What to Expect on Your First Visit
It is very important to complete all of the forms prior to your first visit. If you do not have time to complete the downloadable forms, please arrive at least 15 minutes prior to your scheduled appointment time. It is also important to bring your current insurance information. If we cannot make a copy of your current insurance card, we will have to reschedule your appointment.

Even if this is not your first pregnancy, your first prenatal visit with one of our OB counseling nurses is still very important. It is during this meeting that we gather pertinent background information to save you time on your future prenatal visits as well as to order necessary tests based on your background information.

On your first visit, you will speak with one of our OB counseling nurses, Teddie, Mary, or Carla. This is an exciting visit, introducing you to our office and allowing us the opportunity to learn about you and your expectations during your pregnancy. We’ll also give you an idea of your due date and will provide you with lots of interesting material to make your pregnancy go as smoothly as possible. You will receive: diet information, hospital policies, and as many free samples as we can get our hands on. This appointment runs about one hour in length.

We are piloting a new group pre-natal counseling session on one Saturday morning each month. Patients will have this option instead of the individual weekday appointment if desired. This gives AAW patients more options to coordinate your individual lifestyles. If you choose this option, your appointment will be 2-3 hours instead of 1 hour.

Your OB counseling visit is scheduled 7-8 weeks into your pregnancy. Your first prenatal visit with your doctor is scheduled for around week 10.

First Trimester Information Packet

Our Responsibilities to You

• Provide high quality obstetrical care in a caring, comforting and attentive atmosphere.
• Communicate with you openly about your pregnancy, including recommending additional testing or laboratory work that will help us in providing you the highest quality care.
• Listen to your desires for your care and accommodate your wishes to the extent possible.
• Return your phone calls within 48 hours.
• Augment the education provided by Child Birth Education Classes regarding what to expect during pregnancy and at the time of delivery.
• Let you know if we are running behind schedule. Each patient’s circumstance is different. When you are with one of our doctors, please be assured that you have her undivided attention. However, sometimes this attentiveness puts the doctor behind schedule.

Your Responsibilities to Us
Complete all your and the baby’s father’s prenatal testing and laboratory work prior to your second doctor visit. IT IS EXTREMELY IMPORTANT THAT YOU COMPLETE THIS LABORATORY TESTING IN A TIMELY MANNER, NO MATTER HOW MANY TIMES YOU HAVE BEEN PREGNANT BEFORE. All About Women, PA reserves the right to postpone your doctor visit or discontinue your care if you fail to comply with this request.
Know if your insurance company requires a referral or other pre-authorization before we can provide care. Obtain any necessary referrals/authorizations before your visit.

When scheduling an appointment, tell us if you have specific problems to discuss or if you need to leave by a certain time. That way, we can allow enough time for your appointment.

Be flexible regarding which practitioner you see during your routine OB visits. We would like each patient to see all six of our practitioners at least once during her prenatal care. Please note that our nurse practitioner, Dina Anderson, is here four days a week and therefore it is often easier to get a more convenient appointment time with her. In addition, because she does not see problem visits or provide hospital care, she usually runs closer to schedule.

Arrive 15 minutes before your appointment time if you are a new patient or have any change in information (e.g. new insurance, change of address) Try to bring your spouse/significant other and not to bring children to your pre-natal counseling visit with the nurse.

Call if you are going to be late for an appointment. Understand that if you are more than 10 minutes late, we may have to reschedule your appointment. You will be seen in order of when your appointment was scheduled, not by when you arrived. Some doctors may see patients faster than others. If a patient arrives after you, and is called first, it is because she is being seen by another provider.

Do You Keep Thinking of More Questions?
That’s OK! These new body changes during pregnancy and nursing can be very confusing. At All About Women, we understand! If you find that our links and searching the Internet haven’t answered all of your questions, keep a notebook and write your questions in it. On your next obstetrical visit, bring your notebook and ask your doctor, or contact our office for a nurse to respond in a timely manner. We’re happy to make you as comfortable as possible during your pregnancy.

What to Pack
It’s always a good idea to have a suitcase packed and ready to take to the hospital … just in case. Here’s a handy checklist to help you.
http://my.webmd.com/content/article/49/39976.htm

All About Labor and Pre-labor

Premature Labor
Premature labor, also called preterm labor, is labor that starts before 36 weeks of pregnancy, or more than 3 weeks before your due date. Premature labor can often be stopped if you identify it early. Premature labor is related to 70% of infant deaths due to low birthweight. A low birthweight is 5 lbs, 8oz or less.

Warning Signs

• Uterine Contractions — If you feel like your uterus tightening or the baby balling up for four times or more in one hour.
• Menstrual-like Cramps — Cramps like those you may have during your period may come and go, or be constant.
• Abdominal Cramps — These feel like stomach cramps with or without diarrhea.
• Low Backache — This is a backache near your tailbone that comes and goes or is there constantly.
• Pelvic Pressure — This feels like the baby is pushing down in your vagina.
• Change in Vaginal Discharge — There may be a sudden change in your discharge. It may increase, or become more mucousy, watery or slightly bloody.

What to Do

If you have one or more of these warning signs, you could be in premature labor. You should:

• Lie down
• Drink 2-3 glasses of water
• If the symptoms are not gone in 1 hour, call your doctor immediately. Also call your doctor if you have any vaginal bleeding that is more than a light day of menstrual period or if you experience a sudden gush of fluid from your vagina.

Causes of Premature Labor

Experts do not really know the actual causes of premature labor, but some things that may put women at risk include:

• previous premature labor or delivery of a premature baby
• twin or triplet pregnancy
• medical problems, such as high blood pressure, diabetes, kidney or lung disease
• abnormality of the uterus or cervix
• abnormality of the placenta
• women under 17 years
• DES exposure

The Labor Process

Things to Watch for in the Next Several Weeks
Some swelling of the legs and feet is normal. Excessive swelling in the hands and face are not, and you should call me immediately if you experience this. In addition, if you experience unusual headaches, you should call the office.

Sharp abdominal pain with bleeding or bright red bleeding is not normal and you must call the office immediately.
You may sense that your baby’s movements have subdued somewhat, however, what is happening is that as the baby grows, there is less room for him or her to move. Be aware of the overall patterns of movements as you progress. Please call the office if you have concerns about these patterns.

A gush of fluid from the vagina or continuous leaking should be evaluated. If you experience either, please call the office.
The onset of labor – If you experience contractions that are regular and are no more than 5 minutes apart, please call the office.

Preparing for Labor

How to Tell When Labor Begins
When you finally do go into labor, you may feel generalized pain from time to time. This is normal. If you are uncomfortable at times, you may do any of the following:

• Sit in a warm bath
• Have someone give you a lower back massage. Using common household items such as a tennis ball or a rolling pin can be effective.
• Use ice, a heating pad, or a combination of both on your lower back.
• Consume water, juice or even a popsicle as a way of maintaining fluids.
• Generally speaking, anything you find relaxing is acceptable.
• By the time you go into labor, you will likely feel frequent contractions (sometimes referred to as Braxton-Hicks contractions). These are normal and are an indication that your body is preparing for actual labor. While the onset of labor is different for each woman, one of more of the following may occur as you begin to go into labor:
• You may begin to suffer persistent back pain. Many times the pain will be accompanied by a feeling similar to premenstrual cramps.
• The appearance of a mucous discharge. It might be slightly blood-tinged. This plug blocks the cervix and its passing indicates that labor could be imminent. Even if it’s several days away, this indicates that things are moving in the right direction.
• You also may begin to suffer from diarrhea.

Is it Really Time?
At All About Women, we recommend that patients call us when any or all of the following occur:

• Your water breaks
• You are having contractions 5 minutes apart, or less, for more than 1 hour.
• You can’t carry on normal conversation during the contraction
• You are experiencing heavy vaginal bleeding
• You notice a significant change in fetal movement patterns
• These are all signs of active labor and you should call our office and plan to proceed to the hospital immediately.
• But … always call us if you have concerns not listed above.

Hospital Procedures
When you arrive at Christiana Care Hospital, go to the Maternity Receptionist Desk in the Women’s Health Building. The admission staff at the hospital will ensure that you are properly processed and admitted in a timely manner. If you are not pre-registered, please contact our office to identify the documents you will need upon admission to the hospital.

At the Hospital
Once you are admitted, and probably before your doctor sees you at the hospital, several things already will have occurred:
You will be placed on a fetal monitor so that your contractions and your baby’s heart rate can be monitored.
A member of the hospital’s labor and delivery team will do a vaginal exam to determine your dilation and effacement.
There are various forms of anesthesia or analgesics that may be offered to treat your labor pain. If you have elected to have an epidural, the labor and delivery nurse will coordinate with your physician (or the delivering OB) and the anesthesiologist to administer the epidural at the appropriate time. This may occur before you are seen by your physician, but not without the consent of your physician.

Christiana Care Hospital OB Information

Parent Education
Christiana Care Hospital offers you resources and education to help increase your knowledge and confidence during pregnancy and prepare you physically, mentally and psychologically for childbirth, postpartum, breastfeeding and early parenting.

The professional team of certified childbirth educators are all registered nurses experienced in labor and delivery, pediatric and postpartum care. There also are lactation consultants available to meet your special needs.

Childbirth Education helps prepare mothers and fathers for active participation in the birth of their baby and to make informed choices in the birthing process.

If you have any questions about any testing you may need at Christiana or any of its offerings for the OB patient, please call 302.733.”MOMS”. You can learn more about the Women’s Health Services by visiting their website: Christiana Care Hospital

Christiana Chare Child Safety Seat Inspections
Nationally certified technicians are available to answer questions and check children’s car seats on Mondays between 10a.m. and 2p.m. and Thursdays from 10a.m. to 2p.m. at the Women’s Health Building entrance at Christiana Hospital. Call Referral Services at 302.428.4100