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					                               PRENATAL WORKBOOK
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                        Written and provided for you by:




My MCH Team is:_____________________________________________________________


Family Medicine Center                                (919) 966-0210

Maternity Care Coordinator                            (919) 966-4196
Denise Shaver, RN

Perinatal Nurse, Maternal Child Health                (919) 966-2109
Barbara Hotelling, RN BSN MSN

Family Nurse Practitioner                             (919) 843-3003
Jan Tedder, BSN FNP

Assistant, Maternal Child Health                       (919) 843-7678
Erin Hoagland
ehoagland@unch.unc.edu
For Breastfeeding Concerns, please call                    (919) 923-8295

To reach the MCH Pager, please call        (919) 216-3048
*This pager is for pregnancy emergencies/significant medical issues only.

Our Website: http://www.med.unc.edu/fammed/for-patients/maternal-childcare
Last revised 03/11/10




                                           TABLE OF CONTENTS
Introduction                                                    You and Your Baby ........................ 31
   Prenatal Care at UNC FMC .............. 3                    Preparation for Breastfeeding ........ 32
   Calling with Questions……… ……….4                              Baby Blues ..................................... 32
   Good Books……………… …………..4                                     Preparing Other Children ............... 33
   Group Prenatal Care ........................ 5               Packing bags for Mom and Baby ... 34
                                                                Group B Strep ................................ 35
Chapter One - The First Trimester                               Discomforts in Third Trimester ....... 36
  You and Your Baby .......................... 6                Questions for my Provider.............. 37
  Tests at First Visit ............................. 7        Chapter Four - Planning for the Birth
  A Healthy Pregnancy ........................ 8                Definition of Labor .......................... 38
  Exercises for Pregnancy................... 8                  When to Call in Labor .................... 39
  Weight Gain During Pregnancy ........ 9                       Coming to UNC Hospital’s ............. 40
  Nutrition in First Trimester .............. 10                Support in Labor ............................ 41
  Folic Acid ........................................ 10        Birth Plans or Preferences ............. 42
  You Are What You Eat ................... 11                   Comfort Measures in Labor............ 42
  Best Iron Sources ........................... 12              Drugs in Labor ............................... 43
  Sources of Calcium ........................ 13                Donation of Cord Cells ................... 45
  Junk Food Alternatives ................... 14                 Birth Plan: Baby’s B-day Wishes… .47
  Safety Facts-Fish…… ............ …….15                        Videotaping and Still Photography . 48
  Safety Facts-Listeriosis…… ……….16
  Breastfeeding: Tips for Success ..... 17                    Chapter Five - Planning for Your Baby
  Choosing the Right Breast Pump ... 18                         Safety Issues ................................. 49
  Breastfeeding-a healthy start.......... 19                    Telling Your Story .......................... 50
  Discomforts in First Trimester......... 20                    Circumcision: A Choice .................. 51
  Domestic Violence .......................... 21               Scheduling Circumcision………… . 52
  Questions for my Provider .............. 22                   Birth Control Choices ..................... 53
                                                                Permanent Sterilization………… ….57
Chapter Two - The Second Trimester                              Healthcare for Your Baby ............... 59
  You and Your Baby ........................ 23                 Choosing Babysitters or Daycare ... 60
  Sex during Pregnancy .................... 24
  Nourishing Yourself ........................ 25             Chapter Six - Special Situations
  Fetal Movement.............................. 26               When Your Baby is Overdue.......... 61
  Warning Signs of Preterm Labor .... 26                        Cesarean Birth ............................... 61
  Caring for Yourself if You Get Sick..27                       Vaginal Birth After a Cesarean....... 62
  Influenza in Pregnancy……… .. …..28                            Singing the Post Partum Blues ...... 63
  Discomforts in Second Trimester ... 29
  Questions for my Provider .............. 30                 Chapter Seven - Community Resources
                                                                Childbirth Classes at UNC Hosp .... 64
Chapter Three - The Third Trimester                             Community Childbirth Classes ....... 66
  Doula Resources ............................ 71
  HypnoBirthing Classes ................... 72
  Massage ......................................... 72
  Post Partum Home Care ................ 73
  Community Resources for Parenting
    and Child Care ........................... 74
  Support for Breastfeeding Mothers . 76


Special thanks:
*Arizona Department of Health for permission to
adapt their “9 months to get ready” series.
*Alex Solomon for assistance with revision 2009
                 Prenatal Care at UNC Family Medicine Center

Welcome to the UNC Family Medicine Center (FMC), Maternal and Child Health
Program. We look forward to working with you during your pregnancy and birth
and caring for you and your new family after your birth.

Who Will I See for Prenatal Care?
After you see our prenatal nurse for your first visit, you will begin to have prenatal
visits with your “MCH Team”. Your team is the group of Family Medicine resident
doctors who will be on Labor and Delivery when your baby is due. These same
doctors will give you all your prenatal care so you will see the same three people
all through your pregnancy and birth. You come in every month until you are 28
weeks pregnant, every 2 weeks from 28 weeks until 36 weeks, and every week
from 36 weeks until birth. We offer several types of prenatal care.

Standard Prenatal Care: One of the doctors on your MCH team will see you for
each of your prenatal visits.

Group prenatal care: Group prenatal care starts at about 12-18 weeks of
pregnancy. If you choose group care, you will still see your MCH team for a few
individual visits at the beginning of your pregnancy and the end of your pregnancy.
There are 10 group visits in the middle of the pregnancy that will take the place of
your regular prenatal visits. Visits are 90 minutes long. Each woman learns how to
take her vital signs and writes them in her prenatal chart. There are usually 4-8
other pregnant women in the room who are at about the same point in their
pregnancy that you are. Your team doctors will take turns coming to the group
visits so you still meet with them. There is also a doctor or midwife and a nurse
who come to each of your group visits. Partners are welcome.

Focused prenatal care: For those women who feel that they are experienced with
pregnancy and do not want to come in for all of the prenatal visits, we offer a
shortened schedule of appointments (7 instead of 14). You need to have an
uncomplicated pregnancy to use focused prenatal care. If you are interested, talk
to the prenatal nurse (Perinatal Clinic Coordinator) to arrange it.

Midwifery care: We do not offer a midwifery service (24 hour midwifery coverage),
however, we do have one midwife on staff who can be involved in your prenatal
care if you choose. She is on Labor and Delivery two days a week. Talk to the
Perinatal Clinic Coordinator to arrange for this if you are interested.
WHO DO I CALL WITH QUESTIONS?
You can call the main number for the Family Medicine Center: 919-966-0210.
1. If you have a medical question, use our pregnancy line, which is option
   #4 on the phone tree. You will be asked some basic information about
   what is happening and then be connected to one of our doctors.
2. For non-urgent questions, you may leave a message for your regular
   clinician on the phone or by email. They will usually answer in 24-48
   hours.
3. You can also page the doctors directly using the MCH pager number
   which is 919-216-3048.

How do I use this workbook?
This workbook is meant to be interactive. There are sheets you can fill out and
bring in to your visits to discuss with your doctor or midwife. Each discussion sheet
will have the Family Medicine Team MCH Logo at the top.

Getting Information about Pregnancy and Childbirth
The more information you have, the more choices you create. We encourage you
to use the Internet and your local library to learn as much as you can! Some book
suggestions:

Pregnancy and Birth
Any books by Penny Simpkin, Sheila Kitzinger, Henci Goer or Ina May Gaskin
A Child is Born by Liennart Nilsson (lots of pictures of babies in the uterus)
Birthing From Within by Pam England
The Official Lamaze Guide: Giving Birth with Confidence by Lothian and DeVries
Gentle Birth, Gentle Mothering by Sarah Buckley
Our Bodies, Ourselves: Pregnancy and Birth by Judy Norsigian

Breastfeeding
Nursing Your Baby, by Karen Pryor.
The Nursing Mother’s Companion by Kathleen Huggins
Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers by Nancy
Mohbacher and Kathleen Kendall-Tackett
The Ultimate Breastfeeding Book of Answers by Jack Newman

Babies
The Baby Book by William & Martha Sears
    UNC Family Medicine: If you choose to come to group visits
          Group Prenatal Care – Keeping Confidences

If you are interested in group prenatal care and are unsure when your group will
begin, call the Perinatal Clinic Coordinator (919-966-2109)

Being a part of a prenatal care group is different in some ways than having a
private appointment with your provider. We will be sharing personal information
about our families, health, and what is going on in our private lives with others in
the group. This is part of what makes group care special – we can learn so much
from each other. But, we also need to be careful to protect one another’s privacy.
Everyone has the right to expect what is shared during group prenatal care private
and confidential. We are committed to keeping your privacy, and you will also
have the responsibility to protect the privacy of others. If there is useful information
about pregnancy and health care that is not personal, please feel free to share
that with others. But what you hear and learn about individual group members and
their families should stay in the room.

We will also be compiling a list of contact information for the women in your group
so that you may contact each other outside of our sessions if you would like to. If
you want your information to be on this list, please fill in your information below. If
you would rather have your contact information listed for others in the group, just
leave it blank.

Name: __________________________________

Address: ________________________________

Email/phone #: ___________________________

Signature: _______________________________
Date: ___________________________________
                    Chapter One - The First Trimester
               (0 to 14 weeks after your last menstrual period)

You and Your Baby
This is when the baby’s major organs (heart, lungs, brain, kidneys, and liver)
develop. Ask us if you have any questions about your work or home environment.

Your Baby
Your baby’s heart will beat by the 25th day of pregnancy (about 40 days since
your last period), but we won’t be able to hear the heartbeat in the clinic until 10 to
12 weeks of pregnancy.

By 12 weeks of pregnancy, your baby will be three inches long and weigh an
ounce. Your baby is starting to open and close its mouth and move its tiny hands,
legs, and head.

Your Body
Even though you ovulate (release an egg), and become pregnant about half way
between one period and the next, we start counting the weeks of your pregnancy
from the first day of your last menstrual period. So, by the time you have missed a
period, you are four weeks pregnant.

Most of the symptoms of pregnancy are caused by the pregnancy hormones your
body makes. They usually begin at about 6 weeks of pregnancy, and are much
better by about 14 weeks of pregnancy.

During the first trimester (0-14 weeks of pregnancy), you will feel your waist
thicken. Your uterus may feel like a small lump above the pubic bone. As it
crowds the bladder, you will feel the need to urinate more often. Most women feel
very tired during the first trimester of their pregnancy. Even though you don’t see
much happening from the outside, your body is very busy building the baby.

The placenta (or afterbirth) grows along with the baby. It begins to pull nutrients
from your circulation at about 11 weeks of pregnancy. It is attached to the wall of
your uterus and connects to the baby by the umbilical cord. Your uterus is about
the size of a large grapefruit.
Tests at your first visit

  Blood Group and Rh Testing       Some maternal blood types are associated with risks to
                                   the baby, which can be prevented with early identification
                                   and follow-up.
 Blood Antibody Screen             Tests for red cell antibodies in the mother’s blood.
 Rubella Testing                   Rubella infections in pregnancy can harm the baby; if a
                                   woman is not immune to rubella, we recommend rubella
                                   immunization in the postpartum period.
 Hepatitis B Surface Antigen       Children of chronic carriers of Hepatitis B need special
 (HBSAg)                           immunizations at birth to prevent hepatitis infections.
 Complete Blood Count (CBC)        Tests for anemia
 Urine Culture                     Urinary tract infections can increase in pregnancy
 HIV: Recommended                  Identification of women with HIV infection is important to
 (requires consent)                treat her and to prevent the baby from becoming
                                   infected.
 Syphilis Testing                  Identification of women with syphilis is important to treat
                                   her infection and to prevent the baby from becoming
                                   infected. State Law
 Varicella Testing                 Done on women with no known history of chicken pox or
                                   immunization for chicken pox. If a woman is not immune,
                                   we recommend varicella immunization in the postpartum
                                   period.
 Cystic Fibrosis Carrier Testing   Cystic Fibrosis is a lung and digestive disease that is
 (optional)                        inherited when both parents carry the gene. The risk of
                                   carrying the gene is different among races and
                                   ethnicities. There is a blood test available to see if you
                                   and your partner carry the gene. Not all health insurance
                                   plans cover testing. Talk to your provider to learn more
                                   about testing.
 Sickle Cell Carrier Testing       Sickle cell disease is a problem of the blood cells that is
 (optional)                        inherited when both parents carry the gene. The risk of
                                   carrying the gene is different among races and
                                   ethnicities. There is a blood test available to see if you
                                   and your partner carry the gene.

Tests with your pelvic exam

 Pap smear                            This screening test for cervical cancer is done if there
                                      has not been a Pap in the last year
 Gonorrhea                            Screening for asymptomatic infection. Treatment
                                      lowers the risk of infection to the baby and preterm
                                      delivery. State law
 Chlamydia                            Screening for asymptomatic infection. Treatment
                                      lowers the risk of infection to the baby and preterm
                                      delivery. State law
Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Lab%20Studies.pdf (last revised Feb 2008)
                                            A HEALTHY PREGNANCY

To take care of your baby, you need to start by taking care of yourself during your
pregnancy. Make good food choices, exercise, and make time in your life to relax.
Here are some helpful things you can do for your baby as well as some things you
should avoid.
Things that are good for your baby
 Vitamins You and your baby need vitamins and minerals. Eating a good diet
   is the best way to get them. Taking a vitamin supplement is also helpful.
 Exercise
 Drink plenty of water Try to drink about 2 liters (4 bottles or glasses)each day
 Rest
 Practice good safety habits at work and at home
       Wear low-heeled shoes and change positions every hour
       Squat instead of bending over to pick things up
       Avoid toxic fumes or chemicals

Exercises for Pregnancy, Childbirth, and Postpartum

Swimming, walking, and stationary bicycling are excellent exercises. If you are
not used to exercise, don’t overdo it. Warm up before exercising and cool down
slowly afterwards. Avoid getting overheated and drink plenty of fluids. At the peak
of your workout, you should still be able to speak.
1. Kegal “Key-gull” Exercises or Pelvic Floor Exercises
Purpose: This will strengthen the muscles around the vagina, called the pelvic
floor muscles, which is good for pregnancy.
How to Do Kegal Exercises:
 To get the feel of the muscles, stop and start your urine when you use the
    toilet.
 Try to tighten the muscles a small amount at a time, “Like an elevator going up
    to the tenth floor,” then release very slowly one “floor” at a time.
 Try to tighten the muscles from front to back.
 Practice while you sit, stand, walk, drive or watch TV.
 Do these exercises 10 times every morning, afternoon and evening.
2. The Pelvic Rock
This will strengthen your tummy muscles, relieve backache & increase blood flow.
How to do The Pelvic Rock There are two positions you can use:
Position 1: Get on your hands and knees with your arms and back straight and
tighten your tummy muscles while you tuck your hips forward. Your back will arch
like a cat. Then relax into a straight-backed position.
Position 2: Start with your back against a wall and tighten your tummy muscles
and tuck in your buttocks so the small of your back is flat against the wall. If you
put your hands on your hipbones, you should feel your hips rock.

                      WEIGHT GAIN DURING PREGNANCY

As your pregnancy progresses, both you and your baby will gain weight.
Pregnant women need to add about 300 calories a day to their diet.
Expect to gain about 2 to 4 pounds the first 3 months. After that you will normally
gain about one pound a week. Expect your total weight gain to be about 24 to 30
pounds.

                      Average Total Weight Gain (pounds)
                                       1lb Placenta
                                      2lbs Uterus
                                       1lb Breast enlargement
                                   8 ½ lbs Extra blood and fluid
                                  7 ½ lbs Baby
                                       4lb Maternal fat stores
                                    24 lbs TOTAL



It is important NOT to diet during pregnancy. Both you and your baby need extra
nutrition. If you start your pregnancy weighing over 200 lbs, you may gain less
weight with the pregnancy.

If you are on a special diet (for example, vegetarian or dairy-free) let your provider
know so you can discuss any dietary needs. Usually you do not need to change
your diet during pregnancy.


Bonus for breastfeeding
Mothers who breastfeed use 500 more calories each day and often find they
lose weight faster than mothers who don’t breastfeed!
NUTRITION IN THE FIRST TRIMESTER
The placenta and umbilical cord form at about the
11th week of pregnancy. The most important thing
you need in the first trimester is folic acid (or
folate). Folic acid is used to make the extra blood
your body needs during pregnancy. All women of
childbearing age should get 400 micrograms of folic
acid a day.

When should I start taking folic acid?
All women of childbearing age should take folic acid.
Neural tube defects (birth defects of the brain or
spinal cord) usually develop in the first 28 days of
pregnancy, often before a woman even knows that
she is pregnant. If you find you are pregnant and
have not been taking folic acid, you should go ahead
and start taking folic acid right away.
What foods contain folic acid?
About half of all pregnancies are unplanned, so the
FDA has added folic acid to certain foods. The
following foods can help you get your recommended
amount of folic acid:



          Foods that are naturally high in folic acid,             Foods that have folic acid added to them:

   Beans and lentils                                                Breakfast cereals (Some have 100%
   Peas (black-eyed peas, chickpeas, green peas)                     of the Daily Value of folic acid in each
   Juices (orange, tomato, grapefruit, pineapple)                    serving)
   Fruits (oranges, cantaloupe, honeydew melon, avocado,            Breads
    papaya, raspberries)                                             Flours
   Soymilk                                                          Pastas
   Vegetables: green leafy vegetables such as spinach,              Cornmeals
    lettuce, turnip greens, mustard greens, collard greens,          White rice
    and Chinese cabbage; broccoli; Brussels sprouts;
    asparagus; artichokes; okra; corn; cauliflower; potato;
    beets; green onions; sweet red peppers
   Nuts
   Sunflower seeds
   Peanuts and peanut butter
   Liver
   Giblets
*A daily vitamin with folic acid may be suggested by your health care provider since the
food listed above may not contain enough folic acid to meet your daily needs.

Source: http://www.americanpregnancy.org/pregnancyhealth/folicacid.html (Last updated October, 2008)
               You are what you eat: Nutrition during Pregnancy

         Write down everything you ate or drank in the last 24 hours below:

    Breakfast:                 Dinner:                   Lunch:                     Snacks
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________
    __________________         __________________        __________________         __________________



Goals:
        Eat home cooked meals everyday and when you do go out to eat, pick healthy foods.
        Make healthy snack choices. Fresh fruits, vegetables, cheeses or yoghurt are all great options!
        Take in the daily recommended amount of calcium (1200mg) and iron (27mg).
        Choose frozen/fresh vegetables and fruits over canned goods.
        Drink 64 fl oz (about 4 L) of water in combination with juice or milk—soda is not good for you!

Rules of thumb:
    FRESH fruits and vegetables, and carbohydrates which contain WHOLE grains are healthier
       choices.
    Dark green vegetables are especially good for pregnancy
    Its also important to eat a wide selection of lower fat protein-containing foods including: grilled
       chicken and fish, all kinds of beans (soybeans, lentils, chick peas, chili beans) and low fat nuts
       such as almonds and hazelnuts.


It is commonly said that during pregnancy you are “eating for two” and while it is true that your
developing baby needs to be nourished through what you eat and drink, it doesn’t mean DOUBLE of
everything! Every woman is different, but in general most women need an extra 300 calories per day,
and gain about 25-35 lbs during pregnancy. This extra weight goes to lots of places – your baby, the
placenta and amniotic fluid, normal enlargements in your uterus, breast tissue and blood volume, and
normal fat stores during pregnancy which help get your body ready for breastfeeding.
                               BEST IRON SOURCES
               Where does iron come from in your diet? Goal: 27 mg/day
                                      *Percent of Daily Value
     Selected Sources of Heme Iron (Heme iron is from animal sources and absorbed more easily)
                      Food                           Serving Size     Milligrams per serving     % DV*
              Chicken liver, cooked                   3½ ounces                12.8               70
           Oysters, breaded and fried                  6 pieces                4.5                25
         Beef, chuck, lean only, braised              3 ounces                 3.2                20
              Clams, breaded, fried                     ¾ cup                  3.0                15
            Beef, tenderloin, roasted                 3 ounces                 3.0                15
           Turkey, dark meat, roasted                 3½ ounces                2.3                10
           Beef, eye of round, roasted                3 ounces                 2.2                10
           Turkey, light meat, roasted                3½ ounces                1.6                 8
        Chicken, leg, meat only, roasted              3½ ounces                1.3                 6
      Tuna, fresh bluefin, cooked, dry heat           3 ounces                 1.1                 6
            Chicken, breast, roasted                  3 ounces                 1.1                 6
            Halibut, cooked, dry heat                 3 ounces                 0.9                 6
       Crab, blue crab, cooked, moist heat            3 ounces                 0.8                 4
                Pork, loin, broiled                   3 ounces                 0.8                 4
          Tuna, white, canned in water                3 ounces                 0.8                 4
   Shrimp, mixed species, cooked, moist heat           4 large                 0.7                 4
Selected Food Sources of Nonheme Iron (nonheme iron comes from plant or fortified foods and is more
                               common but less easily absorbed)]
                      Food                           Serving Size     Milligrams per serving     % DV*
    Ready-to-eat cereal, 100% iron fortified            ¾ cup                  18.0               100
 Oatmeal, instant, fortified, prepared with water       1 cup                  10.0               60
           Soybeans, mature, boiled                     1 cup                   8.8               50
                 Lentils, boiled                        1 cup                   6.6               35
         Beans, kidney, mature, boiled                  1 cup                   5.2               25
       Beans, lima, large, mature, boiled               1 cup                   4.5               25
          Beans, navy, mature, boiled                   1 cup                   4.5               25
     Ready-to-eat cereal, 25% iron fortified            ¾ cup                   4.5               25
          Beans, black, mature, boiled                  1 cup                   3.6               20
          Beans, pinto, mature, boiled                  1 cup                   3.6               20
              Molasses, blackstrap                   1 tablespoon               3.5               20
                 Tofu, raw, firm,                       ½ cup                   3.4               20
            Spinach, boiled, drained                    ½ cup                   3.2               20
        Spinach, canned, drained solids                 ½ cup                   2.5               10
       Black-eyed peas (cowpeas), boiled                1 cup                   1.8               10
        Spinach, frozen, chopped, boiled                ½ cup                   1.9               10
Grits, white, enriched, quick, prepared with water      1 cup                   1.5                8
           Raisins, seedless, packed                    ½ cup                   1.5                8
               Whole wheat bread                        1 slice                 0.9                6
                Source: http://dietary-supplements.info.nih.gov/factsheets/iron.asp (last
                updated August 2007)
                                       SOURCES OF CALCIUM
                       Where does calcium come from in your diet?
During pregnancy, you will need about 1200 milligrams of calcium a day. Calcium promotes the
growth of your baby’s skeleton and teeth. The baby requires more calcium than normal during
the last trimester, when the teeth are forming and skeletal growth is most rapid. Calcium is also
important for mothers. Dairy products are the best dietary source of calcium. Here are some
foods and the amount of calcium they have in them.

Food Source (Dairy)                              Serving Size (oz.)           Calcium (mg)
Plain yogurt, non fat                            8.0                          452
Romano cheese                                    1.5                          452
Pasteurized process Swiss Cheese                 2.0                          438
Plain yogurt, low fat                            8.0                          415
Fruit yogurt, low fat                            8.0                          345
Swiss cheese                                     1.5                          336
Ricotta cheese, part skim                        4.0                          335
Pasteurized process American Cheese              2.0                          323
Provolone cheese                                 1.5                          321
Mozzarella cheese, part skim                     1.5                          311
Cheddar cheese                                   1.5                          307
Fat free (skim) milk                             8.0                          306
Muenster cheese                                  1.5                          305
1% low fat milk                                  8.0                          290
2% reduced fat milk                              8.0                          285
Buttermilk, low fat                              8.0                          284
Whole milk                                       8.0                          276
Yogurt, plain, whole milk                        8.0                          275
Ricotta cheese, whole milk                       4.0                          255
Blue cheese                                      1.5                          225
Mozzarella cheese, whole milk                    1.5                          215
Feta cheese                                      1.5                          210

Food Source (Non-dairy)                          Serving Size (oz.)           Calcium (mg)
Soy beverage, calcium fortified                  8.0                          368
Sardines, Atlantic, in oil, drained              3.0                          325
Tofu, firm, prapred with nigari                  4.0                          253
Pink salmon, canned, with bone                   3.0                          181
Collards, cooked                                 4.0                          178
Spinach, cooked                                  4.0                          130
White beans, canned                              4.0                          96
Kale, cooked                                     4.0                          90
Okra, cooked                                     4.0                          88
Blue crab, canned                                3.0                          86
Soybeans, mature, cooked                         4.0                          88
Clams, canned                                    3.0                          78
Source: http://www.health.gov/Dietaryguidelines/dga2005/document/html/AppendixB.htm (last updated July 2009)
                  WHAT CAN I EAT INSTEAD OF JUNK FOOD?

Junk food has little or no food value per calorie and is often high in sugar, fat, or
salt (which is why we like it!). Try to eat only small amounts of junk food so you
have more room for nutritious foods.

TRY TO CHOOSE SNACKS FROM THESE FOODS
     Whole grain crackers
     Unbuttered popcorn
     Dry cereals, such as shredded wheat biscuits
     Unsalted pretzels
     Raw vegetables
     Dips or spreads made with yogurt, cottage cheese and peanut butter
  Fruit snacks
     Dried fruit, frozen fruit while icy, fruit “canned in it’s own juice”, ice-cold fresh
     fruit or juice.
  Desserts
     Make cookies with whole wheat flour, molasses, applesauce, raisins, nuts or
     oatmeal.
     Reduce sugar and fat in favorite recipes by using 2 Tbs less than the recipe
     calls for.
     Try applesauce, low fat ice milk, custard, pudding, or yogurt with fruit
     toppings.

READ PACKAGE LABELS
Ingredients are listed by weight with the first ingredient being the main ingredient
in the food. Be sure that sugar, corn syrup or any word ending in -ose (a form of
sugar) is not one of the first four ingredients.

TRY TO LIMIT THESE FOODS TO 2 SERVINGS A WEEK
Fast foods: hamburgers, fried chicken, pizza, french fries, tacos, chips, candy, ice
cream, soda pop, pastries and rich desserts. Recipes calling for fats, white flour
and sugar.

WANT SOME FEEDBACK ON WHAT YOU EAT?
Keep a diary for 3 days. Write down everything you eat and drink including the
amount and the time you eat it. Bring it in to talk about at your next prenatal visit.

Are there foods I should be avoiding? There are a few foods you should avoid
during pregnancy. The following information about Listeriosis and Fish will fill you
in. If you have any other questions about food in pregnancy, please talk to your
clinician about them.
                     Safety Facts for a Healthy Pregnancy
                                    ~FISH~
When you are pregnant, eating well and taking care of yourself are very important for you and your
baby. Fish is a good source of protein. Here is some important information about the safest ways to
choose, prepare and eat fish during pregnancy. The information is also important for nursing
mothers and young children.
Is eating fish healthy during pregnancy?
Fish and seafood are healthy foods. They are rich in protein and low in saturated fat. Also, certain
kinds of fish contain nutrients such as omega-3 fatty acids, oils, minerals, and essential amino acids
that help keep your heart healthy. However, some kinds of fish contain chemicals which can be
harmful. Eating fish that have too much methyl mercury could cause birth defects or damage to an
unborn or nursing baby.
How can you eat fish safely during pregnancy?
The United States Food and Drug Administration (FDA) and the Centers for Disease Control and
Prevention (CDC) have put together guidelines to help women eat fish safely. These guidelines ask
pregnant and nursing women to avoid the kinds of fish that contain methyl mercury.
Specific recommendations are:

   • Do not eat SHARK, SWORDFISH, KING MACKERAL, CANNED WHITEFISH (ALBACORE
      TUNA), SPANISH MACKERAL or TILEFISH.
   • Eat no more than one serving (6 ounces) of fish from local rivers, lakes or ponds each week. If
      you eat fish from local waters, don’t eat other fish in that same week.
   • Do not eat these fish if they were caught either east or south of I-85: BLACKFISH, (BOWFIN),
      LARGEMOUTH BASS, OR JACK FISH (CHAIN PICKERAL)
   • Eat no more than two servings (12 ounces) of other fresh or canned ocean fish (like salmon,
      tuna and flounder) or seafood (like shrimp, oysters and clams) each week.
   • Good choices for fish are shrimp, canned light tuna, salmon, pollock, and catfish

What is the safest way to prepare fish and seafood?
When you are making meals for yourself or your family, follow these guidelines so that you or your
family members do not get sick from bacteria that may be present in raw fish or seafood:

   • When you are preparing raw fish or seafood, often wash your hands and anything that comes
      in contact with the fish with hot, soapy water.
   • Keep raw fish or seafood away from already cooked fish or seafood. For example, do not put
      cooked fish on a plate or dish that had raw fish or seafood on it without first washing the plate
      or dish with hot, soapy water.
   • Be sure to completely cook the fish. Test the fish for doneness by putting a fork into the thickest
      part of the fish and look for meat that flakes easily.
   • Put leftover cooked or raw fish or seafood in the refrigerator or freezer right away. Do not allow
      this food to stay out of the refrigerator or freezer overnight because it can grow bacteria in
      just a few hours.

 If you have other questions or concerns about food safety in pregnancy or while you are nursing your baby, ask
                                           your health care provider.

 Another resource for the most up-to-date information is the North Carolina Public Health Department at 919-733-
                                      3410 or www.epi.state.nc.us/epi/fish
                   Or the Environmental Protection Agency at www.epa.gov/waterscience/fish
Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Lab%20Studies.pdf (last revised Feb 2008)

                         Safety Facts for a Healthy Pregnancy
                                     ~Listeriosis~
What is Listeriosis?
Listeriosis is a disease caused by the bacteria known as Listeria monocytogenes (Listeria). This
disease can cause miscarriage, premature birth, stillbirth, and problems for your baby after birth. It
can also cause infections to the brain tissues and seizures in older adults and persons with chronic
illnesses.

How does a person get listeriosis?
Eating food contaminated with Listeria causes most listeriosis infections in humans. Listeria is a
bacteria that exists everywhere in our environment – in the soil, groundwater, and on plants.
Although most people who come in contact with Listeria do not get sick, pregnant women are at
greater risk because of immune changes in pregnancy.

What can I do to prevent Listeriosis?
The United States Food and Drug Administration (FDA) advises you to do these things to decrease
the chances of infection:

    • Wash raw vegetables before eating.
    • Wash hands, knives and cutting board after handling uncooked foods.
    • Consume fruits and vegetables and ready-to-eat foods as soon as possible.
    • Do not eat hot dogs, deli meats, and luncheon meats unless they are heated to be steaming
        hot.
    • Avoid getting fluid from hot dog packages on other foods, utensils and food preparation
        surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
    • Do not eat soft cheese such as feta, Brie, Camembert, blue-veined cheeses or fresh Mexican-
        style cheeses like queso blanco, queso fresco. However, you can eat hard cheeses, such as
        cheddar, semi-soft cheese such as mozzarella, pasteurized processed cheese slices and
        spreads, cream cheese, and cottage cheese.
    • Do not eat refrigerated, smoked seafood unless it is as an ingredient in a cooked dish like a
        casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or
        mackerel, is most often labeled as “nova-style”, “kippered”, “smoked” or “jerky”. The fish is
        found in the refrigerator section or sold at deli counters of grocery stores and delicatessens.
        Canned or shelf-stable smoked seafood may be eaten.
    • Do not drink raw (non-pasteurized) milk or eat foods made with raw milk products.

How will I know if I have Listeriosis?
Listeria causes symptoms similar to the flu, such as chills, fever, muscle aches and upset stomach
or diarrhea. These symptoms can be mild and can come on gradually over several days or weeks.
Your health care provider can do a blood test to see if you have listeriosis.

Can Listeriosis be treated?
Listeriosis can be treated with an antibiotic. Usually, this prevents infection in the fetus. Babies who
are born with listeriosis can be treated with antibiotics as well. The safest choice is to prevent
infection so that neither you nor your baby need medicines for this disease.
Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Lab%20Studies.pdf (last revised Feb 2008)
                    Breastfeeding tips: Setting up for Success
The following are general signs that your full term, breastfed baby is doing well

              Infant nurses 8-12 times in 24 hours
              You hear baby swallowing while nursing
              Breasts feel softer after the infant feeds
              Infant shows contentment after most feedings (arms and fists are relaxed, not tight or clinched)
              Wet diapers increase at about the third or forth day to 6-8 wet cloth diapers in 24 hours (place
               cotton handkerchief or sturdy paper towel in disposable diaper if not able to tell when wet only; if
               you smell the diaper, expect a slight urine odor).
              Soiled diapers change from the dark meconium of first two days to small curds that are mustard-
               yellow in color. Expect at least 3 of these diapers in 24 hours. A tiny yellow “stain” on diaper does
               not count.
              By the third or forth day, initial weight loss has stopped and gain of 5-10 oz per week occurs.
              Infant appears alert and responsive and happy for periods of time during the day.

Signs that you need help breastfeeding

          Infant wants to nurse continuously; never comes off the breast spontaneously by itself
          Infant does not relax arms and legs towards the end of the feeding
          Infant has less than 5 wet diapers in 24 hours or diaper has a strong urine smell
          Infant does not stool or has less than 3 stools in 24 hours
          Soiled diaper does not change from dark meconium to yellow-mustard with curds by 3-4 days
          Infant loses more than 7% of birth weight
          Infant does not regain birth weight by 10 days to 2 weeks after birth
          Infant nurses less than 7 times in 24 hours, seems to be really easy-going, usually does not “ask” to
           be fed, and sleeps a lot

VERY IMPORTANT!

If your baby is showing ANY of the signs mean you need help with breastfeeding, please call the UNC
Family Medicine Center Lactation Consultant.

                                    Ellen Chetwynd RN, BSN, IBCLC
                                      UNC Family Medicine Center
                                          Lactation Consultant
                                            Phone 966-2109
                                     Email chetwynd@med.unc.edu
                            Choosing the Right Breast Pump
There are a huge variety of breast pumps on the market. Unfortunately, there is no quality control,
so it is worth doing some homework before you buy a pump. There are some pumps still being sold
that don’t work or may even cause problems. The brand names you can always count on are
Ameda and Medela. These are all reputable companies.They are available for sale or rent at many
maternity, baby, or department stores. If you search eBay you can sometimes find new pumps at
discounted prices.

Are you a stay-at-home mom or only planning on pumping occasionally?
Every nursing mother does not need a breast pump. If you are a stay-at-home mom, a breast pump
may not be necessary at all, especially if you learn to hand-express your milk. If you only need to
pump occasionally, hand-expression can be very easy and effective -- and it's free! And, best of all,
once you learn to hand-express, you never need to worry about being caught without your pump in
tow. If you do decide to purchase a pump for occasional use, choose from a manual pump, a
battery-operated pump or a mini-electric pump.

Manual pumps come in three styles: rubber bulb or bicycle horn pumps (not recommended!),
cylinder pumps, which you need two hands to operate, and squeeze-handle pumps, which only
require one hand. In general, these pumps are easy-to-use, quiet and inexpensive (around $30.)
Since they are not battery-operated, they are not subject to poor operation due to low battery power.
UNC Hospitals includes a manual breast pump as part of the discharge pack to every breast feeding
mother before she leaves the hospital. Make sure you receive one before you go.

Battery-operated pumps are another option for the occasional pump user, however, a major
drawback of battery-operated pumps is that the batteries need to be changed very frequently which
can be costly.

Small motorized pumps are medium priced and lightweight (usually under one pound.) They can be
quite noisy, depending on the model you choose. These pumps are intended as alternatives to
manual pumps.

Are you planning to go back to work outside the home?
Mothers who will be working outside the home full-time usually are looking for a breast pump that is
quick (able to double-pump) and efficient. Working moms usually need to express their milk during
breaks and lunch, and don't want to spend all their free time pumping. Cost may not be as important
as convenience.

For full-time working moms who have a good milk supply, you can rent a hospital-grade electric
breast pump. These are comfortable, easy to use, quiet and lightweight (around six pounds), and for
most moms do a good job of maintaining their milk supply. .

Another good option for working moms is an automatic electric pump. These range in price from
about $150 to $300.

Don't forget that UNC Family Medicine has a lactation consultant to help if you have any breast
feeding questions or concerns.
                Breastfeeding: A Healthy Start for You and Your Baby
When you are pregnant you make many decisions about yourself and your baby. It is important to
consider the choices for feeding your baby and find the one that’s best for both of you. More and more
women in this country are choosing to breastfeed. Studies show breastfeeding is the healthiest choice for
most babies.

Why breastfeed your baby?
Breastfeeding is healthy for babies because breast milk has all the nutrients a baby needs to grow well.
When you breastfeed, your baby is less likely to have allergies, ear infections or other illnesses. The
baby is also less likely to have problems with weight, tooth decay, diarrhea, and constipation. Breastfed
babies usually spit up less often than babies who are fed formula. Studies also show that mother’s milk
helps with babies’ brain development.

Is breastfeeding healthy for mothers?
Breastfeeding is healthy for mothers because it helps the uterus, or womb, return to normal size quickly
after the baby is born. It may help you with weight loss and may protect against several illnesses, such
as some cancers and osteoporosis, which is thinning of bones. The longer a woman breastfeeds the
more likely she is to be protected from developing these problems in later life.

What are common questions and concerns that you may have about breastfeeding?
   Can I make enough milk for my baby? Yes. Your breasts make milk whether you breastfeed or
      not. As long as your baby nurses long enough and often enough, your body will produce the right
      amount of milk for your baby. Mothers can even make enough milk for twins.
   How often will I need to breastfeed my baby? Most newborns need to feed for about 30
      minutes every 2 ½ - 3 hours.
   Can I still breastfeed if I need to be away from my baby? Yes. After your baby is a few weeks
      old, someone else can give the baby your expressed milk or formula in a bottle if you need to be
      away from the baby at feeding time.
   What can I do if I feel embarrassed? There are several ways to breastfeed without showing
      your breasts. Many mothers go into another room to nurse privately. You can plan to be at home
      when it is time to feed your baby. Some mothers pump extra milk and feed it to their babies in a
      bottle when they are away from the home. There are also ways to cover yourself and the baby so
      that no one can see your breast.
   Does breastfeeding hurt? When your baby is breastfeeding correctly, it does not hurt. If your
      nipples or breasts become sore, get help from a lactation consultant, your provider or clinic, or
      someone at the WIC office.
   How long should I breastfeed? Each mother and baby are different, and any amount of
      breastfeeding is good for both of you. Babies need nothing but your breast milk for the first 6
      months. At 6 months they are ready to add some solid foods while they continue breastfeeding. If
      you stop breastfeeding before your baby is one year old, you need to talk to the baby’s doctor
      about what kind of formula to use.

Where can I get help with breastfeeding after my baby is born?
   Most clinics and WIC offices have someone who specializes in helping mothers with
      breastfeeding. While you are still pregnant find out who that person is.
   The nurses in the hospital are very experienced in helping mothers with breastfeeding.
   Lactation Consultants are professionals specially trained to help breastfeeding mothers and
      babies. They can help you if your baby or you are having problems.
   Once you are home from the hospital you can either call the UNC Breastfeeding Warmline to talk
      to a Lactation Consultant or use your clinic resources if you have questions or need help with
      breastfeeding.
   The Lactation Consultants from the hospital can arrange to see you in the UNC OB clinic.
Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Breastfeeding.pdf (Last updated January 2003)
                    Discomforts in the First Trimester

Nausea and Vomiting
If you are nauseated, here are some suggestions:
 Eat small meals with carbohydrates (white rice, pasta, baked potato, and dry
    toast).
 Drink your fluids between meals rather than with meals.
 Avoid rich, fatty foods, and food smells that bother you.
 Have a high protein snack before going to bed (half a sandwich or cheese and
    crackers)
 Eat crackers or cookies before getting out of bed.
 Ginger or peppermint in any form can help. If they give you heart burn, don’t
    use them. If you take ginger capsules, don’t take more than 2 grams.
 Eat a snack at night when you take your vitamins (you may sleep through
    nausea).
 Use “Sea Bands,” which are wristbands designed to prevent motion sickness.
 Take 25 mg of Vitamin B6 two or three times a day.


Constipation
The bowels ordinarily move daily, however, if the stools are soft, moist and well
formed, a movement every other day is fine. Constipation may cause painful
hemorrhoids, made worse by pressure from the baby. Laxatives are not
recommended because the more you take, the more you need. Fiber supplements
like Metamucil®, Fibercon®, Citracel® or Alfalfa are safe and effective.

 Drink Water Before breakfast, drink two large glassfuls of water (preferably
  warm). Expanding your stomach after it has been empty during the night may
  stimulate a bowel movement. Drink at least 10 large glassfuls of water during
  the day.

 Eat Plenty of Fruit Eat six prunes or figs daily, preferably stewed instead of
  dry. Eat whole fruits and leafy vegetables as they are natural laxatives. Avoid
  tea and cheese, which are constipating.

 Have a routine A regular daily routine as to time of meals, time of getting up,
  and time of going to bed helps maintain regular bowel habits.

   Exercise Daily Regular exercise helps promote regular bowel movements.
Sinus Problems or Colds
Use a vaporizer if you have a cough or dry mouth. Saline nose drops (one-
teaspoon salt in one quart of water) can be used safely for nasal irrigation. Try to
avoid over-the-counter remedies.

Headaches
Try non-drug relief measures -- for example, lying down in a quiet, dark room and
trying to rest. You may find an ice pack or a cold washcloth on your forehead will
help. You can also take Tylenol® (acetaminophen). If these measures don’t work,
you need to call your health care provider who will have other suggestions.

Environmental Exposures
Usually our own bodies provide enough protection to our unborn babies, but there
are a few things it would be best to avoid during pregnancy:
 Cat Litter or feces
 X-rays
 Pesticides, herbicides, fertilizers
 Strong household cleaners

REASONS TO CALL
   If you have been vomiting and unable to keep anything down for 24 hours
   If you have cramping and bleeding combined
   If you have a fever over 100.5 degrees and you can’t get it down with
    acetaminophen (Tylenol®)
   If you have signs of a urinary tract infection (pain and pressure with
    urination)
   If you have signs of a vaginal infection (vaginal itching and irritation
    combined with an increase or change in smell or texture of vaginal
    discharge)




 A Special Note on Domestic Violence
 Physical and emotional abuse during pregnancy is all too common and can
 be harmful to mother and baby. Abuse can take many forms and often starts
 or increases during pregnancy.
 This can be difficult to talk about, but we encourage you to try so we can
 work with you on a plan for safety.
Questions to Ask My Provider




Advice and Answers to My Questions:
                      Chapter Two - The Second Trimester
                                (14 to 28 Weeks)
You and Your Baby

Your Baby
When you reach 16 weeks, your baby weighs about 6 ounces and is 6 to 8 inches
long. All major organs, such as the heart and lungs, are formed, but they are not
mature. If you could see inside the uterus, you could easily tell whether you have
a boy or a girl.

By 20 weeks, your baby weighs close to one pound and is 8 to 12 inches long.
His/her body is covered with very fine hair called lanugo. Around 20 weeks, you
will start to feel your baby move, which is initially a “fluttering” feeling in your lower
belly. Write down the day you first notice this. If this is your second or third baby,
you might notice those little flutters a few weeks sooner because it is a lot easier
to recognize movement when you’ve felt it before.

By 28 weeks, your baby is about 15 inches long and weighs 1 1/2 to 2 pounds.
She/he is fully formed but not ready to come out. His/her skin is wrinkled and
covered with vernix, a white sticky covering that protects the baby’s skin while in
utero.

Your Body
Most mothers feel well during the second trimester of pregnancy. Nausea is
usually gone and appetite and energy return. If you are planning any trips during
your pregnancy, this is a good time to travel.

Your metabolism is speeding up to take care of you and your baby, and you may
notice your heart beating faster or that you sweat a lot. If you exercise, make sure
that at the peak of your workout, you can still speak. Remember that in
pregnancy, your endurance goes down, so you might not be able to do as much
as you could before pregnancy. Listen to your body and don’t push yourself too
hard.

By 20 weeks, your uterus will be at the level of your umbilicus (belly button). You
might notice occasional tightening or contraction of your uterus, known as Braxton
Hicks contractions. This is normal, but if the contractions start coming every 5 to
10 minutes for more than an hour or two, you need to notify your provider who will
check you for premature labor.
                      SEX DURING PREGNANCY
Sex starts a pregnancy but pregnancy does not mean the end of sex! Intercourse
can be enjoyed throughout the pregnancy, unless you develop a medical problem.
Making love during pregnancy is a special experience and includes ways to share
pleasure and feel close with or without intercourse. Expectant couples often have
questions about sex. Talking with each other is the key to a good sexual
relationship, and it is important to share your feelings.

Will sex harm the baby?
No. The baby is protected by a membrane (bag of water) and fluid as well as by
the abdominal wall and the bony pelvis. Sex during pregnancy is safe unless your
clinician has advised against it due to a pregnancy complication.

Will desire for sex change during pregnancy?
Your desire for sex may increase or decrease during pregnancy. It is normal for
feelings to vary a great deal due to hormonal and body changes in pregnancy.
Physical changes include more blood flowing to the pelvis, which can intensify
sexual feelings. The growing belly may get in the way and partners may need to
try different positions.
       Both partners need to adjust to these changes. While a woman can feel
changes going on inside and outside, a partner can often only guess at how she
feels. Many pregnant women feel the need for more affection and need to know
they still look nice and are loved. Talk about your feelings with your partner.
Sharing your feelings and concerns will help you meet each other’s needs.

Is it harmful to have an orgasm during pregnancy?
No. If sexual activity and orgasm increase pelvic tension or even cause
contractions to occur, the body will relax after an hour or so.

Some sex practices are risky to your health!
 Protect your baby and yourself from AIDS. Always have safe sex!
 Some sexually transmitted disease (STD’s) can be passed to your baby. If
   you think you have an STD, call your provider to be seen and evaluated.
 Taking drugs or alcohol to increase sexual feelings can cause serious
   damage to the unborn baby.
   Take care that bacteria from the rectum do not enter the vagina. This can
    cause infection. Bacteria from the rectum can pass to the vagina by anal
    intercourse.
                                   Nourishing Yourself
                         “When mamma ain’t happy, ain’t nobody happy.”

Mothers the world over are known for their fierce love and selflessness in caring for their
children. In the midst of this important role, women often lose track of their own needs and set
aside the things in life that allow them to “be their best” – physically, emotionally, spiritually,
professionally. While this is likely necessary in some parts of life at least for a time, it is
unhealthy for you, your partner, and your new baby if you lose track of what makes you YOU.
Now is a good time to begin to plan to nourish yourself.

List some things you like to do to “nourish yourself”:


PHYSICALLY (for example - take a warm bubble bath, go swimming, get a massage or a
manicure)



EMOTIONALLY (for example – call a good friend, read a book, go for a walk in the woods)



SPIRITUALLY (for example – go to church or synagogue, listen to music, write in your journal)



PROFESSIONALLY (for example – take on a new challenge at work, organize a special event
in your neighborhood or in a community organization)



Now think about how often you actually get around to doing these things, and why that
happens? How do you feel about that? Can you tell when you are not “at your best”? How do
you usually get back on track?
Keep this list nearby and share it with your partner and other close friends you trust. Practice
nourishing yourself now (even in 15 minutes a day!) so that after your new baby is here, you will
have good patterns of self-care in place.
                             FETAL MOVEMENT
You probably first felt your baby move between the 17th and 20th weeks of your
pregnancy. Other people will be able to feel your baby move somewhere between
24-28 weeks. By now, you should be aware of your baby’s kick pattern. Some
babies move more in the morning or evening, while others kick throughout the
day. This kicking movement should continue until your baby is born. In general,
babies should move at least ten times a day.

If you feel your baby is moving less than usual, one way to reassure yourself that
everything is o.k. is to do a fetal kick count. Lie down, have something sweet to
drink, then count your baby’s movements.
If your baby does not move five times in an hour, he/she may be sleeping so try
again in one to two hours. If the baby is still not moving five times in an hour, call
the Family Medicine Center at 966-0210.

            WARNING SIGNS OF PREMATURE LABOR
Premature labor (also called preterm labor) is labor that starts before 37 weeks of
pregnancy or more than three weeks before your due date. Premature labor can
often be stopped if it is caught early.
Call the Family Practice Center if you have any of these symptoms:
 Uterine Contractions: If you feel your uterus tightening or the baby “balling
     up” four times or more in an hour, you might be in labor.
 Menstrual-like Cramps: These feel like you’re having your period. They
     may come and go or remain constant.
 Abdominal Cramps: These are stomach cramps with or without diarrhea.
 Low Backache: Back pain can be a warning sign of premature labor.
 Pelvic Pressure: This feels like the baby is pushing down in your vagina.
 Change in Vaginal Discharge: You may notice an increase in your
     discharge, or that it becomes more mucousy, watery, or slightly bloody.
If you have one or more of the above symptoms, you might be in premature
labor and should:
      1)    Lie down
      2)    Drink two to three glasses of water or juice

      If these symptoms are not gone in one hour, call the clinic right away.
                           Caring for Yourself if You Get Sick
The following list was created in response to questions pregnant women often have and may
help you know how to safely care for yourself while you are expecting.

   •   COUGH AND COLD TREATMENT IN PREGNANCY:
         • Hot drinks with lemon/honey, lots of fluids, steam inhalation
         • Safe: cough medicine with guaifenesin (Plain Robitussin®) and/or dextromethorphan,
           pseudophedrine if needed for decongestant but better to wait until after first 12 weeks.
         • Avoid: cough medicines with iodine and decongestant preparations with extra caffeine
           and/or aspirin
         • Pseudophedrine and dextrrmethorphan can both decrease breastmilk supply after the
           baby is born.

   •   PAIN RELIEF AND FEVER:
          • Lots of fluids, cold compresses
          • Safe: acetaminophen (Tylenol® – regular or extra strength)
          • Avoid: aspirin and ibuprofen

   •   ALLERGIES:
         • Try to stay out of air conditioning and away from dust/pollen
         • Safe: chlorpheniramine (Chlortrimeton®), diphenylhydramine (Benadryl®, Claritin® and
            Zyrtec®), allergy shots are OK

   •   HEARTBURN AND UPSET STOMACH:
         • Avoid smoking, too much caffeine, spicy foods, peppermint, eating large meals
         • Safe: Maalox®, Mylanta®, etc…but too much will bind iron! Zantac® and Pepcid® are
           OK

   •   REPELLANTS AND SUN BLOCKS
         • Deet 20% max in repellants and any sunscreen is OK. Wearing sunscreen decreases
            the formation of malar rashes.

   •   OTHER THOUGHTS:
         • There are no known problems from hair care products, but avoid exposure to
            pesticides and paint fumes as much as possible
         • Most medications are safe while breastfeeding.
         • For dental procedures, local anesthesia is FINE but x-rays only if necessary
            (especially in first 12 weeks) and always use a lead apron
                     Influenza (Flu) In and Around Pregnancy
The staff at North Carolina Women’s Hospital is committed to protecting the health of you and your baby.
Many women and families have heard a lot about the flu. Here are some commonly asked questions and
answers about the flu.
What is the flu?
The flu is a virus that affects the nose, throat, and lungs. It is spread when a person who has the flu
coughs, sneezes, or speaks and other people breathe in the virus. It is also spread when a person
touches something, such as a used tissue, that has flu virus on it and then touches their eyes, nose, or
mouth.
Why is the flu important for pregnant women and newborns?
Pregnant women and newborns are at high risk for developing very serious problems from the flu. Lung
infections such as pneumonia can be very serious for pregnant women and newborns.
How can I prevent getting the flu?
The single best way to prevent the flu is to get the flu shot. FluMist ® (the nose spray vaccine) cannot be
used while pregnant or immediately after pregnancy. Many pregnant women will have already had their
flu shot this year. If you have had your flu shot and you get the flu, it is likely that you will have a very
mild case. If you live with someone who has the flu, your health care provider may provide you with a
prescription for antiviral medicines that prevent the flu. You should avoid close contact with people who
are sick, including visitors to your home to see you and your new baby.
How do I know if I have the flu?
It is very hard to know if you have the flu, the common cold, or another respiratory illness. The symptoms
of the flu are very similar to many other illnesses common in the wintertime
You may have the flu if you have:
       • a fever, (temperature of or above 101°F (38°C)
       • dry cough
       • sore throat
       • runny or stuffy nose
       • muscle aches
       • headache, and
       • extremely tired
Your health care provider can perform a test to determine if you have the flu.
To prevent the spread of illness:
      • wash your hands often.
      • cover your mouth and nose with a tissue when coughing and sneezing
      • throw tissues away in a trash can
      • avoid touching your eyes, nose, or mouth
      • stay home when you are sick, if possible
If I get sick this flu season, how should I take care of myself?
You should get plenty of rest and drink a lot of water and juice. You can take Tylenol or Extra-Strength
Tylenol for fever. For cough, you can take Robitussin (plain or DM). You can take Actifed (only if you do
not have high blood pressure or some other chronic disease) for a cold. You can gargle with a warm salt-
water solution (one teaspoon salt to one quart water) or use Chloroseptic spray for sore throat.
When should I call my health care provider?
You should call your health care provider if you have a fever greater than 101º (F) or 38° (C) AND a dry
cough or breathing problems. Do not come to the hospital unless you have called your health care
provider.
Can my baby still receive my breast milk?
Yes, it is important for your baby to continue getting your breast milk. The flu is not passed through
breast milk Wash your hands and wear a mask over your nose and mouth before uncovering your
breasts and when breastfeeding your baby. Always wash your hands before and after breastfeeding.
If you have additional questions or concerns, please contact your health care provider, the UNC OB-GYN
clinic at (919) 966-6823 from 8:30-4:30, or Labor & Delivery at (919) 966-3422
Source: http://mombaby.org/UserFiles/File/Influenza%20In%20and%20Around2.PDF (last revised November 2008)/


             DISCOMFORTS IN THE SECOND TRIMESTER
Dizziness Pregnant women often notice dizziness or lightheadedness when
they get up quickly, change positions, skip meals, or stay in the heat too long. To
avoid this, change your position slowly, eat regular meals, and avoid prolonged
exposure to the sun. If you stand or sit all day at work, try to change positions
every hour, even if it is only for five minutes. Wear low-heeled, comfortable shoes
since pregnancy can also affect your balance.

Skin Changes You may develop acne because your body’s sweat glands are
stimulated by the pregnancy hormones. You may also notice changes in the
coloring and pigmentation of your skin. Be careful in the sun, because your skin
may be more sensitive. Let your provider know if any moles change.

Heartburn If you have heartburn, try eating four to five small meals a day and
drinking fluids between meals. Antacids like Maalox, Mylanta, Tums, etc. can be
helpful.

Back Pain Back Pain, both upper and lower, is a common complaint in
pregnancy. Maintaining good posture is important. Exercises can help relieve the
discomfort as well. The “angry cat” position (get on all fours and rock you pelvis,
described on page 7) can provide some relief.

Tingling and numbness in the hands Swelling in the hand and wrist area can
cause pressure on the nerves, known as carpal tunnel syndrome. It may be worse
in the morning. Hold your hands above your head and move your wrists around.
Be sure to maintain good posture through the shoulders, too.

Pain in the groin The round ligaments that support the uterus start to stretch
significantly in the second trimester, often causing pain on either side of the pelvis.
Try not to stand too long or get up or change positions suddenly.

Leg Cramps Stretch your calves by standing with your toes on a step and
dropping your heels downward until you feel your calves stretch. Warm soaks can
help, too.
Questions to Ask My Provider:




Advice and Answers to My Questions:
                  Chapter Three - The Third Trimester
                             (28-40 weeks)
You and Your Baby
If you haven’t started already, it is time to start getting ready for the baby. All
parents benefit from classes, whether they are choosing “natural” childbirth or not
(see pages 64-72 for local classes). You can also start to think about the birth, and
decisions you’ll make after the baby arrives. On the next page you will find some
information about writing up your birth plan or preferences. Bring this with you to
one of your prenatal visits to talk to discuss with your clinician. Now is not a bad
time to think about after the baby as well, for instance what kind of birth control
you will use, who you will use for daycare, if you will need that. If you planning to
have your “tubes tied” after delivery and you have Medicaid, you need to sign a
surgery consent form by 34 weeks.

Your Baby
Did you know your baby can now suck its thumb? By the end of your 36th week,
your baby will weigh about 5 1/2 pounds and be 18 inches long. Your partner and
friends can try to hear the baby’s heartbeat by putting their ear on your belly. At
birth, the average baby weighs seven and a half pounds and is 20 inches in
length. Your baby’s skin is less wrinkled, the fine hair (lanugo) is mostly gone,
and the vernix (waxy coating on their skin) is thick.

Your Body
As your body adjusts to the growing baby, you will probably start to notice a little
more tugging and pulling. If this is your second or third baby, you may feel these
discomforts sooner. Most mothers, especially in the summer, will notice swelling
in their feet. Be sure to drink lots of water, cut down on salt (not just salty foods
like chips but canned and frozen foods) and put your feet up. Pre-eclampsia is a
condition that can develop in the third trimester. Symptoms include high blood
pressure and protein in the urine. Be sure to let your health care provider know if
you develop a headache that is unrelieved with Tylenol, spots in front of your
eyes, or pain in your upper belly.

By 36 weeks, the uterus is just below the breastbone and ribs. Amniotic fluid
volume is decreasing. About 3 weeks before the birth, your profile may change,
as the fetus descends into the pelvic cavity (this is called engagement, dropping or
lightening). You may feel less pressure on your diaphragm and find it easier to
breathe and eat. After the baby drops, you may feel an increased need to urinate.
Your cervix begins to thin out (efface) and open (dilate) during the last weeks of
pregnancy. Toward the end of your pregnancy, the uterine contractions become
more obvious and more frequent.
                      PREPARATION FOR BREASTFEEDING

The first step is to become familiar with your breasts. Look at yourself in the mirror,
keeping in mind that while the size and shape of breasts and nipples vary from woman to
woman, almost every woman can produce milk. Colostrum, your first milk, may leak
from your breasts or appear as a dried crust on your nipples, even before the baby is
born. Notice the shape and size of your nipples. Do they point out or in? If they are flat
or inverted (dimpled), you may need some help learning to get the baby “latched on” or
attached to the breast. Talk to your clinician or our Lactation Consultant if you have
concerns.

Conditioning or toughening your nipples to prevent soreness is NOT helpful, but learning
about breastfeeding before your baby is born can be. You and your support people may
want to take a breastfeeding class or read a book on breastfeeding, especially if no one
you know has successfully breastfed. UNC Hospitals offers a breastfeeding class (call
843-1759 for more information). You can also attend a La Leche League meeting. The
first half of the meeting is run like a free breastfeeding class and the second half is more
casual conversation with a group of breastfeeding mothers you can call for help after the
baby is born. They welcome pregnant women at their groups.

The first few weeks after birth you need time to rest and feed your baby as you and your
baby learn how to breastfeed. Figure out which friends or family can help with cooking
and caring for other children. Try to think of someone who breastfed their baby who you
can call if you have questions. UNC Family Medicine also has a Lactation Consultant
you can call. It is always better to call early rather than late if you have problems or
questions.

                                      BABY BLUES

Even though the birth of a baby is wonderful, it also is demanding and exhausting, and
many new mothers feel overwhelmed. Additionally, your hormones are changing. This
causes most new mothers to have feelings of unexpected sadness, often accompanied
by crying. This is called the “baby blues.”

Think about who will be there to support during your first weeks at home. Allow friends
and family to cook, clean, run errands, and anything else you need so that you can rest
and focus on the baby.

The “baby blues” are usually a temporary state, lasting less than a week. If the sad
feelings persist longer, please call us. We will continue to check on you by giving you a
questionnaire to fill out to make sure you are not getting depressed. There is a post
partum depression support group at Family Medicine if you need it.
     PREPARING OTHER CHILDREN FOR BIRTH AND BREASTFEEDING


Before the Baby is Born
Here are a few suggestions to help your children prepare for a
new baby:
 Tell your child what s/he was like when s/he was a baby. Go through the baby
  album.
 Make a family baby book. Collect pictures of family members and talk about
  how everyone may look alike, and how he or she looks different.
 Bring your child with you to a prenatal visit so they can hear the baby’s heart
  beat and ask questions.
 Get a baby doll for him/her to “take care of.”
 Have your child draw a picture of what s/he thinks the baby will look like.
 Try going through what happens when you go to the hospital. Consider taking
  your child on a hospital tour so s/he knows exactly where you’ll be.
 Explain to your child that you will be breastfeeding the new baby.
After the Baby is Born
 Have the children give each other a gift.
 Create homemade birth announcements drawn by your child.
 Spend some time with your older child to show him/her the new baby’s
    characteristics.
 When you are feeding your baby, read to your child or have special toys for
    the child to play with.
 Talk to your older child about when s/he breastfed
 Sometimes older children will remember breastfeeding and want to try again,
    but they usually will not start breastfeeding again
 Your older child can breastfeed a doll while you breastfeed the baby.

If you are planning to have your child present at the birth:
Be sure your child wants to be there. Most children will tell you if they are
interested or not. Sometimes parents want their children to be there so much,
they forget that the child may not want to be there. Once you know your child is
interested, share materials about birth with your child and consider bringing
him/her to several prenatal visits. There are children’s books about childbirth such
as Mom and Dad and I are Having A Baby as well as videos to rent or buy. Talk
about what will happen during labor and the birth, what your child might see, and
how you might act.

UNC Hospitals supports your decision of having your child present for birth;
however you need to bring a support person for your child. This person must be
there for your child and not have a strong need to see the birth as they will be in
and out of the room with your child.




                            Packing Bags for mom and baby

As your estimated date of delivery draws near, you may find yourself increasingly “nesting” or
preparing for the arrival of your baby and wanting to get things in order. Part of this will be
preparing the space where your baby will sleep and be cared for in your home. Another part of it
will be getting things together to take to the hospital for the delivery and days afterwards. It’s a
great idea to think ahead and have special items with you to make you feel as at home as
possible.

Some ideas for what you may want to include:

      Cassette tapes or CDs to listen to in labor
      Camera (though, remember it is not possible at UNC to take photos, either still or video of
       the actual birth or in the operating room if you would have a caesarian section)
      Any items that will help you with labor – massage tools, a birth ball, etc…
      Self-care products – massage oil, powder, lotion, your own shampoo or soap
      Clothes – heavy socks or slippers for walking around, a robe and loose nightgown (if you
       don’t want to wear the hospital gowns), a loose set of clothing to wear home
      Snack food and drink, including food for your support people!
      Sanitary pads and a few diapers (though the hospital will also provide a few)
      A going home outfit for your baby (including a warm blanket and hat depending on the
       season)
      A baby book if you want your newborn’s footprints stamped in!
      An infant car seat that has been tested by the fire department and is installed correctly
       (you may want to leave this in the car, but you NEED to have one before you take your
       baby home)


My own packing list:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
__________________________________________________________________
                            Group B Streptococcus (GBS)
The staff at North Carolina Women’s Hospital is committed to giving your baby the healthiest birth
possible. Many women and families have heard a lot about GBS in the past few years. Here are some
commonly asked questions about GBS.
What is Group B Streptococcus (GBS)?
GBS is a normal bacteria that can be found in the rectum and vagina of many women. It is not sexually
transmitted and does not usually make healthy women sick, but it can cause minor bladder infections.
One in four women who are pregnant test positive for GBS.
Why is GBS important?
GBS is important because for every 1000 GBS positive mothers, one or two babies will become infected
and need treatment.
How do I know if I have GBS and what is the treatment?
You will be tested for GBS between 35-37 weeks of pregnancy at your regular clinic visit. A sample from
your vaginal and rectal areas will be collected on a cotton swab and will be sent to the lab for testing. If
you test positive for the GBS bacteria you will need to be treated during labor with an antibiotic
(Penicillin) through an IV. This will reduce the chance that your baby will become infected during his or
her delivery. If you are allergic to Penicillin, you will receive another antibiotic called Kefzol or Cleocin.
You will not need treatment for GBS after the birth of your baby because it’s a normal bacteria in adults.
What will happen if I am not tested for GBS during my pregnancy? Will I still need treatment?
You will be treated only if you have risk factors. These risk factors include:
         Previous infant with GBS infection
         GBS urine infection in this pregnancy
         Breaking of the bag of waters for 18 or more hours
         Premature labor (before 37 weeks)
         Increased temperature during labor
What if I am having a planned cesarean section?
You will still be tested for GBS at 35-37 weeks and only receive treatment
if you experience labor or ruptured membranes prior to your cesarean section.
Do I need to do anything special when I go into labor?
Call your health care Labor and Delivery provider if your water breaks or contractions start, and let him or
her know that you are positive for the GBS bacteria. Your prenatal record will be available in Labor and
Delivery but when you check in you should also let your labor nurse know that you are GBS positive.
Will my baby and I be able to go home before 48 hours?
You may be able to go home before 48 hours if you were treated with at least 2 doses of Penicillin before
your delivery and your baby was full term. If you were treated with a different antibiotic, you may be
asked to stay an extra day so that we can watch your baby for signs of infection.
When I go home, is there anything I need to watch for in my baby?
Over 90% of infants who develop GBS infection do so in the first 24 hours after delivery. However, the
first week that you and your baby are home, you should watch for signs of infection. Fever is the most
important sign of problems. If your baby’s temperature is 100°F or 38.4°C or higher, call your baby’s
health care provider right away. Also call if your baby has any of the following:
         Excessive sleepiness
         Fussiness
         Trouble breathing or
         Refuses two feedings in a row
When you see your baby’s health care provider for the first time remember to inform him or her that you
were GBS positive during your pregnancy.

Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Group%20Beta%20Streptococcus.pdf (last
revised June 2007)
                       Discomforts in the Third Trimester

Backache
 Try keep your back straight and check your posture
 Wear good, supportive shoes with low heels
 Change your position once an hour
 If you sit all day, place a small stool under your desk to rest your feet on
 Try doing the pelvic rock exercise
 Consider using a belly bra for back support
 Do not lift anything heavy and squat instead of bending over to pick things up
 If your belly is putting a strain on your back, you can try belly support

Dizziness
 Change your position frequently and get up slowly
 Drink lots of fluids, especially if you are outside on a hot day

Hemorrhoids
 Avoid constipation by eating lots of fruit, fiber, and vegetables
 See p 20 for more information about managing constipation
 Exercise regularly and drink plenty of fluid
 Avoid straining

Leg Cramps
 Put your legs up as much as you can during the day
 Point your toes towards your nose or stand on a step with your heels hanging
  over the edge to stretch your calves
 Use a heating pad, hot water bottle, or warm soaks in the tub

Vaginal Discharge
 Bathe your outer vagina often
 Use soap without perfume
 Wear cotton panties and avoid pantyhose and tight pants
 Tell your provider if your discharge won’t go away or if you have itching or
  burning

Swelling of the ankles
 Put your feet up as often as you can during the day
 Swimming or soaking in a tub can help decrease swelling

Difficulty Sleeping
 Use lots of pillow for comfort and support
 Try drinking warm milk or chamomile tea before bed




Questions to Ask My Provider:




Advice and Answers to My Questions:
                 CHAPTER FOUR - PLANNING FOR THE BIRTH

DEFINITION OF LABOR

The following is a stage-by-stage guide of what to expect, what
to do, and how your support people can help you.

What is Labor?
Labor is exactly what it sounds like -- hard work. In fact, giving birth may well be
the hardest work you will ever do in your life. But under the right conditions, it can
also be your most exciting and satisfying experience. The work of labor is
concentrated in the uterus. The job of the uterus is to protect and nourish the
unborn baby during pregnancy, and then, when the time is right, to push it out into
the world.

The pregnant uterus is the largest muscle in the body. When the uterus contracts,
it compresses and squeezes, and then it relaxes. Each time the uterus contracts,
the squeezing action pulls up and out on its lower portion, the long, narrow “neck”
called the cervix. The contraction, combined with the pressure of the baby’s head,
causes the cervix to open (dilate) and shorten or thin out (efface). This gives the
baby a shorter, wider passage to travel through during birth.

Stage I The cervix must dilate to a diameter of 10 centimeters (about four and a
half inches) and efface from 0 to 100 percent in order for a full-term baby to pass
through it. This shape-changing process is called Stage I, and it is the longest
stage of labor. If this is your first baby, Stage I is usually anywhere from eight to
24 hours. If you’ve given birth before, it will probably be shorter. Stage I usually
begins slowly and hesitantly with short contractions that are mild and far apart. As
Stage I progresses, the contractions will get longer, stronger, and closer together.
You may spend much of early labor at home.

Stage II When Stage I is complete, and the cervix is fully dilated and effaced,
Stage II begins. During Stage II, baby is pushed out of the uterus, down the birth
canal, and into the world. Stage II takes a lot of hard, physical work from the
mother. It lasts an average of 2 hours for first time mothers and about 1 hour or
less for mothers who have given birth before.

Stages III Stage III lasts from the birth of the baby until the placenta delivers and
can take about 10 to 45 minutes. The uterus will contract to deliver the placenta
and then will continue to contract to get the bleeding to stop.
WHEN TO CALL IN LABOR
We believe that labor progresses more easily at home where you can be
comfortable, private, and you are surrounded by your own things. We encourage
you to remain at home as long as you are comfortable, keeping in touch with your
clinician for updates, reassurance, and support. We have written the following
guidelines, but remember that labor has many different patterns. Call if you have
any questions or are unsure about what to do.
What to Do When You Go Into Labor
As your due date approaches, learn to recognize if you are experiencing labor.


True Labor                                    False Labor
 Contractions move from front to              Contractions begin in the front but
back                                            do not move around to the back
 Contractions are regular                     Contractions don’t get longer,
 Contractions usually get longer,              stronger, or closer together
  stronger and closer together                 Contractions stop if you stop your
 Contractions don’t stop if you                activity, or they increase with
  change your position or activity              activity
 Drinking water does not affect               Drinking water may stop
  contractions                                  contractions

General Guidelines to follow
If your membranes rupture (“breaking the bag of water”), take note of the time
and the color of the fluid. Please call and let us know if this happens. Amniotic
fluid will often contain small flakes or some blood. You should report fluid that
looks green or appears bloody. It is not always easy to tell if your membranes
have ruptured so we may need to see you to figure out if it has actually
happened.

If This is Your First Baby….
Call whey you have 60-second contractions, five minutes apart, for one hour.
We may not ask you to come to the hospital right away, but your clinician will
give you further instructions after talking with you.

If This Isn’t Your First Baby….
Call when your contractions are five to seven minutes apart and last about a
minute, or when you notice a significant change in your labor.
                                         North Carolina Women’s Hospital

   Coming to the Hospital When You Are in Labor
Where do I come if I am at least 36 weeks pregnant?
You may enter through the lobby of the NC Women’s or Children’s Hospitals if you are in the
last month of pregnancy (36 weeks or more). There are stork signs to lead you to the elevators,
and wheelchairs at each entrance if you wish to use one. Only the elevators in the Women’s
                                                                       th
Hospital will take you to Labor and Delivery, which is on the 4 floor. You will see the doors to
Labor and Delivery on the left. Pick up the phone by the door.
You can leave your car with the parking attendant or security person at the hospital entrance for
Stork Parking. The cost for this is $10 per day.

What if I am less than 36 weeks pregnant?
You should go to the Emergency Room, if you are less than 36 weeks and/or:
   • Have the urge to push or bear down with contractions
   • Are having heavy vaginal bleeding
   • Feel that something is wrong that might be an emergency

Parking

    ��Valet    parking is located at the Children’s Hospital entrance, which is always open. If there
          is no one at the valet parking stand and you are in labor, step inside and ask for an
          attendant.

    ��Get    a parking pass for your car from the valet attendant or security guard and leave your
          keys with him or her. After 30 minutes, if you have not moved your car, it will be moved
          to Valet Parking. The charge for Valet Parking is $10 per day. There may be additional
          charges if you move the car within the 24 hour period.

    ��If   you prefer not to leave your car with Valet Parking, your driver can drop you off at the
          door and drive across the street to the hospital visitor parking deck. The charge for the
          parking deck is $1.25 per hour up to $6 per 24 hours.

    ��If   you park at the Emergency Room, your support person will be asked to move the car as
          soon as you are settled in Labor and Delivery.

Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/The%20Stork%20Entrance.pdf (last revised
April 2009)
                             SUPPORT IN LABOR

It is important that you know the advantages and disadvantages of your many
options for pain relief in labor. The decisions you make about what you choose
to use for pain relief are very personal. Your clinicians are not against using
drugs in labor, but we often find that other ways to reduce pain work as well or
even better. Remember, labor is not usually as scary as it looks on TV.

Who is going to be with you during labor?
Studies have shown that women who have support in labor have shorter
labors. If you have your partner, your mother, or a friend with you during labor,
you are likely to feel safe and supported. Make sure you only invite people to
your birth that you feel very comfortable being with, and who you know will be
able to help you. You might want to ask your mother or grandmother about
their birth experience. Think about your preferences during labor and let your
support person(s) know. We believe that providing support and
encouragement is an important part of our role as well.

SHOULD I GO TO CHILDBIRTH CLASSES?
YES! One of the most helpful things you can do for yourself, your baby, and
your support people is to attend a childbirth class so everyone will know what
to expect in labor. You will learn how to tell if you are in labor, when to call,
relaxation methods and breathing techniques. There are lots of choices YOU
can make if you are prepared. See “Community Resources” on pages 64-72
for classes offered in the community, or check out the classes offered at UNC
at their website <nchealthywoman.org> or call 843-1759.

WHAT IS A DOULA?
A doula is someone who supports women in labor. She does not provide
medical care, but comforts and supports you and your partner during labor.
Research shows that women using doulas are more likely to have shorter
labors and use fewer medications. They also have more positive feelings
towards both the baby and the birth experience, and less post partum
depression. A professional doula will have several appointments with you
before the birth, be on call to help you with your birth both at home and once
you go to the hospital, and also usually meet with you once or twice after the
birth. See page 71 for a list of doulas

UNC BirthPartners is a volunteer doula program at UNC Hospital. Since it is
a volunteer program, there is not someone available all the time, but if you are
interested, please let your clinician or the nurses on Labor and Delivery know
you would like to use the BirthPartner program
BIRTH PLANS or BIRTH PREFERENCES
Writing out your goals and expectations for birth is a good idea. First, the task
of writing everything down helps you and your support people think things
through. Also, when you bring it to your prenatal visit to talk to your clinician,
you can make sure everything you think is important is discussed before the
birth. That conversation will help you get a sense of what ideas your clinician
has about birth also. When you arrive on Labor and Delivery, the nurses use
the birth plan to get to know you quickly. On page 47, you will find “Baby’s
Birth Day Wishes” which is UNC Hospital’s birth plan guide.

COMFORT MEASURES
There are lots of comfort techniques that you will learn about
in childbirth classes. Your nurse and your provider will also
know techniques that may help you in labor. Here are a few
basic things you and your partner can do during labor:

1) Change positions frequently. Position changes are important to help the
baby move down the birth canal. If your baby is doing well in labor, you will be
free to move around as you like. Positions include standing, sitting in a rocking
chair or on the toilet, squatting, using the birth ball, walking, or taking a shower
or bath. Practice your breathing exercises in different positions. Practice
squatting ahead of time in order to strengthen those muscles. If you have a lot
of back pain in labor, try getting in a hands and knees position.

2) Hands-on techniques. There are lots of things your partner can do to help
you in labor. Here are a few ideas:

 Hot compresses (you can fill a sock with uncooked rice and put it in the
  microwave in the hospital, or bring a hot water bottle)
 Cold compresses
 Massage
 Effleurage (light, tickling massage to the abdomen)
 Water (cool washclothes, warm soaks in the tub or shower)

To relieve back pain during labor, you may want to try the following;

 back rub with hands or objects
 counterpressure (constant steady pressure to the middle of the lower back
  with a fist or object (like a tennis ball)
 Hot towels on your back
 Inward pressure on the highest part of the hip bones from both sides at
  once.
3) Eating and drinking in labor. Labor is hard work and you need to keep your
energy level up. Ask your partner to remind you to drink something every 15
minutes. You can try fruit juice (orange may have too much acid, but grape
juice has lots of sugar for quick energy), popsicles, or hot tea with honey.
Because you are drinking, remember to empty your bladder regularly as well,
which will also help your baby have more room in the birth canal.

4) There are lots of tools at the hospital we can use together to help you have
the experience you want. There are birthing stools so you can labor and push
out of bed, birthing balls to sit on in labor, squat bars to help you change
positions in the bed, baths and showers, CD players for your music, blankets
that have been warmed, and telemetry monitors, which are monitors that can
check the baby’s heartbeat without your being plugged into a machine with
cords. For some women, like women who are having a vaginal birth after a
cesarean, we recommend continuous monitoring, but we
still want to make sure you can move around in labor!

DRUGS IN LABOR
There are two choices for drugs in labor -
            1) Narcotics (as a shot or in your IV)
            2) Epidural.

NARCOTICS
A narcotic can be given in your veins (through an IV) or as a shot in your hip.
Some narcotics last longer than others, so your provider will select one that is
best for you based on where you are in labor. For example, if this is your third
baby and the labor is likely to progress quickly, it is safer to give you a short-
acting narcotic (it won't last too long) so that it wears off by the time the baby is
born (so the baby isn’t sleepy). Narcotics can make you feel groggy and
sometimes make it hard to remember parts of your birth. They are considered
safe in pregnancy, but do cross the placenta and go to the baby as well.

EPIDURAL
An epidural is a needle placed in between the spines in your back. A small
catheter is fed through the needle into the epidural space, the needle is
removed and the catheter stays in your back so medicine can be given through
it. It is very effective in providing pain relief, even allowing a woman to sleep.
You can usually still feel pressure with your contractions, and this helps you
push when you are ready, but the sharpness of the contraction pain is gone.
For about 1 in 20 women, the relief from an epidural is patchy or one-sided.
The anesthesiologist will work with you try to fix this problem. Usually it can be
corrected without needing to reinsert the needle or replace the tube.
There is an anesthesiologist available on Labor and Delivery 24 hours a day.
Once they are in your room, it takes about 10 minutes to put the epidural tube
in your back, and another 10-15 minutes for the medication to start working.
You can usually continue to move once you have an epidural, but you will be
numb from about your chest downwards.

Like any medical procedure, epidurals do have side effects, although they are
considered a safe method of pain control for both mothers and babies.

 Epidurals make your legs numb so mothers can no longer walk around or
  use sitting positions. They often cannot feel their bladder and a urinary
  catheter may be necessary to keep the bladder empty.
 Epidurals dilate (open up) your blood vessels and sometimes your blood
  pressure drops. Whenever an epidural is placed, mothers must have an IV
  and must have continuous electronic fetal monitoring to make sure the
  blood pressure is okay and the baby’s circulation is not compromised.
 If an epidural is given too early, it may slow down labor, which can require
  the use of pitocin, a drug to stimulate more contractions.
 Some women do not have a strong urge to push with epidurals and may
  require the use of a vacuum or forceps to help the baby out.
 Some women experience itching from the medication used, fever not
  caused by infection, headaches after epidurals are taken out (2-3 out of 100
  women) or tenderness where the tubing was in the back. None of these are
  dangerous, and all can be treated.

If you want an epidural, the anesthesiologist will come to your room and talk
with you about how the procedure is done and what the risks are. If you are
thinking about having an epidural, talk to your doctor or midwife before labor so
you can ask questions. Labor is not the time to learn about your options; you'll
be too busy!

                          After the Baby is Born

                           The birth is just the beginning of your life together
                           with your baby. The time immediately after your baby
                           is born is also really important. Hold your baby skin to
                           skin with you. Take your gown down, unwrap the
                           baby, and lightly drape a blanket over both of you.
                           This will help breastfeeding get off to a good start,
and is the best way to bond with your baby. Try to keep the noise in the room
down, and tell your visitors they can hold the baby after he or she has fallen
asleep. There is plenty of time for others, this is your time for you and your
baby’s father to spend special time with your new baby.
               Donation of Umbilical Cord Blood Cells
What are umbilical cord blood cells?
Umbilical cord blood cells are a special type of cell found in the blood of your baby's
umbilical cord. These cells are also called stem cells.
What are stem cells used for?
Stem cells can be used to make different kinds of cells in the body. These new cells can be
used to treat some medical problems including leukemia (a type of blood cell cancer), some
types of anemia and other medical conditions. These cells are not used for cloning. If these
stem cells are not stored, they are typically thrown away after a baby is born.
How are stem cells collected?
A member of your medical team, who has had special training in cord blood banking, will
collect blood from the placenta and umbilical cord after delivery. There is no pain for the
mother or baby since cells are collected after the baby has been delivered and the umbilical
cord has been cut.
How are stem cells stored?
After cord blood is collected, the cells are isolated and frozen for future use. There are two
options for storing these frozen cells:
             A public cord blood bank
             A private cord blood bank
How does a public cord blood bank work?
      After delivery, a person with special training in cord blood banking collects blood from
       the placenta and umbilical cord.
      Once the blood is collected, the cells in the blood are tested to see if they are usable.
      Cord blood cells are then tested to see what type they are. This helps the bank to
       know which patients could use the cells for treatment. This information is put into a
       secure computer database.
      Cells are frozen and saved in a central storage facility where they are available to
       any patient who needs them for treatment.
      It is important to remember that if you use a public bank, your baby's cord blood cells
       are not saved for your baby or your family. They can be used by anyone who needs
       them.
      Public cord blood banks are free.
How does a private cord blood bank work?
      After delivery, your provider collects the cord blood using a kit that the private cord
       blood bank has sent you before birth.
      The cells are sent to the private bank where they are frozen and stored.
      These cells are then reserved for your baby and your family.
      Private cord blood banks charge a fee for storing these cells. The cost depends on
       the specific bank used, however, there is usually an initial fee for freezing the cells
       and then an additional yearly fee to keep the cells stored.
What are my options for cord blood banking if my baby is born at the University of
North Carolina Women's Hospital?
At UNC Hospitals, we offer the option of public cord blood banking. We use the Carolina's
Cord Blood Bank, which collects blood at UNC Hospitals, Duke Medical Center, Durham
Regional Hospital and Western Wake Hospital.
The Department of OB/GYN, including the Divisions of Maternal Fetal Medicine, Women's
Primary Health, and Nurse Midwifery, as well as the Department of Family Medicine have
agreed not to collect cord blood for private storage. The University of North Carolina
Women's Hospital does not allow patients or their family members to collect cord blood
themselves.
Why does the University of North Carolina Women's Hospital not participate in
private cord blood banking?
There are a number of reasons the University of North Carolina Women's Hospital has
decided not to participate in private cord blood banking. Some of them include:
    The odds of finding a cord blood donor from a public bank are already quite high and
      improving steadily as public cord blood bank donations increase.
    The chance of a child using his or her own cord blood for transplant is extremely
      small. It has been estimated to be between 1 in 1000 to 1 in 200,000.
    Many private banks do not have a program in place to check the quality of cells. Even
      when properly trained people collect cord blood, almost 1 in 3 units are unusable.
    Many doctors who treat children with leukemia or other medical problems do not think
      children with the disease should receive their own stem cells. There are two reasons
      for this:
               A child's own stem cells may already have a genetic change that caused
                 their disease.
               In children with leukemia, their own cells may not fight off the leukemia
                 cells as well as the stem cells from another person (this is called graft-vs-
                 leukemia effect).
    Although stem cells from umbilical cord blood could be used for older children or
      adult relatives with leukemia or other diseases, very few of these attempts have been
      successful. This is because there are not usually enough stem cells in one baby's
      umbilical cord blood to treat an older child or adult. Cord blood transplants from
      multiple donors have been more successful.
What if I am interested in private cord blood banking?
If you are interested in private cord blood banking, there are other institutions in the area
that offer this option. You can ask your provider about these institutions and, if you desire,
how to transfer your care to a provider who delivers at one of these hospitals.


Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Donation%20of%20Cord%20Blood.pdf (last revised February 2008)
                                       Birth Day Wishes

Think about developing a place that will be supportive for you during labor and
deliver…..use all of your senses! Plan what might be helpful to prepare in advance to bring
to the hospital.

Sight:            Sound:              Taste:              Touch:              Smell:________          __




I am planning for the following people (up to three, including a doula) to be present to support me
during labor and childbirth: _________________________________________________

I would like to let my care providers know about the following concerns, desires or fears related to
labor and delivery:
________________________________________________________________________________
______________________________________________________________________

My plans for handling contractions and pain are:
________________________________________________________________________________
______________________________________________________________________

Specific interventions I would like to avoid if they are not medically indicated for my health or the
health of my baby are:
________________________________________________________________________________
______________________________________________________________________

In the first moments of my infant’s life, I would like to be able to:
________________________________________________________________________________
______________________________________________________________________

While I am in the hospital with my baby and adjusting to being a new mother, I would like to be able
to:

________________________________________________________________________________
______________________________________________________________________
           Videotaping & Still Photography in Labor & Delivery
The NC Women’s Hospital and its staff are delighted to be part of the birth of your baby. Because
the birth of a baby is a special time that many people like to record with pictures and video, we want
you to be aware of the following is information on the UNC Hospital policies regarding photography.

May we take pictures during labor and delivery?
You may take pictures before and after the birth of your baby. If you wish to have pictures or video of
the events surrounding the birth of your baby, we encourage you to arrange for one of your support
persons to bring a camera or cameras and be in charge of picture taking. It is a good idea to discuss
ahead of time which pictures you would like taken and which ones you would not. Here are some
important points for successful recording of these events:

      Bring extra film, digital cards and batteries so you get all the pictures you want.
      Cameras must be battery operated – electrical cords are a safety hazard.
      You cannot use a tripod in Labor & Delivery.
      Phone cameras must be turned off at all times in Labor & Delivery because their signal can
       interfere with monitoring of patients anywhere in the unit.
      Please ask staff before including them in your photos and respect their decision if they do not
       wish to be in a picture.
      Ask your support person to take only pictures you will want to have – nothing that will be
       embarrassing later.

Are there times when we cannot take pictures?
For numerous reasons, including patient safety and infection control, UNC Hospitals does not allow
direct filming of medical procedures. This means that no photography is allowed during the following
times in Labor and Delivery:
     During medical procedures in labor, such as placement of an epidural or checking of the
         cervix
     At the actual moment of the vaginal or cesarean birth, regardless of whether the birth occurs
         in a labor and delivery room or in an operating room; for additional patient safety reasons, no
         cameras are allowed in the operating rooms at UNC
         Hospitals
     During medical procedures on the newborn – ask the care providers when you may turn on
         your camera to take the first picture of your new family member
     If the staff becomes very busy because of a problem, please turn off your cameras and follow
         any directions given by the medical team as they work; they will let you know when it is safe
         to continue taking pictures

     After a cesarean birth, the mother will be taken to a recovery room where you may take pictures
     after your nurse or physician says it is safe. There may be another patient in the recovery room
     at the same time, and you are asked to respect the privacy of the other patient.

     Once mother and baby have been moved to the Maternity Care Center, you are free to take
     pictures of your new little one in your room at any time. If your baby should go to Newborn
     Critical Care, you may also take pictures there.

If you have any questions about photography and our policies, talk with your physician or midwife.
Again, we are pleased to share this important event with you.
Source: http://mombaby.org/UserFiles/File/WomensHealthEducation/English/Videotaping.pdf (last revised October 2006)
                  CHAPTER FIVE - PLANNING FOR YOUR BABY

                    It’s time to think about plans for your baby!
                                   SAFETY ISSUES
Car Seats
All 50 states require that children, including newborns, ride in car seats. You
will need a car seat to bring your baby home from the hospital. The safest way
for your new baby to ride is in the car’s back seat with the car seat and infant
facing backwards. You can stop by your local Fire Station and they will check
your car seat for you.

Important: Don’t ever strap your child into your safety belt with you. Don’t
use an infant carrier as a car seat unless it is made for this purpose.

Cribs
 Small babies can get caught or hurt themselves if the crib isn’t safe.
 The space between the crib bars should be no wider than 2 1/16 inches.
 Make sure the bars are not loose or missing.
 There should not be any posts sticking up or any cutout areas on the
     crib’s headboard or footboard.
 The mattress should fit snugly into the crib frame. If you can put two
     fingers between the mattress and the side of the crib, you need a bigger
     mattress.
 It is recommended not to use pillows, crib bumpers, or stuffed animals in
     the crib.
New cribs will probably be safe for your baby. If you use an old crib, check it
carefully for safety. If the crib was made before 1978, it may be painted with
lead paint and should not be used.

Keep the crib away from windows so your baby won’t fall out or get tangled in
the cords for the window shades or curtains.


Important: Even if you use a Baby Monitor, you should still check on your
sleeping baby from time to time.
                                     Telling Your Story

Every woman is unique, and your pregnancy and childbirth will be a story that only YOU can
tell. No one else will be able to capture all the details of the changes your body went
through, how you felt, and your hopes and dreams. Often, writing down your birth story, and
sharing it with friends is an important part of marking this life event. There will be things you
remember (for example: the exact moment you knew you were pregnant, how the baby’s
first kick felt, or what you were doing when your water broke) and maybe things you would
rather forget (for example: what a mess it was in the delivery room, how intense the
contractions were, being challenged by the first few days of breastfeeding). There is no right
or wrong way to write a birth story. Becoming the author of your birth story while all the
events are still fresh is a good way to process the intense experience of pregnancy and
childbirth, and may be a gift to those you share it with – including your new baby some day
in the future!

Ideas for what to include in your birth story:

-Estimated date of delivery and the REAL birthday of your baby
-The names of the people who helped care for you – friends and family, doula, doctors,
midwives and nurses
-Photos – make a photo-journal birth story with pictures from when you were pregnant, at
delivery or holding your new baby

Pregnancy:
-How you felt when you knew you were pregnant
-What foods you craved during pregnancy
-How it might have changed your view on other things – your work, relationships, planning
for the future
-What your experience of prenatal care was like, and what you learned/shared
-what you might want to tell your child about what they were like in utero

Delivery:
-The story of your birth
-What special things you took to the hospital or wanted to be a part of your birth
-What you remember feeling when you first held your baby

Postpartum:
-What it was like to arrive back home with your new baby
-Who your first visitors were, and how you celebrated this new stage of family life
       MAKING A DECISION ABOUT CIRCUMCISION FOR YOUR SON

The history of circumcision in our country is interesting. We began to circumcise boys in the
United States routinely in the early 1900s. For about two or three generations now, we have
circumcised most of our baby boys. But beginning in the middle of the 1980s, the research
began to show that there was not a good medical reason to circumcise and fewer and fewer
families are choosing to circumcise their sons. The circumcision rate in the United States is
about 50%-60%. In the rest of the world, the rates of circumcision are about 15% and most
of these are done for religious reasons.

What is a foreskin?

All newborn boys have skin that covers the end of the penis, called
the foreskin. The foreskin is like an eyelid in that it is tougher on the
outside, and more sensitive on the inside. In fact, the inside of the
foreskin is one of the most sensitive places on the male penis. For
example, brush your fingers against the palm of your hand. Now
brush your fingers against the back of your hand. The palm of your
hand has lots of nerve endings that are especially sensitive to light tough. These are also on
the inside of the foreskin.

The foreskin also protects the head of the penis while a boy is in diapers. When a boy is
born, the foreskin is attached to the head of a penis like a fingernail. This protects the top (or
the glans of the penis) from irritation in the diaper.

There are lots of theories about why we started doing circumcisions on boys. Today, the
practice has become commonplace.
Risks and benefits of circumcision
Problems from the surgery are usually minor. Although serious complications are rare, they
do occur. Of every 1,000 boys who are circumcised:
      20 to 30 will have a surgical complication, such as too much bleeding or infection in
       the area.
      2 to 3 will have a more serious complication that needs more treatment. Examples
       include having too much skin removed or more serious bleeding.
      2 will be admitted to hospital for a urinary tract infection (UTI) before they are one
       year old.
      About 10 babies may need to have the circumcision done again because of a poor
       result.
In rare cases, pain relief methods and medicines can cause side effects and complications.
You should talk to your baby’s doctor about the possible risks.
Of every 1,000 boys who are not circumcised:
      7 will be admitted to hospital for a UTI before they are one year old.
      10 will have a circumcision later in life for medical reasons, such as a condition called
       phimosis. Phimosis is when the opening of the foreskin is scarred and narrow
       because of infections in the area that keep coming back. Older children who are
       circumcised may need a general anesthetic, and may have more complications than
       newborns.
Circumcision lowers the risk of a man getting sexually transmitted HIV by about 50%, if they
are exposed to the disease. However, to safely protect men against HIV infection, they need
to use a condom. Circumcision is not considered good protection against HIV for men and it
does not protect women from HIV at all. Men will pass this disease to women equally
whether they are circumcised or not. .
Is circumcision recommended?
The American Academy of Pediatrics does not recommend routine circumcision though they
recognize that some parents choose circumcision for their sons for cultural or religious
reasons.


Scheduling a Circumcision for Your Baby Boy At UNC Family Medicine

 Before making a decision, please also look at Circumcision Information Resource
 Pages at www.cirp.org and/or read the American Academy of Family Physicians
 Position Paper at www.aafp.org/x1462.xml and/or the American Academy of Pediatrics
 Guidelines at www.aappolicy.aappublications.org for excellent educational information.



Because it is elective surgery, some health insurance companies, including North Carolina
Medicaid, no longer cover the cost of the procedure. This means, if you choose to have
your son circumcised, and your insurance company does not cover the cost, you will be
responsible for paying for the surgery.

UNC Family Medicine charges about $300 for circumcision. It is the same cost in the
hospital and in our clinic. Full payment is required before a circumcision is done.

If you would like to have your son circumcised, please call our financial counselors,
Rodney Mangum (919) 966-2943 or Robin Roberson (919) 966-0898, and they will tell you
how to set up payment. Once it has been completely paid, they will put a note on your
prenatal chart so the doctors know everything is ready and they can circumcise your son.
DO NOT MAKE PAYMENT AT THE HOSPITAL FOR THIS PROCEDURE.

It is never too early to call and begin payment. If you pay for a circumcision and have a girl,
or decide not to have one done, you will get a full refund.
                           Family Planning Decision Information
                        “Which birth control method is right for me?”

HORMONAL methods: work by preventing release of an egg from your ovaries into the uterus and
may also make the uterus an “unfriendly” environment for sperm. Hormonal methods are all
temporary methods of family planning.
                                                                                                                     Does this
                                                                                     How
                         How                                                                       Do I need a        method
                                                            How quickly can          much
                       effective   How often do I need                                          prescription or to    protect
                                                            I get pregnant if I    does this
                        is this        to use it?                                               see a provider for    against
                                                              stop using it?        method
                       method?                                                                    this method?       HIV and
                                                                                     cost?
                                                                                                                       STDs

                                   Applied once a week      Once stopped, it                    Yes. To receive a
    The Patch                       for 3 weeks; during      may take a few          $25-        prescription and
                         99%         th                                                                                 No
   (Ortho-Evra)                    4 week no patch is         cycles before        30/month    learn how to apply
                                           used             you can become                     the patch correctly
                                                             pregnant again

Oral Contraceptive
                                                            Once stopped, it
Pills(many different                 You should take                                            Yes. To receive a
                                                             may take a few
  types including                  your pill everyday, at                            $20-        prescription and
                       95-98%                                cycles before                                              No
combined estrogen                   approximately the                              35/month     learn how to take
                                                            you can become
  & progesterone                     same time of day                                                the pills
                                                               pregnant
 and progesterone
       only)

   Contraceptive                      You receive an         Ovulation may         $60-75        Yes. A provider
 injection – Depo-      >99%       injection every three    be delayed up to        every        administers the        No
      Provera                              months               one year            three      injection each time
                                                                                   months
                                                                                                 Yes. Your health
     Progestin-                     Lasts up to 5 years      Once removed,         $400 for
                                                                                                 care professional
      releasing         >99%       but may be removed       fertility can return     five                               No
                                                                                               inserts/removes the
Intrauterine Device                     at any time          within one year        years
                                                                                                        IUD
   (IUD) -Mirena

                                    Each month, a new
                                                            Once stopped, it
                                       vaginal ring is                                          Yes. You need to
                                                             may take a few        $35-40
   Vaginal Ring                     inserted and left in                                       learn how to insert
                         99%                                 cycles before           per                                No
   (NuvaRing)                       place for 3 weeks.                                           and remove the
                                                 th         you can become         month
                                   During the 4 week,                                              vaginal ring
                                                               pregnant
                                   you do not wear the
                                            ring
                                    Lasts up to 3 years     Once stopped, it       $300 on      Yes. Your health
      Implants
                        >99%       but may be removed        may take an           average       care provider          No
    (Implanon)
                                        at any time          average of 6            with       places/removes
                                                                 months to          insertion      Implanon
                                                                 become
                                                                 pregnant

NON-HORMONAL methods: Prevent pregnancy by providing a barrier against sperm, or by
interfering with sperm movement, or by creating an “unfriendly” environment for sperm. These
methods do not use hormones, so they do not interfere with your natural reproductive cycle.
                                                                                                     Do I need a       Does this
                             How
                                                              How quickly can        How much      prescription or      method
                           effective     How often do I
                                                              I get pregnant if I    does this         to see a         protect
                            is this      need to use it?
                                                                stop using it?      method cost?     provider for     against HIV
                           method?
                                                                                                    this method?       and STDs
                                                                 Without the
                                        A new one must        condom, there is
                                                                                     $0.50 - $3
    Male Condom            85-97%      be used every time       no protection                            No              Yes
                                                                                    per condom
                                          you have sex             against
                                                                 pregnancy
                                                                 Without the
                                        A new one must        condom, there is       $0.50 - $3
   Female Condom           85-95%      be used every time       no protection                            No              Yes
                                                                                    per condom
                                          you have sex             against
                                                                 pregnancy
                                                                                                      Yes. Your
                                        Lasts at least 10      Once removed,                         health care
 Intrauterine Device
                                       years, but may be         fertility can       $430 for 10       provider
        (IUD)               <99%                                                                                          No
                                        removed at any          return within          years         inserts and
     (Paraguard)
                                              time            about one month                       removes the
                                                                                                         IUD
                                                                Without using                      Yes. You need
                                                                                     average of
                                       Must be used with      the device, there                    to be fitted and
                             85-                                                      $100 for
      Diaphragm                         spermicide every       is no protection                    must learn how         No
                            05%%                                                     fitting and
                                       time you have sex           against                            to use the
                                                                                     diaphragm
                                                                  pregnancy                          diaphragm

    Spermicides –                                               Without using
different preparations                   Must be used         fresh spermicide
                           80-94%                                                   $0.50-$3 per
   available – jelly,                    every time you       every time, there                          No               No
                           effective                           is no protection         use
 sponge, cream and                         have sex
     suppositories                                                 against
                                                                  pregnancy
                                          Natural family                                             No, but your
    Natural Family                     planning, based on                                          health provider
                                                              Without periodic
 Planning (includes:                      the menstrual                                            may be able to
                                                               abstinence,
  fertility awareness,     75-85%      cycle, with periodic                            No cost       explain the          No
                                                                there is no
 periodic abstinence,                   abstinence during                                            best way to
                                                                 protection
 and other methods)                       fertile times of                                           use natural
                                                cycle                                              family planning
                                                   st
                                          For the 1 six
                                          months after                                              No, but your
                                        delivery or until     If not exclusively                   health provider
   Lactational                         your first menses,     breastfeeding, or                    may be able to
Amenorrhea Method          85-90%         if exclusively          beyond 6             No cost       explain the          No
     (LAM)                                breastfeeding       months, there is                      best way to
                                         there is SOME           no protection                       exclusively
                                       natural protection                                            breastfeed
                                        from pregnancy

   PERMANENT                           Once the surgery                             $250-400 for   Yes. Need to
     METHODS:                          is performed, it is       You will no           men          discuss and
                            >99%
Surgical Sterilization –                   considered         longer be able to                    plan with your         No
                           effective                                                 average of
 male vasectomy OR                      permanent and           get pregnant                        health care
female bitubal ligation                    irreversible                              $1200 for      professional
                                                                                      women
                                BIRTH CONTROL CHOICES

Birth Control With Hormones
There are 2 types of hormone related types of birth control. Some have both estrogen and
progesterone, and some just have progesterone. They both work by usually stopping your ovaries
from making an egg, but they also thicken cervical mucous which prevents the sperm from joining
with the egg. They are all up to 99.7% effective, meaning, if they are used correctly, less than 1 out
of every 100 women using this method of birth control will get pregnant. For all hormonal types of
birth control, once they are stopped, fertility returns quickly. Breastfeeding mothers can use
hormones for birth control (after 6 weeks) and continue to breastfeed.

For combination hormones some women will have irregular bleeding (spotting) for the first few
months, shorter periods, less acne, less cramping, less PMS, breast tenderness, weight gain or loss
or may feel nauseated. You should not use combination hormones if you are over 35 and smoke.

For progesterone only hormones, side effects vary depending on how they are administered.

COMBINATION HORMONES
      The Pill Your clinician will prescribe the best type of pill for you if you choose this method.
You have to remember to take a pill at around the same time every day.

       The Patch looks like a large band aid. You put a new one on once a week every week for 3
weeks, and then don’t use one for the forth week. The same cycle repeats every month. Rarely
women’s skin will react where the patch is put on. May be less effective in women weighing over
198 lbs.

        The Ring is a small, flexible, plastic ring that is inserted deep into the vagina. It stays in
place for 3 weeks and is removed for the forth week. No special sizing is needed. Neither the
woman using the Ring or her partner should be able to feel it during intercourse. Sometimes it will
cause increased vaginal discharge, irritation, or infection.

PROGESTERONE ONLY HORMONES
       Depo-Provera is an injection that that is given at your clinic every 3 months. Some women
experience loss of monthly period, change of appetite, weight gain, depression, hair loss, or
increased hair on the face or body, nervousness, skin rash or spotty darkening of the skin, or
change in sex drive. Side effects of medication don’t go away until medication wears off (up to 12
weeks). To reduce the risk of bone thinning, this method may not be used continuously for more
than two years unless no other method is an option.

      Progesterone only pills (mini pills) are just like regular birth control pills without the
estrogen. They have fewer side effects than the combination pills, and are less likely to cause a
problem with milk production.
        IUD (Intrauterine Devices) with progesterone is a small device shaped like a “T” that is
inserted into the uterus through the cervix (opening of the uterus) by your clinician. It lasts for 5
years at a time and can be removed at any time before that. An IUD should only be used by women
who have only one sexual partner, with that partner having no other partners as well. This is
because it can be dangerous to acquire a sexually transmitted disease with an IUD in place. Side
effects include cramping, backaches, and an increased amount of bleeding during periods. If
you choose this method, it is usually put in no sooner than six weeks postpartum.
Birth Control without Hormones

BARRIER METHODS work by blocking the sperm from reaching the egg. They are often combined
with spermicides which immobilize the sperm and keep them from joining with the egg.

        Diaphragm The diaphragm is a rubber cup that is filled with spermicide jelly and put into the
vagina by the woman or her partner before making love. You will be fitted for it at your check up six
to eight weeks after your birth. For a diaphragm to work, you must use it every time you have
intercourse and leave it in your vagina for six to eight hours after making love. If used correctly
every time you have intercourse, about 2 to 10 out of 100 women will get pregnant in one year of
use. A few women report more bladder (urine) infections while using the diaphragm.

         Condoms (also known as rubbers) look like long balloons that cover the length of the penis.
Your partner or you unrolls the condom onto the erect penis before the penis touches the vagina.
You must leave one-half inch of room at the tip to collect the man’s sperm and hold on to the
condom when taking the penis out of the vagina after ejaculation to prevent it from slipping off and
spilling the sperm. When used correctly every time intercourse takes place, about two out of 100
women will become pregnant in a year, though in reality about 12 out of 100 women become
pregnant in one year because they are often not used correctly. Sometimes people will have an
allergy to the condom (latex), but otherwise, there are not many side effects. One really good thing
about condoms is that they can protect against sexually transmitted infections (STIs), including
AIDS, so if you are with a new partner and are using another type of birth control, you may want to
also use the condom just for the extra protection from STIs.

IUD (INTRA UTERINE DEVICE) WITHOUT HORMONES are small “T-shaped” devices that are
inserted into the uterus for up to10 years. The IUD that does not use hormones, uses copper to
keep the sperm from reaching the egg, and rarely, preventing implantation of a fertilized egg. Less
than one woman out of every 100 who uses this method will become pregnant in a year. There may
be more cramping and bleeding with periods. If a pregnancy occurs, it is more likely to be in the
fallopian tubes instead of the uterus, and rarely, a clinician might cause harm or infection during
insertion.

VAGINAL SPERMICIDES
Spermicides work by immobilizing the man’s sperm so it never reaches the woman’s egg. Vaginal
spermicides are usually found as foam, cream, jelly, film or suppository. You don’t need a
prescription for any of these. When used correctly, but without a condom, about six out of 100
women will get pregnant in a year. If you use a spermicide with a barrier method, pregnancy rates
are similar to “the pill” - about 1 woman will get pregnant in a year. Spermicides helps protect
against sexually transmitted diseases, though not as well as a condom. Occasionally a woman will
have an allergic reaction to the chemicals in a spermicide.

FERTILITY AWARENESS METHOD (“rhythm method”) is when a woman knows when she is
fertile, and avoids intercourse or uses alternate methods of birth control during the time when she is
fertile. Women can use checking temperature daily, checking cervical mucus daily, recording
menstrual cycles on calendar, keeping a very accurate record of when your period comes each
month, or keeping track of your menstrual cycle using a string of beads called CycleBeads to figure
out when they are fertile. You must be very committed and well informed regarding this method for it
to work. Women with regular, predictable menstrual cycles are more likely to be successful in
preventing pregnancy with this method. Estimates vary from one out of 100 women becoming
pregnant in one year to 25 out of 100. There are no side effects to this method and it is acceptable
to most religions. If you are interested in this type of birth control, ask your clinician for more
information.
LACTATION AMENNORHEA METHOD (LAM) Breastfeeding is also considered a natural method
of birth control. Mothers who breastfeed their babies at least every four hours, on both breasts,
around the clock (at least 6 times a day) are unlikely to get pregnant. The reliability of this method
falls off as the months go by and is not reliable after 6 months. If there has been a period, it can no
longer be considered effective. 2 out of 100 women will get pregnant using this method effectively.

PERMANENT STERILIZATION
         Tubal ligation If you choose this method, you can have it done within a few hours after
delivery while you are in the hospital anyway, or it can be done after you are six weeks postpartum.
It requires local anesthesia with sedation, an epidural, or general anesthesia. If you are interested in
this method and you have Medicaid, you need to sign a consent form at least 30 days before you
deliver.
         Vasectomy It should have no effect on sexual desire or performance. This procedure can be
done in the office under local anesthesia.

    Vasectomy or Tubal Ligation: which is the best choice for your
    family?
Are you ready for permanent sterilization?

1. Are you sure you do not want any more children?
2. Can you tolerate a surgical procedure?
3. Can you afford the procedure?
4. Have other methods been considered?
5. Does this method fit your religious or moral beliefs?
6. Do you want to discuss this method with you clinician, family planning clinic staff, partner,
friend, or family member?

Which of you will have the surgery?

When you and your partner have decided that your childbearing days are complete and you
do not plan to have any more children, surgical sterilization may be your best option for
preventing pregnancy. Deciding which of you will undergo surgery will be the next step.
Women can have a tubal ligation to permanently prevent pregnancy. Men can end their
fertility by having a vasectomy. Tubal ligation has been the most commonly performed
method of permanent sterilization, however, vasectomy is generally a far safer and easier
procedure to perform. At the UNC Family Medicine Center, we provide vasectomy services.
For tubal ligations we would refer you to our colleagues in the Department of Obstetrics and
Gynecology.

Deciding…
The following table will help you to decide which procedure is right for you. If you have
further questions, speak to your provider or refer to one of the sites listed below.


References/Resources:
http://www.fhi.org/en/fp/fpfaq/index.html#anchor379850 Family Health International website (updated on January 26,2002.)
http:\\plannedparenthood.org      http:\\womenshealth.about.com

More questions on vasectomies? Call 1-888-vasec-4-u. This number will provide you with someone who can: describe the
procedure, reasons why vasectomy makes sense for a man, and answers to other commonly asked questions.
Procedure:      Vasectomy                                       Tubal Ligation
What is it?     1.) A surgical procedure that prevents          1.) A surgical procedure that
                pregnancy by blocking the passage of            blocks the fallopian tube to
                sperm into the ejaculate seminal fluid          prevent the sperm and egg from
                (cum).                                          uniting.

                2.) Procedure is permanent and should only
                be used in couples that do not want more        2.) Procedure is permanent and
                children.                                       should only be used in couples
                                                                that do not want more children.
How does it     Interrupts vas deferens, preventing sperm       Closes tubes between ovaries and
work?           from entering semen, so ejaculate               uterus stopping the sperm cells of
                contains no sperm.                              a man from meeting with the eggs
                                                                in a woman and causing
                                                                pregnancy.
Advantages &    1. Simple procedure usually done in the         1. More involved surgical
Disadvantages       clinic using localized pain medication      procedure usually using spinal
                2. Highly effective (1% failure in 10 years),   anesthesia
                    but does not work until sperm count
                    reaches zero (about 20 ejaculations or      2. Highly and immediately
                    12 weeks) *Must use another method to       effective. (*2% failure in 10 years.)
                    prevent pregnancy in the meanwhile.         *If surgery was successful it is
                3. Only testable method of sterilization        immediately effective and no
                    (Sperm counts verify if procedure           contraceptives are needed.
                    worked)
                4. Does not change lovemaking:                  3. No tests available to verify if
                * No changes in hormones                        procedure worked
                * No change in consistency, amount or
                taste of ejaculate
                * No change in sex drive or performance         4. Does not change lovemaking:
                                                                * No changes in hormones
                5. Less risks than female sterilization         * Does not make a woman stop
                6. In general $250-$1000                        having her period
                7. No protection from STDs or HIV               * Does not cause menopause
                8. No increased risk to pregnancy if            * No change in sex drive or
                procedure fails                                 performance
                                                                5. More risks than vasectomy

                                                                6. In general $1000-$2500
                                                                7. No protection from STDs and
                                                                HIV
                                                                8. Increased risk of tubal
                                                                pregnancy if procedure fails
Possible Side   1. Some pain/discomfort after procedure.        1. More pain/discomfort after
Effects:                                                        procedure.
Recovery:       1. No heavy physical activity for 48            1. Limit heavy lifting for at least
                hours                                           one week after surgery
                2. Must return to give sperm samples to         2. Routine follow-up one week
                verify effectiveness two times.                 after procedure to check site
                   And Baby Makes Three (or four, or more…)
                  Choosing a health care provider for your baby
Although you are getting close to the end of your experience of pregnancy, you are approaching
the BEGINNING of a whole new experience of parenting! Whether this is your first, middle or
last child it will be important for you to make a good decision about who will care for your child’s
health with you. Your doctor (or nurse practitioner) will have a long term relationship with your
child and family. It is important to have someone you are comfortable with and can trust.

We hope that you will consider bringing your child to UNC Family Medicine for health care, but
we want you to make the choice that is best for you and your family. It’s a great idea to meet
your baby’s prospective doctor face to face – even before you deliver – to be as certain as you
can be that you are comfortable with him or her, and with the office where you will get care.
Different health providers have different training and practices, and it is important to find out
what works best for you.

Here are some things to think about:

      What is your sense of the family-centered care provided by the doctor and clinic? Will
       you be able to discuss what is important to you, and ask questions?
      Does the doctor listen to you, and explain things in a way that makes sense to you?
      Where is the office and is it convenient for you?
      What other supports are available in the office – breastfeeding support? nurse advice?
       social services (such as WIC or Medicaid)?
      Is it easy to get appointments that work for you and your family?
      If your baby needs care in a hospital, will your doctor, or someone else care for him/her?
      Is there always someone available to talk to (even when the office is closed) if needed?
      Until what age will the doctor continue to care for your child? Family doctors (and some
       doctors trained as Pediatrician/Internists) care for people of all ages while Pediatricians
       care for infants through teenagers.
      How will you handle payment for services, and will this office work with you for this?


It’s good to think about these questions in advance and we want to help you make the best
choice. Feel free to ask us questions and let us help you figure out what might work for you. Our
job at is caring for families so we are pretty good at listening!
                                  Health Care for Your Baby

                                  Your provider at the UNC Family Medicine Center can
                                  continue as your family doctor and take care of your new
                                  baby too. We have a same day clinic especially for kids in
                                  the morning, and a full time lactation consultant on staff.
                                  Remember to bring a copy of your birth certificate to the
                                  baby’s first appt so we can add the baby’s name to our
                                  computer system. There are other pediatric practices and
                                  family practice clinics available as well.




CHOOSING A BABYSITTER/DAYCARE

Choosing a babysitter: The more confidence you have in your babysitter, the easier this
experience will be for you. You may want to have your first sitter be someone very close
and trusted, such as the baby’s grandparent, or a close friend, who is familiar with both you
and your child.
   After you’ve survived the first separation, you may want to look for a regular babysitter.
Start by asking friends, relatives, or co-workers for recommendations. Interview every
candidate in person with your baby present. Look for someone who is affectionate, capable,
and shares your views about caring for children. If you feel comfortable with the individual
after you’ve talked a while, let her hold your baby so you can see how she handles him/her.
Although experience, references, and good health are all very important, the best way to
judge a sitter is by giving her a trail while you’re home. It will give your baby and the sitter a
chance to get to know each other before they’re alone together, and will give you an
opportunity to make sure that you feel comfortable with the sitter.
   Whenever you leave your baby with a sitter, give her a list of all emergency phone
numbers, including those where you or other family members can be contacted if problems
arise. Establish clear guidelines about what to do in an emergency. Let a nearby neighbor
know about your arrangement so they can help if there’s an emergency. Be sure that the
sitter knows what to do for a child who is choking or not breathing. Ask the sitter to jot down
any questions, or observations that she has about your baby.

   Choosing a daycare: When infants and young children receive warm and responsive
care, they feel safe and secure so it is important that your daycare provider has a good
relationship with your baby or child. Positive relationships with caring adults will actually
allow your child’s brain to grow and develop in the best possible way.
    Visit the family child care homes and child care centers under consideration, and talk to
those who will be providing your child’s care. Finding and choosing the right child care
arrangement is not always easy. You can expect an initial adjustment period for both you
and your child. Drop in from time to time to make sure everything is going well. Pay
attention to how your child acts when seeing the caregiver each day. Is your child happy
and excited? Does your child seem comfortable? This is the best indication that you have
made a good choice. The right child care can be a wonderful opportunity to enrich your
child’s life, and help him realize his full potential.
                   CHAPTER SIX - SPECIAL SITUATIONS

When YOUR BABY IS OVERDUE

Many women are frustrated when they have not had their baby by their due
date. Remember that a due date is an average; it is common for women to
deliver up to two weeks before, or two weeks after their due date. Infants who
are "postmature" or born more than 2 weeks late, may have some increased
risks of problems either during labor or in the first week of life. Because of this,
if you go one week past your due date, we will begin talking with you about a
plan to induce your labor.

 When you reach 41 weeks, we will offer a non-stress test and/or ultrasound
and examine your cervix. If your cervix is “ripe” (soft or ready for labor), we
may induce labor with PITOCIN at 42 weeks. This medication is just like the
hormone OXYTOCIN that your own body produces when you go into labor.
This drug is given in small amounts through an IV (intravenous fluids going into
your veins).

If your cervix is not “ripe,” then we will consider other ways to get it ready. A
medicine called misoprostol may be placed in your vaginal near the cervix or
steady pressure of a foley catheter bulb may be placed in the cervix and left
overnight. This helps soften and ripen the cervix and makes labor induction
with Pitocin more effective.

There are other ways to stimulate labor when you are overdue. These include
having sex, an exam technique called "stripping the membranes", nipple
stimulation, enemas, or taking castor oil. There are some herbs that may also
open your cervix or stimulate labor.

CESAREAN BIRTH
What Is a Cesarean Birth?
A cesarean section is delivery of the baby through an incision in the abdomen
and the uterus (womb). Sometimes it is the only way to get the baby out safely
and it is not a sign of failure. The rate of cesarean section is going up, and in
the United States, our rates are about 30%. Our cesarean section rate is much
lower than that at UNC Family Medicine.

Why Is a Cesarean Birth Needed?
Common reasons for a cesarean section are:
   The mother previously had a cesarean section and either she or her
    provider choose to repeat this method
   The baby is too big to pass through the mother’s pelvis.
   The baby’s heartbeat indicates it is experiencing signs of distress.
   The baby is not in a head down position (is breech or transverse).
   Labor is not progressing in spite of efforts to try and help it along

What Happens During a Cesarean Birth?
 A nurse will shave the area above your pubic hair and clean your abdomen
 A catheter will be inserted into your bladder
 An IV needle will be inserted into your arm.
 You will be given an antacid to drink to neutralize acids in your stomach
 Most mothers have an epidural for anesthesia unless it is an emergency
  requiring immediate general anesthesia (put to sleep).

After Cesarean Birth
If the baby is doing well (cesarean babies sometimes need extra time and
stimulation to begin breathing on their own), and you are awake, you should be
able to hold your baby. Hold your baby skin to skin as soon as you are able to.
If the father is in the Operating Room (one visitor is allowed to come back to
the Operating Room with you), he should be allowed to hold and cuddle the
baby, too. Once in the recovery room, you can begin to breastfeed the baby.

VAGINAL BIRTH AFTER A PREVIOUS CESAREAN (VBAC)

Although "once a cesarean section always a cesarean section" used to be the
rule, it is now recognized that most women can deliver safely by vaginal
delivery in a subsequent pregnancy. This is called a "trial of labor".

We will review your records to make sure it is safe for you to try for a vaginal
birth. We will look at the type of uterine incision you had. Low transverse
(back & forth) incisions are safer because there is less chance of rupturing
(opening) the uterus during labor. Most women have had a low transverse
incision and are able to attempt a vaginal birth, with about 70-80% succeeding.

It is important that you understand the risks and benefits involved and discuss
these with your clinician. With a vaginal delivery you have a shorter hospital
stay, less anesthesia, no need for an operation, and better stimulation of the
infant by the vaginal birth. The risks include the fact that 1% of women with a
scar on their uterus from a previous cesarean section will rupture their uterus
during labor. In about 25% of this small group of women, the baby or the
mother will have a poor outcome, meaning that the baby could have problems
after birth or the mother will need a hysterectomy (removal of the uterus).
If you have had a previous cesarean section, the options for delivery will be
thoroughly discussed with you and your questions answered.




                            Singing the postpartum blues
It is very common for new mothers (and sometimes fathers too!) to have the “baby blues” which start
a few days after delivery. Usually, this is because of a combination issues - learning to care for your
new baby, getting less sleep, and the changes in your hormones and body after birth. Most new
mothers feel overwhelmed, sad and irritable for a little while, but this should not stop you from taking
care of your baby. It’s a great time to let your family and friends help out. Most often the “baby blues”
go away by 10-14 days after delivery. If you have symptoms that interfere with your ability to care for
yourself or your baby, or that last longer than two weeks, you may have postpartum depression.
Postpartum depression is very common; affecting two out of every 10 new mothers and it may occur
any time in the first year after delivery.

Postpartum depression can be caused by a mixture of issues including stress, hormone changes,
lack of support, trauma and extreme fatigue. Women who have had depression before are more
likely to become depressed during pregnancy or after birth. Unlike, “baby blues”, postpartum
depression will usually not get better on its own. If you are depressed you need to get help. With
help you can feel like yourself again. During prenatal care and after delivery, we will ask you about
symptoms of depression but you should tell us too if you think you are depressed.

Watch for the following symptoms:
   Feeling very sad, anxious, or lonely
   Feeling very tired all the time
   Lack of interest in things you usually enjoy
   Changes in sleeping or eating patterns (more than comes from just having a baby!)
   Feeling hopeless, guilty or worthless
   Problems concentrating or making decisions
   Thoughts about death or suicide
   Thoughts about hurting your baby (even if you will not act on them)

Depression in pregnancy and postpartum can be treated by:
    Medicine that is safe to use while pregnant or breastfeeding
    Individual or group therapy
    Support from your family, friends and community.

Being a good mother means being good to yourself. It is important to know about postpartum
depression and to get help if you need to. If you need to talk to someone about this, you can always
reach the MCH doctor on call (pager: 216-3048). If it is an emergency and you cannot reach anyone,
you should call 911 or go to the closest emergency room to be certain that you and your baby are
safe. You can also call (1-800-273-TALK – a national suicide prevention lifeline).
            CHAPTER SEVEN - COMMUNITY RESOURCES

CHILDBIRTH CLASSES

We believe that all parents benefit from childbirth preparation,
especially if this is their first baby. Classes are not just for women
who want natural childbirth; they help to prepare you for all of your
options in labor, including medications, labor and birth positions, etc.
There are many classes available in the Triangle area. You need to
consider the type of class, location, and cost. Many of the
instructors will work with you if cost is a problem. Some of the
classes are covered by MEDICAID or are at lower cost if you have
MEDICAID. If this is not your first baby, you might consider
refresher classes, not just to provide you with information, but more
often to give you and your partner an opportunity to discuss your
plans for this birth. In order to get the class of your choice, you need
to sign up early! Start thinking about classes any time after your
20th week. It is best if you finish the classes two to four weeks before
your due date.


N.C. Women’s Hospitals and Women’s Health Information Center, UNC Hospitals
Website: nchealthywoman.org
Phone (919) 843-1759 Email info@nchealthywoman.org

Childbirth Classes and Tours

Classes:
Prepared Childbirth ($85 per couple)
Classes focus on the normal birth process with emphasis on how mother and partner can
work together to have a healthy, positive experience. Register when mother is between 15
and 25 weeks pregnant. Plan to start the class at 28 to 32 weeks.
Breastfeeding ($25 per couple)
This course acquaints couples with the basics of breastfeeding.
CPR for Family and Friends ($40 per couple)
This class teaches CPR techniques for infants, children and adults and provides information
on injury prevention. For your safety and comfort, take this class before your third
trimester.
Newborn Care ($25 per couple)
This class will help to prepare you for life with a newborn. Topics addressed will include
sleep, crying, soothing and illness.
Boot Camp for New Dads ($25 per dad)
Dads-to-be meet with "Veteran" Dads who bring their babies to class. Topics include:
changing diapers, crying babies, finances, taking care of Mom and more.
Choosing & Using Childcare (free)
This class teaches strategies for finding quality childcare for infants, toddlers and school-
age children. In addition, parents learn about community childcare options.
Prenatal Yoga ($50 for 5 sessions)
This 5-week class offers a wonderful way for an expectant mom to optimize her health and
comfort during pregnancy.
Moms and Emotions ($10 per couple)
This class teaches couples about depression and anxiety disorders, by far the most
common serious medical complications of pregnancy.

Baby in the Dog’s House ($10 per couple)
This seminar teaches parents-to-be how to successfully prepare the family dog for the
arrival of a new baby. Take this class early in your pregnancy to allow time to work with your
dog.
Photographing Your Baby ($10 per couple)
This class will help you to prepare for capturing lovely, vibrant memories of your new
baby. Class topics include: composition, lighting, software, web-based tools and more
Tours:
Maternity Center Tours (free)
Tours of labor and delivery and the maternity care center are designed to answer your
questions about the hospital and what to expect when you arrive to have your baby.
Sibling Tours are for families with children ages 3 to 10.
Tours de Maternidad en español (gratis)
Reciba información sobre la maternidad en el Hospital de Mujeres de N.C. Incluye una guia
del piso de las salas de partos. Llame (919) 843-1891 para reservar su asiento.
                      OTHER CHILDBIRTH CLASSES IN THE AREA
                   Please note trianglebirth.com is and excellent website

CHAPEL HILL

Carrboro Yoga Center                                                       933-2921
Website: www.mycyco.com
Paula Huffman essentialh@intrex.net
 Childbirth Education Alternatives: Prepared Childbirth Classes
   Classes are small and set in a nurturing environment. Topics based on facts presented with
   humor and active participation. Guest speakers, videos, handouts, and reading references
   are used to give you the best information from a wide array of sources. These classes are
   right for everyone regardless of the type of birth experience you are hoping for or where you
   choose to deliver. Smart informed decision making to maximize the birth and postpartum
   experience is my goal for all participants. Classes are once a week for 7 weeks. $100 per
   couple
 Prenatal Yoga (open class)
   Develop a sense of relaxation, confidence, and body awareness to enhance the birth
   process. Relaxation, breath work, strengthening, and stretching will be our focus. Come and
   meet new moms while you journey through this special and amazing time of life.
   Wednesdays & Fridays 5:30 doors open for Question & Answer time and 5:45 class begins,
   but time is relative for pregnant women so this class is flexible for time... coming and going...
   bathroom breaks... whatever you need.
 Mommy Yoga Restorative Workshop
   This will be a time for new moms to come together to rest, renew, and restore. Baby stays at
   home while mom gets some time for herself. Restorative yoga is comprised of restful poses
   in which the body is supported with props, and the poses are held for extended periods of
   time. It soothes, regenerates and promotes a calm peaceful state of mind, body and spirit.
   You can achieve deep relaxation, helping to bring balance to our demanding daily lives. No
   prior yoga experience is needed. This workshop is safe and effective for any stage of
   postpartum up to one year.
 Prenatal Workshop For Couples
   This workshop is an opportunity for you and your partner to better understand the birth
   process. Partners will gain greater awareness of how to support the birthing mother with
   confidence, sensitivity, and calmness. Class includes: · Labor Breathing · Relaxation ·
   Partner Massage and yoga · Focusing and visualization Comfort techniques, positioning &
   more! Taught by Paula Huffman, BS, RN, certified childbirth educator, yoga teacher, doula,
   and perinatal fitness instructor. $45 a couple, singles, $25.
 Mommy & Baby Postnatal Yoga Workshops
   Come bond with baby and other new mothers as you gently restore and renew yourself.
   Easy exercises help to strengthen, tone and reshape the body, while the nurturing
   atmosphere and good company helps soothe the spirit. This workshop is open to all levels of
   new mothers and prior yoga experience is not necessary. This is a loose, fun filled class that
   allows for nursing, crying, teething, venting, questions and answers as well as reality checks.
 CPR Classes American Heart Association Standards
   Whether you need CPR for work or simply want to learn the technique for personal reasons,
   this class will work for you. Options in CPR offered in a personable, relaxed, non-hurried
   setting. Go to Paula's Page for info.
   * Healthcare Providers
   * Heartsaver for the Workplace
   * Adult-Child-Infant CPR
   * AED Instruction

Svea Oster                   svea.oster@gmail.com                          929-8282
Class offerings include childbirth preparation classes, a comprehensive series of classes for
first-time parents, refresher classes geared to the needs of experienced parents, and sibling
preparation classes. Class content includes normal labor and delivery, variations and
complication, medical interventions including cesarean birth, late pregnancy, birth planning
and informed consumerism, newborn care, breastfeeding, positioning, massage, affirmation,
visualization, and others. The approach is eclectic and focuses on developing a confident
and informed attitude towards pregnancy, birth and parenting. $120 per couple. Taught at
Women’s Birth and Wellness Center

Jo Garrett                  jo4joyfulbirth@gmail.com                  919-338-8055
Bradley Method natural childbirth instructor
The standard Bradley® series is designed for small classes with lots of individual attention.
The standard length of the classes is 12 weeks covering 12 units of instruction. The Student
Workbook is included in classes. It has 130 pages with over 75 pictures and illustrations. A
coach card is also included. Topics covered are nutrition, exercise, relaxation, labor
rehearsals, birth plans and many more! For more information regarding the Bradley Method
please visit: www.bradleybirth.com

HILLSBOROUGH

Hillsborough Yoga & Healing Arts                                               732-3051
Website: http://www.hillsboroughyoga.com/
Paula Huffman essentialh@intrex.net
 Childbirth Education Alternatives™
    “Prepared Childbirth Classes with a Difference”
    Small classes set in a nurturing environment. Topics based on fact presented with
    humor and active participation. Guest speakers, videos, handouts, reading references
    are used to give you the best information from a wide array of sources. These classes
    are right for everyone regardless of the type of birth experience you are hoping for or
    where you choose to deliver. An experiential approach to learning with topics that
    include Anatomy and Physiology of Labor, Coping Techniques approached from many
    different philosophies, Partner Roles, Variations and Complications, Medical Technology
    and Pain Relief and much more. Each class includes breath, relaxation and mobility
    practice with an incorporation of Mindfulness Techniques as developed by Jon-Kabat
    Zinn. Smart informed decision making to maximize the birth and postpartum experience
    is the goal for all participants.
    This is a 7 week series held on Thursday evenings from 6pm-8:30pm.
    Please see workshops/events for the next start date of these sessions.
    For more information or an outline contact babies@hillsboroughyoga.com
 Weekend Blitz
    This is a weekend class held on Saturday and Sunday for two weekends.
    Classes are scheduled for 3 hour sessions for a total of 12 hours.
    This class is appropriate for those who cannot attend the 7 week course. Most of the
    class time will be spent in practice with the expectation that the basic factual foundations
    of labor and birth knowledge will be completed by the participants prior to class. Please
    see workshops/events for the next start date of these sessions.
   Mommy Baby Yoga
    Bring the baby to Yoga! Enjoy your time with other new moms while you move your
    body. This class includes time for talking, sharing stories and resources. The yoga
    practice focuses on pregnancy and birth recovery as well as stretching and moving all
    those places affected by carrying and breastfeeding babies. You can start as early as 4-
    6 weeks postpartum and continue up until your baby is actively crawling.
   Prenatal Yoga
    Come and join this supportive group of moms to be for sharing and yoga practice. This
    class offers community as well as a time to deeply connect with the baby you are giving
    life to. The asana practice focuses on comfort during pregnancy and physical
    preparation for labor and delivery.
   Fusion Yoga
    Moms to Be! New Moms with Baby! Dads! Stiff Dads who have never done Yoga!
    Partners! Grandmothers! Grandfathers! Friends! Come and enjoy this lively, positive
    energy class that is open to all! This is a gentle practice that makes yoga possible for
    anyone who is willing to roll out a mat!
   Prenatal Couples Workshop
    This workshop is designed to provide an overview of skills and comfort measures that
    can be used to enhance comfort in pregnancy and facilitate the birth process.
    The following will be included in this 3 hour workshop.
             o Mindfulness Techniques for body awareness
             o A simple Yoga Routine for Pregnancy and Birth Preparation
             o Breath Work
             o Relaxation Practices including Visualization
             o Positioning for Labor
             o Comfort Techniques for partners to provide including management of Back
               Labor
             o The use of Rhythm, Relaxation and Ritual in labor
             o Optional viewing of The Business of Being Born (not included in the 3 hour
               time period)
    An experiential workshop that may function as an adjunct to any Prepared Childbirth
    Class. Also a great Refresher for those who have already given birth. Please see
    workshops/events for the next scheduled Prenatal Couples Workshop.
   The Birth Circle™
    The Birth Circle is a group started by Paula to provide a time for women to come
    together, meet, share stories and find out what is available in the community for moms to
    be and new parents. The Circle is a free group that alternates locations. Guest
    Speakers from the community will offer information on topics of interest to moms and
    moms to be. (sorry guys, baby boys, girls and women only)
    The Circle is free and no registration is required. Snacks provided. A $3.00 donation is
    appreciated. Please see workshop/events for the next location and guest speaker
    information.
    The Birth Circle is always held on the first Saturday of every month.
   CPR Classes
    CPR classes will be held monthly at alternating locations.
    American Heart Association Standards
    Please see workshop/events for the next location and registration information.
   Breastfeeding Classes for Mom and/or Couples
    Third Saturday of every month.
   Preconception and Fertility Classes
    See the workshop/events page for schedules.
ALAMANCE COUNTY
Call Alamance Regional Hospital Office of Education at 336-538-7550.

DURHAM COUNTY

Birth Partners and Healthy Expectations
Tara Owens 957-7979 or hlthyxpectation@aol.com
  Lamaze Childbirth classes
    We prepare expectant women and their families for normal labor, birth, and postpartum.
    Focus will be on building confidence in a woman’s ability to give birth, comfort strategies
    including relaxation and positioning, communication and negotiation skills, making
    informed decisions about medications and interventions, breastfeeding, and early post
    partum adjustment. Weekend classes provide 8 hours of instruction $85 per couple
  Labor Comfort Technique class
    This class is designed to guide women and their partners through extra practice on non-
    medicated techniques to help them through labor and birth. It is recommended that
    women have attended a childbirth class prior to attending this class. Class is 2 hours.
    $25 per couple.
  Private Classes
    For women who are on bed rest or prefer an in-home class specially designed to meet
    her needs. Instructor will tailor the class content after assessing the woman’s and her
    partner’s plans for birth. Classes held in the convenience of your home. Minimum of 4
    hours. $100
  Infant/Child CPR
    Venus, an American Red Cross trained instructor, prepares parents to respond to
    emergency situations. Training teaches skills to restore breathing and circulation in
    infants and children ages 0-8 years old. $40 per person.

WAKE COUNTY

Carolina Childbirth Classes                                                  481-1878
Website: http://carolinachildbirthclasses.com/
Elissa Brody
Childbirth is an exciting time for couples and families. There are many choices available to
make each birth unique and rewarding. Carolina Childbirth Classes’ goal is to help you
understand your choices. Classes are taught by a labor and delivery nurse who is a
certified childbirth educator. Classes are small (six to ten couples) to encourage group
interaction and friendship. Coaches learn to support and guide the laboring woman. Labor
rehearsal and infant care are practiced. Cost is $85 per series (four sessions). Two
session accelerated classes are $100. Private classes are $125. Elisa has a lending library
including >150 books and >200 videos.

Birth and Beyond                                                             345-1253
Website: www.birthnbeyond.com
Sue Dyer
  “Warm up” An early pregnancy class designed for those 12-20 weeks. Topics include
    nutrition, exercise and stretching guidelines, relaxation and breathing, routine medical
    tests, how your baby and your body are changing. Classes are 1 hr. $20
   "Halftime" Classes designed for the middle of the pregnancy, 20-28 weeks. Topics
    include how your body and your baby are preparing for labor each and every birth, true
    vs. false labor, how labor progresses, warning signs and symptoms of pregnancy
    complications (including preterm labor), review of relaxation and breathing. Two
    classes, each 1 ½ hour $40

   "Finish Line" Classes designed for the last trimester, 28-36 weeks. Topics include
    comfort measures, positions and support roles for all phases and stages of labor, when
    to call your OB provider, pain control options, medical interventions, cesarean delivery,
    physical and psychological changes in the postpartum period and newborn
    characteristics. Each class is 2 hours. Three classes, $80

   Package of all classes above (including new parent and infant massage) - $100.

   "Training Camp" Weekend This seminar includes all topics covered in the individual
    classes as well as additional topics such as breastfeeding basics, infant care & safety,
    and infant/child CPR in a convenient, condensed weekend format of childbirth and
    parenting preparation. Weekend $150

   Optional Couples Massage Sat evening $20.

   “Coach’s Corner" A class specifically designed for those who choose to attempt labor
    and delivery without the use of epidural anesthesia. Extra labor rehearsal and additional
    comfort measures will be explained and practiced. Class 1 ½ hr. $15

   The "Game Plan" A class designed for those who would like assistance creating a
    unique birth plan that can be presented and discussed with their healthcare providers.
    One class, one hour and a half: $15
Bonnie Borchert                                                    919-844-2043
Website: www.affirmativebirthchoices.com
Private classes based on risk versus benefit. Given complete information, women will do
what they feel is best for their babies.
Carol Harrocks                                                       919-518-2889
Website: www.trianglechildbirth.com
I teach 12 Unit Bradley Method Childbirth Classes
                                        Doula resource list
A doula is a professionally trained labor support person. She does not provide medical care, but
comforts and supports you and your partner during labor. Research shows that women using
doulas are more likely to have shorter labors and use fewer medications. They also have more
positive feelings towards both the baby and the birth experience, and less post partum depression.
A doula will meet with you during pregnancy, in the hospital, and visits during the post partum
period. The doula assists with comfort measures, objective information to assist you in decision-
making, and physical and emotional support. Whatever Mom and Dad need, the doula is there to
provide. Many doulas combine different backgrounds into their doula work. Pricing is not included
in the following list because it so variable depending on the time spent at births.
Wanda Sunderman,                                                      933-5562
Massage therapy, cranio-sacral therapy for mom and baby, and doula services.
Also assists with a home birth service.

JoAnne Dahill                                                                416-9831
Website: http://www.journeyofmotherhood.com/
Massage therapy and doula services.

Judith Brooks                                                                260-1430
Website: www.meridianhealingnc.com
Acupuncture, counseling, massage therapy and doula services.

Claudia Kaplan                                                               932-9635
Doula services.

Elspeth McClanahan                                                   877-0375
Website: http://elspeth_doula.tripod.com/
Doula services.

Christie Wells                                                               732-1797
Doula services

UNC BirthPartners is a volunteer doula program at UNC Hospital. The doulas are trained
according to national standards and screened for readiness before they come to the hospital. Since
it’s a volunteer program, there is not someone available all the time, but if you are interested, please
let your clinician or the nurses on Labor and Delivery know you would like to use the BirthPartner
program. Theresa Howard can be contacted at 843-1707.

    **This is a limited list of doulas. There are many more available in the area. You can look at
                   www.trianglebirthnetwork.com or www.dona.org for other options
                                      HYPNOBIRTHING

ThetaWorks                                                             919 491-5023
www.thetaworks.net
Expectant mothers want (and deserve) to welcome their children into our world in a safe and
loving environment. The revolutionary Mongan Method of HypnoBirthing® breaks the chain
reaction of fear, tension, and pain without invasive procedures or chemicals. Stephanie Embry,
a Certified HypnoBirthing® Practitioner, teaches classes to couples from across the Triangle.
In HypnoBirthing®, you learn to use hypnosis to empower your natural birthing instincts. You
and your birthing companion create a birthing environment that is calm, serene, and joyful. .

Positive Beginnings - HypnoBirthing®                                   919-522-0157
www.positive-beginnings.com
Offering HypnoBirthing® (Mongan method) classes in the Triangle area. Private classes
available. HypnoBirthing® is a minimal-discomfort, mother- and child-positive method of
bringing babies into the world. There is a strong emphasis on prenatal bonding. Alternative
family friendly!

JoAnne Dahill                                                             416-9831
Website: http://www.journeyofmotherhood.com/hypnobabies_classes
Hypnobabies is a six-week series. Each class is 3 hours in length and limited to 5 couples.
Students receive hypnosis scripts on CD and on paper, a workbook, quick reference materials
to have on hand at the time of birth, information created for the birth partner, and additional
support materials. The cost of the series is $300 for group classes and $400 for private
classes. All classes are held in Durham, North Carolina.

                       PREGNANCY AND POST PARTUM MASSAGE

CHAPEL HILL
Wanda Sunderman                                                        933-5562
Pregnancy and post partum massage. $70/75 min

Nina Ligh                                                                967-9755
Pregnancy and post partum massage. Cranio-sacral therapy also available. $70/hr

Jeannette Bennett         bennett_jeanette@hotmail.com                        401-9663
Pregnancy and post partum massage $35/half hr $65/hr $95/90 min

DURHAM
Tracy Moon                tjmoon@mindspring.com                        491-1777
Swedish deep tissue and pregnancy massage. $65/hr $90/90 min

Mary McFarland                                                          477-9887
Pregnancy and post partum massage. Also practices in Mebane (636-0458).
$65/hr $90/90 min

JoAnne Dahill                                                         416-9831
Website: http://www.journeyofmotherhood.com/prenatal_and_postpartum_massage
Pregnancy, labor, post partum and newborn massage.
Judith Brooks                                                      260-1430
Prenatal and labor massage.

RALEIGH
Barbara Kult              bbelscher@hotmail.com                    272-4962
Pregnancy and post partum massage. $70/hr $95/90 min

Laura Kershaw        emily@advancedhealthcaresolutions.org        846-2239
Pregnancy and post partum massage.
Finds 1 ½ hrs better for pregnancy massage. $115/90 min. 1 hour available on request.


                              POST PARTUM HOME CARE

Susan O’Hara-Brill         sohara-brill@earthlink.net               423-8943
Susan is a post partum doula and lactation consultant. She offers three to eight hour
sessions in the home to help guide you through the first days and weeks with your newborn,
providing assistance with establishing breastfeeding, newborn and sibling care, light
housework and meal preparation, overnight assistance as needed, active listening and
counseling with phone follow-up. Breast pumps and breastfeeding accessories available for
rent or sale.

Triangle Mothercare        Marcia@trianglemothercare.com           255-2493
Website www.trianglemothercare.com
Triangle Mothercare services focuses on in-home postpartum care for mother, infant and
other family members. We provide a nurturing atmosphere for the whole family through our
support and our services. Multiple packages and gift certificates available.
Pamela Diamond                                                   274-0445
Website: www.firstdaze.com
First Daze Mommy Care doulas provide guidance, emotional support and practical
assistance to make the transition from pregnancy to motherhood more manageable.

Homewatch Caregivers                                             960-6038
Website: www.homewatchcaregivers.com
Homewatch provides post partum homecare including light housekeeping, laundry, cooking,
companionship, personal care, errands, and transportation. Covered by insurance if there is
a medical necessity.
            COMMUNITY RESOURCES FOR PARENTING AND CHILD CARE

Each county has a child care agency and a child care unit at the local Department of Social
Services that provide information locating a child care provider and financial assistance.
The following is a list of some of the local child care agencies by county:
      Alamance County Partnership for Children – 336-513-0063
      Chatham County Child Care Networks - 542-6644
      Durham Child Care Services Association - 403-6950
      Orange County Day Care Services Association - 967-3272
      Wake County Child Care Services Asscociation – 779-2220

Welcome Baby
Website: www.WelcomeBaby.org
Welcome Baby is a free program to all Durham County residents that provides information
and support for parents before and after the arrival of a baby. Services include a lending
library of books, videos and magazines, a support group, a giving closet and volunteers and
staff available to discuss parenting concerns – 560-7150.

Healthchoice
Website: http://www.dhhs.state.nc.us/dma/healthchoice/index.htm
Health Choice is a free or reduced price comprehensive state health insurance program for
children ages 0-18 that includes well child care, sick visits and dental care. Your children
may be eligible for this program if they are currently uninsured and if your family income
meets income guidelines. Applications can be obtained at your local health department or
department of social services. Call 1-800-367-2229 for further information.

Chapel Hill/Carrboro Mothers Club
Website: www.chapelhillmothersclub.org
The Mothers Club consists of local moms and dads united by the common bond of
parenting. We welcome all members. Some of our many membership benefits include:
monthly meetings with guest speakers; closed playgroups (assigned by your child's age with
4 to 6 members per group meeting weekly); a book club; a monthly mom's night out; service
projects; fitness walks; and a monthly newsletter.
If you are interested in joining the club, fill out the Sign Up Form at our website. Or, if you
want to talk to a real live person about our club, contact Lia Williams at 919-932-7352.

The Durham Mothers Club
Website: www.durham-mothers-club.org
Founded in 1988, is a non-profit support network for mothers that offers playgroups,
educational meetings on parenting, mom's night out, book club, etc. With over 150 members
we serve both mothers who are at home and those who work full or part time. Come meet
new friends and connect with other moms in the area.
Activities include Mom's Night out, Book Club, Movie Night, Game Night, among others!
Membership is $15 for the first year and $10 per year thereafter. Guests are welcome to
visit with us for two membership meetings prior to joining. For more information, contact
Victoria Zula 806-8450 vmz@mindspring.com
NINO Nine In Nine Out: The baby wearing organization
Website: http://groups.yahoo.com/group/trianglebabywearers/
If you live in the Triangle area of Central North Carolina and love wearing your baby then
this group is for you. Talk about slings, babywearing methods and parenting in the Triangle
with like minded parents.
If you're new to babywearing and need help with using your sling, you'll probably find
someone here to help you. This group is also for arranging meetings between local
babywearers. Let’s get together, let the kids play. Make some new friends, and have some
fun!

Parents Without Partners Capital Area Chapter 1349
Website: http://www.capitalareapwp.org/
This group serves Raleigh, and surrounding cities. Our chapter has over 100 members and
continues to grow. All chapter activities are conducted by our members. We are an active
organization providing single parent education, recreation, and social activities geared to
needs of single parent families. For information email info@capitalareapwp.org
              SUPPORT in the Community for BREASTFEEDING MOTHERS

La Leche League
Website: www.lalecheleague.org
La Leche League is an international, nonprofit, nonsectarian organization dedicated to
providing education, information, support, and encouragement to women who want to
breastfeed. All breastfeeding mothers and pregnant women interested in breastfeeding are
welcome to come to our meetings or call our Leaders for breastfeeding help.
All pregnant and breastfeeding women are welcome to attend any of our monthly meetings.
A variety of planned discussion topics are covered, but leaders encourage women to bring
up any questions or problems to meetings or during informal, or during social time following
the meeting.
Chapel Hill
Pam Freedman 932-6885 or email pmfree@aol.com.
Barbara Cameron 286-3179
Becky Straub 338-2595

Durham County
Elizabeth 919-382-8750
Ruthie Lloyd 919-405-2279 or email ruthie.l@mindspring.com

Nursing Mothers of Raleigh
Website: www.nursingmothersofraleigh.org
Nursing Mothers of Raleigh is a group of experienced mothers encouraging breastfeeding
through the education and support of women who want to nurse their babies.
Nursing Mothers of Raleigh provides support and information for breastfeeding. We can
help you achieve your breastfeeding goals, including the challenges faced by women who
work outside the home.
Our monthly meetings offer information and support to women who want to
breastfeed. Meetings are free and open to any woman interested in breastfeeding. Babies
and children are welcome. There is a main topic for the meeting and then time for questions
on any aspect of breastfeeding.
Four topics are offered in succession. Attending consecutive day or night meetings will
cover all the topics: click on the topics for detailed outlines.
Contact information at website, or you can call Jean at 847-5147

Lactation Consultants in Chapel Hill & Durham
UNC Hospital Breastfeeding Warmline 966-4148
Ellen Chetwynd 966-2109
Sue Marachi 493-9066
Susan O’Hara-Brill 423-8943
Nancy Albrecht 933-3301


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