Foxhall OB/GYN Associates would like to congratulate you on your pregnancy! We are excited to be chosen as your health care provider during this very special time of your life. We are happy to guide you through pregnancy, provide you a relaxing and reassuring atmosphere in labor and be supportive during the postpartum phase.

We would like to provide you with some information we hope you will find useful during your pregnancy. There are seven physicians at Foxhall OB/GYN who practice obstetrics: Dr. Richard Beckerman, Dr. Shannon Green, Dr. Lynne Lightfoote, Dr. Nichole Pardo, Dr. Maro Sarafian, Dr. Lindsay Snyder and Dr. Renee Stany. Drs. Green, Lightfoote, Pardo, Snyder and Stany practice in a group; they share their obstetrical patients and each physician has a day she is assigned to the hospital which is their “on call” day. Patients that are seeing the group physicians will be delivered by the physician who is on call when they go into labor. During prenatal care, patients are asked to rotate and meet all the physicians so they feel comfortable with each and every one of them. Please be assured of the competence of all the physicians in our practice and the communication between physicians which assures your continuity of care.

Alternatively, Drs. Beckerman and Sarafian practice as solo practitioners. They each have their own obstetrical patients and will each go deliver their own patients Monday through Friday. Their patients do not rotate with other physicians and have a different answering service number to call when they are in labor.

On weekends and holidays, all of the Foxhall physicians cross-cover. There is a physician assigned to each weekend who takes call Friday through Monday morning. On weekends and holidays, Dr. Brendan Burke, a local board certified solo practitioner, also rotates in the call schedule. If you are delivered by Dr. Beckerman, Dr. Sarafian or Dr. Burke on the weekend and they do not participate with your insurance plan, please do not be alarmed. You will be billed by Foxhall OB/GYN Associates and will not accrue any additional fees.

If you experience a life threatening emergency either during office hours or after hours, you should call 911 immediately. During business hours, if you are in labor, you should call the office number and have any of the staff direct you to “Sue” who will contact the physician on call. If you are in labor in the evening or on a weekend, you should call the office number and follow the directions for contacting the answering service. The doctor on call should contact you within fifteen minutes. If you have not heard back in fifteen minutes, please contact the answering service again to insure that the page has been received. Please refrain from the temptation to use the answering service for routine questions or lab results. The physicians are not in the office and do not have access to your chart.

IMPORTANT TELEPHONE NUMBERS

Foxhall OB/GYN Associates (202) 243-3500

Foxhall Answering Service (757) 875-9228

(888) 337-0309

Sibley Hospital Labor and Delivery (202) 537-4577

Sibley Hospital Emergency Room (202) 537-4080

LABOR

If you start feeling painful contractions after 36 weeks of labor, start timing the interval between contractions. You should call the physician once the contractions are five minutes, last for at least forty seconds, and persist for at least an hour. The purpose of the internal examinations starting at 36 weeks is to fine tune these instructions, for example, if you have a history of rapid labor, have had a baby before or are dilated more then three centimeters, you will be given more specific instructions on when to call.

RUPTURE OF MEMBRANES

Amniotic fluid will be watery, not the consistency of discharge, and it will feel like you are urinating without being able to control the flow. If you are not sure, simply put on a pad and observe for an hour. Generally speaking, when the membranes are ruptured, even when there is not a big gush, you will leak constantly. You should call immediately if the fluid is not clear (greenish-- which is indicative of meconium passage) or you are

Group B Strep positive. If you are still not sure, simply call the office or the doctor on call and you will be given instructions on how to proceed. Do not take a bath, swim or have sex if you suspect your membranes may be ruptured.

PRETERM LABOR

Preterm labor is strictly defined as frequent uterine contractions that change the cervix anytime prior to 37 weeks of gestation. If you are less than 36 weeks gestational age and are experiencing more than six contractions per hour, we recommend you get off your feet, rest, and also increase hydration by drinking liquids. You should then monitor your contractions for another hour. If you continue to contract more than six contractions an hour, you should call your physician immediately. As there is no way to distinguish harmless contractions from labor, you will be asked to go into the hospital for evaluation. If you are less than 32 weeks, you may be asked to go to Georgetown Hospital rather than Sibley Memorial Hospital.

TRAUMA

If you experience direct abdominal trauma (a fall in which you hit your abdomen directly or a motor vehicle accident in which your abdomen hits the steering wheel), contact your physician as soon as possible. If you are in your third trimester, you will be asked to go to the hospital for monitoring.

BLEEDING DURING FIRST TRIMESTER

Of the clinically recognized pregnancies, approximately 20% are lost in the first trimester. Although a miscarriage is distressing, please be assured that it is very common and does not increase the risk in future pregnancies. An ultrasound demonstrating fetal heart activity reduces the subsequent risk of miscarriage to 5%.

Vaginal spotting is relatively common during the first trimester and does not warrant a phone call. Spotting may be caused by intercourse, vaginal or cervical lesions, infection or increased fragility of the cervix. Heavier menstrual type of bleeding occurs in approximately 20% of women during the first trimester of the pregnancy, and of those patients, approximately one-half will miscarry. If you experience menstrual type of bleeding, please call your physician.

Most spontaneous abortions are the inevitable consequence of genetic or developmental abnormalities in the fetus. In most cases, there is nothing you can do to increase or decrease the chance of miscarriage. There is no evidence that bed rest is helpful; continued activity will not influence fetal outcome.

BLEEDING DURING SECOND AND THIRD TRIMESTER

If you note minimal vaginal spotting (red or brown tinged blood in underwear or upon wiping yourself) but are not contracting, leaking amniotic fluid and are feeling good fetal movement, you should try to get off your feet and rest. If the bleeding turns into menstrual type of bleeding, you should call your physician immediately. Please note that a pregnant cervix is very easily traumatized; you might notice bleeding anytime after receiving an internal exam or after intercourse.

FETAL MOVEMENT

Each fetus has its own degree of activity. By third trimester (28 weeks) most patients become familiar with the degree of fetal movement they expect. If in the third trimester, you suspect decreased fetal movement, we recommend that you first get off your feet, increase fluids and have something sweet to eat or drink. In general, you should then feel about 10 movements over 2 hours. Contact your physician if your fetus does not meet the recommendation. Please note fetal activity prior to the third trimester is unreliable and the same recommendation does not apply.

FEVER

Fever is defined as an elevation of body temperature above 101(38.5C). Elevated temperature alone is not necessarily a cause for alarm. It is a sign that the body is trying to fight an infection. You should make an appointment during business hours for evaluation. Tylenol (acetaminophen) can be used to reduce fever at any gestational age.

We hope you find this information useful. Please keep it for reference. We are happy to answer any routine questions that might come up during your prenatal visits. Please keep a list and review with your physician. We hope you have an easy and uneventful pregnancy.

FOXHALL OB/GYN PHYSICIANS