Pregnancy

So... you want to have a baby... Congratulations! What do you do next?

We've listed a lot of useful information below, with more details in the Family section about other resources (e.g., mailing lists, lactation rooms, etc.). 

Feel free to also post recommendations on our JHPDA Families Forum: http://groups.google.com/group/jhpdafamilies
Our JHPDA Blog has an article on "Useful Baby Items." Please add your own suggestions/recommendations in a comment on that post! :)



Health and Fitness

Most folks who are physically fit have an easier time going through the pregnancy, so make sure you exercise! You don't want to over-exert yourself, but getting your heart rate up for 15 to 30 minutes a day will help, even if it's just brisk walking or using the elliptical or bike at the gym.

Some of our postdocs recommend taking pre-natal vitamins even before you're pregnant (around a month before you conceive), which is said to help prevent neural tube defects. We recommend multi-vitamins on a daily basis, anyway. You can also wait to see if your OB-GYN will recommend specific vitamins for you. If you have any questions about vitamins, definitely ask your doctor.

One resident recommends flax seeds -- "no more constipation after that!" Others suggest MiraLax (which helps your colon absorb more water for easier transit) or Metamucil.

If you're feeling queasy from "morning sickness" (which often occurs in the evenings, too), then go for "anti-nausea" foods, like ginger ale, rice, and minty things. Some women eat ice chips or drink cold things to get the queasiness out. If you feel hunger pangs (and you will!), try to go for multi-grains instead of refined bread, so that you'll get hungrier less often. (Refined breads may make you feel hungrier in maybe three hours or so.) Small, frequent meals are key -- don't over-eat, but don't let yourself get super hungry, either. Each person is different, but your baby bump will probably start showing around four to five months.

Avoid large quantities of alcohol and drugs. 


Pregnancy Tests

Usually, the first step to determining whether you're pregnant is taking the grocery store urine test and getting a positive result. Some tests claim that they can detect a pregnancy six days BEFORE your period. These usually come with two tests per box, so it's good to re-test a few days AFTER your scheduled period, anyway. Even though these tests are pretty accurate, most folks wait until after the first trimester (the riskiest portion of the pregnancy) to start telling others the good news. 

Some websites also have nifty pregnancy calculators that tell you approximate dates for what's developing at every step of the way. The first day of your most recent period is the first day of your "pregnancy," even though conception usually occurs two weeks after that.


Choosing a Hospital

One of the considerations in choosing a hospital is the location -- it's probably best to be close to where you work or where you live, in case you need to get to the hospital in a hurry! 

When you're considering a particular hospital, also be sure to note not just the delivery process, but also how the babies are taken care of after the delivery. Hopkins is especially known for catering to high-risk pregnancies and has a high-intervention approach, which may be particularly useful for people who could have difficult pregnancies. 

Also many hospitals and private organizations hold pregnancy and infant care relate classes that are very useful for preparing. You will be more comfortable with knowledge about what is normal and how things should go. Becoming a parent is something that we recommend preparing for!

Hopkins

If you are pregnant, you can either see someone at the University Health Center right away (they can usually accommodate walk-ins within a day or two), or you can schedule an appointment directly with the OB Clinic at Hopkins. 

You may see your Primary Care Physician (usually at UHS) to get confirmation of the pregnancy (e.g., with a positive blood test) or to make sure you're healthy, but after that, you will need to choose an OB-GYN or nurse midwife for OB appointments. If you are considering NOT keeping the baby, then make an appointment ASAP at UHS so that you can figure out which options are available for you.

If you want to keep your baby, then you can call the OB Clinic at Hopkins directly. Since OBs are primary care physicians, you usually don't need a referral, as long as you have EHP. You'll set up two appointments, the first with a nurse and the second with an Obstetrician/Gynecologist (OB-GYN). Depending on the clinic that you go to, at your first OB appointment, you may need a letter from your PCP that states confirmation of your pregnancy. At Hopkins, the OB Clinic does not need a blood test to confirm your pregnancy (usually, the urine tests are fine), but they may administer one at your first appointment.

Because it's a large clinic, your appointments will usually be scheduled with a different doctor each time. You can designate a particular doctor as your primary doctor. Many people prefer to see a different person each time to increase the chances of knowing the doctor on call whenever you happen to deliver.

Your first appointment at the OB Clinic is usually with a nurse, and usually in the afternoon. The nurse will get a detailed medical history, asking you a long list of health history questions (smoking, drinking, etc). They'll send you down the hall to get a few blood tests done, too.

Your second appointment at the OB Clinic is with an OB-GYN. At nine to eleven weeks, you'll have the first internal exam and ultrasound. Both will be done by a resident or trainee with a supervisor. In general, ultrasound techs may not give an opinion about whether everything looks healthy as they're taking measurements, which can be a little nerve-wracking, but just ask how things look or what those various body parts are, and they may be able to tell you. 

Appointments are initially a few weeks apart, about once a month. Then, as your delivery day draws near, you'll meet with the OB-GYN once every two weeks, then once a week. Unless there are complications, the last appointment is usually six weeks postpartum. These appointments generally include a urine sample, blood pressure and pulse check, and weigh-in. Check in with the nurse and doctor on any relevant issues.

On the day of your delivery, the OB-GYN on call will be delivering your baby. If you have a primary doctor, then the staff will call your primary doctor when you arrive at the hospital, and he/she will discuss the procedure with the OB-GYN on call. (This is fairly typical in large hospitals.) If you opt to have a C-section, the doctor will most likely be a surgeon that you've never met. Generally, at Hopkins, they are pretty clear about who is a trainee, and ask permission for whether you are comfortable with people "learning on you." Several people have had an attending doctor, fellow, resident, and med student in the delivery room, though the doctor and fellow tend to do most of the work. Sometimes, a senior physician will oversee a resident who does the actual work.

Hopkins is also an interesting hospital because it's very diverse -- located in Baltimore City, the patients range across a wide variety of backgrounds.

Most people say that the nurses and facilities are quite good. They also have good doctors and midwives. The nurses are also lactation consultants, which are very helpful. That said, they can also be very aggressive about breastfeeding. If you have a difficult pregnancy and your milk just isn't coming in yet, then don't be afraid to ask for formula so that your baby gets some nourishment during those crucial first days of early development.

These days, births usually take place in the Birthing Center of the Sheikh Zayed tower (more information here) at the Johns Hopkins Hospital. You should schedule a tour and register for birthing classes during your third trimester. Tours are free. Birthing classes range from a few hours on a Saturday to access to many online videos. One postdoc also compiled this .pdf with information from their tour from August 2013, including photos of the birthing center.

One postdoc says that Zayed has nice big rooms with seating. She was allowed to have three people in the room (e.g., her husband and parents), and was supported by nurses throughout the process. Doctors showed up from time to time to check progress and manage care. The doctors did everything they could do to ensure a successful vaginal birth while maintaining the baby's health. Her recovery and postpartum room was also a single, and she stayed for two days. If you opt to have a C-section, you may need to stay longer in the hospital. 

The baby stays in your room, except for weigh-ins. Newborns need to eat every three hours, so the first month is exhausting. The nurses may also ask if you want your baby to stay in the nursery for about an hour or two so that you can get some sleep.


Hopkins + Insurance (EHP)


Something to keep in mind: If you go to the JHH main hospital, you may get charged twice -- a doctor's bill and a facility charge. Other facilities, like White Marsh, does not have a facility charge, but more invasive procedures (CVS and amnio) cannot be performed on the White Marsh campus; these procedures would have to be performed on the main medical campus.

Note also that if you want to go to a non-Hopkins place, make sure that it is in-network in terms of your insurance. Otherwise, you may get some interesting financial surprises...

Coverage by the 2013 EHP Student Health Program can be found on the EHP website: http://www.ehp.org/johns-hopkins-student-health-program; however, you should always call customer service to get the most up-to-date information, especially regarding your particular plan. As of August 2013, if the mother is under the Student Health Program at EHP, newborn care at the hospital is covered by EHP at 90%. Once the baby gets a name and social security number, you usually have 30 days to put him/her on your insurance policy. Note that a newborn is NOT automatically covered by your insurance, especially for out-patient care.

If you deliver at Hopkins, you get some perks. One postdoc says that they gave her a free accessory kit for the mother's rooms at Hopkins ($30) and a free pump as a benefit of her insurance (~$200). You may be able to get a free pump if you deliver somewhere else, but, according to our postdocs, at Hopkins, they're more familiar with EHP, and are quicker with these types of requests. If you have any questions, just ask -- everyone is really helpful! According to the UHS Benefits Manager, breast pumps and contraceptives are covered at 100% for the student plan, beginning July 1, 2013, as a result of the Affordable Care Act. For more information on breast pumps, see the "Breastfeeding Resources" section below.

All MD employees are eligible to take up to 12 weeks of unpaid leave for medical reasons including pregnancy under the Family and Medical Leave Act (FMLA), which includes dads! More information on sick/maternity leave can be found in the Basic Benefits section of our website.

Hopkins also has a BabyStepsRewards program, which lets you track milestones (i.e., your 20-week ultrasound, keeping particular appointments, etc), and rewards you with Amazon.com gift certificates. Once you see your OB/GYN, you'll get more information on how to sign up for this program, usually with a personalized URL.


Hopkins Maternal/Fetal Medicine Practice at JHH

This department specializes in high-risk pregnancies, but also sees all of the residents and faculty members whether they're high-risk or not.

Hopkins Bayview

Fewer medical students at Bayview, so the delivery would probably feature an attending, resident, and maybe fellow.

Hopkins White Marsh

This branch in White Marsh doesn't have a facility charge, but more invasive procedures (e.g., CVS and amnio) cannot be performed on the White Marsh campus. 


Recommended Primary Care Physicians

These PCPs have been recommended by postdocs and Hopkins faculty members:
  • University Health Services
    • Dr. Nancy Codori -- straightforward and efficient
  • JHCP: Greenspring Station
    • Dr. Norman Dy -- nice and capable guy


Maryland General Hospital

This hospital has one of the few certified nurse midwife systems in the state, and one of the lowest C-section rates. They also have OB/GYN doctors for those who would rather see a medical doctor. Maryland General Hospital is considered "in network" under postdocs' EHP insurance.

According to one postdoc, "The midwives are highly professional, yet very caring and happy to listen to you, something I find rarer amongst MDs. Consequently, despite a long and difficult labour, they did everything possible to help me avoid a C-section and have a good birthing experience. The baby was monitored and never in any danger, but from what we know, in most other settings, they would have cut me open without giving me the fighting chance for a vaginal birth. We had a fantastic labour team and are very happy with the care we received!"

In particular, our postdocs recommend Lorraine Goldstein (CNM). She has 35 years of experience as a midwife. This practice has a low intervention/natural birth philosophy. She and her associates are located at:

Women's Healthcare Associates
821 N. Eutaw Street, Suite 209
Baltimore, MD 21201
410-225-8991


Pregnancy-Related Services for US Citizens

If your overall family income is below 250% of the federal poverty level you may be eligible for Medical Assistance for pregnant women though the Maryland Children's Health Program (MCHP). This situation would apply to junior postdocs with spouses who don't work or have minimal income. They will cover the gap between your primary insurance (EHP) and the total cost of care.

Women, infants and children (WIC) Program: you are eligible if you have MCHP or Medical assistance. Services include pregnancy-related education and nutritional assistance. They have lactation consultants for women interested in breastfeeding. This is a valuable resource if the hospital you deliver at does not have a consultant.


Pediatricians

Keep in mind that you should add your baby to your insurance policy BEFORE the baby is born. It's also good to call pediatric offices to set up appointments for a pre-natal visit before the baby is born, to figure out whether your family would be a good fit.

Here are a few recommendations from your fellow postdocs for pediatricians in the Baltimore area:
  • Hopkins White Marsh Pediatric Practice: recommended by a lot of the people that work in the White Marsh OB office.
  • JHCP Canton Crossing: recommended by several postdocs and residents; also very close to where we live!
    • Dr. Cathy Parrish
    • Dr. Susan Schrock
    • Dr. Kathryn Omron
  • Wyman Park: near Charles Village (3100 Wyman Park Dr, Suite 359A)
    • Dr. Edward L. Barlett
    • Dr. Ardele Shefchek
  • Maryland General Hospital: 
    • Dr. Ajit Das (821 N. Eutaw St., Suite 301)
  • Pediatric Partners in Towson: flexible evening and weekend hours, and you can call w/ medical concerns 24-7.
    • Dr. Stephen Feldman

Breastfeeding Resources

These resources are available from the Johns Hopkins office of Work, Life, and Engagement.

Breastfeeding Support Program: The Work, Life and Engagement website provides information on lactation rooms across the Johns Hopkins’ campuses and directs you to information about breastfeeding.

Pumps for Purchase Program: As part of the WorkLife Discounts Program, Ameda and Medela breast pumps and Mother’s Room accessory kits can be purchased for yourself, a co-worker, family member or friend. Employees should visit the WorkLife office at Johns Hopkins @ Eastern (1101 E. 33rd Street, Suite C-100, Baltimore, MD 21218) to purchase these products between 10 a.m. and 4 p.m. They accept cash or a money order only for these purchases. As of June 2013, the Pumps for Purchase Program offered:
  • The Medela Pump in Style Advance Tote, Item #0 20451 57063 1, which includes pump, accessory kit, carry bag, and cooler pack with extra bottles, for $180.00.
  • The Ameda Purely Yours Carry All Pump, Item #17077P, which includes pump, assessory kit, carry bag and cooler pack with extra bottles, sells for $150.00.
  • The Ameda Elite & Medela Symphony Mother’s Room Accessory Kits are $30.00 each.
Note: If you have the EHP student plan, then you can get a free breast pump. After you have the baby, your doctor (either the obstetrician or the pediatrician) would fax a prescription for the breast pump to the EHP Care Management Department (phone number: 410-424-4480, fax number: 410-762-5250). The Care Management Department would ship the breast pump directly to you. These breast pumps are 100% covered as a preventative item, and the deductible is waived. You can get one breast pump per live birth. If you live in Baltimore City, the supplier is Johns Hopkins PharmEquip (phone number: 410-288-8250), and the standard breast pump is an Ameda Purely Yours.


Childcare

Start looking into childcare options during the first trimester. Most places already have waiting lists! Options other than childcare centers include a private nanny or nanny-share arrangements. If you want quality, none of these is cheap. Some options can be found in the Families section, including some resources from the Hopkins Office of Work, Life, and Engagement.


What About Dads?

We recommend that expectant couples take a birthing class together. There are many different types ranging from online, one whole day, a weekend session, one to two hour sessions spaced out over several weeks, etc. Dads are also welcome at many prenatal visits. Husbands should definitely find out about paternity leave policies at their work, and discuss childcare options with their partner well in advance of the birth.

Hopkins postdocs have a legal right to take paternity leave. One postdoc says that he took two weeks of paid paternity leave after his wife delivered via C-section. Our benefits allow for a certain amount of paid time for paternity leave, so check the policies before you head to the hospital.

All MD employees are eligible to take up to 12 weeks of unpaid leave for medical reasons including pregnancy under the Family and Medical Leave Act (FMLA), which includes dads!


Recommended References


Books

  • Mayo Clinic Guide to a Healthy Pregnancy
  • What to Expect When You're Expecting (note: this book has mixed reviews -- lots of useful information, but could also make you anxious...)
  • 12 hours sleep by 12 weeks

Websites


Abbreviations

  • EHP: Employee Health Plan (through Hopkins)
  • OB-GYN, OB/GYN: Obstetrician/Gynecologist (MD)
  • PCP: Primary Care Physician

[More information coming soon!]