UTMB Health Pregnancy Guide Booklet

Congratulations on your pregnancy!

We are delighted that you have chosen The University of Texas Medical Branch (UTMB Health) to take care of your pregnancy needs. Each mother-to-be experiences pregnancy and birth differently, so we have created this guide to help keep your and your baby safe. Please keep this patient guide handy to assist with all your pregnancy health care needs. Feel free to use the pockets for important visit information, appointments, and contacts. We have also provided a journal space for notes and milestones, as well as a space for your first ultrasound pictures.

It is our commitment to provide exceptional care for you and your baby just as we would care for our own family. Thank you for choosing UTMB Health!

How to Contact Us

For nonurgent problems/questions, please utilize MyChart messaging to contact your nurse. A nurse or staff member will reply within two to three business days.

For urgent matters during regular office hours, please call your clinic between 8 a.m. and 5 p.m. After Hours

If you have an urgent health concern during nonclinic hours, call the 24/7 Access Center at (409) 772-2222 to speak with a provider on call. Tell the UTMB Health phone services operator the nature of your concern, and they will direct you accordingly. In case of a medical emergency, dial 911.

Your Care Team

Your care team encompasses multiple clinic locations across Southeast Texas. Babies are delivered at UTMB Health John Sealy Hospital in Galveston, Clear Lake Campus, and Angleton Campus.

Clinic Phone Numbers

Angleton: (979) 864-8415

Clear Lake: (832) 505-3010

Friendswood: (832) 505-5050

Galveston: (409) 772-9507

Lake Jackson: (979) 297-2755

Regular Office Hours

Monday – Friday, 8 a.m.–5 p.m.

Labor and Delivery, Angleton Hospital

Peklo Women’s Pavilion 132 East Hospital Drive 2nd Floor (979) 848-9180

Labor and Delivery, Clear Lake Hospital

200 Blossom Street 5th floor (832) 632-7539

Labor and Delivery, John Sealy Hospital 301 8th Street 3rd Floor (409) 772-2893

Pregnancy 101

Pregnancy is divided into three trimesters. Months one through three are the first trimester, four through six are the second trimester, and seven through nine are the third trimester. Good prenatal care is important for your health and the health of your baby. This includes taking prenatal vitamins, avoiding alcohol and smoking, exercising, eating well, and keeping all scheduled doctor’s visits.

Prenatal Appointments

Prenatal care includes regular visits with the doctor throughout your pregnancy. Call your doctor to schedule your first prenatal care appointment. Most women will see their doctor on the following schedule:

Weeks 4 – 28: Every 4 weeks

Weeks 28 – 36: Every 2 weeks

Weeks 36 – Delivery: Weekly

What to Expect at Your Initial Visit

Your first prenatal visit will take longer than the other visits. You can expect detailed questions about your health history, your family history, and any genetic disorders.

Your provider may perform an ultrasound to determine your gestational age, as well as a complete physical evaluation, including a pelvic exam and Pap test. UTMB Health follows the recommendations of the American College of Obstetricians and Gynecologists (ACOG) and the Centers for Disease Control and Prevention (CDC) regarding recommended lab testing. During your initial visit, the following blood and urine tests and screens will be performed: Blood type and antibody screen. This test will determine your blood type and whether you have a protein called the RH factor in your red blood cells. Women who don’t have it are “Rh negative” and usually need treatment to help protect their babies from a blood condition that could be dangerous. An antibody screen will also be performed to see if there are any unusual antibodies that can affect the care of your baby.

CBC

A complete blood count (CBC) will test white blood cells, red blood cells, and platelets. Low red blood cell count can indicate anemia, which could increase the risk for preterm delivery.

Serologies

The rubella (German measles) and varicella (chicken pox) test is an antibody test. If positive, this means that you are immune or have antibodies present that protect you from acquiring this illness. If you test negative, you are not protected against these illnesses, and we recommend a vaccination after you deliver. Babies born to women who contract these diseases for the first time during pregnancy are at a higher risk for birth defects.

Hepatitis B, hepatitis C, syphilis, HIV, and other sexually transmitted infections (STIs) can be transmitted to the baby during pregnancy or delivery. Early detection is important to determine how to best care for you and your baby.

Urine Testing

A urine sample will be taken at each appointment. Pregnant women are susceptible to UTIs, and certain conditions can be detected through urine testing. For example, glucose in your urine can be a sign of diabetes, and protein can be related to blood pressure. Your doctor may suggest further evaluation if you are found to have either of these.

Pap Test

A Pap test (also called a Pap smear) screens for cervical cancer or abnormal cervical cells that could lead to cervical cancer. If you are due for a Pap test, your provider will perform it during your visit.

After your initial visit, you will come in about every four weeks until you are at 30 weeks, every two weeks until you are at 36 weeks, then weekly until delivery, unless your provider tells you differently.

Regional Women’s Services and Pediatrics (RWSP)

Our clinics offer a variety of medical, referral, and counseling services for women. These services include pregnancy testing, family planning, prenatal care, and screenings for dysplasia, breast cancer, and cervical cancer. Through several available funding sources, eligible women may receive services at no fee, or at a reduced fee, based on family income and size. Scan to learn more about our RWSP services or visit

RWSP, Angleton

1108 East Mulberry Street Angleton, TX 77515

M: 8 a.m. – 7 p.m.

Tu – F: 8 a.m. – 5 p.m. (409) 266-1888

RWSP, Beaumont

195 North 11th Street Beaumont, TX 77702

M – F: 8 a.m. – 5 p.m. (409) 266-1888

RWSP, Conroe

701 East Davis Street, Suite A Conroe, TX 77301

M, W – F: 8 a.m. – 5 p.m. Tu: 8 a.m. – 7 p.m. (409) 266-1888

RWSP, Katy

511 Park Grove Drive Katy, TX 77450

M – W, F: 8 a.m. – 5 p.m. Thur: 8 a.m. – 7 p.m. (409) 266-1888

RWSP, McAllen

620 South Broadway Street McAllen, TX 78501

M: 8 a.m. – 5 p.m.

Tu – F: 7:30 a.m. – 6 p.m. (956) 686-4224

RWSP, New Caney

21134 US Hwy 59 New Caney, TX 77357

M, W – F: 8 a.m. – 5 p.m.

Tues: 8 a.m. – 7 p.m. (281) 577-8966

RWSP, Orange

2014 North 10th Street Orange, TX 77630

M – F: 7:30 a.m. – 5 p.m. (409) 266-1888

RWSP, Pasadena

3737 Red Bluff Rd, Suite 150 Pasadena, TX 77503

M: 8 a.m. – 7 p.m.

Tu – F: 8 a.m. – 5 p.m. (409) 266-1888

RWSP, Pearland 2750 East Broadway Pearland, TX 77581

M: 8 a.m. – 7 p.m.

Tu – F: 8 a.m. – 5 p.m. (409) 266-1888

RWSP, Sugar Land

14823 Southwest Freeway Sugar Land, TX 77478

M: 7:45 a.m. – 7 p.m.

Tu – F: 7:45 a.m. – 5 p.m. (409) 266-1888

RWSP, Texas City

9300 Emmett F Lowry Expressway, Suite 138 Texas City, TX 77591

M: 8 a.m. – 7 p.m.

Tu – F: 8 a.m. – 5 p.m. (409) 266-1888

RWSP, UHC Galveston

1005 Harborside Drive 7th Floor

M, W – F: 8 a.m. – 5 p.m. Tu: 8 a.m. – 7 p.m. (409) 747-4952

Prenatal Screenings

Prenatal genetic screenings are optional tests that can detect chromosomal or genetic abnormalities and indicate the likelihood of certain genetic disorders. It is your choice whether to have prenatal testing.

Noninvasive Prenatal Testing (NIPT) or cell-free DNA

This screening consists of a maternal blood test that looks at the fetal DNA. It can be drawn as early as 10 weeks and screens for trisomy 21 (Down syndrome), trisomy 18 (Edwards syndrome), trisomy 13 (Patau syndrome), sex chromosome abnormalities, triploidy (an extra set of chromosomes), and microdeletions of certain genes. It can also determine fetal gender, if desired. This test is about 99% accurate in detecting these disorders.

This test is followed by an AFP (alpha-fetoprotein) test, which consists of a maternal blood test in the second trimester. This test screens for neural tube defects such as spina bifida or abdominal wall defects.

Please note: Your insurance may or may not cover NIPT, depending on your plan. We encourage you to contact your insurance beforehand to ask about coverage. If your insurance does not cover this test, the company that manages the lab can offer financial assistance; our staff can provide more information.

Carrier Screening

Carrier screening is a type of test that allows you to determine your risk of passing an inherited genetic condition to your child. Carriers often do not know that they have a gene for a disorder and may have either no symptoms or mild symptoms. Most conditions require both parents to be a carrier for a pregnancy to be at risk of being affected. If you are found to be a carrier of a genetic condition, your partner will be offered testing to determine if they are also a carrier of the same genetic condition. Carrier

screening is optional and needs to only be done once in a person’s lifetime. It can be done before or during pregnancy.

Please note: Your insurance may or may not cover carrier screening based on your specific plan. We encourage you to contact your insurance beforehand to ask about coverage.

What if my screening test is positive?

A positive screening test means that your baby is at a higher risk for of having a genetic disorder compared with the general population. It does not mean that your baby definitely has the disorder. If you have a positive screening test, your doctor will offer you diagnostic testing. Diagnostic testing consists of an amniocentesis, a procedure that samples amniotic fluid to check for genetic abnormalities. This test is done with our Maternal Fetal Medicine (MFM) specialist and has its owns risk and benefits. We recommend a detailed discussion with your doctor if you are interested in this option.

Anatomy Scan

An anatomy scan is performed between 18 and 20 weeks. This ultrasound evaluates your baby, placenta, uterus, and surrounding fluid. It can detect certain disorders or anatomical abnormalities. A transvaginal ultrasound may also be performed to measure the length of your cervix.

Your anatomy scan will be separate from your prenatal visit and you will likely not see your doctor during this ultrasound. If any abnormalities are found, your doctor will contact you.

Maternal Fetal Medicine

If you are high-risk or have any medical conditions that will need to be managed in your pregnancy, you may be referred to Maternal Fetal Medicine (MFM). The UTMB Health Maternal Fetal Medicine Division has the training and expertise to care for all high-risk conditions.

The MFM Specialist will work closely with your OBGYN to ensure high-quality care during pregnancy, delivery, and postpartum.

What to Expect at Your Ultrasound Appointments

About Your Ultrasound Appointments

Throughout your pregnancy, you may have several ultrasound exams. Each serves a specific medical purpose, such as:

• Dating ultrasound – confirms your due date and early pregnancy development

• Anatomy scan – a detailed evaluation of your baby’s growth and development

• Growth and follow-up scans – monitors your baby’s size, movement, and well-being as needed

• Transvaginal ultrasound – used for a closer view during early scans or to assess the cervix or placenta

What to Expect

• Ultrasounds are diagnostic medical exams. Our primary goal is to obtain the necessary images and measurements for your health care team.

• Exams may feel quiet at times. This is because our sonographers are focusing on capturing clear, accurate images.

• Not every exam will include extended viewing. Some babies may not be in an ideal position to see clearly, but rest assured, we do our best to get images when possible.

• Follow-up appointments may be needed if not all anatomy can be seen in one visit.

• Phones may not be used to take pictures or record video during the exam. We’re happy to print keepsake images for you at the end.

Visitor Policy

• Due to space limitations and to maintain focus and safety of our sonographers and ultrasound equipment, we permit only two visitors in the ultrasound room with the patient.

• It is preferred and our strong recommendation that you do not bring children due to low lighting, need for a quiet environment, the fragile equipment, and need to stay seated throughout the study.

• In addition, this is a medical visit and there can be unexpected medical findings, so it is not always a comfortable environment to have your children present to receive results.

• If a child is brought to an appointment, they count as a visitor and there must be another adult present to care for them. Additional children are not allowed to be in the waiting room without adult supervision. Please note, your care is our priority, and your visitors will be asked to step out of the ultrasound room if they are disruptive, which includes moving throughout the room, or if a child becomes upset/crying during the visit.

• Unfortunately, if you arrive for an ultrasound visit without an additional adult to supervise a child that is with you, then you will be asked to reschedule.

This policy helps ensure your sonographer can concentrate on obtaining the best possible images to assess your baby’s health.

Thank you for trusting us with your care. We’re excited to be a part of your journey.

Health and Nutrition

Maintaining a healthy diet is a must during your pregnancy. Afterall, the food you eat is your baby’s only source of nutrition. While morning sickness and cravings may make sticking to a healthy diet difficult at times, it is important to do your best.

Calorie Requirements

Your calorie needs will depend on your weight, and your doctor will advise you based on your individual circumstances. Most pregnant women need to consume an additional 300 calories a day. When it comes to weight gain, most women are advised to gain 25 to 35 pounds. Below is a general guideline to follow:

Prenatal Vitamins

It is generally a good idea for women of reproductive age to regularly take a prenatal vitamin, but it is most important to begin taking a prenatal vitamin as soon as you find out that you are pregnant. During pregnancy, you might fall short on key nutrients for your baby, and a prenatal vitamin can help fill any gaps. For example, during pregnancy, you need more folic acid and iron than usual. Folic acid helps prevent neural tube defects of the brain and spinal cord, and iron supports the development of the placenta and fetus.

Beyond checking for folic acid and iron, look for a prenatal vitamin that contains calcium and vitamin D, which help promote the development of the baby’s teeth and bones. Other vitamins to check for include vitamin C, vitamin A, vitamin E, B vitamins, zinc and iodine.

ACOG.org and MyPlate.gov are excellent resources for nutrition, food safety, and meal planning guides.

ACOG.org provides an extensive library of health and nutrition related FAQs for all stages of pregnancy and postpartum, including guides for foods to avoid, food-safe practices, and more.

Many prenatal vitamins also include omega-3 fatty acids, a type of fat found in many kinds of fish that helps promote a baby’s brain development. If your prenatal vitamin does not include omega-3 fatty acids and you don’t eat fish or other foods high in omega-3 fatty acids, your health care provider may recommend taking a supplement in addition to prenatal vitamins.

Herbal Supplements and Vitamins

Talk to your provider about any herbal supplements you are taking. Do not take any vitamins or other supplements until your health care provider says it is safe.

Tobacco, Alcohol, and Drugs

MyPlate.gov offers meal planning guides for pregnant and breast-feeding women, as well as cost-saving opportunities that can help you make healthy choices within your budget.

During pregnancy, women should not use tobacco, alcohol, marijuana, illegal drugs or prescription medications for nonmedical reasons. Talk to your OB-GYN about your tobacco, alcohol, or drugrelated habits. If you are dependent on any of these substances, you may need specialized counseling and medical care.

All tobacco products – including cigarettes, e-cigarettes, smokeless tobacco and secondhand smoke – are harmful to your growing baby. Consuming tobacco products during pregnancy increases the risk of preterm birth and serious health problems, such as cleft lip and cerebral palsy, sudden infant death syndrome (SIDS), childhood asthma, and obesity.

It is safest not to drink at all while you are pregnant, as alcohol can interfere with the normal growth of a fetus and cause birth defects. Fetal alcohol syndrome (FAS) is the most severe disorder that can be caused by drinking and can lead to: growth problems, mental disability, behavioral problems, and abnormal facial features. FAS is most likely to occur in infants whose mothers drink heavily throughout pregnancy, but alcohol-related problems can still occur with lesser amounts of alcohol use.

What Medications Are Safe During Pregnancy?

The best scenario is that you do not need any medicine during your pregnancy, especially during the first trimester. However, we understand that sometimes it is necessary. Some medications are safe, but others can cause harm to the baby or may cause birth defects.

It is important to check with your doctor before taking any mediations or supplements – including pain relievers, laxatives, cold or allergy remedies, and skin treatments. Below is a chart of approved overthe-counter medications that you can take without checking with us. You may want to take a photo of this chart to keep on your phone for handy reference.

Symptom

Acne

Back Pain

Cold/Flu/Cough

Pillows (knees, back, abdomen) or support belt

Increase water intake to stay hydrated.

Constipation Increase fluids (water and juice).

Diarrhea

Avoid milk and milk products. Don’t eat for 4-6 hours, then drink clear liquids and BRATT Diet (bananas, rice, applesauce, toast, tea).

Gas Avoid spicy and fried foods

Headache or Migraine

Heartburn or Indigestion

Hemorrhoids

Nausea

Rest in dark room, massage neck and shoulders.

Small frequent meals. Avoid spicy and fried foods.

Maintain good fiber intake. Avoid constipation and excess straining during bowel movement.

Small, frequent meals. Eat plain crackers before getting out of bed. Drink Sprite, 7-Up, ginger ale.

Sinus/Allergies Increase water intake.

Sleep Aid Warm shower, warm decaf tea

Sore Throat Warm decaf tea with honey

Benzoyl Peroxide

Tylenol

Cough drops (no Zinc lozenges), Mucinex, Vitamin C, Robitussin (Plain), Benadryl, Honey, Zyrtec Claritin, Allegra, Nasal Saline, Vick’s Vapor Rub

Milk of Magnesia, Benefiber, Metamucil, Dulcolax, FiberCon, Docusil, Fiber Choice, Colace, Citrucel, Correctol, Miralax

Imodium, Kaopectate

Gas X, Beano, Mylanta Gas

Tylenol, Tylenol PM

Nexium, Pepcid AC, Prilosec, Tums, Prevacid, Maalox, Mylanta, Gaviscon

Preparation H, Americaine, Anusol, Nupercaine, Tucks

Ointment, Tucks Medicated Pads

Seabands (bracelets), Doxylamine (Unisom), B6 50 mg

Claritin, Benadryl, Vick’s Vapor Rub, Nasal Saline

Benadryl, Tylenol PM

Tylenol, Chloraseptic Throat Spray, Cepacol Spray, Halls Cough Drops

Also safe to use: Nix for head lice, perms, haircoloring products, and sunscreen. If you have a cat at home, please avoid scooping the litter box due to the risk of toxoplasmosis.

Disclaimer: This content is reviewed periodically and is

Vaccines

Vaccines train your immune system to attack specific viruses and bacteria. This makes vaccination an important part of preventing infections during pregnancy. Talk to your physician to ensure that you are up to date on all necessary vaccinations. Vaccines that are safe and recommended during pregnancy include:

• Tdap vaccine: This vaccine is recommended between 27 and 36 weeks of pregnancy and protects against tetanus, diphtheria, and pertussis (whooping cough).

• Flu vaccine: The flu can be much more severe during pregnancy. It is recommended that you get the flu vaccine as early in the season as possible (October through May).

• RSV vaccine: The Pfizer RSV vaccine is recommended if you are 32 to 36 weeks pregnant between September and January. RSV is a seasonal virus that can be dangerous for babies and young children.

• COVID-19 vaccine: If you are pregnant and not up to date, you should get the currently recommended vaccine.

• Hepatitis, pneumonia, and certain meningitis vaccines: These may be recommended based on your risk of contracting these diseases.

Discomforts and Other Concerns

Nausea and Vomiting

Commonly known as “morning sickness,” many women find that nausea during pregnancy can happen at any time during the day. Nausea usually can begin as early as four weeks of pregnancy, but most women experience it around six weeks. Approximately half of women who experience nausea during pregnancy feel relief at around 14 weeks, or the beginning of the second trimester. If you are experiencing nausea and vomiting, there are a few treatments that can help relieve symptoms. Talk with your doctor about the best course of action for you.

First try:

• Vitamin B6 (Pyrdoxine): 10 -25 mg, three to four times per day. If you can only find 100 mg dosage, take half a tab twice a day.

If nausea persists, add:

• Unisom (Doxylamine): 12.5 mg, three to four times per day. If you can only find 25 mg dosage, take half a tab, four times per day or one tab twice a day. This can be taken with Vitamin B6. Doxylamine may make you drowsy. Please do not drive until you know how the medication is going to affect you.

Bleeding

Contact your OB-GYN immediately if you have any bleeding at any time during pregnancy. If you cannot reach them, or it is an emergency, DO NOT WAIT, go to the ER for immediate evaluation.

Please note: There is no OB-GYN available at the UTMB Health League City Campus. It is best to go to the emergency department at the UTMB Health Clear Lake Campus, Galveston Campus, or Angleton Campus.

Some are serious and others are not. Bleeding can occur early or later in pregnancy. Light bleeding or spotting in early pregnancy is common, and in many cases, it does not signal a major problem. Bleeding later in pregnancy can be more serious. Regardless, if you experience any bleeding, always contact your OB-GYN and follow their instructions.

Back Pain

Backache is one of the most common pregnancy problems, especially in the later months. The pain usually goes away after the baby is born. But for many women, back pain lingers for months after giving birth. Many factors can cause back pain, including your growing uterus, extra weight, and pregnancy hormones.

There are several things you can do to prevent or ease back pain:

• Wear supportive clothing and shoes. Abdominal support garments can help take the weight off of your belly and back muscles, and some maternity pants come with a wide elastic band that fits under the curve of your belly to help support its weight. When it comes to shoes, choose low-heeled (but not flat) shoes with good arch support, such as walking shoes or athletic shoes. Avoid high heels – they tilt your body forward and strain your lower back muscles.

• Sit in chairs with good back support, or tuck a pillow behind your lower back.

• Use a heating pad or warm water bottle. Heating pads should be set at the lowest possible temperature setting. Cold compresses can also help ease pain. Limit the time you use heat or cold.

Dental Care

Periodontal (Gum) Disease and Preterm

Labor

Pregnant women with gum disease have a higher risk for preterm birth (delivery before 37 weeks). Gum disease can be controlled if treated early.

Pregnancy Gingivitis

When you get pregnant, your body makes special hormones that can affect your gums, causing them to get red, swollen or even bleed. See your dentist if you have these problems and they can give you tips on how to take care of your mouth at home.

Constipation

Constipation is common near the end of pregnancy. Eating more foods with fiber can help. Fiber is found in fruits, vegetables, whole grains, beans, nuts, and seeds. You should aim for about 25 grams of fiber in your diet each day. Good sources of fiber include:

• Apples

• Bananas

• Lentils

• Raspberries

• Split peas

• Whole-wheat pasta

Check the labels on packaged foods and choose higher-fiber options if possible. If you have not been getting your 25 grams a day, increase the amount of fiber you eat a little each day. Be sure to drink a lot of water as you increase your fiber intake.

Dental X-Rays

Dental X-rays are one of the safest kinds of X-rays and are usually safe to have during pregnancy.

Drugs and Dental Care

If your dentist says you have a dental problem that needs medication, talk to your physician. They can work together to find the best treatment for you. Your UTMB Health provider has a letter you can give your dentist that provides information regarding approved procedures and medications.

Fitness

You should discuss exercise with your physician during your early prenatal visits. If you are healthy and your pregnancy is normal, it is most likely safe to continue or start regular physical activity.

Light or moderate exercise does not increase your risk of miscarriage or early delivery. If you were active before pregnancy, you can probably continue doing the same workouts with your ob-gyn’s approval. If you are new to exercise, start out slowly and gradually increase your activity. Begin with as little as five minutes a day. Add five minutes each week until you can stay active for 30 minutes a day.

Routine exercise can help relieve stress and return you to your pre-pregnancy shape after childbirth. It can also help reduce backpain, ease constipation and may decrease your risk of gestational diabetes, preeclampsia and cesarean delivery.

Safe exercises during pregnancy:

• Walking

• Swimming and water workouts

• Stationary bicycling

• Modified yoga and Pilates

Mental Health

Depression During Pregnancy

Depression affects approximately 1 in 10 pregnant women. Some women experience depression and anxiety for the first time in their lives during pregnancy or after delivery. Some pregnant women with depression have a hard time taking care of themselves. They may eat poorly, have trouble sleeping, miss appointments, or even misuse drugs or alcohol. All these factors could harm the baby.

Activities to avoid:

• Contact sports (basketball, soccer, boxing, etc.)

• Skydiving

• Activities that may result in a fall (skiing, surfing, horseback riding, etc.)

• Hot Yoga

• Scuba diving

• Activities performed above 6,000 feet

Stop and call your healthcare provider if you experience the following symptoms. Signs to stop exercise or physical activity:

• Bleeding or leaking fluid from the vagina

• Dizziness or feeling faint

• Shortness of breath

• Chest pain

• Headache

• Muscle weakness

• Calf pain or swelling

• Regular painful contractions of the uterus

If you suspect you may be suffering from depression and have symptoms, seek the help of your health care team immediately. There are many treatments available for depression during pregnancy, and your provider will help find the right treatment for you.

Symptoms of depression:

• Frequent feelings of sadness and hopelessness

• Loss of interest or pleasure in things you used to enjoy

• Major changes in sleep patterns; sleeping too little or too much

• Extreme feelings of guilt

• Obvious changes in appetite

• Thoughts of hurting yourself or ideas of suicide

• Frequent restlessness, agitation, or slowed movement

• Continued trouble with memory or concentration

• Constant crying

• Withdrawal from family and friends

• Persistent headaches, body aches, pains, or stomach problems that won’t go away

Postpartum Depression

About two to three days after childbirth, some women begin to feel depressed, anxious, and upset. They may feel angry with the new baby, their partner, or their other children. They also may cry for no clear reason, have trouble eating, sleeping, and making choices, and question whether they can handle caring for a baby. These feelings — often called the baby blues — may come and go during the first few days after childbirth, and usually go away within one or two weeks without treatment.

Postpartum depression (PPD) can occur up to a year after having a baby, but most commonly starts around one to three weeks after childbirth.

PPD can be caused by a combination of factors, including:

• Changes in hormone levels

• History of depression

• Emotional factors – including doubts about being a parent and feelings of sadness, guilt, or even anger about your circumstances

• Fatigue

• Lifestyle factors – such as lack of support and stressful life events like the death of a loved one, family illness, or moving to a new city.

PPD can be treated with medications called antidepressants. Talk therapy also is used to treat depression, often in combination with medications. If you think you may have postpartum depression, or if your partner or family members are concerned that you do, it is important to see your ob/gyn or other health care professional as soon as possible. Do not wait until your postpartum checkup.

Postpartum Psychosis

The rarest and most severe form of PPD is postpartum psychosis. It can begin within the first three months after delivery. Women affected by postpartum psychosis can lose touch with reality. They may hear and see things that aren’t really there, or may suffer from insomnia, irritability, and may act strangely. Women who suffer from this need immediate treatment. They almost always require medication and, in some cases, may need to be hospitalization to prevent them from hurting themselves or others.

Conditions That Can Develop During Pregnancy

Gestational Diabetes

Gestational diabetes (GD) is a condition in which too much glucose (sugar) stays in the blood instead of being used for energy. Health problems can occur when blood sugar is too high. Some women develop diabetes for the first time during pregnancy. Women with GD need special care both during and after pregnancy.

Testing

All pregnant women should be screened for GD. Your provider should ask about your medical history to determine whether you have risk factors for GD. If you have risk factors, your blood sugar will be tested early in pregnancy. If you do not have risk factors or testing does not show you have GD early in pregnancy, your blood sugar will be measured between 24 and 28 weeks of pregnancy.

Risk Factors

It is possible for GD to develop in women who have no risk factors. However, several risk factors are linked to GD, including:

• Being overweight or obese

• Being physically inactive

• Having GD in a previous pregnancy

• Having a very large baby (9 pounds or more) in a previous pregnancy

• Having high blood pressure

• Having a history of heart disease

• Having polycystic ovary syndrome (PCOS)

Treatment

You may be able to control your blood sugar by eating a healthy diet and participating in regular exercise. A dietitian or diabetes educator can help you make a food plan to help control your blood sugar levels. If diet and exercise do not help, you may need medication. Your doctor will work with you to determine the best course of treatment.

Preeclampsia and High Blood Pressure

Your health care provider should check your blood pressure at each prenatal care visit. Blood pressure changes often during the day. If you have one high reading, another reading may be taken later during your office visit.

When pregnant, your body makes more blood to support the fetus’s growth. If blood pressure goes up during pregnancy, it can place extra stress on your heart and kidneys. This can lead to heart disease, kidney disease, and stroke. High blood pressure during pregnancy also increases the risk of preeclampsia, preterm birth, placental abruption, and cesarean birth, and reduces blood flow to the placenta, resulting in the fetus not receiving enough nutrients and oxygen.

Preeclampsia is a serious disorder that can affect all the organs in your body. It usually develops after 20 weeks of pregnancy, often in the third trimester. When it develops before 34 weeks of pregnancy, it is called early-onset preeclampsia. It can also develop in the weeks after childbirth.

Symptoms

The symptoms of preeclampsia are high blood pressure and protein in the urine. Other signs include swelling in the legs, hands and feet, sudden weight gain, headaches, and vision changes. Because preeclampsia can happy quickly, it is important to call your doctor if you have any of these symptoms. Doctors refer to “moderate risk” and “high risk” of preeclampsia, but it is not clear why some women develop the condition.

Moderate Risk Factors

• First-time pregnancy or having more than 10 years between your current and previous pregnancy

• Body mass index (BMI) over 30

• Family history of preeclampsia (mother or sister)

• Being age 35 years or older

• Complications in previous pregnancies, such as low birth weight

• In vitro fertilization (IVF)

High Risk Factors

• Preeclampsia in previous pregnancy

• Carrying more than one fetus (twins, triplets, or more)

• Chronic hypertension

• Kidney disease

• Diabetes

• Autoimmune conditions such as lupus

• Having multiple moderate risk factors

Your Support System

Partners, family members, and your health care team all play key roles in helping you through the changes you are experiencing, and it is important to have a support system in place during your pregnancy. The members of your support system should be people you can rely on and trust. Whether your birth partner is your spouse, life partner, or family member, below are some tips for ways they can help and support you during your pregnancy.

• Attend preconception and prenatal visits. Get to know the team, ask questions, and provide medical history, if needed.

• Read, watch videos and visit trusted websites (we recommend ACOG.org) to learn more about childbirth, how to take care of a baby, and how to be a parent.

• Help plan for the baby. Communicate about what both of you want, make important decisions as a family – such as where the baby will sleep, baby names, and special events – and go shopping for baby items together.

Management and Treatment

Your doctor may prescribe medicine if your blood pressure is too high; however, the only cure for this condition is giving birth. Your doctor will try to deliver the baby once they feel that the baby has grown enough to be born. If the baby is born prematurely, there is a special health care team that will take care of your baby.

• Create a financial plan. If you are worried about having enough funds, prepare a budget ahead of time and consider setting money aside to help cover for additional expenses. Ask family members and friends for help with new or used items, such as baby furniture, clothes, and toys.

• Attend childbirth classes. Your health care team can provide a list of classes offered near you.

• Make healthy choices together. Stick to a healthy diet, encourage a smoke-free and alcohol-free environment, take walks, and do activities that promote movement and exercise.

• Avoid illegal drugs. All members of the household should avoid illegal drugs.

• Promote rest and a low-stress environment. Help with household chores like cooking, cleaning, and shopping. Offer patience and understanding.

Preparing for Your Baby’s Arrival

The last trimester of pregnancy is exciting but can also be stressful. Below are a few things that should be done in the weeks leading up to birth. You can find a full checklist for your third trimester on page 27

GBS Testing

Group B streptococcus (GBS) is one of the many bacteria that live in the body. It usually does not cause serious illness, and it is not a sexually transmitted infection (STI). In women, GBS most often is found in the vagina and rectum. This means that GBS can pass from you to your fetus during labor. This is rare. It happens to one or two babies out of 100 when the mother does not receive treatment with antibiotics during labor. The chance of a newborn getting sick is much lower when the mother receives treatment.

Between 36 and 38 weeks of pregnancy, your provider will use a swab to take a sample from the vagina and rectum to see if you have GBS. If the results show that GBS is present, antibiotics are usually given through an intravenous (IV) line once labor has started. This is done to help protect the fetus from being infected. The best time for treatment is during labor.

Fetal Movement and Kick Counts

Counting kicks (fetal movement counting) during pregnancy is a way to monitor your baby. It involves expectant parents tracking fetal kicks and movements during development in your uterus. Changes in movement patterns can sometimes indicate the baby is under stress.

There are a few ways to count fetal kicks. Using an app on your phone may help, or you can use a timer or clock and a piece of paper. Here are the steps to count fetal kicks:

• Choose a time when you are least distracted or when you typically feel the baby move.

• Get comfortable. Lie on your left side or sit with your feet propped up.

• Place your hands on your belly.

• Start a timer or watch the clock.

• Count each kick. Keep counting until you get to 10 kicks.

• Once you reach 10 kicks, jot down how many minutes it took.

While it’s a good idea to always be aware of fetal movements during pregnancy, kick counting becomes more important in the third trimester (between weeks 28 and 40). Talk with your provider about when to do kick counting or how many kicks you should feel. There is a range of what’s considered normal, and only you and your provider can decide what’s normal for you.

Choosing a Pediatrician for Your Baby

Choosing a pediatrician is one of the most important decisions you’ll make regarding your child’s health, and it can be a difficult one. A pediatrician is a doctor who specializes in the physical, behavioral, and mental care of children. They don’t just care for babies and toddlers, though. Pediatricians also care for adolescents up to the age of 18 and sometimes beyond. They perform physical examinations and immunizations, monitor development, and diagnose and treat illnesses. You’ll have a long-term relationship with your pediatrician, so it’s important to pick the right one.

The Department of Pediatrics at UTMB Health has an expansive network of highly trained, board-certified pediatricians to care for your baby throughout childhood and adolescence.

After your baby is born, and before you are discharged, a staff member will help schedule your baby’s first doctor appointment with the pediatrician of your choice one to three days after discharge. If you choose a non-UTMB Health pediatrician, we may not be able to access their schedule, but will do everything we can to connect you with them before you leave.

Signs of Labor

Labor is the process by which contractions of a pregnant uterus causes birth. During labor, the cervix thins and opens. The baby then moves down the birth canal and is born. How long it lasts and progresses is different for every birth. If at any point you are unsure, always come in to be checked.

Possible Signs of Labor

• Regular contractions – approximately four or more in 20 minutes, or eight or more within one hour. Count from the beginning of one contraction to the beginning of another. Normal labor contractions last 45 seconds to 1 minute.

• Your water breaks – it may be a gush or a constant trickle.

• Bleeding like a period.

Go to Labor and Delivery when your contractions are 5 to 7 minutes apart and you have been able to time them for an hour. If you live more than 30 minutes from the hospital, go when your contractions are 10 minutes apart after timing them for an hour.

Braxton Hicks Contractions

Braxton Hicks contractions can happen for many weeks before real labor begins. These “practice” contractions can be very painful and make you

Stages of Labor

Each labor is a unique experience and there is a wide variation in the length of labor. The process of labor is divided into three stages: active labor, pushing, and delivering the placenta.

Stage One: Active Labor

During the first stage of labor, the cervix will eventually dilate to 10 centimeters. This is typically the longest part of labor and can last several hours. Your contractions will begin to occur at relatively regular intervals and gradually become longer, stronger, and closer together. Labor induction is a procedure used to bring on contractions and stimulate labor. Your doctor may suggest induction for several reason, primarily when there is a concern for you or your baby’s health, or you are past your due date.

think you are in labor when you are not. One way to determine if you are experiencing true labor contractions or Braxton Hicks is by timing the intervals you are experiencing them. Braxton Hicks contractions do not have a pattern and do not become more frequent. True labor contractions come at regular intervals and as time goes on get closer together.

Preterm Labor

Preterm labor happens before the 37th completed week of pregnancy. In most cases, the closer you are to term, the better for the health of your baby. Each day counts – your baby is still developing. If any signs of labor occur before 37 weeks of pregnancy, call your doctor immediately.

Other things that may happen

• Your water leaks. This happens for only about 15 percent of women.

• Your baby “drops” low in your pelvis. Not every woman experiences this.

• You lose your mucus plug. The mucus plug will appear as a brownish-pink discharge. You can lose your mucus plug up to three weeks before labor. Let your health care team know if this happens.

Methods of Inducing Labor

• Amniotomy (breaking of water): The doctor may choose to break your water if it has not already done so. This is not usually painful, but you may feel a gush of fluid.

• Cervical ripening: If your cervix is not ready for labor, your doctor may give you medicine to soften your cervix.

• Oxytocin (Pitocin): If your cervix is ready or your water breaks but you are not contracting, the doctor may give you intravenous (IV) medicine that will induce contractions.

Stage Two: Pushing

Pushing begins when you are fully dilated and you push the baby down the birth canal and out into the world. This stage can last as little as 15 minutes to hours. The duration can depend on many factors, including previous births, position of baby’s head, the size of the baby, and the birth canal.

Cesarean Section

A cesarean section (c-section) birth is the delivery of a baby through incisions – surgical cuts – made in the belly and the uterus. In the United States, about 1 in 3 babies is delivered this way.

There are a variety of reasons why a c-section is performed, both planned and unplanned. That’s why no matter what type of birth you are planning to have, you shouldn’t rule out the possibility of a c-section delivery.

Some women may request a c-section birth even if a vaginal delivery is an option. Reasons for this may include having had a previous c-section birth, complications like preeclampsia from prior pregnancies, or even fear or anxiety about labor and delivery. As with any surgery, there are risks to consider. This decision should be weighed carefully and discussed with your doctor.

Stage Three: Delivering the Placenta

During the last stage of labor, you will deliver the placenta and membranes that nourished and contained your baby during your pregnancy. The uterus will contract, separating the placenta from the uterine wall. This stage normally takes 5 to 10 minutes.

Common reasons for an unplanned c-section:

• Failure of labor to progress. Contractions may not open the cervix enough for the baby to move into the vagina.

• Concern for the baby. For example, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.

• Multiple pregnancy. Many women having twins are able to have a vaginal delivery. But if the babies are born too early, are not in good positions in the uterus, or if there are other problems, a cesarean birth may be needed. The chance of having a c-section birth goes up with the number of babies.

• Problems with the placenta or uterine rupture.

• A very large baby.

• Breech presentation.

• A medical condition that makes vaginal birth risky. A c-section delivery may be done if you have an active vaginal infection during labor, certain heart conditions, or certain brain problems, such as an aneurysm.

What happens during a c-section

Anesthesia – routine IV, spinal or epidural. Upon arrival to the operating room, anesthesia is administered to numb the bottom half of your body. Staff will then set up a screen that blocks your vision from your abdomen, so that area remains sterile and you do not see yourself being cut.

Incision. The doctor will make a small incision at your lower abdomen, and suction out the amniotic fluid.

Delivery. The doctor will deliver the baby by removing it out of the incision, cut the cord and then remove the placenta, checking to make sure nothing is abnormal. Your incision is then stitched or stapled together.

After the c-section

If you are awake for the surgery, you may be able to hold your baby right away for a few minutes. You and your baby will then be transported to your motherbaby recovery room. If all is going well for your and your baby, you should be able to start breastfeeding soon after delivery. Your nurse may recommend that you stay in bed for a while, and a nurse or other adult should help you the first few times you get out of bed. A hospital stay after a c-section is usually two to four days, depending on the reason for the c-section and how long it takes for your body to recover. It is important to limit your activities following a c-section and your healthcare team will give you instructions regarding special care, pain management and recovery. Rely on your support system for help during this time.

Pain Management

The idea of giving birth can be overwhelming, but there is no need to panic. Your health care providers are there to make sure you are as comfortable as possible. You do not need to make a decision about using pain management medication until you are actually in labor. However, it is a good idea to learn about your options and consider your preference before your labor starts.

You should not feel pressured to choose a particular option by your partner, friends, family, or health care provider. Only you know how you feel and handle pain. It is also OK to change your mind about which pain management method you want to use.

Pain Relief Medications

The use of pain medications does not make your labor “less natural.” It also does not increase the likelihood that you will have a cesarean birth. Pain relief medications are tools that can help you better cope with labor and delivery. Additionally, the medications used to relieve pain during labor and delivery have no long-term effects on the baby. They also have no effect on a child’s later development.

In general, there are two types of medicated pain relief methods:

• Analgesia relives pain without the loss of feeling or muscle movement. The medications used are known as opioids, and are used to lessen pain, but usually do not stop pain completely.

• Anesthesia relives pain by blocking most feeling, including pain. These can be either systemic, which affects the whole body, regional, which affects a region of the body such as below the waist, or local, which affects only a small area.

Regional analgesia and regional anesthesia are used during labor and delivery to lessen or block pain below the waist. These methods include the epidural block, spinal block, and combined spinal-epidural block.

Typically, the mediation includes an anesthetic that may be mixed with an opioid analgesic, and may be given as a single shot, or administered through a thin tube placed in the lower back.

Nonmedicated Pain Relief Options

Childbirth classes can help teach you different techniques that can help you cope with pain. The Lamaze method and Bradley method are popular nonmedicated approaches to childbirth. Common

Mother-Baby Recovery

In most cases after delivery, you and your baby will recover for a short period in the labor and delivery room. Skin-to-skin bonding is encouraged during this time. You will then transition to a mother/baby room, where you and your baby will stay until discharged. These rooms can comfortably accommodate family members and caregivers including physicians, midwives, nurses, and the pediatric team. Couplet Care provides a nurse who cares for you and your baby. This nurse is specialized in caring for the family as a unit and providing breastfeeding support during these important first days. All suites are equipped with everything needed for a safe and healthy

Preparing for Discharge

Taking care of yourself after pregnancy is very important to your health and your ability to care for your baby. Recovery at home may take several weeks.

You will experience many changes to your body after having your baby and it may take time to adjust. Make sure you read your UTMB Health New Parent Manual which you will receive during your hospital stay.

options for coping with pain include massage and breathing exercises. Music and calming scents (aromatherapy) can also help promote relaxation. Additionally, short walks and changing positions during labor or moving around can reduce pain.

recovery, plus a few extras to make the event one that is comfortable and easy to share with loved ones, including convertible sleep chairs, refrigerator, flat-screen TV, and a private bathroom with walk-in shower. During this time, a lactation specialist will come to help you through your first few breastfeeding sessions and go over beneficial techniques and tips to help with latch, milk production, and any other questions you may have. You may also contact your lactation consultant for additional consultation appointments after discharge.

Follow-Up Appointments

Before you are discharged, a staff member will help schedule your baby’s first doctor appointment with the pediatrician of your choice one to three days after discharge, and another at one to two weeks. A follow-up appointment will also be scheduled for you with your OB-GYN. If you are seeing a non-UTMB Health pediatrician or provider, we may not be able to access their schedule but will do everything we can to get you connected with them before you leave.

Below is the typical follow-up schedule you can anticipate after discharge, depending on your delivery method.

Spontaneous Vaginal Delivery (SVD) Routine follow-up 3 and 6 weeks

SVD with tubal ligations Wound check 1-2 weeks

Routine follow-up 6 weeks

Cesarean Section Wound check/staple removal 1-2 weeks

Routine follow-up 6 weeks

Birth Certificate Information

You will complete the application for your baby’s birth certificate and Social Security card prior to discharge. The birth registrar will be available to answer any additional questions you may have. After discharge, any changes or additional orders for a birth certificate can be made through the Galveston County Health District Vital Statistics division in person, online, or by mail. For more information, visit www.gchd.org or call 409-938-7221

Car Seat

Before you take your baby home, you will be asked if you have a car seat. Make sure to bring an infant car seat with you and, if needed, you can ask for

Postpartum Care

Your OB-GYN can provide you with a comprehensive postpartum care plan, but the following are some things you can plan and prepare for before you deliver your baby.

Vaginal Bleeding

You will have some vaginal bleeding for up to six weeks after your baby is born. You may use sanitary pads during this time, but DO NOT use tampons or douche during this six-week period. Be sure to change your pad every three to four hours as germs

help on how to place the baby in the car seat. It is a good idea to practice and install the car seat before the baby is born. If your baby is premature, you may bring the car seat a week prior to discharge and a nurse will help make sure it is safe and secure for the baby.

Additional information may be found in the UTMB Health New Parent Manual.

Discharge

Your health care provider will determine when you and your baby are ready to leave. Your nurse will help you and your baby to your car. Don’t hesitate to ask any questions, that’s what your nurse is here for!

can grow and cause infection. During this time, you can expect:

• Bright red blood with a few clots the first couple of days

• Decreased bleeding by the fourth day, becoming thinner and lighter in color

• Within 10 days to two weeks, you will see less bleeding but may still have a brownish discharge

• By six weeks you should no longer have a discharge

Bowel Movements

Constipation can cause pain and injury, especially if you had an episiotomy (a cut between your vagina and rectum). Some ways to avoid constipation include:

• Drink plenty of fluids

• Eat foods high in fiber

• Stay active and take frequent walks or exercise

If you do become constipated, use a stool softener, with your health care provider’s approval. Do NOT take over-the-counter laxatives.

Hemorrhoids

Some women develop hemorrhoids during late stages of pregnancy or after child birth. To ease discomfort while the hemorrhoids heal, soak in a warm tub and apply chilled witch hazel pads to the affected area. Your health care provider might also recommend a topical hemorrhoid medication.

Having Sex

You can safely resume sexual intercourse six weeks after birth when bleeding has stopped and the episiotomy has healed, unless otherwise advised by your doctor. Your physiologic reactions to sexual stimulation may be slower or less intense for the first few months after birth. This is normal and usually resolves with time.

The vagina does not lubricate well for the first six months after birth. A water-soluble gel, contraceptive cream, or lubricant jelly may be recommended.

Contraception

If you are not using birth control, it is possible to become pregnant very soon after having a baby. Breastfeeding is not a reliable method of contraception. Using a birth control method in the weeks or months after you have a baby will help avoid an unintended pregnancy and allow your body time to completely heal. Talk to your provider about the most appropriate contraception option for you.

My Pregnancy Journal

My Pregnancy Journal

Important Numbers

My Doctor:

Clinic/Doctor’s Number:

Clinic Location:

Delivery Hospital:

Hospital Number:

Family Emergency Contacts (Name/Phone):

Contact #1:

Contact #2:

Important Numbers

Important Dates

First positive pregnancy test

When I started to tell my family and friends

First ultrasound

Cesarean Section

First fetal heart tones

When I started to feel sick

When I first felt the baby kick

When I started to wear maternity clothes

When I weighed more than my partner

When I started to dilate

When my water broke

When my labor started

Length of labor

Things I Want to Remember

My Appointments

Pregnancy Journal

Use this space to journal your thoughts, observations about your pregnancy, personal notes, questions for your doctor, baby names, and just about anything you can think of involving your pregnancy.

Preparing for Your Hospital Stay and New Baby

Be ready. You never know exactly when your baby is ready to be born. As the big day draws near, make sure to have packed for your and your baby’s hospital stay.

“While-You-Wait” Checklist

Talk to your baby.

Create a birth plan.

Preference for pain management techniques, who’ll be present during delivery, etc. You may discuss further with your doctor.

Start lining up helpers for when baby arrives.

Pre-register/tour the hospital.

We recommend that you tour your hospital before or around the eighth month of your pregnancy. This will help you plan and prepare for your arrival in advance and allows you to focus on having the best possible experience for having your baby. Ask your health care provider for more details.

Complete all forms with employer (e.g. disability forms).

Identify insurance for the baby.

Find a pediatrician for your baby.

Finding a pediatrician for your baby is very important. Your child’s primary care provider (PCP) provides the first point of contact for health care and medical information. UTMB Health Children’s Health offers leading-edge pediatric primary care at clinics located on Galveston Island and throughout communities on the mainland. Visit www.utmbhealth.com or call 409-772-2222.

Prepare for breastfeeding.

Wash baby’s clothes and linens.

Prepare baby’s crib.

Read up on baby care. Stock up on personal and household supplies.

Research baby names.

Learn how to install your child safety seat.

What to Include In Your Hospital Bag (Suggested)

Two to three pairs of warm, nonskid socks

Slippers and socks

Warm robe

Maternity undergarments, enough for three to five days

Comfortable nightgowns

Your own comforter or blanket

Your own pillow for comfort

Towels

Nursing pads and ointment

Sanitary pads

Lip balm

Toiletries

Hairbrush and headbands

Breast pump, if you plan to use one and would like help from a lactation specialist

Light reading

Keepsake book

Camera and batteries/charger

Cellular phone with charges/cords

Identification and insurance card/information

Payment method for any deductibles or co-payments that may incur

Pack a loose-fitting outfit for you trip home with comfortable shoes

What to Bring for Your Baby

Proper infant car seat

Baby bag

Baby outfit for pictures

Baby’s outfit to wear home

Extra onesies or shirts (optional)

Receiving blanket

Warm blankets

Diapers (newborn)

Seasonal appropriate gear (e.g. hat, socks)

Labor Contraction Log Sheet

If you think you are in labor, record when contractions start and end below. Use the comments column to comment on the strength of the contractions. This can help your health care provider determine if labor has begun. If you’d rather use electronics, there are a number of online timers and applications you can find to track your contractions. Time Contraction Began

(from beginning to the end of the same contraction)

Comments

(from the beginning of one contraction to the beginning of the next

EXAMPLE

7:05

helped

minutes Hard one!

When your labor begins, record your contractions here:

Time Contraction Began How Long It Lasted Frequency or How Often

(from beginning to the end of the same contraction)

Comments

(from the beginning of one contraction to the beginning of the next

WELCOME little baby

My name is

I was born on

Date At

Time

I weighed

Weight

I measured

Length

When my family rst found out I was on the way, they thought I was going to be a ...

O Boy O Girl

O

They wanted a surprise

Sonogram Picture

When I arrived...

I was due

I arrived Which made me O Early O Late O Right on time

First Photograph

My parent’s story

Mom’s Name

Age when I was born

First felt me kick at Weeks

Craved

Felt

Dad’s Name

My parent’s story

Age when I was born

Felt

Found out I was on the way

Rolls over Months

Milestones & Memories

First word Months

First steps Months First haircut

First solid food Months

First tooth Months

First vacation Months Favorite food Favorite toy

Other special moments