TO OUR PREGNANT PATIENTS

We are happy and privileged to be providing your pregnancy care. What follows is a description of the routines of prenatal care in our office as well as answers to some of the most commonly asked questions.

 

 

SCHEDULE OF VISITS

At each visit we will check weight gain, blood pressure, urine for signs of infection, ask questions about any symptoms of premature labor, answer any questions you have, examine the uterine size and fetal heart tones.

First OB visit (6-8 weeks- please note that this is counted from the first day of your last menstrual period; this is called your "gestational age"). We prefer to bring our patients in to formal pregnancy care as soon as the pregnancy test is positive. Starting OB care early can relieve many anxieties and some complications can be prevented. We have a lengthy questionnaire for you to complete. Please be patient! The information is very important for care of you and your pregnancy. Please complete the questionnaire and bring it with you for your first appointment - or earlier if possible.

Second OB visit (10-12 weeks). This visit is important to be able to check for the baby's heart beat "fetal heart tones".

Third OB visit (15-18 weeks). Any prenatal labs that have not been done will be drawn at this visit (see below).

Fourth OB visit (20-22 weeks). We will review all lab results. We will want to confirm the date you first were sure you felt the baby moving.

Fifth OB visit (24-28 weeks). We will test for "gestational diabetes" or pregnancy associated diabetes.

Sixth OB visit (28-30 weeks). If you are Rh negative, we will check again to see if you have become sensitive to Rh positive blood during this pregnancy. If you have not, then we will give you a injection to prevent you from becoming sensitized during the third trimester, a higher risk time.

Seventh OB visit (30-32 weeks).

Eighth OB visit (34 weeks).

Ninth OB visit (36 weeks).

Tenth through thirteenth (or more if necessary) visits are scheduled weekly from 37 weeks until delivery. During this last trimester we focus on answering any questions that you have about labor delivery, hospital care, infant feeding and care, and birth control after this pregnancy. Fetal growth (size of the uterus) and fetal position are important during the third trimester as well as changes in maternal health - blood pressure, swelling and management of any complications of pregnancy are intensively managed through this time.

ROUTINELY RECOMMENDED PRENATAL LAB TESTS

1. Urine culture - silent urinary tract infection is common in pregnancy and increases the risk of premature labor.
2. Blood type; also a test for antibodies against other blood types.
3. Complete Blood Count - to rule out anemia.
4. Immunity against Rubella (German Measles).
5. Tests for carrier state for Hepatitis B, the AIDS/HIV virus and syphilis to decide if treatment during the pregnancy is necessary to protect both mother and fetus.
6. "AFP" or Alpha Fetoprotein test measures a protein from the fetus found in the mother's blood to determine if this pregnancy is at increased risk for having a "neural tube defect" (also called open spinal cord, spina bifida or hydrocephalus) or chromosome abnormalities of Down Syndrome or Trisorny 18. An abnormal test does not make a diagnosis; further studies would be recommended at that time. The majority of the advanced tests are normal. If a fetus is confirmed to have a problem it allows us to arrange for adequate support of your family, safest delivery route and resources needed for the infant after birth.
7. One-hour glucose tolerance test: done in high-risk mothers at 18 weeks, but more typically this is done at 24-28 weeks to test for pregnancy associated diabetes.

NON-ROUTINE PRENATAL TESTS

Ultrasound: According to the American College of Obstetrics and Gynecology there is NO indication for routine ultrasound in pregnancy. If dating for the pregnancy is unclear and fetal heartbeat is not heard when expected, then we need an US for date confirmation. If you have any complications of pregnancy we may also get an US., If you are determined to have an US and do not have a medical indication, contact your insurance company and ask about their policy and call your hospital to find out the cost of the US which will potentially be all out of pocket expense to you.

CLASSES

We strongly recommend the following for all first time parents:

1. Pregnancy and Childbirth classes.
2. Prenatal exercise class.
3. Breastfeeding class-even if you haven't made up your mind about breastfeeding.
4. Parents as Teachers or "P. A. T." through the Family Resource Center.
5. Infant CPR.

In addition, for our patients on Healthy Start or Medical Assistance, we make referrals to "Prenatal Care Coordination" to make sure all possible resources are made available for a healthy pregnancy.

COST OF CARE AND INSURANCE

We request that all our pregnant patients discuss this directly with Judy in our front office. This will be scheduled with one of your prenatal visits.

EMERGENCY NEEDS

During office hours (Monday and Tuesday 8 a.m. - 6 p.m., Wednesday - Friday 8 a.m. - 5 p.m., Saturday 9 a.m. - 12 noon) please call here with any urgent concerns (see warning signs below). Office number is 893-0526.

During all non-office hours: Our home number: 920-893-5757. If no answer call the hospital OB unit where you plan to deliver and they will reach us by pager. I will not respond to medical messages that are left on my home answering machine.

REASONS TO CONTACT US:

1. Severe headache that does not subside with Tylenol in 2 - 3 hours.
2. Burning or painful urination.
3. Fever above 102 degrees.
4. Blurred vision.
5. Any bleeding.
6. Any vaginal leaking of watery fluid.
7. Severe nausea and vomiting.
8. Severe lower abdominal pain that does not subside.
9. Sudden facial swelling.
10. Concerns about fetal movement.

"COVERAGE"

Drs. Arenberg and Schroeder make it a priority to be available to our patients if at all possible. We are married (since 1983) and have two children and do take family time off. In addition, we are required to obtain a minimum of 300 hours of continuing medical education every six year period (along with completing our Board exam every six years) to maintain our Family Practice certification and that will also cause us to be unavailable at times. Please understand that we intend, if at all possible, to be with you when you need us; but when this is not possible our cross coverage is with the family physicians at the Sheboygan Clinic if you deliver at Sheboygan Memorial Medical Center, or the physicians at Marsho Medical if you deliver at St. Nicholas Hospital.

HOSPITAL

Dr. Arenberg delivers babies at both St. Nicholas Hospital and Sheboygan Memorial Medical Center.

Please bring your questions and concerns to each visit. Please bring your binder with you as well (this will be given to you at your first visit).

Dr. Mary E. Arenberg, M. D.
Dr. George S. Schroeder, M. D.