Pregnancy guidelines

Even before you get pregnant, there are things you can do to help make sure you will have healthy babies. Here's how to take good care of yourself before and during pregnancy.

Preconception Guidelines
Nutrition	Details
Folic acid	HOW MUCH: At least 0.4 to 0.8 milligrams every day Folic acid is a B vitamin that helps protect your baby from birth defects of the spine and brain (such as spina bifida). Folic acid should be taken 12 months before pregnancy if you have a baby planned and throughout pregnancy.
Immunizations	When	Description
Rubella immunity	Determine immunity and immunize if needed	Rubella (or German measles) is caused by a virus. It can hurt the fetus. Often, babies with rubella die before or shortly after birth. Other birth defects from rubella can include hearing loss, eye defects and heart defects.
Hepatitis B	For those at high risk	Hepatitis B is a disease that affects the liver. It is spread by the blood or body fluids of an infected person. Often, there are no signs of the disease. You need to have a blood test to tell for sure. People at high risk are: Health professionals who work with blood products Dentists who come in contact with saliva People who use illegal drugs and share needles A three-shot series will help protect you from hepatitis B.

Prenatal Guidelines
Exam	When	Description
	First visit: As early as possible in the first 12 weeks of pregnancy Every four weeks for the first 28 weeks of pregnancy Every two to three weeks between 28 and 36 weeks of pregnancy Weekly after 36 weeks of pregnancy	Prenatal exams are important for you and the fetus because growth and development in the first eight weeks are critical. Every woman needs to know that she is in the best possible health. She also needs to know what to do and what not to do during pregnancy, such as exercise.
Clinical Screenings	Details
Initial screenings	Complete physical screenings, including family history. Medical, surgical, social, OB history and drugs you may be taking (including vitamins, herbs or over-the-counter medicines), screening for tobacco use, alcohol misuse and family and intimate partner violence. A complete history and physical exam gives your doctor an idea of what problems to look for and take care of, and helps assess your overall health.
Other tests	CBC (complete blood count) Urinalysis (urine test) Blood type, Rh and antibody screening Rubella titer Hepatitis B antibody titer VDRL serology Pap test (if needed) As determined by the doctor, you may be tested for group B strep or maternal serum alpha-fetoprotein. An amniocentesis or chronic villus sampling may be done if you are older than age 34 or have a family history of some diseases.
HIV, chlamydia, gonorrhea screening	Completed for all pregnant women
Influenza (flu) vaccine	Given after the first trimester (14 weeks or more) in the fall
Tdap (tetanus, diptheria and acellular pertussis) vaccine during pregnancy	A single dose is given in the postpartum period or in the second or third trimester if your last vaccination was more than 10 years ago.
Ongoing clinical screenings: Blood pressure Weight Urine test Fundal height Fetal presentation	Fetal presentation is the way the fetus is facing before birth. Is the fetus in the right position so that the head will be delivered first, or are the feet coming first? Normally, the head should come first, but sometimes the feet do. This is called a breech birth, which may result in delivery complications.
Swelling	A little swelling of the ankles is normal during pregnancy, but too much can cause problems, including a condition called toxemia. Your provider will watch for signs of this.
Fetal heartbeat and activity	The fetus moves, kicks, swallows and can even hear your voice. There are times the fetus rests, but you should be able to feel fetal movement throughout the pregnancy. If you don't feel movement, your doctor may do tests to make sure that everything is OK.
Ultrasound	WHEN: In the second trimester, if needed. An ultrasound is another way for your provider to check the growth and health of your fetus.
Glucose (sugar) screening	WHEN: Up to the 28th week of pregnancy, if needed Sometimes women have high levels of sugar during pregnancy (gestational diabetes). Insulin uses sugar in the body and turns it into energy. If insulin is blocked, the sugar is not used and spills over into the urine. Too much sugar may harm the fetus.
Urine culture	At 12 to 16 weeks.
To help have a healthy baby, don't smoke, drink or use drugs. Ask your doctor before taking any over-the-counter medications, herbs or dietary supplements.

Follow-Up Guidelines
Physical exam	When	Description
	One visit four to six weeks after delivery	Going back to see your doctor for a physical exam one month after delivery is important. Your doctor checks for bleeding, signs of infection or STDs. The best reason to go is to make sure you are healing well physically and are doing OK at home. This is also a great time to ask your doctor questions about breastfeeding or bottle-feeding, postpartum depression, knowing when you can begin having sex again and taking care of your newborn.
Clinical Screenings	Description
Weight and blood pressure, blood count (if needed), breast exam, abdominal exam, pelvic exam, Pap test (if needed), postpartum exam, counsel women on the importance of breastfeeding for at least three months	During your postpartum exam (after your delivery), your weight and blood pressure will be checked to make sure that everything is OK. A breast exam is done to make sure your milk is flowing well if you're breastfeeding, that your nipples look normal and that there are no signs of infection. If you're not breastfeeding, your doctor will check to make sure your milk has dried up. Your doctor may also do an abdominal and pelvic exam to see if your uterus is moving back into its normal place and to see if it is healing well. Sometimes a Pap test is done if there are signs of an infection. All of these tests are routine.
If you suffer from postpartum depression, substance abuse, domestic violence or emotional problems, help is available. Call our Behavioral Health Department 24 hours a day at 800 673-8043.