Prenatal Care

We’ll Keep You and Your Baby Healthy

Obstetrics Orientation

Welcome to Alaska Women’s Health! We are happy that you have chosen our practice for your prenatal care and delivery. On this page, we’re going to discuss:

• Our Practice Model of Shared Care
• Accessing Our Online Patient Portal
• Billing & Insurance Information
• Developing a Prenatal Care Plan
• Prenatal Laboratory Testing
• Staying Healthy During Pregnancy
• Pregnancy Warning Signs
• Labor After Cesarean Section

Our Practice Model of Share Care

Our Obstetricians, Nurse Practitioner, Nurses and Medical Assistants all provide comprehensive medical care with personal attention to your individual needs.

We have the ability to deliver at two hospitals in Anchorage:

1. Providence Alaska Medical Center
2. Alaska Regional Hospital

We have six delivering providers in our office.

Accessing Our Online Patient Portal

Our patient portal allows you to update your medical history and demographics as well as corresponding with your care team via portal messaging. Please do not use the portal messaging for urgent questions or concerns – please call Triage and/or our after-hours Provider instead.

You can set up your voicemail and let us know if it is okay to leave a medical message.

Billing & Insurance Information

Billing

Please call our patient accounts representative, Sheryl Makelim, at 907- 339-1609. It is often most beneficial to speak to Sheryl prior to your first appointment. Please do not hesitate to call her!

You can talk to her about:

• Financial questions
• Payment plan questions
• Insurance questions
• Billing questions

Insurance

We ask that all our patients please take the time to learn and understand your insurance plan. Not knowing could lead to paying more money, for example:

• Using a lab your insurance does not consider “preferred”
• Obtaining a test or ultrasound without authorization
• Delivering at a hospital outside your insurance network

What You Can Do

• Know your preferred lab (Labcorp, Quest, PAMC, ARH)
• Know if you need authorization for specific tests or ultrasounds
• Know which Hospital is preferred for delivery prior to delivery

How We Can Help

• Contact your insurance company
• If you have any trouble, we are here to help! Please call our patient accounts representative for assistance

We can guide you in the types of questions you may want to ask your insurance and assist you in understanding the terminology your insurance company may use. We can also help you obtain an overview (including deductible, co-ins, co-pays, and out-of-pocket limits) of your insurance plan, and give you an estimate of what you are personally likely to pay for services.

Our team is always happy to discuss payment plan options for services rendered.

However, we can’t guarantee that what your insurance provider says on a phone call is exactly what they will or will not do. We will not always know if you require a pre-certification or authorization for a procedure or test, or what labs or hospitals your insurance will consider “preferred.”

Download this PDF for questions to ask your insurance provider before your first prenatal appointment.

Developing a Prenatal Care Plan

What to Expect

Obstetrician (OB) checks range from 10-30 minutes, depending on whether you are low-risk or have any pregnancy complications. Routine OB visits will usually be:

• Once per month until you are 28 weeks
• Every two weeks from 28-36 weeks
• Weekly from 38 weeks until delivery

Routine Lab Work

Typical OB labs include your blood type, screening for anemia, STIs, pap (if due), and immunity to certain diseases such as Varicella and Rubella. Fetal testing may be indicated for some women in their pregnancy to closely monitor mom and baby as you get closer to your due date.

We usually schedule a postpartum visit about 6 weeks after delivery.

Your First Appointment

This appointment is all about you! We ask that you please do not bring children, but we encourage your partner or a support person to come along. Please feel free to bring questions for our team!

This visit is about getting to know you, which includes:

• A head-to-toe physical exam
• An ultrasound (this could be transvaginal or abdominal)
• Talk about your estimated due date (EDD)
• Order lab work (there is no need to fast)
• Discuss available screening tests

Prenatal Laboratory Testing

First Timester Labs

CBC, HIV, Hepatitis B and C, Blood Type and antibody screen, Varicella, Rubella, Syphilis, Gonorrhea, Chlamydia, Urine Culture.

We may order additional labs based on your history or risk factors.

28 Week Labs

CBC, One-Hour Glucose Screening Test, Antibody Screen (if Rh- blood type).

Additional labs may be ordered at any point during your pregnancy.

Please note there is no need to fast as these are random tests. We also conduct separate testing for special situations, including DM, HTN, and infertility.

Routine Ultrasounds

• Initial dating ultrasound
• Anatomy ultrasound (performed between 19-21 weeks)
• Baby’s position ultrasound (performed between 36-37 weeks)

We will also conduct other ultrasounds if indicated.

Routine Vaccines

• Tdap
• Influenza
• If you are not immune to Varicella and/or Rubella, you will need to avoid exposure while pregnant. We will offer these vaccinations postpartum as they are not given during pregnancy.

Genetic Screening

Your doctor will talk to you about genetic screening options at your first OB appointment.

First Trimester Screen (11-13 weeks)

• Screens for Down Syndrome, Trisomy 13 and 18
• Testing performed via maternal blood sample and Nuchal translucency ultrasound (Ultrasound and blood draw must be done on the same day)

Non-Invasive Prenatal testing NIPT/Cell Free DNA/ Prenatal Screen

• Available to everyone, but usually only recommended for high-risk patients
• Screens for a series of genetic abnormalities such as Down Syndrome and optionally can find out baby’s gender
• Testing is performed by maternal blood sample

MSAFP (16-18 weeks)

• Screens for Open Neural Tube defects such as Spina Bifida
• The AFP test is measuring levels of alpha-fetoprotein. The results are combined with the mother’s age and ethnicity in order to assess probabilities of potential disorders.
• If the first trimester screen is combined with AFP, it’s called an “Integrated Screen.”

Carrier Screening

Carrier screening is optional testing for inherited genetic conditions. These tests can tell whether or not you (Mom) are a carrier of a specific gene mutation that could be passed to the baby.

Examples of carrier testing include screening for Cystic Fibrosis, Spinal Muscular Atrophy, Fragile X, Muscular Dystrophy. Carrier testing can be done prior to pregnancy or during pregnancy – it is specifically testing whether or not Mom (not baby) is a carrier.

If Mom is a carrier of the condition, testing the father of the baby will be recommended to determine what probability the baby may have of being affected.

Cystic Fibrosis

The most common carrier screening performed is for Cystic Fibrosis. This is a genetic disease that affects 1 in 3,500 births each year in the United States. It causes the body to produce abnormally thick mucus leading to life threatening lung infections, digestive problems, diarrhea, poor growth and male infertility.

Download this PDF to learn more about Genetic Testing and Carrier Screening.

Exposure to Disease During Pregnancy

Toxoplasmosis

Can be exposed by contact with cat feces, unwashed fruits and vegetables, contaminated water. Avoid changing cat litter while pregnant. If unavoidable, wear gloves and practice good hand hygiene.

Varicella (Chicken Pox)

Pregnant women who are exposed to Varicella for the very first time during pregnancy are at risk for serious complications. If you’re exposed to chickenpox during pregnancy contact your health care provider immediately.

Staying Healthy During Pregnancy

In this section, we cover everything from optimal weight gain to prescriptions, hydration, nutrition (including seafood), cravings, exercises, recommended activity restrictions, and what to do if you fall.

Optimal Weight Gain

Many pregnant women wonder how much weight they should gain. This is based on your pre-pregnancy BMI, and is intended only for women carrying ONE baby:

• Underweight (BMI <18.5): 28-40 lbs
• Healthy weight (BMI 18.5-24.9): 25-35 lbs
• Overweight (BMI 25-29.9): 15-25 lbs
• Obese (BMI >30): 11-20 lbs

Prescriptions

Some pregnant women must take medications to treat certain health conditions and it is important you continue to do so during pregnancy. For example, if a woman has asthma, epilepsy (seizures), high blood pressure or depression, she might need to continue to take medication to stay healthy during pregnancy. If these conditions are not treated, a pregnant woman or her unborn baby could be harmed. It’s ESSENTIAL that you speak to your doctor very early on about medications you are taking to ensure they are safe to continue during pregnancy.

Hydration

During pregnancy, your blood volume will increase 30-50%. This starts as early as six weeks! While you’re pregnant, you should aim to drink 2-3 liters every day (this equals about ten 8oz cups in a 24-hour period). It is possible to drink too much, so we recommend you don’t exceed 3 liters.

Nutrition

Your caloric intake should increase by 200-300 calories per day in second and third trimesters. You should eat everything in moderation, including foods from all the major groups: grains, dairy, fruit, vegetables, and protein. We also recommend avoiding processed foods where possible.

When it comes to caffeine consumption, you should drink no more than 200mg per day. This is equivalent to about two 8oz cups of regular strength coffee.

Seafood

Seafood (fish, shellfish) can be a great source of protein, iron and zinc – all of which are crucial nutrients for your baby’s growth and development. Just make sure it’s well-cooked! Many types of fish include Omega-3 fatty acids in many fish, which will help your baby’s brain.

What Seafood is Safe?

• Alaskan Salmon
• Anchovies
• Herring
• Sardines
• Trout
• Mackerel
• Shrimp
• Pollock
• Tilapia
• Cod
• Catfish
• Canned Light Tuna

However, we recommend you limit white (albacore) tuna and tuna steaks or halibut >44 lbs (weight when caught) to 6 ounces (170 grams) per week.

What Seafood to Avoid

Uncooked fish, such as sushi or sashimi, can carry parasites and are off-limits during pregnancy. However, cooked sushi is generally fine, as long as you consume it only in moderation.

It’s important to note that large, predatory fish can contain high levels of mercury such as:

• Shark
• Swordfish
• King mackerel
• Tilefish

General Foods to Avoide

Listeria is a foodborne bacterial illness, most commonly contracted by eating improperly processed deli meats and unpasteurized milk products. To keep yourself and your baby safe, we recommend:

• Always avoiding raw fish and meat
• Avoiding soft cheeses, including brie, feta, fresh mozzarella, and blue cheese
• Avoiding raw, unpasteurized milk
• Heating lunch meats (such as turkey, ham, or bologna) to 165°F before you eat them

Strange Cravings

If you begin to crave non-food items that have no nutritional value – please notify us! We love getting these calls because they are so interesting. Examples may be chalk, ice, dirt, and paper. These may indicate that you are anemic or have PICA. Don’t be afraid to pick up the phone.

Exercise During Pregnancy

It’s fine to exercise during pregnancy, but you should consider what exercises you are doing and modify them accordingly. There are no maximum heart rate limitations, but when it comes to intensity recommendations, we suggest that you should be able to talk while exercising.

• Low-impact exercise, such as yoga or swimming, is great
• It’s best if you avoid low-oxygen activities like scuba diving or mountaineering
• You should avoid high-impact sports where you could fall, such as downhill skiing, horseback riding, or mountain biking, just to keep yourself and your baby safe

Recommended Activity Restrictions

Hyperthermia is an abnormally high body temperature. It can raise concerns during pregnancy, particularly in the first trimester, so we recommend you avoid saunas, hot tubs, and hot showers.

What to Do if You Fall

Please call us immediately! Increased abdominal girth moves your center of gravity. Falls can happen at any time, and slipping on ice is very common in Alaska. It’s worth investing in ice grippers.

Pregnancy Warning Signs

• Bright red bleeding
• Sharp, stabbing pain that does not go away with rest or position change
• Period-like cramping with bleeding

If you have any of these warning signs during normal business hours, please call the office and speak to one of our triage nurses. If they occur after hours, please speak to our Provider on-call (563-5151) or report to the emergency department at the hospital where you plan to deliver.

Labor after Cesarean Section

Trial of Labor After C-Section

A trial of labor after C-section is sometimes referred to as a TOLAC.

If you desire a trial of labor after a prior C-section:

• You will have a detailed visit to address this in the early 3rd trimester
• This will include a fetal growth ultrasound at about 36 weeks

Please note that AWH providers do not do TOLACs at Alaska Regional Hospital.

Elective Repeat Cesarean Section

If you have had a prior C-section and do not wish to labor or try for a vaginal delivery, “elective repeat C-sections” are done at 39 weeks and we can start working on scheduling this.

Please talk to your provider if you have questions!