We would like to welcome you to our office and thank you for selecting Womens Healthcare Affiliates, P.A. for your obstetrical care. Our goal is to render the best health care for you and your baby. We hope you will find this pregnancy a pleasant and rewarding experience.
During your pregnancy, beginning with the confirmation visit, you will receive literature on pregnancy and pregnancy related topics. There are brochures explaining certain tests and/or procedures that we may recommend at some point during your pregnancy. It is crucial that you read this information and apply it when necessary. Additionally, we offer educational tapes for your viewing. Information on Childbirth classes in addition to Breastfeeding classes is also available. It is recommended that you attend if this is your first pregnancy or if it has been an extended period of time since your previous pregnancy.
If you have insurance coverage, we will gladly file your claim once you have delivered. Budget arrangements can be made for your convenience on the amount that your insurance company does not cover but must be paid in full by the end of the 5th month of pregnancy. Please remember that you, the patient, not the insurance company, is ultimately responsible for payment of all professional services rendered. It is imperative that you notify our office of any demographic changes, i.e. changes in insurance company, termination of coverage, changes in telephone number, address, employer or spouses employer, etc. This also includes transferring of care to another physician either inside or outside the practice. Failure to notify our office of these types of changes may result in you being responsible for the entire amount of billed charges. Many insurance carriers stipulate stringent billing time frames and guidelines. Please communicate with our Patient Financial Counselor on a regular basis during your pregnancy. The patient Financial Counselor is there to assist you with your coverage and out-of-pocket options.
Should a medical problem arise, we ask that you call our office day or night. Phones are answered 24 hours a day. Questions of a non-emergency nature should be made during regular office hours. If a prescription refill is needed, please contact your pharmacy as your pharmacy will notify us for approval. Please anticipate and plan for refills as authorization cannot be granted on weekends.
It is crucial that every appointment be attended. You must arrive no later than 10 minutes prior to each scheduled appointment. In the event you need to reschedule your appointment, as a courtesy, please notify our office a minimum of 24 hours in advance. Failure to attend your appointment and/or consistent tardiness of your appointment may result in disengagement from the practice due to non-compliance. Both, you and your baby's health are important to us; therefore, every effort must be displayed in attending your appointment.
Office Visit Frequency
1 to 28 weeks gestation - Every 4 weeks
28 to 36 weeks gestation - Every 2 to 3 weeks>
36 to 40 weeks gestation - Every week
Nurse Calls
Womens Healthcare Affiliates has a dedicated nursing staff to receive medical calls during regular office hours. If your physicians nurse is assisting another patient, you may reach their voice mail. Please leave your name, telephone number, date of birth and reason you are calling. Please be assured that our nursing staff is consistently retrieving the messages and your call will be responded to promptly. Please choose the option 2 "to speak with your physicians nurse.". Please do not opt out of the automated telephone system as this will only delay in your call being returned.
Lab
Your prenatal lab will be drawn between the 12th and 18th week of pregnancy. It will consist of:
CBC to rule our anemia
RPR to screen for syphilis
Indirect Coombs to detect possible antibodies
Rubella titer to determine immunity against rubella (German measles)
Blood type and RH
Hepatitis and HIV screening
Trisomy/Quad screening is elective, but recommended around the 17th week of pregnancy to screen for neural tube defects
Glucose screening/CBC in the second trimester
Strep B cervical culture is done routinely at approximately 28 weeks
A urine culture will be obtained during the pregnancy to rule out a bacterial infection in the urine.
Ultrasounds are not scheduled routinely, but when medically indicated as recommended by the National Institute of Health and The American College of Obstetrics and Gynecology. The decision will rest with your physician on whether or not an ultrasound will be necessary.
Instructions: Drink 32 oz. of water 30 minutes prior to your ultrasound appointment if you are 14 weeks or more pregnant.
Limitations: Maximum of 2 visitors/observers. All children should be strictly supervised. Toddlers should be restrained in adult arms. VCR and DVD recording is available.
Ultrasound exams will not reliably show physical abnormalities in the infant. This should not be considered a guarantee that no abnormality is present.
Please note that we offer 3D/4D Ultrasounds.Typically, this is a non-covered service by insurance companies, however, you may want to strongly consider this as several pictures and recordings may be produced and given to you to begin creating long lasting memories on this wonderful event in your life.
Non-Stress Tests
Non-stress testing (NST), an in-office procedure monitoring fetal heart rate and cardiac activity, may become necessary to verify fetal well being. A good breakfast/meal prior to an NST is essential.
Pre-Admission
Pre-admission to the hospital should be made in person at least by your 28th week of pregnancy.
Cord Blood
Cord blood is one of the richest sources of stem cell. It is taken painlessly from the umbilical cord at the time of the delivery and stored for future use. It is found to treat and cure multiple diseases. This is not to be confused with other controversial sources of stem cell. Please speak with your physician and/or his nurse for further information regarding this potentially life saving option. We have partnered with one of the worlds most reputable company to ensure proper storage of your babys blood. Note, this process may only be done at time of delivery, therefore, it truly is a once in a lifetime opportunity to take advantage of. For further information, please speak with your physician regarding this option.
Anesthesia
Arrangements for an epidural anesthetic are usually required before the onset of labor. Please contact the hospital that you plan to deliver at to ensure that you are pre-registered with anesthesia.
Medications Acceptable through Pregnancy
Throughout pregnancy minor problems or illnesses may occur. Below is a list of common ailments with approved (OTC) over the counter remedies.
Headache: Tylenol or Extra-Strength Tylenol
Minor sore throat: Chloraseptic spray/gargle
Head cold/sinus: Sudafed, Benadryl or Drixoral Cough: Robitussin (plain)
Hemorrhoids: Tuck pads, Anusol or Preparation H
Constipation: Prunes or Milk of Magnesia
Indigestion/Heartburn: Riopan, Mylanta or Sodium-free Tums
Diarrhea: Clear liquids for 24 hours (7-Up, Sprite, Ginger Ale) Advance to bananas, rice, applesauce and tea. Once the diarrhea has stopped, resume regular diet. Imodium, an over the counter drug may be taken.
Morning Sickness: Vitamin B6 50mg one, four times daily
Minor swelling: Reduce salt intake and elevate feet as often as possible
If any of these symptoms persist or are accompanied by fever call the office.
Dental Appointments
Only non-elective dental work is recommended during pregnancy. X-rays should be avoided, but if necessary, an abdominal shield should be used. Epinephrine is not recommended for anesthetic. Call our office to have prescription medications approved.
Hair Care
Hair permanents are not recommended during pregnancy.
Extermination / Paint Exposure
Have someone else enter and air out area for several hours prior to you entering.
Delivery
Questions often arise regarding "having my own physician" at delivery. Due to office scheduling, family commitments, continuing medical education requirements, vacation, etc., this is not always possible. If you wish to meet the other physicians within the group, we will gladly schedule you an appointment with them at some point during your pregnancy. Be assured that whichever physician attends your delivery, you will receive the best of care.
AIDS in Pregnancy
AIDS (Acquired Immunodeficiency syndrome) is caused by a virus called Human Immunodeficiency virus (HIV). People who are infected with the virus may show no symptoms of the disease and feel well. The virus is often passed on from a pregnant woman already exposed to human immunodeficiency virus (even if she shows no signs of the disease) to her unborn child. If this occurs, the child may develop AIDS or AIDS related conditions.
The following groups of people are known to be at high risk of carrying HIV. In some cases these risk factors are associated with life-style, and in other cases with geographic location or medical history.
Women whose partners are known to be immunodeficiency virus positive Intravenous drug users or their partners Prostitutes
Women whose male partners have had a homosexual experience
Hemophiliacs and partners of hemophiliacs
Women whose partners immigrated from African malaria belt of Haiti after 1975
There is a blood test available to identify people who have been exposed to this virus. If you belong to a high risk group, the Department of Health and Human Services and Center for Disease Control and the Department of Obstetrics strongly suggest that you have this blood test to determine the best health care for you and your unborn child.
In order to arrange a confidential blood test, or if you wish to have further information, please let your physician know. You will not be asked to identify which risk group you belong to.
Again, thank you for selecting Womens Healthcare Affiliates for your obstetrical care.
Endometrial ablation may be an alternative to hysterectomy for some women. If heavy and/or prolonged menstrual bleeding is interfering with your health, well-being, or quality of life, this procedure may be recommended by your doctor. Unlike hysterectomy, this procedure is performed in an outpatient facility or "Same Day Surgery" under light anesthesia. The patients are usually in and out in 4-5 hours. Most patients have little or no pain and can return to work the next day.
The goal of this operation is to reduce or eliminate the patient's abnormal menstrual pattern. In general, 60% of the patients will stop having menstrual periods. In another 35%, one or two days of light menstrual flow will occur. For reasons that are unclear, the operation will not help 5% of the patients and hysterectomy may be the final choice.
The operation is performed with an instrument called a recectoscope. A hysteroscope (very thin telescope) is placed through the cervix (mouth of the womb) which allows the surgeon to see the cavity of the uterus (womb). A special instrument called a 'rollerball' is placed against the wall of the uterus and while looking through the hysteroscope, the ball is moved up and down the wall like a paint roller. A radio wave similar to the waves used in the microwave ovens is released from the ball and destroys the lining of the uterus (endometrium). Once the procedure is completed, the patient is awakened from her anesthetic and observed in a recovery room for one to two hours before discharge.
Within three to six weeks, the uterus will be healed. During this time, there are no restrictions to physical activities as most patients return to full activity the day after surgery. For several weeks there may be a blood tinged, yellow discharge, part of the healing phase. On occasion, light periods will occur. These usually disappear after several cycles.
Endometrial ablation is not recommended if you want more children. Though this procedure is not meant to replace a sterilization operation, most patients will be unable to become pregnant. To be sure that pregnancy will not occur in the future a sterilization operation can be performed at the same time as the endometrial ablation.
This operation is not a hysterectomy. Only the lining of the uterus is destroyed. You will still need yearly exams and pap smears. Because the uterus remains, the chance of uterine diseases (e.g., fibroid tumors) is still present. This procedure does not start the menopause -- that will come at the natural time of life. Though this operation is not a replacement for hysterectomy, for some it can be an alternative. Where a patient's health is impaired, this option may be the safest choice.
