Dear Expectant Mother:

I am glad that you have chosen me as your physician. I look forward to our close relationship in the upcoming months of your pregnancy.

I am a graduate of the University for Health Sciences Colleges of Osteopathic Medicine in Kansas City, Missouri. I am also Board Certified in Obstetrics and Gynecology. I am usually available during the week (9:00 AM - 5:00 PM) if you call my office at (231) 777-2748. After hours or on the weekends, either call Special Delivery (231) 777-6291 or my answering service at (231) 737-5731.

I look forward to attending your delivery, however occasionally I am out of town at an Educational Seminar or on a much-needed vacation. In my abscence on of four physicians may be on call for me. They include: Janice L. McDonald, D.O., Mark T. Karnes, D.O., Natalie S. Leibensperger, D.O., or Deniece M. Warren, D.O. My ansewering service will direct your call to one of them if needed.

Your prenatal visits will be approximately every 4 weeks until the 28th week. Then they will be every 2 weeks. Visits will be weekly the last month or more often if your condition warrants it. I urge you to keep these visits. Good prenatal care contributes to the good health of Mom and Baby.

I deliver almost all of my patients at Mercy General Hospital - Oak Campus. I have courtesy privileges at North Ottawa Community Hospital. For information on hospital charges, please contact the hospital. Mercy General offers Prenatal, VBAC, and Mom-Be-Fit classes, as well as Sibling classes. Please call Special Delivery at 777-6291 to arrange for classes or a private tour. I require my first-time patients to attend these classes, so call early to get on the waiting list. If you need a cesarean section and want Baby's father there, he needs to have attended the class on cesarean sections given as part of the prenatal class. Special Delivery has now over 8 Labor-Delivery-Recovery-Postpartum rooms. I enjoy delivering in this atmosphere. We also have use of hot tubs and possible intermittent auscultation for laboring moms. Decide ahead of time who will be there. Usually due to space, we ask that only 2 people be with Mom at the time of delivery and 2-4 people while in labor. We have a very liberal postpartum visiting policy. Please, however, ask children or adults who are ill or have a "bug" not to visit. If you have questions, check with the nursing staff.

Please take no medication while pregnant unless prescribed or authorized by me. However, the following over-the-counter medications should be safe while pregnant:

• Tylenol or Extra-Strength Tylenol - 2 tablets every 4 hours for pain or elevated temperatures
• Imodium AD
• Maalox, Mylanta, Tums, and Rolaids - 1 tablespoon or tablet every 2-4 hours as needed for heartburn or gas. Sometimes keeping Maalox-Plus or Mylanta-Plus at bedside can be helpful at night
• Robitussin Plain Cough Syrup - 1 teaspoon every 4 hours for cough
• Cepastat - lozenges for sore throat
• Sudafed - 1 tablet every 8 hours for sinus problems can help
• Metamucil or Effersyllium - 1 teaspoon in 8 ounces of juice or water for constipation
• Surfak - 1 or 2 daily to soften stools
• Kaopectate - for diarrhea, 1 tablespoon after each loose stool, up to 6 doses per day is allowable. If you need more than 6 doses in 24 hours, please contact me.
• Never use Pepto Bismol while pregnant.

  Activities: Normal activities are encouraged. Please refrain from douching, riding a dune buggy or motorcycle, horseback riding, water/snow/jet/cross-country skiing while pregant. Race care driving, sky-diving, and bungee jumping are no-nos. Jacuzzi hot tubs over 97 degrees Fahrenheit should be avoided. Tanning booths and suntan lotions that contain Paba should also be avoided. Please do not travel more than 75 miles away after your 34th week of pregnancy.

  Work: It's a good idea to find out the Pregnancy Leave Policy at your place of employment. Do this early in pregnancy. Some employers provide wages and benefits for elective time-off before delivery (4 weeks). Many do not provide these benefits. If you have a medical problem such as pre-eclampsia, pre-term labor, severe high-blood-pressure, or difficulty controlling blood sugar, I will provide documentation to your employer to help you qualify for benefits. I can only do this for problems that could jeopardize your pregnancy. Usual time off after delivery is 6 weeks. Some moms look into the government mandated 12-week Family Leave Programs. However, usually only 6-8 weeks postpartum are paid leave. Again, find out what your employer's policy is. Today, many moms work up to the due date, in order to have the maximum time off with Baby.

  Helpful Hints: Leg cramps are very common in pregnancy and aren't due to calcium deficiency. They occur most often at night and can be terribly frightening. Please get up and walk. The pressure of walking usually helps to ease leg cramps.

  Please call me if you have a temperature over 101 degrees Fahrenheit for more than 24 hours that doesn't come down with Tylenol or Extra-Strength Tylenol (2 every 4 hours).

If you have bleeding of bright, red blood that saturates one normal pad or more in 1-2 hours, please let me know. Spotting red, pink, brown, or black blood can occur after intercourse or a pelvic check. If you have post-intercourse spotting, abstain for 4-5 days.

If you have burning with urination or your water breaks, please call my office or Special Delivery.

Discharge is normal in pregnancy as long as it doesn't cause itching or burning. Discharge the last 6-8 weeks may be enough to require using a pad.

Often times moms will have round ligament pain. This is a sharp pain in the lower right or left sides of the abdomen that lasts a few seconds to 5-10 minutes. This can be frightening, but it is not harmful to Mom or Baby. A warm shower, tub bath, or lying on the opposite side can help.

Usually one of the residents will see you during labor and delivery. There might also be an intern or extern in the room. I will be there and in charge of your delivery or the specialist covering for me will be there. If you have a problem, please let me know during the course of your prenatal visits.

OB Services Include:

• Complete physical and 2 post-partum visits after delivery
• Prenantal care during office hours. This, of course, does not include office or hospital visits due to injuries or illness not related to the pregnancy.
• Urine checks (dipsticks) at each visit
• Complete care of Mom at delivery
• There is no charge for forceps, vacuum delivery, or prolonged labor

Services Not Included Are:

• Lab work at the hospital or outside labs
• Medications such as vitamins, iron pills/shots, or hormone shots
• House calls or night office calls
• Other surgery
• Cesarean sections or VBAC
• Tubal ligation
• Circumcision of male infants
• Hospital care other than at the time of delivery
• Charges made by the hospital
• Delivery of twins
• Amniocentesis
• Non-stress and stress tests

Payments:

Please check with the billing office, and they will go over charges and discuss your insurance coverage and any amounts that may be due to by you. It is best if you check with them each visit and let them know of any insurance changes. We will complete your insurance claims as a courtesy to you. However, I cannot accept responsibility for collecting claims or negotiating a settlement on a disputed claim.

If you leave my care before delivery, you will be charged only for prenatal visits or other services already performed. Any overpayment will be refunded to you after we have heard from your insurance company. Any payments determined to be due by you should be paid by the end of your 6th month of pregnancy. Those payments should be handled as discussed with the insurance and billing staff.

In Reference to Going to Deliver:

Patients wonder when to go to the hospital. If your water breaks, go to Special Delivery immediately. They will call me. If you are leaking or think your bag of waters has ruptured, go to Special Delivery right away. They have the tools to ascertain if your water has broken. I can't do that over the phone.

If this is your first baby and if you have contractions 5-7 minutes from the start of one to the next and if the contractions last 45-60 seconds and persist this way longer than an hour, go to Special Delivery. They will check you and call me. If this is your second or more delivery, go to Special Delivery when contractions are 7-10 minutes apart lasting 45-60 seconds. If you have bleeding where you saturate 1 regular pad, please contact me or Special Delivery. Usually one of the residents at the hospital can answer your questions or can reach me so I can return your call.

If you think you are in labor, please refrain from any heavy meals. Please try and arrange beforehand for your family doctor or pediatrician to care for your baby. You may want to discuss selection of a pediatrician with me.

My ultimate goal is to provide you with good obstetrical care and for you to have continued good health during you pregnancy and after the delivery of a healthy baby. With your cooperation, hopefully this goal will be attained. If you have any questions or concerns, please feel free to discuss this with me at any time.

Sincerely yours,

Carol J. Markiewicz, D.O.

Disclaimer: The articles and information, while with the best effort to be accurate and up-to-date, may not be. Also, every physician and medical professional holds their own views on certain diagnosis and advice. There truly are no textbook cases. It is always best to consult with your personal physician regarding medical/health related problems. The information is to be used as a general resource and not as a substitute for trained medical advice and/or treatment.