Obstetric FAQs

Due Dates are calculated from the first day of the last menstrual period. An ultrasound to confirm your due date will be scheduled at one of your first appointments. The estimated due date is indeed just an estimate, as “term” is considered to be from 37 to 42 weeks. (Your estimated due date is calculated as 40 weeks).

We will do a screening ultrasound between 18-22 weeks. This is a good time to visualize the baby’s anatomy which cannot be completely seen at earlier dates

Women with uncomplicated pregnancies are encouraged to engage in aerobic and strength training exercises before, during, and after pregnancy. Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes in obese women, and enhances psychological well-being.

Guidelines recommend at least 150 minutes per week of moderate-intensity aerobic activity (i.e., equivalent to brisk walking), for healthy pregnant and postpartum women. Pregnant women who regularly engage in a vigorous-intensity aerobic activity (i.e., the equivalent of running or jogging), or who are highly active “can continue physical activity during pregnancy and the postpartum period provided that they remain healthy and discuss with their health care provider how and when activity should be adjusted over time”. A reasonable goal is to do moderate-intensity exercise for at least 20-30 minutes per day on most or all days of the week.

Examples of safe physical activities during pregnancy:

• Walking
• Swimming
• Stationary cycling
• Low-impact aerobics
• Modified yoga or Pilates
• Running or jogging
• Strength training

Cycling is good in early pregnancy but can become more difficult later in pregnancy because of balance issues and the risk of falling, so stationary cycling is more acceptable.

Examples of activities that should be avoided:

• Contact sports (ice hockey, boxing, soccer, basketball)
• Activities with a high risk of falling
• Scuba diving
• Hot yoga or hot Pilates

A good way to monitor exercise intensity during pregnancy is using the “talk test.” As long as you can carry on a conversation while exercising, you are likely not overexerting yourself. It is very important you stay well hydrated.

Due to body changes in pregnancy, including weight gain and a shift in the point of gravity, more pressure is put on your joints and low back. Low back pain is very common in pregnancy. Strengthening of abdominal and back muscles can minimize this risk. If you experience significant low back pain, water exercise is an excellent alternative.

You should avoid long periods of lying flat on your back. Core strengthening exercises are very important, but sit-ups or crunches should only be done for the first 3 months of your pregnancy. Later in pregnancy, these exercises can worsen abdominal muscle separation, decrease blood flow to the uterus, and make you feel lightheaded.

Stop exercising if you have any of these warning signs:

• Vaginal bleeding
• Regular painful contractions
• Amniotic fluid leakage
• Dizziness
• Headache
• Chest pain
• Muscle weakness affecting the balance
• Calf pain or swelling

Women who exercise in pregnancy have easier pregnancies, labor, delivery, and fewer cesarean sections. They also have a decreased postpartum recovery time.

Once cleared by your doctor postpartum, exercise in the postpartum period is equally important. Regular aerobic exercise in breastfeeding women has not been shown to affect milk production, composition, or infant growth. Nursing women should consider feeding their infants before exercising in order to avoid the exercise discomfort of engorged breasts. Adequate hydration is particularly important postpartum, so the milk supply does not decrease.

SMOKING cigarettes, ILLICIT substances, VAPING, TOBACCO use, and DRINKING alcoholic beverages are absolute NOs when pregnant or breastfeeding. Your baby is greatly affected by what is taken into your body. If you are struggling with smoking, alcohol, or drug use, please let us know right away. Your information is confidential and we are here to help you.

When pregnant, please call our office first for an evaluation of your health problems. We may refer you to your family doctor or to a specialist. Remember, it’s always helpful if you can place the call yourself to answer any pertinent questions. Also, check your temperature before calling. If you have a fever greater than 100 degrees, take two Tylenol, drink 2-3 glasses of water, and notify your doctor.

Use NO medications, including over-the-counter preparations, unless authorized by our office. A listing of all herbs not to be used in pregnancy can be found below.

If you must medicate yourself, the following medications have been authorized by your physician:

The herbs listed below are not to be used in pregnancy. Those herbs in bold print can be used in food/dietary items, but should not be used in medicinal concentrations. (For example, garlic may be used in food, but do not take garlic pills).

Saunas, hot tubs, Jacuzzis, and tanning beds are NOT recommended in pregnancy. Increased body temperatures can cause problems for you and your baby. Even a hot bath or shower may cause light-headedness. So, moderate temperatures and a minimal length of time in the water are recommended.

Sex may be continued as long as you’re interested, and it causes no discomfort. Some women lose interest while pregnant, others have increased desire; either way is normal. Keep communication open with your partner and try varying positions for comfort. Your doctor will let you know if sex during your particular pregnancy is not appropriate.

Travel is allowed until the last month of pregnancy. In the final month, don’t plan to drive more than 1-2 hours outside of Des Moines. Flying is allowed up to 36 weeks unless otherwise stated by your physician. When traveling, always drink plenty of water and walk around to stretch your legs every 1-2 hours. Wearing compression socks on your lower legs during long periods of travel is helpful to prevent leg swelling.

Waterbeds are acceptable if the temperature is not too hot. There are some questions about electric blankets in pregnancy. If you need an electric blanket, please keep the temperature relatively low.

Seatbelts are not only safe but essential! To properly wear a seatbelt in pregnancy, secure the lap belt under your belly, low and snug on your hip bones. Never wear the belt across or above your belly. The shoulder belt should fit snuggly between your breasts and off to the side of your belly.

Douching is not recommended in pregnancy.

Perms and hair coloring are safe for you and your baby, but they may not take as well as when not pregnant due to hormonal changes.

Cats can be great fun, but their stool and litter can carry a virus that could harm the baby. If you have cats, let someone else clean the litter box.

Painting is fine, as long as you’re using water-soluble (latex) paint and the area is well ventilated. Anything that smells strong enough to irritate your nose or eyes or give you a headache is an indication to leave the area until ventilation is improved.

Dental care and dental visits are not only encouraged but are recommended. Teeth and gums need good hygiene, as usual. Be sure your dentist knows you are pregnant and postpone major dental procedures until after delivery, when possible.

X-rays may be taken, if medically necessary, and with a physician’s approval. The abdomen must be shielded.

Lead poisoning is a concern for all people, including pregnant moms and their babies. If you are around a remodeling or paint-chipping job, find out if they are working with lead-based paint (commonly used in the 1950s and 1960s). If so, you should stay clear of the area until the job is done.

CMV is most commonly transmitted by young children at home or at work. Those infected with CMV often show no signs or symptoms; others may have mild flu-like symptoms such as fever, sore throat, or fatigue. When CMV occurs during pregnancy, the baby can become infected before birth (congenital CMV), and this may cause damage to the brain, eyes, and/or inner ears. Children born with congenital CMV may develop permanent medical conditions and disabilities such as deafness, blindness, cerebral palsy, other mental and physical disabilities, seizures and in some cases, it may result in death.

Incidence

• According to the National CMV Foundation, 1 in 150 children in the United States are born with congenital CMV and 1 in 5 of those children will develop permanent problems such as hearing loss or developmental disabilities.
• Congenital CMV is the most common cause of non-hereditary loss in children.

Transmission

The virus is generally passed from infected people to others through direct contact with bodily fluids such as:

• Urine
• Saliva
• Blood
• Tears
• Mucus
• Other bodily fluids

Prevention

Always wash your hands with soap and water after changing diapers, feeding a young child, wiping a young child’s nose/mouth, and handling toys. Don’t share food, drinks, eating utensils, or toothbrushes. Try to avoid contact with saliva when kissing or snuggling. Make sure to clean toys, countertops, and other surfaces that may have come in contact with children’s saliva or urine. Women who are pregnant or planning to become pregnant, and who have close contact with young children should discuss their risk of CMV infection with their medical provider.

Eat healthy, balanced, well-rounded meals at least 3 times a day. If you have problems with nausea or fatigue, eating more frequently in smaller amounts is helpful. The website can even help you develop a healthy meal plan. Another good resource is the book “What to Expect: Eating Well When You’re Expecting” by Heidi Murkoff.

Here are food sources for some nutrients you need when you are pregnant or breastfeeding:

• Vegetable Group: carrots, sweet potatoes, pumpkin, spinach, cooked greens (kale, collards, turnip greens, beet greens), winter squash, tomatoes, red sweet peppers. These vegetables all have both vitamin A and potassium. When choosing canned vegetables, look for “low-sodium” or “no-salt-added” on the label.
• Fruit Group: cantaloupe, honeydew melon, mangoes, prunes, bananas, apricots, oranges, red or pink grapefruit, 100% prune juice, or orange juice. These fruits all provide potassium, and may also provide vitamin A. When choosing canned fruit, look for those canned in 100% fruit juice or water instead of syrup.
• Dairy Group: fat-free (skim milk), low-fat (1% milk), or calcium-fortified soymilk is recommended. Make sure your choices are fortified with vitamins A and D. • Grains Group: Fortified ready-to-eat or cooked cereals and bread. Choose options made from whole grains and that is fortified with iron and folic acid.
• Protein Group: Beans and peas (pinto beans, soybean, white beans, lentils, kidney beans, chickpeas). Nuts and seeds (sunflower seeds, almonds, hazelnuts, pine nuts, peanuts, peanut butter). Lean beef, poultry, lamb, and pork. Oysters, mussels, and crab. Salmon, trout, herring, sardines, and pollock. All of these foods provide protein. In addition, beans and peas provide iron, potassium, and fiber. Meats provide heme-iron, which is the most readily absorbed type of iron. Nuts and seeds also contain vitamin E. Seafood provides omega-3 fatty acids. Protein bars are a good snack, but should not be used to replace a meal.

Dietary Guidelines for Americans recommend women who are pregnant or breastfeeding to consume between 8-12 ounces of a variety of seafood per week, from the choices that are lower in mercury. Refer to the FDA’s Advice for Eating Fish for detailed recommendations.

Guidelines to prevent listeriosis or bacterial contamination of food:

• Do not eat hot dogs or lunch meats unless they are reheated until steaming hot.
• Avoid soft cheeses such as feta, brie, Camembert, Roquefort, blue-veined, queso Blanco, queso fresco, or Panela unless they are labeled as made with pasteurized milk. Hard cheeses, processed cheeses, cream, and cottage cheeses are safe.
• Do not eat refrigerated pates or meat spreads. (Listeria thrives at refrigerator temperatures). Canned and shelf-stable versions are safe.
• Avoid refrigerated smoked seafood unless it has been cooked (as in a casserole). Canned and shelf-stable versions can be eaten safely.
• Do not consume unpasteurized milk or foods made from it.

Is it safe to consume raw sprouts and unpasteurized juices?

Pregnant women may drink pasteurized juices, but unpasteurized juices should be avoided. Fresh (unpasteurized) fruit and vegetable juices are loaded with vitamins. Unfortunately, they can carry disease-causing bacteria (such as salmonella and E. coli), making them unsafe choices for pregnant women. Raw vegetable sprouts (including alfalfa, clover, and radish) should be avoided for the same reason. In healthy adults, salmonellosis and E. coli infection generally cause diarrhea, nausea, abdominal cramping, and fever lasting for several days.

However, pregnant women can sometimes become seriously ill from these infections. Occasionally, a pregnant woman can pass salmonella or E. coli infection on to her baby. Diarrhea, fever, and less frequently, meningitis can develop in the baby after birth. Check the label – the FDA requires that packaged unpasteurized juices carry a label stating that they are not pasteurized.

Is it risky to eat undercooked meat, poultry, or eggs during pregnancy?

TOXOPLASMOSIS is a parasitic infection that often causes no symptoms or only mild flu-like symptoms. However, if a pregnant woman contracts it, there’s about a 40% chance she will pass it on to her unborn baby. Some affected babies develop vision and hearing loss, mental retardation, seizures, and other problems. When toxoplasmosis is diagnosed during pregnancy, antibiotic treatment may reduce the severity of symptoms in the newborn. Besides undercooked meats, another common cause of toxoplasmosis is in contact with cat feces. A pregnant woman should always have someone else clean the litter box. Toxoplasmosis can also be transmitted through contact with infected materials or insects in the soil. Pregnant women should wear gloves when gardening or doing yard work.

AVOID FRIED FOODS because they are higher in calories than foods prepared by other methods. For example, a fried egg has 120 calories, compared to 80 calories for a boiled or poached egg. If foods are fried, drain them well. Also, fatty meats, fried foods, and highly seasoned foods may cause indigestion, so eat at your own risk. Foods made with milk will be lower in calories than if the cream is used. Skim milk has fewer calories, but the same nutrients as whole milk.

AVOID SNACKING ON “JUNK FOOD”. These provide little in the way of nutrients and may leave you with little room or appetite for the proper foods. When snacking, make healthy choices. For example, drink a glass of milk, eat fruit or raw vegetables, or eat a sandwich (which would include both the grain and meat groups).

DRINK AT LEAST 8 GLASSES OF WATER PER DAY. This is very important to help your body adjust to changes during pregnancy. Drinking a lot of water will not cause fluid retention. However, maintaining a low sodium diet may help prevent fluid retention. Coffee, tea, soda, and drinks with caffeine dehydrate your body and should be avoided in excess. Drinking water in Des Moines is generally safe. If you hear warnings for infants, don’t drink it.

PRENATAL VITAMINS should be taken daily while pregnant and breastfeeding. However, if they cause increased gastrointestinal upset in early pregnancy, try omitting them temporarily. Try taking them at bedtime with orange juice and toast/ crackers. If still unable to tolerate, chew 2 Flintstones® vitamins every day.

CAFFEINE & ARTIFICIAL SWEETENERS are both acceptable in moderation (which we consider to be 1-2 servings daily). Most experts believe that consuming less than 300 mg of caffeine per day appears safe in pregnancy. In general, brewed coffee contains the highest amounts of caffeine, with an average of 137 mg per 8-ounce cup.

DAIRY CONSUMPTION is a rather common concern. If having trouble consuming the recommended quantity of dairy products, you may supplement with Tums with Calcium (4 daily) or calcium supplements. Your total calcium intake should be about 1200 mg.

Weight gain recommendations for pregnancy are based on pre-pregnancy weight category and body mass index as follows:

Fetal movement can be quite variable during the 1st and 2nd trimesters. This is because the baby is still relatively small in a large pool of fluid in the uterus. As the baby develops and enters the 3rd trimester (28 weeks) movements start becoming stronger and more consistent. We do recommend counting the baby’s kicks/movements as a way to monitor your baby’s health in the 3rd trimester.

How to count kicks:

• Count the kicks (or movements) every day, preferably at the same time.
• Pick the time based on when your baby is usually active.
• To get started, sit with your feet up or lie on your side. Count each of your baby’s movements as one kick. Count until you reach 10 movements. After a few days, you will begin to see a pattern for your baby (how long it takes you to get to 10).
• Most of the time it will take less than 30 minutes, but it could take as long as 2 hours.
• Knowing what is a normal pattern for your baby is key. When “normal” changes, this could be a sign of potential problems and an indication to call your doctor.
• As pregnancy progresses the movement of the baby will change. Count each movement as one kick.

Every pregnancy and every baby is different. The most important thing is to count your baby’s kicks every day so you will know what is normal for your baby. For example, if you normally count 10 movements in 30 minutes and then you notice that it is taking 2 hours to count 10 movements, that is a change in your baby’s movement pattern.

Babies don’t run out of the room. Babies do not slow down at the end of pregnancy. While they may run out of room for somersaults, babies move all the way up to and during labor.

If you are not getting the kicks you normally do, you can try having something cold and/or sugary to eat or drink (like a glass of cold juice), and continue counting. This may stimulate the baby to move more. Some women chose to do kick counts after a meal for this reason.

If you still are not getting the kicks, don’t hesitate to call the office or go to the hospital. Trust your instincts!

Definition of Preterm Labor: In most pregnancies, labor starts between 37-42 weeks after the last menstrual period. Preterm labor starts before the 37th week.

Diagnosis of Preterm Labor: It can be hard to tell true and false labor apart. Preterm labor can be diagnosed only by evaluating the change in your cervix. This means your doctor will need to examine you.

If preterm labor is found early enough, delivery can sometimes be prevented or postponed. Sometimes medications will be given to increase fetal lung maturity in preterm babies. Even a few more days may mean a healthier baby.

Signs of Preterm Labor

Call the office if you have any of these signs:

• Vaginal discharge – that is itchy or causes burning. Watery or blood discharge is concerning.
• Pelvic or lower abdominal pressure
• Constant, low, dull backache
• Regular abdominal cramps, with or without diarrhea
• Regular or frequent contractions or uterine tightening, often painless
• Ruptured membranes (your water breaks) It is common to have contractions before labor starts. These are called Braxton Hicks contractions or false labor. If you have contractions more often than 6 times an hour, that lasts for more than 1 hour, call the office or go to the hospital for an examination.

Risk Factors for Preterm Labor:

• You have had preterm labor during this pregnancy
• You had preterm labor or preterm birth in a previous pregnancy
• Carrying more than 1 baby (twins, triplets)
• One or more second-trimester induced abortions (the planned ending of a pregnancy)
• Abnormal cervix (due to surgery, for instance)
• Abnormal uterus (bicornuate, didelphic)
• Abdominal surgery during this pregnancy
• Serious infection during this pregnancy
• Bleeding in the 2nd or 3rd trimester of your pregnancy
• Exposure to DES
• Smoking cigarettes or using drugs
• Little or no prenatal care

Monitoring for Contractions: To monitor yourself, lie down, and gently feel the entire surface of your lower abdomen with your fingertips. This is called palpation. You are feeling for a firm tightening over the surface of the uterus. In most cases, these feelings of tightening are not painful.

If You Feel Contractions: Empty your bladder and drink 2 large glasses of water. Turn to your side and keep monitoring for 1 hour. Count how many contractions you have in 1 hour. Having some uterine contractions before 37 weeks of pregnancy is normal. But, if your contractions occur more than once every 10 minutes (6 or more per hour), you need to call the office (515-223-5466) or go to the hospital if outside of business hours.

Keep in mind that a diagnosis of preterm labor can only be made after a pelvic exam to see whether your cervix has begun to change. You should contact the office each time you have more than 6 contractions per hour unless you are advised otherwise.

When do you want me to come to the hospital?

• Contractions every 5 minutes for 1 hour with your 1st baby
• Contractions every 5-7 minutes for 30 minutes with your 2nd baby
• If your water breaks
• If you have bleeding like a period

There is always a possibility that you may be sent home if you are not in active labor.

You DO NOT need to call the on-call physician when you go to the hospital for these reasons. There is an OB/GYN physician at MercyOne Hospital at all times.

What activities do you suggest doing during early labor?

Walking and showers are encouraged. If your water is broken, you may be up and moving around once the baby’s head is confirmed to be safely down in the birth canal.

Do you prefer a more passive approach to labor (allowing labor to progress at its own pace), or do you prefer an active approach (rupture membranes and/or using Pitocin) for a prolonged phase of labor?

We use an active approach to managing labor.

Do you encourage fluid intake in early labor?

Yes, we suggest ice chips, popsicles, tea, broth.

Do you routinely use an IV in labor?

Yes, an IV will be started when you are inactive labor.

How often do you use fetal monitoring? What types of monitors do you use?

We continuously use external monitoring on all laboring patients. We use internal monitors if there is a question as to how the baby is doing, or how labor is progressing.

What types of pain management (beyond breathing, relaxation) are available? When can I have pain medication?

We offer inhaled nitrous oxide, various IV medications, and epidurals to patients when they are inactive labor (when the cervix is changing) and/or beyond 3-4cm dilated.

Do you routinely make episiotomies?

No, episiotomies are not routine. However, most, 1st-time moms will have at least minor tears requiring some dissolvable stitches.

How often will I see the doctor while I am in labor?

If things are going well you will see the physician at the time of delivery or break your water if appropriate. They will be in communication with nursing staff throughout the entire labor process.

Which doctors may be caring for me during labor and delivery?

We rotate our time on-call among all the physicians in the group. The physicians are S. Rani Makkapati, D.O., Jennifer Booth, M.D., Julia Lange, D.O., Sarah Massey, D.O., Tasha Beenken, D.O., and Nicole Davis, D.O.

What if I choose to have permanent sterilization done at the time of my planned c-section?

We can help facilitate scheduling tubal sterilization during the time of your planned c-section. If this is not able to be completed at MercyOne, we can schedule your planned c-section at UnityPoint-Iowa Lutheran Hospital.

Paternity Testing:

Paternity testing may be performed in the postpartum period if you desire. This testing is not directly performed by our office or MercyOne Medical Center. Please contact MercyOne Social Services for available locations and methods of testing.

Breastfeeding is the method of choice for mothers who are willing and able. Both the American College of Obstetricians and the American Academy of Pediatrics recommend breast milk over formula feeding for several reasons.

Breast Milk Benefits for your Baby:

• Provides a perfect balance of nutrients for your baby, and it is more easily digested.
• Requires no preparation or sterilization and is readily available.
• Lowers the risk of asthma, food allergies, and eczema.
• Helps your baby have fewer or less severe gastrointestinal disorders (for example diarrhea).
• Helps your baby have fewer or less severe respiratory illnesses and infections (for example ear infections).
• Decreases the risk of chronic diseases, such as insulin-dependent diabetes if your baby is exclusively breastfed for at least 6 months.
• Decreases the risk of Sudden Infant Death Syndrome (SIDS).
• Reduces the risk of childhood obesity.

Breastfeeding Benefits for Mother:

• Promotes a lasting bond.
• Returns the uterus to normal size more quickly after delivery.
• Reduces the risk of heavy bleeding after delivery.
• May promote weight loss after delivery.
• Allows convenient feedings away from home.
• Reduces your risk of breast and ovarian cancer, diabetes, hypertension, and heart disease.

Exclusive breastfeeding (or giving expressed/pumped milk) is recommended for the first 6 months of life. From 6 to 12 months of age, gradually giving appropriate supplemental foods but continuing to breastfeed or give breast milk is suggested. Breastfeeding or providing breast milk can continue beyond the first 12 months of life, as long as it seems right for you and your baby. Any amount of breastfeeding, even for a few weeks, is better than not at all!

Although breastfeeding is considered “natural,” the art and skill of breastfeeding are learned. We are here to help! Skin-to-skin care immediately after delivery and rooming-in during your hospital stay can help you initiate breastfeeding. During your postpartum stay, your postpartum nurse and/or a lactation specialist can help with breastfeeding. Once you are discharged, the lactation specialists are available on an outpatient basis. Their phone number is 515.358.2082.

To learn about breastfeeding or read about specific breastfeeding topics: La Leche League International is an excellent resource: https://www.llli.org/ breastfeeding-info/

Most medications and vaccinations are safe for use during breastfeeding. Weaning, or stopping breastmilk even temporarily can have a downside, so research rarely recommends weaning.

Resources for medication safety in breastfeeding:

• LactMed, US National Institutes of Health’s Drugs and Lactation Database
• Dr. Hales’ Infant Risk Hotline and Website

Please call the office or your pediatrician if you have specific questions about a medication you take.

If breastfeeding is not for you, the pediatrician will help with formula selection, feeding techniques, and schedules. If your baby needs formula supplementation (for a variety of reasons), or breastfeeding isn’t working for you and/or your baby… that’s okay! Everyone’s goal is to have both a happy healthy mom and baby, no matter how your baby is fed. Notify your pediatrician if you have concerns about your baby’s eating.

BREASTFEEDING WEB LINKS

• www.womenshealth.gov/breastfeeding
• www.breastfeedingmadesimple.com
• www.LLLI.org
• www.medelabreastfeedingus.com/for-nuring-mothers
• www.kellymom.com
• www.breastfeedinginc.ca
• www.infantrisk.com/category/breastfeeding

The American Academy of Pediatrics recommends these steps to reduce the risk of SIDS and other sleep-related infant deaths:

1. Infants should be placed on their back to sleep for every sleep until 1 year of age.
2. Use a firm sleep surface.
3. Infants sleep in the parents’ room, close to the parent’s bed, but on a separate surface designed for infants. This is required for 6 months but recommended for one year.
4. Keep soft objects and loose bedding away from the infant’s sleep area to reduce the risk of SIDS, suffocation, entrapment, and strangulation.
5. Consider offering a pacifier at nap time and bedtime. It is unclear why, but studies have reported a protective effect of pacifiers on the incidence of SIDS.
6. Avoid smoke exposure during pregnancy and after birth.
7. Avoid alcohol and illicit drug use during pregnancy and after birth.
8. Avoid overheating and covering the head of your infant.
9. Avoid commercial devices that are inconsistent with safe sleep recommendations.
10. Supervised tummy time while your baby is awake is recommended to facilitate development.

The birth of a baby can trigger a jumble of powerful emotions, from excitement and joy to fear and anxiety. It can also result in something you might not expect – depression.

Most new moms experience postpartum “baby blues” after childbirth, which commonly include mood swings, crying spells, anxiety, and difficulty sleeping. Baby blues typically begin in the first 2-3 days after delivery and may last for up to 4 weeks.

Some new moms experience a more severe, long-lasting form of depression known as postpartum depression (PPD). Postpartum depression isn’t a character flaw or a weakness. Sometimes it’s simply a complication of giving birth. If you have postpartum depression, prompt treatment can help you manage your symptoms and enjoy bonding with your baby.

Symptoms of baby blues: mood swings, anxiety, sadness, irritability, feeling overwhelmed, crying, reduced concentration, appetite problems, trouble sleeping

Symptoms of postpartum depression are similar to symptoms of baby blues. They are more intense and last longer. Eventually, symptoms may interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier (during pregnancy), or later (up to 1 year after birth).

These symptoms include:

• Depressed mood or severe mood swings
• Excessive crying
• Difficulty bonding with your baby
• Withdrawing from family and friends
• Loss of appetite or eating more than usual
• Inability to sleep (insomnia) or sleeping too much
• Overwhelming fatigue or loss of energy
• Reduced interest and pleasure in activities you previously enjoyed
• Intense irritability and anger
• Fear that you are not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt, or inadequacy
• Diminished ability to think clearly, concentrate, or make decisions
• Restlessness
• Severe anxiety and panic attacks
• Thoughts of harming yourself or your baby

If you’re feeling depressed after your baby’s birth, you may be reluctant or embarrassed to admit it. If you experience symptoms of postpartum baby blues or postpartum depression, call the office to schedule an appointment.

It is very important you call if: your symptoms don’t fade after 2 weeks, are getting worse, make it hard for you to care for your baby, make it hard to complete everyday tasks, or include thoughts of harming yourself or your baby.

We, the physicians and staff of West Des Moines OB/GYN Associates, are pleased that you have provided us with the privilege of participating in your care during this special time. To help you in the planning process, we are providing you with some information regarding our billing procedures.

Obstetric billing is done in a global fashion. This means that you are not billed for each and every individual service that you receive. Rather, most of the services you receive will be billed in a single charge at the time of your delivery.

The services included as part of your global bill are:

• Your initial prenatal visit and exam
• Regular/routine prenatal visits (including routine urinalysis)
• Your delivery
• The postpartum exam(s) following delivery (unless due to complications)

These services are billed immediately after the birth of the baby. The day of delivery will be the date of service shown on the bill.

There are some services you may receive that are not part of the global billing. These services are billed at the time they are done.

Those could include but are not limited to:

• Confirmation of Pregnancy visit and ultrasound
• Laboratory tests completed in the office or sent to outside laboratories (pap smear, blood work, cultures)
• Ultrasounds
• Other specialty services
• Non-routine prenatal visits (example: you have an extra visit because you have uncontrolled gestational diabetes or a complication beyond your routine prenatal visit)

You must provide our office with all current insurance information to allow us to file a claim. Please notify us immediately if you change insurance plans or if your benefits change at any time during your pregnancy.

West Des Moines OB/GYN Associates will file all charges with your insurance company and will attempt to obtain precertification when necessary. It is to your advantage, however, to contact your insurance company to advise them of your pregnancy. It is your responsibility to contact your insurance company to ensure precertification has been completed and to answer any questions your insurance company may have regarding your pregnancy.

After your initial nurse visit, your insurance benefits will be verified to determine the benefit levels that are available for your delivery so that you can plan to make financial arrangements. We will estimate the amount that you will need to prepay for your global obstetrical care and meet with you to discuss our findings. You will need to pay that estimated amount by the date specified (usually two months prior to your due date). Note: if it is determined that prepayment is not required, you may not need to meet with our billing staff, however, this does not mean that you may not have a financial obligation after insurance processes your claim. Also, if you anticipate prepayment with your flex spending account (FSA) or health savings account (HSA), you will be required to pay after delivery (due to rules set forth by these specific accounts). Please contact the billing office if this is the case, or at any time if you are unable to prepay your specified amount. After your delivery, a claim will be sent to your insurance company and will be processed based on the benefits available at the time of delivery. The payment will come directly to our office. If the insurance reimburses more than the estimated amount, we will promptly refund the overpayment. If the insurance payment is less than the estimated amount, we will bill you for the outstanding balance. This will also be the time that you will be billed to pay from your flex spending or health savings account.

If you have any additional services (for example ultrasounds or referral to another specialist), please check with your insurance company prior to having these services. Some services may require a referral from your primary care physician or prior authorization from your insurance company. Also, some services may not be a covered benefit under your insurance plan.

You will need to verify that the facility or doctor participates in your insurance plan. These things all need to be done before the services are provided. Please let us know if you need assistance in getting this information from your insurance company.

Please also be sure to check with your insurance company or your employer for the correct procedure to follow after the baby is born to add the baby to your insurance plan. Some companies require that the baby be added to your policy within thirty (30) days after birth. Usually, this is done by completing a form with your employer.

If the correct procedure is not followed, the baby’s services in the hospital and thereafter may not be covered by your insurance company.

Finally, if you deliver a boy and our physicians provide circumcision services, we will obtain the initial billing information from the inpatient facility. However, if you receive any bills from our office for your son’s services, contact our office to update any necessary billing information.

We charge a nominal fee for the completion of non-patient disability and FMLA forms.

If you ever have questions about your specific bill or the billing process in general, please contact the Billing Department at 515-223-5466.