• Your provider will ensure you are not having any concerning symptoms and will answer any questions you have. It’s a great idea to write down your questions between appointments and bring them with you so you don’t forget them!
• When you get further into your pregnancy (starting around 20 weeks), your abdomen will be measured to ensure your uterus is growing appropriately.
• Your provider will always listen for, or try to see via ultrasound, your baby’s heartbeat at your appointments.

Your copay will vary based on your insurance plan. The amount that you will be responsible for is determined by your particular insurance plan (deductible, co-pay, co-insurance, etc.) and the contracts that they process by.

For an estimate of what your out-of-pocket costs will be, please contact your insurance company directly (number located on the back of insurance card.) An estimate of charges can be provided by contacting the OB-GYN clinic at 360.299.4212.

• You will be seen in clinic every 4 weeks until you are around 28 weeks gestation. This may be more frequent depending on your risk factors.
  • After your first OB appointment, you will complete all your standard pregnancy labs.
  • At 10 weeks and beyond, you can have cell-free (cf) DNA testing completed for genetic screening.
  • At 15-20 weeks, you can have a quad screen completed for genetic screening if your insurance doesn’t cover cfDNA.
  • Your anatomy ultrasound will be completed at 18-20 weeks gestation
  • At 25–28 weeks, you will complete your gestational diabetes testing with a glucola test.
• From 28 weeks until 35–36 weeks, you will be seen every 2 weeks.
  • At 36 weeks, your Group B Strep swab will be completed.
• From 35–36 weeks and until you deliver, you will be seen every week.
  • You can discuss the need for cervical exams with your provider.

Refer to this handout on creating a safe sleeping environment for your baby.

• Island Health offers convenient and affordable childbirth education classes! Learn more at: https://islandhealth.org/classes/
• If Island Health’s birthing classes don’t work with your schedule, many area hospitals offer childbirth classes. What is important is that you and your partner choose a class that you can both attend together so that you’re both getting the same information, even if that means you choose an online class.

We recommend the following vaccines while pregnant. They have all been researched and are safe to obtain during pregnancy.

https://www.acog.org/womens-health/infographics/vaccines-during-pregnancy

• Flu vaccine (available in clinic or your pharmacy) – Receive during the flu season.
• COVID vaccine (available at local pharmacies) – An updated booster is recommended for each pregnancy.
• Tdap vaccine (available at local pharmacies) – Recommended in the third trimester (>28 weeks). Immunity is passed to your baby to protect them prior to them getting their first DTaP vaccine.
• RSV vaccine (available at local pharmacies) – This alleviates the need to vaccinate the baby after they are born, as immunity is passed to your baby. Recommended between 32–36 weeks of pregnancy.

Refer to this document for pregnancy-safe over-the-counter medications.

• Prenatal vitamins are recommended for all pregnant women to help support your pregnancy and support the formation of your baby’s nervous system.
• Prenatal vitamins should have at minimum 400mcg of folic acid. (If you find a vitamin that states it contains folate, which breaks down into folic acid, that should be at least 700mcg of folate or 700mcg DFE.) Your provider will tell you if you need a vitamin with more.
• Your vitamin should also contain iron. Very few women eat enough iron in their diet to prevent anemia during pregnancy.
• There is not a specific brand that we recommend, but if you have special needs (such as difficulty swallowing large pills or prefer a vegan-friendly vitamin), the OB intake nurse can help with some suggestions.
• Vitamins may make your nausea worse. If this is an issue, you can try taking them at night or with food, or transition to gummy vitamins.

Spotting can be normal in pregnancy, usually it is caused by sexual activity or vigorous exercise. In this case, a small amount of spotting within a day or two is the amount expected, it comes from the surface of the cervix and is very common and normal. If you have bright red bleeding or if you are passing clots or tissue, please call us right away.

• Constipation is very common in pregnancy. Try to focus on eating high fiber foods, and drinking plenty (significantly more than usual!) of water. If you need to, you can take a fiber supplement. You can try dried fruits and smooth-move tea as well.
• If you are still constipated, Miralax and Docusate are safe. Dulcolax and Senna are safe for shorter durations (<2 weeks).

• Cramping can be normal in pregnancy. Often it is the way that the body asks for attention.
• If you need to use the restroom but have been “holding it,” that often causes cramps. Dehydration, overexertion and constipation also cause cramping. Some women also start to cramp when they have been either sitting or on their feet for too long. If you give your body what it is asking for and the cramps go away, this is normal.
• Round ligament pain is also common. It typically starts in the groin and then radiates up into the abdomen, usually to one side. It is worse when rolling over or standing quickly. Stretching and heat (heating pad, shower/bath) can help with this.
• Menstrual-type cramping should be monitored. Ensure you are drinking adequate water. If you are having regular tightening of your abdomen with cramping pain more than once every 10–15 minutes and you are less than 36 weeks gestation, please call us.

• Focus on eating many smaller snacks/meals throughout the day. Frequently having some food in your stomach can help with nausea.
• If you are most nauseated when you first wake up, try to eat a bedtime snack that is mostly fat and/or protein like cheese, eggs, nuts or avocados.
• Ginger and peppermint can be very helpful as well as teas, gum or candies. For ginger ale, check the ingredients to make sure that it actually contains ginger—artificial flavoring will not help.
• If that’s not enough, try taking vitamin B6 and doxylamine (the generic form of the sleep aid Unisom) up to three times/day. Do not take this and drive, if you find it sedating.
• If your nausea persists, talk to your provider about prescription options.

• Focus on eating smaller snacks/meals throughout the day.
• Try not to lay down within an hour of your last meal.
• Even though this sounds odd, many pregnant women’s heartburn improves by adding more acid to their diet, using things like citrus fruits, tomatoes and vinegars (i.e., apple cider vinegar, vinaigrette salad dressings, pickles, etc.).
• You can safely take Tums, Rolaids or Maalox. If you prefer to stick with food items, baking soda and warm water will also work.
• If that’s not enough, try Pepcid.
• If you are still experiencing symptoms, please talk with your provider.

• It is very normal to have more than your usual amount of vaginal mucus/discharge (particularly in the 3^rd trimester).
• Please let us know if the discharge has a bad smell or if you are having pain, itching or swelling in your vaginal area. You may need some extra testing.

No need to panic, or call!  This will naturally happen, but does not mean you are going into labor. You can simply flush it down the toilet. Feel free to let your OB know at your next appointment.

• Back pain can be very common in pregnancy, particularly in the 3rd trimester.
• We recommend starting with some basic stretches to help (cat/cow, child’s pose, opposite hand to knee) and heat (heating pad or bath/shower) to help.
• Tylenol is safe to take, if needed.
• Some patients find “pregnancy bands” or “belly bands” very helpful.
• If your pain is worsening, or starting earlier in pregnancy, please talk with your provider. Sometimes osteopathic manipulative treatment, acupuncture/dry needling or physical therapy can be helpful.

• Swelling can be normal in pregnancy, but can sometimes be concerning.
• Gradually increasing swelling, particularly in the 3^rd trimester, that improves with leg elevation is generally safe. Compression socks can be very helpful.
• If you are having facial and upper body swelling accompanied by headache, vision changes or right upper quadrant abdominal pain, please call.
• If you have been asked by your provider to specifically monitor for swelling, please let us know if it is worsening.

• Dizziness can be common in pregnancy, and one of the best ways to avoid this is by staying well hydrated.
• Gauge your water intake based on your urine color. Your urine should be light yellow to clear in color.

• For a list of foods to avoid during pregnancy, visit: https://www.foodsafety.gov/sites/default/files/2019-05/food-safety-infographic-pregnant-women.jpg

• Fish provide key nutrients that support brain development. Choose a variety of fish that are lower in mercury. This list provides a great overview of which fish are best to eat during pregnancy: https://www.fda.gov/media/102331/download?attachment

• Try to limit your caffeine consumption to less than 200mg/day. This is about 1–2 cups of coffee daily or 3–4 cups (using tea bags) of black tea.
• Please limit yourself to coffee and tea for caffeine and avoid energy drinks. Many energy drinks have more caffeine than is safe to drink while pregnant, and they may also contain herbal ingredients that are not safe to use in pregnancy.

• Island Health’s offers several nutrition classes throughout the year: https://islandhealth.org/classes/
• Check out these tips from the Office of Disease Prevention and Health Promotion to eat healthy during pregnancy and breastfeeding: https://www.dietaryguidelines.gov/sites/default/files/2021-12/DGA_Pregnancy_FactSheet-508c.pdf