Phone: (706) 227-8999
Fax: (706) 227-6118
Address: 1181 Langford Drive, Building 300, Suite 101, Watkinsville, Georgia, 30677
Q. When should I start getting mammograms?
A. Although we conduct a physical examination of your breasts during your annual check-up, you won't need to have regular mammogram screenings until your 40's. We will provide the order needed to obtain your mammogram at the facility of your chosing during your visit. Please call the facility directly to schedule the mammogram at a convenient time for you.
Q. What kind of birth control is the best?
A. Each woman's body responds differently to different types of birth control. We usually start you out at a low dose of a commonly used birth control pill and go from there. You may end up trying out a couple different ones before finding one that works best with your body. If you have a pre-existing condition, it may effect what we prescribe. We also provide IUDs (Mirena and Paraguard), tubal ligations, Essure, Implanon, Depo Provera, diaphragm fitting and referral for vasectomies. Talk to your provider to determine the best selection for you.
Gynecology covers many aspects of women's health, but most specifically it focuses on the female reproductive system and problems that may arise related to it. We encourage regular annual exams to catch any potential problems before they progress. Our providers care for all varieties of issues related to gynecology. Discuss your concerns at your appointment for the most specialized and compassionate care. Visit the link on our resource page; American Congress of Obstetrics and Gynecology (ACOG), for reliable information about gynecologic issues.
There are many reasons why a woman may not be able to get pregnant. Infertility requires thorough evaluation before any treatment is started. Infertility is fairly common, effecting 1 in 7 couples worldwide. If you have been trying to get pregnant for more than 9-12 months you qualify for this evaluation.
Difficulties conceiving can be caused by age, hormone imbalances, genetic factors, ovulation problems, tubal blockage, and many other reasons. Treatment varies depending on the cause. We have had great success at our practice helping couples start or expand their family. Meet with one of our physicians to see what options are available to you.
Visit the link on our resource page; Resolve, for more specialized reliable information regarding infertility.
Laparoscopic surgery or minimally invasive surgery is performed through several small incisions (usually .5-1cm). Our physicians prefer to use laparoscopic surgery because it results in less scarring, quicker recovery time, and causes less pain for our patients. A large number of patients can benefit from this approach for evaluation of pelvic pain, ovarian masses, tubal ligation, treatment of endometriosis, infertility evaluation, removal of ovaries, and even hysterectomy. Talk to your provider to see if you are a candidate for this type of surgery.
Ultrasound is used often in both Obstetrics and Gynecology. It uses ultrasound waves instead of x-rays to form images. Several ultrasounds are generally performed during Obstetric care to monitor your pregnancy. We also recommend ultrasounds for gynecological conditions including ovarian cysts, uterine fibroids, dysfunctional uterine bleeding, and pelvic pain. We try to include this in your visit on the same day; however, some conditions may require the exam to be performed at an imaging center.
When estrogen levels begin to drop in the body (usually around the time of menopause), it becomes more difficult for your body to absorb calcium. This can lead to weaker bones and even to osteoporosis. Approximately 1 in 4 women over the age of 60 experience a bone fracture related to osteoporosis. Early screening for osteoporosis can lead to treatment that will help stop or significantly slow the loss of calcium from your bones if you are at risk. Bone mineral density can be determined with low dose x-ray or DEXA scan. Ask your provider if you are a candidate for testing at your appointment. This can be done on the same day and takes 10-15 minutes.
Management and prevention of osteoporosis may include increasing your calcium and vitamin D intake, increasing the amount of exercise you get, reducing alcohol consumption, hormone therapy, or other prescriptions. Your physician will determine the most beneficial course of action at your exam.
Menopause naturally onsets for most women sometime between the ages 45-55 years old and can last several years. During menopause, estrogen levels begin to drop in the body. This can effect mood, menstruation, and many other aspects of your physiology. Blood tests can be used to help diagnose this more accurately. The fluctuating hormone levels can cause many symptoms. For severe problems, hormone replacement may be necessary. We can help you navigate through this important time of adjustment. Visit our link on our resource page; North American Menopause Society (NAMS), for more specialized reliable information about menopause.
Part of your visit may require blood testing. We have a trained phlebotomist on site who handles drawing and prepping the blood samples, so that you do not have to schedule a separate appointment elsewhere. Labcorp currently provides this service for our patients. If your insurance directs you to use a different lab, labcorp will process and send your specimen to the appropriate location. Some lab tests may need to be fasting so you may need to return at another time for this reason. Our lab hours are 830am-500pm. (on lunch break 12-1pm)
If you elect for obstetric care to be provided by WCA, you will be an obstetric patient of all three physicians: Drs Anderson, Halbach, and McPherson. You will not be assigned a single primary obstetrician. During the course of a routine pregnancy you will have 14-15 appointments at WCA and see each obstetrician 4-5 times. Hopefully, by the time of your due date, you will be most comfortable with all three physicians.
Each of our physicians considers obstetrics a most rewarding profession and feels it is an honor to provide maternity care. However, obstetrics often demands extremely long hours of work during both day and night. In order for us to provide you with an obstetrician who is well rested, alert, and attentive to your care, we must rotate on-call services and can not guarantee that any one physician will deliver your baby.
If you are going to be delivered by scheduled cesarean section or induction of labor, we will make every effort to accommodate by providing the physician of your choice. All other after hours obstetric care will be provided by one of the three on-call obstetricians.
At approximately 18-20 weeks gestation, you will be scheduled to see Dr. Richard Rosemond, a perinatalogist, (700 Sunset Drive, Ste 301, Athens GA 706-549-0087) for a complete anatomical ultrasound of your baby. This ultrasound is done with the most state of the art ultrasound equipment and is successful in detecting potential physical birth defects. It can also determine the gender of your baby if you desire this information.
Dr. Rosemond is a Board Certified Perinatalogist and therefore his area of expertise is in obstetric ultrasound and high risk obstetrics. Although your pregnancy man not be considered a high risk pregnancy, this 18-20 week ultrasound will provide you with the most expert and professional assessment of your baby that is available.
-MEDICATION YOU CAN TAKE WHEN PREGNANT-
(If possible, it is best to avoid all medications during the first 13 weeks of pregnancy.)
1)Dramamine II less drowsy (as directed)
2)Salt Water Nasal Spray (Ocean Mist)
3)Cool Mist Humidifier
1)Benadryl, Sudafed, Tylenol
1) First Trimester: Mylanta Liquid / Tums / Maalox
2) Second Trimester: Pepcid, Prevacid
3)Milk of Magnesia
1) Tums or Calcium Supplements
2)Salt Water Gargles
-CALORIES AND WEIGHT GAIN-
Some women worry about adding pounds when they are pregnant. Pregnancy is not the time to fret about putting on weight. It’s also not an excuse to eat too much, though. Most women need between 1,800 and 2,200 calories a day when they are not pregnant. Pregnant women need about 300 more calories.
Condition Before Getting Pregnant | Weight Gain (lbs)
Underweight | 28-40
Normal Weight | 25-35
Overweight | 15-25
Obese | 15
Carrying Twins | 3-45
-RECOMMENDED OBSTETRIC LITERATURE-
Either book is sufficient
1. Pregnancy Week by Week
2. What to Expect When You Are Expecting
-FIRST TRIMESTER BLEEDING-
Approximately 33% of all clinically established pregnancies are complicated by first trimester bleeding. However, the generally quoted value for first trimester spontaneous abortion (miscarriage)is only 15%.
Patients with first trimester bleeding should undergo a pelvic ultrasound. If you are having spotting or light bleeding and have already had an ultrasound in which the fetal heart beat was visualized, your chance of losing the pregnancy is diminished.
Just because you are experiencing light bleeding, spotting, brown discharge, or even some mild cramping, does not mean you are going to lose the pregnancy. These are signs and symptoms of the threatened miscarriage. Unfortunately, there is no medical treatment that has been proven effective in preventing a threatened miscarriage from developing into a full miscarriage. But, remember, most threatened miscarriages do not develop into a full miscarriage. Many of these proceed to normal pregnancies. We advise you to refrain from intercourse, limit your activity, drink plenty of high water content fluids to avoid dehydration, and call our office the next working day, and we will bring you in for another ultrasound to confirm that your pregnancy is normal.
You may read in some books that bed rest is helpful, however there are few if any data to support that strict bed rest will prevent a pregnancy loss.
If you experience bleeding, abdominal pain, weakness, dizziness or cramping and have yet to have an ultrasound that demonstrated a fetal heart beat, you should contact our on call physician without delay. These signs and symptoms could be caused by an ectopic pregnancy (a pregnancy outside the uterus), and could represent a medical emergency.
-BACK PAIN IN PREGNANCY-
Back pain is one of the most common discomforts during pregnancy. During pregnancy, the uterus expands to as much as 1,000 times its original size. Imagine the uterus during pregnancy as being a balloon and every day the balloon is bigger than the day before. This amount of growth in the center of your body can affect the balance of your body and cause some significant discomfort.
As the uterus expands during pregnancy, it causes strain on the back muscles. By mid-pregnancy,
the uterus is large enough to change your center of gravity. You then slowly begin to change your posture and the ways that you move. Most women begin to lean backward in the later months of pregnancy and this causes the back muscles to work even harder.
Weakness of the abdominal muscles can also cause back pain. The abdominal muscles normally support the spine and play an important role in the health of the back. The hormones of pregnancy cause the muscles to relax and become loose. This may cause some back pain. It can also make you more prone to injury during exercise.
To help prevent or ease back pain, try to be aware of how you stand, sit, and move. Here are some tips that may help:
1. Wear low heeled (but not flat) shoes with good arch support.
2. Ask for help when lifting heavy objects.
3. When standing for long periods, place one foot on a stool or box.
4. If your bed is too soft, have someone help you place a board between the mattress and box springs.
5. Don't bend over from the waist to pick things up- squat down, bend your knees, and keep your back straight.
6. Sit in chairs with good back support, or use a small pillow behind the low part of your back.
7. Try to sleep on your side with one or two pillows between your legs for support.
8. Apply heat to the painful or stressed area. Massage therapy and muscle vibrators may also help.
9. Over the Counter "Sports Creams" such as BenGay cream or patch, or ThermaCare heat wraps may be used. Never use one of the creams or ointments at the same time as using a heating pad.
10. Special exercises for the back may also lessen the discomfort. You can ask any of our office staff for a copy of "Easing Back Pain During Pregnancy" which has illustrations of several exercises that may be helpful.
11. There are numerous commercially available maternity girdles and back braces that some patients find useful. One such company, About Babies, Inc., has several different products to choose from. Order forms are available in our office or you can contact them directly at 1-800-383-3068, fax 989-386-6020 or visit their website at www.aboutbabiesinc.com.
Back pain can also be caused by other problems. If back pain is associated with a fever, it may be secondary to a kidney infection and you should contact our office. If back pain is associated with vaginal bleeding it could be a sign of a problem with the placenta and you should also contact our office.
During pregnancy your body will go through many changes. Some of these changes may cause discomfort. This is normal. Backache is one of the most common complaints during pregnancy. However, if you follow the tips given here and do exercises to strengthen your muscles, you can ease some of the pain.
Much of the information in this article is duplicated from an educational pamphlet produced by the American College if Obstetric and Gynecology and a copy is available in our office. The pamphlet is an ACOG patient education resource entitled "Easing Back Pain in Pregnancy."
-SCREENING FOR FETAL CHROMOSOMAL ABNORMALITIES-
Screening for chromosomal abnormalities including Downs Syndrome, Trisomy 18 & 13 are completely optional. If you choose to pursue screening you have many different options.
The first option is Chorionic Villus Sampling (CVS). This is done between 10-13 weeks and involves removing cells from the placenta. The second option is an amniocentesis done between 16-18 weeks which involves sampling the amniotic fluid around the baby. These are both considered invasive tests and carry a small risk of miscarriage (1/200).
Noninvasive testing includes the Quad Screen which measures hormones in the maternal bloodstream drawn between 15-21 weeks. The accuracy of this blood test is 81%. Another noninvasive option is a First Trimester Screen. This involves an ultrasound done by the perinatologist in town between 11-13 weeks and blood testing. The ultrasound measures nuchal translucency and a blood test measures bHCG and PAPPA in the mother's blood. The detection rate for Down's Syndrome with the First Trimester Screen is 90%. Both the First Trimester Screen and the Quad Screen have a 5% false positive rate.
What is Cystic Fibrosis?
Cystic Fibrosis (CF) is a life-long illness that is usually diagnosed in the first few years of life. The disorder causes problems with digestion and breathing. Cystic Fibrosis does not affect intelligence or appearance.
What are the health needs of children with Cystic Fibrosis?
The digestive problems can usually be treated by taking daily medications. To treat lung problems, most children with CF need to have respiratory therapy for about half an hour every day; this helps clear mucus from the lungs. This is something the parents or other family members can do at home. Sometimes lung infections still develop. The children may need to be treated with antibiotics at home or in the hospital. However, the infections tend to become worse over time and more difficult to treat. Treatments are costly and may be burdensome without adequate health insurance.
Do all people with Cystic Fibrosis have the same symptoms?
No. Some individuals have milder or more severe symptoms than others for reasons that are not completely understood. It is not always possible to tell from a prenatal test how mild or severe a child's symptoms will be. While most people with CF have a shortened life span, some die in childhood and others live into their 40's or even longer. Although there is no cure for CF, research on more effective treatments is under way. Still, by adulthood, most people with CF will have some breathing and digestive problems. Despite these physical problems, there are many people with CF who attend school, have careers, and have fulfilling lives.
What is the purpose of Cystic Fibrosis carrier testing?
The purpose of CF carrier testing is to see if a couple is at increased risk for giving birth to a child who will have CF. Cystic Fibrosis carrier testing is a laboratory test done on a sample of blood or saliva. If testing shows that a couple is at high risk, additional testing can be done on the developing baby to see whether or not it will have CF. However, most women's test results are normal. Cystic Fibrosis can not be treated before birth. The purpose of having this information about your developing baby is so you can prepare yourself to care for a child with special health care needs or so you can terminate the pregnancy.
What causes Cystic Fibrosis?
Cystic Fibrosis is a genetic disorder. All genes come in pairs, so everyone has two copies of each gene. One copy comes from your mother and the other from your father. Some genes do not function properly because there is a mistake in them. If a gene has a mistake, it is said to be altered or changed. For some diseases-like CF- both genes of the pair have to be altered for a person to have the disease.
If a person has one changed copy of a CF gene, that person is a carrier for CF. A carrier
does not have CF. There is no known health problems associated with being a carrier of
CF. If a person has two changed copies of the CF gene, they will develop CF.
When both partners in a couple are carriers, any child they have has a l in 4 (25%) chance to inherit a changed copy of the gene from each parent. A child with two changed copies of the CF gene will develop CF.
Could I be a carrier of Cystic Fibrosis?
Yes. You could be a carrier of CF even if no one in your family has CF and even if you already have children without CF. About one of every 30 white people (about 3 in 100 or about 30%) carries the changed gene. If your family background is not white your chance of being a carrier is less than 1 in 30. For example, some Asian-American groups have carrier rates of 1 in 90.
If a relative of yours has CF, or is known to be a carrier of CF, your chance of being a carrier is greater based on your family history than on your ethnic background.
If my test result is normal, could I still be a carrier?
Yes. There are some mutations in the CF gene that the current test cannot find. For this reason, you could be told your test result is normal and you could still be a carrier. Like most medical tests, this one has limitations because not all CF mutations are known. However, these unknown CF mutations are rare. The likelihood that you are a carrier even though you had a normal result is very small.
If the test shows that I am a carrier, what should I do?
If the test shows that you are a carrier, the next step is to test the baby's father. Both parents must be carriers for the baby to be at risk for CF. If the father has a normal test result, the chance that your baby will have CF is very, very small. The remaining risk is because the test is not 100% accurate, as mentioned in the previous section.
What if both my partner and I are Cystic Fibrosis Carriers?
If two people who are carriers have a child, that child may have CF. When two carriers have a child together, there is a l-in-4 (25%) chance with each pregnancy that the child will have CF. This is true even if they already have other children with-or-without CF.
If CF testing shows both parents are carriers, you might then see a specialist for genetic counseling. This person could give you more information and help you decide if you want to test the baby for CF. This could be done around the 11th week of pregnancy using CVS (chorionic villus sampling). This involves removing a tiny piece of the placenta. Or it could be done around the 16th week of pregnancy using amniocentesis, a procedure where a needle is used to take fluid from around the baby for testing. If either test shows that the baby will develop CF, you could choose to either terminate or continue the pregnancy.
If I had Cystic Fibrosis testing, do I need it again?
If the test shows you are a carrier, the result is definite and will not change. However, if you are a carrier and have a new partner for a future pregnancy, testing should be considered for that new partner. If you test negative now and become pregnant in the future, you should discuss CF carrier testing at that time with your provider, as test technology changes.
How do I decide whether or not to have carrier testing?
After learning about CF carrier testing, some people decide to have testing, and others decide against it. The cost of testing is covered by some insurances and not by others. You may want to check with your insurance company before deciding if you want testing.
Listed as follows are some reasons other people have given for having or not having CF
Possible reasons to be tested:
• If CF seems like a very serious disorder to you
• If the chance of being a CF carrier seems high to you; this may be especially likely if a member of your family or your partner's family has CF or is a known carrier.
• If you and the baby's father would consider amniocentesis or CYS to help you decide about continuing the pregnancy or to help you prepare for the birth of a baby with CF-if you were both found to be carriers.
• Because test results are usually reassuring
• Because the cost of testing is covered by your insurance
Possible reasons not to be tested:
• If CF does not seem like a serious disorder to you
• If the chances of being a CF carrier seems low to you; this may be especially likely if you are Asian American or African American
• If you and the baby's father would never consider having amniocentesis or CVS-to help decide about terminating the pregnancy or preparing for the birth of a baby with CF-even if you were both found to be carriers
• Because the test is not perfect and will not identify all carriers
• Because the cost of testing is not covered by your insurance company
Resources to Learn More:
1. Cystic Fibrosis Foundation
6931 Arlington Road
Bethesda, MD 20814
I-800-FIGHT CF (1-800-344-4823)
2. National Society of Genetic Counselors
233 Canterbury Drive
Wallingford, PA 19086-6617
1-610-872-7608 Press 7
www.nsgc.org Click on ResourceLink
3. Genetic Alliance
4301 Connecticut Avenue NW, Ste 404
Washington, DC 20008-2304
This information duplicated from the American College of OB/OYN patient information
booklet on "Cystic Fibrosis Carrier Testing: The Decision is Yours."
Ultrasound studies or sonograms will be performed at specific times in the course of your
1. Initial OB visit- The study is done to verify pregnancy, determine the gestational age, obtain fetal heart tones, and search the adnexal region for pelvic masses.
2. 9-12 weeks: At this stage in your pregnancy a study is done to determine the fetal heart rate, the dating parameter, and fetal activity (movement of limbs).
3. 18-20 weeks: At this time a study is done to scan the fetal organs and dating parameters for growth and weight, and determine the general well being of the fetus. During this scan the gender of the baby can be identified. Please note, if the mother wants to know the sex of the baby this is the only time the information can be given.
Sonograms generally take about 30 minutes and no preparation is needed prior to the study.
It may be necessary to do additional studies under the following conditions:
1. Elevated Quad Screen
2. Increased or decreased in fundal height
3. Fetal heart tones not detected with doppler
4. Determine position of fetus
5. Determine the amniotic fluid
6. Problems with pain or bleeding
-ADVISORY ON FISH/SHELLFISH CONSUMPTION-
The Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) have issued a joint statement concerning mercury in fish and shellfish. Research indicates that high levels of mercury in the bloodstream of unborn babies and young children may harm the developing nervous system. The key parts of the advisory are:
Fish and shellfish are an important part of a healthy diet. Fish and shellfish contain high quality protein and other essential nutrients, are low in saturated fat, and contain omega-3 fatty acids. A well balanced diet that includes a variety of fish and shellfish can contribute to everyone's heart health and children's proper growth development. Thus, women and young children in particular should include fish in their diets due to the many nutritional benefits.
By following these three recommendations for selecting and eating fish or shellfish, women and young children will receive the benefits of eating fish and shellfish and be confident that they have reduced their exposure to the harmful side effects of mercury:
1. Do not eat shark, swordfish, King Mackerel, or tilefish because they contain high levels of mercury.
2. Eat up to 12 ounces (two average meals) a week of a variety of fish and shellfish that are lower in mercury. Five of the most commonly eaten fish or shellfish that are low in mercury are shrimp, canned light tuna, salmon, Pollock, and catfish. Another commonly eaten fish, albacore ("white") tuna, has more mercury than canned light tuna. So when choosing two meals of fish and shellfish, you may eat up to six ounces (one average meal) of albacore per week.
3. Check local advisories about the safety of fish caught by family and friends in local lakes, rivers, and coastal areas. If no advisory is available, eat up to six ounces (one average meat) per week of fish caught from local waters, but don't consume any other fish that week.
Follow these same recommendations when feeding fish and shellfish to young children, but serve smaller portions.
If you would like a brochure, one can be obtained by calling the EPA at 1-800-490-9198, publication number EPA-823-F-04-009 (English) or EPA-823-F-04-010 (Spanish).
Additional information is available at:
-PROTECT YOUR BABY FROM FOODBORNE ILLNESSES-
Pregnant women are at high risk for getting sick from Listeria, harmful bacteria found in many foods. Listeria can lead to disease called Listeriosis. Listeriosis can cause miscarriage, premature delivery, serious sickness, or death of a newborn baby. If you are pregnant, you need to know what foods are safe to eat.
What can I do to keep my food safe?
• Listeria can grow in the refrigerator. The refrigerator should be 40 F or lower and the freezer 0 F or lower. Use a refrigerator thermometer to check your refrigerator's inside temperature.
• Clean up all spills in your refrigerator right way-especially juices from hot dog packages or raw meat or chicken/turkey.
• Clean the inside walls and shelves of your refrigerator with hot water and liquid soap then rinse.
• Use precooked or ready to eat food as soon as you can. Don't store it in the refrigerator too long.
• Wash your hands after you touch hot dogs, raw meat, chicken, turkey, or seafood or their juices.
1. CLEAN: Wash hands often with soap and warm water. Use clean dishes, spoons, knives and forks. Wash countertops with hot soapy water and clean up spills right away.
2. SEPARATE: Keep raw meat, fish, and poultry away from other food that will not be cooked.
3. COOK: Cook food to a safe internal temperature. Check with a food thermometer. Ground beef 160 F; Whole turkey 180 F; Pork 160 F.
4. CHILL: Refrigerate or freeze within 2 hours-refrigerate or freeze within 1 hour in hot weather (above 90 F). Don't leave meat, fish, poultry, or cooked food sitting out.
What can I do to keep my baby and myself from listeriosis?
• Do not eat hot dogs, luncheon meats, bologna, or other deli meats unless they are
reheated until steaming hot.
• Do not eat refrigerated pate, meat spread from a meat counter or smoked seafood found in the refrigerated section of the store. Foods that don't need refrigeration, like canned tuna and calmed salmon, are okay to eat. Refrigerate after opening.
• Do not drink raw (unpasteurized) milk and do not eat foods that have unpasteurized milk in them.
• Do not eat salads made in the store such as ham salad, chicken salad, egg salad, tuna salad, or seafood salad.
• Do not eat soft cheese such as Feta, queso blanco, queso fresco, Brie, Camembert cheeses, blue-veined cheeses, and Panela unless it is labeled as made with pasteurized milk. Make sure the label says, "MADE WITH PASTEURIZED MILK”
For more information about food safety:
U.S. Department ofAgriculture Food Safety and Inspection Service
USDA Meat and Poultry Hotline
1-888-MPHotline (toll-free nationwide) or 1-888-674-6854
-WORK DURING PREGNANCY-
Now that you are pregnant you should inquire to your employer about company maternity leave benefits and policies. These policies may vary from employer to employer, but standard maternity leave ranges between 6 and 12 weeks. Some people choose to use some of their maternity leave prior to the estimated due date, such as starting leave two-three weeks prior to the due date. This leave time should be outlined by and through your employer.
Should you develop any medical complications during pregnancy (high blood pressure, diabetes, etc.) then your doctor may limit or halt your work activity prior to your estimated due date.
Most pregnant workers should be able to continue working until the onset of labor, according to the report on pregnancy to the American Medical Association from its Council on Scientific Affairs, Division of Scientific Activities.
In its report, the council recommended that the AMA continue to endorse the "Guidelines on Pregnancy and Work" from the American College of Obstetrics and Gynecology (ACOG) and National Institute for Occupational Safety and Health (NIOSH) for employees with normal pregnancies.
The guidelines include recommendations for maximum levels of work during a woman's
• Secretarial and light clerical: May continue up to 40 weeks gestation;
• Professional and managerial: May continue up to 40 weeks gestation;
• Standing for prolonged periods of time (more than 4 hours per work day): May continue
up to 24 weeks of gestation;
• Stooping and bending below knee level-repetitive (more than 10 times per hour) may
continue up to 20 weeks gestation. Intermittent (less than 10 times per hour not more
than 2) may continue up to 28 weeks of gestation. Infrequently (less than 2 times per
hour) may continue up to 40 weeks gestation.
• Repetitive lifting, no greater than 25 lbs may continue up to 20 weeks gestation.
• Intermittent lifting, no greater than 25 lbs may continue up to 30 weeks gestation.
DISABILITY CERTIFICATION FOR OBSTETRICAL PATIENTS
Pregnancy is a completely normal and healthy state. It is not a sickness. Although patients may encounter occasional tiredness, nausea, vomiting, pelvic discomfort, back pain, or minor swelling of hands and feet during pregnancy, they should be able to carry on with normal activities that they were accustomed to performing before they became pregnant. Physicians cannot certify to employers or insurance companies that patients are disabled due to any of the above reasons.
To certify either partial or complete disability, physicians must find a definite medical indication that either a patient's health of her baby's health would be endangered by continuing normal activities. Such indications may include: hypertension, excessive edema, severe anemia, kidney or heart disease, severe diabetes, or a previous history of complications during pregnancy such as premature rupture of membranes or premature onset of labor. If these or other signs are not clearly indicated, the physicians cannot state that a patient is disabled.
The American College of Obstetricians and Gynecologists have recommended that disability for pregnancy be certified two weeks before term in uncomplicated cases, but that patients who prefer to work until labor begins should be allowed to do so. Patients should not return to work until six weeks after delivery.
Contemporarv OB-GYN Vol 16, Sept, 1980
-EXERCISE DURING PREGNANCY-
Regular exercise sessions are recommended for all healthy, pregnant women because of exercise's favorable cardiovascular, metabolic, and biomechanical effects.
Exercise should be done three or more times per week at a comfortable intensity that does not result in fatigue. In women who have exercised regularly prior to pregnancy, the overall exercise load may be higher than that recommended for women who are beginning to exercise regular.
For safety's sake, the continuous portion of each session should be limited in intensity and duration while paying specific attention to environmental conditions and adequate fluid and caloric intake. This avoids undue physiologic stress. For the same reason, each session should begin with a warm up period and end with a cool down period.
The type of exercise should also minimize the risk of fetal and maternal trauma. Stationary cycling and swimming are two recommended forms of exercise because the risk of physical injury is minimal.
Most, if not all, complications of pregnancy, as well as any chronic maternal disease, are either relative or complete contraindications to exercise during pregnancy.
Weight bearing exercise, at the levels recommended by ACOG, are safe for sedentary women who wish to begin a regular exercise regimen as early as the 8th week. Women who exercise regularly prior to pregnancy can safely maintain a weight bearing exercise regimen up to a level of 60 minutes of moderate intensity exercise 5 days a week throughout pregnancy.
Moderate exercise in early pregnancy stimulates placental growth.
The amount of exercise in late pregnancy has significant effect on the infant size at birth.
The type of carbohydrate in a mother's diet has a significant affect on both maternal weight gain and infant size at birth. (Unprocessed sources of carbohydrates are best: nonroot vegetables, nuts, fruits, and whole grain bread. As opposed to "bad" carbohydrates: root vegetables, packaged cereals, breads, snack foods, beverages, and dessert foods.).
Most physicians believe that breast feeding is far better than bottle feeding for a baby's health, and that it enhances the quality of mother child bonding. Each mother's breast milk is genetically unique, and is therefore tailored to meet her infant's specific nutritional needs. Besides being more easily digestible than formula, a mother's milk contains a number of immune boosting elements that can prevent certain childhood diseases. There is no current hard evidence that infants who are formula fed are developmentally at risk, however. The decision on which method to use is a personal one
and ideally should be made by both expectant parents.
Nursing babies are known to have fewer gastrointestinal infections, ear infections, allergic disorders, and respiratory illnesses than those who are formula feed. Recent evidence also suggests that infants who are breast fed have a lower incidence of Sudden Infant Death Syndrome (SrDS) and juvenile diabetes. There even exists some evidence that breast fed infants have higher levels of intelligence and are less apt to develop learning disorders than those who are bottle fed.
On another tangent, breast feeding enables a woman to establish a psychological "bond" with her child that occurs naturally during the intimacy of the feeding. It is also more convenient than bottle feeding and is less expensive than the cost of bottles and store bought formulas.
Perhaps the only disadvantage to nursing is that the father is unable to directly partake in the process. He can, however, become part of the bonding process in the first few weeks by carrying the infant to the mother for the feeding or by changing the baby's diapers. After the third week, the mother may also hand express or pump her milk into a bottle so that the father can feed the child.
Underscoring the medical community's support of breasting feeding, one of the surgeon general's goals for the year 2000 was for 75% of all mothers to nurse their infants upon discharge from the hospital. As of 1988, when that goal was established, the figure stood at 54%.
The American Academy of Pediatrics recommends that all infants be breast fed during the first year of life. However, breast feeding even a shorter period of time can benefit infants for up to a year after nursing has stopped.
Successful breast feeding is a process that must be learned by a mother and child, and it therefore requires practice and patience. Understanding the way in which lactation, or milk secretion, occurs will help you carry out the process. The first step in successful suckling is the ability of the mother to eject her milk, a process known as "let down". Because the hormone to eject milk originates in the brain, sometimes stress, anxiety, or other stimuli in the environment can interfere with her ability to carry out the process. The length of time between putting the baby to the breast and letting down, therefore, is highly variable. Let down may be accompanied by a tingling sensation or a sharp pain;
however, in the beginning, there usually is no sensation at all. Typically, an infant will suckle 90% of the milk in one breast 10 minutes after let down.
The substance emitted from the woman's breast during the first few days following birth is not actually milk. Rather it is a substance called colostrums, which is a thick, yellow fluid rich in protein and other substances that help to fight infection. Several days after delivery, the body will begin to produce milk and the production of colostrums will subside. The fat content of the milk will increase during the suckling session, often starting out thin and watery and becoming increasingly fatty as the feeding goes on. Given this fact, it is crucial that infants not only be fed when they want to be (usually ranging between 1 ½ - 4 hours), but that they also be allowed to nurse until they are satisfied, rather for an arbitrary period of time.
The baby should suckle on as much of the areola (dark circumference around the nipple) as possible in order to receive enough milk. Also if the infant is being held in a cradle position, he or she should be turned so that the tummy is against the mother's. During each feeding, the baby should be allowed to feed on both breast, and the mother should alternate which breast she begins with each time. This may reduce some of the pain and soreness that many women often experience as they begin nursing. The infant should be burped once or twice with each feeding.
COMMON QUESTIONS ABOUT DONATING UMBILICAL CORD BLOOD
What are umbilical cord blood cells?
Umbilical cord blood contains a special type of cells, called stem cells. Stem cells live a long time and can develop into many different types of blood cells. Stem cells are found in many parts of the body. The
stem cells that are leftover in a baby's umbilical cord and placenta are typically thrown away after a baby is born.
What are stem cells used for?
Stem cells can be used to make new blood cells. Often they are used for treating some medical problems including leukemia (a type of blood cell cancer), some types of anemia, and several other medical conditions. These cells are not used for cloning.
How are they collected?
Until recently, the extra blood in the placenta and umbilical cord was routinely thrown away after a
delivery. Now, stem cells from leftover blood in a baby's umbilical cord and placenta can be collected
after a baby is born and before the placenta is thrown away. There is no pain or risk for the mother or the baby since cells are collected after the umbilical cord has been cut and the baby has been delivered.
How is cord blood stored?
After cord blood is collected it can be frozen for future use. There are two options for storing these frozen cells; (1) a private cord blood bank, or (2) a public cord blood bank.
How does a public cord blood bank work?
• After delivery, a specially trained person collects blood from the placenta and umbilical cord. In some situations, a specially trained obstetrical provider may collect the cells at the time of delivery.
• Once blood is collected, the amount of cells in the blood are tested to be sure that the unit is usable,
In addition, other tests for various infections are performed.
• Since each person has a unique HLA blood type, cord blood cells need to be tested to see what "type" they are. 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 that 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.
• Public banks typically collect from only a few designated hospitals in their area.
How does a private cord blood bank work?
• When cells are collected for a private cord blood bank, the provider who delivers your baby collects them using a kit that the private bank has sent to you before the birth.
• These cells are sent to a private bank where they are frozen and stored.
• These cells are then reserved for your baby or your family.
• Private cord blood banks charge a fee for storing these cells, The cost depends upon 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.
As a parent, how can I possibly figure out if it's worth paying the fees to have umbilical cord blood stored in a private cord blood bank?
Keep these things in mind in making your decision:
• The slim overall chance of a child using its own cord blood for transplant has been estimated to be about one case in 2,700.
• Many private banks do not have a program in place to check the quality of the cells. Even when specially trained people collect cord blood, almost 1 in 3 units are deemed unusable and discarded by public cord banks.
• Many doctors who treat children with leukemia or other medical problems do not think that these children should receive their own stem cells for two reasons: (1) A child's own stem cells may already have a genetic change that caused their disease. (2) In children with leukemia, these cells may not fight off the child's leukemia cells as well as the stem cells from another person (this is called graft-vs.-leukemic effect).
• Directed donation of cord blood (either through private banking or through special arrangements
with a public bank) should be considered when there is a specific diagnosis of a disease within a family known to be treatable with stem cell transplantation.
• Although stem cells from umbilical cord blood could be used for adult relatives, very few of these
attempts have been successful to date. A major problem is that there are not enough stem cells in
one baby's umbilical cord blood to be sufficient for an adult transplant
Source: Adapted with permission from M.K. Moos. Chair, North Carolina Women's Hospital Patient Education Steering Committee, Chapel Hill. N.C.
Updates available at:
http://www.mombaby.org/index.php?c=1&s=25; Donation of Umbilical Cord Blood Cells.