Dear Millennium Mommy,

Congratulations! You are a Millennium-Mommy-to-Be!
Thank you for choosing Millennium Gynecology. We are honored to have your trust and for allowing us to take care of you and your baby. Pregnancy is an exciting period in your life and we are dedicated to make it the most beautiful experience.

Let’s begin.The first step is to review this packet. It contains important information related to your experience with us. It is written by Michael Yuzefovich, MD, FACOG (known by patients as “Dr. Mike”) – medical director of Millennium Gynecology. You should use this packet as a guide to help you become familiar with our practice. Keep in mind that the information presented is not a substitute for medical advice, as all medical decisions should be made between you and one of our health care providers.

In this folder, you will notice our exclusive programs – offered only to Millennium Mommy’s to be. When you read through this guide, there will be references to the folder or packet. This refers to several programs that we have put together to help you through your pregnancy and after you have delivered.

This packet is divided into 3 main sections corresponding to the 3 major phasesduring your pregnancy:

  1. Ante-Partum
  2. Intra-Partum
  3. Post-Partum

Each section contains relevant information we would like you to become familiarized with. The more you know, the greater will be your experience. So relax and feel at ease, you are a Millennium Mommy to be.

We are always here to help with any questions or concerns you may have.

Sincerely,

Michael (“Dr. Mike”) Yuzefovich, MD
OB/GYN | Medical Director
Millennium Gynecology

Table of Contents

Disclaimers

1.Ante-Partum Period

General

1st Trimester

2nd Trimester

3rd Trimester

What’s expected of you?

What Activities Can I Do?

Who will take care of me during my prenatal period?

When Should I call?

Going to the hospital

Your visits to the office

Resources

2.Intra-Partum Care

How do I know that I am ready?

What does it mean that I am ready for delivery?

How should I deliver?

Where will I deliver?

Who will deliver my baby?

What should I bring?

Do I need anesthesia in labor?

Neonatal Care

3.Post Partum Care:

General

Discharge Instructions

Activity & Exercise

Medications

Follow-Up

Emergency Reasons to Call and Get Help

Birth Control

Getting My Body Back

Annex A

Which Medications Are Safe During Pregnancy?

Annex B

Your Diet during Pregnancy

Disclaimers

General Disclosures

The information presented in this packet is for general public information. It should not be misunderstood as medical advice, in any context, and the reader will hold Millennium Gynecology PLLC harmless, in the event of any such misrepresentations. It is the absolute responsibility of the patient, to consult the Physician regarding any portion of this informational packet prior to any medical decision making.

Disability Policy

While we truly understand the hardships associated with pregnancy, we cannot justify unwarranted disability requests, as it is against the law. It is recommended that patients follow the disability policies established by their employers, unless medical circumstances warrant otherwise.

Intellectual Property

These materials are property of Millennium Gynecology and their patients; any dissemination or copying will be fully prosecuted

1.Ante-Partum Period

General

The Ante-partum (also known as the Prenatal) period occurs from when you are first diagnosed as being pregnant to the time just before you go to the hospital to deliver your baby. There are generally 9 months in this period. However, clinicians prefer to count weeks, as weeks are much more precise. There are approximately 40 weeks that a woman is pregnant. As a reference, this 40 week mark is designated as your due date. You will be assigned a due date, and it is important that you remember it.

My Due Date is ______
Thereality is that most babies are not born exactly on thedue date. Actually no one can truly predict the day your baby is born. You may also hear the term trimester, which spans about 14 weeks in length. There are 3 trimesters in total spanning the 40 weeks.

A full term pregnancy is defined as a pregnancy 37 weeks and beyond. If your pregnancy extends into 40 weeks then you are considered Post Dates, and specialized testing becomes necessary to make sure that everything is fine. Below are common symptoms experienced in each trimester.

1st Trimester
Nausea and Vomiting:It is common to feel morning sickness. As long as you are able to function throughout the day and tolerate some foods and most liquids, this will usually improve in several weeks. If your symptoms are more severe, you need to tell us immediately. Safe ways to help alleviate such symptoms are ginger supplementation and vitamin b6 which can be found in organic and health food stores.

Breast Tenderness: Increasing levels of progesterone produced by your ovary and newly forming placenta contribute to this effect. Safe ways to help alleviate this is by using evening primrose oil which can be purchased in most pharmacies.

2nd Trimester

Round Ligament Pain: This pain is usually noticed in the creases of your hips known as the inguinal area. This pain occurs with walking as a result of your ligaments stretching as your uterus grows. If the pain is mild and only occurs when walking and resolves completely with rest- don’t worry! We encourage stretching exercises and periodic rest when pain occurs.
Physiologic Dyspneaa: This refers to a difficulty in taking a deep breath when laying flat in bed. This occurs when the uterus presses up on the diaphragm, which is a large muscle responsible for the movement of air in our lungs, and limits the amount the diaphragm can move. We recommend that you use 1-3 pillows at night to elevate your upper body so the uterus doesn’t push so much on the diaphragm. If you still continue to feel short of breath, after such maneuvers, then seek medical attention.

Fetal Movements: Women experiencing their first pregnancy (aka Prima-Gravida) usually start feeling movements around 21 weeks. Women who’ve had kids before (Multi-Gravida) usually begin to feel movements around 19weeks. It’s common that the baby will not begin moving vigorously until 4 weeks after you first feel baby movements. After that, fetal movements must be felt on a frequent basis. Extreme movements by the baby are highly reassuring and do not suggest trouble. Baby’s can’t keep moving all the time however, as they need their sleep as well. Most babies sleep for about 40 minutes to 1 hour. At that time you may experience little movement, which is ok as long as they return to their baseline activity afterwards. If for some reason you aren’t feeling the baby move as usual, you are expected to do the following:

Kick Counts. This is a very valuable test that you can do to ensure fetal well being. Drink a glass of orange juice or milk, lie down on your left side, put both hands firmly on your belly, and feel for the baby to move. If you feel 10 movements in 2 hours, then be reassured. If there are less than 10 movements in 2 hours, call us immediately.

Again, it is common that the baby is not moving vigorously until 4 weeks after you first notice a movement. Also, as you approach full term, your baby will start having limited space to move. So the amount of movement may be slightly diminished, however the frequency of movements must be maintained.

3rdTrimester

Braxton Hicks Contractions: A tightening of the abdomen, lasting 20-45seconds, followed by complete resolution, is a contraction. If these contractions occur a few times/ day, they are not dangerous as they are simply Braxton Hicks. They are not associated with labor. It’s the way that your uterus begins its preparation for the real thing that may occur in the future.

Discharge 3rd trimester:Further along in pregnancy you may begin to experience a slight, white, thick, non odorous, mucous discharge, on your panty liner a few times per day. This is secondary to increased cervical secretions. If you experience anything other than what is mentioned, you must let us know. Bloody Show is a term used to describe another discharge that occurs after the minor dilation of your cervix. This slight discharge is blood tinged and mixed with mucous. If this occurs at or near Term, don’t worry as long as the baby continues to move appropriately. Bloody Show is normal; however, if you experience any active bleeding, you must inform us immediately.

Back Pain: It is common for women to start experiencing mild generalized back pain. This is mainly from the weight of the pregnancy and compression of the nerve roots that exit through your vertebral column. This pain may occasionally radiate down the back of your thigh called Sciatic Nerve pain. If you experience these symptoms, it is advised to bed rest with a heating pad. If your symptoms are severe at any point, please contact us.

Swelling in your legs: You may begin to experience swelling in both of your legsthat changes throughout the day. This is secondary to the increased volume of fluid collected in your body and gravity that causes that fluid to collect mainly in the lowest part of your body- your legs. It’s important to use a pillow to elevate your legs at night. If the swelling occurs in only 1 leg, you must contact us immediately.

What’s expected of you?

Staying safe: It is important that you avoid any situations that may cause you harm. It is best that you apply a common sense approach to this recommendation. If you feel that you are under the threat of someone or in a dangerous situation, please call 911.

Staying positive: Babies can handle an enormous amount of stress, however its always best to maintain positive emotions, by securing an environment around you that will inspire serenity and good feelings. If you require stress reduction, we recommend exercise, support groups, and even Yoga. Remember, this is your pregnancy, don’t let anyone spoil it for you.

Prenatal Vitamins: If you consume a well balanced diet, you will most likely fulfill all your nutritional needs for your pregnancy. Nevertheless, supplementation is encouraged especially for Iron, Folic Acid, Calcium, and DHA Omega 3 fatty acids, so make sure your pre-natal vitamin has these. In general, pre natal vitamins, regardless if brand named or over the counter, have similar nutrients. Sure, little differences exist, but these subtle differences are usually not clinically significant. So don’t go broke trying to buy a fancy vitamin such as Neevo or Ob Complete One, because a generic over the counter brand is nearly as good. For those moms who are too nauseous for a big pill, try a chewable Flinstones vitamin, but don’t tell Wilma or Fred!

Hydration: It is important to drink 8-10 glasses of water each day. Dehydration can lead to premature contractions.

What Activities Can I Do?

Sex: Sex is safe in pregnancy. You won’t give the baby a headache. However, if you have a high risk condition, your doctor may advise otherwise.

Travel: It is safe to travel by plane and car. If you do, we recommend you get up from the seat every 1-2 hours for 15minutes to increase the blood circulation in your legs. Some airlines restrict flight overseas at 34 weeks and beyond. Most domestic airlines restrict flights 36weeks and beyond. This is not because it is dangerous to the baby; simply the airlines do not want to take a chance that someone will deliver on their flight. It is best to check with the particular airline regarding their flight rules.

Exercise: Exercise is safe and encouraged in pregnancy. Yes, avoid starting an intense workout your body has never been exposed to. Again, exercise your common sense first. We also advise against activities with a high risk of falling or trauma, or require a significant time laying flat on your back.

Who will take care of me during my prenatal period?

The Millennium team is a group of highly trained obstetric providers. Everyone, from our receptionist to the doctor, is responsible for your well-being. We all work together to ensure the best medical care is being delivered to you and your baby.

Standard Business Hours-In the office you will be examined by either Dr. Mike, TarynThibeault NP, or Rupali Singh MD. If a situation requires hospitalized care then Dr. Mike or Dr. Singh will manage the situation.

Afterhours during the work week- Dr Mike or Dr Singh will most often manage the critical emergency in the hospital after initial assessment by the nurses and Hospitalist Group.

Hospitalist Group- As a service to our patients, Millennium Gynecology ensures that a Board Certified Doctor is present in the hospital 24 hrs a day/ 7 days a week to take care of any Millennium Mom who needs urgent medical care. It is an enormous benefit to know that a trusted Millennium affiliated physician is always in the hospital in case a critical situation occurs that needs to be dealt with that second. The Hospitalist Group is composed of 5 physicians: Dr. Thomas/Rasul/Martinez/Duncan/Josephs that alternate each 24hr shift. Most often, after their initial assessment, will contact Dr. Mike or Dr Singh, so they can safely take control of the situation.

Millennium is affiliated with the Georgetown School of Medicine and George Washington School of Medicine so resident physicians and medical students may be present to learn and observe.

When Should I call?

If you experience:

  • painful contractions lasting 1 hour
  • leakage of fluid
  • unexpected vaginal bleeding
  • if the baby is not moving well
  • anything else that you consider an emergency

CALL US: 703-224-9999

During business hours- a staff member in the office will advise you.

Afterhours- a representative from our answering service will advise you to go directly to the hospital.

For afterhour non-emergency phone calls- a representative from our answering service will take a message so that a member from the office will contact you the very next business day.

Please commit our number to memory. Sometimes there may be an interruption in the answering service, mainly due to telecommunication issues. Again, if is a medical emergency – Do NOT Wait, just proceed directly to the Virginia Hospital Center.

Going to the hospital

If it is an emergency, you need to go to the Virginia Hospital Center (formally known as Arlington Hospital.) Virginia Hospital Center is the exclusive choice hospital for Millennium Gynecology, chosen for its excellence in patient care and outstanding patient satisfaction.

For directions to the Virginia Hospital Center,refer to your folder.

These are the steps to take:

  1. 10 minutes away from the hospital, call labor and delivery 703-558-5000 and tell them you are 10 minutes away and may need a wheelchair and that you will be dropped off at the lobby.
  2. Once you arrive at the hospital, we encourage that you be dropped off at the front of the Women’s and Children’s lobby
  3. Tell the security person I am a Millennium Gynecology patient and have an emergency
  4. If you are less than 20 weeks pregnant, they sometimes will send you to the Emergency Room.
  5. If you are >20weeks, then you will be sent to the 3rd floor to an area called Triage.
  • Triage is an area where pregnant women are evaluated to determine if they need to truly be hospitalized or it’s just a false alarm. In Triage, the nurses will assess you and get in touch with the doctor for further instructions.

Your visits to the office

Welcome Visit:Your first visit will begin with our nurse supervisor. She will review your history and introduce you to our practice as a Millennium Mommy to Be.

/ Please refer to Annex A for a list of safe medications and Annex B for nutrition recommendations, at the end of this document.

The First Medical Visit:

  • The Clinician will review your history and address any issues that you may have.
  • You may have a Pap Smear and Genital cultures performed
  • Your due date will be assigned

Weeks11-22 genetics:
Within this period you have to decide on the level of genetic screening you would like done. Below are the options:

  1. Non-Invasive testing: These tests are not invasive and do not pose any risk to the fetus.
  • First Trimester Screening. This non-invasive test is performed by a specialist sonographer in an outside radiology center between 11.0 -13.6weeks. Ultrasound is used to measure something called the Nuchal Translucency, which correlates with the risk of chromosomal abnormalities such as down syndrome. This test is about 93% accurate.
  • The location will mainly be based on your preference and the complexity of your pregnancy.
  • Antenatal testing center (ATC): 703-776-6654
  • Dr Reyes of Virginia Hospital Center: 703-558-6077
  • For a list of the locations and contact information for all testing locations, please refer to the folder- Antenatal Testing Center
  • Quad Screen. This is a simple blood test performed 15.0- 22.0 weeks. This test will be performed at the same blood testing center you will be having all your blood work done. The circulating level of certain proteins in your blood correlates with the risk of chromosomal abnormalities. This test is about 87% accurate.
  1. Invasive Testing: These tests are associated with a minor risk to the fetus, however they are >99% accurate
  • CVS Test. Performed at 11.0 weeks where cells from the placenta are retrieved for chromosomal analysis
  • Amniocentesis. Performed at 15.0weeks and beyond where cells from the amniotic fluid are retrieved for karyotype analysis.

Invasive testing will be performed by a Perinatologist, usually by Dr. Reyes at the Virginia Hopsital Centeror by your own designated Perinatologist. Such testing is optional for all pregnant women and it is your choice to accept or decline such testing.