Moreland Pregnancy Navigator: Guiding You Through Every Trimester

At Moreland OB-GYN, all newly pregnant patients will speak with an MPN and establish an individualized care plan. Patients are assessed and scheduled for ultrasounds and provider appointments in the first trimester. Your confirmation of pregnancy appointment with your physician will be between 7-8 weeks (unless you’re experiencing issues) and will include an ultrasound. 

After pregnancy is confirmed, you will have a scheduled call with your MPN at the 8/9-week mark. This 20-30-minute call will include health history questions and educational points relevant to your first trimester.

Your Initial Prenatal Visit (IPV) appointment is scheduled for 12-13 weeks gestational age (GA) and lasts about 20 minutes. Your appointments moving forward (Routine Prenatal Visit- RPV) with the physician are about 10 minutes long and are at these approximate intervals: 

• From your first visit to 28-30 weeks GA, a visit every four weeks. 
• From 30-36 weeks GA, a visit every two weeks. 
• From 36 weeks GA to delivery, a visit every week. 

The information listed above is a guideline for routine visits. For a problem or illness visit, you may be seen by an NP/PA or your physician whenever needed. If your pregnancy has complications, your doctor may add visits, labs, or ultrasounds to your care plan. If you are over age 35 and considered Advanced Maternal Age (AMA) or if you are diagnosed with Gestational Diabetes, your doctor will likely add additional tests or appointments to your care plan.

Your MPN will explain why each test is recommended and help you schedule them at the appropriate dates throughout your pregnancy. Routine appointments will include ultrasounds, pelvic exams, weight and blood pressure monitoring, and a glucose tolerance test, between 24 and 28 weeks GA. 

You can find a detailed overview of all prenatal tests and appointments in our Prenatal Care Guide!

The following vaccines are recommended by The Center For Disease Control (CDC) during pregnancy and as part of your postpartum care:  

• Flu Vaccine
• Whooping Cough (Tdap) Vaccine 
• RSV Vaccine 
• Covid Vaccine

Learn more about these vaccines and why they are recommended during pregnancy and postpartum here. 

Below are common symptoms and discomforts you may experience during your first trimester:

• Shortness of breath: This is typically caused by the increasing size of your uterus putting pressure on your internal organs which then puts pressure on your diaphragm. Near the end of pregnancy, when your baby drops lower into your pelvis, this tends to get better.**If you’re experiencing severe chest pain or shortness of breath, call 911 or go to the ER. 
• Frequent urination: This can occur even in the beginning of pregnancy and will likely return at the end of the pregnancy. If you have burning or discomfort with urination, feel as though you are not emptying your bladder completely, urinating even more than you have been or have any one-sided lower back pain, call your physician.
• Constipation: Your bowels may experience decreased mobility. Taking Miralax, stool softeners, or Milk of Magnesia may help. 
• Heartburn: Increasing your fluid intake, avoiding spicy/fatty foods, and sitting up after eating can help ease heartburn. 
• Ligament and joint pain: Ligaments on each side of the abdomen hold the uterus in place. As the uterus grows, the ligaments stretch and may cause some discomfort. You may feel as though your joints are loose, pop or even feel achy. Lower back pain is extremely common as your pregnancy progresses. 
• Fatigue: Fatigue is very common in early pregnancy, and you should try to rest as much as possible. You will generally notice an increase in your energy levels around the start of the second trimester.
• Breast tenderness and growth: A supportive bra may help.
• Sciatica: A common condition in pregnancy that causes pain in the sciatic nerve, which runs from the lower back down each leg. Treatments include PT, massage, or medication. 

For many women, nausea and vomiting may occur during the early months of pregnancy. Most women’s nausea resolves around the start of the second trimester, 14 weeks, but for some women, it may last longer into the pregnancy. Although this is often referred to as “morning sickness,” it can happen at any time of the day or night. 

Pregnancy nausea is thought to be caused by the increase in hormone levels, estrogen and progesterone, produced by the ovaries early in pregnancy. Because of increasing levels of these hormones, the secretory cells in the stomach increase their production of gastric juices, and the bowels slow down their ability to empty the contents of the stomach. This can cause nausea and, in some cases, vomiting. 

The following are a few tips and tricks to help alleviate nausea and vomiting:

• Keep some saltine or graham crackers at your bedside and eat them before you get out of bed in the morning.
• Get out of bed slowly in the morning.
• Slow position changes, from sitting to standing, etc.
• Sip carbonated soda, caffeine-free (Sprite, 7Up, etc.).
• To increase fluid intake, try lemon slices in water, lemonade, and Lemonhead candy. You may also try sparkling water instead of plain, as the carbonation may help.
• Peppermint hard candy or peppermint gum. No peppermint essential oils.
• Avoid greasy, fried, or spicy foods.
• Avoid smells that bother you.
• Eat small, frequent meals or snacks every two to three hours.
• Increase protein intake (eggs, cheese, nuts, meats, yogurt).
• Rest when able.
• Get some fresh air. Breathe through your nose.
• Sea-Bands.
• Ginger tea or Ginger ale.
• Ginger tablets 250-500mg two or three times/day.
• Vitamin B6, 25mg, three to four times/day (up to 200 mg/day).
• Unisom (Doxylamine) 12.5mg two times/day or 25mg before bed. Unisom is a sleep aid and may cause you to feel drowsy.
• Reliefband®

*** If you are unable to keep any fluids or food down for 24 hours or more, please call the office at 262-544-4411. Do not send a MyChart message. 

Focusing on getting essential pregnancy nutrients during the first trimester and throughout your pregnancy can help keep the mother healthy and the baby strong. It's best to eat regularly and not skip any meals. A healthy diet during pregnancy should include:

• Protein with each meal from lean meats, eggs, beans, edamame, milk, or fish (one to two times a week).
• Calcium from dairy products (milk, cheese, and yogurt)  and dark leafy greens help build the baby’s teeth and bones.
• Iron is vital for your increased blood supply during pregnancy. On top of prenatal vitamins, you can get iron from beef, chicken, eggs, tofu, and spinach.
• Kale offers several nutrients, such as fiber, folate, and Vitamins A, C, E, and K. 
• Bananas are a potassium-rich food and can be palatable for queasy stomachs.

Food Restrictions During Pregnancy 

The following are foods you should avoid during pregnancy:

• Lunch meat, deli meat (cold cuts), and hot dogs need to be consumed in small amounts over the course of your pregnancy. You will need to cook hot dogs completely and heat lunch/deli meat for 30 seconds in the microwave before eating. Processed meats have a greater risk of listeria bacteria which is harmful in pregnancy.
• Meats and poultry need to be cooked completely (Poultry:165°/Pork:160°/Beef:160°)
• Fish and seafood are limited to 1-2 servings (6-8 oz) per week. You should not consume anything raw, so avoid Sushi or any raw seafood such as oysters. Fish to avoid completely are Tilefish, Kingfish, Shark, Whale, Swordfish and King Mackerel. Light tuna is allowed, however if you do eat it, it will count as your 2 servings for that week.
• Avoid all unpasteurized food products such as raw milk, raw honey, apple cider and soft cheeses like Brie, Blue, Goat, and Feta unless labeled as pasteurized. Restaurants, Farmers Markets and Health Food Stores may stock these cheeses unpasteurized.
• Fatty and spicy foods (can lead to heartburn)
• Caffeine consumption is limited to one 8-12 oz serving per day (200 mg or less) of regular coffee, tea or soda. Avoid all Energy Drinks. Avoid Herbal teas.
• Artificial sweeteners may be used in small amounts. However, saccharin is not recommended in any amount during pregnancy.  
• Avoid raw or undercooked foods. 
• Wash all fruits and vegetables before eating.
• Certain supplements are not recommended during pregnancy. Bring all your supplements and powders to your first visit with your physician.

Vitamins and Supplements in Pregnancy 

It’s important to have a healthy, well-balanced food intake along with a daily prenatal vitamin. Your Prenatal Vitamin (PNV) needs to both include and avoid certain ingredients. 

Below are the vitamins you should include:

• 400-800 mcg of folic acid.  
• 600 IU of vitamin D3 daily but no more than 2,000 IU daily. Vitamin D is required for your body to absorb calcium properly. Calcium is essential for bone protection during pregnancy. 
• PNV usually has a range of 100-200 mg of calcium. You need 1,200 mg of calcium daily.  Obtaining this level of calcium daily is easily achieved through food. 
• 150 mcg Iodine. 
• 27 mg Iron. 
• 200 mg DHA (a type of fish oil)

You should avoid a PNV containing herbal supplements and/or essential oils. These components have not been studied for pregnancy safety. Labeled “natural or organic” does not necessarily mean harmless.

It is generally recommended that you DO NOT take any additional supplements other than what is generally recommended above, this includes Vitamin Water. More is not always better! 

Too much Vitamin A can be harmful to your baby. Your PNV likely has Vitamin A; you should not exceed 8,000 IU daily. Vitamin A in the form of beta-carotene in foods is considered safe. Beta-carotene is found in orange and yellow fruits/vegetables  (carrots, squash, peaches, cantaloupe) and some green vegetables (lettuce, parsley, collard greens). Also, Vitamin C intake should be limited to less than 2,000 mg a day.

*** Your MPN can help guide you towards what vitamins you should include and avoid during pregnancy.

Weight Gain During Pregnancy 

Gaining weight during pregnancy is a natural and essential part of supporting your baby's development and ensuring your health. The amount of weight you gain during your pregnancy depends on several factors:

• Your pre-pregnancy weight
  • Normal weight, you should gain about 25-35 lbs. 
  • Overweight, you should gain about 15 lbs. 
  • Underweight, you should gain about 27-40 lbs. 

• Your activity level
  • Light to moderate exercise is recommended throughout pregnancy. 

• Your calorie consumption 
  • It’s important to consult with your healthcare provider to determine the appropriate calorie intake for your pre-pregnancy weight and activity level. 

**You should never be on a weight loss/diet program during pregnancy. 

Pregnancy and Exercising 

It’s generally safe to continue exercising during the first, second, and even third trimesters of pregnancy, and it is often encouraged as long as you have your healthcare provider's approval. Safe exercise options include walking, swimming, prenatal yoga, and low-impact aerobics.

Avoid high-impact activities, contact sports, and exercises that involve lying flat on your back. If you continue to run during your pregnancy, make sure to run on flat running surfaces or a treadmill with safety bars. 

Remember, you are in control of your body. Always listen to your body, stay hydrated, and stop exercising if you experience any discomfort or unusual symptoms. Before starting or continuing any exercise regimen, consult your pregnancy navigator to ensure it’s safe for your specific situation.

Things to Avoid for a Healthy Pregnancy 

Eating well, exercising, and taking a prenatal vitamin are things you should do to have a healthy pregnancy. There are also things you should avoid to decrease the risk of possible complications in pregnancy, including:

• Avoid all alcoholic beverages.
• Avoid changing a litter box. 
• Avoid all tobacco and smokeless products. E-cigarettes and vaping are not safe alternatives to cigarette smoking! 
• Avoid the use of any recreational drugs.
• Avoid hot tubs and saunas during your pregnancy.
• Avoid extreme sports and activities, such as riding ATVs, snowmobiles, horses and rollercoasters. 
• Avoid sleeping on your back. 
• Avoid prolonged exposure to loud noise. 
• Avoid skin care products that contain Retinol, Retin-A, or Salicylic acid.

Talking with your MPN can help you understand why certain products should be avoided during pregnancy. Your MPN can also provide the resources and support needed if you’re finding it difficult to quit smoking or drinking alcohol. 

Is loud noise exposure during pregnancy safe for your baby? This blog post has the answer.

Several tests are available during weeks fifteen to twenty-two of pregnancy. Triple screens (measuring AFP, HCG, and Estriol) aim to detect Down Syndrome or other neural tube defects. Additional tests during this period check for gestational diabetes, genetic problems, or hereditary conditions. Your MPN will help schedule these screenings and tests and explain what to expect during each screening and why they are recommended.

You can find a detailed overview of second trimester screenings and tests in our Prenatal Care Guide!

 

You may notice a decrease in early pregnancy symptoms like morning sickness and fatigue as your body adjusts to hormonal changes. However, as the baby grows, you may still experience slight back, joint, and ligament discomfort. Digestive issues such as constipation and heartburn are also common, along with nighttime leg cramps.

The end of your second trimester is a great time to start taking birthing classes. Childbirth classes cover topics such as stages of labor, comfort techniques during labor, postpartum and infant care, and breastfeeding tips. 

Other benefits of birthing classes include:

• Learning what to expect during labor and delivery can help reduce birthing anxiety.
• These classes help partners learn how to support you physically and emotionally during labor.
• Meeting other expecting parents is a great way to share your experiences with others who are going through a similar thing and gain additional support.
• Birthing classes can be an additional resource for any questions and help inform you to make the best decisions for you and your family. 
• Many classes offer tours of the birthing facility where you will give birth, which can be helpful when making your birthing plan.

Your pregnancy navigator can help you find a birthing class that best suits your needs.

Once you’ve reached week thirty-six of pregnancy, you will have weekly doctor visits until delivery. Your doctor will continue to run tests during the third trimester. These final visits are vital for preparing for a safe delivery and include cervical exams and discussions of labor signs and birthing plans. If you have clear desires or needs during delivery, discuss these at your final prenatal appointments.

The beginning of the third trimester is an ideal time to create a birthing plan. This plan is a tool that helps your healthcare team to understand and support your preferences and expectations for labor and delivery, ensuring you feel reassured and cared for. 

Your birthing plan will include insights into your pain management options (epidural, natural pain relief methods, etc.), who you want to be present during labor and delivery (partner, family members, etc.), and preferences for after birth (immediate skin-to-skin contact, delayed cord clamping, breastfeeding). 

Your MPN will help walk you through your birthing plan and offer personalized advice and support to ensure all aspects are covered, helping you feel confident as your due date approaches. 

 

You should prepare your hospital bag or suitcase in the final month leading up to your due date. When packing your bag, you may want to include:

• Toothbrush and toothpaste
• Hairbrush
• Cosmetics and lip balm
• Bathrobe and slippers
• Two to three sets of loungewear
• A comfortable outfit to wear on the way home
• Nursing bras if you plan on breastfeeding
• Pads and witch hazel pads
• Snacks for your partner or support person
• Phone chargers
• Baby clothes
• A car seat

If you still need to do so, it is a good time to practice a trip to the hospital to determine the best route and how long the drive will take. The hospital can also give you a tour of the labor and delivery area.

Read this blog post for a more in-depth look at what to pack in your hospital bag.

During the third trimester, the baby’s rapid growth may cause lower back pain or difficulty sleeping. To help ease late pregnancy pains and discomforts, you can do the following:

• For back pain, use a heating pad, stretch, and take Tylenol in moderation. A foam roller can also help aching muscles.
• Using a pregnancy pillow can provide extra support when sleeping or resting.
• Wear compression socks and elevate your feet and legs to help decrease foot swelling.
• Because heartburn worsens when you lay down, avoid eating before bed or take antacids if the problem persists.
• Eat high-fiber foods and stay hydrated to avoid hemorrhoids and constipation.

Identifying the early signs of labor can help you know when it’s time to prepare for your baby’s arrival. Here are several key indicators that labor may be starting:

• Contractions or Tightening: These may feel like the top of your uterus is "knotting up" and can radiate through your belly and lower back. If these contractions occur five minutes or less apart for an hour or more, last a minute or longer, and continually get stronger, it’s a sign that labor is beginning.
• Belly and Lower Back Pain: Persistent pain or cramping in your belly and lower back can be an early sign of labor, especially if contractions accompany it.
• A "Show": “Show” refers to the discharge of the mucus plug from your cervix. It can be a clear or slightly blood-tinged discharge, indicating that your cervix is beginning to dilate in preparation for labor.
• Water Breaking: The rupture of the amniotic sac, commonly known as your water breaking, can happen as a sudden gush or a slow trickle of fluid. Only 10-15% of women experience their water breaking before labor begins. If your water hasn't broken but you are experiencing regular contractions or other signs of labor, you should contact your healthcare provider. 

Learn more about the signs of labor here. 

Before your baby arrives, it is a good time to plan for your fourth trimester, the twelve weeks following your delivery. Your body needs time to recover, and your baby will adjust to the outside world. 

Planning for the fourth trimester in advance gives you peace of mind and more time to focus on your little one once they arrive. When planning for the fourth trimester, consider the following:

• Learn your newborn’s needs and how to support them best. Swaddling your baby and rocking them back and forth mimics the motions they feel inside your belly, which may help them sleep better.
• Plan how you will care for yourself when your newborn arrives. Your primary focus should be eating healthy and sleeping when you can while meeting your baby’s needs. Preparing freezer meals and healthy snacks can help you meet your nutrition goals during this transition period.
• Have realistic expectations of cleaning, cooking, and laundry. Delegate household responsibilities before delivery.
• Set up a visitor policy for your family and friends. Decide who will be in the delivery room or if you want to limit the number of hospital or home visitors.
• Surround yourself with those that will support you after birth. Your family, friends, and other mothers can help you through the first few weeks.
• Educate yourself and your partner about postpartum mental health and how they can best support you. The “baby blues” and postpartum depression are common after the first few days, and you should reach out to your doctor if these feelings persist.

Your first postpartum visit with your Moreland OB will be scheduled at six weeks, although your MPN will call you anywhere from ten days to three weeks to check up on how you and your newborn are adjusting.

Your postpartum visits aim to ensure that the mom is doing well physically and emotionally, that the baby is gaining a proper amount of weight, and to provide the opportunity to discuss any medical concerns. 

The following are tips on how you can care for yourself and your baby after delivery:

• Sleep when you can. Your baby isn’t the only one that needs naps! Try sleeping when your baby sleeps. If you’re struggling to sleep, use blackout curtains, keep your phone in a different room, and limit caffeine consumption.
• Eat a healthy diet and continue to move your body. Consume plenty of fluids, fruits, and vegetables. Light exercise such as walking or yoga is great for your healing body. Discuss which activities are safe with your doctor, especially if you had a C-section.
• Prepare yourself for postpartum body changes. Your body may undergo changes such as hair loss, hormonal acne, sore nipples, severe gas, or odd-smelling discharge. Remember, these are all normal symptoms as your body recovers.
• Keep your mind busy. While recovering at home, you can read, listen to podcasts or audiobooks, do a puzzle, or start your baby book. 

If you are anxious about your baby’s safety when they are down for a nap or bed at night, follow safe sleep guidelines. Keep your baby on a firm mattress on their back, remove pillows, blankets, and toys from the crib, give them a pacifier, and consider sharing your room with a bedside sleeper for your baby.

Remember, this phase doesn’t last forever. While it may feel like your whole life has drastically changed, you will quickly find your new normal.

Postpartum depression (PPD) is a type of depression that can occur after the birth of a child. Unlike the "baby blues," which are short-lived and affect up to 80% of new mothers, PPD is more severe and long-lasting. It can begin any time within the first year after childbirth and can impact a mother's ability to care for herself and her baby.

Signs of postpartum depression include anxiety, changes in appetite, disinterest in your baby, family, and friends, or sudden irrational anger are signs of postpartum depression. If you feel this way, contact your MPN or Moreland OB-GYN physician immediately. 

Learn more about what to expect after delivery in this blog post. 

A pregnancy navigator supports expectant mothers by providing guidance, resources, and assistance throughout their pregnancy, helping them navigate medical, social, and emotional challenges.

Remedies for nausea and vomiting in pregnancy include eating small, frequent meals, staying hydrated, consuming ginger, and taking vitamin B6 supplements. Check out our complete list of remedies here.

Over-the-counter medications generally considered safe during pregnancy include acetaminophen for pain relief and certain antacids for heartburn. Our pregnancy medication guide provides a complete list of safe medications during pregnancy.

Your developing baby is protected by the amniotic fluid and the strong muscles of the uterus. Sexual activity won't harm your baby unless you have specific medical conditions or complications.If you experience any type of pain during intercourse or have vaginal bleeding, then abstain and call your physician. It is considered normal to see a very small amount of spotting when wiping with bathroom tissue 24-48 hours after intercourse. If this is all that you experience, then no need for concern. However, even though it is considered “normal”, we ask that you do not have anything inside of your vagina then for the next 7 days. There are some problems in pregnancy that could cause your physician to tell you to avoid sex completely during your pregnancy. We call this “pelvic rest”. Please ask any questions you have about sexual relations during your pregnancy. 

In most cases, you can resume having sex about six weeks after giving birth, but it's important to wait until you've had a postpartum check-up and your healthcare provider confirms it's safe.

You should never douche during pregnancy. Douching can disrupt the natural balance of vaginal bacteria and can lead to infections and complications.

Dying your hair is generally safe during pregnancy because only a small amount of dye is absorbed through the skin. Still, it's best to consult your healthcare provider and use ammonia-free, low-chemical products. 

Regular dental cleanings and check-ups are important to continue. Always let your dentist know you are pregnant and use extra protection if x-rays must be done.

Yes, you can use sunscreen and insect repellent while pregnant; for safety, choose mineral-based sunscreens and DEET-free insect repellents. We suggest you shower off these products at the end of the day. 

Yes, you should wear your seatbelt while pregnant, ensuring the lap belt is placed below your belly and the shoulder belt between your breasts for maximum safety.

Yes, you can get a manicure, pedicure, and massage while pregnant, but ensure the salon follows proper hygiene practices and the massage therapist is trained in prenatal techniques.

Yes, exercising during pregnancy is generally safe and beneficial, but it's important to choose appropriate activities and consult your healthcare provider for personalized advice. There are a few restrictions to keep in mind. No weight - lifting or resistance training over 25 lbs. Now is not the time to take up a new routine or sport. Use common sense, if you do not feel well doing something you are used to doing, then stop! Always use correct form and body mechanics. Drink plenty of fluids and eat. Abdominal crunches and lying flat on your back after 16-18 weeks GA should be avoided. If you need activity restrictions during your pregnancy for any reason, your physician will discuss it with you.

The added weight and shifted center of gravity might lead to flat feet, muscle cramps, and permanent foot growth. Flat feet can cause discomfort in your calves, feet, and back, but supportive shoes or orthotics can help. Muscle cramps are common and can be eased by moving and resting. Your feet might also grow due to hormonal changes and weight gain, so wearing well-fitting shoes is crucial to prevent problems like ingrown toenails and bunions.

During a healthy pregnancy, occasional air travel is almost always safe. Most airlines allow you to fly domestically until about 36 weeks of pregnancy. There are several precautions and restrictions, however. Please stop all travel outside of the immediate area (within 1 hour or less of the hospital) at 35 weeks GA. If you are traveling by airplane, drink plenty of water and get up out of your seat to walk around 3-5 minutes for every 1 hour of flying. For travel by car, stop and walk around for several minutes every 2 hours. You are at an increased risk for blood clots during pregnancy and these tips will keep your circulation moving. If you plan to vacation/travel to altitudes above 8,000 feet sea level, stay well hydrated and be aware that you may not tolerate high altitudes well when you are pregnant. It is always important to discuss travel plans with your physician. 

You should avoid hot tubs, saunas, and spas during your pregnancy. The high temperatures may elevate your body temperature above 101 degrees and may have a harmful effect on the baby.

If you experience constipation during pregnancy, you might notice fewer bowel movements, hard stools, and lower belly pain. This happens due to pregnancy hormones slowing bowel movement and iron supplements. To prevent constipation, eat high-fiber foods like fruits, vegetables, and cereals, drink at least eight glasses of water daily, and exercise regularly. If you're already constipated, increase fiber intake gradually, stay hydrated, and try prunes or prune juice. If these remedies don’t work, consult your doctor, especially if you have severe pain or rectal bleeding.

You should call your physician during pregnancy if you experience severe abdominal pain, heavy bleeding, persistent headaches, vision changes, swelling, or any other unusual symptoms.