During your pregnancy, you may find that you are suffering from yeast or vaginal infections, cold or flu, stomach upset or other common complaints. In order to help you take care of these problems or alleviate these symptoms, we provide you with the following information. It is not in any way to replace advice from your physician. If you have any questions, please discuss them with your provider.

At Desert Sage, we feel that any medication use in pregnancy should be avoided if at all possible. There is no guarantee that medication is safe to take in early pregnancy. Adequate studies cannot be done to determine the effects of medications on the baby. Our purpose is to alleviate maternal symptoms without causing harm to the baby. The medications mentioned below have been used in pregnancy with limited to no known adverse effects to the baby.

We recommend frequent small meals. Try toast or crackers before getting out of bed to settle the stomach. Flat ginger ale or ginger capsules may also be used. You may also try Dramamine or Emetrol, which are sold over the counter in the drugstore. It is best to avoid greasy, spicy foods. Vitamin B6 100mg taken with Unisom 25mg daily will act in combination and quiet the nausea and vomiting. If symptoms persist or you are unable to keep any food or liquid down, please call our office.

If you have had a yeast infection in the past, you are familiar with the curd-like discharge, itching and redness of the vagina and vulva. It is safe to use over the counter medications such as Monistat during pregnancy. Please follow the directions on the package and use caution when inserting the applicator. We recommend inserting the applicator only halfway. Your symptoms should improve in several days. If the infection does not respond to medication, it is necessary to schedule an appointment.

It is safe to take Tylenol or Tylenol Extra Strength for fever or aches related to a cold. No aspirin or ibuprofen should be taken during pregnancy. For congestion, we recommend symptomatic relief first. This includes inhaling steam, salt water gargles, saline nasal spray and throat lozenges. Sudafed or Actifed may be taken for congestion. Plain Robitussin or Triaminic without alcohol may be used for cough. In the event you experience coughing at night that keeps you from sleep, Benadryl tablets or capsules may be used. Follow package directions for any of these medications. If you experience fever greater than 101 degrees, productive cough or discolored sputum, shortness of breath or difficulty catching your breath, or changes in fetal movement, please contact your doctor for instructions.

Heartburn is a common complaint during pregnancy. Over the counter medications such as Tums, Maalox, Zantac 75 or Tagamet HBare all safe during pregnancy. Pepto-Bismol is not recommended because it may be metabolized to aspirin. Avoid lying down immediately after eating. If your heartburn is accompanied by upper abdominal pain, high pressure, swelling and headache, this may be a sign of a pregnancy complication, and you should contact your physician for instructions.

Colace, Surfac,or Metamucil may be used according to package directions. Increasing your fluid intake and eating high fiber products (bran) along with exercise may also be helpful.

If you are vomiting, it is important to avoid anything orally until the vomiting stops. Hydration is much more important than eating food, so clear liquids are recommended until your stomach settles down. These include: soft drinks without caffeine, weak tea, Gatorade, Jell-O and Popsicles. Plain water may be nauseating to an upset stomach. As your appetite increases, you may want to try the BRAT diet. B – banana, R – rice, A – applesauce, T – toast. Avoid dairy products, greasy, fatty or rich foods of any kind until you are feeling better. It is safe to take Kaopectate or Imodium for diarrhea. Again, Pepto-Bismol is not recommended. If you are unable to keep any fluids down, are experiencing excessive thirst or decrease in urination, please contact your physician for further instructions.

Each new obstetric patient is recommended to purchase a copy of “Planning Your Pregnancy and Birth” by The American College of Obstetricians and Gynecologists. These topics are discussed in this book and we have referenced the pages for you. This book is a wonderful reference and gives you accurate answers to many of your questions.

• If a problem develops, please try to call during regular hours 602-466-1111, so your medical record is available and an appointment may be scheduled.
• If a problem develops after hours, please call the answering service at 480-804-5538.
• It is very important to know a 24-hour pharmacy number nearest your home and the hospital your insurance plan has approved.
• If you feel it is a severe emergency, please proceed to your insurance plan’s designated emergency room for evaluation.

(First 3 Months of Pregnancy)
1-12 Weeks
Pregnancy is timed from the first day of the last period and is represented by weeks from that point in time.
12 weeks = 3 months
24 weeks = 6 months
36 weeks = 9 months
40 weeks = Due Date

First Appointment
• Physical exam including pap smear if not done within last 6 months
• Baby’s heart beat may be heard at 10 weeks
• Genetic testing as needed or desired Ultrascreen test done at 10-13 wks
• Blood tests
• Counseling and answering questions
• Make next appointment

Physical Changes
• Breast tenderness and fullness
• Nausea, vomiting and changes in appetite
• Fatigue
• Cramping in lower abdomen
• Bloating in mid-abdomen
• Increased need to urinate

• Performed in first trimester only if problem identified
• Routine ultrasound scheduled at 18-20 weeks. May see if boy or girl.

Problems to Report
• Bleeding
• Abdominal pain or severe cramping
• Watery discharge or “leaking”
• Fever, chills or other illness
• Continuous vomiting
• Accidents or falls

Baby’s Growth
• Embryo: 1-8 Weeks
• Fetus: 9-40 Weeks

Approved Medications for the following:
• Pain or Fever – Tylenol (Regular or extra strength) * No Aspirin or Ibuprofen
• Congestion or Allergy – Actifed, Sudafed, Benadryl, Tylenol Cold and Sinus, Claritan
• Heartburn – Tums, Mylanta, Maalox, Zantac, Tagamet, Pepcid AC
• Cough – Robitussin, Triaminic
• Nausea – Vit B6 50mg 2X daily, Peppermint or ginger tea
• Constipation – Metamucil, Colace, Surfak, Glycerin suppository
• Diarrhea – Kaopectate, Immodium

Learn More
There are many excellent books about pregnancy and maternity related issues.
“Countdown to Baby” by Susan Warhus, MD, Addicus Books, 1-800-352-2873

(3-6 ½ Months of Pregnancy)
12-27 Weeks

• Usually every 4 weeks
• Check baby’s heart beat
• Measure uterine growth
• Check blood pressure, urine, weight
• Blood test to check for possible diabetes (26-28 weeks)
• Blood test offered to check for risk of Down’s Syndrome or Spina Bifida (16-20 weeks)
• Umbilical cord blood banking options
• Counseling and answering questions


• Routine at 18-20 weeks
• Level II for mother over 35 years at 17-20 weeks
• Amniocentesis as needed or requested

Classes (Take at 20-34 Weeks)
• Childbirth
• Breastfeeding
• Daddy boot-camp
• Infant CPR

Hospital Information
• Pre-Register for delivery and classes at either Paradise Valley or Scottsdale Shea Hospitals
• Choose your pediatrician (Check with your insurance for approved doctors)
• Request tours at the hospitals

Physical Changes
• Backache
• Usually a decrease in nausea and vomiting
• Weight gain
• Varicose veins
• Constipation
• Hemorrhoids
• Fatigue
• Vaginal mucousy discharge
• Begin to feel baby’s movement (17-22 weeks)

Baby Growth
• 14 weeks 1 ounce, 4 ½ inches
• 18 weeks ½ pound, 6 inches
• 22 weeks 1 pound, 10 inches
• 26 weeks 2 pounds, 12 inches

Problems to Report
• Bleeding
• Watery discharge
• Menstral-like cramps
• Backache that comes and goes with or without cramping
• Not feeling the baby move after 23 weeks
• Accident or fall
• Fever or other illness

(7-10 Months of Pregnancy)
28-40 Weeks

• Every 2 weeks (30-36 weeks)
• Every week (36-41 weeks)
• Check baby’s heart beat
• Measure uterine growth
• Check blood pressure, urine, weight
• Rhogam injection for Rh negative mothers at 28 weeks
• Glucose test at 28 weeks if not done at 26 weeks
• Vaginal culture testing for beta strep at 36 weeks
• Vaginal exam to check for cervical dilation starting at 36 weeks

Physical Changes
• Backache
• Difficulty sleeping
• Increased urination
• Pelvic pressure as baby gets bigger
• Breast changes:
o Fullness
o Tenderness
o Nipple discharge
• Baby may decrease large movements due to decreased space in the uterus

Classes (Take at 30-34 Weeks)
• Childbirth, labor and delivery
• Breastfeeding
• Daddy boot-camp
• Infant CPR

Problems to Report
• Baby not moving
• Signs of labor before 36 weeks
• Fever or other illness
• Accident or fall

Signs of Labor
• Uterine contractions: menstral-like, becoming stronger and closer together and may cause back pain
• Bag of water leaking or breaking
• Vaginal Bleeding

• Learn about your options: Pills, condoms, vaginal foam, IUD, patch or ring.
• No intercourse for 6 weeks after delivery.

The flu can be more serious in pregnant women than non-pregnant women. Women in their second and third trimester should get vaccinated against the flu. Not only should you get the influenza vaccine, but so should your husband (or significant other) and it is also recommended any other children you have receive the influenza vaccine to prevent them from infecting you and the rest of the family.

The flu is a much more serious condition than the common cold. Most symptoms of influenza such as fever, head congestion, runny nose, muscle aches and pains, usually last 7-10 days. But in some persons, especially those at risk, influenza can cause more serious problems. The season usually lasts from October to April, though outbreaks have been observed earlier.

There are several methods to combat influenza. The most effective means of preventing the flu is vaccination. The body produces antibodies that protect you from the virus. Antibodies are most protective for the first four months or so after vaccination. In some people, the vaccination does not work, and their immune system doesn’t respond, or they are exposed to the flu virus after immunity has worn off.

The Centers for Disease Control (CDC) recommends that women who will be in the second or third trimester of pregnancy during flu season get the vaccine because some studies suggest that pregnancy can increase the risks of the flu as a result of changes in the body during pregnancy.

No adverse side effects have been shown in pregnant women. The flu vaccine is a “passive” vaccine and no live or dead virus is injected, and there is no known fetal risk to passive immunization. Breast feeding women can safely get the vaccine. Yet, persons with egg allergies should not get the vaccine, as vaccine making process can include chicken eggs.

There is very little known about herbal medicine and nontraditional medications during pregnancy. Many women don’t consider herbal remedies to be medicine and when pregnant women don’t report their use of theses substances to their obstetricians, this is worrisome because even “herbs or vitamin supplements” can have side effects or interactions with other medications.

Herbal medications are not regulated by the Food and Drug Administration (FDA), therefore there is no good control over these products. In some cases, herbal remedies may not even contain the substance that is listed on the bottle. It may contain the concentration stated in the label or it may have a higher or lower level of the substance.

Women who don’t think of herbal remedies as medicines should volunteer the information about its use to their physician.

Fish and shellfish are an important part of a healthy diet. A well balanced diet that includes a variety of fish and shellfish can contribute to heart health and childrens proper growth and development. However, nearly all fish and shellfish contain traces of mercury that accumulate in streams and oceans as they feed. Some fish are not a health concern. Yet, some fish and shellfish contain higher levels of mercury that may harm an unborn baby or young childs developing nervous system.

Larger fish that have lived longer (swordfish, shark, king mackerel and tile fish) have the highest level of mercury because they’ve had more time to accumulate it.

The risks depend on the amount of fish and shellfish eaten and the levels contained. Therefore, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) are advising women who may become pregnant, pregnant women, nursing mothers and young children to avoid some types of fish and only eat fish and shellfish that are low in mercury.

Fish sticks and “fast food” sandwiches are commonly made from fish that are low in mercury. Tuna steaks generally contain higher levels of mercury than canned light tuna. When choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of tuna per week. If you eat a lot of fish one week, you can cut back for the next week or two since one weeks consumption of fish does not change the level of mercury in the body at all. Just make sure you average the recommended amount per week.

By following the three (3) recommendations for selecting and eating fish or shellfish, women and young children will receive benefits and be confident that they have reduced their exposure to the harmful effects of mercury:
• Do not eat: shark, swordfish, king mackerel or tilefish
• Eat up to 12 ounces (two average meals) a week of a variety of fish and shellfish that are lower in mercury such as shrimp, canned light (albacore white tuna has more mercury than canned light tuna), tuna salmon, Pollock and catfish.
• Check local advisors (your local Health Department) about the safety of fish caught by family and friends in your local lakes, rivers and coastal areas.

Visit the FDA’s Food Safety Website at http://www.cfsan.fda.gov/ or the EPA website athttp://www.epa.gov/ost/fish for a listing of mercury levels in fish.

Fifth disease is an infection caused by human parvovirus B19 and is spread through hand-to-mouth contact or respiratory secretions. Usually considered a childhood illness, it is also known as “slapped cheek disease”, because children who have it get a distinctive bright red rash on their cheeks.

About 50% of women are immune to fifth disease because they had it in childhood, often without knowing it. You only need to be concerned about it during pregnancy if you aren’t immune. An adult infected with fifth disease may have no symptoms or may have flu like symptoms, such as headache, sore throat, or joint pain. These can be caused by a number of other conditions. Many adults are not aware they have the virus. But once you’ve had the infection, you develop antibodies and are immune forever. A simple blood test can determine whether you carry antibodies against parvovirus B19.

Right now, there are no clear guidelines for pregnant women who work or live with small children. If a pregnant woman is certain she has fifth disease, there is no need to be concerned about exposure to the disease. If she is uncertain, a blood test can determine whether she has had fifth disease in the past and is thus immune. Pregnant women who are not immune should wash their hands thoroughly after touching tissues and dispose of them promptly. She should also avoid sharing drinking glasses or utensils with anyone who has the illness or was exposed to it.

There is no evidence or treatment for the disease itself, but Tylenol and plenty of fluids an treat the flu like symptoms.

Compression hosiery can help with varicose veins during pregnancy and promote vaso compression (compression of the dilated veins).  They support the lower extremities and can be tailor-made with “fabric pressures.”

Visit the web site http://www.ameswalker.com/ for complete details.

During long distant travel, it is advised that frequent rest-stops or breaks be made (at least every 2 hours). Standing, stretching or walking exercises are also encouraged. If you are unable to stand or walk during travel, it is advised that you flex your feet and legs at least every hour.

Loose fitting clothing and comfortable footwear are advised, as well as adequate water intake (8-10 glasses a day).

You may want to check with your travel carrier (airline or cruise-line) ahead of time to see if they require a note from your provider. Most carriers will accept pregnant women up to 35 weeks gestation. We will be glad to write a note stating that you are under the care of an Obstetrician, any risk factors (or lack of), and the number of weeks gestation.

Please be aware that there are risks involved with travel during pregnancy. This note will not signify permission to travel, as this is a patient’s free will. We can only advise and educate a pregnant women about the risks of travel.

We also suggest the patient be familiar with a near-by healthcare facility if problems or concerns arise.

Call us today to schedule an appointment – 602.466.1111