During Pregnancy

Please call any time; someone is always available by phone. Have your provider's phone number close at hand throughout your pregnancy.

Additionally, please call your doctor or nurse if you have any of the following:

• Severe nausea and vomiting (not able to keep anything down for a whole day)
• Bleeding from your vagina
• Discharge from the vagina that smells bad, itches, or causes pain
• Pain or burning on urination
• Pain in the lower abdomen
• Severe headache not relieved by Tylenol (acetaminophen)
• Fever of more than 100 degrees
• You think you have been exposed to a contagious disease
• Severe depression or emotional upset
• Someone in your life making you feel unsafe

Download and print the list to post by your phone.

Schedule of Regular Visits to Your OB Provider

Up to 28 weeks of pregnancy – Every 4 weeks
28 - 36 weeks of pregnancy – Every 2 weeks
36 weeks of pregnancy to delivery – Once a week

Note: This is a "typical" schedule. Your provider may advise a different schedule for you.

Changes You May Experience During Pregnancy

Although many weeks may pass before there are outward signs of pregnancy, tremendous changes are taking place in your body. You may feel a wide range of physical and emotional reactions. Even if you've been pregnant before, you may well find that no two pregnancies are the same, and that you have a different set of reactions and feelings to this particular pregnancy.

Here are some of the things that commonly occur, and some ideas on how to manage so you feel your best. Please ask your obstetric provider about any concerns you may have related to the changes in your body, your emotions, and your life during this special time.

For more information on all of these topics, download our full guide.

Feeling tired

Many pregnant patients feel more tired than usual in the first weeks of pregnancy. This is normal as your body adjusts to meeting the needs of your growing baby.

Nausea, vomiting, or heartburn

Pregnancy hormones affect the way your stomach works. They also affect your sense of smell and appetite. In some cases, this leads to nausea. Some women find that strong odors or spicy foods make nausea worse. Hormones can also affect the acid in your stomach, leading to classic symptoms of heartburn or indigestion.

Food cravings, food aversions, and hunger

Many patients experience food cravings during pregnancy. In general, this does not pose a problem. If you crave sweets such as ice cream, it's okay to indulge occasionally. But try to limit your intake of foods high in fats and sugars. Cravings for more nutritious foods can almost always be satisfied without worry. You may also suddenly find that you can't stand the thought of a food you once adored. Food aversions are also common now, and should not worry you as long as you continue to eat a wide variety of healthy foods. (See more tips on healthy eating in the Eating Well section below.)

Headaches

Pregnancy hormones can trigger headaches in some patients. This may be especially true if you were prone to headaches before you got pregnant. Some patients have headaches related to vision changes during pregnancy. In these cases, adjusting the eyeglass prescription may help.

Frequent urination, leaking urine

Early in pregnancy, hormones can cause you to urinate more frequently than usual. They also relax the muscles in your genital area, which can lead to leakage of urine. Later, your baby's weight puts pressure on the bladder, which can also cause frequency and leakage. Don't be concerned about going to the bathroom a lot, unless there is pain or burning when you use the bathroom. If this happens, be sure to call for advice — you could have an infection. If urine leakage becomes a severe or ongoing problem, now or in the future, please be sure to tell your provider. Treatments are available that help many women.

Breast tenderness, leaking fluid

Hormones cause your breasts to get larger during pregnancy, and can also sometimes cause fluid to leak from your breasts. Wear a support bra in the right size. Make sure the bra fits well.

Vaginal discharge

Your body naturally increases the secretions in your vagina during pregnancy. The secretions help prevent bacteria from entering the uterus, and should be white or very pale yellow. They should not be bloody, smell bad, or cause pain or itching; tell your provider if they are.

Gas, constipation, hemorrhoids

Early in pregnancy, hormone changes affect your stomach and bowels, causing more gas and, in some women, constipation. Later, the pressure of the baby on your intestines can interfere with moving the bowels. All the usual diet and exercise remedies for these problems also help when you are pregnant. Drink plenty of fluids, get enough exercise, and make sure you have fiber in your diet. Hormones cause the walls of the blood vessels in your rectum to relax, which can lead to hemorrhoids. Later, the pressure of the baby can make the problem worse. Constipation can also worsen hemorrhoids.

Changes in your legs

The weight of your baby can have an effect on the blood vessels in your legs. For some women, varicose veins become an issue during pregnancy. For others, swelling of the ankles and feet is a problem. For mild swelling, elevating your feet and legs whenever you can is the best treatment. For more severe swelling, or to treat swollen veins in your legs (varicose veins), you may want to try compression stockings.

Emotional changes

Most people are aware of how hormones can affect mood and emotions. The hormone changes of pregnancy will probably have some effect on how you feel. In addition, just being pregnant is bound to cause strong emotions, which vary depending on whether the pregnancy \was planned, whether you have people around you to provide support, and how much stress you feel in your daily life. While "mood swings" are normal to a certain extent, some women are prone to develop problems such as depression during this time. Be sure to talk with your obstetric provider about any feelings that are causing you concern.

Changes in relationships

Pregnancy is a time when relationships shift and change in new ways. Some partners pull together as they prepare for the birth of their baby. However, pregnancy can also increase the stress or tension in a relationship. Now more than ever, it is important that you make sure you feel safe at home. For more information, or to talk with someone further about these issues, please call the Center for Violence Prevention and Recovery at Beth Israel Deaconess Medical Center at 617-667-8141.

Download our full guide for more information.

Your body will go through a great deal of change as your baby grows. Here are some things you can do to make sure you feel your best and to avoid some of the discomforts that sometimes occur.

Pay attention to posture

As the weight in the front of your body increases, it will be important to pay attention to your posture. This will help prevent backaches and fatigue. Remind yourself as often as possible to sit or stand correctly. Don't sit slumped with legs crossed. Sit in a firm chair for support. When you are standing, make sure your weight is even on both feet. If you need to stand for a period of time, try to put one foot on a small stool or put one foot slightly forward. Change your position often. Stand with shoulders back, chest lifted, chin tucked, knees slightly bent, and feet apart.

Be aware of changes in balance

You also may find that the changes in weight make you feel awkward or even clumsy. If so, you are not alone. Accidents such as slips and falls are common in pregnancy. This is because the new weight in your belly changes your body's center of gravity. Although you will naturally make adjustments in how you move in order to stay balanced, be aware that your sense of balance is changing. Be careful going up and down stairs or walking on slippery surfaces. And be sure to wear only low-heeled shoes.

Get regular exercise

If you've been working out regularly for a long while, there is usually no need to stop during pregnancy. Talk with your obstetric provider about the kind of exercise you may do, and about what level of exertion is okay for you. You should not exercise to the point where you become exhausted.

If you haven't been active before pregnancy, now is not the time to begin a vigorous exercise program. But there are safe, easy exercises you can do to help you feel better and maintain your health and stamina. Walking and swimming, for example, can be done throughout most of your pregnancy, even if you are not used to exercising. Start slowly and work at a pace that is comfortable for you.

Strengthen your pelvic floor

The pelvic floor refers to the muscles in your genital area. It includes the muscles around your vagina, urethra (urinary opening), and anus (bowel opening). Doing exercises, called Kegels, to strengthen these muscles helps support the area under the weight of your baby. Doing Kegels may help you keep control of your bladder during and after pregnancy, and can also help prepare you for labor.

Good eating habits during pregnancy will help make sure both you and your baby are as healthy as possible.

Download our full guide to learn what foods you need for healthy eating and how much of each food is recommended each day.

If you have special concerns or needs regarding nutrition, ask about a referral to a dietitian.

How much weight should I gain?

Most sources recommend that a woman gain between 25 and 35 pounds during pregnancy. Women who were underweight before becoming pregnant may gain more; women who started out overweight may be able to safely gain less.

Check with your obstetric provider about the amount of weight gain that is right for you. In general, it's not the number of pounds you gain that is important — it's whether you are eating well and whether your baby is growing as it should.

What precautions must I follow regarding foods or drinks?

There are some precautions you must take regarding what you eat and drink. Some foods may contain bacteria or other organisms that could be harmful to you or your baby. Others foods or drinks have toxic materials that could have harmful effects on your baby's growth and development. Ask your doctor if you have any questions.

Vitamin Supplements, Iron, and Folic Acid (Folate)

Prenatal vitamins are recommended by almost all obstetric providers as a way of making sure you get the nutritional support that both you and your baby need. But some women prefer not to take prenatal vitamins, or find that certain types of vitamins (such as those with iron) cause unpleasant side effects.

Most women are able to take in nearly everything they need for a healthy pregnancy by following a healthy, well-balanced diet, as described in this chart. However, there are two important exceptions:

Folic acid

Folic acid, or folate, has been found to be important in preventing the development of a group of birth defects called neural tube defects. Examples of neural tube defects are spina bifida and anencephaly. Folic acid is also needed by both you and your baby to form red blood cells. While you are pregnant, your need for folic acid is at least 600 micrograms (mcgs) per day.

Iron

Your need for iron begins in the first trimester, and continues through childbirth. Iron is an important part of the body's blood cells. It is needed during pregnancy to form red blood cells in both you and your baby. However, because of loss of iron with the monthly periods, many women enter pregnancy low on iron. This can lead to low red blood cell counts, which is not good for you or your baby.

What is listeriosis?

Listeriosis is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes, and is an important public health problem in the United States. The disease primarily affects older adults, pregnant women, newborns and adults with weakened immune systems. However, rarely, persons without these risk factors can also be affected. The risk may be reduced by following a few simple recommendations.

How great is the risk for listeriosis?

In the United States, an estimated 1,600 persons become seriously ill with listeriosis each year. Of these, 260 die. The following groups are at increased risk:

• Pregnant women: Pregnant women are about 20 times more likely than other healthy adults to get listeriosis. About one in six (17%) cases of listeriosis occurs during pregnancy.
• Newborns: Newborns suffer the most serious effects of infection in pregnancy.
• Persons with weakened immune systems from transplants or certain diseases, therapies, or medications.
• Persons with cancer, diabetes, alcoholism, liver or kidney disease.
• Persons with AIDS. They are almost 300 times more likely to get listeriosis than people with normal immune systems.
• Older adults.

Healthy children and adults occasionally get infected with Listeria, but they rarely become seriously ill.

How do you get listeriosis?

You get listeriosis by eating food contaminated with Listeria. Babies can be born with listeriosis if their mothers ate contaminated food during pregnancy. However, healthy persons may consume contaminated foods without becoming ill. Persons at risk can prevent Listeria infection by avoiding certain high-risk foods and by handling food properly.

What are the symptoms of listeriosis?

A person with listeriosis usually has fever and muscle aches often preceded by diarrhea or other gastrointestinal symptoms. Almost everyone who is diagnosed with listeriosis has "invasive" infection in which the bacteria spread beyond the gastrointestinal tract. The symptoms vary with the infected person:

• Pregnant women: Pregnant women typically experience only a mild, flu-like illness. However, infections during pregnancy can lead to miscarriage, stillbirth, premature delivery or life-threatening infection of the newborn.
• Persons other than pregnant women: In addition to fever and muscle aches; symptoms can include headache, stiff neck, confusion, loss of balance, and convulsions.

Download our full guide to Listeriosis

Fish and Mercury

Here is a list of different types of fish, the levels of mercury they are likely to contain, and whether you can safely eat them during pregnancy.

Fish-eating guidelines from the Massachusetts Dept. of Public Health

Highest Mercury – Avoid Eating

Lowest Mercury – Enjoy two 6-oz. servings per week

Lower Mercury – Eat no more than six 6-oz. servings per month

High Mercury – Eat no more than three 6-oz. servings per month

It is normal to experience many discomforts during pregnancy.

During pregnancy it is common to experience heartburn, constipation, colds and other types of infections (yeast, urinary tract, gingivitis); as well as day-to-day symptoms like hay fever or seasonal allergies.

Listed below are some common medications approved for use in pregnancy, mostly over the counter drugs. This list is only a start. There are many other medications that are safe that are not listed here. Your other health care providers can check to see if the medications they want to use are safe for use in pregnancy. You can call us if you have any questions about medication use in pregnancy.

There is no need to buy brand names. Look for the store brand and save money!

Allergy

Sleep

Vitamins

Antacids

Cold/Sore Throat

Cough Drops

• All brands are okay

Diarrhea

• Imodium (limited use)

Antibiotics

Nasal Spray

Nausea & Vomiting

Constipation/Hemorrhoids

Pain Reliever

• Acetaminophen (Tylenol)

Medications You Should NOT Take During Pregnancy

Here are some of the most common questions women have in the first half of pregnancy. Topics covered include:

• Safe medications
• Sex during pregnancy
• Traveling
• HIV testing
• Dental visits
• Smoking, alcohol, drugs
• Chemicals to avoid
• Getting sick while pregnant
• Immunizations/vaccinations during pregnancy

Download our full guide to get all your questions answered. Please talk with your obstetric provider about any additional questions or concerns.

Here is a list of tests you will need during your pregnancy to assure that you and your baby are healthy.

8 - 12 Weeks

• Prenatal blood work: CBC (complete blood count), Hepatitis B, Rubella, RPR (Syphilis), Blood type, HIV (if desired), Cystic Fibrosis (if indicated), Tay Sachs (if indicated)
• Urinalysis/Urine Culture
• Pap Smear Pelvic Exam: Pap Smear, Gonorrhea, Chlamydia.

10 - 13 Weeks

• CVS (Chorionic Villus Sampling – if desired)
• Early Risk Assessment

11 weeks, 2 days - 13 weeks, 6 days

• First trimester (if desired): This is a screen test used to determine which pregnancies are at a higher chance to be affected with three of the most common chromosome abnormalities. Specifically, this screens for Down Syndrome, Trisomy 18 (Edwards Syndrome) and Trisomy 13 (Patau syndrome).

15 - 20 Weeks

• Quadruple test: This is a blood test to assess for chromosomal abnormalities. (Includes AFP, Down Syndrome and Trisomy 18).
• Maternal Serum AFP only: To screen for open neural tube defects
• Sequential Screen: If you had a First Trimester Screen done, you can opt for a Sequential Screen. This increases the accuracy of the risk analysis for chromosomal abnormalities (includes AFP).

16 - 19 Weeks

• Amniocentesis (if desired)

18 - 20 Weeks

• FFS: Full Fetal Survey (ultrasound)

24 - 28 Weeks

• Glucose Screening for Gestational Diabetes
• CBC: Complete Blood Count

28 Weeks

• Rhogam (If indicated)

36 Weeks

• GBS: Group B beta strep

Throughout your pregnancy, you may have tests performed to screen for certain medical conditions that can affect either you or your baby. The following is a list of the tests with an explanation.

Pre-Conceptually OR at Your First OB Visit

Complete Blood Count (CBC)

A blood test to provide a count of red and white blood cells and platelets.

• Red blood cells are responsible for carrying oxygen to your organs and to your baby. If you do not have enough red cells (a condition called anemia), you may become excessively tired and your baby may not be getting the oxygen she/he needs. Sometime further testing is needed. Treatment for anemia is generally iron supplements.
• White blood cells fight infection and disease. An increased or decreased number alerts us to the need for further testing.
• Platelets are responsible for blood clotting. Certain abnormalities in platelets may never cause symptoms but can lead to problems during delivery. An abnormal value may indicate the need for further testing

Type and Screen

A blood test to determine your blood type and the presence of any unusual antigens (proteins on the red blood cells). The RH Factor is the most common antigen that is either present (Rh+) to absent (Rh-).

If a mother is Rh- and the father is Rh+, there is a chance the baby will be Rh+. This can cause problems if there is a crossover of the baby's Rh+ cells into the mother's blood stream. These "foreign" cells may lead to the production of a substance in the mothers blood (antibody) which actually attacks fetal red cells and may cause many problems in the baby; including heart failure, anemia, enlarged liver and spleen, jaundice (yellowing of the skin), and even still births.

If you are Rh-, you will need to have an injection of Rhogam automatically at 28 weeks or anytime you bleed during your pregnancy; and possibly after giving birth. This injection will prevent your body from making any of the potentially harmful antibodies.

You are also tested for other antibodies similar to those produced against the Rh factor, whose presence can also affect the baby.

Rubella

A blood test to determine whether you have immunity to Rubella (German Measles). If a woman has not been immunized by the Rubella vaccine or contracted Rubella herself, she is at risk for getting the disease if exposed. Exposure during pregnancy is associated with numerous birth defects including mental retardation, deafness, cataracts and heart defects. If you are not immune, you will need to avoid contact with persons who have the disease. You will be offered vaccination after you baby is born.

Syphilis

A blood test for the sexually transmitted disease Syphilis. This disease can be passed to the baby during pregnancy and can cause certain birth defects including still births, bone and teeth defects and brain damage. Treatment for Syphilis is antibiotics.

Hepatitis B

A blood test for the viral liver infection, Hepatitis B. This condition poses a problem for the baby after delivery. If you test positive for this virus, your baby will receive immunization and special handling after birth.

Chlamydia

A test of your urine which indicates exposure to the sexually transmitted disease Chlamydia. This disease can cause pneumonia and eye infections in babies. Treatment for Chlamydia is antibiotics.

Urine Culture

A test of your urine to determine if it is infected with bacteria that could cause urinary tract infection (UTI). Urinary tract infections are more common in pregnancy due to anatomical changes of the urinary tract and may cause no recognizable symptoms. Treatment for bacteria in the urine is antibiotics.

Genetic Testing

Such as Cystic Fibrosis or Tay-Sachs disease. Your risk of carrying the gene for some diseases depends on your inherited ethnicity. Your risks will be reviewed and recommendations for testing made. These tests will require you to sign a consent form informing you of the limitations and uses of testing.

HIV

A blood test for the presence of HIV (Human immunodeficiency virus), the causative agent for AIDS (Acquired immune deficiency syndrome). This test is optional and voluntary and can be obtained only after you sign a consent. We encourage all women to consider this testing option as 25 percent of women who are HIV-positive and untreated will pass this disease to their babies; and because treatments like AZT can dramatically lower transmission rates. This will be fully explained to you at your first visit.

Toxoplasmosis

A blood test for the presence of active or past infection with the parasite Toxoplasmosis. Infection with this parasite can cause mild to severe congenital defects, and is contracted by exposure to undercooked red meats, garden soils, and cat feces. If you have exposure to these risk factors you will be tested for Toxoplasmosis. If not, we will discuss ways to avoid exposure during pregnancy.

Parvovirus

A blood test for the presence of active or past viral infection with the organism that causes Fifth's disease. This disease is contracted by exposure to persons (most commonly young children) who have Fifth's disease. Exposure to this virus during pregnancy can cause fetal anemia or heart failure and even miscarriage. If you have extensive contact with groups of young children, you will be tested for the presence of this virus. We will discuss ways to avoid exposure during pregnancy.

Varicella

A blood test for the presence of past infection with, or immunization to, the virus that causes chickenpox. If you have had chickenpox in the past you are immune to the disease and need not be tested. If you are unaware of past disease and have not been vaccinated, you will receive this test. Varicella infection during pregnancy can cause numerous birth defects and may increase the risk of miscarriage. You may be vaccinated against varicella after your baby is born. Second Visit: During this visit you may have a complete physical examination, including a pelvic exam, and the following tests:

Pap Smear

A gentle scraping of the cervix which yields cells that are screened for cervical cancer. During pregnancy, a soft brush is used which rarely causes bleeding, although a small amount of spotting is normal. If an abnormality is found, an additional test called colposcopy will need to be performed.

Gonorrhea Culture

A test of cervical fluid for the bacteria, which causes the sexually transmitted disease Gonorrhea. Transmission of Gonorrhea can occur to the baby and cause blindness. Treatment for this infection is antibiotics.

24-28 Weeks

Glucose Test

This blood test screens you for the risk of gestational diabetes. You will be asked to drink a sweet tasting beverage called Glucola, and have your blood drawn one-hour later. An abnormal result on this test does not necessarily mean that you have diabetes. For confirmation another test called a Glucose Tolerance Test may need to be performed. This involves fasting overnight, having your blood drawn, drinking more Glucola and then having your blood drawn at 1, 2, 3-hour intervals. Gestational diabetes may lead to complications in pregnancy and with the baby. If you have diabetes, you will be evaluated by a specialist and begin a diet, exercise, and testing program developed for you.

36 Weeks

Group B Strep

Vaginal and rectal cultures that test for the presence of Group B Strep, a common non-sexually transmitted bacterium found in 30 percent of women. Babies exposed to this bacterium during birth may develop life-threatening illness unless the mother is treated. If you are positive for this bacterium you will be given IV antibiotics while you are in labor or as soon as your membranes rupture.

What You Need to Know

Ultrasound examinations are an important diagnostic test for women who are pregnant. They are commonly used to date a pregnancy, view the placenta, amniotic fluid, and rule out or confirm the presence of twins. Specifically, the Full Fetal Survey ultrasound scan provides an opportunity to look closely at your developing baby.

About the Procedure

By use of the sound waves transmitted throughout the uterine wall, an image of the baby is projected onto a screen. Through that image a maternal-fetal medicine specialist can examine fetal structure such as the heart, spine, and kidneys. Normal growth and development can be assessed through fetal measurements. It is also possible to view the placenta as well as evaluate the amount of amniotic fluid.

This procedure is generally performed around 18 weeks of pregnancy or during the second trimester. It is not considered a painful procedure; however, you may feel some discomfort due to a full bladder. The need for a full bladder will vary depending upon your gestational age and the person performing your ultrasound.

It is important to know that a normal ultrasound does not promise a healthy baby. There are many abnormalities that cannot be determined using ultrasound alone, including Down syndrome.

An ultrasound exam may be a part of your routine obstetrical care during your pregnancy or may be done if there is some clinical indication, such as having previously had a child with a specific birth defect.

There are currently no known fetal or maternal risks associated with ultrasound use in pregnancy.

In order to address the possibility of risk factors for your offspring, we recommend that you contact one of our genetic counselors to review any family history concerns, and whether or not it is appropriate for you to consider prenatal diagnosis. It is important to remember that there is no one test or combination of tests that will rule out the presence of all fetal birth defects, mental retardation or genetic disease.

For more information, please call the Division of Genetics at Beth Israel Deaconess Medical Center at 617-667-7110.

The two-hour glucose test helps to measure how your body is using sugar during your pregnancy. This test is important to do because pregnancy hormones can cause the level of sugar in your body to be too high. High levels of sugar are not good for you or your baby. If your sugar levels are high, they can be treated.

This test will tell your doctor if you have gestational diabetes (diabetes during pregnancy). If you do have gestational diabetes, this can be treated. Your doctor will talk with you more about this once the test results are back.

How do I prepare for this test?

• You should have nothing to eat or drink after midnight the night prior to your test.
• You should NOT change your diet at all before this test. Please eat as you normally would.

What will happen on the day of my test?

• You will need to be at the office for two hours for this test.
• You should report to Shapiro 8 at the time you were given. You will check in at the phlebotomy lab.
• You will have your blood taken for the first time.
• You will be given a sweet liquid called GLUCOLA to drink which you will need to drink entirely in about 5 minutes.
• You will need to tell the phlebotomist what time you finished drinking the GLUCOLA.
• Your blood will be drawn again one and two hours after you have finished drinking the GLUCOLA.
• You may drink ONLY WATER during this test. You may eat and drink as usual once the third blood test has been done.

How will I know the results?

Your health care provider will have the results the day after the test and will discuss them with you.

Infection with HIV (Human Immunodeficiency Virus – the virus that causes AIDS) has become a growing problem for women. Many women question whether to be tested for the HIV virus. An HIV antibody test can determine if a person has been infected with HIV. A person who is infected with HIV may feel well and look healthy, but can still pass the virus onto his/her sexual partners, needle-sharing partners and to their unborn children.

Anyone who has had sex without using a condom can be at risk. Certain women have a higher risk of contracting HIV:

• IV drug users or partners of IV drug users
• Women with bisexual partners
• Women whose partners have other sexual partners
• Recipients of blood or blood products between 1978 and 1985
• Women with a history of sexually transmitted diseases

If you are concerned that you may be infected or at risk, you should talk to your health care provider about HIV testing. It is important that you understand your choices, and receive counseling before and after the test.

For more information about HIV testing, talk to your health care provider or call the testing information hotline at 800-235-2331.

When picking a pediatrician there are a number of things you need to think about.

What kind of practice?

• Solo practitioner
• Partnership
• Group practice
• Practice that has a pediatric nurse practitioner

Is this the right doctor for you?

• Hospital Affiliations – Where the pediatrician admits patients to.
• Credentials – Board-certified by the American Academy of Pediatrics?
• Office location – Is the office someplace easily accessible to you?
• Office hours – Are the hours convenient for your schedule?
• Atmosphere – Is the staff responsive to their patients?
• Decor – Look for an area that will make waiting more comfortable for you and your baby. Are sick children separated from those that are seen for well visits?
• Waiting Time – Find out from the receptionist how long the wait times are for patients and reconcile this with your schedule.
• Protocol for taking phone queries – How does your doctor handle phone calls? For example, some may have a call-in time during which they answer questions.
• How are emergencies handled? – Exactly how does the doctor handles emergencies? Some have you go straight to the emergency room, others instruct you to come to their office.
• Financial Matters – Different offices offer different forms for payment. Some may bill you and some may expect payment at the time of the visit. If you have insurance, check to see whether or not this physician accepts your plan.
• Style – You need to find a provider who fits your style. Do you want someone who is easygoing and laid back or one who is very formal? One who welcomes your input or one who takes charge?
• Philosophy – You should find a provider who agrees with you on the major issues such as breastfeeding, preventative medicine, circumcision and feeding schedules

Once you settle on a doctor you should call, many physicians offer a courtesy prenatal interview. Some insurance also cover a prenatal visit to the pediatrician. You need to call your insurance provider to see what the protocol is. While we don't endorse any one practice, here is a list of some providers in the community that may be helpful: Pediatrician List (PDF).

We understand that whether this is your first baby or your last, the right time to call about coming to the hospital may seem unclear. The following are guidelines to help you decide. In some cases, your doctor will give you more individualized instructions. Call if you experience the following symptoms:

What is normal?

• Contractions that are irregular are normal at the end of pregnancy.
• A mucousy or bloody show can occur up to several days before the onset of true labor.
• There is nothing to do if either of these things occur.

If it's your first baby

• Your water breaks or
• Contractions are regular – Occurring every 5 minutes and lasting approximately 45 - 60 seconds for 1 hour
• The contractions should be strong and require effort in coping. This means that you have difficulty reading or having a conversation or performing tasks because of the discomfort.

Before 24 Weeks

• Bleeding
• Ruptured membranes or leakage of fluid vaginally
• Fever over 100°F that persists despite the use of Tylenol (Acetaminophen)
• Abdominal pain that is severe or prolonged
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

24 - 37 Weeks

• Experiencing more than four contractions in a one hour period
• A decrease in fetal movements from your baby's baseline, or less than 10 movements in 10 hours
• Unusual, severe or prolonged headache
• Changes in vision such as blurred or partial vision
• Bleeding
• Ruptured membranes or leakage of fluid vaginally
• Fever over 100°F
• Abdominal pain that is severe or prolonged
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

After 37 Weeks

• Heavy bleeding which soaks a pad (light bleeding or spotting is normal after vaginal exams)
• Regular painful contractions at 5 minutes apart which is persist for an hour
• Ruptured membranes or leakage of fluid vaginally
• Severe abdominal pain
• A decrease in fetal movements from your baby's baseline, or less than 10 movements in 10 hours
• Fever over 100°F
• Unusual, severe or prolonged headache
• Changes in vision such as blurred or partial vision
• Persistent vomiting or diarrhea
• Feeling threatened or being harmed either physically or sexually

Cesarean birth is sometimes needed to ensure the health of you or your baby.

Sometimes a Cesarean section is planned in advance because of certain issues that have arisen during the pregnancy, such as:

• breech presentation
• placenta previa (a complication of pregnancy in which the placenta grows in the lowest part of the womb [uterus] and covers all or part of the opening to the cervix)
• prior Cesarean sections of a special kind
• multiple gestations
• active herpes infection
• an exceptionally large baby

Other times, Cesareans are not planned and the decision is made together with you during labor. For example:

• A baby may be too large to pass through the pelvis
• Cervical dilation or descent of the baby's head stops during labor. This may be called "cephalopelvic disproportion"
• At other times, babies do not tolerate labor or show concerning changes in their fetal heart rate. In these cases, a Cesarean may be necessary.

Cesarean birth is a major surgery and requires anesthesia. Once you and your physician have decided that a Cesarean is necessary, you will speak with the anesthesiologist to discuss your options. Depending on how quickly the Cesarean has to be performed; you will be given either a spinal, an epidural or general anesthesia. You may feel some pressure during the surgery but you should not feel pain. Your support person should be able to stay with you in the operating room if you have a spinal or epidural anesthesia. If you need general anesthesia, then your support person will have to wait in the recovery room.

Infection is a possibility anytime a person has surgery. There are several important steps that we take together with you in order to prevent infection that may follow a Cesarean. First, please do not remove hair from the area around your planned incision (this includes your groin and stomach area) for about a week prior to surgery. Second, you will also be given instructions to use a special anti-bacterial soap to shower with the night before and morning of planned surgery. This should be used only on your body, not your scalp or face. Lastly, we give all women undergoing Cesarean birth antibiotics to prevent infection; it is important to let your health care providers know of any allergies to antibiotics that you have experienced in the past.

Preventing infection for you and your baby is important, particularly during the flu season. Infections can affect new moms, their babies, and families - often, simple preventive steps are the most effective thing we can all do to stop serious illnesses such as the flu (influenza), whooping cough (Pertussis), and other illnesses caused by a variety of bacteria and viruses.

Here is basic information on how to prevent infection for yourself, your baby, and your family. Download and print our full guide for your reference.

We ask that you keep the following in mind while you are here at BIDMC, and once you are at home:

The most important method of limiting infections is keeping hands clean.

This is particularly important during flu season, but hand hygiene helps to prevent nearly all types of infections. Keep your hands clean, and remind your friends and family to do the same. You should expect that your nurse and doctor will clean their hands when they enter and leave your room.

It is also very important to limit contact with visitors who may have an infection.

This is critical during the flu season (approximately October through April). But at any time of year, please ask friends and family to postpone their visit if they do not feel well, have been recently exposed to someone with the flu, or have a rash that has not been evaluated by a physician.

Vaccinate yourself and your family against the flu and whooping cough.

Vaccines are safe and effective. Ask your Obstetrician about the influenza and Tdap vaccines. You will also be offered these vaccines here at BIDMC when you are admitted to the hospital.

It is important for you to know that some bacteria and viruses are naturally present on all human bodies, including those of newborn infants. Although most bacteria generally do not pose a threat for healthy babies and their parents, some may result in treatable skin infections, while some bacteria or viruses could be a problem for people who are very sick or for very premature babies.