Welcome to Cape Obstetrics, Midwifery and Gynecology
Congratulations!
We are pleased that you have chosen us to provide your obstetrical
care. Our mission is to provide comprehensive, compassionate and high
quality care to all of our patients. We will strive to support you in the style of birth that you desire from natural childbirth to epidurals.
Drs.
Susan Anderegg, Elizabeth Murray, Jean Talbert, and Dale Weldon share
coverage of the practice 24 hours per day, 7 days per week. Marcia
Denine, our nurse practitioner, provides obstetrical and gynecologic
care in the office but does not perform deliveries. Please call the
office for non-urgent questions and prescription refills between 9AM
and 4:30PM weekdays. If you have an urgent question or concern you may
call the office phone number (508-457-0088) at anytime. If the office
is closed, an answering service will take your message and page the
covering provider. Your call will be returned, in most cases, within 30
minutes. If you have a block on your phone for unlisted numbers, please
remove it until you hear back from the physician. In the unlikely event
that the office phones are out of service, you can reach the covering
provider by calling the maternity unit at Falmouth Hospital
(508-457-3630).
Prenatal Care
· Your first visit with
us will be scheduled with one of our nurses between six and eight weeks
of your pregnancy. This appointment will take approximately one hour
and will include a review of your medical history and any concerns that
you may have regarding your pregnancy. Routine prenatal blood work will
be drawn. No examination will be performed during this visit unless you
report a problem. The nurse will also provide you with a general
description of our practice, prenatal care and what to expect during
the first trimester of your pregnancy.
· Your first physical
exam will be scheduled with a physician or nurse practitioner at
approximately ten to twelve weeks of the pregnancy. A brief ultrasound
may be performed at this visit if fetal heart tones are not audible.
Everyone will have a formal ultrasound scheduled at 18-20 weeks for an
anatomy survey.
· Subsequent visits may be scheduled with the
provider of your choice. We recommend that your first 3 visits and last
4 visits be scheduled with a single provider. The physicians in our
office rotate call so any one of them may be present when you deliver.
We encourage you to meet all of our providers at least once during your
pregnancy.
Schedule of Routine Prenatal Appointments and Tests First Trimester: 6-8 weeks: Nurse Interview
Prenatal
Labs - blood type, antibody screen, complete blood count, hepatitis B
screen, syphilis serology, rubella titer. HIV testing is recommended
but optional.
Physician Consultation if high risk
10-12 weeks: Review of medical history and lab results
Physical exam, including pelvic exam, breast exam, pap smear. An ultrasound may also be performed.
First
trimester screening (ERA) for Downs syndrome will be offered to women
who will be 35 or older at the time of delivery. This testing involves
blood work and an ultrasound for nuchal thickening. It is performed at
the referral centers in Boston. This testing is optional.
Second Trimester: Appointments will be scheduled every 4 weeks
16-18
weeks: Alpha-fetoprotein quad screen (AFP4). This test is optional. It
is a blood test that screens for neural tube defects and Down's
Syndrome.
If you will be 35 or older at the time of your
delivery or are at high risk for a birth defect, you will be offered
additional testing that may include blood work, level 2 ultrasound,
amniocentesis and/or genetic counseling.
18-20 weeks: Ultrasound to check fetal anatomy and confirm dates.
Third Trimester: Appointments will be scheduled every 2 weeks between 28 and 36 weeks, then weekly until delivery.
26-28
weeks: Gestational diabetes screen and blood count. If your blood type
is Rh negative, an antibody screen will also be drawn and you will be
administered Rhogam.
35-37 weeks: Group B Streptococcus screen
39 weeks: Internal pelvic exam to check for effacement and dilatation. (optional).
Postpartum: Scheduled 6 weeks after delivery. Physical exam including breast and pelvic exams, pap smear.
PREGNANCY GUIDELINES
Medications:
We
recommend that you try to limit any medication exposure during the
first twelve weeks of the pregnancy. Please let us know prior to
conception or as soon as you find out that you are pregnant regarding
any regular medications that you take. We will counsel you regarding
risks and benefits of your medication in pregnancy and help you to find
the safest alternatives if a change is necessary. Please do not stop
your medications without consulting with a provider first.
Listed
below are some common medications that are safe in pregnancy if used
according to package insert instructions. Please feel free to call us
if you have any questions.
Pain relievers - Acetominophen
(Tylenol, Extra Strength Tylenol) may be used safely for headache and
minor discomforts. We recommend that you avoid Ibuprofen (Motrin,
Advil) and aspirin unless otherwise advised by a physician.
Decongestants - Pseudoephedrine (Sudafed) may be safely used after the first 12 weeks of pregnancy.
Nasal
sprays - Saline nose drops are always safe. Oxymetazoline and
phenylephrine (Afrin, Afrin Allergy, Neosynephrine) may be used for 3-4
days as needed for congestion.
Antihistamines - Diphenhydramine (Benedryl), Triprolidine (Actifed) and Chlorpheniramine (Chlor-trimeton) are safe.
Cough
Suppressant - Guafenesin (Robitussin) may be used for several days.
Consult a provider for persistent coughs or coughs associated with high
fevers.
Antibiotics - Penicillin, Amoxicillin and Erythromycin
are the antibiotics most commonly used when needed during pregnancy. Be
sure that any provider treating you is aware that you are pregnant.
Stool
softeners - Fiber additives (Metamucil, Fibercon) and Docusate (Colace)
may be used as directed. Magnesium hydroxide (Milk of Magnesia) or
Senna (Senokot) may be used occasionally if needed for severe
constipation.
Antacids - Calcium carbonate (Tums) are safe and
are a good source of calcium. Products containing magnesium hydroxide
(Mylanta, Maalox) and acid reducers such as cimetidine (Tagamet),
ranitidine (Zantac) and famotidine (Pepsid) may also be used.
Diet:
A well-balanced diet is very important in every pregnancy. A 25-35
pound weight gain is expected for women who begin the pregnancy at a
normal weight.
Several food restrictions are advised during pregnancy:
Fish:
Avoid shark, swordfish, king mackerel and tilefish whenever possible
due to risks of increased mercury exposure. High levels of mercury can
harm the developing brain and nervous system of the baby. Up to 12
ounces per week of other fish can be safely consumed during pregnancy.
This may include shellfish, canned fish, smaller ocean fish and
farm-raised fish. The mercury content of fresh-water fish caught by
family and friends is often unknown. We recommend only consuming fish
purchased in stores or restaurants.
Cheeses: Avoid unpasturized
dairy products and soft cheeses (such as Brie) during pregnancy. Soft
cheeses can occasionally be contaminated with a bacteria called
listeria. Active infection with listeria can cause preterm labor and
fetal death.
Raw meat and unwashed fruits and vegetables:
These products may contain the parasite toxoplasmosis. Toxoplasmosis
infection is usually asymptomatic in healthy adults but it can cross
the placenta and cause mental retardation and blindness in a fetus or
newborn. Many cats are also infected with this parasite. Women are
encouraged to avoid cat litter boxes and gardening without gloves
during pregnancy. Normal handling of healthy pet cats (petting,
holding) does not place a woman at risk.
Introduction to our practice
Information about our practice
Thank
you for choosing Cape Obstetrics and Gynecology for your obstetrical or
gynecologic care. Our mission is to provide comprehensive,
compassionate and high quality care to all of our patients. Listed
below are some general guidelines regarding our services.
Telephone Advice: Our nurses are available to answer questions from 9-4:30 daily. If
you reach voice mail, please leave a message including phone numbers
where we may reach you. We will make every attempt to return your call
promptly. If an urgent question or concern arises after regular
office hours or on the weekend, you may call the office and leave a
message with the answering service. We will return your call as soon as
we can.
Prescription Refills: Please advise us during your office visit if you need any prescription refills. If you need a refill between visits, please call the office between 9 AM and 4:30 PM weekdays. In
order to call in your refill, we need to have your name, date of birth,
phone number, pharmacy name and phone number and the name and dose of
the medication that you need refilled. We will make every effort to call in your prescription within 48 hours.
Test results: Pap
smears: Results will be mailed to you in your self-addressed envelope
in approximately 2-3 weeks. Please call us if you do not receive your
results after three weeks.
Blood tests: Most blood test results
are available in 24-72 hours. Your provider will call or mail these
results to you. Please call our nurse if you do not receive your
results at the expected time.
Biopsies: Biopsy results are
usually available in 7 days. We will call you as soon as we can. Please
call our nurse if you have not received results in 2 weeks.
Insurance Coverage
Please confirm with our receptionist that we have your correct name, address, telephone numbers and insurance information at every visit.
Referrals: Some
managed care plans (HMOs), such as HMO Blue and US Health Care, cover
only one routine exam with a gynecologist per year. Under these plans,
all other GYN office visits require prior authorization or referrals
from your primary care provider. It is your responsibility to obtain
the referral PRIOR to your visit. We will make every effort to work
with you and your insurance company but if you do not have the referral
numbers at the time of your visit you may be billed for the services
rendered.
Annual examinations: Many insurance plans
(including Tricare, Blue Cross/Blue Shield Master Health Plus) do not
cover routine examinations. Insurance coverage is generally provided
for problem-oriented visits. A referral from your primary care provider
may be necessary. Please check with your insurance company to find out
about your specific policy.
Medicare: Medicare will cover a routine annual GYN exam every two years and a routine mammogram
every year for high risk women or women over age 40. Problem-oriented
visits will be covered by Medicare when deemed medically necessary.
Co-pays: Co-pays are expected at the time that services are rendered.
Pregnancy: Pregnancies
are billed as a global fee. This covers routine OB office visits,
delivery and postpartum care. Non-routine visits, lab work,
ultrasounds, genetic counseling, amniocentesis and non-stress tests may
not be included and will be billed separately. Please check with your
insurance company regarding the coverage that they provide.
Managed
care plans require a referral from your primary care provider for
global prenatal care. It is your responsibility to obtain the referral
prior to your visit. You will need separate referral numbers for
non-routine visits during your pregnancy. A referral from your primary
care provider may also be necessary for genetic counseling, perinatal
consults and level 2 ultrasounds.
Ultrasound: Premier
Diagnostics provides formal ultrasound services in our office twice a
week. The films are read by the radiology department at Brigham and
Women's Hospital in Boston.
If your health insurance does not cover your ultrasound, Premier requires that full payment of $150 be paid on the day services are rendered.
Please
feel free to discuss any billing questions or concerns our office
manager during routine office hours. We will make every effort to help
you. Thank you.
What To Expect: This
is a procedure that samples the lining of the uterus (endometrium). It
is usually performed to help diagnose abnormal vaginal bleeding or
infertility. The procedure is performed by passing a small catheter or
tube through the cervix and into the uterus. A sample of the uterine
lining is then drawn up into the catheter with gentle suction. The
specimen will be sent to the laboratory to be analyzed.
We may
use a small amount of local anesthesia (numbing medicine) on the cervix
to minimize your discomfort. Most women do feel some cramping but it
usually goes away within several minutes. You should expect to have
some light vaginal bleeding for 1-2 days after the procedure.
Complications of the procedure are rare but they include infection or
injury to the wall of the uterus. You should contact our office if you
develop any unusual abdominal pain or fever within one to two weeks
after this test.
Preprocedure: No special preparation is necessary.
You may want to take a dose of acetominophen (Tylenol) or ibuprofen (Motrin) before the procedure to minimize your discomfort.
Postprocedure: You
should not use tampons, douche or have sex for 2 days after the
procedure to lower your risk of infection. It is not necessary to
restrict any other activities.
It usually takes aboout one week
to get your results back from the laboratory. We will call you as soon
as they are received. Please call us if you have not heard back from us
in 2 weeks.
Procedure Description: Vulvar Biopsy
What To Expect: This
procedure is usually advised when a vulvar skin lesion is seen during a
pelvic exam or if you have persistant vulvar pain or itching. The
procedure is performed with local anesthesia (numbing medicine). You
feel a pin prick and a burning sensation when the medication is first
injected. This will last less than one minute. You should not have any
other pain during the procedure. The biopsy is performed by surgically
removing (cutting out) all or part of the abnormal area. Absorbable
sutures (stitches) will be place if necessary. These will dissolve on
their own and do not need to be removed.
Preprocedure: No special preparation is needed for this procedure.
You may take acetominophen (Tylenol) before the procedure to minimize your discomfort.
Postprocedure: You
may have some light bleeding and tenderness in the area for several
days after the procedure. You may take acetominophen (Tylenol) or
ibuprofen (Motrin) as needed for comfort. Signs of infection would be
increasing pain, foul-smelling drainage, fever, or swelling in the
area. Please call the office if you have any of these concerns.
Your
specimen will be sent to the laboratory to be analyzed. It usually
takes one week to get results back. We will call you as soon as your
results are received. Please call us if you have not heard from us in 2
weeks.
Procedure Description: Colposcopy
What To Expect: Colposcopy
is the examination of the cervix, vagina, and vulva with a specialized
microscope called a colposcope. It is usually performed by placing a
speculum in the vagina, swabbing the cervix with vinegar and examinning
the area with a microscope. Vinegar helps to highlight abnormal cells.
If an abnormality is identified, a biopsy will be performed. Only a
small amount of tissue needs to be removed (less than 1/4 inch). You
may feel a pinch or a cramp when the biopsy is taken. Most women do not
have severe pain.
Preprocedure: No special preparation is needed.
Please
call the office if you are menstruating at the time of your scheduled
appointment. The colposcopy may need to be rescheduled.
You may take some acetominophen (Tylenol) prior to the visit to minimize your discomfort.
Postprocedure: You
may have some light vaginal bleeding or brown discharge for several
days after the procedure. Heavy bleeding or infection are rare but you
should call if you have increasing pain or fever.
Do not use
tampons, douches or have sex for 2 days after the procedure in order to
lower your risk of complications. You do not need to restrict other
activities.
The biopsy specimens are sent to a laboratory to be
analyzed. It usually takes 1-2 weeks to get all of your results back.
We will call you as soon as your results are received in our office.
You should call us if you have not heard from us in 3 weeks.
