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Welcome! Congratulations! You’re Pregnant! Congratulations on your pregnancy! We thank you for choosing us as your care provider. At Northeast Georgia Physicians Group (NGPG) OB/GYN, we are all dedicated to your health and look forward to caring for you over the course of the coming months. Having a baby is one of the most memorable and important experiences for a woman and her family. We will do all we can to ensure your pregnancy is safe, healthy and happy. This booklet is designed to provide answers to common questions you may experience along the way; we encourage you to keep it nearby, as a resource, throughout your pregnancy. You can also visit our website at www.ngpg.org/OB/GYN for more valuable information and to view our “9 Months and Counting” video series. Thank you for placing trust in our care. The Physicians, Midwives, Practioners and Staff NGPG OB/GYN

Your Providers Like many OB/GYN practices, Northeast Georgia Physicians Group OB/GYN is a group practice. As such, our providers have days they work in the office, days they are on-call for deliveries at the hospital and days they are off. This means your primary provider may not be on-call on the day you are admitted for labor and delivery. With this in mind, we encourage you to schedule your regular prenatal visits with as many of the providers, who deliver at the hospital of your choice, as possible. This will allow you the opportunity to meet all of the providers who may deliver your baby.

Office Information NGPG OB/GYN Braselton 1404 River Place, Ste. 303, Braselton, GA (770)-848-9335

NGPG OB/GYN Cleveland 2578 Helen Hwy., Cleveland, GA (770) 219-9530

NGPG OB/GYN Gainesville 1315 Jessee Jewell Pkwy., Ste. 200, Gainesville, GA (770) 219-9300

NGPG OB/GYN Dawsonville 300 Dawson Commons Cir., Suite 310, Dawsonville, GA (706) 216-2345

NGPG OB/GYN Dahlonega 1298 South Chestatee, Dahlonega, GA (706) 864-3400

NGPG OB/GYN Toccoa 274 Big A Rd., Toccoa, GA 706-886-3169


Table of Contents Prenatal Visits. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Baby’s Growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Nutrition During Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 What to Avoid in Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Common Pregnancy Questions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Common Pregnancy Symptoms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Nausea Prevention Tips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Safe Medications During Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Tests and Precautions During Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11 When to Call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Additional Healthcare Providers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Preparing for Labor and Delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Labor and Delivery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15 Delivery Hospitals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Suggested Items for Your Hospital Bag. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Breastfeeding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Disability During Pregnancy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Postpartum Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Postpartum Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Additional Notes and Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 My Pregnancy Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 My Appointments Tracker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25


Prenatal Visits Because pregnancy is a time of great change for your body, as well as the fetus, you will be visiting our office on a regular basis. During your regular appointments, we will check your weight, blood pressure and urine. Around your week 12 visit, we will begin monitoring your baby’s heartbeat. The baby’s growth will be monitored by measuring your stomach, around week 20. Visits will be as follows: • Monthly office visits until 28 weeks • Office visits every 2 weeks from 28 weeks to 36 weeks • Weekly office visits from 36 weeks to 40 weeks, or until delivery • Postpartum follow-up visit 4-6 weeks after delivery Please bring this book and bookmark with you to each of your scheduled prenatal visits, so you may document the dates your visits occur. Prenatal Visits Draw prenatal labs Review diet Review current medications Discuss signs and symptoms First ultrasound Review medical/surgical history Review obstetric history Weight Blood pressure Urine sample Listen to baby’s heartbeat Measure belly Listen to baby’s heartbeat Glucose test and results Tdap vaccine Rhogam given if negative blood type

Discuss pregnancy expectations, including: Weight gain Prenatal vitamins Exercise Review family history/genetic history Discuss genetic screening Physical exam and pap smear, if needed Measure belly to check growth starting at 20 weeks Approx 20 weeks-ultrasound with gender reveal option; observe baby’s development Review any questions Discuss symptoms of preterm labor Discuss childbirth classes Sign tubal ligation papers, if needed Pre-register online with hospital Review any questions

Every 2 weeks until 36 weeks

Check vitals—weight, blood pressure, urine Listen to baby’s heartbeat and measure belly

Review any questions 36 week visit will check for Group B Strep

Weekly visits until delivery

Check vitals—weight, blood pressure, urine Listen to baby’s heartbeat and measure belly Discuss labor plans

Discuss anesthesia plans Vaginal exams to check dilation Review any questions

Confirmation visit 5-7 weeks First OB visit 8-10 weeks Every 4 weeks until 28 weeks

24-28 weeks

Postpartum visit 4-6 weeks after delivery

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What to Expect

Physical exam, education


Baby’s Growth

WEEK 4

Baby's organs begin to develop. Taking PNV with DHA and Folic Acid is important to aid in healthy development Approx. size: Poppy Seed

WEEK 16

Baby’s skeletal system and nervous systems start to coordinate movement Approx. size: Avocado

WEEK 28

Baby is starting to take 20- to 30-minute naps Approx. size: Eggplant

WEEK 8

Baby’s tiny fingers and toes start to develop Approx. size: Raspberry

WEEK 20

Baby's skin thickens and begins to have some fat beneath it Approx. size: Artichoke

WEEK 32

Baby's movements become more of a rolling movement due to increased size Approx. size: Coconut

WEEK 12

Baby’s facial features continue to become more defined, particularly the nose and chin Approx. size: Plum

WEEK 24

Baby's movements are becoming more consistent. Approx. size: Grapefruit

WEEK 36

Although baby’s bones are hardening; the skull remains soft and flexible for birth Approx. size: Honeydew

WEEK 40

A surge of hormones in baby’s body could play a part in initiating labor Approx. size: Watermelon

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Nutrition DURING Pregnancy Recommendation for weight gain Underweight women with a low weight gain during pregnancy have an increased risk of having a low birth weight infant and pre-term birth. On the other hand, obese women have an increased risk of having an infant who is large for its gestational age, post-term birth, and other pregnancy complications.

Recommendation for weight gain during a pregnancy are as follows: Underweight women (BMI less than 20): 30-40 lb Normal weight women (BMI 20-25): 25-35 lb Overweight women (BMI 26-29): 15-25 lb Obese women (BMI >29): up to 15 lb * Ask your provider about weight gain recommendations if you are pregnant with multiples.

Healthy diet The first step toward healthy eating is to look at your daily diet. Eating healthy snacks is a good way to get extra nutrients. Pregnant women need an additional 100-300 calories per day, or equivalent to a small snack for (i.e., half of a peanut butter sandwich and a glass of low fat milk.) Prenatal vitamins (PNV) — We recommend a PNV that contains folic acid and DHA/EPA supplement throughout pregnancy and while breastfeeding. You can also add an Omega-3/DHA supplement to your diet prior to conception. Please check with your provider before taking any vitamins, herbs, or other supplements, as some may be unsafe during pregnancy. Key nutrients to include during pregnancy with diet and a PNV: Nutrient Calcium (1000 mg) Iron (27 mg) Vitamin C (85 mg) Vitamin D (600 IU/daily) Folic Acid (600mcg) Omega-3/DHA/EPA (at least 200 DHA in addition to PNV)

Reason for importance Helps build strong bones and teeth.

Sources milk, cheese, yogurt, dark greens, broccoli, sardines

lean meat, dried beans and peas, iron-fortified Helps create the blood cells, which deliver oxygen cereals, prune juice to the baby and prevent fatigue. *NOT in gummy vitamins Helps your body absorb iron and promotes healthy gums, teeth and bones.

oranges, melons, strawberries

Needed to produce blood and protein, also helps prevent brain and spinal cord defects.

Green leafy vegetables, liver, orange juice, beans and supplements (PNV)

Works with calcium to build strong bones and teeth. Essential for healthy skin and eyesight.

Vitamin D fortified milk, salmon and other fatty fish, sunlight

Important for brain and visual development, before and after birth. Also helps prevent perinatal and postpartum depression.

Up to 2 servings or 12 ounces of fish per week. Avoid swordfish, king mackerel, raw fish and tilefish Limit tuna to 6 oz/week. Flax and chia seeds

Protein (75-100 gms/daily) Essential for fetal growth and brain development. meat, eggs, nuts, fish, tofu, milk, yogurt, cheese

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Recommended Sources of Essential Nutrients AND SERVING SIZES Calcium (1,000mg/daily) 1 cup milk (with Vitamin D) 1 cup yogurt 2 cubes (about 1”) cheese Dark greens Broccoli Sardines

Iron (27 mg/daily)

Proteins Iron-fortified cereals Dried beans and peas Prune juice

Vitamin C (85mg/daily)

1 orange 1 apple 1 banana 1 cup vegetables, raw and leafy ½ cup cooked vegetables ¾ cup juice

Folic Acid (600 mcg/daily)

Orange juice Green, leafy vegetables Nuts Beans Strawberries

Vitamin D (600 IU/daily)

3 oz. salmon or fatty fish 8 oz. orange juice (D Fortified) 8 oz. low-fat milk(D Fortified) 1 large egg yolk

Protein (75–100 gms/daily)

3 oz. lean meat 1 egg ½ cup beans ½ cup nuts 3 oz. fish (fish-oil requirement) Tofu 1 cup protein dairy

FOODS/BEVERAGES TO AVOID DURING PREGNANCY:

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What to Avoid in Pregnancy Foods to avoid • Raw meat – avoid raw seafood and undercooked beef or poultry, due to risk of bacterial contamination, toxoplasmosis and salmonella. • Fish with mercury – avoid fish with high levels of mercury including shark, swordfish, king mackerel and tile-fish. (Limit albacore tuna to 6 oz./week). • Smoked seafood – refrigerated, smoked seafood should be avoided, due to risk of listeria contamination. • Raw shellfish – like clams, oysters and mussels can cause bacterial infections. • Raw eggs – raw eggs, or any foods containing raw eggs, can be contaminated with salmonella. • Soft cheeses – imported soft cheeses may contain listeria (pasteurized soft cheeses are safe). • Unpasteurized milk – may contain listeria, which can lead to miscarriage. • Caffeine – limit caffeine intake to equivalent of one cup of coffee a day. cdc.gov is a great website for the most up-to-date warnings, considerations and information. Alcohol/drugs No amount of alcohol, or street drugs, are known to be safe during pregnancy and should be avoided. Drinking alcohol or using drugs can result in birth defects, mental retardation and abnormal brain development. Smoking If you smoke, SO DOES YOUR BABY! This is a very important fact of pregnancy. You and your baby are connected, transferring both nutrients and toxins through the placenta. The placenta connects your uterus to the developing baby by way of the umbilical cord. The job of the placenta is to pass nutrients, oxygen, vitamins and other substances from your blood to the baby. The placenta is the organ that essentially “feeds” your baby, allowing it to grow and develop. It also carries baby’s waste products to your kidneys, liver, and lungs—acting as these organs for baby until his/her organs are mature enough to function on their own, outside the womb. Cigarette smoke contains more than 2,500 chemicals. Both nicotine and carbon monoxide (the same gas released from a car’s exhaust) are believed to play a role in causing bad pregnancy outcomes. These chemicals are directly transferred from your lungs to your blood and then, by way of the placenta, to your baby’s blood. Imagine how these toxic chemicals can negatively affect the fragile tissues of a developing baby. Here are some known complications from smoking during pregnancy: • Low birth weight – this can be a result of prematurity (birth prior to 37 weeks), poor growth, or a combination of both. Risk of prematurity is increased for smokers and is the number one cause of neonatal death and chronic illnesses, like cerebral palsy, lifelong lung and kidney issues, as well as other problems. • Placenta previa - low – lying placenta that covers part or all of the opening to the uterus. Placenta previa blocks the exit of the baby from the uterus, causing the baby and/or mother to bleed. • Placental abruption - the placenta tears away from the uterus, causing the mother and baby to bleed. • Stillbirth - the baby dies in the womb before birth. • Premature rupture of membranes - the water breaks before 36 weeks. This is associated with low birth weight babies and an increased risk of pre-term labor and delivery.

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Common PREGNANCY Questions When will I feel my baby move? Mothers usually begin to feel baby moving between 16-25 weeks of pregnancy. Initially, movements will be infrequent and may feel like butterfly flutters. However, as your baby grows, you will feel movement more often. It is recommended to start counting fetal movements beginning at 28 weeks, at least once daily, until you get 10 movements within 2 hours. A good time to count is 20-30 minutes after breakfast or dinner. If you are concerned about movement, eat or drink something sweet and cold, such as ice water and/or juice, then lie on your side and press your hands on your belly. If you still have concerns at that point, or notice a decrease in movements, contact your provider. Why am I so tired? What’s the best sleep position? It’s normal to feel more tired. You may also notice you need more sleep than usual, try to get at least 8-10 hours per night. Also, listen to your body for cues. If you are tired, rest. Sleeping on your side is the best position because it allows for maximum blood flow to baby; while lying on your back can cause your blood pressure to drop. When lying on the side, many women find it helpful to put a pillow behind their back and between the knees for comfort. As your pregnancy progresses, use more pillows and frequently change positions to help stay comfortable. Can I use a jacuzzi? Using a jacuzzi or whirlpool bath is not recommended during the first trimester and should be limited to 15 minutes or less in the second and third trimester. The water temperature should not exceed 100 degrees. Can I travel? Traveling is safe for uncomplicated pregnancies, however, after 36 weeks, we recommend staying close to home. If you do travel, be sure to take breaks

to stand up/walk around at least every two hours. If traveling by vehicle, wear a seat belt, positioning it under your abdomen as your baby grows. If you are involved in a car accident, please call your provider immediately. You may need to be monitored. Can I care for my pets? If you have cats, please let us know. Avoid changing the litter box or use gloves if you must change it. Toxoplasmosis is a rare infection that can be transferred by cat feces. What do I need to know about dental care? Your teeth and gums may experience sensitivity throughout the pregnancy. Inform the dentist of your pregnancy and shield your abdomen if x-rays are necessary. Poor dental care is associated with preterm labor and/or infection. Contact our office with any questions about dental care. Can I go to the salon for treatments? Hair coloring and nail care should always be done in large, well-ventilated areas. If possible, avoid treatments in the first trimester. Can I exercise? 30 minutes of daily exercise is recommended for uncomplicated pregnancies. This could include walking, jogging, biking, aerobics, yoga or swimming. Light weight training is also acceptable. Listen to your body during exercise and drink plenty of fluids. After 20 weeks, avoid lying flat on your back and any activities with a high risk of falling or trauma to your belly (i.e., snow skiing, kickboxing, horseback riding). Can I have sex? You can have sex, unless you are having complications or sex becomes too uncomfortable. Exercise and sex should be avoided if you are experiencing vaginal bleeding, leaking amniotic fluid, pre-term labor or placenta previa, or if instructed by your provider.

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Common Pregnancy Symptoms Nausea/vomiting - feeling nauseous during the first three months of pregnancy is very common. For some women, it can last longer, while others may not experience it at all.

To relieve the cramp, try stretching your leg with your foot flexed toward your body. A warm, moist towel or heating pad applied to the muscle may also offer relief.

Discharge - an increase in discharge is common in pregnancy. If the discharge is watery or has a foul odor, call the office.

Dizziness - you may feel lightheaded or dizzy at any time during your pregnancy. Try drinking 1-2 glasses of water and then lying down on your left side. If symptoms persist, contact the office.

Spotting - light spotting can be common, especially in the first 12 weeks of pregnancy. It may occur after intercourse, cervical exams, vaginal ultrasounds or strenuous activity/exercise. If the bleeding is heavy, or is accompanied by pain, contact us immediately. Constipation - is a common complaint that can be related to hormone changes, low fluid intake, increased iron or a lack of fiber in your diet. Try to include whole grains, fresh fruits, vegetables and plenty of water in your diet. There are also safe overthe-counter medications you may use. If you develop hemorrhoids, try stool softeners, over-the-counter medications/ointments and/or sitzbaths. If the pain persists, contact the office. Cramping - some cramps and contractions are normal. Take these steps if they occur: empty your bladder, drink 1-2 glasses of water and rest. If you are less than 36 weeks pregnant, having more than eight contractions an hour, and do not experience relief from these remedies, contact the office. Leg cramps - cramping in your legs or feet can be common. Eating bananas, drinking low-fat or non-fat milk and consuming calcium-rich foods like dark green vegetables, nuts, grains and beans may help.

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Swelling - your body is increasing production of blood and body fluids. As such, swelling can be normal in your hands, face, legs, ankles and feet. To help ease these symptoms, you can elevate your feet, wear comfortable shoes, drink plenty of fluids and limit your sodium intake. Supportive stockings may also help. If the swelling occurs rapidly, or is accompanied by headache or visual changes, contact your provider. Heartburn - you may experience heartburn throughout the pregnancy, especially during the latter part when your baby is larger. Try to eat 5-6 smaller meals a day and avoid lying down immediately after eating. Some over-the-counter medications are also safe to use. Aches and pains - backaches are common, especially as your baby grows. You may also feel stretching and pulling pains in the abdomen or pelvic area. These are due to pressure from your baby’s head, weight increase and the normal loosening of joints. Practice good posture and try to rest with your feet elevated. You may also treat with heat and TylenolŽ.


Nausea Prevention Tips • Before getting out of bed in the morning, eat a few crackers, a handful of dry cereal, or a piece of toast or dry bread. Put these within reach of your bed the night before. • Get up slowly and sit on the side of the bed for a few moments before standing up. • Eat 6-8 small meals during the day. Never go for long periods of time without food. • Eat foods that are high in long-acting proteins such as milk, yogurt, cheese, peanut butter, and nuts. • Drink fluids, including soups, between meals (instead of with meals). • Peppermints, cinnamon-flavored candy, lemons or lemon-flavored candy and ginger (in tea, candies or ginger-ale) have all been proved to provide relief for nausea. • Avoid greasy, highly seasoned and fried foods. These include butter, margarine, bacon, gravies, pie crust, pastries, fried meats and french fries. • Avoid unpleasant smells. When you cook, open windows or use the exhaust fan to get rid of odors. After cooking, wait a short period of time before eating. • Always eat a high-protein snack before bedtime. • If the nausea is severe, avoid drinking citrus juice, coffee or tea. • If you are having difficulty keeping food down, try eating popsicles. • If nausea persists, take 25 mg of vitamin B6, three times a day, with 50 mg of Unisom at night.

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Safe Medications During Pregnancy Note: Use medications sparingly in the first 14 weeks of pregnancy. Call the office if you have a fever of 100.4°F or greater, or if symptoms persist or worsen. ALLERGIES Claritin Zyrtec Benadryl ANTACIDS Tums Rolaids Mylanta Zantac Tagamet, Pepcid, Prilosec, Prevacid (If no relief from Tums or Rolaids)

COLDS, FLU Tylenol (for Aches and Pains) Chloraseptic/Cepacol Lozenges (for sore throat)

CONSTIPATION High-bran diet and increase water Metamucil Psyllium Colace/Docusate Milk of Magnesia COUGH Robitussin (plain) Mucinex DECONGESTANTS Instant Ocean Spray Rhinocort Nasonex Flonase

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DIARRHEA Kaopectate Immodium BRAT diet (bananas, rice, applesauce, tea or toast) DENTAL It’s okay to see a dentist, , but be sure to use an abdominal shield if having x-rays done. You can also have Novocaine® and certain antibiotics and pain medications. Be sure to notify dentist that you are pregnant. HEADACHE/MILD PAIN Tylenol HEARTBURN/GAS Mylanta Maalox Tums Rolaids Gas-X/Simethiconem, Tagamet, Pepcid, Prilosec, Prevacid (If no relief from Tums or Rolaids)

HEMORRHOIDS Preparation H Anusol HC Tucks pads Sitz baths with or without Epsom salts Konsyl Easy Mix (daily to keep stools soft)

IRON SUPPLEMENTS

*Look for a supplement with a stool softener or add Colace/Docusate when taking iron

Slow Fe Fergon Feosal Bifera Irospan

INSOMNIA/SLEEP AID Benadryl Tylenol PM (if you also have pain) Unisom Chamomile Tea LEG CRAMPS Caltrate Calcet Viactiv Calcium, magnesium supplement Epsom salt baths NAUSEA Small, frequent meals (every 2-3 hrs) Sea bands (wristband) Vitamin B6 (25mg 3 times/daily and 1 Unisom/Doxylamine at night)

Ginger, ginger tea Peppermint and cinnamon SORE THROAT Warm salt water gargle (several times/day)

Cepacol lozenges Vicks lozenges or spray

(Avoid anything with phenol or hexylresorcinol)


TestS AND PRECAUTIONS During Pregnancy You’ll have the opportunity to take a variety of tests that can help identify potential genetic diseases. If you are interested in any of these optional tests, please check with your insurance company to see if they are covered. Any questions you may have regarding these optional tests, and their associated risks, can be discussed at your first appointment. Some of these tests may be referred to a maternal fetal specialist and require a separate appointment outside of our office. Cystic fibrosis screening - an optional blood screening used to determine if you are a gene carrier for cystic fibrosis. If you test positive, further testing will be required to determine if the baby has cystic fibrosis. First trimester screening - an optional ultrasound and blood test, that can be performed between 10-13 weeks, to determine if there is a high or low risk for Down syndrome, Trisomy 13 or 18. Non-invasive perinatal testing (NIPT or cell-free fetal DNA testing) - this optional blood screening evaluates baby’s chromosomes and can diagnose certain chromosomal abnormalities. MSAFP- (alpha fetal protein) - an optional blood screening p between 15-22 weeks. The test determines high or low risk for Down syndrome, trisomy 18 as well as open neural tube defects . Ultrasounds - recommended at your first visit and again around 18-22 weeks to view the baby. Rh factor test - assesses your blood for the Rh factor. If your blood type is Rh negative, then you may be at risk for Rh disease, which only ffects about 10% of people. Rh disease presents a pregnancy complication in which your immune system attacks the baby’s blood and can result in a life-threatening situation for the baby, if left unknown. Fortunately, it can be prevented with a shot, called Rhogam, which is given at 28 weeks (or anytime if vaginal bleeding occurs). If you are Rh negative and you develop bleeding or experience trauma to your belly, please, contact our office immediately. Rhogam given: Vaccinations - the Centers for Disease Control (CDC) recommends that pregnant women receive a flu shot. The CDC also recommends every pregnant woman, regardless of prior immunization, receive the Tdap vaccination between 27-36 weeks. Receiving this vaccine during pregnancy gives your baby extra protection against whooping cough, which can be very dangerous for newborns. Flu shots can be administered in any trimester. Flu given:

Tdap given:

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When to Call If you experience any of the following, please contact us immediately, as these are considered an emergency: • Continuous leaking of fluid (water broken) • Abdominal trauma or car accident • Heavy bleeding • Fever greater than 101º

• Decreased fetal movement (baby moves less than 4 times in a 30-minute period) • Urinary tract infection • Headache with vision changes

• Painful contractions greater than 6 times an hour, if less than 36 weeks

If an emergency or it is indicated to call immediately, the after hours line is 770-219-9000. Ask for the NGPG OB/GYN on-call. ILLNESS/ SYMPTOM Bleeding/ cramping

Some bleeding/spotting may occur after an internal exam

Vomiting

Common in 1st trimester

Decreased fetal (baby) movements after 24 weeks

CALL THE OFFICE IF: • Bleeding persists or is accompa-

nied by cramps; common in 1st trimester

• Unable to keep down liquids

and solids for more than a 24hour period • Weight loss of more than 3-5 pounds • Baby moves less than 4 times in

a 30-minute period while you are resting, during a normally active period for baby

• Contractions stronger than

Braxton-Hicks (mild, irregular contractions), but may not be regular Preterm labor8 or more contractions within less than 37 weeks • an hour • Low persistent backache that comes and goes, accompanied by cramps

Rupture of membranes Urinary urgency and/or pain with urination

Frequency is common in early and late pregnancy

Swelling

Cold and Flu

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CALL IMMEDIATELY IF: • Bleeding is heavy (using a pad

every 2 hours)

• 2nd and 3rd trimester cramping

or painless heavy bleeding • Cramping is equal or worse than menstrual cramps • Signs of dehydration occur (e.g.

dry mouth, fatigue/lethargy, poor skin elasticity) • Abdominal pain accompanied with vomiting • No fetal movement after

trying juice, food, ice water, and position change

• Contractions are every 5 - 7

minutes for more than an hour that are not relieved by water and rest • Water breaks; small leak or a gush • Bright red bleeding • Pain or contractions won’t go away

HOME TREATMENT: • Rest • Avoid heavy lifting (more than

25-35 pounds)

• 25 mg of Vitamin B6, 3 times a day • Separate liquids from solids

(e.g. dry cereal followed by a glass of milk 1 hour later) • Plain popcorn • Rest • Avoid hot sun • Rest • Drink juice or soft drink • Eat a small snack • Lay on left side

• Increased water and rest • Dehydration can cause contrac-

tions, especially in the summer

• Empty your bladder • Lay on left side to increase

circulation to the placenta and baby

• Water breaks; small leak that

continues when walking or large gush of fluid

• Pain with urination • Feeling of urgency to void with

little urine produced

• Recent, noticeable increase in

size of feet and ankles • Swelling of face and hands

• Temperature of 101ºF or higher • Green or yellow mucus develops • Persistent cough for more than

5 days

• Temperature of 101ºF or higher • Pain in upper back • Contractions occur • Blood in urine • Swelling accompanied with head-

ache or upper abdominal pain

• Elevated blood pressure if using

home monitoring

• Breathing is difficult or wheez-

ing occurs

• Urinate at regular intervals • Increase fluid intake to 8-12

glasses daily

• Lie on left side and elevate legs • Avoid salty foods (e.g. ham,

pizza, chili)

• Tylenol, Robitussin , Rhinocort,

saline nasal spray, Flonase

• Increase fluids • Rest • Use humidifier


Additional Healthcare Providers WHAT IS A MIDWIFE? Certified nurse-midwives (CNMs) are licensed health care providers educated in nursing and midwifery. Midwives have received a master’s degree in nursing from an accredited college, have passed a national examination and are licensed to practice midwifery from the state. WHAT DO MIDWIVES DO? In the United States, CNMs help over 300,000 women give birth each year, with most of these deliveries occurring in hospitals. Beyond pregnancy and childbirth, CNMs provide health care to women throughout life including: prenatal care, birth, care after birth, care for the new baby, annual exams, birth control planning, menopause and health counseling. WHY CHOOSE A MIDWIFE FOR PREGNANCY CARE? CNMs believe you need time and special attention so you can be healthy and able to take care of your baby. They specialize in providing support, regular health care and in assisting you, if additional care is needed. Midwives are experts in knowing the difference between normal changes that occur during pregnancy and symptoms that require special attention. CAN I HAVE A MIDWIFE WITH A “HIGH-RISK PREGNANCY”? WHAT IF THERE ARE COMPLICATIONS? Your CNM can prescribe medicine and order treatments for common illnesses you may experience during pregnancy. Midwives also work with physicians who specialize in illnesses during pregnancy — so if you have a medical problem during pregnancy, or complication during labor, your midwife will work with the right physician to make sure you get the best and most appropriate care for you and your baby. Your midwife will also work with other health care providers, nurses, social workers, nutritionists, doulas, childbirth educators, physical therapists and other specialists, to make sure you get the care you need. DO MIDWIVES PROVIDE NON-PREGNANCY CARE? Many women go to their CNM for annual check-ups, family planning and care for common infections unique to women. For example, your midwife can answer questions about birth control methods, help you decide what is best for you and prescribe it for you.

What is a Women’s Health Nurse Practitioner? Women’s health nurse practitioners (WHNPs) are certified advanced practice providers specializing in women’s health care, throughout their life span. WHNP’s have received a master’s degree in nursing and have passed a national certification exam. WHNP’s can diagnose, treat, prescribe medications, manage acute and chronic illnesses, conduct physical exams and interpret medical history, as well as provide prenatal care, screenings and counseling. At NGPG OB/GYN, WHNPs provide prenatal and postpartum care, well-woman care and reproductive and gynecological care. During your pregnancy, our WHNP’s will collaborate with your healthcare team to help provide you both education and prenatal care. Not only will our WHNPs provide care for normal and high risk pregnancies but they also place special emphasis on education and knowledge that will allow you to make informed decisions about your healthcare. WHNPs will not be present during your delivery, but can be seen throughout the entire pregnancy and lifespan for annual visits, family planning and gynecological issues.

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Preparing for Labor and Delivery Once you hit the 20 week mark, you are half way through your pregnancy! It is time to start considering a few things to make some decisions; this list should help.

20 Week To Do List r Register for childbirth classes r Choose your preferred delivery location: NGMC Braselton or NGMC Gainesville ngpg.org/delivery-locations r Register for your delivery

nghs.com/ob-patient-registration

r Choose a pediatrician/practice r Consider cord blood donation or banking r Visit nghs.com/cord-blood-donation

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for more information


Labor and Delivery When to call Northeast Georgia Physicians Group OB/GYN 1) Call when you are having contractions 5 minutes apart, lasting 1 minute each, for 1 hour 2) When your water breaks or leaks 3) If you are experiencing heavy bleeding and/or unremitting, severe pain. • During office hours, please call our office to discuss plans • Outside office hours, please call: (770) 219-9000 In general, when at term, there is NO need to call if: 1) You are cramping or have erratic contractions, even if some are strong 2) You note a slight bloody discharge, pass your mucus plug, or see blood-tinged mucus in the absence of regular labor pains Usually, labor pains are uniform in their intensity and predictably rhythmical in their timing.

True Labor Contractions are regular, get closer together, last 40-60 seconds and are 3-5 minutes apart for one hour Contractions continue despite how much you are moving around or resting

False Labor Contractions are irregular, do not get closer together and last 20-40 seconds Contractions may stop when you walk or rest, or may change with change of position

Pain/discomfort is usually felt in back and moves around to front. Pain/discomfort is often felt in abdomen. Contractions steadily increase in strength

Contractions usually are weak and do not get much stronger

Bloody show (small amount of blood or blood-tinged mucus) may be present

Bloody show is usually not present

Induction Induction simply means that the process of childbirth and labor is started with medication. Labor may be induced for medical reasons or as an elective procedure after 40 weeks. If there is concern for your health, or the health of your baby, a medical induction will be indicated. Forceps & vacuum assisted deliveries We are highly skilled in the use of vacuum and forceps for deliveries. We will recommend using them only if medically indicated. Our goal is to deliver your baby in the safest manner. There certainly are times when this is the safest way to help your baby into the world. Cesarean birth and recovery During a Cesarean birth, you will have a team of nurses, anesthesia staff and your physician with you in the operating room, as well as a group of neonatal health care providers will be with you. Your blood pressure and heart rate/rhythm will be monitored as well as your baby’s heart rate. Once surgery begins, the baby will be delivered in a relatively short time. However, it will take approximately 45-60 minutes to complete the surgery, which results in your incision being closed with either staples or sutures. You will then be moved to the recovery room, where you will stay for at least two hours before being transferred to your room, or postpartum floor, depending on the delivery hospital. Visitors are limited to one in the recovery room, and children under the age of 16 are not allowed. Children can visit once you have been transferred out of recovery.

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DELIVERY HospitalS The staff at Northeast Georgia Medical Center (NGMC) is proud to have been a part of thousands of births in the more than 65 years we’ve been delivering babies. NGMC believes in Mother/Baby Care and allows you to actively participate in caring for your newborn during your hospital visit. Part of Mother/Baby Care at NGMC is having your baby in the room with you as much as you’d like. NGMC offers two convenient locations for delivery. To learn more about the Gainesville campus, visit ngpg. org/gainesville-babies. For more information about the labor and delivery unit in Braselton, visit ngpg.org/ braselton-babies. Be sure to discuss your preference and options with your provider.

To do:

Now (early in pregnancy) • Remember to have your delivery pre-certified by your insurance carrier. • Consider breastfeeding 3 to 6 months • Register for childbirth classes at nghs.com/obclasses. 6 to 9 months • Pre-register for your hospital stay, about three months prior to your due date. Registration is easy online at www.nghs.com/ob-patient-registration, or you can request a paper form from our office. • Review the visiting guidelines at nghs.com/visiting-guidelines and communicate them with your friends and family. • Buy an infant car seat, and learn how to install it correctly. You can attend one of the free car safety seat classes offered monthly by NGMC and Safe Kids Gainesville/Hall County at nghs.com/obclasses. • Pack your hospital bag. (There is a helpful checklist on page 17) • Review hospital admissions instructions. Quick Reference Medical Center Phone Numbers:

OB Class Registration............................. 770-219-1495 Breastfeeding Assistance: Braselton....770-848-3319 Breastfeeding Assistance: Gainesville.... 770-219-7574 Pre-Admission/Insurance Information....770-219-1483

Billing Questions.................................... 770-219-7219 Birth Certificate Information..................770-219-1642 Safe Kids (car seat information).............770-219-8095

What is cord blood banking and donation? Your baby is born with a lifesaving gift: cord blood stem cells. After a baby is born and the umbilical cord has been clamped and cut, some blood remains in the blood vessels of the placenta and the attached portion of the umbilical cord. This cord blood and cord tissue is rich in unique, powerful and smart stem cells that have been used in more than 30,000 transplants. These stem cells are also being explored for their ability to treat conditions, such as cerebral palsy and autism, that currently have no cure. Collecting and storing these stem cells gives your family access to a potentially lifesaving treatment option. However, you only have one chance to collect and store your baby’s stem cells – immediately after birth. It’s important to make a decision about storing your baby’s stem cells before the due date. You may choose to store these stem cells for your family’s private use or donate them for public use. Cord blood donation is offered at NGMC to every patient without complications. Once collected, the amount will be weighed and determined if it is an acceptable amount to be stored for patients in need. Please ask one of your physicians for more information about cord blood banking and donation options.

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Suggested Hospital Bag ITEMS Your items Toiletries …… Shampoo …… Conditioner …… Hair dryer …… Facial cleaner …… Any special soaps or lotions …… Deodorant …… Lip balm …… Contact lenses and supplies (if necessary) …… Makeup (if you desire) Clothes …… Nightgown (if you plan to breast feed, make sure it will accommodate) …… Bathrobe …… Slippers …… Warm socks …… Supportive, full-coverage bra (to prevent engorgement) …… Yoga pants Clothes to wear home …… One loose-fitting, comfortable outfit Baby’s items (The hospital will provide t-shirts, blankets and diapers while the baby is in the hospital, but they will not let you take any of the clothes or blankets home. Therefore, you will need one outfit for the baby to go home in) …… T-shirt or “onesie” …… Blanket …… Appropriate outerwear, depending on the season …… DO NOT FORGET THE CAR SEAT!

Dad’s items …… Toiletries and grooming items (like razor, toothbrush, etc.) …… Pajamas or shorts (even if you don’t wear them to sleep in at home, you will need them since nurses and doctors will be in and out of your room - even while asleep) …… Comfortable clothes Other items …… Glasses (in case you need to remove contact lenses) …… Camera and video recorder (make sure you bring extra film, batteries and any necessary plug-in adapters) …… Music and appropriate equipment to play it on (some women find light music soothing during labor) …… Telephone numbers of family and friends to call …… Paper and pencil to write down all the information you will get upon discharge (future appointments for you and baby, etc.) …… Snacks for your birthing coaches (if you can stand to watch them eat in front of you when you will only be allowed clear liquids) …… ALL visitors must bring a photo ID to the hospital

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Breastfeeding Choosing whether or not to breastfeed is a very personal choice - and is a decision only you can make. Mother Nature, though, has provided you with the best food to feed your baby. Human milk is a unique combination of fats, sugars, mineral proteins, vitamins and enzymes, custom-made to promote brain and body growth. Colostrum, also called first milk, is a milky or yellowish fluid secreted by the mammary glands a few days before and after birth. Colostrum provides unmatched immunity against bacteria and viruses and acts as a natural laxative to help clear the meconium (first bowel movement) from the baby’s intestine, which helps decrease the chance of jaundice. Some advantages to breastfeeding • Healthier baby • Fewer ear infections • Fewer acute respiratory illnesses • Lowers risk for asthma and eczema • Passive immunity • Lowers risk of Sudden Infant Death Syndrome (SIDS) • Decreases risk for breast cancer in mom • Promotes postpartum weight loss • It’s FREE! For additional support, you may call to schedule a breastfeeding class or receive information from The Lactation Center at 770-219-7574 in Gainesville and 770-848-3319 in Braselton. Breastfeeding seems difficult; wouldn’t it be easier to bottle feed? Don’t give up! Breastfeeding can be challenging, but is very rewarding for you and your baby. NGMC provides free lactation services to every mother. If you really want to breastfeed, surround yourself with supportive people. Before the baby arrives, discuss your desire to breastfeed with your significant other so you have a healthy breastfeeding environment from day one. I am not leaking any breast milk; does that mean I am not going to produce any milk? No, this is not a determining factor of future breast milk production. How often should I nurse my baby? Every baby is different, so be sure to follow your baby’s lead. It is recommended that your baby eat at least 8-12 times in a 24-hour period; this equates to feeding every 2-3 hours. Remember to drink lots of water! The more you feed, the more water you require to keep a steady milk production. The more often baby feeds, the more milk you will produce. How do I know my baby is getting enough? The average baby will nurse frequently, so listen for audible swallowing while nursing. Your baby should be alert while feeding, appear healthy, have firm skin and you should notice growth. Appropriate weight gain along with wet and dirty diapers are the best determining factors to ensure they are getting adequate amounts of breast milk. Your pediatrician will help you monitor adequate growth.

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Breastfeeding (cont.) Are there any foods I should avoid while breastfeeding? La Leche League, a non-profit organization that promotes breastfeeding and breastfeeding education worldwide, recommends eating a well-balanced diet, without too much of any one food. Different cultures recommend avoiding different foods. Pay attention to your baby. If you notice your baby reacts to certain foods with symptoms like an upset stomach, extra gas or spit-up, we recommend avoiding that food or seasoning. When should I start pumping, if returning to work? About 7-14 days prior to returning to work, begin practicing with a pump to become familiar with the technique. It will take 3-4 times before you become proficient. How do I store my pumped milk? Milk can be left at room temperature for up to 4 hours, in a refrigerator for up to 3 days and in a freezer for 3-6 months. If using a freezer, be sure to store milk in the back of the freezer (not the door). If you have a deep freezer, you can store milk for 6-12 months. Storage bags specifically designed for storing breast milk are readily available for purchase. Drinking alcohol while breastfeeding? It is not recommended that you ingest alcohol while breastfeeding. There is conflicting information about drinking alcohol while nursing; proceed at your own risk. How do I manage sore nipples? The first step is prevention, so make sure your baby is latched on correctly. Check baby’s position and encourage your baby to open wide when latching. If not latched correctly, break suction gently by putting your finger in the corner of your baby’s mouth. Use deep breathing, soft music or other relaxation techniques before and during breastfeeding. You can also stimulate “let down” by hand-expressing milk before your baby latches to help reduce vigorous sucking. You can also apply freshly expressed breast milk to your nipples after feeding to soothe and reduce infection. Applying modified Lanolin before nursing will also help to form a moisture barrier so that your nipples stay dry. Contact the Lactation Center 770-219-7574, or your provider, for more tips and advice. What should I do if I have a fever and cold chills? Can I continue nursing? If you have a fever over 101 degrees, cold chills and/ or a red, painful area in your breast, you will need to contact your provider. You may have developed an infection called mastitis. Continue nursing, but let your provider know as soon as possible in case the infection warrants antibiotics. Will insurance help pay for my breast pump? Your breast pump could be free or discounted, depending on your insurance. Contact your insurance company for a complete explanation of benefits.

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Disability During Pregnancy Your pregnancy may easily affect your work; as such, it is important to prevent any misunderstandings that may occur between a pregnant woman, her health care provider and her employer. Disability will be granted only for medical illnesses that may jeopardize a mother’s ability to safely nurture, protect and promote the development of her unborn child. Disability will not be granted for symptomatic complaints that stem from the normal physical or emotional changes of pregnancy. Usual pregnancy discomforts (i.e., nausea, fatigue, back and low abdominal pain) do not constitute a need for work disability. Additionally, routine pregnancy complications or illnesses unrelated to your pregnancy do not qualify. However, if you are unable to perform certain tasks necessary for your job, you should speak to your employer. We require your employer to submit a complete and specific job description in order to determine if there is a need to place physical restrictions on your work. If it is determined that physical restrictions are necessary, official paperwork will be completed and provided to your employer. If these restrictions prevent you from performing your job, it is then the responsibility of your employer to find a less demanding position or, if no such position is possible, give you disability. If you become too uncomfortable to work, you may want to discuss a leave of absence with your employer. Please do not ask your provider for disability unless you have been restricted from ALL work. Most employers will give disability two weeks prior to your due date through six weeks after your delivery. We will happily furnish a letter with those dates. The decision to grant medical disability any earlier in pregnancy will be made honestly, carefully and only with proper justification. Please allow 5 working days for the completion of any disability forms.

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Postpartum Instructions 1. Make an appointment to see your provider for a check-up 6 weeks after vaginal delivery, or 2 weeks after a Cesarean, for an incision check, and then again at 6 weeks postpartum. 2. Refrain from douching, tampons and swimming until after your post-partum check-up. 3. You may ride in a car, but no driving for about 2 weeks. Do not drive if taking narcotic medications. 4. If breastfeeding, continue your prenatal vitamins daily, eat a well-balanced diet and increase your fluid intake to 10-12 glasses of water per day. If you experience any signs of a breast infection (fever, flu-like symptoms, pain or redness in the breast), call the office for further instructions. 5. If you are not breastfeeding, you should still wear a good supportive bra and bind breasts to reduce pain, if necessary. You can also use ice packs, take Tylenol or Motrin for discomfort and call the office if soreness persists or worsens. 6. Vaginal bleeding may continue for 6-8 weeks while the uterus is returning to pre-pregnancy state. You may have spotting and/or menstrual-like flow that increases with activity. If bleeding or cramping increases to greater than a period, take two Advil and get off your feet. If bleeding is persistently heavy, call the office for further instructions. 7. Avoid lifting anything heavier than your baby until after your post-partum check-up. 8. When exercising, avoid sit-ups, jumping jacks and aerobics until after your post-partum check-up. We recommend walking and kegel exercises. 9. Constipation is very common. Drinking 6-8 glasses of liquids every day, as well as, Citrucel, Metamucil and stool softeners (i.e.,Colace), can be helpful. Include food like bran cereal, fresh fruits and vegetables in your diet. Stool softeners are recommended while taking Percocet. 10. Hemorrhoids usually are more symptomatic after delivery. If they are a problem for you over the counter medications can be used. If symptoms persist, you can discuss options with your provider. We can prescribe medication to relieve symptoms. 11. Postpartum blues like sadness and crying are normal responses to hormonal changes in your body. Please let us know if you need additional assistance, or if you are concerned that the blues have turned into depression. 12. Abstain from intercourse for 6 weeks, or until our postpartum visit. Any birth control needs or questions can be discussed with your doctor at your check-up, or earlier if you have special needs. 13. Please call the office if you have a fever of 101ยบF or greater, or swelling, tenderness or redness in the lower leg. 14. If you had a Cesarean delivery, keep your incision clean with soap and water. Call the office if the incision is swollen, red or has any unusual drainage. Remove any steristrips after 10 days. 15. Tub bathing and showering are permitted.

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Postpartum Depression 40-80% of women experience mood changes after their delivery. These changes typically start 2-3 days after delivery and usually ease naturally after a couple of weeks. It is important to eat properly, get adequate sleep and reduce stress. Sometimes the symptoms require treatment, especially if mom is not bonding or enjoying her baby, unable to care for herself or the baby, feeling excessive sadness, depression or anxiety. Please schedule an appointment if you feel a problem is occurring. We are known for our compassionate care and have effective treatments for postpartum depression. Please contact your provider if you are concerned; DO NOT WAIT for your postpartum checkup! Questions to Consider • Are you overcome by sadness and anxiety? • Do you feel resentful towards your child? • Do you have thoughts of harming yourself or your baby? • Do you have overwhelming anxiety or panic that interferes with your life and caring for your baby? Please come talk to us, and we can set you up with a postpartum counselor or start medications, if necessary.

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Additional Notes and Questions Use the space below to jot down any questions or concerns you may have for your next appointment. If a situation arises where you need to call the office or need to speak to the doctor on call, it will be helpful to have your pharmacy and phone number on hand; we have provided a space for this information as well. If such a situation arises, it is important that we speak to you directly, if possible. My pharmacy and phone number:

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MY PREGNANCY NOTES First Trimester

Month 1

Month 2

Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

When did you learn you were pregnant? How are you feeling? Any interesting cravings? What are you most excited about?

Second Trimester How are you feeling? How is everyone adjusting to your pregnancy? Have you started shopping for baby, what have you bought?

Third Trimester How are you feeling? Are you still getting around okay? How is the baby’s room coming along? How big is baby now?

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MY APPOINTMENTS TRACKER

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NGPG OB/GYN Braselton 1404 River Place, Ste. 303, Braselton, GA (770) 848-9335 NGPG OB/GYN Gainesville 1315 Jessee Jewell Pkwy., Ste. 200, Gainesville, GA (770) 219-9300 NGPG OB/GYN Cleveland 2578 Helen Hwy. Cleveland, GA (770) 219-9530 NGPG OB/GYN Dahlonega 1298 South Chestatee, Dahlonega, GA (706) 864-3400 NGPG OB/GYN Dawsonville 300 Dawson Commons Cir., Suite 310, Dawsonville, GA (706) 216-2345 NGPG OB/GYN Toccoa 274 Big A Rd., Toccoa, GA 706-886-3169

ngpg.org/ob/gyn/

Guide to a Healthy Pregnancy  
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