MAHEC New OB Patient Welcome Booklet 2020 (English)

Caring for You and Your Baby with Heart and Compassion

Women make the majority of healthcare decisions for the whole family. Just empowering a woman to think about her own health ultimately blossoms out into her family.

Dr. Beth Buys DIRECTOR

MAHEC DEPARTMENT OF OB/GYN

ABOUT OUR PRACTICE

MAHEC Ob/Gyn Specialists is a group practice offering complete obstetrical and gynecological care for women. Our approach focuses on personalized care plans that meet each woman’s changing needs throughout every stage of her life. With empathy and expertise, our physicians, nursemidwives, and nurse practitioners provide a full range of general and specialty care services to women in Western North Carolina. We demonstrate patient-centered care and clinical quality through streamlined referral processes and care coordination with referring clinicians, timely patient- and caregiver-focused care management, and continuous clinical quality improvement.

Pregnancy Overview and FAQ

FREQUENCY OF PRENATAL CARE

8-10 Weeks

10-28 Weeks

Initial prenatal appointment including lab work (blood work and testing for infections), education, orientation to the clinic, and scheduling of future prenatal appointments.

You will visit a provider every 4 weeks. If you are participating in Centering, you will see the same provider during each visit.

16-20 Weeks

You will be scheduled for your Anatomy Ultrasound.

28-36 Weeks

You will visit a provider every 2 weeks. If you are participating in Centering, you will see the same provider during each visit.

28 Weeks Lab work.

36 Weeks

You will visit a provider every week until the birth of your baby. If you are participating in Centering, you will see the same provider during each visit.

36 Weeks

Additional lab work.

Additional appointments may be scheduled if needed, including additional ultrasounds, lab work, or non-stress tests (NST).

WARNING SIGNS DURING PREGNANCY

If you experience any of the following, please call your provider.

• Excessive vomiting, unable to keep down any fluids

• Pain or burning with urination

• Fever or chills

• Bleeding or leaking of fluid from the vagina

• Blurry vision, or seeing bright flashing lights or stars

• Unusual or severe abdominal (stomach) pain or backaches

• Frequent, severe, and/or constant headaches

• Dizziness

• Swelling of face, hands, and feet

• Feelings of hopelessness, depression, or anxiety that do not improve over time, or you or one of your support persons are concerned about you

HOW TO CONTACT YOUR PROVIDER

Concerns or problems? Our staff and providers can be reached at 828-771-5500. You may call this number after hours, nights, weekends, and holidays and the answering service will page one of our providers to call you back if it is urgent .

WHAT DOES A CONTRACTION FEEL LIKE?

Everyone describes contractions differently because everyone’s perception is unique. Contractions may begin as a tightening sensation that starts in your lower back and comes around to the front of your pelvic area. Some expectant moms say that it feels like their baby balls up in their abdomen, making everything feel tight. Others may describe their contractions as very strong cramping that lasts longer than menstrual cramps.

How do I time contractions?

• Frequency (how often does it occur)

Time from the beginning of one contraction to the beginning of the next contraction.

• Duration (how long does it last)

Time from the beginning of one contraction to the end of that same contraction.

What do I do if I’m having contractions?

• If the contractions occur every 4 minutes, last for one minute, and happen for at least one hour, it is an indication of labor. Please proceed to the hospital.

• If the frequency and duration are unknown, measure the contractions for one hour and contact our office if they do not meet the above criteria.

Please contact our Triage Nurses at 828-771-5500 for any other questions related to contractions. They will evaluate the need for an appointment and can provide guidance.

Centering Pregnancy

WELCOME TO CENTERING

While traditional prenatal care is always an option at MAHEC Ob/Gyn Specialists, we also offer Centering Pregnancy—an evidence-based model of group prenatal care recommended by the American College of Obstetricians and Gynecologists based on studies that show group prenatal care can improve birth outcomes, patient education, social support, and patient satisfaction.

Our group approach gives families more time with dedicated providers to explore healthy pregnancy and parenting information in a supportive environment with families at similar stages in their pregnancy journey. We find families really enjoy the extra support they receive in our Centering Pregnancy groups, and we encourage you to give this evidence-based approach a try.

Centering Pregnancy includes a traditional health checkup with additional time and attention in a setting with other expectant parents. You’ll have your one-on-one healthcare checkup with your provider. Then, you will join other women, who are due near the same time, for shared discussion of all things related to pregnancy, birth, the postpartum period, and parenthood.

You might be interested in Centering if you want to…

• See the same providers your entire pregnancy

• Take part in your own healthcare

• Know your appointment times/days for the entire pregnancy ahead of time

• Reduce your risk of preterm delivery and low birth weight

• End long wait times

• Increase breastfeeding success

• Gain knowledge about: pregnancy, labor, delivery, and postpartum & newborn care

• Reduce your chances of a cesarean section

• Have snacks during your visits

QUESTIONS OR CONCERNS ABOUT CENTERING?

If you are interested in this model or care or would like to ask more specific questions, please feel free to reach out via email. One of our Centering Specialists would be happy to help you.

WHAT TO EXPECT WHEN CENTERING

Centering Pregnancy is a way for you to share learning and experiences with other pregnant women and to be involved in your own care. At your first prenatal appointment, you will receive a schedule of 12 appointments which make up your pregnancy care. You may choose the day and time of your visits. Your providers will remain the same throughout your pregnancy.

What information is shared with other members?

Only the information you are comfortable sharing will be shared with the other women. Private information/concerns will be kept confidential.

What if I have a high-risk condition?

Some patients with “high-risk” conditions can still be in Centering. These patients may need a few extra appointments for extra ultrasounds or counseling visits related to their conditions. Ask your provider if you are a candidate.

Who can I bring?

If you choose to bring a support person, you can, but it is not required. This should be time for you to enjoy your pregnancy with this baby, so please refrain from bringing other children. We can provide information about childcare options if needed.

How can I be sure that my medical information is kept confidential in group?

Confidentiality is very important to us at MAHEC. Every participant will agree to keep shared information private and signs an agreement to do so.

Does MAHEC provide childcare?

MAHEC does not have the ability to provide childcare. However, the YWCA on South French Broad Avenue does offer Empowerment Childcare, which is available specifically to allow you to attend your medical appointments. Please contact Alesia Summey, Director of Empowerment Childcare, at ecc@ywcaofasheville.org or 828-254-7206, ext. 113.

What if I have very private concerns or need an exam?

No worries! If you need an exam or request extra privacy, you will be escorted to a private exam room to ensure your comfort.

Pregnancy Care Management

PREGNANCY CARE MANAGEMENT THROUGH COMMUNITY CARE OF WESTERN NORTH CAROLINA (CCWNC)

Pregnancy Care Management services are available to pregnant women enrolled in North Carolina Medicaid statewide, and to a limited number of low income, uninsured pregnant women in some counties. Pregnancy Care Managers are registered nurses or social workers who will work with you and your prenatal care provider to ensure you receive the best possible care while you are pregnant and after you deliver your baby. Our goal is to help you have a healthy pregnancy and a healthy baby.

Your Pregnancy Care Manager can help you by:

• Going over your prenatal care provider’s plan for a healthy pregnancy

• Coordinating your care across all of your providers

• Helping you get the important services you need, like medical care, transportation, food, or stable housing

• Referring you to other programs, like childbirth or breastfeeding education classes, family planning, and the Women, Infants and Children (WIC) nutrition program

• Offering ways for you to take care of yourself during pregnancy

• Providing assistance in managing any medications you may be taking

• Meeting with you after you have been in the hospital or the emergency room

• Making follow-up appointments

• Answering your questions

Over-the-Counter Medications

WHICH OVER-THE-COUNTER MEDICATIONS ARE SAFE IN PREGNANCY?

As a rule, most care providers recommend no medicines (prescription or over-the-counter) during pregnancy, other than vitamins and iron supplements. Some medicines may need to be continued to keep you and your baby safe, such as medicines to control breathing or seizures. Talk to your provider (physician, nurse practitioner, midwife, or pharmacist) about all of the medicines you take.

The most sensitive time of development for your baby is in the first trimester (the first 12-13 weeks). Avoid any medicines unless your provider says it is okay during the first trimester. Many over-the-counter medicines are safe for minor symptoms. If you ever have any concerns about using a medicine or supplement, talk to your provider before starting the medication. If you use a medicine, try to use the lowest dose for the shortest time possible.

General Recommendations

• Avoid alcohol, tobacco, caffeine, and recreational drug use—including marijuana

• Check all medication labels to make sure the active ingredient is safe

• Avoid combination products that contain many different medicines in one pill

• Always take your prenatal vitamin and 600-800 mcg folic acid

• Some medicines may be safe during pregnancy but not safe during breastfeeding

You should schedule an appointment with your provider if:

• Your symptoms last more than 3-5 days after treatment

• Your symptoms are severe

• These medications cause side effects

• You are unsure what you should take

FOR ACHES, PAINS, OR HEADACHES

TRY FIRST

• Injuries: Rest, elevation, compression, and hot or cold therapy

• Headache: Rest, avoid bright lights, and drink plenty of water

SAFE TO USE

• Acetaminophen (Tylenol®) 325 mg up to 4 times a day

GENERALLY AVOID

• Naproxen (Aleve®) and Aspirin (Ecotrin®)

• Aspirin could be used for other reasons—only take this medicine if your doctor says it is okay

UNSAFE

• Ibuprofen (Advil®)

FOR NAUSEA, VOMITING, OR HEARTBURN

TRY FIRST

• Eat smaller, more frequent meals or high-carbohydrate, high-protein meals

• Ginger (up to 1 g daily) or cold drinks

• Eat a few crackers before getting out of bed in the morning

• Avoid hunger, spicy foods, or food with strong smells

SAFE TO USE

• Heartburn: Calcium carbonate (Tums®) 150 mg (up to every 12 hours)

• Morning Sickness: Pyridoxine (Vitamin B6) 10-25 mg every 8 hours with doxylamine (Unisom®) 25 mg at bedtime (up to every 8 hours). This medicine can make you tired.

• If Symptoms Continue: Ask your doctor if one of these medicines are safe for you: Omeprazole (Prilosec®), Esomeprazole (Nexium®), or lansoprazole (Prevacid®)

UNSAFE

• Alginic acid, Sodium bicarbonate (baking soda), or Aluminum/magnesium hydroxide

FOR CONSTIPATION

TRY FIRST

• Exercise, drink plenty of water, and increase dietary fiber (whole grains, nuts, and fruits like prunes)

SAFE TO USE

• Bulking agents (Psyllium), Polyethylene glycol (Miralax®), or a stool softener such as Docusate (Colace®). These medicines may take several days to start working. Drink plenty of fluids while using them.

GENERALLY AVOID

• Senna or Bisacodyl (Dulcolax®)

UNSAFE

• Mineral oil or Castor oil

FOR DIARRHEA

TRY FIRST

• Drink plenty of water and avoid spicy or fatty foods

UNSAFE

• Loperamide (Imodium®) or Bismuth subsalicylate (Pepto-Bismol®)

• If diarrhea is severe, your doctor may prescribe one of these medicines—do not use without doctor supervision

FOR COUGH OR SORE THROAT

TRY FIRST

• Hydration, hard candy, salt water gargle, fruit juices, or hot tea with lemon

SAFE TO USE

• Acetaminophen (Tylenol®) 325 mg up to 4 times a day

• Guaifenesin ER (Mucinex®) 600-1200 mg every 12 hours as needed

• Dextromethorphan (Delsym®) 10 mL every 12 hours as needed

GENERALLY AVOID

• Combination products

UNSAFE

• Products that contain alcohol (Robitussin®) or codeine

FOR RUNNY NOSE OR CONGESTION

TRY FIRST

• Saline nasal spray, nasal strips (Breathe Right®), or using a humidifier

SAFE TO USE

• Chlorpheniramine: ChlorTabs® 4 mg every 4 hours as needed (do not use in the last two weeks of pregnancy). This medicine could make you drowsy or sleepy.

• Non-drowsy Allergy Medicines: Cetirizine (Zyrtec®) 10 mg daily or Loratidine (Claritin®) 10 mg daily

• Nasal Sprays: Budesonide (Rhinocort®) 1 spray in each nostril daily or Luticasone (Flonase®) 1-2 sprays in each nostril daily

GENERALLY AVOID

• Combination products

UNSAFE

• Decongestants, such as pseudoephedrine (Sudafed®), phenylephrine (Sudafed PE®) or oxymetalozine (Afrin®)

• Brompheniramine

Physical Activity and Weight Gain

PHYSICAL ACTIVITY

The Centers for Disease Control and Prevention recommend that pregnant women get at least 150 minutes of moderate-intensity aerobic activity every week.

• If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as 5 minutes a day. Add 5 minutes per day each week until you can stay active for 30 minutes a day.

• If you were very active before pregnancy, you can keep doing the same workouts with your healthcare professional’s approval. 30 Minutes Per Day

It is important to discuss exercise with your obstetrician or other member of your healthcare team during your early prenatal visits.

Remember: Physical activity during pregnancy does not increase your risk of miscarriage, low birth weight, or early delivery.

HEALTHY WEIGHT GAIN

Recommendations for weight gain during pregnancy are dependent on your Body Mass Index (BMI) before pregnancy. BMI is a measurement based on your weight to height ratio.

• Underweight: BMI below 18.5

• Normal weight: 18.5 to 24.9

• Overweight: 25.0 to 29.9

• Obese: 30.0 and above

Weight gain recommendations for full term pregnancy are as follows:

• Underweight: 28 to 40 pounds

• Normal: 25 to 35 pounds

• Overweight: 15 to 25 pounds

• Obese: 11 to 20 pounds*

Normal Weight Gain = 25 to 30 Pounds

*For a pregnant woman with BMI 30 or above who is gaining less weight than recommended but has an appropriately growing fetus, no evidence exists that encouraging increased weight gain will improve maternal or fetal outcomes.

Nutrition Basics

MAINTAIN A BALANCED DIET

1st Trimester: no additional calories

2nd Trimester: 340 additional calories per day

3rd Trimester: 450 additional calories per day

• Whole Grains: Breads, cereals, pastas and brown rice.

• Fruits: All types of fruits—fresh, frozen or canned—without added sugars.

• Vegetables: Eat a variety of colorful vegetables—fresh, frozen or canned—with no added salt. Raw sprouts should be avoided.

• Lean Protein: Choose lean protein from meat, poultry, fish, eggs, beans, peas, peanut butter, soy products and nuts. Pregnant women should avoid eating tilefish, shark, swordfish and king mackerel, and limit white (albacore) tuna to 6 ounces per week. Deli, luncheon meats and hot dogs should be reheated if consumed.

• Low-fat or Fat-free Dairy: This includes milk, cheese and yogurt. Unpasteurized milk and some soft cheeses that are made from unpasteurized milk should also be avoided.

• Healthful Fats: From foods such as avocados, nuts and seeds as well as vegetable oils such as canola and olive oil.

Avoid extra calories from added sugars and solid fats, which can lead to unhealthy weight gain. Cut down on foods such as regular soda, sweets and fried snacks.

CONSUME IMPORTANT NUTRIENTS

• Reduces the risk of birth defects

• Pregnant women/women of childbearing age require at least 400 micrograms per day

• Natural food sources of folate include legumes, green leafy vegetables, citrus fruits, fortified foods such as cereals, pastas and bread as well as supplements

• Most common nutritional deficiency during pregnancy

• Pregnant women require at least 27 milligrams per day

• Foods with high and moderate amounts of iron include red meat, chicken and fish, fortified cereals, spinach, some leafy greens and beans

• For women who do not eat meat, combine plant-based sources of iron with vitamin C-rich foods (e.g. spinach salad with mandarin oranges or cereal with strawberries)

• Needed for the healthy development of a baby’s teeth, bones, heart, nerves and muscles

• The recommended daily amount of calcium during pregnancy is 1,300 milligrams per day for adolescents 14 to 18 years old, or 1,000 milligrams per day for women aged 19 to 50

• Milk, yogurt, and cheese are rich natural sources of calcium. Nondairy sources include vegetables, such as Chinese cabbage (bok choy), kale, and broccoli

A prenatal vitamin or mineral supplement can help ensure that you consume enough folic acid, iron, calcium and other nutrients.

Information sourced from the Academy of Nutrition and Dietetics

Foods to Avoid During Pregnancy

GUIDELINES FOR A SAFE AND HEALTHY PREGNANCY OUTCOME

Because pregnancy affects your immune system, you and your unborn baby are more susceptible to the bacteria, viruses, and parasites that cause foodborne illness. Even if you don’t feel sick, Listeria and Toxoplasma can infect your baby and cause serious health problems. It would be wise to invest in a food thermometer to check the temperatures of cooked food prior to consumption. Your baby is also sensitive to toxins from the food that you eat, such as mercury found in certain kinds of fish. Keep this list handy to ensure that you and your unborn baby stay healthy and safe!

DO NOT EAT REASON WHAT TO DO

Soft cheeses with unpasteurized milk (Brie, feta, Camembert, Roquefort, queso blanco, queso fresco, etc.).

Raw cookie dough or cake batter.

Unpasteurized milk

May contain E. coli or Listeria. Eat hard cheeses, such as cheddar or Swiss. Read the label and make sure that it’s made from pasteurized milk.

May contain Salmonella. Bake the cookies and the cake, but don’t lick the spoon!

May contain harmful bacteria such as Campylobacter, E. coli, Listeria, or Salmonella.

Drink pasteurized milk.

Unpasteurized juice or cider, including fresh-squeezed.

Packaged deli salads such as ham salad, chicken salad, egg salad, tuna salad, seafood salad, etc.

Raw or undercooked sprouts such as alfalfa, clover, mung bean, and radish.

Raw shellfish , like oysters and clams.

Raw or undercooked fish , especially sushi.

Certain fish: King mackerel, marlin, orange roughy, swordfish, shark, tilefish (Gulf of Mexico) and tuna (big eye).

Fish you or others have caught from streams, rivers, and lakes that are under fish advisories.

May contain E. coli. Drink pasteurized juice. Bring unpasteurized juice or cider to a rolling boil and boil for at least 1 minute.

May contain Listeria. Make salads at home, following the food safety basics: clean, separate, cook, and chill.

May contain E. coli or Salmonella. Cook sprouts thoroughly.

May contain Vibriobacteria. Cook shellfish to 145° F.

May contain parasites or bacteria. Cook fish to 145° F.

Contain high levels of mercury, but there are many other choices of fish that have lower levels of mercury.

May contain unsafe levels of mercury or other contaminants.

Use the seafood advice on the next page for 36 “best choices” and 19 “good choices” to eat while pregnant.

Check state advisories for fish in your area and find out how often you can safely consume them.

BE CAREFUL OF REASON WHAT TO DO

Deli-style meat and poultry such as hot dogs, luncheon meats, cold cuts, fermented or dry sausage, etc.

Eggs and pasteurized egg products.

May contain Listeria. Even if the label says that the meat is pre-cooked, reheat these meats to steaming hot or 165° F before eating.

Undercooked eggs may contain Salmonella.

Cook eggs until yolks are firm. Cook casseroles and other dishes containing eggs or egg products to 160° F.

Eggnog

Homemade eggnog may contain uncooked eggs, which may contain Salmonella.

Make eggnog with a pasteurized egg product or buy pasteurized eggnog. When you make eggnog or other egg-fortified beverages, cook to 160°F.

Fish May contain parasites or bacteria. Cook fish to 145° F.

Homemade ice cream

Homemade ice cream may contain uncooked eggs, which may contain Salmonella.

Make ice cream with a pasteurized egg product safer by adding the eggs to the amount of liquid called for in the recipe, then heating the mixture thoroughly.

Meats such as beef, veal, lamb, and pork (including ground meat). May contain E. coli if undercooked. Cook beef, veal, and lamb to 145° F. Cook pork to 160° F. Cook all ground meats to 160° F.

Meat spread or pâté

Poultry and stuffing , including ground poultry products.

Smoked seafood

Unpasteurized refrigerated pâtés or meat spreads may contain Listeria.

Undercooked meat may contain bacteria such as Campylobacter or Salmonella.

Refrigerated versions are not safe, unless pre-cooked to 165° F.

ADVICE FOR EATING SEAFOOD

Eat canned versions, which are safe.

Cook poultry to 165° F. If the poultry is stuffed, cook the stuffing to 165° F. Better yet, cook the stuffing separately.

Eat canned versions, which are safe, or cook to 165° F.

Fish, shellfish, and other protein-rich foods can help your child’s growth and development. The nutritional value they provide is important before birth, in early infancy for breastfed infants, and in childhood. Understanding which fish to eat—and how often—is key to a healthy diet.

BEST CHOICES (2-servings per week)

OR GOOD CHOICES (1 serving per week)

Anchovy, Atlantic Croaker, Atlantic Mackerel, Black Sea Bass, Butterfish, Catfish, Clam, Cod, Crab, Crawfish, Flounder, Haddock, Hake, Herring, Lobster (American and spiny), Mullet, Oyster, Pacific Chub Mackerel, Perch (freshwater and ocean), Pickerel, Plaice, Pollock, Salmon, Sardine, Scallop, Shad, Shrimp, Skate, Smelt, Sole, Squid, Tilapia, Trout (freshwater), Tuna (canned light), Whitefish, and Whiting.

Bluefish, Buffalofish, Carp, Chilean Sea Bass or Patagonian Toothfish, Grouper, Halibut, Mahi Mahi or Dolphinfish, Monkfish, Rockfish, Sablefish, Sheepshead, Snapper, Spanish Mackerel, Striped Bass (ocean), Tilefish (Atlantic Ocean), Tuna (albacore, white tuna, canned tuna, and fresh/frozen), Tuna (yellowfin), Weakfish or Seatrout, and White Croaker or Pacific Croaker.

Managing Nausea and Vomiting

Instead of several large meals each day, try eating small frequent meals that consist of easy-to-digest carbohydrates, low fats, and proteins.

Some foods are tolerated better than others. Aim to consume some of the following:

• Starchy foods such as sweet potatoes, brown rice, whole grain cereals and bread, whole wheat pasta, crackers, and toast

• Fresh fruits and vegetables

• Peanut butter, cheese, yogurt, and cottage cheese

• Nuts, seeds, or other salty snacks

• Ginger snaps and lemon water can greatly reduce symptoms of nausea

Avoid skipping meals as hunger can make nausea worse.

Before getting out of bed, try eating dry crackers or peanut butter crackers. Move slowly when getting up. 4

Consuming cold fluids and foods can help combat nausea. 5

Avoid foods that are hot or have strong aromas, as well as foods that are spicy or fried. Common foods that can cause nausea include:

• High fat foods like French fries, gravies, pizza, and certain casseroles

• Gas-producing foods such as cauliflower, broccoli, cabbage, and beans

• Processed meats such as hot-dogs, bologna, salami, and sausage

• Processed sweets such as candies, cookies, or sweet teas

Hydration is key, but aim to drink fluids (mainly water or water with lemon) 20 minutes before or 20 minutes after eating. This will prevent feelings of fullness and reduce the potential for vomiting during meal times.

With frequent vomiting, the addition of an electrolyte drink for rehydration may be beneficial. The best sources are Pedialyte, Gatorade, and G-2.

Avoid triggers such as stuffy rooms, odors (perfume, food, smoke), heat and humidity, and visual or physical motion (visually over stimulating or moving too quickly).

Light activity each day—such as walking, yoga, stretching, and breathing exercises—can help control nausea.

Sniffing freshly cut lemons or ginger can help control nausea. Drinking ginger drinks or water with lemon can help settle your stomach as well.

Over the counter medications to ease feelings of nausea include:

• Vitamin B6 one 25mg tablet 3 times a day

• One 250mg Ginger tablet four times a day

• Unisome (doxylamine), taking one at bedtime and one-half tablet at midmorning and midafternoon as needed

If nausea and vomiting have not improved after you have tried these recommendations for 3-4 days, please call your care provider at 828-771-5500.

Mood and Anxiety Disorders

FACTS ABOUT PERINATAL MOOD AND ANXIETY DISORDERS

Perinatal Mood and Anxiety Disorders have been identified in pregnant and postpartum people of every culture, age, gender presentation, income level and race, and do not usually resolve without treatment. About 10% of new partners have mood or anxiety problems, as well.

Many factors increase risk of developing a perinatal disorder, including: history of depression and/ or anxiety, or other mental health diagnosis, partner conflict, living alone, limited social supports, pregnancy as a teenager, history of miscarriage, and other major life stressors.

You are not alone. You are not to blame. With help, you will be well.

TYPES OF PERINATAL MOOD AND ANXIETY DISORDERS

Depression/ Anxiety in Pregnancy:

15-20%

It is estimated that 15-20% of pregnant people will experience symptoms of depression and/or anxiety.

Postpartum Depression:

15%

PPD is different than the “Baby Blues,” which occurs in 80% of women and disappears within 2 weeks following birth. PPD includes feelings of anger, fear, guilt, and/or lack of interest in the baby; appetite and sleep disturbance; difficulty concentrating/making decisions; and possible thoughts of harming the baby or oneself. Without help, perinatal depression can have long-term negative effects on the parent and the child.

11%

Postpartum Panic Disorder: Feeling very nervous, recurring panic attacks (shortness of breath, chest pain, heart palpitations), and many worries or fears.

Postpartum Obsessive-Compulsive Disorder: Obsessions (persistent thoughts or mental images related to the baby), Compulsions (doing things over and over to reduce the fears and obsessions), and a sense of horror about the obsessions. These parents know their thoughts are bizarre and are very unlikely to ever act on them.

Postpartum Post-traumatic Stress Disorder: Traumatic childbirth experience with a re-experiencing of the trauma (dreams, thoughts, etc.), avoidance of stimuli associated with the event (thoughts, feelings, people, places, details of event, etc.), and persistent increased arousal (irritability, difficulty sleeping, hypervigilance, exaggerated startle response, etc.).

0.1%

Postpartum Psychosis: Very rare (about 1 in 1000 births). The onset is usually sudden, within the first 4 weeks, with symptoms including: delusions (strange beliefs) and/or hallucinations, irritation, hyperactivity, decreased need for sleep, and significant mood changes with poor decision-making. There is a 5% infanticide/suicide rate associated with psychosis and thus immediate treatment is imperative.

Treatment is safe for pregnancy and nursing, and we have a team here in the clinic that can help!

IF YOU ARE EXPERIENCING OR WORRIED ABOUT ANY OF THE ABOVE

Please contact Natasha Harvey at 828-771-3613 or tell your provider.

Project CARA

SUBSTANCE USE DISORDER CLINIC

Our goal is to provide you with the best care possible in a safe, supportive, and judgement-free environment.

Our Ob/Gyn care team, working alongside our substance use treatment providers, will meet you wherever you are in your drug use, recovery, or parenting. Our team is here to support you.

If you are pregnant, whether planned or unplanned, we know you want the best care for your child. We want that too. We also want you to have the best care possible and to know that you are worthy of it.

COMPASSIONATE, COMPREHENSIVE, AND CONVENIENT CARE

Project CARA—Care that Advocates Respect, Resiliency, and Recovery for All—makes it easy for you to get the quality care you deserve.

If you are pregnant, we’ll take good care of you and your baby through:

• Regular checkups and tests to ensure you and your baby are healthy

• Substance use and mental health counseling

• Treatment with medication (buprenorphine), if desired, to reduce or stop opioid craving and withdrawal symptoms

• Support from team members who are in long-term recovery from substance use

• Help accessing resources including housing, food, and transportation

• Support for quitting smoking, if desired

• Free legal consultation for bills, insurance, or other challenges, if needed

• Labor and delivery support in the hospital

PLEASE NOTIFY YOUR MEDICAL TEAM

if you have a substance use disorder so we can ensure you are connected with the resources you deserve.

Breastfeeding Support

FINDING SOLUTIONS TO COMMON PROBLEMS

The mission of the MAHEC Breastfeeding Clinic is to serve the women of Western North Carolina with thorough diagnosis and treatment options when ongoing pain is affecting breastfeeding. It is not necessary to be a MAHEC patient to be seen at the Breastfeeding Clinic.

Our team of healthcare providers serves breastfeeding women in Western North Carolina who are having issues with:

• Chronic mastitis (infection of the breast)

• Cracked and/or infected nipples

• Deep breast or nipple pain with latch

We provide consultation for patients having concerns with positioning and latch-on and milk supply.

Our multidisciplinary staff will work with you and your support team to find a solution and help you reach your breastfeeding goals.

PREPARING FOR YOUR VISIT

At your first appointment we ask that you bring any supplies with you that you would usually use while breastfeeding such as pillows, a Boppy, and any medications or creams you have been using including herbal products. Please plan on an extended appointment time for your first visit.

You may see any or all of the following in addition to your provider: an intake nurse, a lactation consultant, and a counselor. This visit may take 1-2 hours. Devoting this amount of time to the appointment will allow us to provide you with the best possible care.

TO MAKE AN APPOINTMENT

F or an appointment, call 828-771-5500 and ask for an appointment with the Breastfeeding Clinic. No referral needed.

Women, Infants, and Children (WIC)

WHAT IS WIC NUTRITION PROGRAM?

Women, Infants, and Children (WIC) Supplemental Nutrition Program is designed to improve the health and well-being of low-income pregnant, breastfeeding, and postpartum women, infants, and children up to age five who are at nutritional risk by providing:

• Nutrition education

• Breastfeeding education and support

• Referrals for healthcare

• Free language assistance

HOW DO I BECOME PART OF THE PROGRAM?

If you qualify for Medicaid or Food Assistance, you will automatically qualify for WIC. You will need to bring the following information for each family member that is applying for WIC:

(Bring One)

• Current driver’s license

• Social Security card

• Work/school ID

• Medicaid card

• Military ID

• Birth Certificate

• Immunization record

(Bring One)

• Recent bills (electric, gas, cable, or phone)

• Current rent or mortgage agreement

• Current driver’s license

Note: Immunization records must be brought to the first appointment for all infants and children up to age 5.

(Bring One)

• Current Medicaid card

• Letter of certification from Food and Nutrition Services

• Last paycheck stub

• Letter from job with gross income and how often you are paid (if self-employed, recent tax return)

Financial Services Information

UNINSURED PATIENT POLICY

Any uninsured (self-pay) patient will automatically receive a discount of 75% off all facility charges.

• Patient will be asked to pay 50% of the remaining balance as a down payment for any elective/non emergent services. If patient is unable to pay deposit, the ordering provider’s office will be contacted and asked to reschedule or cancel the procedure until the patient is able to pay deposit.

• Patient will be eligible to apply for financial assistance on the remaining balance after the services have been billed.

HIGH DEDUCTIBLE POLICY

Patients with high deductibles will not be required to pay a percentage down prior to services rendered.

• Services/procedures will not be rescheduled or canceled due to lack of deposit being paid.

• Patient will be eligible to apply for financial assistance on the remaining balance after services have been billed.

Pregnancy-related services including surgeries, deliveries, and ultrasounds will not be cancelled or rescheduled due to failure to pay uninsured deposit or financial obligations.

FINANCIAL SERVICES INFORMATION

For more information on what services are available, visit www.missionhealth.org/financial-services or call 828-213-9634.

PLEASE NOTE

If you are scheduled for services at Mission facilities, expect a call from Mission Pre-Access Services prior to the procedure to go over registration and any financial obligations. Calls that are not answered or returned could result in the services being postponed or canceled.

Patient Financial Advocates

WHAT THEY DO

Our Patient Financial Advocates (PFAs) assist our patients in making informed decisions regarding the financial aspect of their healthcare. They work with patients to set up payment arrangements and to utilize other resources, such as our MAHEC Charity Care Program and outside agencies (like the Department of Health and Human Services) to assist those who do not have the financial resources to meet their healthcare obligations. Our PFAs are available to speak to patients in person before or after their appointment and by phone.

WHAT DO I NEED?

Medicaid:

FINANCIAL OPTIONS INCLUDE:

• Medicaid for pregnant women

• Medicaid Family Planning Waiver

• Presumptive Medicaid for pregnant women

• Charity Care

• Payment plans

• ACA marketplace insurance

• ID (The caseworker processing the application will contact the patient and request any additional documentation.)

Charity Care:

• Two most recent paystubs or a letter from your employer

• Identification/address verification (driver’s license, utility bill, employment ID, or other)

BILLING QUESTIONS

If you have a question about your bill, please call our Billing Department at (828) 257-4725 and follow the prompts to navigate to the billing specialist for your insurance/self-pay type. Our billing specialists are available Monday through Friday from 7:30am until 5:30pm. The confidentiality of your healthcare information is important to MAHEC. Federal and state law requires our staff to verify that we are speaking with the patient or a documented designee of the patient.

If you are unable to pay your bill in full, please call to speak with a Patient Financial Advocate:

Office Hours: Monday–Friday, 8:30 am–4:00 pm

24/7 Call Answering Service: 828-771-5500