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Obstetrics Resources


DO's & DON'Ts During Pregnancy

VITAMINS: Take your prenatal vitamin every day. If it upsets you stomach, try taking it right before bedtime, or break it in half and try half at night. If it still makes you sick, stop taking it and call the office. Prenatal vitamins and iron are very toxic to children. (KEEP OUT OF CHILDREN'S REACH PRENATAL VITAMINS AND IRON ARE VERY TOXIC TO CHILDREN)

MORNING SICKNESS: If you feel sick to your stomach, try keeping a few soda crackers by your bed and eating them before you get out of bed. Try eating smaller meals more frequently. Call our office if you vomit every day. Call our office or Emergency Room at St. Joseph's Regional Medical Center if you are unable to keep any liquids down for more than six hours.

VAGINAL BLEEDING OR SPOTTING: If any vaginal bleeding or spotting occurs, stay off of your feet as much as possible and call our office during office hours 208- 746-1383 ext 6510. If bleeding is as heavy as a period, or heavier contact our office or the OB/GYN on call, they can be reached by calling the office number after hours. In case of vaginal bleeding do not put a tampon in the vagina and avoid sexual intercourse.

COLDS AND FLU: Drink lots of fluids, especially water and juices. Take your temperature 2-3 times a day. If your temperature is over 101, call your family Doctor or our office. Although no medication is actually tested safe for pregnancy, the following over-the-counter medications seem to be relatively safe for use:

  • Acetaminophen - any brand (for example, Tylenol). You make take 2 regular strength or one extra-strength tablet every 4-6 hours for aches and fever.
  • Sudafed - (Not Sudafed Plus or PE) as directed on package, for congestion.
  • Robitussin DM - when needed for a bad cough. Call your primary care provider if you are coughing up green or yellow phlegm or if cough is severe. You may call or office if you cannot reach your primary care provider.
  • Warm salt water gargles can be soothing to a sore throat. You can also try Cepacol throat lozenges occasionally. If your throat is very sore, call your family doctor or our office.

AVOID: Aspirin, Ibuprofen. Call our office if you have a special need for medication not listed. Try to avoid most medications during the first trimester unless otherwise stated by your doctor.

Allergies: You may try ChlorTrimeton, Benadryl, Zyrtec, Claritin.

Constipation: Try to increase your fluid intake, natural fiber in the form of fruit, vegetables and dried fruit. If need you can try stool softeners and miralx.

Diarrhea: If you are unable to tolerate any food or fluids call our office and you may try Imodium for severe diarrhea. Remember to stay well hydrated.

HEARTBURN: You may use TUMS, Rolaids, Mylanta, Maalox, Gas-x, Gelusil or Gaviscon. Do not use Pepto Bismol. Gaviscon is a better product for true heartburn.

HEADACHES: Try 1 extra strength or 2 regular strength Acetaminophen (Tylenol) tablets. Rest and ice. Call our office or you family doctor if the headache is severe.

HEMORRHOIDS: Anisole is an over-the-counter medication that you can try. Try to keep your stool soft by eating high fiber foods like fruits, vegetables, whole grain cereal and bread. Also drink 6 - 8 glasses of water per day.

SWELLING OF YOUR HANDS AND FEET: Try to stay off of your feet more. Rest. Drink plenty of water and avoid salty foods. Wear support pantyhose. Avoid knee- high socks or stockings. Try to avoid sitting in a way that puts pressure on the back of your knees. Call our office or the on call Doctor at the hospital if you have sudden swelling of your face, or if there is a sudden increase in you swelling.

FAINTNESS OR DIZZINESS: This is a common problem during pregnancy and usually does not indicate a serious medical condition. Getting up slowly from lying or sitting positions best relieves it. If this becomes a frequent problem, do not drive or operate heavy machinery, and contact the office for further evaluation.

TRAVEL: The doctors are not opposed to travel up to a month before your due date, as long as there has been no bleeding or other complications with your pregnancy. If you will be riding in a car for a long distance, it is a good idea to get out of the car every 2 hours and walk around for at least 5 minutes and schedule frequent bathroom stops. Flying is okay if in pressurized planes, as long as you are not anemic. For long distance travel, be aware of local medical facilities along your route.

OTHER THINGS TO AVOID: Hot tubs, saunas, tanning booths, hot springs. Do not drink alcoholic beverages including beer and wine. Do not use any "recreational drugs."


KEGEL EXERCISES

The pubococcygeus muscle is a supportive sling which helps to form the walls of the vagina and to support the urethra and rectum. Having the muscle in good tone is important. It helps the vagina resume its previous shape and feeling after childbirth and aids in preventing the loss of urine with coughing or sneezing (stress incontinence) and in urge incontinence (detrusor instability). In the area of sexual function, a good pubococcygeus muscle is related to sexual feelings and the ability to have orgasm. Improving the tone of the muscle may also be important in some cases of painful intercourse.

Dr. Arnold Kegel developed a set of exercises, appropriately named Kegel exercises, for improving the tone of this muscle. Your goal is to progressively strengthen the vaginal muscles and tissues.

You will need to do them daily for the rest of your life. It is sometimes helpful to do the exercises with something in your vagina such as a tampon or your fingers. This provides something for the muscle to push against and gives you additional feedback.

HOW TO IDENTIFY THE CORRECT MUSCLE

We would be happy to assist you in the proper technique of Kegel exercise. The following instructions are NOT REQUIRED of you, but merely suggestions which may help you.

  1. To find the muscle, place your finger into your vagina or rectum. Try to squeeze around your finger. That is the muscle you want to exercise. This muscle is the same one you use to hold back gas or a bowel movement or if you are trying to stop urinating. Do not be discouraged if you do not feel a strong squeeze. We want to first make sure you are doing the exercises correctly. Your squeeze will become stronger as you do more exercise.
  2. Remember, it is very important that you not use your stomach, legs or buttocks muscles. The most common mistake is using too many muscles. To find out if you are also contracting your stomach muscles, place your hand on your abdomen while you squeeze your pelvic floor muscles. If you feel your abdomen moving, you are using your stomach muscles. To find out if you are using your buttocks muscle, place your hands under your buttocks. If you feel movement when you squeeze your pelvic floor muscle, you are also using your buttocks muscles. The same goes for the leg muscles. Try placing your hand underneath where the hip joins the thigh and also on your inner thigh. If there is movement felt, you are more than likely using an incorrect muscle there as well. If you continue to have difficulty with this let us know. We will be more than happy to help you.
DOING THE EXERCISE

  1. If your pelvic floor is very weak, it is best to do these exercises lying down at first. The pelvic floor Muscles have to work harder in sitting or standing positions. Maintain normal breathing at all times.
  2. Squeeze the muscle which you have already identified as the correct muscle. Hold for a count of 5. Then relax for a count of 10. Remember, it is just as important to relax as it is to contract this muscle. Always try to relax twice as long as you hold the squeeze. Work up to holding the squeeze for 10 seconds, increasing your relax time to 20 seconds. Do not be discouraged if you cannot do this at first. Just do the best you can and go from there. You will get stronger in time. This muscle is not one we regularly use, so be patient with yourself.
  3. Begin by doing 50 Kegels each day. You do not have to do them all at one time. If you have trouble remembering to do these, set some time aside each morning and set a kitchen timer for 5-10 minutes each day, increasing it to twice daily. You will be surprise how this helps you get into the routine. Over time, increase to 3 times a day, if possible, eventually increasing the total number of daily exercises to 100.
  4. Also work on a more rapid, repeated squeeze (about 10-20 repetitions). These do not need to be held for any length of time and can be performed when coughing, sneezing or lifting to help control leakage, they will also help reduce urgency.
WHEN WILL YOU NOTICE THE CHANGE?

You should notice a slight decrease in urinary incontinence (accidents) after about 2 weeks of consistent, daily exercise. You will see an even bigger difference within one month. However, it may take up to 6 months if your pelvic floor is very weak. Obviously, the more consistently you do these exercises, if done correctly, the more benefit you will receive from them.

These exercises cannot harm you in any way. You may feel some muscle soreness as your body adjusts to this new activity. Most people find them relaxing and easy to do. If you get back or stomach pain after exercising, you are probably trying too hard and may be using your stomach or back muscle. If this occurs, go back and try to find the correct muscle. Remember, these exercises should be easy. If you experience headaches you may be holding your breath. Try to remember to relax and make these as easy as possible. In time, you will learn to practice effortlessly. Eventually, these will become a part of your lifestyle, like brushing your teeth. Remember, though, in order to receive and maintain maximum benefit from the exercises, it is important that you continue doing them on a daily basis.


Obstetrics and Gynecology Department Medication Directions

Medication: Clomid-

Patient will ovulate near the 14th day of her menstrual cycle, Day 1 being the first day of menses (any bleeding or spotting). The patient should have intercourse on days 12, 14, and 16 of their menstrual cycle. Sperm live approximately 72 hours with in the vagina. The patient may purchase an ovulation predictor kit to verify ovulation. These kits can be purchased at any drug store.

After taking Clomid and following the directions above, the patient will wait for her next menstrual cycle to begin. If menses does not begin by the 30th day of the cycle, then the patient should take a pregnancy test. If the pregnancy test is positive, the patient needs to make a routine appointment with her provider. If the pregnancy test is negative, then the patient needs to allow her menstrual cycle to start naturally, or can take progesterone to start menses.


GETTING A GOOD START WITH BREASTFEEDING

PERKS FOR MOM AND BABY

  • The hormone produced while breastfeeding relaxes mom and baby which decreases stress hormones and its negative effects.
  • Increases oxygenation and improves vital signs.
  • Introduces baby's tummy to "good" bacteria to help fight off "bad" bacteria and improves digestion making baby less fussy with tummy aches.
  • Baby is warmest and uses less energy keeping warm while nursing and skin to skin with mom.
  • Earlier breastfeeding success = earlier discharge from the hospital.
  • Earlier success and more skin to skin time = increased milk production.
  • Improved parent - infant bonding.
  • Breast milk adapts to baby's needs depending on your baby's age and the time of day.
TIPS TO MAKE IT BETTER

  • Place mother and infant skin to skin at birth and allow baby to start breastfeeding with no interruption.
  • Room in with your baby at the hospital to help pick up on your baby's feeding cues and allow baby to suckle more frequently.
  • Start feeding baby before he/she starts crying (crying is a late sign of hunger). Look for smacking of lips and rooting.
  • No bottle or pacifiers until latch and milk supply is well established. Milk supply increases and maintains by the suckling on the nipple, emptying the milk from the breast and by not allowing baby to suckle on anything else. Supplementation will decrease milk production.
  • Skin to skin (baby dressed down to at least a onesie or naked.....the more skin contact the better) while cuddling with baby and during feedings ...Daddy, too! Skin to skin proves to be very beneficial for baby's physical and mental health and does so for up to 8 weeks.
  • Learn about latch ahead of time...take a class, research on the internet, etc.
  • Have father of baby, family and friends on board to support and help you.
WHAT TO EXPECT

  • You and your baby will have to "learn" to breastfeed.
  • The first days are practice and may present challenges.
  • You'll have colostrum first- there doesn't seem to be much and it is clear to yellow in color, but don't worry-baby's tummy only holds a marble sized amount and it is made to be easy on the new little tummy.
  • Babies lose weight due to water loss - up to 10% is normal, but baby should return to its birth weight by 2 weeks of age.
  • Babies are sleepy and don't nurse much the first day (except for right after delivery).
  • Then in the first few days after birth, baby will want to latch a lot. The sucking that the baby is doing is what helps bring your milk in........it can be normal to nurse for a whole hour, sleep for 2, nurse for 1 and on and on. Don't worry feedings will shorten and satisfy baby longer as your milk comes in and baby gains weight.
  • Your milk will come in 3-5 days after baby is born and your breasts will be very full and tender- keep nursing to relieve the pressure.
  • Babies cry a lot - period. Expect that they will and know that it doesn't necessarily mean something is wrong with baby nursing or your milk. Keep trying to nurse and comfort the baby and call for professional help if needed.
  • Your nipples may become chapped and sore, but if the baby hurts you while latching, seek professional help.
  • Newborn babies don't have a schedule and "cluster" feeding is common, where babies nurse frequently at a certain time of day. This can prepare baby for longer sleep cycles and increase milk production.
AND MORE...

  • Human milk is the perfect food, for this baby at this time!
  • The first 2 weeks are usually the most challenging and then it gets much easier and more comfortable.
  • Don't be afraid to ask for breastfeeding help from professionals.....call the phone nurse line (208)746-1383 ext 6510 and speak with the nurse about making an appointment with Andrea Hedrick, our nurse midwife and lactation specialist. SJRMC Family Beginnings also has a lactation consultant and their number is (208)799-5430.
  • At times you may need a break, so much that you can't follow all the tips, and that is ok.
  • HIV+ moms, please ask about breastfeeding.
For more information and tips see:

BREASTFEEDING VIDEOS





PREGNANCY INDUCED HYPERTENSION

The following is only a concern for those in the last trimester that have been diagnosed with "PIH".

Pregnancy Induced Hypertension can be a sign of pre-eclampsia that is a condition of pregnancy marked by high blood pressure and excess protein in your urine. Pre-eclampsia often causes only modest increases in blood pressure, but can lead to serious complications.

Please call your provider or SJRMC L&D if you have been diagnosed with PIH and have these signs and symptoms:

  • Headaches
  • Nausea and vomiting
  • Sudden increase in swelling to your lower extremities, hands or face.
  • Seeing spots or blurry vision
  • Right upper quadrant abdominal pain
  • Just feeling "not well", "icky" or "different"
SJRMC L&D 799-5430/ VMC 746-1383 ext.6510


NUTRITION

15 Non Dairy Foods High in Calcium

Contrary to popular belief, you don't need to drink your milk in order to get your calcium.

The government recommendation for adults ages 19-50 is 1000 mg of calcium per day. One cup of milk has 296 mg, but there are plenty of reasons you might not want to drink milk, from personal preference to medical reasons.

Here are 15 foods high in calcium that don't come from a cow:
Swiss Chard One cup of boiled chard has 102 mg.
Sesame Seeds A quarter cup of sesame seeds has 351 mg calcium.
Kale Once cup of boiled kale has 94 mg.
Spinach A cup of boiled spinach has 245 mg.
Brazil Nuts Two ounces of Brazil nuts (12 nuts) have 90 mg.
Collard Greens A cup of boiled collard greens has 266 mg.
Celery Two cups of raw celery have 81 mg.
Blackstrap Molasses One tablespoon has about 137 mg.
Almonds One ounce of almonds (23 nuts) has 75 mg.
Kelp One cup of raw kelp has 136 mg.
Papaya One medium papaya has 73 mg.
Tahini Two tablespoons of raw tahini (sesame seed butter) have 126 mg.
Flax Seeds Two tablespoons of flax seeds have 52 mg.
Broccoli Two cups of boiled broccoli have 124 mg.
Oranges One medium orange has 52 mg.

As you can see, eating a varied diet rich in dark leafy greens, fruits, nuts, and seeds will give you plenty of calcium and you'll get so many other health benefits from these foods as well.

IDEAL PROTEIN

The Ideal Protein Weight Loss Method is a medically designed protocol that results in fat loss while sparing muscle mass.

Click here to visit the Ideal Protein website.


Glucose Test Diet Instructions

Orders have been sent to our lab for a glucose tolerance test. The following diet instructions have been specially designed for you for use prior to this test. It is designed to supply the proper amounts of food needed to obtain an accurate test of how well your body burns carbohydrates. It is very important that you eat at least the amounts shown on the diet; however, you may eat more than these amounts, or additional types of food, if desired. Just please be certain to eat everything listed on the diet. Snacks are permitted.

  1. Eat the food listed each day for three (3) days, plus anything else you desire.
  2. No food or liquid, except water, should be consumed after 10pm the night prior to your test on day four (4).
  3. Continue to take only those medications prescribed by your doctor.

Breakfast:

  • Fruit (1 banana, 1 orange, ½ grapefruit, or ½ cup of fruit juice)
  • Cereal (1/2 cup)
  • Bread (1 slice)
  • Milk (1/2 cup)
  • Sugar (2 teaspoons)

Lunch:

  • Meat, cheese, or egg (as desired)
  • Bread (2 slices) or spaghetti, macaroni, rice, or noodles (1 cup, cooked)
  • Dessert (fruit, cake, pie, or cookies)
  • Milk (1 cup)
  • *Meat, tomatoes, etc. can be added as desired

Dinner:

  • Potato (1 medium)
  • Vegetable (at least ½ cup)
  • Bread (1 slice)
  • Meat (as desired)
  • Milk (1 cup)
  • Dessert (tapioca, rice pudding, or fruit)

If you have any questions concerning the test or instructions, please call our office at 208-746-1383, extension *6500 and we will be happy to answer your questions. Thank you.


INSURANCE BENEFITS

Use the Insurance Benefits form to lookup procedure codes. Contact your insurance company using the procedure code so they can inform you of how much of the procedure cost they will cover.
Web Resources
Below are Medical Resources available on the World Wide Web. All links on this site are provided exclusively for educational purposes. Valley Medical Center, PLLC does not endorse the content of external links.


The Office on Women's Health (OWH) was established in 1991 within the U.S. Department of Health and Human Services. Its Vision is to ensure that "All Women and Girls are Healthier and Have a Better Sense of Well Being." Its mission is to "provide leadership to promote health equity for women and girls through sex/gender-specific approaches." The strategy OWH uses to achieve its mission and vision is through the development of innovative programs, by educating health professionals, and motivating behavior change in consumers through the dissemination of health information.


Newman Breastfeeding Clinic & Institute offers a wealth of free online resources for breastfeeding mothers as well as health care professionals.

Advice and answers to your breastfeeding questions. What are the benefits of breastfeeding? How soon can I start breastfeeding my baby? How many times in a day should the baby be breastfed? Find the answers to those questions and more.


Find everything you need to know about IMPLANON, the birth control that goes under the skin of your arm.

To view other birth control options click here.


Intra Uterine Device or IUD

What is an Intra Uterine Device or IUD? These sites describe at large the Mirena and ParaGard IUD devices.

To view other birth control options click here.


Home page of Essure - permanent birth control. Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor's office in less than an hour.

Lamaze is a nonprofit organization that promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting. Knowing that pregnancy and childbirth can be demanding on a woman's body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years.

This page provides information about the overview of the Gynecare thermachoice which mainly defines as an effective, nonhormonal, permanent treatment for heavy periods. It involves a minimally invasive, 8-minute procedure that can be performed in your doc