Discover specialized foot care services at Amoskeag Health. Our experts provide comprehensive treatment for various foot conditions, helping you maintain optimal foot health and comfort. FOOT CARE Podiatry Services Dr. Barry Alan Frank, our Podiatrist, provides foot care to our patients on-site at Amoskeag Health. As a Podiatrist, Dr. Frank can perform regular services such as diabetic foot care as well as management of common podiatry problems such as ingrown toenails, bunions, callouses, infections, and more. Please talk to your Primary Care Provider for more information about Amoskeag Health Podiatry Services! Barry Alan Frank, DPM

Explore mental health services at Amoskeag Health. Our compassionate team offers support for various mental health needs, including therapy and counseling, to help you achieve emotional well-being and improve your quality of life. MENTAL HEALTH Our philosophy is that mental and physical health go hand-in-hand. That's why we have an "integrated" model of care where we address all of your physical health concerns in addition to talking about any external or mental health challenges. If you are struggling with finances, childcare, or housing, or any other necessity, you may become stressed and overwhelmed. Eventually, that impacts your health. We have dedicated Case Managers who can connect you with local resources and services. Talk with your provider at your next appointment. We'll connect you with the right person to help you navigate these challenges. We provide behavioral health services to patients of all ages, ranging from traditional therapy to substance misuse counseling. Most of the time, we can provide brief behavioral health interventions during regularly scheduled appointments. These interventions are conducted by a Behavioral Health Clinician (BHC) to help identify and manage mental health, substance misuse, and crisis-related issues . If you're interested in seeing a BHC, please talk to your Primary Care Provider at your next appointment. We also have Psychiatric Nurse Practitioners who can provide psychiatric medication assistance. Common mental health issues treated at Amoskeag Health include anxiety, depression, and mood disorders. Once patients are stabilized on their medication regimen, they are transferred back to their Primary Care Providers. Everyone works together on your healthcare team. Physical and Mental Health are Linked Services Provided Amoskeag Health’s Pediatric Behavioral Health team offers counseling care to children, adolescents, and young adult patients from birth to age 20. Behavioral Health Clinicians (BHCs) provide a range of services including brief supportive check-ins during medical visits, short-term counseling, and referrals to mental health care providers in the community. Please talk to your Primary Care Provider at your child/teen’s next well-check visit if you feel they would benefit from Behavioral Health services. Pediatric Behavioral Health Amoskeag Health provides 40-60-minute mental health therapy sessions, on a weekly or bi-weekly basis, for our patients who are struggling and want to make changes in their life. Please talk to your Primary Care Provider for more information on mental health therapy. Mental Health Therapy (Traditional) Amoskeag Health provides assessment and counseling sessions, ongoing weekly or bi-weekly, for patients struggling with substance use. If you are in need of Substance Use Counseling , please talk to your Primary Care Provider about your options. Substance Use Counseling Your journey to recovery begins at Amoskeag Health! Amoskeag Health offers Medication Assisted Treatment for opiate use and alcohol misuse disorder. Amoskeag Health uses Suboxone, Naltrexone, Sublocade, and Vivitrol to support recovery. If you are interested in learning more about Amoskeag Health’s Medication Assisted Treatment program , please call 603-935-5263 or talk to your Primary Care Provider at your next visit. Medication Assisted Treatment Behavioral Health Clinicians Behavioral Health Clinicians Meet Your Mental Health Team

Join Amoskeag Health's Morning Matters 2024, an annual breakfast fundraiser supporting the Dr. Selma Deitch Center for Children & Teens. This year, Dr. Laura Rubin, an expert in child psychology, will speak on youth mental health trends. Learn more about our impactful event, aimed at raising funds to benefit our youngest patients. MORNING MATTERS What is Morning Matters? Morning Matters is our annual breakfast fundraiser benefiting the Dr. Selma Deitch Center for Children & Teens (formerly known as Child Health Services). Each year, we select a new, relevant subject and an engaging speaker in a topic related to children's healthcare with the goal of raising funds that directly benefit our youngest patients. Trends in Youth Mental Health: Risk and Protective Factors Dr. Laura Rubin is a licensed clinical psychologist and neuropsychologist and 2006 founder of the Portsmouth Neuropsychology Center in Portsmouth, NH. She received her Ph.D. in Child Clinical Psychology at Loyola University of Chicago and her undergraduate psychology degree at the University of Michigan. She has received specialized training in neuropsychology assessment at the University of Chicago, North Shore Hospital, and New York University Medical Center. Dr. Rubin has extensive experience providing neuropsychological evaluations for children, adolescents, and adults. She has particular expertise in evaluating individuals with autism spectrum disorders, ADHD, learning disorders, and mood/anxiety disorders. Additionally, she provides psychotherapy to children, adolescents, and adults and supervises post-doctoral fellows. Dr. Rubin speaks regularly in the community regarding child development, learning and mental health, parenting, and psychotherapeutic treatment at medical centers, universities, elementary schools, and community organizations. She is also a frequent media contributor and also presented “Reframing to Rewire Your Brain ” at TEDxPortsmouth. Dr. Rubin previously served as a former adjunct professor at the University of New Hampshire and board member of the Richie McFarland Children’s Center. She lives in the Seacoast with her husband and three children. 2024 Keynote Speaker Sponsors of Morning Matters: THANK YOU to ALL 2024 Sponsors whose generosity makes health care accessible for ALL CHILDREN View the 2024 Morning Matters Program Book 2024 VENUE SPONSOR 2024 KEYNOTE SPONSOR 2024 PROGRAM SPONSORS John Sigel and Sally Reid Catholic Medican Center CCA Global Partners Eastern Bank Elliot Health System Harbor Group Lavallee/Brensinger Architects Fund Rich and Sarah Sigel WellSense Health Plan 2024 ADVOCATE SPONSORS Associated Grocers of New England, Inc. BerryDunn Charla Stevens Consulting, LLC Joanne & Richard Gustafson Harvey Construction Corporation Judith Jolton 2024 TABLE SPONSORS

Discover primary health care services at Amoskeag Health. Our team provides comprehensive, patient-centered care for a range of health needs, focusing on prevention, treatment, and overall wellness for individuals and families. PRIMARY HEALTH Pediatric care focuses on children newborn to 20 years old and includes their wellness care, immunizations, and development of physical and emotional growth. To support your child, we also can connect parents and caregivers with case management and mental health services if needed. Pediatric Care We focus on treating the whole person and focus on the unique health situations patients between 12 and 20 years old often face. We can screen for depression and anxiety; provide counseling and treatment for substance use; offer information and guidance about appropriate diet and exercise; ensure access to behavioral health therapy; and ensure that all necessary immunizations are up to date. We also offer a full range of education on sexual health including contraception, pregnancy testing, and testing/treatment for sexually transmitted infections (STIs). Adolescent Care Amoskeag Health offers comprehensive, team-based integrated healthcare for adults from all backgrounds and experiences. We address both physical and mental health together! We are considered a Patient Centered Medical Home, which is a model for achieving primary care excellence by providing care in partnership with patients and their families to ensure decisions respect patients’ wants, needs, and preferences. Our goal is to ensure that every single patient has the education and support they need to make decisions and participate in their own care. Adult Primary Care If you are 65 or older, you might experience some extra health challenges! We still want to help you live your best life and can connect you with available senior services and community resources as you age. We offer Chronic Care Management with the help of our dedicated Older Adult Case Managers who perform in-home visits. Through this program, we can help you manage chronic conditions and illnesses, including: Arthritis/Osteoporosis Asthma/COPD Cancer Dementia/Alzheimer's Disease Depression Diabetes Heart Disease High Blood Pressure Older Adult Care Mental Health Women's Health Sexual & Reproductive Health Pregnancy & Delivery School-based Health Other Primary Care Services at Amoskeag Health Medical Providers Medical Providers Pay Your Bill Behavioral Health Clinicians Meet Your Healthcare Team

LEADERSHIP Maureen Cassidy, MSN, RN Chief Nurse/Chief Compliance Officer Raised in Massachusetts and beginning her career as a diploma nurse, Maureen Cassidy has built a distinguished career defined by progressive leadership, clinical excellence, and a deep commitment to patient-centered care. She earned her Master of Science in Nursing with a Nurse Executive concentration, graduating Magna Cum Laude, and has since established herself as a senior healthcare leader across federally qualified health centers and academic medical institutions in New England. Since 2021, Maureen has served as Chief Nurse and Chief Compliance Officer at Amoskeag Health in Manchester, New Hampshire. She oversees clinical operations and the Corporate Compliance Program, ensuring regulatory integrity, quality outcomes, and safe, effective care delivery. For three years, she also led the Human Resources department, strengthening workforce strategy and organizational alignment. She partners closely with executive leadership to advance quality improvement, operational performance, and a culture of accountability. Previously, Maureen served as Director of Nursing at Beth Israel Deaconess Medical Center and held leadership roles at Lakes Region General Health Care, where she led multidisciplinary teams, improved care delivery systems, and drove operational efficiencies across inpatient and ambulatory settings. Licensed in both Massachusetts and New Hampshire, Maureen brings extensive expertise in clinical leadership, regulatory compliance, and strategic healthcare operations, and remains committed to advancing excellence in patient care and organizational performance. Back to Leadership

ORAL HEALTH SUPPORT Dental Programs and Resources Keeping your mouth healthy is an important part of your overall health. While Amoskeag Health offers a pediatric oral health program as part of well-child care, many dental needs are met through community programs across New Hampshire. Our Pediatric Oral Health program is offered at every Well Child Check for children ages 0 to 5. During these visits, our team applies fluoride varnish to help lower the risk of cavities. Research shows it works even for kids who see a dentist regularly. As part of the program, your child will receive two fluoride varnish treatments per year and an age appropriate oral health kit with resources you can use at home to keep their teeth healthy. Children who are at higher risk for cavities may receive varnish more often. Pediatric Oral Health Program NH Smiles Dental Program for Children The NH Smiles Program for Children, offered through the New Hampshire Department of Health and Human Services, provides preventive and basic dental care for children covered by New Hampshire Medicaid. Families can use this program to find a dental home, get routine cleanings, and access treatment that helps keep kids’ teeth healthy as they grow. The link below takes you to DHHS for more program information. NH Smiles for Children NH Smiles Dental Program for Adults The NH Smiles Dental Program for Adults helps people 21 and older with New Hampshire Medicaid get basic dental care. DHHS picked Northeast Delta Dental, working with DentaQuest, to run the adult dental benefit. Through this program, adults can get checkups, cleanings, and other routine care. The link below takes you to DHHS for more information and mobile clinic dates. NH Smiles for Adults Medicaid Dental Services: New Hampshire Smiles Program

Support Amoskeag Health and make a difference in our community. Your donation helps provide essential healthcare services to those in need. Learn how you can contribute and support our mission to offer high-quality care to everyone, regardless of their circumstances. DONATE Building a Healthier Community Where Collaboration Grows Resilience, Encouragement, and Understanding Amoskeag Health works toward a healthy and vibrant community where strong families and a tight social fabric ensure that everyone has the tools they need to thrive and succeed. Every day, an integrated healthcare team of primary care professionals, behavior health clinicians, support case managers, and community health workers deliver the essential services that give people the power to make healthcare decisions, establish a care plan, and pursue a path to well-being and stability. Amoskeag Health accepts most insurances, making this exceptional team accessible to everyone. However, for the children and adults who are uninsured, underinsured, or without access, YOUR donation delivers accessible, affordable, quality healthcare for them. Every dollar you donate helps us to continue our mission of delivering exceptional and accessible healthcare. Use the form below to make a secure online donation. Donate Today! The President’s Wellbeing Sustainers Society unites philanthropists who share a vision of providing every child and family the healthcare and support services they need to thrive. By making an annual contribution, members of the President's Wellbeing Sustainers Society actively improve the health and welfare of Greater Manchester's residents. Participation is open to anyone passionate about supporting the health and well-being of their neighbors. Made annually or monthly, your generous tax-deductible gift will immediately support access to healthcare services, funding the care for those unable to pay, and delivering concrete supports to patients of all ages. As a member in the Wellbeing Sustainers Society, you will be invited to an exclusive annual event. Additionally, you'll receive a lapel pin and a window decal to display your membership and encourage philanthropy! The President’s Wellbeing Sustainers Society has various levels: The Generosity Guild gives $200+ monthly/$2,400+ annually Community Champions donate $100 monthly/$1,200 annually Healthcare Heroes contribute $50 monthly/$600 annually Consider Joining The President's Wellbeing Sustainers Society Make a Lasting Impact—Now and Beyond Your Lifetime When you include a legacy gift as part of your estate planning, you create a meaningful way to support accessible healthcare for generations to come. You can ensure that your values and vision for the people of Greater Manchester endure with a lasting, profound impact. Thank you for considering a gift to Amoskeag Health. For more information on giving, please contact our Director of Donor Relations, Christopher Dugan by emailing cdugan@amoskeaghealth.org , calling 603-851-6237, or mailing to Amoskeag Health, Attn: Advancement Dept, 145 Hollis Street, Manchester, NH 03101. Your contribution is important to us and is also fully tax-deductible to the extent allowed by law. Amoskeag Health is a 501(c)(3) nonprofit organization with tax ID number 02-0458174. Please call 603-851-6237 or email Director of Donor Relations, Christopher Dugan at cdugan@amoskeaghealth.org. Please Note: Amoskeag Health can no longer accept donations of used clothing, toys, or baby gear. Thankfully, many area partners can! (Click here to view a full list of local organizations accepting those donations. ) We will gladly accept donations of gift cards so that clients can purchase their own new items of need. Charitable Giving Questions? The Insider By signing up for "The Insider," our quarterly Stakeholder eNewsletter, you'll receive donor spotlights, organization-wide updates, and patient impact stories. Sign up Today! Stay Connected to Amoskeag Health Thank You to All Donors: Corporate, Foundation, and Individual You make our work possible! City of Manchester Community Improvement Program Oleonda Jameson Trust Samuel P. Hunt Foundation THE MARY GALE FOUNDATION Associated Grocers of NE and AG Supermarket Employees Corbit Family Fund Dorothy Gould Cook Memorial Fund Grandgeorge Family Fund John H. Pearson Fund James W. Squires Social Justice Fund Lavallee/Brensinger Architects Fund Mary and Charles Howe Family Fund New Hampshire Charitable Foundation Raymond G. and Olga Cote Family Fund Aegis Consulting & Solutions Group Alexander Eastman Foundation AmazonSmile Foundation AmeriHealth Caritas New Hampshire Amoskeag Quilters Guild Associated Grocers of New England Aurora Business Solutions BerryDunn Bill Cahill’s Super Subs Brookside Congregational Church Catholic Medical Center CCA Global Partners CGI Business Solutions Charla Stevens Consulting LLC Dahar Law Firm Dartmouth Health Dartmouth Health Children's Eastern Bank Foundation Elliot Health System Energy Efficient Investments, Inc. Firefly Bistro & Bar Granite Group Benefits, LLC Granite State Credit Union Granite State Generosity The Greenspan Foundation Hannaford Bloomin’ 4 Good Program Hannaford Community Bag Program Harbor Group Harvey Construction Corporation Lavallee/Brensinger Liberty Mutual Group Inc. Lindner Dental Associates, P.C. Manchester Community College MCPHS University Members First Credit Union The Mental Health Center of Greater Manchester Microsoft Rewards/Give with Bing Mutual of America Foundation New Hampshire Healthy Families North End Properties Oceanfront Gaming, Inc. Pastori Krans, PLLC Professional Office Services, Inc. The Rotary Club of Bedford Saul O. Sidore Memorial Foundation Shaw’s Give Back Where it Counts Program Southern New Hampshire University Southwest NH Project Linus Chapter St. Mary’s Bank Walmart Community Grants Team/Store #2399 Well Sense Health Plan Whole Foods Market - Bedford, NH The Women's Fund of New Hampshire

LOCAL PHARMACIES Most insurance plans will cover prescriptions at many different pharmacies. If you’re not sure which ones your insurance works with, call the number on your insurance card. They can give you a list. Please note: CVS does not accept Wellsense Insurance. Walgreens does not take New Hampshire Healthy Families Insurance, except at the Valley Street Walgreens in Manchester. How to update your pharmacy: Tell the front desk or your provider which pharmacy you want to use. If you need a refill before your next visit, call us and let us know which pharmacy you’d like us to use. Please note that it can take five to seven days for the transfer to happen. You do not need to call your old pharmacy. Your prescriptions will move once we send them to your new pharmacy. Update Your Pharmacy Pharmacy Address Phone Number CVS Pharmacy 250 Mammoth Rd, Manchester, NH 03109 603-623-3995 CVS Pharmacy 432 S Main St, Manchester, NH 03102 603-623-3532 CVS Pharmacy 788 S Willow St, Manchester, NH 03103 603-668-4637 Elliott Pharmacy at River’s Edge 175 Queen City Ave, Suite 1, Manchester, NH 03101 603-663-5678 Genoa Pharmacy 2 Wall St, Manchester, NH 03101 603-509-2106 Hannaford Bros Co Pharmacy 201 John E Devine Dr, Manchester, NH 03103 603-626-1233 Hannaford Bros Co Pharmacy 605 Mast Rd, Manchester, NH 603-626-4366 Ken's Pharmacy Inc. 36 Elm St, Manchester, NH 03101 603-623-2813 PillPack by Amazon Pharmacy 250 Commercial St, Suite 2012, Manchester, NH 03101 855-745-5725 Walgreens 606 Valley St, Manchester, NH 03103 603-668-7924 Walgreens 227 S Main St, Manchester, NH 03102 603-666-8538 Find a Pharmacy Outside of Manchester: CVS Pharmacy Hannaford Bros Co Pharmacy Walgreens Manchester Pharmacy Locations Explore Other Helpful Pages Language Assistance Language Assistance Pay Your Bill Financial Assistance Pay Your Bill Transportation Assistance

Discover comprehensive pregnancy and delivery care at Amoskeag Health. Our expert team provides personalized support and services to ensure a healthy, positive experience for you and your baby. Learn about our prenatal care, delivery options, and postnatal support. PREGNANCY & DELIVERY EXPLORE THE TABLE OF CONTENTS BELOW Welcome to Prenatal Care What to Expect Routine Tests Common Symptoms During Pregnancy Keeping My Baby and Me Healthy Common Medications Commonly Asked Questions 9th Month of Pregnancy WELCOME TO AMOSKEAG HEALTH COMPASSIONATE CARE FOR YOUR PREGNANCY Thank you for choosing and trusting Amoskeag Health for the care of your growing family. At Amoskeag Health, we are dedicated to providing you and your family with exceptional compassionate care for throughout your entire pregnancy and your delivery – this is often called "prenatal care." Our providers and staff are looking forward to getting to know you and your family over the coming months and working together to ensure your pregnancy experience is safe, happy, and healthy. At Amoskeag Health, prenatal care is a group effort that involves initial screenings by a team that includes social workers, counselors, nutritionists, and prenatal nurses. All prenatal patients are seen primarily by a Nurse Midwife but have the opportunity to meet with all of the medical providers on the prenatal care team. Downloadable guide for up to 36 weeks Downloadable guide for 36 weeks - birth Amoskeag Health provides comprehensive, team-based primary care focused on quality and safety. We use the Patient-Centered Medical Home (PCMH) model which means that we provide care in partnership with the patient and their families to ensure decisions respect patients’ wants, needs, and preferences. We provide extensive education and support so that patients can make decisions and participate in their own care. BACK TO TOP WHAT TO EXPECT This webpage is meant to provide you with information and answers to common questions you may experience throughout your pregnancy. We look forward to taking this amazing journey with you! DUE DATE Pregnancy means that a baby is growing inside of your uterus (womb). A normal pregnancy lasts about 40 weeks from your last menstrual period. Pregnancy is divided into three blocks of time called trimesters. Your provider can estimate (guess) when you may have your baby. This can be done using the start (first day) of your last menstrual period. It can also be done if you know the date that you became pregnant. This estimate is called your due date. Your due date may change later in your pregnancy, based on certain tests. You may give birth to your baby any time from two weeks before your due date, to two weeks after your due date. Prenatal Care What to Expect: Prenatal care is the regular visits that you have with your health care provider throughout your pregnancy. It is important to start prenatal care as early in your pregnancy as possible. Prenatal care can help prevent problems during pregnancy and childbirth. It can also help find certain problems early, so they can be treated. Your provider may want to see you every month or so during your early months of pregnancy. Your provider will need to see if you develop complications with pregnancy. At your first appointment, you will meet with one of our Prenatal Nurses. They will review your overall health history and review some general pregnancy education topics. At this appointment, we will schedule laboratory tests. Please complete this testing so we can review them at your first provider visit. Though family members are welcome during visits, especially to hear the baby’s heartbeat, we will ask everyone to leave the room to ask you some additional questions in private. Everything you tell your provider is confidential. This means it cannot be shared with anyone without your permission. So please don’t be afraid to tell them things that may be uncomfortable or embarrassing, like if your partner hurts or scares you, or if you smoke, drink alcohol, or use recreational drugs. It is important to be open so we know how to best help you and your baby. At each visit, we will take your weight and your blood pressure. We may test your urine. We will measure your baby’s growth. Your provider will listen to your baby’s heartbeat. Your provider will talk to you about ways to keep yourself and your baby as healthy as possible. If any pregnancy risk factors or medical concerns are identified, we will discuss plans for management in your pregnancy. ROUTINE TESTS There are various routine tests and exams that you can expect during your pregnancy. Before your first provider visit, we will order routine lab testing. A blood count – to determine if you have anemia (low iron), platelet count, syphilis, rubella, hepatitis B, HIV antibodies. Blood Type and Rh factor. A urine sample – to look for bladder infection and sexually transmitted infections. Blood Tests: Blood tests will be done several times throughout your pregnancy to check many things about your health. Blood type and Rh factor: Your blood type (A, B, or O) is checked and is also tested for its Rh factor. An Rh factor describes a type of protein you have in your blood. Most people have the Rh factor so they are called “Rh positive.” People who do not have the Rh factor are called “Rh negative.” Your Rh factor does not change. If you are Rh negative we will give you an injection of a medicine called Rhogam. It is usually given 28 weeks into the pregnancy. An injection of this medicine: Stops your body from making antibodies against your baby’s blood cells. Protects your baby against Rh-induced hemolytic disease. Helps protect you during any future pregnancy from making antibodies against your baby’s blood cells after your baby is born. If your baby has Rh-positive blood, you will need a second injection. Glucose Test: We will order a glucose test between 24-28 weeks. For this test, we will give you a sugary drink and then have the lab draw your blood 1 hour later to see how well your body is processing sugar in pregnancy. We will also ask the lab to test you for anemia (low iron). If you are Rh negative, we will retest your antibodies prior to your RhoGAM shot. Group B Strep (GBS): At approximately 36 weeks, we will perform a vaginal and perineal swab to look for Group B (beta-hemolytic) streptococcus (GBS). If you have GBS bacteria, you will receive IV antibiotics (through a tube directly into your blood stream) during labor which help prevent an infection in the baby. While maternal and infant infections during birth and the post-partum period are rare, they can be serious. GBS bacteria is identified as being the main cause of these rare infections. GBS is NOT a sexually transmitted disease; it is a bacteria that is normally present in the vagina and rectum in about one of every three women. In non-pregnant women, GBS rarely causes any problems. During pregnancy and birth, however, the bacteria can cause an infection in the mother’s uterus or in the baby. Pelvic Exam: During a pelvic exam, your provider checks your female organs for certain problems. Your provider can also tell a lot about your pregnancy during a pelvic exam. For example, the size and shape of your uterus is checked to help see how your baby is growing. This is usually performed at your first provider visit. If you are due for a PAP smear we will do one at that time. BACK TO TOP ROUTINE TESTS Ultrasounds: At 18-20 weeks, we recommend that all women have a routine anatomy ultrasound. This ultrasound is to check the baby’s growth and development, the fluid around the baby, and the placenta location. An ultrasound can tell whether or not abnormalities are suspected and if further testing is recommended. You can ask the ultrasound worker if your baby is a boy or a girl at this visit! Optional Additional Ultrasounds and Genetic Testing: We refer all patients to Elliot Maternal Fetal Medicine based on your pregnancy and risk factors. We will discuss these risks with you based on your family and your partner’s family history. Some ethnic groups have a higher risk of certain genetic conditions. We will discuss these with you at your prenatal visits. Screening for Down Syndrome and Trisomy 18: The First Trimester Screen is performed between 11 and 14 weeks of pregnancy to screen for Down syndrome. It combines information from an ultrasound examination of your baby with maternal blood analysis. It is suitable for women of all ages. It is a screening test and cannot determine definitely whether or not a baby has Down syndrome. A screening test identifies those women who have an increased risk of Down syndrome pregnancy so that they can be offered a diagnostic test (such as chorionic villus sampling). The diagnostic test identifies women who actually have an affected pregnancy. You will discuss the test with your health care provider and you can decide whether you would like to be screened. NST: Sometimes during your pregnancy your provider may ask the nurse to preform a Non-Stress Test or NST. An NST is a simple, painless procedure. We will monitor your baby’s heartbeat, which is a way of evaluating your fetus’s well being. We will listen to and record the baby’s heartbeat while the baby is resting and while the baby is moving. It usually takes 20 to 40 minutes to complete an NST. If you have certain conditions such as high blood pressure or diabetes you may need this test 2 time per week towards the end of your pregnancy. BACK TO TOP COMMON SYMPTOMS DURING PREGNANCY Refer to our safe medications in pregnancy list for over the counter medications that may help. Please call the office if you have not been able to hold down food or fluid for 12 hours or more. Backache: This is caused by a change in your posture. Hormones cause the joints and ligaments in your pelvis to relax. These changes may cause backache and joint pain. These tips may be helpful. Wear a supportive bra, low-heeled shoes and/or pregnancy support belt Use proper body movements – when lifting or moving Change your position often, do not stay in any one position for more than 30 minutes Use pillows to support your lower back Put pillows between your legs when you sleep on your side Take a warm tub bath for 30 minutes with or without Epsom salt A massage Do pelvic rocking exercises or try doing prenatal yoga Start or maintain an exercise routine 3-4 times a week. There are classes and home-based programs geared for pregnant women Eat healthy foods and a well-balanced diet Consider chiropractic or physical therapy treatments. Amoskeag Health offers Osteopathic Manipulative Treatment, or OMT, to ease a patient’s muscles and joints using techniques that include stretching, gentle pressure, and resistance Breast changes: Your breasts will get larger, heavier, and they may be painful. This can cause you to be uncomfortable. A good support bra may help you feel better. A support bra helps prevent the breakdown of the elastic tissue in the breast. You may need to wear a support bra 24 hours a day, even while sleeping. If you are planning to breast feed your baby, buy nursing bras after you give birth. Your breasts may change in size after your milk comes in. The size of your breasts does not affect your ability to breast feed. It is normal for a thin, yellowish fluid called colostrum to come out of your nipples. This can happen as early as the 10th week of pregnancy. This colostrum changes to milk about three days after you have your baby. You may want to put pads inside your bra to soak up this fluid and help keep your nipples dry. If you have inverted nipples, ask providers if you need nipple cups to help make it easier to breast feed. Your nipples may be sore. Wash them with water only. Do not use soap because it can dry out your nipples. You may want to put some lanolin on them to help the soreness. Do not use petroleum jelly. Colds, Flu, and Allergies: When the first symptoms of a cold or flu appear, try to: Increase fluids including warm fluids that can help relieve a sore throat Take a warm shower Use a humidifier or vaporizer and Vicks (follow directions on the bottle Gargle with salt water to relieve sore throat: 1/2 teaspoon salt to 1 cup of warm water Balance active and rest periods Avoid spreading the virus to others with good hand washing If you have asthma, make sure you are using your medicines. Breathing well is important for you and your baby Refer to our safe medications in pregnancy list for over-the-counter medications that may help. Constipation: Pregnancy can cause constipation, which is when you have hard, dry stools which are difficult to pass. Do not strain to push out stool if it is too hard. Straining can cause hemorrhoids. Walking is the best way to decrease problems with constipation. Drinking more water can help too. Eat foods high in fiber. Good examples are high fiber cereals, beans, fresh fruits and vegetables, and whole grain breads. Prune juice may help make the stool softer. Your provider may also suggest fiber medicine to help make your BMs softer and more regular. Refer to our safe medications in pregnancy list for over-the-counter medications that may help. Headache: Some causes of headaches in pregnancy are changes in hormones, increased blood flow, changes in posture, muscle tension, eyestrain, stress, and fatigue. Spend 15 minutes twice a day using techniques to relax, meditate, breathe, or stretch Make sure you are drinking plenty of water Eat a healthy diet and have an exercise routine Wear comfortable shoes, use proper body movement and make sure your work station supports good posture Rest in a dark room with a cold cloth on your forehead Avoid perfumes, cleaning products, or hair sprays that may cause headaches in some people Having massages, acupuncture, or chiropractic treatments may help Refer to our safe medications in pregnancy list for over the counter medications that may help. Heartburn: Pregnancy hormones cause food to move more slowly through your digestive system, which sometimes causes heartburn. To improve the symptoms of heartburn, avoid lying down right after eating. When you do lie down, sleep with your head slightly elevated. Eat small, frequent meals instead of three large meals. Chew well and eat slowly Avoid greasy or highly spiced foods, coffee, colas, tea, citrus, or chocolate. Don’t lie down for 2 hours after eating Avoid drinking too much fluid with your meal. Sleep with more pillows if this is a problem at night. Refer to our safe medications in pregnancy list for over-the-counter medications that may help. Hemorrhoids: Hemorrhoids are swollen varicose veins of the rectum. They are caused by hormone changes and increased pressure from the pregnancy on the rectum. Avoid constipation and straining to have a bowel movement Take tub baths (sitz baths) 2 to 3 times a day for 10-20 minutes Use witch hazel pads, such as Tucks®, for comfort and cleaning after bowel movements Gently ease (reduce) hemorrhoid into the rectum Apply a skin numbing ointment with lidocaine such as Preparation H® and follow directions on the tube Use an over-the-counter cream such as Anusol or 1% hydrocortisone cream and follow directions on the tube Leg cramps: Many things may cause leg cramps during pregnancy. You may have them due to being tired, or not eating enough foods high in calcium. As your baby grows and puts pressure on your lower body, your legs may not get enough blood. Try to rest often, putting your feet up so that your legs rest higher than your heart. During a leg cramp, straighten your leg and flex your toes toward your head. Standing flat on your feet may also help ease leg cramps. Nausea and Vomiting: Morning sickness is common during the first few months of pregnancy. You might feel nauseated (sick to your stomach) or you could vomit (throw up) many times a day. To improve symptoms of morning sickness, eat small, frequent meals instead of three large meals. Foods high in carbohydrate such as crackers, dry toast, and pasta may be easier to eat for some women. Drink liquids between meals rather than with meals. Avoid foods that have a strong smell and foods that make you feel sick. Avoid having an empty stomach. STOP the prenatal vitamin if it is bothering you or try taking it at night. If you stop the prenatal vitamin, take 2 children’s chewable, a multivitamin for women, or 400 mcg folic acid daily. Once you feel better in a few weeks or months, return to the prenatal vitamin because it has iron in it that is important in the second half of pregnancy. Get enough rest. Nausea and vomiting are worse if you have not slept well Aggressively treat and prevent constipation. Prolonged constipation causes nausea, fatigue, and headaches. The smell of orange also lessens nausea. Try smelling orange tea or orange peels or wearing orange essential oil. Some women find Seasickness bands can help with nausea. These bands use acupressure to help prevent upset stomach and may be a good alternative to medication. Swelling (Edema): Swelling may be normal while you are pregnant. This is most common in your legs and hands towards the end of pregnancy. Wear loose-fitting clothes and comfortable shoes Elevate your legs for a period of time each day. It is best if you can lie on your side for 30 minutes 2-3x per day and/or lie down (slightly tilted to one side) with your legs and feet elevated above your heart Avoid sitting or standing for a long time. Walking improves circulation so walk 20 minutes 1-2 times per day Drink 8–10 glasses of fluid each day to help prevent the body from holding onto excess water. Restricting fluids is not advised. Spend 20-30 minutes a day in a swimming pool or a warm tub with Epsom salts Tiredness: You may need more sleep to feel your best. If possible, take a nap during the day. If you cannot do this, at least take a few 10 to 15-minute rest breaks. Being well rested will help you deal with the physical and emotional changes of pregnancy. If you have trouble sleeping, try taking a warm shower or drink a cup of warm milk before bed. Trouble Sleeping: Many women have trouble sleeping, which can be caused by body changes, a need to go to the bathroom at night, hormone changes, stress, or anxiety. Take a warm tub bath or shower before bed Drink a decaf tea before bed such as Sleepy time® Use techniques to relax—progressive relaxation or meditation is very helpful Talk about any fears with partner, friend, counselor or care provider Use pillows to support good body alignment Get daily exercise, but not within 4 hours of bedtime Eat a bedtime snack such as cheese or protein foods Read or write in a journal if you cannot fall asleep, do not watch TV Take a calcium-magnesium supplement at bedtime to lessen leg cramps and make you sleepy You may take Benadryl (diphenhydramine) or Unisom and follow directions on the bottle Urination: You will urinate more often early in pregnancy, and again later in pregnancy as your abdomen gets bigger. You could also pass urine by accident when you cough, sneeze, or move. Ask providers about doing kegel exercises to strengthen the muscle around your vagina and urethra (urine tube). Doing kegel exercises may help decrease urine leakage both before and after your baby is born. Vaginal Discharge: You may have thicker and heavier vaginal discharge while you are pregnant. If your vaginal discharge becomes yellow, green, curdy white, or has a bad smell, you may have an infection. Talk to your provider if you have vaginal burning or itching, pain, or are concerned about your discharge. Do not douche unless your provider tells you to do so to treat an infection. Vomiting: See ‘Nausea and Vomiting’ above. BACK TO TOP WHAT ELSE CAN I DO TO KEEP MY BABY AND ME HEALTHY DURING MY PREGNANCY? Eat a healthy diet. Eating healthy is very important to feel better and to have more energy. During pregnancy, you need extra protein, vitamins, minerals, water, and calories. You need these to help you have a healthy pregnancy and a healthy baby. It is important to eat a variety of foods every day. Healthy foods include fruits, vegetables, breads, dairy products, and protein such as meat and beans. Dairy products include milk, yogurt, and cheese. Avoid raw or undercooked meat and fish. You will be scheduled a nutrition visit early in pregnancy and usually an Infant Feeding Visit later in the pregnancy to talk more about how to feed your baby. Take prenatal vitamins as directed. Even with a healthy diet, you may not get the amount of vitamins and minerals that your baby needs. Prenatal vitamins can help you get the right amount of vitamins and minerals. Prenatal vitamins may also decrease the risk of certain birth defects. Your provider will suggest the right kind and amount of prenatal vitamin for you. Take your prenatal vitamin every day. Do not skip days because you think your diet is good enough. You should still eat a healthy diet even if you take a prenatal vitamin. Monitor weight gain. Talk to your provider about how much weight you should gain each month. Too much or too little weight gain can be unhealthy for you and your baby. Drink plenty of liquids . Drink at least eight (8-ounce) cups of healthy liquids each day. Healthy liquids include milk, water, or juice. Avoid liquids that have caffeine in them such as coffee, tea, and soda pop. Do not drink liquids that contain alcohol. There is no known “safe” amount of alcohol that you can drink while pregnant. You should not drink beer, wine, liquor (like whiskey or gin), or any other mixed drinks. Alcohol can cause problems to your baby such as a miscarriage (losing your baby), low birth weight, and lifelong learning problems. Do not smoke. You should not smoke cigarettes, or vape during pregnancy. Your baby may weigh less at birth or be born early if you use products containing nicotine during pregnancy. Low birth weight can be dangerous for your baby. Secondhand smoke (being around someone else who is smoking frequently) is dangerous as well. Studies have shown that the residue from vaping is just as dangerous as second-hand smoke. Exercise. Regular exercise during pregnancy will help you feel better and keep you in good physical shape. Your labor and delivery could be easier if you exercise. Start exercising slowly if you were not active before pregnancy. Keep your heart rate below 140 while exercising. Walking and swimming are great choices. Do not do any exercise that could put you or your baby at risk for injury, like mountain climbing, surfing, or racquetball. Your exercise routine may need to change as your pregnancy progresses. Proper body mechanics (how you stand, sit, and lie) are also important to help prevent back pain and other problems. Get Vaccinated. Did you know a baby gets disease immunity (protection) from mom during pregnancy? This immunity can protect baby from some diseases during the first few months of life, but immunity decreases over time. At Amoskeag Health, we recommend the following vaccines during your pregnancy: Tdap. This vaccine protects against Whooping cough, known as pertussis, can be serious for anyone, but for a newborn, it can be life-threatening. About 7 in 10 deaths from whooping cough are among babies younger than 2 months old. These babies are too young to receive a Tdap vaccine. The younger the baby is when they get whooping cough, the more likely they will need to be treated in a hospital. When a pregnant person gets a whooping cough vaccine during pregnancy, her body will create protective antibodies and pass some of them to the baby before birth. These antibodies will provide the baby some short-term, early protection against whooping cough. CDC recommends getting a whooping cough vaccine during the 27th through 36th week of each pregnancy, preferably during the earlier part of this time period. We strongly encourage your partner and other close members of your family who will spend time with your baby to also keep up-to-date on their pertussis (Tdap) vaccine. Flu. Pregnant people are more likely to have severe illness from flu, possibly due to changes in immune, heart, and lung functions during pregnancy. Make sure to receive your yearly flu vaccine it’s the best way for a pregnant woman to protect against the flu and protect the baby for several months after birth from flu-related complications. CDC recommends getting a flu vaccine by the end of October despite flu seasons varying in their timing from season to season. This timing helps protect a pregnant woman before flu activity begins to increase. Other Vaccines: Hepatitis B: A baby whose mother has hepatitis B is at highest risk for becoming infected with hepatitis B during delivery. Talk to your provider about getting tested for hepatitis B and whether or not you should get vaccinated. Hepatitis A: For pregnant women who have a history of chronic liver disease, your provider may recommend the hepatitis A vaccine. What is a healthy diet during pregnancy? A healthy diet during pregnancy contains a variety of foods that provide the amount of calories and nutrients you need. During pregnancy, your body needs extra calories and nutrients to support your growing baby. Some extra nutrients you need include protein and certain vitamins and minerals. Following a healthy diet can help you to gain the right amount of weight during your pregnancy. It can also decrease your baby’s risk of birth defects, low birth weight, and certain health problems. The amount of weight you should gain may depend on your weight before pregnancy, and if you are carrying more than one baby. Your provider will tell you how much weight you should gain. The number of calories you need depends on your daily activity, your weight before pregnancy, and current weight gain. Your calorie needs also depend on the stage of pregnancy you are in. In the first trimester, you usually do not need extra calories. In the second and third trimesters, most women should eat about 300 extra calories each day. We will schedule a visit with our nutritionist to discuss your personal pregnancy diet needs. Alcohol. You should not drink beer, wine, liquor (such as whiskey or gin), or any other mixed drinks. Drinking alcohol can increase your risk of having a miscarriage (losing your baby). Drinking alcohol when you are pregnant is the cause of Fetal Alcohol Syndrome (FAS), a leading cause of birth defects. Your baby may also have health problems such as being born too small and having learning problems. Children born with FAS have facial deformities, are of low weight and height, have a smaller-than-normal head, and exhibit mental and physical retardation. Caffeine. Drinking excessive amounts of caffeine is linked to miscarriages, lowered birth weight, and other complications during pregnancy. Because caffeine may cause birth defects, the consumption of caffeine during pregnancy is discouraged. The American Dietetic Association recommends that pregnant women consume no more than 100 mg caffeine per day. This is the amount typically found in one 10 oz cup of coffee. Limit your intake of caffeine to avoid possible health problems. Caffeine may be found in coffee, tea, cola, sports drinks, and chocolate. Drinking alcohol during pregnancy can: Damage the baby’s central nervous system. Cause a miscarriage, premature separation of the placenta, and low birth weight. Interfere with the body’s ability to absorb and use some vitamins and minerals (thiamin, folate, vitamin A, vitamin B6, zinc, phosphorus, calcium, and magnesium Common sources of caffeine: Instant coffee (10 oz) Amount: 100mg Decaf coffee (10 oz) Amount: 4-10mg Caffeinated tea (10 oz) Amount: 40-90 mg Ice Tea (12 oz) Amount; 22-36mg Milk Chocolate (1 oz) Amount: 1-15mg Mountain Dew (12 oz can) Amount: 52-55mg Diet Cola (12 oz can) Amount: 36-59mg Cola (12 oz can) Amount: 35-46mg Sprite (12 oz can) Amount: 0mg Foods that contain mercury. Mercury is naturally found almost all types of fish and shellfish, and is not harmful to most people. However, some types of fish absorb higher levels of mercury that can be harmful to an unborn baby and young children. During pregnancy, it is important to carefully select the kind of fish that you eat. Do not eat shark, swordfish, king mackerel, and tilefish. You may eat up to 12 ounces of fish or shellfish that have low levels of mercury each week. These include shrimp, canned light tuna, salmon, pollock, and catfish. Because albacore tuna has more mercury than canned tuna, eat only 6 ounces of albacore (white) tuna per week. Raw and undercooked foods. You should avoid eating undercooked or raw meat, poultry, eggs, fish, or shellfish (shrimp, crab, lobster). You should also avoid eating cooked foods that have been near raw foods. Cook leftover foods and ready-to-eat foods such as hot dogs until steaming hot. Unpasteurized food. Unpasteurized foods are foods that have not gone through the heating process (pasteurization) that destroys bacteria. You should not drink unpasteurized milk or juice. Cheese made from unpasteurized milk can also be harmful. This includes Brie, feta, Camembert and blue, or Mexican cheeses. These cheeses contain bacteria that can harm your growing baby. Artificial Sweeteners. Artificial sweeteners are used to give food and beverages the sweet taste of sugar without all of the calories. Many different brands can be found in the supermarket. There is no nutritional need to consume artificial sweeteners. However, if you decide to include them in your diet, use the information below to choose one that is safe for your baby. Also, some people have reported sensitivities to many of the artificial sweeteners, even those deemed safe for pregnancy. If you feel that you have a reaction to an artificial sweetener, stop using it and consult your doctor or nutritionist for more information. Aspartame (Equal, NutraSweet, Nutra-Taste) The FDA and the American Academy of Pediatrics Committee on Nutrition consider aspartame to be safe for both the pregnant woman and the developing infant. We recommend no more than 1-2 servings/day of aspartame containing foods. Saccharin (Sweet’N Low) The use of saccharin is not recommended during pregnancy. It is a weak carcinogen that crosses the placenta. Stevia (PureVia, Sweet Leaf, Truvia) Stevia is a sweetener from a plant native to South America. Stevia is safe to consume during pregnancy. Sucralose (Splenda) Sucralose is a low-calorie sweetener made from normal table sugar through chemical modification. Sucralose is safe to use during pregnancy as it does not cross the placenta If you find that you are having cravings for non-food items, please contact our office and discuss with your provider. BACK TO TOP COMMON MEDICATIONS SAFE IN PREGNANCY (Follow the package directions for over-the-counter medications.) Pain/Fever Acetaminophen (Tylenol, Extra strength Tylenol) You may take up to 1000 mg every 8 hours. Do not take over 3,000 mg in 24 hours Avoid: Ibuprofen, Motrin, Advil, Aleve, Naprosyn (products containing Aspirin or non-steroidal anti-inflammatory drugs) Nausea and Vomiting Take these three medicines four times during the day by mouth (every 4-6 hours). Vitamin B6 50 mg (also called Pyridoxine) or a Vitamin B Complex tablet Diphenhydramine (also called Benadryl®) Take 25 mg: This may make you sleepy. Doxylamine (Unisom sleep tablet verify the active ingredient) must be the “tablet” and NOT the “gel tab”) 1/2 tablet (This may make you sleepy) Please call the office if you have not been able to hold down food or fluid for 12 hours or more. Colds/Flu/Allergies For cold and congestion, over-the-counter products can be used after the first twelve weeks of pregnancy: Phenol throat spray (Chloraseptic®) and most throat drops Nasal congestion or feeling stuffy from colds or flu (follow directions on the box and take only as needed): Pseudoephedrine (Sudafed®)– 30 to 60 mg every 4 to 6 hours (Do not take PE formula (phenylephrine). You will need to ask the pharmacist for this as it is kept behind the counter). If you have HIGH BLOOD PRESSURE, do not take Pseudoephedrine please call our office for alternatives. Chlorpheniramine Maleate (Chlor-Trimeton® )– 4 mg every 4 to 6 hours Diphenhydramine (Benadryl®) and follow directions on the bottle Saline mist spray as needed or: Oxymetazoline (Afrin®) nasal spray – every 12 hours (avoid using Afrin® for more than 3 days). Guaifenesin (Robatussin® or Regular Mucinex®)– 1 to 2 tsp. every 4 hours (do not take more than 8 tsp in 24 hours) Acetaminophen (Tylenol®) – Do not take over 3,000 mg in 24 hours Neti Pot and follow directions on the box Flonase and follow the directions on the bottle Antibiotics Penicillin, Ampicillin, Erythromycin, Azithromycin, and Nitrofurantoin (Macrobid) are a few of the many safe antibiotics that may be safely prescribed Constipation Bulk laxatives like Psyllium Fiber supplement (Metamucil®) or a stool softener such as docusate sodium (Colace) may be used Magnesium Hydroxide (Milk of Magnesia®) or Polyethylene glycol powder (Miralax® is a laxative you can try if needed. Follow the directions on the bottle. Hemorrhoids Use an over-the-counter hemorrhoid cream Phenylephrine rectal (Anusol, Preparation H) or 1% hydrocortisone cream and follow directions on the tube. Heartburn/Nausea/Reflux/Indigestion You can try a liquid antacid Aluminum hydroxide (Maalox®) Calcium Carbonate chew-tab (Tums®). Follow the directions on the bottle or package. You may take over the counter Famotidine (Pepcid) , cimetidine (Tagamet), lansoprazole (Prevacid), esomeprazole (Nexium), and omeprazole magnesium (Prilosec)and follow directions on the bottle. Trouble Sleeping Diphenhydramine (Benadryl®) 50mg (2 tablets) and/or Doxylamine (Unisom® sleep tablet – verify the active ingredient) 25mg (1 Tablet) Topical Medications Hydrocortisone, Benadryl Cream, Bengay, Tiger Balm, Therapatch. BACK TO TOP COMMONLY ASKED QUESTIONS Can I travel? Traveling is safe for uncomplicated pregnancies. Please let us know if you plan to travel so we can discuss a plan to minimize risks. During long car or air travel, be sure to stand up and walk around every two hours to improve circulation in the legs. Can I go to the salon or spa? Hair coloring and nail treatments are safe during pregnancy, but should be well ventilated. Prenatal massages are acceptable throughout pregnancy. You should avoid sauna, steam room, or hot tub with water over 100 degrees. Can I have sex? Sex is safe throughout pregnancy unless certain complications occur and your provider advises against it. Can I Work? Most women can continue their jobs throughout their pregnancy. In fact, keeping active may help you stay healthier and help pass the time more quickly. If you have a question about your particular job, we can talk it over at your prenatal visit. If you are at risk for preterm labor or other high-risk factors, we will talk with you about any necessary changes to your work schedule. Should I visit the dentist? You should continue regularly scheduled dental visits during the pregnancy. Inform the dentist of your pregnancy and shield your abdomen if x-rays are necessary. If you are having a sensitive gag reflex during pregnancy, try brushing with a soft bristled children’s toothbrush. Can I care for my pets? Cat feces can contain toxoplasmosis. When litter boxes are changed, the toxoplasmosis ova can become aerosolized, thus this chore should be avoided in pregnancy. Handling the cat itself is not a concern. Avoid touching soil that may have cat poop in it. Wear gloves when working in the garden. Should I monitor my baby’s movement? Women begin feeling their babies move sometime between 16-25 weeks of pregnancy. Initially, movement will be infrequent and inconsistent. As the baby grows, you will feel more movement. Beginning at 28 weeks, it is recommended to count the baby’s movements once per day at a time when your baby tends to be most active (i.e. after dinner). You should feel the baby move 10 times within a 2-hour timeframe. You can eat something sweet, lie on your side, and press on your belly to encourage the baby to move. If you have concerns about the baby’s movements, and are not able to achieve the kick counts, contact the office. Being sick with certain infections can cause problems for you and your baby during pregnancy. Here is how to protect yourself and your baby. Chickenpox, Measles, and Rubella Ask your provider if you are immune to these infections. If you are immune (protected from getting the infection), you have had it before or have been vaccinated against it. If you are not immune, stay away from people who may have infections. Tell your provider right away if you are around someone who is infected with Chickenpox, Measles, or Rubella. Don’t get vaccinated for these infections during your pregnancy. Wait until you have your baby. Cytomegalovirus (also called CMV) —A common infection in young children that’s dangerous to your baby if you get it during pregnancy. Wash your hands after being around children. Carefully throw away used diapers and tissues. Don’t share glasses, cups, forks or other utensils with children. Fifth Disease: A common childhood illness that’s usually pretty mild., but if you get infected during pregnancy, it may hurt your baby. It usually spreads through the air from an infected person’s cough or sneeze. Wash your hands well after being around children. Carefully throw away tissues used by children. Don’t share drinking glasses, cups, forks or other utensils with anyone who has fifth disease or who is in contact with someone who has fifth disease. HOW DOES MY BABY GROW? At 4 weeks from the beginning of your last period – about when your next period would normally be due, you may be able to get a positive result on a home pregnancy test. Your baby is the size of a poppy seed. Week 8 – All of your baby’s essential organs have begun to form. Your baby has started moving around, though you won’t feel movement yet. Nerve cells are branching out, forming primitive neural pathways. Breathing tubes now extend from their throat to their developing lungs. Week 12 – This week your baby’s reflexes kick in. Their fingers will soon begin to open and close, toes will curl, and their mouth will make sucking movements, although you won’t feel their movements quite yet. Week 16 – Your baby’s eyelids are still fused shut, but they can sense light. If you shine a flashlight on your tummy, they’ll move away from the beam. Ultrasounds done this week may reveal your baby’s sex. Week 20 – Your baby’s senses – smell, vision, touch, taste and hearing – are developing and they may be able to hear your voice. Talk, sing or read out loud to them, if you feel like it. Your baby can swallow now, and their digestive system is producing meconium, the dark, sticky goo that they’ll pass in their first poop – either in their diaper or in the womb during delivery. By 21 weeks, your baby’s movements have gone from flutters to full-on kicks and jabs against the walls of your womb. You may start to notice patterns as you become more familiar with their activity. Week 24 – Your baby’s ears are getting better at picking up sounds. After birth, they may recognize some noises outside the womb that they’re hearing inside now. Your baby may begin practices sucking their thumb. Week 28 – Your baby is now inhaling and exhaling amniotic fluid which helps develop their lungs. These breathing movements are good practice for that first breath of air at birth. Your baby now sleeps and wakes on a regular schedule, and their brain is very active. Your baby’s eyesight is developing, which may enable them to sense light filtering in from the outside. They can blink, and their eyelashes have grown in. Week 32 – Your baby’s muscles and lungs are busy getting ready to function in the outside world, and their head is growing to make room for their developing brain. Your baby’s muscles and lungs are busy getting ready to function in the outside world. Week 36 – It’s getting snug inside your womb! Your baby’s kidneys are fully developed, and their liver can process some waste products. Your baby is gaining about an ounce a day. They’re also losing most of their lanugo hair that covered their body, along with the vernix caseosa, a waxy substance that was protecting their skin until now. Week 40 – Your baby’s physical development is complete, but they’re still busy putting on fat and growing bigger. If you’re past your due date, you may not be as late as you think, especially if you calculated it solely based on the day of your last period. Sometimes women ovulate later than expected. Preterm labor A full-term pregnancy is 37 to 42 weeks long. The estimated due date is determined from the first day of your last menstrual period (LMP) and is averaged out to be 40 weeks. If you are unsure of your last menstrual period or have irregular periods, an ultrasound can be done in the first trimester to help determine your due date. An infant delivered prior to 37 weeks is considered preterm. The cause of preterm labor is not completely understood. There are many factors that may increase the chances of developing this complication. Some of these factors include carrying twins or triplets, untreated urinary tract (bladder) infections, or having had a preterm delivery in the past. It is also possible to develop preterm labor for no apparent reason. “Labor” is the condition in which the uterus contracts in a regular coordinated pattern causing the cervix to open and prepare for delivery. If these contractions occur along with changes in the cervix between 20 and 37 weeks, then the diagnosis of preterm labor is made. Warning signs and symptoms of preterm labor: Uterine contractions are tightening of the uterine muscle. During a contraction, your uterus will tense up and feel hard. Contractions occur normally throughout pregnancy and are generally painless and irregular in sequence. Preterm labor contractions may also be painless but there is often a pattern to them. Contractions that occur every 15 minutes or more than 4 to 6 contractions per hour consecutively for more than 2 hours may cause the cervix to soften or open Menstrual-like cramps felt in the lower abdomen area just above the pubic bone that may be consistent or come in waves. Dull lower backache located mainly in the low back or around the sides. It may be constant or intermittent. It is generally not relieved by a change in position. Pelvic pressure, a feeling of fullness or increased heaviness and pressure in the pelvic area. It is often described as a feeling that the baby is going to “fall out”” Intestinal cramping that may or may not be associated with diarrhea. It may feel like “gas pain”. Change or increase in vaginal discharge. The color may be pink or brown tinged. The discharge may change to a mucous or be thin and watery. A feeling that something may not be right. This may occur without any specific cause. If you should detect any of the above signs or symptoms, we advise monitoring for contractions. This is accomplished by emptying your bladder and then lying down, tilted slightly on your side. Use a pillow to support your back. Place your fingertips in the top of your uterus. Feel if your uterus is getting hard or not. If you feel contractions, time the duration from the beginning of one contraction to the next. Also time the length of each contraction. Monitor the contractions for at least one hour. Sometimes resting will stop the contractions or at least slow them down. Please call us if you have more than 4 to 6 contractions in one hour or if any of the other symptoms should occur, especially any spotting, bleeding, or other change in your vaginal discharge. If you have had a previous pregnancy with preterm labor, your provider will monitor you more closely. You are at an increased risk to have preterm contractions if you have had them in previous pregnancies. To screen for preterm labor, your provider may perform an ultrasound to check the length of your cervix and/or place you on the fetal monitor to check for any contractions that you may be having. Remember you are looking for any changes from your normal pattern. If you are unsure if you are contracting or any of the other warning symptoms, please do not hesitate to contact our office at any time. Early recognition of preterm labor may prevent a preterm delivery. BACK TO TOP WELCOME TO THE 9TH MONTH OF PREGNANCY Contractions: Beginning at 36 weeks, women commonly feeling increasing intra-abdominal and pelvic pressure, experience ‘practice’ contractions called Braxton-Hicks Contractions, and sense stretching and pulling in the abdomen. Baby movements often feel softer and less frequent. Some women experience a burst of energy and are busy preparting their home for the expected baby. Want to learn more about timing contractions and how to prepare for delivery? CLICK HERE to download the 9th month of pregnancy guide! CONGRATULATIONS, YOU'RE ALMOST THERE! BACK TO TOP Explore Other Helpful Pages Pay Your Bill Women's Health Pay Your Bill Mental Health

LEADERSHIP Gavin Muir, MD Chief Medical Officer/Chief Quality Officer Gavin is a Family Physician who joined Amoskeag Health in 1998. He is from suburban Philadelphia but has lived in New Hampshire for three decades. He got his undergraduate degree from Princeton University in Ecology & Evolutionary Biology in 1991 and his medical degree from Temple University in 1995 and graduated from his residency program at Southern Colorado Family Medicine in Pueblo, Colorado in 1998. He was a staff physician for his first three years and then started taking on a leadership role at Amoskeag Health. He served as its Medical Director for a decade and then stepped down for two years from that role to focus on the work he was doing with the Elliot Hospital Medical Staff. He served as the Chair of the Department of Medicine at Elliot Hospital for two years and then spent a decade leading Elliot’s Multispecialty Review Committee. He became the Chief Medical Officer of Amoskeag Health in 2013 and has continued to serve in that role. He was a Union Leader Forty Under Forty winner in 2007 and in 2013 he was named the Family Physician of the Year by the NH Academy of Family Physicians. In 2019 he received the Stephen A. Tzinabos award for his leadership and dedication to the Elliot Hospital’s Medical Staff. Last year he stopped doing inpatient medicine after delivering a little over 1,000 babies over 27 years at Elliot Hospital. He continues to see patients in the clinic. Back to Leadership

Interested in becoming a patient at Amoskeag Health? Learn about our patient registration process, the services we offer, and how you can start receiving comprehensive, compassionate care from our dedicated team. BECOME A PATIENT We are currently accepting new patients! Please call 603-626-9500 or fill out the form below to request an appointment . A Patient Services Representative will contact you as soon as possible to schedule your new patient appointment. If you are new patient who is interested in our Medication Assisted Treatment (MAT) program , please call 603-935-5263 to speak with one of our MAT providers. We accept most insurance plans at Amoskeag Health. Many insurance companies make agreements with healthcare providers to offer lower rates to patients; this is called being "in-network." Please contact your administrator or insurance company to ensure that we are in-network with your health insurance plan. Even if your insurance auto-assigned you to an Amoskeag Health primary care physician, you must fill out the form below before visiting us. If you need help, please call 603-935-5336 . New Patient Information Explore Other Helpful Pages Pay Your Bill Pay Your Bill Language Assistance Pay Your Bill New Patient Forms Financial Assistance Transportation Assistance Language Assistance

LEADERSHIP Betsy Burtis, M.Ed. Chief Operating Officer Betsy has worked at Amoskeag Health for seven years in a variety of roles. For 30 years, Betsy has been employed in multiple healthcare settings and at each has worked to advance health equity and be an advocate for underserved and underrepresented patients. She has witnessed the evolution of health equity from the early days when it equated to simply providing language interpreters to the current outcomes-driven work that is combined with social justice advocacy to ensure everyone has an equitable opportunity to live healthy lives. In her current position as COO, she has taken on a broader range of responsibilities that include Behavioral Health and Substance Use Disorder treatment, Amoskeag’s Special Medical Programs which provide health assessments and treatment to children living with medically complex conditions, Community Initiatives, and finally more traditional operations functions like facilities, medical records, interpretation services, scheduling, and the Call Center. Back to Leadership