• Bleeding – bright red bleeding from the vagina, especially if associated with contractions, pain, or cramps
• Bladder infection – pain, burning, urgency, or blood when urinating
• Vaginal infection – itching, pain, or odor from a vaginal discharge
• Premature contractions (more than 4 weeks before your due date) – more than 5 contractions of your uterus (or “balling up of your belly”) within an hour, especially with a sudden increase in pelvic pressure or vaginal discharge or if vaginal bleeding or back pain are present
  • What to do:
    • Drink two full glasses of water.
    • Lie down on your side for 30–60 minutes with your hand on your belly so you can feel contractions.
    • If you continue to have more than 5 contractions in one hour, please call the clinic.
• Decreased fetal movement (after 28 weeks) – if the baby’s movements slow down a lot
  • What to do:
    • Drink some juice or water, or have something to eat.
    • Lie down with your hand on your baby and count movements.
    • You should feel about 5 movements within an hour. If you don’t, call the clinic.
• Signs of water breaking – a constant trickle or gush of fluid from your vagina (even if you are not sure if your water has broken and if you are not having contractions)
• Other important things to report:
  • A headache that will not go away with rest or Tylenol
  • Constant abdominal pain
  • Changes in your vision, such as lights in the edges of your vision

Following is a brief overview of routine tests recommended around your first visit.

A patient navigator meets with you between weeks 5-8. At this appointment, they share pregnancy tips, resources and answer your questions.

Your first visit with a midwife or OB is typically scheduled between weeks 8-12. We confirm your due date at this appointment. A physical exam is also performed as well as a pap smear (if needed).

Following is a brief overview of routine blood work recommended during the first trimester. All tests are done with a single blood draw:

• Complete blood count (checks for anemia, which is common in pregnancy)
• Blood type and Rh factor screening (if your blood type is Rh negative, you may need a shot of Rhogam at 28 weeks and after delivery)
• Antibody screen (checks for rare antibodies that could affect your baby)
• Rubella test (checks if you are protected from rubella)
• Screenings for: syphilis, hepatitis and HIV/AIDS
• Hemoglobin A1C (tests for diabetes in women who have risk factors)
• Dating ultrasound (to confirm due date based on last menstrual period)
• Urine specimen to test for infection

There are several tests that are offered during the early stages of pregnancy that can tell you if your baby may be at risk for genetic concerns. Your age, family history or personal beliefs may help you decide if these tests are right for you. It is good for pregnant people and their partners to talk together about what the results of a test would mean to them.

Weeks 14-27 make up the second trimester. Many people say they get their energy back and feel great during this time. You will also begin to feel your baby move.

• Anatomy ultrasound: We suggest an ultrasound be done around 20 weeks. This is a good time see the baby after most major organs have developed. The placenta and the fluid around your baby will also be checked. You can usually see if your baby is a boy or a girl, if you want to know.
• Diabetes check: At about 24-28 weeks, a blood test will determine if you have diabetes of pregnancy (gestational diabetes). If so, we will teach you about diet changes and testing yourself for sugar levels to be sure you have a healthy baby.
• Anemia check: The same blood drawn for your diabetes test will also be tested for anemia to see if you need to take iron during pregnancy.
• Syphilis and HIV screening
• Pertussis (whopping cough) vaccination offered

Week 28 marks the beginning of the third trimester. Your baby continues growing and this can be a time filled with excitement to meet your little one.

Group B streptococcus test: Group B strep is found in many people. In rare cases, a person who carries Group B strep can infect her baby at delivery. We test you for this bacteria a few weeks before delivery, around weeks 35-37. If Group B strep is present, we discuss using antibiotics in labor to protect your baby. You may receive a position check to make sure your baby is ready for birthing.

After delivery, your energy and questions switch to adjusting to life with a new baby. The support team in the hospital spends time preparing you for the first days at home. We continue to care for you at your postpartum visits. The topics below are some of the more common that come up after pregnancy.

We encourage everyone to breastfeed their baby. Breast milk is usually the only food your baby needs for the first six months of life, and it is ideal to continue breastfeeding until your baby is one year or older.

Lactation consultants at Providence Mother and Baby Clinics are very skilled and familiar with questions and concerns that many parents have. They evaluate babies for jaundice feeding difficulties and weight gain. They also assess milk supply, breast pain and breastfeeding positioning. Prenatal, newborn and lactation consultations are provided. Same-day consultations are often available. Many of their locations include a store that carries a wide variety of maternity and breastfeeding supplies.

• Babies get sick less often
• Babies have less chance of developing asthma, obesity, diabetes and other health problems
• SIDS (sudden infant death syndrome) is less common in breastfed babies
• Some people find that breastfeeding helps them recover more quickly and help lose weight after pregnancy
• You also have a decreased chance of developing breast cancer later in life if you breastfeed

Many new parents feel sad or nervous after their baby is born. These feelings, called “baby blues,” are very common. Signs of “baby blues” start a few days after the baby is born and usually go away in 1-2 weeks.

If your “blues” don’t go away or get worse, it is called postpartum depression. When depressed, you may not be able to care for your baby or yourself. Severe depression usually goes away with treatment. But without treatment, it can last longer or can get worse and may lead to thoughts of hurting yourself or your baby.

• You have extreme anxiety or invasive thoughts
• You feel more depressed or your depression does not go away
• You need to talk about your problems. You may call the social worker, or one of the other resources below.

Call 911 and seek care immediately if: You feel like hurting yourself, your baby or others.

• Baby Blues Connection – a parent-to-parent support service based in the Portland area. They offer a 24/7 message line, run support groups and provide a large number of resources to help with postpartum adjustment.
• Postpartum Support International – an international organization that helps people and their families cope with perinatal mood and anxiety disorders, including postpartum depression.

You may always call us if you think it might be time but are uncertain – we can help you decide.

If you have had babies before and your labor was fast or you live far from the hospital, please talk with your provider to get guidelines that apply to you.

The easiest way to remember when it is time to come to the hospital is the 5-1-1 rule: You have painful contractions every five minutes that last at least one minute for one hour.

There are exceptions to this rule. You should call us when any of the following occurs:

• Green or clear fluid leaking from your vagina
• Heavy bleeding (blood that runs down your legs or soaks your underwear)
• Fetal movement slows down