Explore valuable resources for parents and caregivers at Amoskeag Health. Find tools, support, and information to help you manage caregiving responsibilities and enhance the well-being of your family. LAUNCH Linking Actions for Unmet Needs in Children’s Health What is LAUNCH? LAUNCH is designed to connect you with resources and services to help support your child’s growth and development. This program is offered at no charge to all Amoskeag Health patients with children 0-8 years of age. LAUNCH is a clinic-based program, which means our "LAUNCH Navigators" work directly with parents and caregivers to discover and navigate local resources for childcare assistance, food access, housing assistance, and more. We provide referrals and set up ongoing support to make sure you have everything you need. Just a Few of the Many Reasons You Might Enroll in LAUNCH... 1 You want to access resources that are available to you and your family You have children 0 - 8 years of age 2 3 You are new to the community You want to connect with other families in Greater Manchester 4 No matter the reason, if you're seeking connection and support as a caregiver of children eight years old and under, we're here for you. Interested in more information? Email CommunityInitiatives@AmoskeagHealth.org ABOUT OUR ADDITIONAL PROGRAMS Ready, Set, LAUNCH! Our Ready Set LAUNCH program is for newborns and their families who live in Manchester and give birth at Elliot Hospital. Newborns and their families are eligible for this one-time home-visiting service! Learn More Free Developmental Screenings Completing the development screenings during your child's first year of life helps you understand your child's milestones, learn what they are focused on and what skills you will see developing soon. Screening can be completed in 30 minutes. Results over the phone or in person. Activity ideas provided to support your child's development. Want to learn more about helping your child reach age-appropriate milestones? Contact Amoskeag Health Navigators at (603)851-6845 to learn more and to schedule your child's first screening. ABOUT OUR COMMUNITY IMPACT Early Childhood Region 4 The Early Childhood Region 4 is led by the LAUNCH Region 4 Leadership Team who helps support initiatives addressing early childhood in Greater Manchester and Greater Derry. The team contributes to the development of a statewide comprehensive, coordinated, and sustainable early childhood system that prepares children for kindergarten and academic achievement; fosters safe, healthy, and engaged families; and promotes social and emotional health and well-being. Learn More About Region 4 Strategic Plan Manchester LAUNCH Family Wellness Collaborative (LFWC) To provide primary prevention events, the Manchester LAUNCH Family Wellness Collaborative (LFWC) brings together a multi-sector coalition of partners. LFWC partners promote cross-sector collaboration and communication to improve family wellness and resiliency. Manchester LFWC attends community-based events with information on child development, community resources, programs, and information in collaboration with partners The Early Learning Collaborative Early Learning Collaboratives offer a space for childcare centers and family-based center directors to convene. These collaborations offer chances to: Participate in monthly meetings for programs in Region 4 to support and discuss current trends related to childcare in NH. Learn about new resources for programs and children in their region. Receive support from likeminded individuals to discuss the challenges that early childhood development programs face. Interested in learning more about our programs or getting involved with our community impact? Email CommunityInitiatives@AmoskeagHealth.org

Join Amoskeag Health's Morning Matters 2026, an annual breakfast fundraiser supporting the Dr. Selma Deitch Center for Children & Teens. Learn more about our event, aimed at raising funds to benefit our youngest patients. 19th ANNUAL MORNING MATTERS Morning Matters is our annual breakfast fundraiser benefiting the operations of the Dr. Selma Deitch Center for Children & Teens. Please join us for an informative and uplifting morning as we celebrate and honor more than three decades of providing quality, patient-centered care and supportive services to children across the community. What is Morning Matters? Wednesday, June 3, 2026 7:30 - 8:45 AM The Derryfield, 625 Mammoth Road, Manchester, NH 7:00 – 7:30 AM: Registration, coffee, networking 7:30 – 8:45 AM: Program Register Here Event Details 2026 PROGRAM SPONSORS John Sigel and Sally Reid Elliot Health System NH Healthy Families Sarah and Rich Sigel WellSense Health Plan 2026 ADVOCATE SPONSORS Associated Grocers of New England BerryDunn Community College System of New Hampshire Granite State Credit Union Harvey Construction Corporation Lindner Dental Manchester Community College Northeast Delta Dental Primary Bank Sheehan Phinney Solvere Health 2026 TABLE SPONSORS THANK YOU to ALL 2026 Sponsors whose generosity makes health care accessible for ALL CHILDREN

Learn about Amoskeag Health's School-Based Health Centers, offering primary care and mental health services directly in Manchester schools. Our program includes nurse practitioners for on-site medical care and weekly mental health counseling, ensuring students' well-being and academic success. HEALTHCARE IN SCHOOLS Our goal is to meet children where they are for their health and wellness needs—that’s why we work with Manchester School District to deliver health care directly in the schools. ABOUT THE PROGRAM We provide weekly mental health counseling and mentorship to K-12 students in Manchester School District’s participating elementary, middle, and high schools. Each partnering school has a dedicated Community Health Worker (CHW) who can work with your family to assess your needs and help you connect with these services and any necessary supports outside of the school district. The School-based Counseling Program provides full mental health assessments and treatment planning with a goal to enhance the overall physical, emotional, and educational well-being of children. We continually foster opportunities to build strong and meaningful connections with their families, schools, and communities. We're fully integrated into the Manchester School District and its "Multi-Tiered System of Support for Behavioral Health and Wellness" (MTSS-B), which provides a comprehensive system of social, emotional, and behavioral supports to promote student wellness and improve engagement in learning . Through this integration and collaboration, the School-Based Counseling Program develops individualized treatment plans and provides interventions to support success. By working with the school district and incorporating elements of MTSS-B, school-based BHCs work within the school to promote improved behaviors and functioning for students in need of additional school support. School-Based Counseling Program HOW DOES THE PROGRAM WORK? Our Amoskeag Health school-based clinicians meet one-on-one with students weekly (for about 20-50 minutes, depending on the level of services required) to provide brief counseling, individualized support, and/or mentoring. They also help coordinate community resources to help students reach their goals, improve their mental health, and their overall health and well-being. Our clinicians stay in touch with Manchester School District! They work directly with the students’ teachers to schedule sessions around their classes. If it’s more convenient, our school-based clinicians can also meet with your child, at Amoskeag Health, summer programs, or via telehealth. The goal of this program is to follow your child through graduation, as research tells us that long-term, supportive relationships increase a child’s chance for success; however, the length of counseling treatment is ultimately based on the individual needs of each participant. THIS SOUNDS LIKE A GOOD FIT – NOW WHAT? Great! Students who want to be a part of the program do not need to be patients at Amoskeag Health, but they must obtain parental/guardian consent. If you would like your child to participate, please call 603-626-9500 and mention that you're interested in school-based counseling at your child's school. The representative will coordinate next steps with you. School-Based Vision Program Amoskeag Health’s Family Eye Care Center partners with Beech Street and Gossler Street Elementary Schools in the Manchester School District to provide eye care for students. Nurses complete a vision screening and refer students to our Eye Care Center for further care. We can offer services to students even if they don’t have a primary care provider at Amoskeag Health. A sliding fee scale is available to make our services affordable, transportation can be arranged if needed, and some students may qualify for free glasses. Our goal is to help every student see clearly, so they can do their best in school. Important Note About Insurance: If your child is currently enrolled in an insurance plan, the health plan will be billed for these services, and you might owe a co-pay or deductible depending on the plan’s benefits. If your child is not insured, Amoskeag Health can help you identify insurance options or determine a discounted fee using our income-based sliding fee scale.

IMPORTANT UPDATE At Amoskeag Health, we are committed to providing the best possible care for our patients while making strategic decisions for our future. As part of our commitment to improving and streamlining services, we will close our McGregor Street location on Friday, November 22, 2024. This closure is part of a temporary consolidation of our locations, as we look ahead to the future opening of the Mark Stebbins Community Center on the West Side of Manchester. McGregor Street Location Closure The McGregor Street site is our smallest location and has played an important role over the years. During the pandemic, it served as our only acute care site, allowing us to deliver essential services safely. However, since early 2023, McGregor has only been open part-time, focusing primarily on wellness visits due to its limited size. Since March 2020, many of our patients from the west side have been receiving their care at our three other locations on Hollis Street, Elm Street, and Tarrytown Road. These larger sites offer a wider range of services, allowing us to meet patient needs more effectively. The closure of McGregor will allow us to strengthen and focus our care at these larger facilities. Why Are We Closing McGregor? While McGregor is closing, this decision is part of a larger plan for the future. We are preparing for the development of the Mark Stebbins Community Center, which will provide expanded facilities and services with easy access for residents on the West Side. We are very excited about plans for the Mark Stebbins Community Center and the opportunities it will bring. Plans for the Future The McGregor Street location will close on Friday, November 22, 2024. As we approach the closure date, patients with appointments scheduled at McGregor will be contacted to reschedule their appointments at one of our other locations. Moving forward, all future appointments will also take place at these sites, where patients can continue to see their regular provider. If transportation to any of the three locations is a concern, we will help arrange transportation to ensure care remains uninterrupted. Next Steps for Patients Closing the McGregor site allows us to allocate resources more effectively and continue delivering comprehensive care at our larger locations. This decision supports our ongoing efforts to provide high-quality care and ensures the financial sustainability of our services as we prepare for the future. If you have any questions or concerns, please do not hesitate to contact us. You can reach us at (603) 626-9500. Thank you for your support as we work to strengthen integrated healthcare services to our community. Supporting Quality Care

Visit the Family Eye Care Center at Amoskeag Health for comprehensive eye care services. Our team offers eye exams, vision correction, and treatment for various eye conditions, ensuring the best care for your family’s eye health. FAMILY EYE CARE CENTER Optometry is health care related to your eyes and vision. It's important to have eye exams even if you don't have trouble reading signs or books. In some cases, an eye exam can be lifesaving. Did you know that some health conditions can be visible in your eye and caught by an optometrist (eye doctor)? Illnesses that can be detected during an eye exam include: Glaucoma (damage to the optic nerve) Potential stroke Diabetes High blood pressure Autoimmune diseases Sexually transmitted diseases Some cancers What is Optometry? At Amoskeag Health's Family Eye Care Center, we can see patients of any age. We will evaluate your eye and vision health and may r ecommend glasses. Please call 603-626-9500 to schedule an appointment. Types of Eye Exams Annual Eye exams can be performed on patients of all ages—even infants—to prevent permanent changes in vision. If needed, the patient may be referred to a specialist to provide further evaluation and testing. We can also fit patients for glasses right in our Family Eye Care Center! Annual Eye Exam These exams are for patients who have acute eye issues. These can be made for same-day or scheduled appointments based on conditions such as: infections, sudden changes in vision, or injuries – but not for glasses. Acute Eye Exam As part of a Diabetic Eye exam, you will have medicated eye drops used to widen your pupils. Using a special magnifying lens, the eye doctor will be able to view the entire inside of your eye, looking for any changes that might develop from Diabetes and other conditions. Diabetic Eye Exam

Explore the Ready, Set, Launch program at Amoskeag Health. This initiative offers resources and support to help parents and caregivers prepare for and navigate key transitions in their family’s journey. Ready, Set, LAUNCH Because it Takes a City to Raise a Baby Home Visiting for All There is no guidebook for bringing home a new baby! Our Ready Set LAUNCH program is for newborns and their families who live in Manchester and give birth at Elliot Hospital. We want to make the first few weeks of caring for newborns a little easier. The Ready Set LAUNCH service is customizable to what YOU need. Newborn Navigators are bilingual Community Health Workers trained to assist families with newborns. They're experts in local resources and can connect you with services like mom's groups, lactation consultants, and childcare scholarships. Your Newborn Navigator can also connect you with free Nutrition and Cooking Classes, support access to SNAP and WIC, or to the local diaper pantry. As parents themselves, they understand how hard the first few months can be and can provide support during those early days at home. About Newborn Navigators Meet a Newborn Navigator Any parent or caregiver of a newborn who resides in Manchester is eligible to receive this FREE, one-time service! You will be introduced to the service at discharge or receive a call from our Newborn Navigator. Our Newborn Navigators will meet you in the hospital and tell you about our service. They will offer to meet you remotely for your visit. Navigators will follow up with you after you leave the hospital and give you a Welcome Baby Bag prior to the visit. How Does Ready, Set LAUNCH Work? Your Newborn Navigator will ask you how your first few weeks have been for you, your child, and your family. Your Navigator will see whether there was anything you wish you had or anything you currently need. Y our Navigator can work with you to make referrals if you'd like them. Your Navigator will determine if you may benefit from, and are eligible for, Enhanced Navigation which provides you with up to five additional home visits to build additional resources and support. Your Navigator will follow up with you after your visit to make sure you and your family are doing well. What Happens During a Home Visit? Since its inception in 2021, the Newborn Navigator has met with 1,433 families at Elliot Hospital, conducted 436 home visits, and referred 482 times to services like Manchester Diaper Pantry, WIC, SNAP, and various food banks. Ninety of these families received services in a language other than English - 80% in Spanish and 20% spread over Dari, French, Nepali, Pashto, Portuguese, and others. About Our Community Impact Interested in learning more about our programs or getting involved with our community impact? Email CommunityInitiatives@AmoskeagHealth.org

Discover language assistance services at Amoskeag Health. We provide support for non-English speakers and those with limited English proficiency, ensuring clear communication and access to quality healthcare for everyone. LANGUAGE ASSISTANCE For patients who speak a language other than English, Amoskeag Health offers language assistance free of charge. Please call 603-626-9500 . For patients who are deaf, hard of hearing, or speech impaired, TTY assistance is available. Please call 711 or 1-800-735-2964 . We believe that everyone has the right to communicate in their own language. At Amoskeag Health, we do our best to make sure that our staff and patients have the ability to talk to one another, even if they speak different languages. We Can Help Amoskeag Health provides high quality, professional language assistance to patients through: Staff Interpreters Video Remote Interpreting (VRI) Over the phone interpreter services that are available for patients during appointments If you need an interpreter for your next appointment, please call 603-626-9500 . Staff interpreters may be available in the following languages: Spanish Portuguese Nepali Arabic Bosnian We also contract with selected agencies to provide face-to-face Video Remote Interpreting (VRI) and over the phone interpreter services in locations where we do not have staff interpreters available. Language Interpretation & Translation Amoskeag Health serves Deaf and Hard-of-Hearing patients through: • Registry of Interpreters for the Deaf (RID) certified sign language interpreters • Written communication and visual aids (Patient Portal online access) • Adaptive electronic equipment such as Video Remote Interpreters Deaf & Hard-of-Hearing Communication Services Explore Other Helpful Pages Pay Your Bill Transportation Assistance Pay Your Bill Financial Assistance

Easily pay your bill online through the Amoskeag Health payment portal. PAY YOUR BILL View the convenient options to pay your bill below. If you need financial assistance, please click here. Click here to pay via patient portal. Online Bill Pay To pay your bill over the phone using a credit card, please call our Billing Department at 603-935-5205 . Pay Over the Phone To pay a bill for a service, please send a check to: Amoskeag Health PO Box 34999 Belfast, ME 04915-0627 Mail Check Questions? Call our Billing Department at 603-935-5205.

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

Explore sexual and reproductive health services at Amoskeag Health. Our team provides comprehensive care, including education, screenings, and treatments to support your sexual health and well-being. CONFIDENTIAL SEXUAL AND REPRODUCTIVE HEALTH SERVICES EXPLORE THE TABLE OF CONTENTS BELOW Our Services Let's Talk About Sex STIs & STDs Condoms Do's and Dont's Pregnancy Relationships For Parents of Teens OUR SERVICES Call 603-626-9500 for more information about... Finding the best method of birth control for you Emergency Contraception STD education, testing, and treatment Abstinence Education Walk-in pregnancy testing Achieving pregnancy on your schedule BACK TO TOP It’s totally normal to think about sex, but it’s very important to consider whether or not you’re prepared to have sex. No matter what, it’s helpful to have a trusted adult that you can talk to, and your Amoskeag Health provider can be that person. In the meantime, these resources can help you learn a little bit more about your body and what might happen when you have sex. Making Healthy Sexual Decisions | Young Men’s Health (youngmenshealthsite.org) Sexual Health | Young Men’s Health (youngmenshealthsite.org) Center for Young Women’s Health (youngwomenshealth.org) Guías de la Salud | Center for Young Women’s Health (youngwomenshealth.org) Dicas de Saúde | Center for Young Women’s Health (youngwomenshealth.org) Let's Talk About Sex Click Here Haga Clic Aqui BACK TO TOP SEXUALLY TRANSMITTED INFECTIONS & DISEASES (STIs & STDs) WHAT IS THE DIFFERENCE BETWEEN STIs & STDs? STIs (sexually transmitted infections) and STDs (sexually transmitted diseases) are basically the same thing! So, why do people sometimes say “infection” instead of “disease”? The word “disease” can make people think of a visual problem, but a lot of STDs don’t have any signs or symptoms – they’re an infection that you might not see. That’s why it’s so important to get screened if you are sexually active. That way, your doctor can help you if you need it. Learn more about STDs: STDs and STIs from GirlsHealth.gov. HOW DO I GET STDs? STDs are caused by bacteria, viruses, and even tiny insects! You can get a STD by having sexual contact with someone who has one. Sexual contact can mean intercourse or putting your mouth, hands, or genitals on someone else’s genitals. Remember, even if they can’t get pregnant, women who have sex with women are also at risk for STDs. WHAT ARE DIFFERENT TYPES OF STDs? Bacterial Vaginosis Chlamydia Congenital Syphilis Genital Herpes Gonorrhea Herpes genital Pelvic Inflammatory Disease (PID) Syphilis Trichomoniasis WHAT HAPPENS IF I GET A STD? STDs are all different. Some can be treated and cured. But you can still get the STD again if you have sex—especially unprotected sex—with an infected person. Ask your provider about treatments for your partner, otherwise you could give each other the infection back and forth. Some STDs can’t be cured, but you can help manage the symptoms. There are also a few STDs that can be life threatening without treatment. BACK TO TOP CONDOM DO'S AND DON'TS DO use a condom every time you have sex. DO put on a condom before having sex. DO read the package and check the expiration date. DO make sure there are no tears or defects. DO store condoms in a cool, dry place. DO use latex or polyurethane condoms. DO use water-based or silicone-based lubricant to prevent breakage. DON’T store condoms in your wallet as heat and friction can damage them. DON’T use nonoxynol-9 (a spermicide), as this can cause irritation. DON’T use oil-based products like baby oil, lotion, petroleum jelly, or cooking oil because they will cause the condom to break. DON’T use more than one condom at a time. DON’T reuse a condom. More Information BACK TO TOP PREGNANCY PREVENTING PREGNANCY Not having sexual intercourse – otherwise known as abstinence – is the most effective way to prevent pregnancy. But there are still birth control options that you can use when you aren’t ready to become pregnant. HAVING A HEALTHY PREGNANCY ON YOUR SCHEDULE Whether or not you’re interested in having a baby, it’s important to take care of your body by staying active and eating the right food . And if you ARE interested in one day having a baby, it’s important to talk to your provider about “Preconception health.” Preconception health is talking about how to take care of yourself so that you can have a healthy baby. If you are ready to have a baby, please talk to your provider. They can help you plan and prepare for a healthy pregnancy. You can schedule an appointment by calling 603-626-9500. Click Here Haga Clic Aqui BACK TO TOP RELATIONSHIPS HEALTHY RELATIONSHIPS Relationships can be tough. It’s important to treat your friends and partners with respect. You deserve that respect as well. Boundaries are so important when you’re creating relationships. When you explore having sex with your partner, you need to have honest and open discussions. No one should feel forced to have sex if they are not ready or do not want to. If you are feeling unsafe with your partner, please tell someone! If you are interested in learning more about boundaries and consent, check out these resources from Bedsider: Boundaries & consent | Sex & relationships | Articles, News, Tips, and Health Information (bedsider.org) Los límites y el consentimiento | El sexo y las relaciones | Artículos, Noticias, e Información de Salud (bedsider.org) Sometimes, dating is complicated. Maybe your family doesn’t approve of your partner or you’re not sure how to end an unhealthy relationship. If you can relate to any of those situations, then love is respect can help! Relationships aren’t all about romance. Are you struggling to make friends, get along with your family, or work out problems in ALL of your relationships? GirlsHealth.gov can help you learn how to communicate and form healthy relationships. ADDITIONAL RESOURCES ABOUT RELATIONSHIPS: Your feelings | girlshealth.gov Healthy relationships for young adults | love is respect Relationships | girlshealth.gov IS SOMEONE MAKING YOU NERVOUS OR UNCOMFORTABLE? No one ever has the right to abuse you! Sometimes, abuse isn’t physical. People can also hurt you by using unkind words meant to bring you down or by trying to control your actions. If you are threatened or hurt by your partner, help is available. It can be very hard to get up the courage to leave a partner who is hurting you (especially if you love them), and it can be a very complicated situation. But it’s not your fault and there are resources to help you. If you don’t feel safe in your relationship, please call 603-626-9500 and ask to speak with a case manager at Amoskeag Health or visit New Hampshire 211 . How can you identify abuse? Click here to learn more. BACK TO TOP FOR PARENTS OF TEENS It’s challenging to parent a teenager! But open and honest two-way communication about sex and their bodies can help keep your teen educated and safe. Helping your teen build a trusting relationship with their healthcare provider is essential. BACK TO TOP

Explore adolescent health education and preparation services at Amoskeag Health. We provide resources and support for teens and their families, focusing on health education, wellness, and preparing for a healthy future. ADOLESCENT HEALTH EDUCATION (PREP) What is PREP Manchester? Program Curriculum Parental Consent Form What are Teens Saying? Video Resources Local Resources Local Health Clinics Online Resources for Teens Online Resources for Parents/Caregivers Community Partners Jump to a Section: The Personal Responsibility Education Program (PREP) is a federally funded, comprehensive sexual health education program provided through Amoskeag Health for teens and young adults in the Manchester community. Educators create a learner-focused environment for students of all backgrounds and experiences. This program works to increase healthy relationships among teens and young adults, positive adolescent development, and to reduce pregnancy and sexually transmitted infections. PREP provides a no-cost, discussion-based course, open to people aged 14-19 years, or up to 21 years old if pregnant and/or parenting. Parental consent is required for participation. What is PREP Manchester? The PREP curriculum emphasizes social and emotional skills as key components of healthy relationships and responsible decision making. Communication skills How to identify healthy relationships Abstinence & other pregnancy prevention methods STD/STI prevention Where and how to safely access sexual health care Our program consists of either six 1.5-hour sessions or eleven 45-minute sessions. We strive to meet our community partners' needs and will accommodate your requirements as much as possible. In addition to gaining knowledge, students can also earn extended learning opportunity (ELO) credits. Return to top of page What Does the Curriculum Teach? If you have any questions about PREP, please email CommunityInitiatives@AmoskeagHealth.org . Completing the consent form below gives permission for your mid-schooler or teen to attend the Personal Responsibility Education Program (PREP). This program will take place at Amoskeag Health, your child’s school, virtually, or at a youth program location within your community. You will be contacted to enroll your teen or middle-schooler in the class that best fits their schedule. Keeping in mind personal beliefs and values, you can preview the two curriculums we offer by emailing communityinitiatives@amoskeaghealth.org . We would be happy to arrange a preview time and answer any questions you may have about the program! Return to top of page Parental Guardian Consent Form If you have any questions about PREP, please email CommunityInitiatives@AmoskeagHealth.org . “There’s no other place we can talk about these things in a safe and understanding environment. It’s comforting to know that people understand us and want to educate us on our health so we can keep ourselves safe.” ~PREP Participant What Are Teens Saying? We believe that teens and young adults deserve access to medically accurate, reliable and informative comprehensive sexual health education. We value, support, and respect everyone’s rights and abilities to make informed choices about their health and safety. Why We Do What We Do All Videos Play Video Play Video 11:31 What is Sexual Health? A Comprehensive and Holistic Explanation of Sex and Sexual Health | Health Ed Discover what Sexual Health and examine the core elements of sexual well-being - https://www.projectschoolwellness.com/what-is-sexual-health/ Play Video Play Video 04:58 8 Habits of Healthy Relationships Healthy relationships are when both partners to feel supported and connected but still feel independent. So, what are the habits partners have to sustain a good relationship? Are you looking for dating advice on how to maintain a healthy relationship? Or dating tips on how to keep an active and healthy interaction between you and someone? Here are 6 habits to keep a healthy relationship. #healthyrelationships #relationship #psych2go Related Video(s): 6 Stages of a Relationship - Which One Are You? https://youtu.be/Umz9SgjRroY 12 Signs You're in a Healthy Relationship https://youtu.be/kCQIDvEnrTg 6 Differences Between Healthy and Unhealthy Love https://youtu.be/4c5dFcC4LNY Writer: Veronica Ma Script Editor: Isadora Ho Script Manager: Kelly Soong VO: Lily Hu Animator: Naphia YouTube Manager: Cindy Cheong References Mason, T. (2020, May 14). 12 Powerful Habits of Happy Relationships. Lifehack. Retrieved from https://www.lifehack.org/articles/communication/12-powerful-habits-happy-relationships.html Virgo, J. (2017, April 7). 11 Habits of Healthy Couples. The Every Girl. Retrieved from https://theeverygirl.com/11-habits-of-healthy-couples/ Play Video Play Video 02:58 Being Safe on the Internet The internet can be an amaze-ing place to explore, but it's also good to practice online safety. Some tips include being careful about sharing personal information, reporting anyone who makes you feel uncomfortable online, and getting familiar with privacy settings. For more, check out the video! -------- To learn more, follow us! Instagram: AmazeOrg Snapchat: AmazeOrg http://amaze.org/ -------- Translation Credits: Daman Education: Persian (Iran) [AMZ-033] Play Video Play Video 01:50 Talking With Your Parents About Sex Sometimes it can be awkward to ask a parent or trusted adult questions about puberty and sex. As uncomfortable as it may feel, remember that they were once your age and went through the same things you are going through. A parent or adult you trust can provide the support you deserve as you go through puberty. That’s why it is important for you to have at least one adult you trust and can talk with. ----------------- AMAZE takes the awkward out of sex ed. Real info in fun, animated videos that give you all the answers you actually want to know about sex, your body and relationships. Please like, share and subscribe to AMAZE! Follow us on Snap and Insta for more info about puberty and growing up. Snap: AmazeOrg Insta: AmazeOrg http://amaze.org/ [AMZ-113] Play Video Play Video 02:11 Finding An Adult That You Can Trust Growing up can be exciting, but challenging. Having an adult that you can trust and talk to about what you're thinking or feeling can be really helpful! ------ Please like, share and subscribe to AMAZE! Follow us on Snap and Insta for more info about puberty and growing up. Snap: AmazeOrg Insta: AmazeOrg http://amaze.org/ ----------- Translation Credits PutAPeriod: Bengali Action for Youth: Vietnamese Daman Education: Persian (Iran) [AMZ-047] Play Video Play Video 02:08 How to Be a Good Listener A huge part about being a good friend or a romantic partner is learning to communicate well with the other person. Being a good listener is more than just allowing the other person to speak—you've got to be able to hear what the other person is saying in order to understand the meaning behind their words. There are few things you can do to be a good listener: 1. Pay attention. Don't be distracted by things happening around you. Don't get on your phone and start scrolling or texting. 2. Don't judge what the other person tells you. Let them finish their thought without worrying that you'll jump to conclusions. 3. Don't spend time thinking about what you're going to say next.This is hard to do if you're feeling defensive, but it'll really help if you listen. 4. Show empathy. Empathy means that you show the other person that you feel what they feel. 5. Don't offer solutions to a problem unless you're asked specifically. Most people just want support—they want to be heard. They don't actually want you to solve problems for them. 6. Ask questions to be certain that you understand what the other person is saying, but don't interrupt. Wait until the other person pauses. 7. Be responsive: nod your head or reflect back by saying something like, "you must be so excited" or "that's terrible." Being a good listener is an important skill and can help you to become good boyfriend or girlfriend material. People like to be heard, especially by those they care about. If you need practice, try it out on your close friends or family members. -- Please like, share and subscribe to AMAZE! Follow us on Snap and Insta for more info about puberty and growing up. Snap: AmazeOrg Insta: AmazeOrg http://amaze.org/ Translation Credits: SUB Factory - Vietnamese [AMZ-039] Play Video Play Video 02:48 Maslow's Hierarchy of Needs Maslow's Hierarchy of Needs is a theory in psychology. It argues that there are five stages of human needs that motivate our behavior. #learn #motivation Never miss a new video : http://eepurl.com/dNU4BQ JOIN us as a Youtube member for special perks: ❤️ https://www.youtube.com/channel/UC-RKpEc4eE9PwJaupN91xYQ/join SUPPORT our mission to create free video lessons on Patreon: ❤️ https://www.patreon.com/sprouts Script: Abraham Maslow proposed his theory in 1943 after studying what he called exemplary people such as Albert Einstein or Eleanor Roosevelt. STAGE 1 First, there are physiological needs, such as the need to breathe, eat, drink or sleep. The moment we got enough of that and we feel awake and our bellies are full, we get motivated by the next thing. STAGE 2 Now we want safety. We try to earn money, build up resources and look for shelter that protects us against dangers. Once we are satisfied and feel safe, we have time to think about what we want next. STAGE 3 At stage three we seek love and belonging. We desire to be close to family and friends, belong to a society or join a gang. But the moment we feel completely part of a group we already wish to be a little different than the rest. At stage four we look for esteem, self-confidence, and respect from our peers. We want to be someone. If we have money, we buy a fancy watch. If we have a brain, we write or think or work a lot. Motivation to perform and compete is now at its highest. Students, sportsmen, and inventors excel. Neil Armstrong even flew to the moon. STAGE 5 Only if we breathe and drink and eat and sleep enough and we feel safe and part of a group and still special, only then we can reach level five: self-actualization. Now we can relax, be creative, accept facts for what they are, give back or do whatever we want. No more pressure, unless of course there is trouble below. If you are a leader and believe in the theory, use it. First, make sure everyone has eaten well. Then make them feel safe and help them belong to a group. Once they feel they belong, they are ready to stand out and excel. Music ID: Z2P1P4KFI0MZSKFY Helpful Videos Local Resources Manchester Police Athletic League (MPAL) – MPAL connects cops and kids through free athletic, educational, and enrichment instruction to help kids make the right choices and become productive members of the community. Office of Youth Services – The City of Manchester Office of Youth Services advocates for youth and their families by providing a safe environment to address the needs of today’s youth. Please refer to their website for more information. Waypoint – Waypoint provides needed services in our community including; adoption, prenatal support, parent education/family empowerment, child care, mental health counseling, family preservation, foster care, homeless youth continuum and many more! Call (800) 640-6486. Waypoint- Youth Drop-In Center – Homeless youth and young adult services; they provide homeless youth and youth in high-risk situations ages 12-23 with resources to survive the night and achieve for a lifetime. Provides food, clothing, laundry services, showers, computer and phone access, and a judgement free zone for young people experiencing homelessness. Call (603) 518-4170. YWCA NH – Comprehensive sexual assault and domestic violence services. Please refer to website for additional information or call (603) 668-2299. NH Rapid Response: Call or Text (833) 710-6477. The Rapid Response system can talk with you about emotional distress, mental health, substance use and suicidality. they can also send a mobile team to meet you right where you are - in your home, or another location in the community. Suicide and Crisis Lifeline: Call or text 988. The 988 Suicide & Crisis Lifeline is here to help you cope with emotional distress, suicidal thoughts, and provides crisis resources 24 hours a day, seven days a week. New Hampshire Resources: Not sure where to turn? Call 211. 211 NH is the connection for New Hampshire residents to the most up to date resources they need from specially trained Information and Referral Specialists. 211 NH is available 24 hours, 365 days a year. Multilingual assistance and TDD access are also available. For those outside of New Hampshire, call (866) 444-4211. 211 Resources include: Clothing and Thrift Shops Community Service and Organizations Domestic & Sexual Violence Services GED - Education Classes & Assistance Employment Services Food Pantries & Nutrition Programs Healthcare Services Housing Assistance - Homeless Prevention, Shelter, Tenant’s Rights Legal Assistance Mental Health & Counseling Substance Misuse Prevention, Treatment, and Recovery Services Support Groups Youth & Family Services And More! Return to top of page Local Health Clinics Amoskeag Health: Confidential reproductive health services with counseling for sexual orientation, pregnancy testing, STI testing and treatment, free condoms, and more! Phone: (603) 626-9500. Find a location. CVS Minute Clinic: Pregnancy testing, free condoms, birth control care, and STI & HIV testing and treatment. Located at 250 Mammoth Road, Manchester, NH. Phone: (603) 623-3995 Equality Health Center: Birth control, STI & HIV testing and treatment, counseling, gynecological/reproductive care, men’s sexual health, and more! Located at 38 S Main Street, Concord, NH. Phone: (603) 225-2739 Manchester Health Department: STD clinic with visits for $25.00 (cash only) that includes screening for STIs and STDs. Located at: 1528 Elm Street, Manchester, NH. Phone: (603) 624-6466. Planned Parenthood: Pregnancy testing, free condoms, birth control care, and STI & HIV testing and treatment. Located at: 24 Pennacook Street, Manchester, NH. Phone: (603) 669-7321. Return to top of page FOR TEENS: Amaze - AMAZE takes the awkward out of sex ed. Real info in fun, animated videos that give you all the answers you actually want to know about sex, your body and relationships. Let's Talk Consent – A guide to help teens understand that consent involves agreeing to sexual activity beforehand and continually ensuring comfort, promoting healthy relationships where boundaries are respected. Love is Respect – The national resource to disrupt and prevent unhealthy relationships and intimate partner violence by empowering young people through education, support, and resources. Scarleteen – A comprehensive, supportive sexuality and relationships website that provides information for teens and emerging adults. Please refer to their website for more information. We Think Twice – Tools and resources to help teens make healthy decisions, set goals, manage money, improve leadership skills, look out for their mental health, and resist peer pressure. Return to top of page Helpful Online Resources RESOURCES FOR PARENTS/CAREGIVERS/SAFE ADULTS: AMAZE for Parents – An online resource to help parents/caregivers/safe adults talk to youth about everything from babies to bodies to consent to relationships. Love is Respect – The national resource to disrupt and prevent unhealthy relationships and intimate partner violence by empowering young people through education, support, and resources. Social Media and Teen Mental Health – A guide for parents and caregivers to support healthy social media use among teens. Return to top of page We Are Grateful for Our Community Partners This web page was made possible by Grant Number 90AK0089-01-00 from the Department of Health and Human Services, Administration for Children and Families. Its contents are solely the responsibility of Amoskeag Health and do not necessarily represent the official views of the Department of Health and Human Services, Administration for Children and Families.

MANCHESTER YOUTH WELLNESS AND PREVENTION COLLABORATIVE Amoskeag Health is proud to partner with Makin' It Happen, the YMCA of Greater Manchester, and the Boys and Girls Club of Manchester to offer the Botvin LifeSkills program to at-risk youth in our community. This evidence-based program, led by trained facilitators, teaches young people important life skills to help them make healthier choices and reduce risky behaviors. Makin' It Happen also coordinates the Substance Use and Mental Health Prevention Collaborative, a group of community partners who meet monthly to explore new ways to expand prevention programs in Manchester. These partners are key to the success of the Botvin LifeSkills program, playing a vital role in its implementation. Amoskeag Health has also teamed up with Catalyst Evaluation Group, experts in data collection and evaluation. This partnership ensures we can track progress, report findings, and keep the community, stakeholders, and SAMHSA up-to-date on the program's outcomes. 2026 Strategic Action Plan 2025 Program Annual Report 2024-2025 Botvin Lifeskills Program Evaluation Please check back regularly for the latest information on this important initiative and its impact on our community. Interested in Joining the Manchester Youth Wellness and Prevention Collaborative as a Stakeholder? Have Questions About Our Prevention Framework and Programs? Please contact us by email at communityinitiatives@amoskeaghealth.org. This project is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human Services (HHS) under grant number 5H79SP083836-02 for the Community-Based Strategic Prevention Framework. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA, HHS, or the U.S. Government. Building Stronger Futures: A Collaborative Approach to Prevention