things you can do. Now

is the time to think about avoiding too much weight gain. For tips about weight

gain, refer to Nutrition in Pregnancy in the Resource Section.

• Receive and discuss information on exercise, benefits of breastfeeding, and

other health related behaviors.

• Discuss initial information regarding options for screening for birth defects

including chromosomal abnormalities. More detailed counseling will be

arranged at later visits. See Genetic Screening in Resource Section.

• Receive needed immunizations and information on ways to decrease chance

of getting various diseases.

• Have recommended blood work and urine screen completed.

• Discuss your anticipated due date which may change when more information

is known and further testing is done. Knowing your last menstrual cycle date

will help determine your due date.

• Often, an early ultrasound will be ordered to confirm or more accurately

determine your due date.

Normal is same

as pre-pregnant

BP or slightly

less than pre-

pregnant BP

My BP:

Your blood pressure

• We will measure blood pressure (BP) at every

prenatal visit. Rapidly increasing or abnormally

high blood pressure can be a sign of Gestational

Hypertension.

• High blood pressure can cause serious

complications such as a decrease in the

blood and oxygen supply to the baby and mother.

My weight:

Your weight

• Your weight will be checked at each visit. If you

are over or underweight, you may be referred to

a Registered Dietitian for additional information.

Your blood

pressure

Your weight

6 Prenatal Information Sheet: 6–8 Week Visit

Your weight

• Whether you are underweight (BMI < 18.5), normal weight

(BMI 18.5 – 24.9), overweight (BMI 25.0 – 29.9), or obese

(BMI ≥ 30.0), you should discuss your optimal weight gain

with your healthcare provider.

• Estimate your pre-pregnancy Body Mass Index (BMI) and

track your weight gain on pages 136 and 137 of this book.

• Total weight gain should be about 25–35 pounds unless you

are over or underweight. Your weight gain is not all fat. It

is mostly water in your body and the weight of the growing

baby.

• Normal pregnancy weight gain:

(if pre-pregnant BMI is normal)

breast ....................1.0 - 1.5 lbs.

blood. . . . . . . . . . . . . . . . . . . . . 3.0 - 4.5 lbs.

extra water .................4.0 - 6.0 lbs.

uterus. . . . . . . . . . . . . . . . . . . . . 2.5 - 3.0 lbs.

placenta/amniotic fluid ............3.5 lbs.

baby .....................7.0 - 8.0 lbs.

fat stores ..................4.0 - 6.5 lbs.

TOTAL .................. 25 - 35 lbs.

• Gaining the right amount of weight by eating the right

type of food is an extremely important part of a healthy

pregnancy.

Your exercise routine

• For healthy pregnant women who have not been advised

differently, regular mild to moderate exercise sessions, three

or more times per week, for at least 20 minutes each, with a

goal of 150 minutes per week, helps to keep

you fit and feeling better during a time when your body is

changing.

• Consider including aerobic exercise, strength training, or a

combination of both in your program.

• Check with your healthcare provider before you begin

an exercise program or before you begin a new type of

exercise.

Breastfeeding - a great start

• Now is the time to think about how you want to feed your

baby.

Your weight

Your exercise

routine

Consider

breastfeeding

Reference:

Prenatal

Fitness and

Exercise

Prenatal Information Sheet: 6–8 Week Visit 7

Breastfeeding - a great start

• Breastfeeding for at least your baby’s first 12

months of life is recommended.

• Breastfeeding is not only best for the baby,

it is also best for your health. Breastfeeding

can improve your health by helping you lose

pregnancy weight and lower the level of

bad cholesterol. On average, women who

breastfeed live longer and healthier lives

compared to women who do not breastfeed.

• See Breastfeeding in Resource Section for further

information.

Take only medications approved by your

healthcare provider

• Discuss any prescription medication with your

provider.

• Over-the-counter drugs considered safe for

common discomforts include:

– Headaches: Tylenol

, Tylenol PM

, Datril

– Cold: Tylenol

, saline nose spray/rinses,

Robitussin

(no alcohol), Benadryl

– Allergies: Claritin

, Zyrtec

, Allegra

– Constipation: Metamucil

, Fiber-All

Miralax

, Milk of Magnesia

– Indigestion: Tums

, Rolaids

, Maalox

Mylanta II

, Simethicone

– Heartburn: Zantac

, Pepcid

, Prilosec

– Hemorrhoids: Preparation H

, Anusol

– Nausea/Vomiting: Vitamin B6, Emetrol

Unisom

, ginger, sea sickness bands

Drugs to avoid

• Aspirin

, Motrin

/Ibuprofen, Tetracycline,

Accutane

• Limit caffeine. For more information, see page

134, Caffeine, in the Resources section of this

book.

Take only

medications

approved by

your provider

Consider

breastfeeding

Drugs

to avoid

8 Prenatal Information Sheet: 6–8 Week Visit

Drugs to avoid

• Alcohol, tobacco, and any illicit drugs are harmful to your

baby; avoidance helps to decrease risks. There is no known

amount of alcohol that is safe to drink while pregnant. All

drinks with alcohol can hurt an unborn baby.

NOTE: If you are using any drugs or substances that may

be harmful to your baby, ask about strategies to quit and

approaches to lifestyle behavior changes.

Work and household activities

• AVOID:

– Cat litter.

– X-rays (may be necessary after discussion

with your OB healthcare provider).

NOTE: Dental x-rays with proper shielding

are safe.

– Use of dry cleaning solutions.

– Children’s sandboxes (cats may use as a litter box).

– Working around radiation or radioisotopes.

– Working with lead or mercury.

– Gardening without gloves.

• If in doubt about your potential exposures, ask your health

care provider.

Avoiding infections

• Practice behaviors that prevent infection: Wash your hands

often, especially after using the toilet or changing a diaper,

before food preparation, and before and after you eat.

• Cover your cough and encourage your family members to do

the same.

• Avoid contact with people who have known infectious

conditions, such as a cold, the flu or a childhood disease such

as chicken pox.

• It is important that you be open with your healthcare provider

regarding exposure to any Sexually Transmitted Infections (STIs).

Sexually Transmitted Infections (STIs) are viruses, bacteria, or

parasites that pose risks of injury or death to your baby.

These STIs include:

– HIV(AIDS)

– Gonorrhea

– Syphilis

– Chlamydia

– Genital Herpes

– Genital warts

Drugs

to avoid

Work and

household

activities

Contact with

certain diseases

infections

Prenatal Information Sheet: 6–8 Week Visit 9

Immunization status

• Your immunizations should be up-to-date. We

will review your immunization and/or past

exposure history for the following:

– Varicella (Chicken Pox)

– Rubella (German Measles)

– Hepatitis B

– Tetanus (Lockjaw)

– Pertussis (Whooping Cough)

– Diphtheria

– Influenza (Flu) (seasonal-related)

• No live virus vaccines are recommended during

pregnancy.

• Flu vaccines are safe to receive during

pregnancy. Please make sure yours is up-to-date

for your pregnancy and delivery.

• While the influenza vaccine is recommended

and safe during pregnancy, the flu mist is a

live vaccine so should not be given during

pregnancy.

• Receive immunizations as needed.

• For more information about immunizations in

pregnancy, visit the Centers for Disease Control

and Preventions web page on maternal vaccines

at: https://www.cdc.gov/vaccines/pregnancy/

pregnant-women/index.html.

• You can avoid many infections by following

good hand washing practices.

Screening for birth defects

• After counseling with your provider, decide

which tests, if any, should be scheduled to

assess for risk of birth defects. This may include

an ultrasound. See Genetic Screening in

Resource Section.

Intimate Partner Violence

• Intimate partner violence often increases during

pregnancy. Please do not hesitate to seek help

from your healthcare provider, counselor, or a

close friend if you are experiencing physical,

sexual, or emotional abuse from your intimate

partner or anyone else.

Domestic abuse

screen

Immunization

status

Serum Screening

Options

10 Prenatal Information Sheet: 6–8 Week Visit

Intimate Partner Violence

• Let your healthcare provider know if, within the past year, or

since you have been pregnant, a current or former intimate

partner (boyfriend, girlfriend, wife, husband, sexual partner,

etc.) has physically hurt you, insulted or talked down to you,

threatened you with harm, screamed or cursed at you, or forced

you to have sexual activity.

• National Domestic Abuse Hotline:

1-800-799-7233

Summary of visit

Due date:_________ Date of next visit: ________________________

Date for lab work/other medical tests: _________________________

Date for any other scheduled appointments: ____________________

____________________________________________

Your next visit

At your 10-12 week visit we will:

• Measure your uterine growth, blood pressure, and weight,

and listen to the fetal heart tone (may not be heard this early in

pregnancy) and discuss any concerns/questions you may have.

• Complete a head-to-toe physical and pelvic exam, Sexually

Transmitted Infection (STI) screening and possibly a Pap smear.

• Discuss lab test results from first visit and have additional labs, if

needed.

• Discuss lifestyle changes if needed.

• Provide further education on Cystic Fibrosis Carrier risk and

discuss your options to be screened with a blood test if not done

at first visit.

• You should plan on at least 30 minutes for this visit.

• You should bring: any copies of your outpatient medical record

and your immunization record for your provider to review and

complete your medical history.

Your next visit

ALWAYS

BRING YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

EVERY VISIT

Summary of visit

Domestic abuse

screen

Prenatal Information Sheet: 6–8 Week Visit 11

My reaction when I learned I was pregnant:

Goals for my pregnancy:

Questions for my next visit:

My partner’s reaction to my pregnancy:

12 Prenatal Information Sheet: 6–8 Week Visit

Notes:

10–12 Week Visit

Prenatal Information

Sheet

Goal: Determine your current health status

and work toward a healthy pregnancy

10-12 Week Visit

Prenatal Information Sheet: 10–12 Week Visit 15

Prenatal Information Sheet: 10 –12 Week Visit

Goal: Determine your current health status and

work toward a healthy pregnancy

Your baby’s growth

• Your baby is now about 2.5 to 3.0 inches long and likely weighs

about 0.5 ounces. The head is about twice the size of the body.

• During this time, your baby’s body and organ tissues grow

rapidly.

• The eyes and ears are moving into normal positions.

• Intestines move from the umbilical cord into the stomach area.

• We may be able to hear your baby’s heartbeat with a Doppler.

Your baby’s

growth

Your body’s changes

• Your uterus is now the size of a grapefruit.

• We may be able to feel the upper edge of your uterus (the

fundus) a little bit above your pubic bone.

• Wear comfortable clothing that provides room to grow.

• Morning sickness often diminishes by the end of this month.

• If you haven’t already started, slowly add healthier food choices

and change unhealthy eating habits.

• Your teeth and gums are affected by pregnancy, just as other

tissues in your body. Routine dental care is important to

maintaining your dental health. Check when your last dental

cleaning was and schedule an appointment with your dental

provider if it has been more than six months. Dental x-rays with

the proper precautions are not harmful during pregnancy.

Your body’s

changes

Your family’s changes

• You may be moody, irritable, tearful, disorganized, have trouble

concentrating, or have irrational thoughts. These feelings are

normal. It may be helpful to talk about them with your family.

• Your sexual desire may increase or decrease - both are normal.

Your family’s

changes

Your thoughts and feelings

• You may find you are more moody or “stressed out” than you

have been in the past. This is in part due to hormonal changes

as your body adjusts to pregnancy. Just planning for your

baby’s arrival can be challenging.

• Most expectant mothers have concerns, whether it is body

changes/discomforts, their health or the baby’s, fear of labor

or changes to their personal or work situation.

Thoughts

feelings

16 Prenatal Information Sheet: 10–12 Week Visit

Your thoughts and feelings

• Discuss your feelings with someone you trust and your

healthcare provider, especially if you have been very sad or

depressed.

• Discuss any concerns about past traumatic events with your

provider. There are options to help you cope with this if it

becomes a problem.

Signs to report immediately

• When in doubt, call the clinic or your healthcare provider or

the Emergency Department!

• Bright red vaginal bleeding, or painful cramping.

• Persistent severe headaches, severe nausea, and vomiting.

• Fever at or over 100.4° F or 38° C.

• Inability to keep liquids down (due to nausea and/or

vomiting) resulting in a reduced amount of urine.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Today’s visit (typical topics)

• Review your medical and mental health history with your

healthcare provider.

• You may receive a complete head-to-toe physical and

pelvic exam that includes screening for sexually transmitted

infections (STI) and may include a Pap smear.

• Review and discuss initial lab results.

• Identify and discuss with your healthcare provider any

additional visits, labs, or tests you may need.

• Discuss with your provider information regarding options

for screening for birth defects including chromosomal

abnormalities. See Genetic Screening in Resource Section.

- If you have chosen to undergo first trimester screening for

birth defects, with a first trimester result, your provider will

review any tests completed.

- If you have chosen a testing strategy with results in the first

trimester but have not yet had testing, and you are still

within the appropriate gestational age, testing will be

arranged.

Your blood pressure

• Blood pressure is measured at every

prenatal visit because high blood

pressure can cause serious complications

for baby and mother if not controlled.

Today’s visit

Your blood

pressure

Signs to report

immediately

Thoughts

feelings

My BP:

Prenatal Information Sheet: 10–12 Week Visit 17

My weight:

___________

Total weight

change:

____________

My optimal

weight gain:

Your weight and nutrition

• Weight gain now is usually two to four pounds.

Monitor/review your weight gain regularly.

• Your baby is likely to be healthier if you eat

nutritious foods.

• Try small, frequent meals to provide needed

nutrition and to decrease nausea and vomiting.

• Choose your calories wisely—make sure each one is good for

both the baby and you.

• If you are currently taking a multivitamin, you may continue

taking it. Discuss your decision with your provider.

• If you are taking specific nutritional supplements (such as

vitamins) or if you are on a special diet, you should discuss

with your provider the need for ongoing supplementation or

additional nutritional consultation.

• Whether you are underweight (BMI < 18.5), normal weight

(BMI 18.5 - 24.9), overweight (BMI 25.0 - 29.9), or obese

(BMI ≥ 30.0), you should discuss your optimal weight gain

with your healthcare provider.

• Estimate your pre-pregnancy BMI and track your weight gain

on pages 136 and 137 of this book.

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• You may find it more difficult to “catch your

breath” even when walking up stairs. Take it

slowly. If you have a concern, discuss it with

your provider.

• It is best to never exercise to the point of

exhaustion or breathlessness. This is a sign that your

body cannot get the oxygen supply it needs, which

affects the oxygen supply to the baby as well.

• Certain activities should be avoided. For further information,

see Exercise in the Resource Section.

• Additional information for active duty service members can be

found on pages 95 through 101 of this book.

Breastfeeding - a great start

• Get to know other breastfeeding moms and get involved in

community breastfeeding groups, such as La Leche League.

• Human breast milk contains more than 100 protective ingredients

not found in a cow’s milk-based formula. Breast milk can’t be

duplicated.

Consider

breastfeeding

Your exercise

Your weight

18 Prenatal Information Sheet: 10–12 Week Visit

Breastfeeding - a great start

• Learn as much about breastfeeding as you can

ahead of time.

• I plan to _______________ feed my baby. I want

to do this for ___________ months.

Fetal heart rate

• You may be able to hear your baby’s heartbeat

at this visit with a Doppler.

Fetal heart

rate:

Uterine size

• At 10 – 12 weeks your uterus is at the top of

your pubic bone.

Uterine size:

Initial lab results

• If any of your test results are abnormal,

your provider will discuss life-style changes,

treatments, and possible outcomes.

Blood type

testing

Blood type testing

• Blood typing and antibody testing will be

done to tell if your blood is Rh (D) negative or

positive.

• If you are found to be Rh (D) negative:

– You will receive a D-immunoglobulin

(RhoGAM

) injection at 28 weeks to prevent

your blood from building up antibodies that

can harm your baby.

– Additional RhoGAM

injections are usually

given if you have certain procedures, such

as amniocentesis, or if you are experiencing

vaginal bleeding during the pregnancy.

– The RhoGAM

injection is repeated after

delivery if baby’s blood is Rh positive.

Rubella and

Varicella results

Rubella and Varicella results

• If screening shows no immunity (tests negative),

we will discuss precautions to protect against

these infections.

Uterine size

Fetal heart rate

Consider

breastfeeding

Prenatal Information Sheet: 10–12 Week Visit 19

Asymptomatic Bacteriuria (ASB) Screen

• ASB is an increased growth of bacteria in the

urine that can only be found through laboratory

analysis of a urine sample. There are no

symptoms, but ASB can result in a serious

kidney infection if left untreated.

• Antibiotic treatment may be prescribed. It is

important to take as directed and finish the

whole prescription or the bacteria can return.

• To reduce the chance of getting ASB, wear

cotton panties and wipe from front to back.

Asymptomatic

Bacteriuria (ASB)

screen

Cystic Fibrosis (CF) Carrier Screen

• This test is optional. The chances of having CF

vary with ethnic groups. See Specific Genetic

Testing in the Resource Section for further

information.

• We offer this test to determine if you are a

carrier for CF and your baby’s chances of

having the disease. If you test positive, then the

next step is to test the baby’s father.

• If you and your partner are carriers, your

unborn baby will have a 1 out of 4 (25%)

chance of having CF.

• You will be given additional information and the

option for further counseling.

• This information allows couples to decide on

their options.

Summary of visit

Due date:_________ Date of next visit: __________

Date for lab work/other medical tests: ___________

Date for dental cleaning if needed: _____________

Date for any other scheduled appointments: ______

____________________________________________

Summary of

visit

Cystic Fibrosis

(CF)

carrier screen

20 Prenatal Information Sheet: 10–12 Week Visit

Your next visit

At your 16 – 20 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, and

discuss concerns/questions you may have.

• Follow-up on results from birth defect and fetal

abnormality screening tests if you elected to do

any.

• Discuss the potential benefit, limitation and

safety of prenatal obstetric ultrasound.

ALWAYS BRING

YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY VISIT

Differences I have noticed recently in my body:

How pregnancy has impacted my relationship with my partner:

Questions for my next visit:

Prenatal Information Sheet: 10–12 Week Visit 21

Notes:

16–20 Week Visit

Prenatal Information

Sheet

Goal: Work toward a more comfortable

and safer pregnancy

16-20 Week Visit

Prenatal Information Sheet: 16–20 Week Visit 25

Prenatal Information Sheet: 16–20 Week Visit

Goal: Work toward a more comfortable and safer pregnancy

Your baby’s growth

• Your baby (fetus) is now about 4.4 to 5.5 inches long and may

weigh about 4 ounces.

• Fine hair, called “lanugo,” is growing on your baby’s head and

is starting to cover the body. Fingernails are well-formed.

• The arms and legs are moving and you may start feeling this

movement. This movement is called “quickening.” You may

not feel movement every day at this point, but the movements

will become stronger and more frequent as your pregnancy

progresses.

Your body’s changes

• Your uterus is about the size of a cantaloupe.

• Your center of gravity changes as your uterus grows. This change

may affect your balance.

• There is an increase in the mobility of your joints that can affect

your posture and cause discomfort in your lower back. As your

uterus grows, the round ligaments supporting the uterus can

stretch and pull. This ligament pain feels like a sharp pulling

sensation on either or both sides of the lower abdomen.

• You may have difficulty sleeping.

• You may have some head stuffiness or frequent nose bleeds.

These symptoms may occur because of changes in your

circulatory system due to hormonal changes.

• Constipation may be a problem. Refer to Common Discomforts &

Annoyances of Pregnancy in the Resource Section for things you

can do.

• You may notice a whitish vaginal discharge.

• You may feel Braxton-Hicks contractions that are usually

painless, irregular uterine contractions or tightening of the uterus

beginning as early as your sixth week of pregnancy.

• Most women, especially in their first pregnancy, will not feel

Braxton-Hicks contractions until after 20 weeks.

Your body’s

changes

Your baby’s

growth

26 Prenatal Information Sheet: 16–20 Week Visit

Your family’s changes

• Open communication is important to developing a strong

relationship that will be the foundation for your family. This is

especially important if military operations or transitions require

family separation.

• Now is the time to begin discussing birth control with your

partner and healthcare provider. There are many effective birth

control options available for you after baby’s birth.

• Keep in mind that breastfeeding alone may not prevent a

pregnancy. Many birth control methods can be used safely while

breastfeeding if you want to prevent/delay another pregnancy.

Your thoughts and feelings

• You may still feel somewhat emotional at times. This will likely

continue through your pregnancy as you and your partner

prepare for changes now and after baby arrives. You will likely

feel more rested which will help you be more positive. As much

as you are excited about planning for your baby’s birth, you

may be worried about how you will adjust to motherhood, labor

and delivery, expenses, work and the changes that are coming.

• Pregnant women deal with many changes. Hormone changes

and weight gain may make you more likely to become frustrated

with yourself and others. Physical discomforts such as not

sleeping well, aches, pain, nausea or heartburn may add to your

frustration.

• Discuss your feelings with someone you trust and your healthcare

provider especially if you have been sad or depressed, or had

thoughts of hurting yourself or others.

• Consider taking time to talk to your mother or mothers who you

admire to help you identify important characteristics of a mother.

Signs to report immediately

• When in doubt, call the clinic, your

healthcare provider or Labor and Delivery!

• Bright red vaginal bleeding.

• Gush of fluid from the vagina.

• Severe nausea and vomiting:

– Inability to keep fluids down.

– You are producing only a small amount of dark urine or no

urine at all.

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Signs to report

immediately

Your family’s

changes

Thoughts

feelings

Prenatal Information Sheet: 16–20 Week Visit 27

Today’s visit (typical topics)

• We will measure your uterine growth, blood

pressure, weight, listen to baby’s heart rate, and

discuss any concerns/questions you may have.

• If you have chosen to undergo screening for

birth defects, your provider will review any test

results. Your chosen strategy may necessitate

that additional blood be drawn or an ultrasound

be arranged after this visit.

• Your provider will discuss with you the risks,

benefits, and indications for an obstetrical

ultrasound. If an ultrasound is indicated, it will

be ordered but not usually done during this visit.

• Discuss how to identify differences in preterm

labor versus false labor.

• Some women who have a history of preterm

delivery, will be offered progesterone treatment

at this visit. Your provider will talk to you about

whether this or other treatment is recommended

for you.

My weight:

Total weight

change:

Your weight

• The usual weight gain is approximately one

pound a week during the rest of the pregnancy.

• Water contributes to 62% of the weight gain, fat

is about 30% and protein is about 8%.

• Slow and steady weight gain is best.

• Use your chart to monitor your rate of weight

gain. Follow the recommendations your provider

made at your first visit.

• No amount of alcohol is safe for your baby.

Your weight

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• Stay off your back while exercising from now

on.

• Mental, emotional and social benefits of

exercise include:

– Helping to prevent depression.

– Promoting relaxation and restful sleep.

– Encouraging concentration and improving

problem solving.

– Helping prepare for childbirth and parenting.

– Helping prevent excess weight gain.

– Improving self-esteem and well-being.

Your exercise

Today’s visit

28 Prenatal Information Sheet: 16–20 Week Visit

Breastfeeding - a great start

• Some advantages to baby include:

– Easier digestion of breast milk.

– No allergy problems to breast milk.

– Less likely to cause overweight babies.

– Less constipation for baby.

– Easier on baby’s kidneys.

– Fewer illnesses in the first year of life.

– Less chance of SIDS (Sudden Infant Death

Syndrome).

– Close infant contact with mom.

Fetal heart rate

• Usually your baby’s heartbeat is easier to locate

and hear at this time in your pregnancy.

Fetal heart

rate:

Uterine size/Fundal height

• At 16 weeks, your uterus is usually midway

between the belly button and the pubic bone or

16 cm above the pubic bone.

• The fundal height is the distance between the

pubic bone and the top of the uterus.

• Beginning at 20 weeks, the fundal height in

centimeters will be about equal to the number of

weeks you are pregnant.

Fundal height:

Screening for birth defects

• If you have not done so already, after

counseling with your provider, decide which

other tests, if any, should be scheduled to assess

for risk of birth defects. This may include an

ultrasound. See Genetic Screening in Resource

Section.

Your blood pressure

• Blood pressure is measured at every prenatal

visit. High blood pressure can cause serious

complications for baby and mother if left

unchecked.

Consider

breastfeeding

Fetal heart rate

Fundal height

Serum Screening

Options

Your blood

pressure

My BP:

_____________

Prenatal Information Sheet: 16–20 Week Visit 29

Ultrasound

• An anatomy ultrasound will be ordered but not usually performed

at this visit.

• An obstetrical ultrasound exam uses sound waves to “see” your

baby in the womb. This exam provides information about your

baby’s health and well-being.

• The result of an ultrasound can be exciting and reassuring, or it can detect

abnormalities in your pregnancy that are not anticipated. Ultrasound exams

provide much information about your pregnancy, but cannot detect all birth

defects. An ultrasound provides information about your baby’s health and

well-being inside the womb such as:

– Gestational age and size.

– The number of babies.

– Rate of growth.

– Placenta position.

– Baby’s heart rate.

– Amount of amniotic fluid.

– Some birth defects.

– Gender, if readily visible.

NOTE: Gender identification is not 100% accurate nor is it usually medically

necessary. It is not routinely noted in the ultrasound report. Lengthy or repeated

ultrasound exams, just to assess gender, are not indicated.

• Ultrasound use, when medically indicated, has not been shown to produce

any harm.

If there is a medical indication for 3D/4D ultrasound, your provider will

perform or order the procedure.

• Typically a trained technician will perform the ultrasound exams. The

technician is not authorized to discuss the findings with you at the time of

your exam. Your provider will discuss the result of this exam with you after

this visit.

• On the day of your ultrasound, wear clothes that allow your abdomen to be

exposed easily.

30 Prenatal Information Sheet: 16–20 Week Visit

Summary of visit

Due date:_________ Date of next visit: _________

Date for lab work/other medical tests: __________

Date for any other scheduled appointments: _____

___________________________________________

Your next visit

At your 24 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, and

discuss any concerns/questions you may have.

• Discuss signs and symptoms of preterm labor.

• Discuss the importance of the test for gestational

diabetes and how this test is done at your 28

week visit for most women, but will be done

earlier if you have a history of gestational

diabetes.

ALWAYS BRING

YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY VISIT

What do you feel is the role of a mother?

What concerns do you have about becoming a mother?

Things I will need to know to breastfeed:

Questions for my next visit:

Summary

of visit

Your next visit

Prenatal Information Sheet: 16–20 Week Visit 31

Notes:

24 Week Visit

Prenatal Information

Sheet

Goal: Prevent preterm labor for a safe

and healthy baby

24 Week Visit

Prenatal Information Sheet: 24 Week Visit 35

Prenatal Information Sheet: 24 Week Visit

Goal: Prevent preterm labor for a safe and healthy baby

Your baby’s growth

• Your baby is now about 8.4 inches long and weighs about 1.2

pounds.

• Your baby is resting and growing inside your uterus, inside of

a sac filled with amniotic fluid. This sac provides the perfect

environment for your baby. Movement is easy and the fluid

serves as a cushion for the fetus against injury. The fluid in the

sac also regulates the temperature. The fluid level should now

begin to increase steadily.

Your baby’s

growth

Your body’s changes

• Your uterus is now an inch or two above the belly button and is

about the size of a small soccer ball.

• You may feel occasional tightening of your abdomen (Braxton-

Hicks), which is normal.

• You may develop varicose veins, increased heartburn, and skin

changes due to the fluctuation in hormones.

• If you have any of the signs of preterm labor, such as cramping

or contractions that do not go away within an hour of rest and

hydration, call your provider immediately.

Your body’s

changes

Your family’s changes

• Talk to your family about ways to help each other adjust to the

many changes you are all facing. Encourage their involvement

by inviting them to your clinic visits. Jointly plan for the future

and share the many emotions, fears, and joys you are all going

through. The more your family is involved now, the easier they

will bond with the new baby and participate in his/her care.

• If the father of the baby is not available, find someone you trust

and who is willing to be your support person.

Who will be my support person?____________________________

Your family’s

changes

Your thoughts and feelings

• You may still feel somewhat emotional at times. This will likely

continue through your pregnancy as you and your partner

prepare for changes now and after baby arrives. As much as

you are excited about planning for your baby’s birth, you may

be worried about how you will adjust to motherhood, labor and

delivery, expenses, work and the changes that are coming.

• Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been sad or

depressed, or had thoughts of hurting yourself or others.

Thoughts

feelings

36 Prenatal Information Sheet: 24 Week Visit

Signs to report

immediately

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

• Bright red vaginal bleeding.

• Gush of fluid from the vagina.

• Four or more painful cramping contractions within an hour (after

resting, hydrating and emptying bladder).

• Severe nausea and vomiting:

– Inability to keep fluids down.

– Producing small amount of dark urine or no urine at all.

• Persistent headache (unrelieved by taking Tylenol

• Loss of vision.

• Sudden weight gain.

• Rapid swelling of hands and face.

• Constant right upper belly pain.

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Today’s visit (typical topics)

• We will measure your uterine growth, blood pressure, weight,

listen to your baby’s heart rate, and discuss any concerns or

questions you may have.

• Schedule lab tests.

• Sign up for breastfeeding and other prenatal classes.

• Check to see if you are having any preterm contractions.

• Learn the signs of preterm labor and what to do if it occurs.

• If you had a cesarean delivery for a prior birth, discuss your

birth options for this pregnancy. See Cesarean Delivery in

Resource Section for further information.

• If you are considering surgical sterilization (“tying your tubes“)

you should discuss this with your provider now. Some states

require several weeks between a signed consent and surgery.

Your weight

• Your weight gain will average close to one pound per week.

• Many common discomforts of pregnancy (constipation, nausea,

heartburn) can be reduced through a change in diet.

• Record your weight on the Weight Chart in the Resource Section.

Today’s visit

Your

weight:

Prenatal Information Sheet: 24 Week Visit 37

Your weight

• How am I doing with my weight gain?

__________________________________________

• What can I do to improve my diet and exercise?

__________________________________________

Your weight

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• We recommend you drink a full glass of water

for every 30 minutes of exercise you do.

• For healthy pregnant women who have not been

advised differently, regular mild to moderate

exercise is recommended.

• Always check with your healthcare provider

before beginning a new exercise program.

Your exercise

Breastfeeding - a great start

• Some advantages of breastfeeding to you

include:

– Burns about the same number of calories as

one hour of exercise and allows you to use

some of the extra fat you have stored during

your pregnancy.

– Helps your uterus get back to its normal size

faster.

– Saves time, money and extra trips to the

store for formula and supplies.

– There are no special foods you have to eat;

however, you should eat a well-balanced

diet, and limit alcohol and caffeine.

• For further information see Breastfeeding in

Resource Section.

Consider breast-

feeding

Fetal heart rate

• Baby’s heartbeat is getting much easier to

hear.

Fundal height

• Fundal height is about 24 cm or two inches

above the belly button.

Fetal heart rate

Fundal height

Fundal height:

Fetal heart

rate:

Your total

weight

change:

38 Prenatal Information Sheet: 24 Week Visit

Your blood pressure

• Blood pressure is measured at every prenatal

visit. High blood pressure can cause serious

complications for baby and mother if left

untreated.

Preterm labor

guidelines

Preterm labor

• Your baby needs to continue to grow inside you for the full

term of your pregnancy. Labor earlier than three weeks before

your due date can lead to a premature (preemie) baby with

many associated risks. Even 37 to 38-week babies can have

difficulties.

• As always, when in doubt call your healthcare provider or Labor

and Delivery.

• Report any of the following symptoms to your health

care provider:

– Low, dull backache

– Four or more uterine contractions per hour. Uterine

contractions may feel like:



Menstrual cramps.



Sensation of “baby rolling up in a ball.”



Abdominal cramping (may also have diarrhea).



Increased uterine activity compared to previous patterns.

– Increased pelvic pressure (may be with thigh cramps).

– Sensation that “something feels different” (e.g., agitation, flu-

like syndrome, and sensation that baby has “dropped”).

• If you experience any of the above symptoms you

should:

– Stop what you are doing and empty your bladder.

– Drink three to four glasses of water.

– Lie down on your side for one hour and place your hands on

your abdomen and feel for tightening/hardening and relaxing

of your uterus.

– Count how many contractions you have in an hour.

– If you have more than four contractions for more than one hour

call either the clinic or Labor & Delivery immediately.

• You should report immediately:

– Change in vaginal discharge such as change in color of

mucus, leaking of clear fluid, spotting or bleeding.

Your blood

pressure

My BP:

_____________

Prenatal Information Sheet: 24 Week Visit 39

Gestational Diabetes (GD) testing

• Gestational diabetes is high sugar levels in your blood during

your pregnancy. It usually goes away after delivery. If your

results are high, this does not mean you have diabetes, it just

means further testing is needed.

• You will have a blood test for gestational diabetes. This blood

test will tell how your body is responding to your sugar levels.

• To prepare for the test at your next visit, eat your usual dinner

the night before the test and your normal breakfast the day of

the test.

• At the lab, you will be given a very sweet drink (glucose

beverage) that has a specific amount of sugar in it. A sample

of your blood will be drawn one hour after you drink the

glucose beverage.

• During the hour between drinking the glucose beverage and

having your blood drawn, do not eat or drink anything,

including gum or candy, because it may affect the test results.

You may drink plain water during this time while you are

waiting.

• The 1-hour glucose tolerance test is conducted between 24

and 28 weeks; an additional 3-hour test may be ordered if the

results of the 1-hour test are not normal.

Summary of visit

Due date:_________ Date of next visit: ______________________

Date for lab work/other medical tests: _______________________

Date for any other scheduled appointments: __________________

________________________________________________________

Your next visit

At your 28 week visit we will:

• Measure your uterine growth, blood pressure, weight, listen to

your baby’s heart rate, and discuss any concerns or questions

you may have.

• Provide instructions on counting fetal movement.

• Provide RhoGAM

if your blood type is Rh negative (D-) and

you are not sensitized.

• If you have not done so already, you will be tested for

gestational diabetes, and possibly other labs. For planning

purposes, be prepared to wait one hour to complete the

gestational diabetes testing. If your healthcare provider has

ordered a second blood test for gestational diabetes, be

prepared to wait three hours to complete the test.

• Sign up for breastfeeding and other available classes.

ALWAYS

BRING YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY VISIT

Summary

of visit

Gestational

Diabetes

(GD) testing

Your next visit

40 Prenatal Information Sheet: 24 Week Visit

Activities or traditions you remember from your childhood that you

would like to continue in your family:

Think about what your baby will look like. Write your thoughts

here:

Questions for my next visit:

Prenatal Information Sheet: 24 Week Visit 41

Notes:

28 Week Visit

Prenatal Information

Sheet

Goal: Monitor baby and your progress and

learn to count fetal movements

28 Week Visit

Prenatal Information Sheet: 28 Week Visit 45

Prenatal Information Sheet: 28 Week Visit

Goal: Monitor baby and your progress and

learn to count fetal movements

Your baby’s growth

• Your baby’s weight has probably doubled since your last visit!

Your baby weighs about 2.5 lbs. and is about 10 inches long.

• The baby starts to lose the lanugo (fine hair), especially from

the face. The baby has a large amount of cheesy-like substance

(vernix) covering the body that protects the skin while the baby is

living in the amniotic fluid. This vernix decreases on the skin as

the baby grows.

• Your baby’s eyebrows and eyelashes may be present now.

• The brain tissue also increases during this time.

• Now that you are 28 weeks, you should be feeling your baby

move (kicks, rolls, twists, turns, and jabs) on a regular basis.

Your body’s changes

• You’ve probably gained about 18 pounds.

• You may also start experiencing some swelling, and/or

numbness or pain in your hands and wrists (Carpal Tunnel

Syndrome). Avoid sleeping on your hands or bending your wrists

for long periods of time. Discuss persistent pain, numbness or

weakness with your provider.

Your body’s

changes

Your family’s changes

• Everyone needs help with child care whether on a full, part-time,

or occasional basis. Consider your needs.

• Active duty moms should be prepared to list their child care

providers upon return to work/duty.

• If you will be returning to work after baby’s birth, now is the time

to explore the various child care options in your community.

Your family’s

changes

Your thoughts and feelings

• Stress may begin to surface. If it seems uncontrollable, talk to

your provider about this.

• Remember to give yourself a break! You may need to adjust the

expectations you have for yourself at this time. Focus on what is

important to you and your family. Sometimes going for a walk

or doing something you enjoy will help you prioritize what is

important or help you relax.

• About 15% of women experience depression during pregnancy or after

delivery. Discuss any concerns with your provider.

• Discuss your feelings with someone you trust, and your healthcare provider,

especially if you have been very sad or depressed.

Your baby’s

growth

Thoughts

feelings

Your body’s

changes

46 Prenatal Information Sheet: 28 Week Visit

Signs to report

immediately

Today’s visit (typical topics)

• We will measure your uterine growth, blood pressure, and

weight, listen to your baby’s heart rate, and discuss any

concerns or questions you may have.

• Check for preterm labor.

• Review signs of preterm labor and what to do if they occur.

• You will receive blood test for gestational diabetes.

• You will learn how to do Fetal Movement Counts.

• Discuss Intimate Partner Violence.

• Discuss and be screened for depression in pregnancy.

• If you are Rh negative, you will have an additional blood test

before receiving RhoGAM

injection.

• Register for Breastfeeding class, Childbirth classes and Labor &

Delivery tour.

• A post-delivery depression screening will be completed (see

page 153 for more information).

Your weight and nutrition

• Try to eat a variety of foods.

• If needed, extra nutrients such as iron, vitamins

B-6 and B-12, and calcium may be prescribed.

• Record your weight on the weight chart in the

Resource Section.

• For further information see Nutrition in Resource

section.

Today’s visit

Your weight

Your

weight:

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

• Bright red bleeding or gush of fluid from the vagina.

• The baby is not moving as much as you expect.

• Four or more painful cramping contractions within an hour (after

resting, hydrating, and emptying bladder).

• Severe nausea and vomiting:

– Inability to keep fluids down.

– Producing small amount of dark urine or no urine at all.

• Persistent headache (unrelieved by taking Tylenol

• Loss of vision.

• Sudden weight gain.

• Rapid swelling of hands and face.

• Constant right upper belly pain (not related to baby movement).

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Your total

weight

change:

Prenatal Information Sheet: 28 Week Visit 47

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• Now that your uterus is getting larger, you need

to avoid exercises that require a lot of balance,

to prevent a fall.

• Make sure the calories you eat are nutritious for

both you and your baby and that you stay well

hydrated.

Breastfeeding - a great start

• Classes on breastfeeding will:

– Help answer many questions.

– Give you confidence in your ability to breast-

feed.

– Introduce you to other breastfeeding moms.

– Reassure you that what you are doing is best

for both you, your baby and your family.

Intimate Partner Violence

• Intimate Partner Violence (IPV) often increases

during pregnancy. Please do not hesitate to

seek help from your healthcare provider,

counselor or a close friend if you are

experiencing physical, sexual, emotional, or

verbal abuse from your partner or anyone.

• Let your provider know if within the last year, or since you

have been pregnant, a current or former intimate partner

(e.g., boyfriend, girlfriend, wife, husband, sexual partner)

has physically hurt you, insulted or talked down to you,

threatened you with harm, screamed or cursed at you, or

forced you to have sexual activity.

• National Domestic Abuse Hotline: 1-800-799-7233

Fetal heart

rate:

Fetal heart rate

• This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart rate

Fundal height

• The top of your uterus measures about 28 cm

from your pubic bone.

Your exercise

Consider

breastfeeding

Domestic abuse

screen

Fundal height

Fundal height:

48 Prenatal Information Sheet: 28 Week Visit

My BP:

_____________

Your blood

pressure

Fetal movement count

• One very reassuring way to determine the baby’s

overall health and wellness is to record your

baby’s movements daily.

• By now, you probably know when your baby is

most active. This may be before or after a meal,

early in the morning, or at night when you go to bed.

Each baby is unique.

• You should count your baby’s movements whenever he or she is

most active. This count should occur about the same time each

day. After 10 times, you can stop counting for the day. You will

need to record the time it takes for your baby to move 10 times.

See Fetal Movement Counting Chart in Resource Section.

• You should be able to feel at least 10 movements within two

hours.

• If you do not get 10 movements within two hours, you should

call or go to Labor & Delivery immediately with your baby’s

movement chart. Don’t wait until the next day or next

appointment.

Your blood pressure

• Blood pressure is measured at every

prenatal visit. High blood pressure can

cause serious complications for baby

and mother if left untreated.

Fetal

movement

count

Fetal

Movement

Count

Preterm labor

• Your baby needs to continue to grow inside you for the full term

of your pregnancy. Labor earlier than three weeks before your

due date can lead to a premature (preemie) baby with many

associated risks.

• As always, when in doubt call your healthcare provider or

Labor and Delivery.

• Report any of the following symptoms to your

healthcare provider:

– Low, dull backache.

– Four or more uterine contractions per hour. Uterine

contractions may feel like:



Menstrual cramps.



Sensation of the “baby rolling up in a ball.”



Abdominal cramping (may also have diarrhea).



Increased uterine activity compared to previous patterns.

Preterm labor

guidelines

Prenatal Information Sheet: 28 Week Visit 49

Preterm labor

guidelines

Preterm labor

– Increased pelvic pressure (may be with thigh cramps).

– Sensation that “something feels different” (e.g., agitation, flu-

like syndrome, and sensation that baby has “dropped”).

• If you experience any of the above symptoms you

should:

– Stop what you are doing and empty your bladder.

– Drink three to four glasses of water.

– Lie down on your side for one hour and place your hands on

your abdomen and feel for tightening/hardening and relaxing

of your uterus.

– Count how many contractions you have in an hour.

– If you have more than four contractions for more than one hour

call either the clinic or Labor & Delivery immediately.

•You should report immediately:

– Change in vaginal discharge such as change in color of

mucus, leaking of clear fluid, spotting or bleeding.

Gestational Diabetes (GD) testing

High blood sugar puts your baby at risk for complications.

• High blood sugar usually develops towards the middle of your

pregnancy.

• Risk factors include: being over age 25, overweight, family

history of diabetes, ethnic background (Hispanic, African

American, Native American, Asian), previous delivery of a baby

weighing over nine pounds.

• This test will determine if you have a normal response to a sugar

load (a beverage containing a specific amount of sugar).

• If your blood sugar levels are high, further testing will be

ordered.

• Often this condition can be controlled through special diet.

Rh (D) negative (Anti-D) prophylaxis

• Earlier in your pregnancy, you had a test to identify your Rh (D)

status.

• Rh (D) negative women will have an additional blood test

(antibody screen) and will usually receive a RhoGAM

injection at this appointment.

• This injection will be repeated after delivery if baby is Rh

positive.

Gestational

Diabetes

(GD) testing

Rh prophylaxis

50 Prenatal Information Sheet: 28 Week Visit

Summary of visit

Date of next visit: ____________________________

Date for lab work/other medical tests:__________

Date of Breastfeeding Class: __________________

Date of Childbirth Class: _____________________

Date of Other Classes: _______________________

Your next visit

At your 32 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to your baby’s heart rate, review

fetal movement record, and discuss any

concerns/questions you may have.

• You will sign up for expectant parent classes (if

not done already).

• You may review preterm labor signs.

ALWAYS BRING

YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY VISIT

Your next visit

Review the goals you noted for yourself early in your pregnancy. Is

there something you need to do to meet your goals? What?

Differences I have noticed recently:

How has the pregnancy effected your family/relationships?

Other things I need to do/get ready in the next four weeks:

Questions for my next visit:

Summary of visit

Prenatal Information Sheet: 28 Week Visit 51

Notes:

32 Week Visit

Prenatal Information

Sheet

Goal: Prepare for your baby’s arrival

32 Week Visit

Prenatal Information Sheet: 32 Week Visit 55

Prenatal Information Sheet: 32 Week Visit

Goal: Prepare for your baby’s arrival

Your baby’s growth

• Your baby weighs almost four pounds, and the length is

18-19 inches!

• Organ systems are now adequately developed.

• Most likely, your baby is in the “head down” position so

you may feel most of his/her kicks and jabs under your ribs.

• If your baby is in the breech or “butt down” or transverse

(sideways) position you may feel the movements in different areas.

Your body’s changes

• The top of your uterus is about four to five inches above your

belly button by now.

• You may also notice that your back and pelvic area may feel

different. The bones in your pelvis are moving and shifting to

make room for the baby’s head to pass through.

• As this happens, the ligaments around the pelvis also stretch,

which can cause some discomfort in the hip joints, back, and

front of the pelvis.

Your body’s

changes

Your family’s changes

• You and your partner may become more anxious as the “big

day” approaches.

• You may become more irritable and find that this can put a strain

on your relationship.

• You’ll probably find that it is harder to do all the things that you

are used to doing, such as sleeping and moving quickly. When

possible, schedule rest periods and avoid quick movements.

• Make sure you have a plan for getting to the hospital no matter

when you need to go! This plan needs to include transportation,

child and pet care options, and phone numbers.

Your family’s

changes

Your thoughts and feelings

• You may still feel somewhat emotional at times. You may feel

increasingly fatigued which will impact how you respond to the

people around you.

• Signs of pregnancy-related depression may include: loss of

interest in activities you enjoy, feelings of guilt or hopelessness,

changes in appetite or sleep patterns, or thoughts of harming

yourself or others. If you experience any of these symptoms,

please contact your provider immediately.

• Discuss your feelings with someone you trust, and your healthcare provider,

especially if you have been very sad or depressed.

Thoughts

feelings

Your

baby’s

growth

56 Prenatal Information Sheet: 32 Week Visit

Signs to report

immediately

Signs to report immediately

• When in doubt, call the clinic, your provider or Labor and

Delivery!

• Bright red bleeding or gush of fluid from the vagina.

• The baby is not moving as much as you expect.

• Four or more painful cramping contractions within an hour (after

resting, hydrating, and emptying bladder).

• Severe nausea and vomiting:

– Inability to keep fluids down.

– Producing a small amount of dark urine or no urine at all.

• Persistent headache (unrelieved by taking Tylenol

• Loss of vision.

• Sudden weight gain.

• Rapid swelling of hands and face.

• Constant right upper belly pain (not related to baby movement).

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Today’s visit (typical topics)

• We will measure your uterine growth, blood pressure, and

weight, listen to your baby’s heart rate, check your baby’s

position, review the fetal movement record, and discuss any

concerns/questions you may have.

• Check for preterm labor.

• Discuss birth control options for after you deliver.

• Receive a domestic abuse screening.

• Sign up for classes such as Breastfeeding, Childbirth, Labor and

Delivery, Postpartum and Newborn tour if not done yet.

Your weight and nutrition

• Continue to monitor/record your weight gain.

• Pregnancy increases your requirements for iron,

calcium, folate, protein, and water.

• Make sure to read food labels carefully.

• Try to limit simple sugars (honey, maple

syrup, white, and brown sugars).

Your exercise routine

• You can continue to exercise right up to delivery and this may

even help the delivery go more easily. Discuss your exercise

routine with your provider.

• Don’t exercise on an empty stomach and make sure you replace

any fluids lost during exercise.

Today’s visit

Your weight

Your exercise

My weight:

___________

Total weight

change:

____________

Prenatal Information Sheet: 32 Week Visit 57

Your exercise routine

• Avoid exercising in very hot and/or humid

weather.

• You may need to modify the intensity of your

exercise routine according to your symptoms.

Now is not the time to exercise to exhaustion or

fatigue.

Breastfeeding - a great start

• Breastfeeding for at least your baby’s first 12

months of life is recommended.

• If you have any doubts or concerns about

breastfeeding, let your provider know. We have

many excellent resources to help you feel more

comfortable and confident with breastfeeding.

Consider

breastfeeding

Fetal heart rate

• This measurement will be done at each

visit to monitor your baby’s well-being.

Fundal height

• The top of your uterus is 32 cm above your

pubic bone or four to five inches above your

belly button.

Your blood pressure

• Blood pressure is measured at every prenatal

visit because high blood pressure can cause

serious complications for baby and mother if

not controlled. It can also be a sign of pre-

eclampsia.

Fetal movement count

• Review fetal movement count record.

Fetal heart rate

Fundal height

Fundal

height:

Fetal heart

rate:

Fetal movement

count

Fetal

Movement

Count:

My BP:

Your blood

pressure

Your exercise

Reference:

Prenatal

Fitness and

Exercise

58 Prenatal Information Sheet: 32 Week Visit

Family planning

• Even though it may seem early to discuss birth control when you

are still pregnant, now is an excellent time to plan for what you

and your partner will use for birth control after baby arrives.

• You can get pregnant the first time you have sexual intercourse

following delivery. Prior to discharge from the hospital, your

provider will discuss birth control with you. See Family Planning

in Resource Section.

•Talk with your provider about plans for your next pregnancy.

Preparing for baby’s arrival

• Most women go through the “nesting” phase a week or two

before delivery. You’ll probably clean everything in sight, so take

it as a blessing in disguise.

• Plan, cook, and freeze some meals ahead of time. Keep a stock

of basic staples, so you won’t have to go to the store for basic

food items.

• If friends offer to help, suggest that they cook a meal or two for

you and your family.

• Baby’s living area: Whether baby has his or her own room, or

is sharing a room with a sibling or with you, be sure the area

is clean and safe. Wash your baby’s new sheets, blankets, and

clothes in a mild detergent (or, if your machine has this feature,

run them through an extra rinse) before you bring baby home.

• Learn about the proper installation and use of car seats and

booster seats at: https://www.nhtsa.gov/equipment/car-seats-

and-booster-seats.

• After the baby comes home, you will have many new duties, a

lot less sleep, and a lot less energy. So plan ahead.

Preterm labor

• Your baby needs to continue to grow inside you for the full term

of your pregnancy. Labor earlier than three weeks before your

due date can lead to a premature (preemie) baby with many

associated risks.

• As always, when in doubt call your healthcare provider or

Labor and Delivery.

• Report any of the following symptoms to your health

care provider:

– Low, dull backache.

– Four or more uterine contractions per hour. Uterine

contractions may feel like:



Menstrual cramps.



Sensation of the “baby rolling up in a ball.”



Abdominal cramping (may have diarrhea).



Increased uterine activity compared to previous patterns.

Preparing for

baby’s arrival

Preterm labor

guidelines

Family

planning

Prenatal Information Sheet: 32 Week Visit 59

Preterm labor

– Increased pelvic pressure (may be with thigh cramps).

– Sensation that “something feels different” (e.g., agitation, flu-like syndrome,

and sensation that baby has “dropped”).

• If you experience any of the above symptoms you should:

– Stop what you are doing and empty your bladder.

– Drink three to four glasses of water.

– Lie down on your side for one hour and place your hands on your abdomen

and feel for tightening/hardening and relaxing of your uterus.

– Count how many contractions you have in an hour.

– If you have more than four contractions for more than one hour call either

the clinic or Labor & Delivery immediately.

• You should report immediately:

– Change in vaginal discharge such as change in color of mucus, leaking of

clear fluid, spotting or bleeding.

Summary of visit

Date of next visit:____________________________

Date for lab work/other medical tests:

___________________________________________

ALWAYS

BRING YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY

VISIT

Your next visit

At your 36 week visit we will:

• Measure your uterine growth, blood pressure,

weight, listen to the baby’s heart rate, check

your baby’s position, review the fetal movement

record, and discuss concerns/questions you may

have.

• Discuss any specific desires you have for your labor and

delivery. See Birth Plan in Resource Section.

• Do a Group B Streptococcus (GBS) test.

Summary of visit

Your next visit

Right now, I am concerned/worried about:

60 Prenatal Information Sheet: 32 Week Visit

Preparation for labor:

Who will be in the labor/birth room with you?

Questions/concerns since taking classes:

Plan for pain relief during labor:

I am planning to use ________________________ method of family

planning to prevent/delay another pregnancy.

Questions for my next visit:

My spouse/partner is concerned/worried about:

Prenatal Information Sheet: 32 Week Visit 61

Notes:

36 Week Visit

Prenatal Information

Sheet

Goal: Begin preparations for your hospital

experience

36 Week Visit

Prenatal Information Sheet: 36 Week Visit 65

Prenatal Information Sheet: 36 Week Visit

Goal: Begin preparations for your hospital experience

Your baby’s growth

• Your baby probably weighs around 6 pounds now and is about

20 inches in length.

• Most likely, your baby is in the “head down” position. However,

some babies settle into the head down position only a few days

before delivery. If baby is in the breech (or butt down) position,

your provider will discuss options to turn the baby to head down

position.

Your body’s changes

• Easier breathing after the baby “drops” or moves down into

pelvis. Some babies don’t “drop” until after labor begins.

• More frequent urination after the baby “drops” down.

• Increased backache and heaviness.

• Pelvic and buttock discomfort.

• Increased swelling of the ankles and feet and occasionally the

hands.

• More frequent and more intense Braxton-Hicks (non-painful)

contractions.

Your body’s

changes

Your family’s changes

• More excitement and anxiety but also more impatience and

restlessness as the delivery date nears are common – for both

you and your partner. Many parents feel a renewed desire this

month to tie up loose ends at work or home, organize the home,

or catch up on social obligations. While you may think you have

more energy now than in the last two months, don’t overdo it.

Involve your partner in carrying out needed tasks.

• Apprehension about the baby’s health and labor and delivery is

common.

• Share your concerns about the changes you anticipate with your

partner and those around you.

Your family’s

changes

Your

baby’s

growth

66 Prenatal Information Sheet: 36 Week Visit

Your thoughts and feelings

• Some women find that as the due date approaches they become

very anxious about labor and delivery or their ability to care for

a newborn. You may experience mood swings, anxiety, or be

very short-tempered and emotional in these last few weeks of

your pregnancy. These feelings are common.

• If at any time you believe you are close to hurting yourself or

someone else, contact your provider immediately. If you cannot

reach your provider, seek help at the hospital Emergency

Department.

• Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been very sad or

depressed in the last couple of weeks.

Signs to report

immediately

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

• Bright red bleeding or gush of fluid from the vagina.

• The baby is not moving as much as you expect.

• Four or more painful cramping contractions within an hour (after

resting and emptying bladder).

• Severe nausea and vomiting:

– Inability to keep fluids down.

– Producing a small amount of dark urine or no urine at all.

• Persistent headache (unrelieved by taking Tylenol

• Loss of vision.

• Sudden weight gain.

• Rapid swelling of hands and face.

• Constant right upper belly pain (not related to baby movement).

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Today’s visit (typical topics)

• We will measure your uterine growth, blood pressure, weight,

listen to baby’s heart rate, review the fetal movement record,

check baby’s position, do a test for Group B Streptococcus (GBS)

and discuss any concerns/questions you may have.

• Discuss any specific plans you have for your birth experience.

• You will complete necessary forms from your healthcare provider

and take them to the Admissions Office.

• Homework - Prior to going into labor and being admitted

to the hospital, make sure you have made arrangements for

childcare and pet care.

Thoughts

feelings

Today’s visit

Prenatal Information Sheet: 36 Week Visit 67

My weight:

___________

Total weight

change:

____________

Your weight and nutrition

• When making your choices from each food

group, pick those that are low in fat and high in

fiber and iron.

• With your enlarging uterus, you may need to

eat smaller, more frequent meals.

• Track your weight gain in the Resource Section

of this book.

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• Regular exercise helps you keep fit during your

pregnancy and feeling better during a time

when your body is changing.

• Avoid overheating by drinking adequate

amounts of fluids and wearing appropriate

clothing.

Your exercise

Breastfeeding - a great start

• Breast milk is the ideal food for a baby and is

easily digested.

Consider

breastfeeding

Fetal heart

rate:

Fetal heart rate

• This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart rate

Fundal height:

Fundal height

• This measurement will be done at each visit to

monitor the progress of your pregnancy.

Fundal height

My BP:

Your blood pressure

• Blood pressure is measured at every prenatal

visit because high blood pressure can cause

serious complications for baby and mother if

not controlled. It can also be a sign of pre-

eclampsia.

Your weight

Your blood

pressure

68 Prenatal Information Sheet: 36 Week Visit

Fetal movement

count

Fetal movement count

• Review fetal movement count record.

Fetal

Movement

Count:

Fetal

presentation

Fetal presentation

• The location of the baby’s heartbeat in the lower half of your

abdomen is a clue to your baby being in the head down

position.

• If the baby’s position is not head-down, your healthcare provider

will discuss with you what may need to occur.

Group B

Streptococcus

Group B Streptococcus (GBS)

• GBS, bacteria commonly found in the vagina or rectum, can

sometimes be passed on to the baby during labor and delivery.

• Testing will determine if you have GBS.

• Your provider will swab the vaginal and rectal area and send

the specimen to the lab.

• Once completed, test results will be discussed with you at your

next visit.

• If the test is positive, you will receive antibiotics during labor.

See GBS in Resource Section for further information.

Birth plan

• It is anticipated that most women will have spontaneous onset

of labor and deliver vaginally. However, induction of labor with

medications may be required if you have premature rupture

of membranes and labor did not start spontaneously, or if you

developed medical problems that required delivery.

• At times, operative delivery is required (forceps, vacuum, or

cesarean section) to assist in the delivery of your baby. Your

provider will discuss with you if operative delivery is required.

• If you have a birth plan or any special requests, please let your

nurse or healthcare provider know and we will do whatever we

can to accommodate you and your family while also providing

an optimal and healthy outcome. Please keep in mind that not

all birth techniques are considered safe and some may not be a

covered benefit. Although your health care team will try to honor

your wishes, ultimately your safety and your baby’s safety come

first.

Prenatal Information Sheet: 36 Week Visit 69

Preparing for baby’s arrival

• Pack two bags, one for you and one for the baby. The baby’s

bag can stay in the car until after the baby is born. This way

your partner will have less to carry while helping you to Labor &

Delivery.

• Bring things to make you comfortable: washcloths, extra socks,

lip balm, hair items, and basic toiletries. If you wear contact

lenses, be sure to bring your case and a pair of glasses.

• Bring several pair of your oldest panties as you’ll be bleeding

quite a bit for a few days after you give birth.

• Remember your phone and your charger for calls to friends and

family, and for taking pictures and video after the birth!

• If breastfeeding, be sure to bring a nursing bra or two.

• Feel free to bring your own nightgowns or pajamas, slippers,

and robe, but we can also provide these items for your use while

in the hospital.

• You will need your own clothes to go home. Make sure they are

comfortable (stretch pants or sweats are ideal), and, yes, you

may still be wearing maternity clothes for a while.

• For baby: bring an outfit to wear home, a blanket, and a car

seat. You won’t need these until the day of discharge. Now

is a good time to install the car seat in your car and have the

installation inspected by a certified car seat technician.

• Feel free to bring your favorite music and a portable music

player. Your tastes/preferences may change as you move

through the different stages of labor, so you may want a variety

of music options.

Preterm/Labor signs

• Technically, this is the last week your need to report

preterm labor symptoms. Most providers will not attempt to stop

labor at this time in your pregnancy. If your baby is born prior to

39 weeks, it may require an extended stay in a special nursery

for monitoring of temperature, heart rate, and breathing.

• Go to Labor & Delivery if you’re having:

– More than six contractions per hour that do not

ease up with drinking three to four glasses of water, emptying

your bladder, and lying on your side for an hour.

– Leaking of clear fluid, spotting or bleeding.

– Or other preterm labor symptoms previously discussed.

– For further information, see Labor and Deliver Basics in

Resource Section.

Preterm

labor guidelines

Preparing

for

baby’s arrival

70 Prenatal Information Sheet: 36 Week Visit

Summary of visit

Date of next visit: _____________________________

Date for lab work/other medical tests:

____________________________________________

Your next visit

At your 38-41 week visit we will:

• Measure your uterine growth, blood pressure,

and weight, listen to your baby’s heart rate,

review the fetal movement record, assess baby’s

position, and discuss any concerns/questions

you may have.

• Discuss results of Group B Streptococcus (GBS)

culture.

• Offer to complete a vaginal exam to check for

any changes in the cervix.

ALWAYS BRING

YOUR

PURPLE BOOK

AND

PREGNANCY

PASSPORT

TO EVERY VISIT

Questions to ask at next visit:

Things to do before baby arrives:

Prenatal Information Sheet: 36 Week Visit 71

Notes:

38–41 Week Visit

Prenatal Information

Sheet

Goal: Preparing for the delivery and

baby’s arrival at home

38-41 Week Visit

Prenatal Information Sheet: 38-41 Week Visit 75

Prenatal Information Sheet: 38–41 Week Visit

Goal: Preparing for the delivery and baby’s arrival at home

Your baby’s growth

• Your baby probably weighs around 7 pounds now and is about

21 inches in total length.

• Most likely, your baby is in the “head down into the pelvis”

position, but some babies won’t drop into position until a few

days before delivery or until labor begins.

• We know babies are usually mature enough to do very well on

the outside beginning at 39 weeks. Many are ready at 37 to 38

weeks. We also know babies continue to grow well within mom

up to 42 weeks. If you have not delivered by 41 weeks, we will

begin testing to ensure the placenta is functioning well.

• If you are still pregnant, labor will be induced sometime during

your 41st week. Keep in mind that a majority of pregnancies are

anywhere from 37 to 42 weeks long.

Your body’s changes

• While baby’s type of movement may change as he or she takes

up more room in the uterus, it is still important to count and

report any decrease in the number of movements.

• Baby is getting big and you are getting tired. Avoid over-

exhaustion; take frequent breaks and prop your feet up.

• If you have trouble sleeping, try a warm bath before bed, a soothing

massage, pillows between your legs, or sleeping on your side.

• You will be seen by your provider more frequently as your due date

nears to promote a safe delivery for both you and your baby.

Your family’s changes

• Keep in mind that you can deliver anytime from today until 42

weeks of pregnancy. Few babies are born on their due date.

• You and your family may become more frightened and/or

frustrated if you have not delivered. Tips on conquering these

fears and frustrations include:

– Talking them over with your partner, friends, or provider.

– Using relaxation techniques such as deep breathing, music,

quiet walks, afternoon naps, and quiet time alone.

• Enjoy this time with your family and try to rest up for the big

event.

• Review your labor and delivery plans/wishes and coping

techniques with your support person and provider.

Your family’s

changes

Your baby’s

growth

Your body’s

changes

76 Prenatal Information Sheet: 38-41 Week Visit

Your thoughts and feelings

• Some women find that as the due date approaches they become

very anxious about labor and delivery or their ability to care for

a newborn. You may experience mood swings, anxiety, or be

very short-tempered and emotional in these last few weeks of

your pregnancy. These feelings are common.

• It is important to notice how you are feeling and coping. Do not

hesitate to ask loved ones or professionals for assistance.

• Discuss your feelings with someone you trust, and your

healthcare provider, especially if you have been very sad or

depressed in the last couple weeks.

Signs to report

immediately

Signs to report immediately

• When in doubt, call the clinic, your healthcare provider or Labor

and Delivery!

• Bright red bleeding or gush of fluid from the vagina.

• The baby is not moving as much as you expect.

• Any nausea and vomiting.

• Producing a small amount of dark urine or no urine at all.

• Persistent headache (unrelieved by taking Tylenol

• Four or more painful cramping contractions within an hour (after

resting, drinking water and emptying bladder).

• Loss of vision.

• Sudden weight gain.

• Rapid swelling of hands and face.

• Constant right upper belly pain (not related to baby movement).

• Fever at or over 100.4° F or 38° C.

• Thoughts of hurting yourself or others, or any mental health

concerns.

Today’s visit (typical topics)

• We will measure your uterine growth, blood pressure, weight,

listen to your baby’s heart rate, review the fetal movement

record, assess baby’s position, and discuss any concerns/

questions you may have.

• With a vaginal exam, your provider may check for any cervical

opening or thinning.

• Discuss Group B Streptococcus (GBS) results.

You may:

• Sign up for any missed expectant parent or prenatal classes and

L&D tours.

• Make sure all necessary forms are completed and are at the

Admissions Office.

Thoughts

feelings

Today’s visit

Prenatal Information Sheet: 38-41 Week Visit 77

My BP/date:

Your blood pressure

• It is still important to report to your healthcare

provider any severe headache, loss of vision,

sudden weight gain, or rapid swelling of hands

and face.

Your blood

pressure

My weight/

date:

Your weight and nutrition

• Recommendations for total weight gain during

pregnancy depend on pre-pregnancy Body

Mass Index (BMI). Your weight gain is not all

fat. It is mostly water in your body and the

weight of the growing baby.

• Estimate your pre-pregnancy BMI and track

your weight gain on pages 136 and 137 of this

book.

• The following table provides more information

regarding recommended weight gain for

women carrying one baby. Ask your healthcare

provider about weight gain recommendations if

you are pregnant with twins.

Pre-pregancy Weight (BMI in kg/m

Recommended Weight Gain

Underweight (BMI <18.5) 28 – 40 lbs

Normal Weight (BMI 18.5 – 24.9) 25 – 35 lbs

Overweight (BMI 25.0 – 29.9) 15 – 25 lbs

Obese (BMI ≥30.0) 11 – 20 lbs

Abbreviations: BMI - Body Weight Index; kg - kilograms(s); lbs - pounds;

m - meters

• Weight gain generally slows down or ceases

towards the end of your pregnancy.

Your weight

Reference:

Prenatal

Fitness and

Exercise

Your exercise routine

• Continue your exercises but modify intensity to

avoid fatigue.

• Don’t forget to finish your exercise with an

adequate cool down and relaxation period.

• See Exercise in Resource Section for further

information.

Your exercise

78 Prenatal Information Sheet: 38-41 Week Visit

Breastfeeding - a great start

• Breastfeeding for even a few weeks has long term health

benefits for the baby and mom.

• Drinking plenty of water will help maintain your milk supply.

• Breastfeeding is not for every mother. Your decision will

depend on lifestyle, desire, time and support.

Fetal heart rate

• This measurement will be done at each visit to

monitor your baby’s well-being.

Fetal heart

rate/date:

__________

Fundal height

• Measure uterine growth, and check to see

if baby is dropping into the pelvis. You may

feel this “drop” as an increase in frequency of

urination and easier breathing.

Fetal movement count

• See Fetal Movement Count record. Complete

Fetal Movement Count daily.

Cervical sweeping

• Towards the end of pregnancy, the cervix

will start to prepare itself for going into labor.

This preparation or “ripening” results in

cervical softening (effacement) and opening

(dilatation). The part of the membranes that

was over the cervical opening can now

usually be felt by a vaginal exam.

• If indicated, your provider may examine your

cervix at this visit. Some providers may offer

you cervical sweeping. This is done by your

provider inserting a gloved finger between

the membranes and the inner wall of the

cervix. The finger is then swept in a circular

motion around the inner cervix to separate the

membranes from the cervical wall.

• Most women will find this process

uncomfortable. Some women, but not many,

will get some contractions and some vaginal

spotting as a result of this procedure. Some

(but not many) will actually go into labor!

Cervical Exam

Date: _______

__________cm

__________%

______station

Cervical Exam

Date: _______

__________cm

__________%

______station

Consider

breastfeeding

Fetal heart rate

Fundal height

Fetal movement

count

Weekly cervical

sweeping

Prenatal Information Sheet: 38-41 Week Visit 79

Postdate pregnancy plan

• If you have not delivered by the end of

your 40th week, you will begin a postdate

pregnancy plan.

• This plan may include:

– Non-stress tests twice a week.

– Weekly ultrasound measurement of amniotic

fluid levels.

– Continued daily fetal movement recording.

– Induction should be offered to women who

reach 41 weeks.

Labor and Delivery

• Hopefully, by now, you have toured the Labor

& Delivery area, are pre-admitted, have

transportation and child/pet care arranged,

and have your phone and charger in your bag.

• Expect to be a little nervous. The big event is

about to happen!

• Prior to admission, you will probably be given a vaginal

exam to determine where you are in labor. Your vital signs

will be taken and the baby will be monitored.

• If you are in active labor or your bag of water broke or you

need close observation, you will be admitted and taken

to a labor room where your baby’s heart rate and your

contractions will be monitored by an external fetal monitor

(same monitor as used for the non-stress test you may have

had). You will have your blood drawn and possibly an IV

started at this time.

• Now you and your partner get to put all that practice to

work! Remember each contraction puts you one contraction

closer to holding your baby.

• If you have any special requests, such as having your partner

cut the cord, or you want to breast feed immediately after

delivery, let the staff know now. Don’t forget your phone and

charger for your baby’s very first pictures.

• Right after the baby is born is a good time to put your baby

to breast. Getting your baby and you skin-to-skin is great for

both of you. This serves two functions: helps you bond with

your new baby and decreases your blood loss by contracting

your uterus.

• Your placenta usually delivers within 30 minutes after the

baby is born. You may be too occupied with baby to take

much notice.

When you are

admitted

Postdate

pregnancy plan

80 Prenatal Information Sheet: 38-41 Week Visit

Postpartum (after the delivery)

• Even though you have worked hard and long to bring about

this birth, most mothers are too excited to sleep. Enjoy this time

but sleep when you can. Getting enough rest will decrease your

irritability, help you feel better, and help in your recovery.

• The staff will be checking on both you and your baby frequently

during this postpartum period. These checks are done to ensure

both of you are doing well.

• If your baby is a male, you will need to decide on whether or

not to have him circumcised. This procedure may be done prior

to hospital discharge. While there may be health benefits, at

present, there is not enough medical evidence to recommend

routine circumcision. Circumcision is a personal decision based

on cultural, health, and religious beliefs.

• If you are having any problems caring for your newborn, let the

staff know immediately. They are there to help you feel more

comfortable and secure in your new role.

• The nursing staff will go over the basics of self and infant care.

Ask questions and make sure you understand the information you

are given.

Going home

• Appointments: At the time of discharge, you will be given

information regarding follow-up appointments to be made for

you and your baby.

• Car seat: Before leaving the hospital, your car seat will be

evaluated and instructions given. The safest place for a newborn

car seat is in the middle of the back seat facing the rear. Learn

more about the proper use of car seats and booster seats at

https://www.nhtsa.gov/equipment/car-seats-and-booster-seats.

• Family Planning: If you need a prescription for birth control, get

it before leaving the hospital.

• Immunizations:

– If your chicken pox and rubella titers indicate you have not had

these diseases you will be given the vaccines to prevent these

diseases in the future.

– If you have not received the flu vaccine, you may receive it

prior to hospital discharge.

– If you are less than 26 years old, we recommend that you

receive the series of three immunizations of the Human

Papilloma Virus (HPV) vaccine. If you have not had it, the first

dose is given after your delivery before discharge from the

hospital, with follow-up repeat immunizations at two months

and at six months after the first immunization.

Postpartum

(after the

delivery)

Going home

Prenatal Information Sheet: 38-41 Week Visit 81

• DEERS: If you or your spouse is active duty military, you must

stop by the Military Personnel Office or the nearest DEERS office

to enroll your baby in DEERS soon after discharge. At this time

you should receive the forms to enroll your baby in TRICARE.

Complete these forms and forward them to your local

TRICARE office.

• VHA Directive 1330.01(2): Health Care Services for Women Veterans

– Additional information regarding VA coverage for a woman veteran’s

newborn can be found on page 102.

• Shaken Baby Syndrome: Going home with a newborn is an exciting but

challenging time. Babies cry for many reasons: when they are hungry, feel

uncomfortable, have pain, or when they just want to be held. At times, no

matter what you do, the baby will not stop crying. This can be very frustrating

for parents and caregivers. It is important that no one ever shakes your infant

for any reason. If you or your partner are having trouble calming your infant,

put your baby in the crib, take a deep breath and call for help from a friend

or contact your baby’s provider as soon as possible to receive help with this.

Additional help may be obtained from the local New Parent Support Program,

telephone number:______________________________

• Intimate Partner Violence: IPV may increase during the postpartum period as

the family adjusts to the changes of adding a baby. Please do not hesitate to

seek help from your healthcare provider, counselor or a close friend if you are

experiencing physical, sexual, or emotional abuse. The National Domestic

Violence Hotline Advocates are available 24/7 at 1-800-799-SAFE (7233) in

more than 200 languages. All calls are free and confidential.

• Postpartum: Many new mothers experience the “baby blues”. This is a very

common reaction during the first few days after delivery. The “baby blues”

may include crying, worrying, sadness, anxiety, mood swings, difficulty

sleeping and not feeling like yourself.

“Baby blues” is not the same as postpartum depression and does not require

medical attention. With time, patience, and the support of family and friends,

“baby blues” will usually disappear within a few days. If “baby blues” persist

or worsen it may be a sign of a bigger problem. You should contact your

provider prior to your scheduled postpartum visit.

Going home

82 Prenatal Information Sheet: 38-41 Week Visit

Post-delivery appointment for newborn

• At the baby’s first appointments, your baby will

be measured, weighed, and receive a complete

physical exam.

• Parenting concerns such as feeding, bowel

movements, sleep, and number of wet diapers

will be discussed.

• Be sure to write down questions you have and

bring them with you to this visit.

• If you, your baby, or your family are having

problems adjusting, be sure to let your health

care provider know.

Additional signs to report

• Prior to your six-week check-up,

call your healthcare provider if you

experience:

– Fever greater than 100.4° F or 38° C.

– Burning with urination.

– Increased pain near your vagina or surgical

site.

– Foul smelling vaginal discharge, or discharge

from your C-section incision.

– Swollen, painful, hot, red area on your leg or

breast.

– Extended periods of hopelessness or

depression (more than two to three days a

week).

– Thoughts of hurting yourself or others, or any

mental health concerns.

Your post-delivery appointment

Prior to when you leave the hospital, you will be

instructed to schedule a post-delivery appointment

for 6-8 weeks after you gave birth.

• You will receive a complete physical exam,

possibly including a Pap smear.

• During this visit, your healthcare provider will

review the following with you:

– Family planning

– Your adjustment to parenthood

– Signs of postpartum depression

• You may receive an HPV immunization.

Post delivery

appointments

Additional signs

to report

Your next visit

Prenatal Information Sheet: 38-41 Week Visit 83

Your post delivery appointment

• If you are especially sad or “blue” in the weeks after the

birth of your baby, contact your provider to discuss this

prior to this visit. Many new mothers get the baby “blues”

for a few days after delivery but it usually doesn’t last very

long. Postpartum depression is more intense and lasts longer.

With postpartum depression, signs and symptoms such as

overwhelming fatigue, insomnia, loss of appetite, lack of

joy in life or thoughts of harming yourself or your baby

may actually interfere with your ability for care for yourself

and your baby.

Your next visit

84 Prenatal Information Sheet: 38-41 Week Visit

Do you think you will be like your mother or different when you

consider what kind of parent you will be?

How do you visualize yourself as a mother (warm, caring, strict,

etc.)?

Write a few words to describe how you feel as a new mother:

Prenatal Information Sheet: 38-41 Week Visit 85

Notes:

Post Delivery Visit

6–8 Weeks

After Delivery

Information Sheet

Goal: Determine health status and promote

adjustment to being a mother and parent

Prenatal Information Sheet: 6-8 Weeks After Delivery 89

Post Delivery Information Sheet: 6-8 Weeks after Delivery

Goal: Determine health status and promote adjustment to being a

mother and parent

Your body’s changes

• As soon as the baby is born your uterus starts to get smaller. By

the time of your postpartum check it should be almost back to the

size it was when you became pregnant.

• You should gradually return to your pre-delivery weight.

Combining a healthy diet with exercise will help you lose weight

and get safely back in shape after delivery.

• It is difficult to predict when you will ovulate after delivery. (This

is why it is very important that you always use birth control

whenever you have sex if you do not plan to become pregnant.)

Your body’s

changes

Your family’s changes

• Your baby is here! What an exciting and challenging time for

everyone as you each adjust to the changes of a growing family.

• You and your partner may both have moments when you

feel anxious or sad. You may both worry about money, your

relationship or the future – not to mention being good parents.

Make time to talk with one another about your concerns.

Involve your partner in your activities and look for other ways to

maintain a relationship. Set aside some time for the two of you to

spend alone together.

• Your partner may feel “left out” because of all the attention you

are giving to the baby. Remember to involve your partner in

activities to help care for the baby.

Your thoughts and feelings

• You may find you have less interest than you expected in having

sexual intercourse with your partner. There are several reasons

for this. One is that the demands of a baby leave you

exhausted. Additionally, your body is still adjusting to changing

hormone levels and the birthing process.

• Discuss your feelings with someone you trust and your

healthcare provider, especially if you have been very sad or

depressed.

• Remember to make time for yourself. If you are feeling especially

tired or stressed leave your baby with someone you trust and

take time to do something relaxing such as going for a walk,

going for a pedicure or just taking a long bath.

Thoughts

feelings

Your family’s

changes

90 Prenatal Information Sheet: 6-8 Weeks After Delivery

Breastfeeding - a great start

•The American Academy of Pediatrics, the American College

of Nurse-Midwives, the American College of OB/GYN, and

the American Dietetic Association all strongly recommend

breastfeeding for at least your baby’s first 12 months of life.

• Consider exploring community breastfeeding groups such La

Leche League. This is an excellent opportunity to get to know

other breastfeeding mothers.

• Discuss any breastfeeding concerns with your provider at this

visit.

• See Breastfeeding in Resource Section for further information.

Today’s visit (typical topics)

• A complete physical exam with a pelvic and breast examination

will be done to see if your body has returned to normal.

• Pre-existing medical conditions will be reviewed to help you

determine a follow-up plan.

• If you had gestational diabetes in your pregnancy, additional lab

work will be ordered.

• Your birth control method will be reviewed and revised as

needed.

• A post-delivery depression screening will be completed (see

page 153 for more information).

• Receive a domestic abuse screening.

• If you have not already completed the HPV vaccination series,

and you want to be vaccinated, your next immunization will be

given.

• If you are going back to work or need a release from your

healthcare provider to return to duty, be sure to let them know

during this visit.

• This is likely the last time you will see your healthcare provider

for a year or so. Do not hesitate to ask any questions you have

about your recovery or concerns you have.

• Your newborn is usually welcomed to accompany you to this

visit. Check with your clinic. If you are bringing your newborn,

bring a carriage or car seat for him/her to use during the exam.

Today’s visit

Consider

breastfeeding

Prenatal Information Sheet: 6-8 Weeks After Delivery 91

My baby’s name:

Date/Time of birth:

Weight/Length:

My labor was - as expected / different than expected:

My support person/coach was:

Others present at delivery:

Things I want to remember:

Prenatal

Information

Resources

Prenatal Information Sheet: Resources 95

YOUR PREGNANCY IN THE ARMY

Information for Active Duty Service Members

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, and

whether your pregnancy was expected or a bit of a surprise, we want your

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone

women on active duty in the military, can be a challenging experience. The Army

has joined our sister services to create a plan of care, based on the best available

current medical evidence, that will maximize your chances of a successful

pregnancy. Our goal is to provide you with the care and education you need

to take home a healthy baby and be optimally prepared to care for your new

addition. After all, your baby will be a new member to our Army family.

The plan of care and educational materials that are associated with these

pregnancy guidelines as well as the requirements/limitations listed on your

pregnancy profile will serve as a framework for your care during your pregnancy.

There may be occasion to deviate from these guidelines due to your specific

circumstances, potential pregnancy complications, local practices, and new

medical information. Please remember these are guidelines and are not a substitute

for specific recommendations made by a qualified provider.

Maternity uniforms

You will be provided two sets of maternity uniforms. At most posts, you will need

to take a memorandum from your Commander requesting the issue and a copy of

your pregnancy profile showing your due date to the Central Issuing Facility (CIF)

or the unit supply room. These uniforms will be turned in upon your return from

convalescent leave. Check with your command to inquire about specifics.

Pregnancy profile

Upon confirmation of your pregnancy (by examination or a lab test), you will be

provided a physical profile which lasts until the end of your pregnancy. Activities

that are acceptable during pregnancy are specifically noted in the profile and

include: specific stretching, aerobic conditioning at own pace, and lifting up to 20

pounds. Limitations specific to your duty will be indicated in your profile.

You are exempt from regular physical training (PT) and Army Physical Fitness

Testing (APFT) / weight standards for the remainder of your pregnancy and for

180 days past delivery. After receiving medical clearance from your provider,

Commanders will enroll Soldiers in the Army Pregnancy/Post-Partum physical

training (PPPT) program. This will help you maintain health and fitness and prepare

you for your APFT.

It is critical that you maintain a copy of your current profile with you at all

times. When you receive your profile, make an appointment to meet with your

Commander to complete your pregnancy counseling. This is also a good time to

start thinking about your family care plan.

96 Prenatal Information Sheet: Resources

Convalescent leave

• Maternity Convalescent Leave – is six weeks (42 days) of non-chargeable

leave that is given to a female Soldier by her physician after she

gives birth and before she is discharged from the hospital. Maternity

Convalescent Leave begins on the on the first full day after the Soldier

leaves the hospital.

• Primary Caregiver Leave – is six weeks (42 days) non-chargeable leave

for the service member who gives birth or to the parent (Soldier) who

is designated with the primary responsibility for caring for the child or

children following a birth. If the parent (Female Soldier) gives birth is also

designated as the Primary Caregiver, maternity convalescent leave must

be completed before the Primary Caregiver Leave may begin.

• Secondary Caregiver leave – is 21 days of non-chargeable leave for the

parent (Soldier) not designated with the primary responsibility of caring

for the infant following birth.

Postpartum profile

Prior to beginning convalescent leave, all postpartum soldiers will also be issued a

postpartum profile. The temporary profile will be for 45 days and it begins on the

day of child birth and allows for Physical Training (PT) at the Soldier’s own pace.

If a Soldier decides to return early from convalescent leave, the temporary profile

remains in effect for the entire 45 days. Participation in a postpartum PT program

is highly encouraged to assist you in returning to the required fitness standards and

to help transition you back to unit PT.

Army Physical Fitness Test (APFT)

You are exempt from the Army Physical Fitness test (APFT) during pregnancy and

for 180 days following delivery. At the end of 180 days, you will take a record

APFT. Your unit may have you take diagnostic APFT in preparation for the record

test.

Both parents active duty

Both parents will need to update their Service members’ Group Life Insurance and

DD93, Record of Emergency Data. Also, both parents will need to let their unit

command know of the new family member. Only the sponsor needs to enroll the

baby in DEERS and TRICARE. Notify the Personnel Administration Center (PAC) of

your new family member.

Congratulations again on the exciting road ahead of you!

97 Prenatal Information Sheet: Resources

References

U.S. Army Public Health Command, Directorate Health Promotion and

Wellness (2010). U.S. Army Pregnancy Postpartum Physical Training Program

Implementation Guide (TG 255A).

https://phc.amedd.army.mil/topics/healthyliving/wh/Pages/Women’sHealth

Portal-Pregnancy.aspx

Comment: Search on Pregnancy Postpartum Physical Training (P3T)

Site provides a succinct summary of the information contained in the specific

references listed below.

AR 40-501 Standards of Medical Fitness, Pregnancy and Postpartum Profiles

AR 614-30 Assignments, Details, and Transfers, Overseas Service in

Pregnancy

AR 600-8-10 Leaves and Passes, Convalescent Leave After Pregnancy and

Childbirth

Army Directive 2019-05 (Army Military Parental Leave Program)

http://www.apd.army.mil

Comment: Navigate through Official Documents, Army Administrative

Publications

Site details considerations in pregnancy.

DoD Directive 1308.1 DoD Physical Fitness and Body Fat Program

Prenatal Information Sheet: Resources 98

YOUR PREGNANCY IN THE NAVY/MARINE CORPS

Information for Active Duty Service Members

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, and

whether your pregnancy was expected or a bit of a surprise, we want your

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone

women on active duty in the military, can be a challenging experience. The Navy

has joined our sister services to create a plan of care, based on the best available

current medical evidence, that will maximize your chances of a successful

pregnancy. Our goal is to provide you with the care and education you need

to take home a healthy baby and be optimally prepared to care for your new

addition. After all, your baby will be a new member to our Navy/Marine Corps

family.

The plan of care and educational materials that are associated with these

pregnancy guidelines as well as the requirements/limitations listed on your

pregnancy profile will serve as a framework for your care during your pregnancy.

There may be occasion to deviate from these guidelines due to your specific

circumstances, potential pregnancy complications, local practices, and new

medical information. Please remember that these are guidelines and are not a

substitute for specific recommendations made by a qualified obstetrical health care

provider.

Maternity Uniforms

The certified maternity uniform is mandatory for all pregnant servicewomen in

the Navy when the regular uniforms no longer fit. The outer garments (sweater,

raincoat, overcoat, peacoat and reefer) may be worn unbuttoned when it no

longer fits properly. You are expected to wear regular uniforms upon returning

from convalescent leave; however, your Commanding Officer (CO) may approve

the maternity uniforms for up to six months from the date of delivery. Enlisted

servicewomen will be given a clothing allowance upon presenting the pregnancy

notification to Personnel Support Detachment (PSD).

Statement of Pregnancy

You will be provided with a Pregnancy Notification Form for use in notifying

your CO. This form will identify your Estimated Due Date (EDD), the 20th week

of pregnancy, and the 28th week of pregnancy. These dates are used by your

command for planning purposes. The OPNAVIST 6000.1 Series and MARINE

CORPS ORDER 5000.12 Series provide guidance and detailed information

regarding assignments and rest periods in relation to a servicewoman’s pregnancy

time line.

Limitations

Few restrictions are required in an uncomplicated pregnancy of a physically fit

servicewoman working in a safe environment. You are exempt from standing at

parade rest or attention for longer than 15 minutes; lying in a prone position for a

prolonged period; working in one position for prolonged periods; and performing

prolonged work at heights.

99 Prenatal Information Sheet: Resources

You are also exempt from participating in weapons training; swimming

qualifications; drown proofing; diving; lifting greater than 25 pounds; exposure to

excessive heat or vibration; and any other physical training requirements that may

adversely affect the health of the servicewoman/fetus.

During the last three months of pregnancy (weeks 28 and beyond) you will be

allowed to rest 20 minutes every four hours and limited to a 40-hour work week

(pregnancy does not preclude watch standing but all hours will count as part of the

40-hour work week). You may request a waiver to extend your hours beyond 40

hours if your health care provider concurs.

Physical Readiness Program (PRP)

You are exempt from the PRP during pregnancy and for six months following

delivery. However, if you have an uncomplicated pregnancy you are encouraged

to perform an individualized exercise program that incorporates regular to

moderate exercise for 30 – 45 minutes, three or more times a week. An exercise

program should be gradually resumed six weeks after an uncomplicated vaginal

delivery or cesarean delivery.

Military Parental Leave Program (MPLP)

The Navy Parental Leave Program policy applies to all active duty Sailors. Reserve

Sailors who were performing active duties, or mobilized more than 12 continuous

months, and are the parents of a qualifying birth are also eligible.

The three family leave categories under the MPLP are:

• Maternity Convalescent Leave is a six-week (42 days), non-chargeable

leave period for the Sailor who gives birth, commencing the first full day

after a Sailor is released from the hospital following a birth.

• Primary Caregiver Leave is a six-week (42 days) non-chargeable leave

period for the parent who gives birth or is designated with primary

responsibility for caring for the child or children following a birth. If the

parent who gives birth is designated as the Primary Caregiver, then then

Maternity Convalescent Leave must complete before the Primary Caregiver

Leave begins.

• Secondary Caregiver leave is a two-week (14 days) non-chargeable leave

period for the parent not designated with primary responsibility for caring

for the child following a birth.

Details about the leave periods are described in MILPERSMSAN 1050-415,

Parental Leave Program.

Useful policy references

OPNAVINST 6000.1 Series: Guidelines Concerning Pregnant Servicewomen

MARINE CORPS ORDER 5000.12 Series: Marine Corps Policy on Pregnancy and

Parenthood

MARINE CORPS ORDER P6100.12 Series: Marine Corps Physical Fitness Test and

Body Composition Program Manual

100 Prenatal Information Sheet: Resources

OPNAVINST 6110.1 Series: Physical Readiness Program

OPNAVINST 1740.4 Series: U.S. Navy Family Care Policy

MARINE CORPS ORDER 1730.13 Series: Family Care Plans

NAVMEDCOMINST 6320.3 Series: Medical and Dental Care for Eligible Persons

at Navy Medical Department Facilities

MILPERSMSAN 1050-415, Parental Leave Program.

References

https://www.med.navy.mil/Pages/default.aspx

https://www.hqmc.marines.mil/

http://www.bupers.navy.mil/

Prenatal Information Sheet: Resources 101

YOUR PREGNANCY IN THE AIR FORCE

Information for Active Duty Service Members

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, and

whether your pregnancy was expected or a bit of a surprise, we want your

pregnancy to be healthy, happy and successful. Pregnancy for anyone, let alone

women on active duty in the military, can be a challenging experience. The

Air Force has joined our sister services to create a plan of care, based on the

best available current medical evidence, that will maximize your chances of a

successful pregnancy. Our goal is to provide you with the care and education you

need to take home a healthy baby and be optimally prepared to care for your new

family member. After all, your baby will be a new member to our Air Force family.

The plan of care and educational materials that are associated with these

pregnancy guidelines as well as the requirements/limitations listed on your

pregnancy profile will serve as a framework for your care during your pregnancy.

There may be occasion to deviate from these guidelines due to your specific

circumstances, potential pregnancy complications, local practices, and new

medical information. Please remember that these are guidelines and are not a

substitute for specific recommendations made by a qualified obstetrical health care

provider.

Maternity Uniforms

Enlisted personnel will receive a lump sum maternity uniforms allowance. You must

take your profile, signed by your Commander to the orderly room. The staff will

forward this to Finance and you should receive your payment within one month.

We advise you do this early in your pregnancy so that you receive your payment

and purchase uniforms before you grow out of your regular uniforms. This payment

is enough to purchase one maternity blues set, ABU set and dress blues set. Visit

your Airman’s Attic on base for spare sets of maternity uniforms.

Profile

Within 24 hours of notification of your positive pregnancy test, you are required

to go to Force Health Management (FHM) for initiation of your pregnancy profile

and Occupational Health Assessment. The pregnancy profile outlines some

requirements and limitations regarding your activity during your pregnancy.

You will receive a memorandum from FHM that will serve as a temporary profile

until the Profile Reviewing Officer has validated your profile. As an Air Force

service member, it is your responsibility to notify your supervisor regarding your

pregnancy soon after pregnancy is diagnosed (AFI 48-123). Your supervisor,

commander and Unit Deployment Manager will receive a copy of your profile via

e-mail immediately upon validation.

102 Prenatal Information Sheet: Resources

Limitations

The pregnancy profile limits requirements for physical training, body weight

requirements and environmental exposures. During your pregnancy and for six

months following delivery, you are not worldwide qualified and must be removed

from mobility status.

Physical Training (PT)

Although you are not required to perform formal physical training or weigh-ins,

we strongly encourage you to eat a healthy diet and perform moderate exercise

during your pregnancy. Most facilities offer programs on appropriate exercise,

health diet, tobacco cessation, labor and delivery, new mom classes and other

programs, specifically for pregnant women. We encourage you to take advantage

of these programs as well as some of the many other activities and resources that

are available to you during your pregnancy.

Convalescent Leave

Maternity convalescent leave is six weeks (42 days), primary caregiver leave is six

weeks (42 days), and secondary caregiver leave is three weeks (21 days). Every

birth mother will have convalescent leave. Caregiver leave is given in addition to

the convalescent leave.

Details about the leave periods are described in Air Force Guidance Memorandum

2018-01 to AFI 36-3003, Military Leave Program, and AFI 36-3003, Military

Leave Program.

Congratulations again on the exciting road ahead of you!

References

Air Force Guidance Memorandum 2018-02 (AFGM2018-02) to AFI 44-102

AFI 44-102 Medical Care Management

(Section 4D. Medical Care Related to Pregnancy)

AFI 10-203, Duty Limiting Conditions

(Section 3.5. Pregnancy-related Duty Limitations)

AFI 36-2905 Fitness Program

(Section 5.2.4. Pregnancy)

Air Force Guidance Memorandum 2018-01 to AFI 36-3003

Air Force Instruction 36-3003, Military Leave Program.

http://www.operationalmedicine.org/ed2/Instructions/Instructions.htm

Prenatal Information Sheet: Resources 103

DEPARTMENT OF VETERANS AFFAIRS (VA)

Maternity Care Benefits for Eligible Veterans

Congratulations!

Whether you are pregnant for the first time or are an experienced mother, we

want your pregnancy to be healthy, happy and successful. Many people are

unaware the Veterans Health Administration (VHA) is authorized to provide

comprehensive pregnancy and postpartum care to eligible women Veterans. If

eligible, maternity benefits begin with the confirmation of pregnancy and continue

through the final post-partum visit, usually at six to eight weeks after the delivery or

when you are medically released from obstetric care.

Most VA Medical Centers do not have obstetrical services “in-house”. Obstetrical

(OB) care is covered by the VA through the Office of Community Care and

provided by authorized maternity care providers in the community. Community

care is routinely used to provide maternity care within a reasonable distance of

your home. The VA covers pregnancy related care and delivery services. This

includes, but is not limited to coverage for required laboratory and ultrasound

tests in pregnancy. You will receive an Authorization for Care letter with details of

your maternity coverage. You should carry this with you to every visit as proof of

coverage. This will help to avoid errors in billing. If an error does occur and you

receive a bill, contact your Office of Community Care.

Once your pregnancy is confirmed, your VA provider and Maternity Care

Coordinator (MCC) or designee will discuss with you all aspects of maternity care

that will be covered. Every facility has an Office of Community Care. Personnel at

your local Community Care office can help explain the process to the OB provider

you choose. They will also be able to determine if the OB provider of your choice

will accept VA payment terms. In some cases you may be asked to choose another

OB provider. It is important for you to make your OB appointment as soon as

possible. The earlier you start prenatal care, the better for you and your baby.

Please discuss coverage for newborn services with your facility Maternity Care

Coordinator (MCC) or designee. These individuals and the Office of Community

Care can assist you with information regarding current newborn health coverage.

Newborn care is furnished for not more than 7 days after the birth of a child.

Newborn care includes but is not limited to inpatient care, outpatient care,

medications, immunizations, circumcision, well-baby office visits, neonatal

intensive care, and other appropriate post-delivery services.

SPECIALTY CARE WHILE PREGNANT: During the pregnancy, if medical concerns

come up and your OB provider thinks you need to see another specialist or need

additional procedures, the OB provider can refer you to a Community specialist

by submitting a Request for Service Form. Depending on the urgency, of the

procedure, the request should be telephoned, faxed or e-mailed securely to the

Office of Community Care. This will allow the OB doctor and hospital to be paid

for the services performed. It is important to present your VA Authorization for

Care letter at all of your specialty care visits.

104 Prenatal Information Sheet: Resources

Make sure that when you see your OB provider you get their emergency contact

information and you know where to go for emergencies. Since most VA Medical

Centers do not have obstetrical services “in-house”, you should go to the hospital

your OB provider recommends if you have a pregnancy related emergency.

FOLLOWING UP DURING AND AFTER YOUR PREGNANCY: Keep in contact with

your local Maternity Care Coordinator or designee during your pregnancy. Make

sure you have a follow-up appointment with your VA provider after the birth of

your baby (within three to six months). Request a copy of your Obstetric records

from your OB provider to be sent to your local VA facility.

My Maternity Care Coordinator or designee is

_______________________________________________________

Maternity Care Coordinator or designee Telephone Number

_______________________________________________________

Office of Community Care Contact Person

_______________________________________________________

Office of Community Care Telephone Number

_______________________________________________________

Prenatal Information Sheet: Resources 105

Partners and Pregnancy

Most partners feel both excited and anxious about the upcoming changes in

their lives. You can help your partner by being understanding of the changes a

pregnant woman may experience and by being prepared and supportive. Your

support contributes to a healthy pregnancy and often helps make labor and

delivery easier.

Emotional Aspects of Pregnancy

Pregnancy can be an emotional journey for both you and your partner. You may

feel isolated as she focuses on her changing body and emotions. It will be helpful

if you attend prenatal visits together. Also, read materials about pregnancy and

parenthood with her.

Pregnancy and Sex

Sexual intercourse is permitted during the entire pregnancy unless your partner’s

provider has told her otherwise. The baby is cushioned within the “womb” and

there is no way to harm the baby during normal sexual relations. However, there

may be times when your partner may not feel comfortable having intercourse.

Remember to be patient and supportive of her feelings.

Partner’s Checklist before Delivery

• Did you take a tour of the hospital?

• Did you and your partner attend prenatal classes?

• Is the hospital pre-admission paperwork completed?

• Do you know your partner’s wishes regarding pain relief during labor?

• Do you want to cut the umbilical cord?

• Do you have a car seat for baby? Do you know how to install it in your

vehicle?

• Do you have cash/change ready for late night vending machine trips?

• Do you have a bag packed? (Things you may want to help you

and her through labor.) Be sure to add your camera or phone.

• Do you have a list of people to contact after the birth?

How to Help During Labor and Delivery

Remember, you are the “coach” during labor and delivery. Being supportive and

staying calm is important.

• During early labor, you can help your partner by going for a walk,

listening to music, or watching a movie with her.

• The “coach” can time contractions from the beginning of one

contraction to the beginning of the next contraction.

• Offer a massage or apply pressure to her back if that relaxes her.

• Help her to focus on something when she is having a contraction and

remind her to breathe. Slow deep breathing can be very relaxing.

Breathe with her.

• Stay calm with a relaxing tone in your voice.

• Encourage her during the pushing stage.

106 Prenatal Information Sheet: Resources

Military Parental Leave

If you are on active duty, discuss parental leave policies with your supervisor. As

a primary or secondary caregiver, you may be eligible for non-chargeable leave

following the birth of your child.

The Postpartum Period

Typically, women will stay in the hospital for one to two days. Have the car seat

installed so you are ready to take your new baby home when your partner is

discharged from the hospital.

If mother is breastfeeding, some partners may feel left out of the bonding process.

You can help her by changing the diaper before bringing the baby to her to

nurse. After the feeding, you can burp the baby and rock the baby to sleep.

Breastfeeding does allow an active role for both the woman and her partner.

Some partners may enjoy bathing the baby.

Sexual Intercourse after Delivery

There is no set time frame before a woman can have sex again after giving

birth. Some health care providers recommend waiting four to six weeks. You and

your partner should discuss with her health care provider when to resume normal

sexual relations.

When your partner does feel ready to have sex again, remember to go slow

and listen to her. Even if a woman is not having a period or is breast-feeding,

she can ovulate. You should use some type of birth control when you start

having sex again, if pregnancy is a concern for you and your partner. For

additional information about birth control, visit CDC site: https://www.cdc.gov/

reproductivehealth/contraception/index.htm.

References

2009 National Defense Authorization Act

Prenatal Information Sheet: Resources 107

fallopian tube

ovary

uterus

bladder

pubic bone

sacrum

cervix

vagina

rectum

perineum

Pre-pregnant anatomy

(side view)

fetus

amniotic sac

uterus

bladder

pubic bone

sacrum

cervix

mucus plug

vagina

rectum

perineum

fundus

placenta

umbilical cord

(bag of waters)

Pregnant anatomy

(side view)

108 Prenatal Information Sheet: Resources

Notes:

Prenatal Information Sheet: Resources 109

Common Discomforts & Annoyances of

Pregnancy

All these discomforts/annoyances are a common part of pregnancy and usually

end eventually. Try the hints given below. If you don’t get relief, talk to your

provider or nurse about other possible measures to try.

Discomfort When What you can do to help Notify provider if:

Ankle/foot

swelling

Second

trimester

until

delivery

• While sitting, prop your feet up

(even a few inches up helps)

and do not cross your legs.

• Continue drinking lots of fluids

(at least 8 glasses daily).

• Wear comfortable shoes or

sandals and avoid high heels.

• Consider support hosiery.

• Redness in legs

• Increasing pain/

redness in calves

Breast

tenderness

Begins

early and

continues

• Wear well fitted, good support

or athletic bra day and night.

• Soak in a warm bath.

• Redness in breast

• Fever

Breast

leakage

May begin

second

trimester

• Wear pads in bra.

• Avoid harsh soaps or creams.

• Red/pinkish discharge

from breasts

• Fever

Bleeding

gums

Entire

pregnancy

• Use a very soft tooth brush.

• Get routine dental care.

• Gently brush teeth at least

twice daily.

• Floss daily.

• Use good dental hygiene.

• More than slight

bleeding from gums

• Pain in teeth

• Pus from gums

Constipation

Entire

pregnancy

• Eat foods high in fiber (bran,

green leafy vegetables, whole

grain cereals/breads, fruits)

daily.

• Drink at least 8 - 10 glasses of

fluids daily.

• If approved by your provider,

exercise daily (this will help

move food through the bowel).

• Walk after meals.

• Do not take stool softeners,

laxatives, or enemas unless you

talk with your provider.

• Blood in stool

• Abdominal pain

• No bowel movements

over extended period

of time

110 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Contractions

(Braxton

Hicks)

After 20th

week

• Know this is part of your uterus

getting “ready” for labor.

• Empty bladder and drink 2 - 3

glasses of water.

• Lie down on your side with

hands on belly.

• Keep track of how often these

occur.

• Regular contractions

that do not go away

• Painful contractions

• No improvement in

symptoms

• History of preterm

labor

Dizziness

As your

uterus

enlarges

• Move slowly when getting up

from lying down or sitting.

• Eat small, frequent meals and

healthy snacks with protein to

avoid low blood sugar.

• Drink lots of fluids especially if

exercising or in hot weather.

• If dizzy, lie down on your side.

• Persistent dizziness

• Feeling faint

• You have diabetes

• Shortness of breath/

chest pain

• Vaginal bleeding or

abdominal pain

Enlarging

belly and

breasts

Second

half of

pregnancy

• Sleep on your side with a

pillow between your legs.

• Wear loose, comfortable

clothes.

• Wear support bra even to bed.

• Use maternity support belt.

Fatigue or

tiredness

Early in

pregnancy

and again

in the last

month

• Take extra naps during the day

if possible.

• Avoid fluids before bedtime.

• Continue mild exercise but not

to the point of exhaustion.

• Try to get at least 8 hours sleep

at the same time each night.

Flatulence

(gas)

Anytime,

especially

after 20

weeks

• Eat foods high in fiber daily.

• Drink at least 8 glasses of

water daily.

• Avoid gas-forming foods such

as beans, cabbage and sodas.

• If approved by your provider,

exercise daily.

• Walk after meals.

Food

cravings

First half of

pregnancy

• OK to indulge if food choice is

not harmful.

• Craving excessive ice

• Craving non-food

items (dirt/paint)

Prenatal Information Sheet: Resources 111

Discomfort When What you can do to help Notify provider if:

Frequent

urination

Begins

early, gets

better mid-

pregnancy,

and then

increases

towards

the end of

pregnancy

when baby

drops.

• Don’t cut back on fluids.

• Know bathroom locations.

• Expect to make many trips to

the bathroom, day and night.

• Avoid drinking lots of fluids

before bedtime.

• Pain or burning with

urination

• History of urinary tract

or kidney infection

• Fever/chills/sweats

• Pelvic, back, stomach,

or side pain

Headaches First half

• Use mild pain relievers such as

Tylenol

as directed

• Avoid aspirin, ibuprofen and

other pain medications, unless

you have discussed their use

with your health care provider.

• Avoid eyestrain.

• Rest eyes frequently and take

frequent computer breaks.

• Get gentle massages and do

mild stretching exercises.

• Drink plenty of water.

• Persistent headache

not relieved by over-

the-counter (OTC)

medication

• Worse headache of

your life

• Associated with vision

changes

Heartburn

Second

trimester

until

delivery

• Eat 6 - 8 small meals daily.

• Eat slowly, chew food well.

• Avoid deep fried, greasy, and

spicy foods.

• Drink fluids between your

meals.

• Avoid citrus fruits or juices.

• Go for a walk after meals.

• Avoid lying down right after

eating.

• Antacids can help.

• Persistent heartburn

not relieved by

antacids

• Associated with

persistent nausea and

vomiting

Hemorrhoids Anytime

• Prevent constipation - try not to

strain with bowel movement.

• Apply hemorrhoid ointment as

needed (discuss with provider).

• Apply witch hazel pads.

• Take sitz baths.

• Do your Kegel exercises

(see prenatal fitness brochure).

• Bleeding hemorrhoids

• Persistent pain from

hemorrhoids

112 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Increased

perspiration

Anytime

• Increase fluids intake.

• Wear easily washable,

comfortable, loose fitting

clothing.

• Practice good hygiene.

Increased

saliva

First

trimester

• Gum and hard candy - watch

excess calories.

• Use mouthwash.

• Avoid starches.

Increased

vaginal

discharge

Entire

pregnancy

• Wear cotton underwear.

• Avoid nylon underwear/panty

hose, feminine hygiene soaps

or sprays.

• Do not douche.

• Yellow or greenish,

thick and cheesy, or

has a strong fish-like

odor

• Soreness, itching or

burning

Leg cramps

Second

half of

pregnancy

• Extra potassium or calcium

may help. Try eating a banana

every day or drinking a glass

of milk.

• Gently stretch by - sitting down,

extending legs and flexing toes

towards body (grab toes if you

can and pull towards yourself).

Your partner can help with this.

• Mild exercise may help.

• Worsening cramps/

pain especially in the

back of calves/legs

• Redness/swelling in

calves

Ligament

pain (sharp

pulling

sensation on

either side

of the lower

abdomen)

Increases

with

increasing

uterine size

• Support your weight with

your hands when changing

positions.

• Move slower.

• A mild analgesic may help.

• Apply ice to affected side.

• Use maternity girdle/belt for

support.

• Lean back in a slant position

supporting your back with your

knees bent.

• Worsening pain

Prenatal Information Sheet: Resources 113

Discomfort When What you can do to help Notify provider if:

Light headed

& dizzy

Begins

early and

continues

• Stop what you are doing and

lie on your left side with your

legs up for short period of

time.

• If unable to lie down, sit

immediately and tell someone

you are dizzy.

• If dizziness resolves, get up

slowing from lying to sitting,

then up to standing position if

possible.

• Ensure adequate hydration by

drinking plenty of water.

• Repeated episodes

• Associated with other

symptoms such as

chest pain/shortness

of breath

• Loss of consciousness

Low

backache

Second

half of

pregnancy

• See page 116. • See page 116.

Nasal

stuffiness &

bleeding

First

trimester

and again

at term

• Use a saline nasal spray.

• Use cool mist humidifier/

vaporizer if air is dry.

• Talk with your provider about

OTC medications.

• Avoid using nasal

decongestant sprays.

• Blow your nose gently.

• Ensure adequate hydration by

drinking plenty of fluids.

• Stop bleed by squeezing nose

between thumb and forefinger

for a few minutes.

• If nasal bleeding is

frequent

Nausea

(Morning

Sickness)

Occurs

in early

pregnancy

and usually

improves

after first

trimester.

• See page 115. • See page 115.

Numbness/

tingling

fingers/

hands

(Carpel

Tunnel

Syndrome)

Second

and third

trimester

• Elevate hands and wrists as

much as possible.

• Rest hands with frequent

breaks.

• Talk with your provider about

wrist splints.

• Your hands are weak

and not just numb

114 Prenatal Information Sheet: Resources

Discomfort When What you can do to help Notify provider if:

Sleeplessness

Anytime

but

especially

last

trimester

• Try a warm bath before

bedtime.

• Avoid stimulating activity

before bedtime

• Avoid drinks containing

caffeine.

• Use relaxation techniques.

• Get in a comfortable position

to sleep; place pillows

between legs.

• Try a glass of milk before

going to bed.

• Talk with your

provider If you are

feeling very stressed,

depressed or nervous

about your pregnancy

Varicose

veins

Increases

pregnancy

progresses

• Avoid tight clothing and

stockings.

• Avoid crossing legs.

• Practice good posture.

• Put support hose, ace wraps

or elastic stockings on in bed

before lowering feet - wear all

day.

• Painful bulging veins

• Redness in area of

veins

• Leg cramps

Vision

changes

Entire

pregnancy

• Don’t buy a new prescription

for your glasses as you will

probably return to pre-pregnant

vision after delivery.

• Take frequent eye breaks.

• May not be able to wear

contact lenses during

pregnancy.

• Wear glasses as prescribed for

reading/distance vision and

for driving.

• Blurry (fuzzy) vision

• Seeing black spots or

shadows

• Headache

• Loss of vision

Prenatal Information Sheet: Resources 115

Nausea and Vomiting in Pregnancy

(aka “morning sickness”)

Nausea can occur during early pregnancy. It usually gets better after the first

trimester.

What can you do?

• Nibble some plain crackers, dry toast, dry cereals before getting out of

bed in the morning and when you are feeling queasy.

• Eat six to eight small meals throughout the day instead of big meals.

• Try eating protein snacks.

• Get plenty of rest.

• Avoid odors or foods that set off the nausea.

• You may have to avoid prenatal vitamins during the first trimester if they seem

to worsen the nausea.

• Drink liquids between meals not with meals.

- Avoid dehydration by drinking water and nutritious smoothies

and eating ice chips.

- Sip on ginger ale, water, weak tea, or mild fruit juices.

- Try diluting a sports drink with half water and sip on this liquid all day.

• Avoid greasy or spicy foods.

• Chew gum or suck on hard candy (mints/ginger) or ice chips.

• Sit and put your head down between your legs.

• Motion/Sea sickness bands may help.

• Acupuncture may be helpful.

Notify your provider if you

• Cannot keep down any liquids or food.

• Have nausea that does not go away.

• Have more than three to five pounds of weight loss since becoming pregnant.

• Have vomiting that is blood tinged.

• Have flu-like symptoms or fever.

• Feel faint.

116 Prenatal Information Sheet: Resources

Low Back Pain

Low back pain in pregnancy is the most common discomfort of pregnancy.

Why does it happen?

• Strain of back muscles.

• Uterus gets bigger and center of gravity changes - thus posture changes.

• Hormones cause ligaments to relax and joints to loosen.

What can you do?

• Use good body mechanics.

• Keep your back straight and your head up.

• Avoid lifting heavy objects by yourself.

• Avoid flat or high heeled shoes (low heel with arch support is best).

• Sleep on a firm mattress (or place a board between mattress and box spring).

• When bending to pick something up, bend from your knees (not waist).

• Gently massage lower back or apply hot/cold compress.

• Take a warm soak in a bathtub. (Make sure to have good grip on

hand rail when exiting tub to prevent a fall.)

• Take a warm shower with pulsating/heavy stream aimed at lower back area.

• When sitting, place a small pillow behind your lower back for support.

• Avoid standing for long periods of time.

• If standing for an extended period, prop one foot up on a stepstool or stair,

this helps straighten the small of your back.

• Sleep on your side and place a pillow between your legs.

• Stretch and stay active in pregnancy (talk with your provider before starting a

new exercise program).

- Forward bend - Sit in a chair, feet flat on ground bend head/shoulders

forward to the knees.

 - Pelvic rock exercises - When on hands and knees, stretch your lower

back – arch so back is rounded, then relax it back to original position.

Use your stomach muscles to keep your back straight when relaxing.

• Talk with your provider about over the counter pain medication if needed.

• Consider a maternity girdle for support.

Contact provider if any of the following occur

• Severe pain

• Intermittent pain (comes and goes)

• Burning with urination

• Vaginal bleeding

• Pain lasting more than two weeks

• Tingling/numbness in lower legs

Prenatal Information Sheet: Resources 117

Exercise

Exercise is encouraged during pregnancy as it has many benefits including

preparing you for labor and childbirth. Exercise should occur at least three or

more times per week for a minimum of 20 minutes per session with a goal of 150

minutes of mild to moderate exercise each week. Exercise will help with some of

the common discomforts of pregnancy including reducing backaches, constipation,

bloating and swelling. It also improves sleep, your mood and posture. Exercise

can help prevent or treat gestational diabetes. If you have any medical conditions

or complications with the pregnancy, it is important to talk to your health care

provider before exercising.

The following activities are safe during pregnancy: walking, swimming, cycling,

and aerobics. Running is also safe for women who were runners prior to

pregnancy; in fact, it is safe to continue most pre-pregnancy exercise routines

throughout pregnancy.

Activities that should be avoided during pregnancy include downhill skiing,

contact sports, parachuting, rappelling, and scuba diving. Activities that increase

your risk of falling should also be avoided such as gymnastics, water skiing, and

horseback riding. You should avoid exercises that involve jumping, jarring motions

or quick changes in direction; or sports that risk contact injuries such as soccer or

basketball.

You should exercise at mild to moderate intensity and it is important to drink lots

of fluids. You should stop exercising if you have any of the following symptoms:

vaginal bleeding, dizziness or feeling faint, increased shortness of breath, chest

pain, headache, muscle weakness, calf pain or swelling, contractions, decreased

fetal movement, or leakage of fluid from the vagina.

Exercise can be resumed postpartum when you feel ready after delivery. If you had

a complicated pregnancy or delivery, you need time to recover and should check

with your health care provider prior to resuming exercise.

Most women think of physical exertion when they think of exercise. In addition to

the exercises mentioned already, women should regularly do pelvic floor exercises,

known as Kegels. These should be done during and after your pregnancy.

Doing Kegels during pregnancy has been shown to facilitate quicker recovery

of postpartum muscle strength. This decreases your risk of urinary and bowel

incontinence caused by stretched or injured pelvic floor muscles. Pelvic muscle

strength also helps maximize effective pushing during labor. After pregnancy,

doing Kegels will help recover strength in the pelvic floor muscles. Strong pelvic

floor muscles may also enhance sexual pleasure for you and/or your partner.

118 Prenatal Information Sheet: Resources

Travel During Pregnancy

Questions regarding travel may arise from time to time during your pregnancy. You

may ask “Is it safe for me to travel?” Whether or not it is safe to travel depends on

how far along you are, whether or not you have complications in your pregnancy,

and your overall comfort level. For most women, traveling is safe during most of

the pregnancy.

The best time to travel is during the second trimester between weeks 18 and 28.

By this time you are usually over morning sickness yet your belly is not so big that

you are very uncomfortable. You do not always have to limit yourself to this time

period. If you feel up to traveling, discuss your travel plans with your provider. If

she or he does not object to your travel plans enjoy your trip! Make sure you keep

your Pregnancy Passport with you during the trip.

If you have an option, what mode of travel should you choose? The best mode of

travel should be the one that will get you to your destination in the least amount

of time. For long distances, such as across the United States, that may be by air.

Be sure that during long plane or car rides you get up, stretch, and move about

periodically. This will help minimize the amount of swelling that can occur in your

legs during such long trips. This also decreases the risk of developing a blood clot.

Blood clots are uncommon but happen more often to pregnant women, especially

if they are lying or sitting still for a long time. Typically, airlines restrict women

beyond 34 weeks from traveling over the ocean and beyond 36 weeks from

flying at all. Make sure you contact the airline and notify your provider if you are

thinking of traveling late in your pregnancy. You may need to bring a statement

from your health care provider approving your travel and stating your due date. If

you decide to take a road trip, try to limit your riding or driving to five to six hours

a day. During this time, take breaks to stretch your legs as you would with an

airplane trip.

Being prepared before you go will ease your mind when you travel and likely

make your trip much more enjoyable.

If you are traveling internationally, check the Centers for Disease Control and

Prevention (CDC) web site at http://www.cdc.gov/travel/. The CDC is a good

resource for travel alerts, safety tips, and up-to-date vaccination facts for many

countries. The CDC web site has a travel page called “Travelers’ Health” that may

be useful to you. The CDC can be reached by phone at 1-800-232-4636.

Another source for help is the US Embassy or Consulate in the country where you

are traveling.

Prenatal Information Sheet: Resources 119

Having Twins, Triplets or More!

Having twins or even triplets seems to be on the rise in the United States. This is

due in large part to the use of fertility drugs and in vitro fertilization. While having

multiples can bring great joy, there are definitely more challenges and often

greater risks involved. These risks include preterm delivery and other complications

that can affect the mother and the babies.

If you learn you are carrying more than one baby, you and your partner will

likely feel both elated and scared. Having one baby brings joy and challenges.

Having more than one can add stress. As always, discuss your concerns with your

provider. The most important aspect of your care will be for you to understand how

to care for yourself while you are pregnant and then how to be prepared for when

you and the babies go home from the hospital.

Your prenatal care will likely require more provider visits than a pregnancy

with one baby. Your weight gain and uterine growth will be monitored closely.

Pregnancy with multiple babies requires greater nutritional intake and often

requires you to rest more than you would with one baby. You will be monitored

closely for complications such as hypertension, preterm labor, and premature

rupture of membranes.

TAKE CARE OF YOURSELF! If you feel tired, rest. Carrying more than one baby

can be very taxing on the body. Listen to your body and rest when you need to –

both while you are pregnant and after your babies are born.

New parents often benefit from having assistance at home when discharged

from the hospital. This is especially helpful with multiple births. Plan for your

homecoming and explore arrangements that will allow you to get as much rest as

possible in the first few weeks home. While you are pregnant you might also check

out community support groups for parents of multiples so that you can be better

prepared for the birth of your babies.

Most women who have multiple births are able to successfully breast feed their

babies. Sometimes this involves pumping or hand-expressing milk. Since most

multiple births are preterm, the babies may have some trouble breastfeeding.

However, most benefit from breast milk regardless of how they get it. They can get

it in many ways. The nursery staff will help you know how and when to feed your

babies. Amazingly, your body will automatically adjust the content of your milk to

best support premature or term babies.

120 Prenatal Information Sheet: Resources

Fetal Movement Counting Chart

Date

Go to Labor and Delivery if less than 10 movements in 2 hours (120 minutes)

120 min.

110 m i n .

100 min.

90 min.

80 min.

70 min.

60 min.

50 min.

40 min.

30 min.

20 min.

10 min.

Start time

Weeks

pregnant

Counting your baby’s movements is an excellent way of knowing that your baby is doing well. It is also a great excuse for you to get off your feet,

relax and get in touch with your baby. You should begin counting your baby’s movements when he or she is usually most active and you have time

to concentrate. Begin your count around the same time each day and start by lying down on your left side with hands over your uterus. Write the

time you begin your counts on the chart in the “start time” row. Also write down the date in the top row marked “date” and the number of weeks

you are pregnant in the bottom row. Count 10 distinct movements and note how long it took, i.e. 15 minutes, two hours, whatever time it took. Put

an “X” in the time box closest to the total time it took for your baby to move 10 times.

If you have not felt 10 movements in two hours you will need to be monitored in Labor & Delivery to make sure your baby is OK. You may want to

call Labor & Delivery to tell them you are on your way (but don’t let the phone call delay you from going in). In most cases your baby is just fine,

but it is always better to be safe than sorry.

Bring this chart with you to your next visit and any time you go to Labor & Delivery.

Prenatal Information Sheet: Resources 121