Standard Practices During Labor & Delivery
The goal for each patient, is to have a healthy mother and baby.
1. Compliance with CDC recommendations regarding vaccination unless a valid medical contraindication exists.
2. Standard gestational diabetes screening using the 1 hour glucose tolerance testing as accepted by the American College of OBGYNs (ACOG) and the AMerican Diabetes Association, with medical management of gestational diabetes if indicated.
3. Delivery, including induction of labor if necessary, no later than 10 (preferably 7) days past your due date.
4. Induction of labor prior to 10 days past your due date if medically indicated for the safety of you and your baby.
5. Standard group B strep screening and a CDC/ACOG approved antibiotic regimen during labor if indicated.
6. Presentation to the hospital within an hour of rupture of membranes.
7. IV access during labor (appropraite to be placed on saline lock).
8. Labor interventions including artifical rupture of membranes and/or Pitocin if medically necessary.
9. Pitocin administration following delivery of the placenta in accordance with American College of OBGYN guidelines to reduce postpartum hemorrhage.
10. Delayed cord clamping up to, but no longer than, the time when the cord stops pulsing. This may not be possible if you newborn requires immediate evaluation after delivery.
If you have questions or concerns that you prefer not to wait until your next visit, please call or message us on patient portal. Our office number of (806) 791-1122 is answered 7 days a week, 24 hours a day. During business hours, our practice’s registered nurses Karen, Brittany, Barbara or Candy will return your call between seeing patients. After office hours, the phone is transferred to an answering service and Karen or Candy will be contacted. They will contact a physician, if needed. In the unlikely event that the phone system is not working, you can call the hospital labor and delivery unit. UMC FBC is (806) 775-8800 and CMC-Lakeside L&D is (806) 725-6494 and talk to a nurse after hours.
What's Ahead During Pregnancy?
Frequency of visits: We routinely see most patients every 4 weeks until 28 weeks, then every 2 weeks from 28 to 36 weeks. Weekly visits occur between 36 weeks and delivery.
Your first visit: We will obtain a complete history, perform a health assessment, and draw prenatal labs. You will visit with Dr. Coon and go over expectations in pregnancy and visit with the office manager about financial counseling. We ask you to communicate your concerns and expectations with us so that we can make sure to meet your every need.
10-19 weeks pregnant: We should be able to hear the baby's heartbeat with a Doppler-type stethoscope. We can schedule you for nuchal fold translucency testing if you are interested in this screening test on your fetus. Genetic screening is offered to pateints who are atleast 10 weeks gestation.
20-24 weeks pregnant: An anatomy ultrasound will be scheudled to screen for any abnormalities, it is usually possible to determine the gender of the fetus at this appointment. You will be given infomration for your glucose test and T-dap vaccine at this appointment as well as a welcome packet based on the hospital of delivery.
24-28 weeks pregnant: During this time, you will be screened for gestational diabetes. At the time of the test, you will be asked to drink a small bottle of carbohydrate-rich drink and a blood test is drawn 1 hour after you have finished the drink. This is not a fasting glucose test. During this time you will also be checked for anemia as well as a state required STD screening. The T-dap vaccine is optimally timed to be given between 27 and 36 weeks gestation.
35-37 weeks pregnant: Group B Strep (GBS) testing will be performed using a cotton swab in the vagina.While it has no symptoms in your pregnancy, this bacterial colonization can cause newborns to become ill within the first 48 hours. If your GBS test is positive you will be treated with antibiotics upon admission of delivery.
Common Symptoms and Recommendations
Some medications can be safely taken in pregnancy. The following list is provided to make you more comfortable. It is important to note that if you think you may have the flu or strep throat Dr. Coon does recommend geting tested.
Aches: Many preventative measures can be taken to avoid muscle aches, such as exercise, proper body mechanics, good posture, and frequent position changes. The use of a heating pad, warm bath, support belt, and or a massage is also recommended for aches in pregnancy. Tylenol ES or the generic equivalent, taken as directed, in combination with these suggestions may help eliminate your discomfort. If these measures are not helpful most women benefit from a consultation with a qualified physical therapist for individual therapy. Chiropractic care can also be very beneficial.
Congestion, Runny Nose, Sore Throat and Cough: Over-the-counter antihistamines, such as Benadryl, Claritin, and Zyrtec, nasal saline, nasal steroid sprays, non-medicated lozenges with glycerin or honey, Mucinex and Robitussin (without the DM) are safe to use in pregnancy. It is strongly advised all decongestants be avoided during pregnancy.
Constipation: By increasing the amount of fiber in your diet, increasing your fluid intake, and maintaining an active lifestyle as possible, you will decrease the occurrence of, or at least help in relieving, constipation. If you are without relief, you may take Colace or Miralax.
Diarrhea: It is important to prevent dehydration and electrolyte imbalance when suffering from diarrhea by drinking enough water and Gatorade to make the color of your urine clear. A clear liquid diet, including items like Jello and popsicles, is recommended. You can slowly return to a regular diet as symptoms disappear and if tolerated well.
Fever: Tylenol ES may be taken as directed, if your temperature is 101.0° F or higher, please
call the office.
Hemorrhoids: Preventative measures are to avoid constipation and straining when having a bowel movement, lifting heavy objects (including children), and standing in one position for extended periods of time. Anusol HC, Tucks, and Dermaplast spray used as directed should provide temporary relief. and tub baths with Epsoms salt are often soothing.
Indigestion: Avoid spicy and/or greasy food, eat small frequent meals, and remaining upright 1 hour after eating will help reduce the frequency of indigestion. For acute symptoms Tums can be taken as needed. If symptoms are severe or persisitent, Pepcid up to twice a day may be taken.
Insomnia: This is common during pregnancy, over-the-counter sleep aides such as Benadryl, Tylenol PM, or Unisom can help initiate sleep.
Nausea: We recommend the use of Vitmain B6 and Unisom as noted below and encourage a bland, carb-based diet, small frequent meals, and ginger.
Vitamin B6 50mg and 1/2 of a Unisom tablet upon awakening
Vitamin B6 50 mg and 1/2 of a Unisom tablet at 2 pm
Vitamin B6 100 mg and a whole Unisom tablet at bedtime
Weight Gain and Nutrition
Weight Gain: A 25-35 pound weight gain is ideal during these next 9 months, and a healthy diet is encouraged.
Listeriosis: This is a bacterial infection potentially harmful to you and your baby and you should avoid eating pate` or store-made meat salads (chicken salad, tuna salad, etc.) and should only eat hot dogs, luncheon meats, bologna or deli meats if they have been re-heated until steaming hot.You should also avoid drinking raw or unpasteurized milk or milk products as well as soft cheeses, including feta,queso blanco, queso fresco, Brie, Camembert, blue-veined cheeses or Panela unless it is specifically labeled “MADE WITH PASTEURIZED MILK.”
Caffeine: There is no known risk of consuming caffeine during pregnancy. The recommended amount is 200 mg/day (about 2 cups of coffee per day).
Alcohol: There is no evidence that a few drinks consumed early in pregnancy will have harmful effects on your developing baby; however, continuing to drink heavily throughout pregnancy could cause harm to your growing baby. Because of these risks, alcohol consumption is not recommended.
Cigarettes: There is evidence that cigarette smoking during pregnancy directly affects the development of your baby. Small birth weight, early birth, premature detachment of the placenta, and premature rupture of membranes are among the most serious complications; therefore, cigarette smoking is strongly discouraged.
We want to see you back in the office at 6 weeks for a routine checkup after all deliveries. If during this 6 week period you develop shortness of breath, fever, heavy bleeding, abnormal discharge, or problems with breasts or breast feeding, please call our office
Intercourse, douching, and tampons are to be avoided for 6 weeks. Vaginal bleeding may continue for several weeks, but is usually resolved by 5-6 weeks. It is important to inform us of any problems with postpartum depression.
Breastfeeding: This can be a wonderful experience for most women, but can be one of the most frustrating if the baby does not nurse well. We encourage consultation with a lactation specialist. Contact either UMC at (806) 775-8864 or (806) 725-6403 for Covenant.
For women who choose not to breast feed, engorged breasts can be treated with ice packs, cold cabbage as a pack to the breasts, Tylenol or Motrin, and binding the breasts. Mothers who are not breast feeding are sometimes relieved by expressing milk then rebinding if other measures do not help.
Postpartum Depression: We strongly advise you to call us if you are having feelings of postpartum depression, as this can be a serious problem for some women. Self-care, adequate sleep, walking, getting out of the house, and asking for help from loved ones or friends can be vital during this postpartum period. Please call if further mangement is needed.
We consider it an honor to be a part of this exciting time in your life !