Pregnancy Instructions & Resources


Pregnancy care instructions and educational resources are noted below. Informed parents with knowledge about pregnancy, labor, and delivery have a less stressful and more empowering journey during this time.

Recommended Books:


  • What to Expect When You’re Expecting by Heidi Murkoff 

  • The Pregnancy Book by Dr. Sears.  

OBaby is a free mobile app that allows expectant moms to track pregnancy milestones and their new baby's development through age 2. Learn about pregnancy symptoms or issues, find out about programs offered at Overlake Hospital, and stay healthy by setting up reminders and using new baby tools, such as feeding, diaper, and growth trackers, all on your smartphone.

Download OBaby:​



We are honored to care for you during your pregnancy. The following instructions and tips below will help keep you safe and healthy. 

First Exam

We want you to feel comfortable while you are at our clinic. This is your time to receive personal care and relax. We invite you to take a breath, get yourself some water or complimentary tea, and allow yourself to de-stress.

Your first OB appointment usually takes place between 8 and 12 weeks. We begin the appointment with a urine test and then you will be invited into the OB exam room. This is where your doctor will ask you questions about you and your family's complete medical history and perform a thorough physical examination.


Your first physical can include any of the following:

  • Pelvic Exam

  • Pap Smear

  • Blood Work

  • Breast Exam

  • Pregnancy Test

  • Early Ultrasound

Results will be reviewed with you and recommendations for any specific testing may be made. 


What's Next? 

In an uncomplicated pregnancy, you will be seen once monthly. When you reach 28 weeks in your pregnancy, you will be seen twice monthly. From 36 weeks of pregnancy until delivery, you will be seen every week.


Screening Tests

There are many screening tests that can be performed during pregnancy:


  • Standard first testing includes a variety of blood testing that will be reviewed with you.

  • We also offer a blood test that is approximately 99% accurate as a screening tool for detecting Down Syndrome in the fetus. This test is often not covered by your insurance. It can be drawn at 10 weeks of pregnancy. If you are interested in this test, we can give you more detailed information. You can contact your insurance company for your individual coverage. With or without insurance coverage, this test can be performed at your request.

  • At approximately 12 weeks, the Combined Screen test is an approximately 92-96% accurate test that screens for Down Syndrome and can detect Trisomy 13 and Trisomy 18, genetic disorders that include a combination of birth defects. The test consists of an ultrasound measurement of the baby’s neck and drops of blood from the mother. Full results from this test are received in approximately 8 days. This test is universally covered by health insurance. If an abnormal test is found, further testing is recommended.

  • In the first 12 weeks of pregnancy, a CVS (chorionic villus sampling) test may be recommended for you. This test is similar to an amniocentesis where we can test the baby's cells to determine different kinds of information.

  • During the second trimester of pregnancy, we will conduct another blood test in order to screen for spina bifida and other related diseases. An amniocentesis, if recommended, will be done in this trimester.

  • An ultrasound is routinely ordered at approximately 20 weeks of pregnancy to visualize baby anatomy.

  • In the third trimester, at approximately 24-28 weeks of pregnancy, we screen for diabetes and possibly anemia. This is another blood test. We will give you a sugar solution with explicit directions around this time in pregnancy.

  • At approximately 36 weeks of pregnancy, we will perform a vaginal swab test checking for group beta strep, a type of bacteria. This is not an “infection," however it is a type of normal bacteria that can cause serious health risks to a baby if it is present at the time of delivery. If the test shows presence of these bacteria, antibiotics are given during labor.

  • At any point during pregnancy, additional testing may be recommended for the mother or baby.

Kick Counts

At approximately 20-24 weeks, baby movement will be felt. After that time, the following needs to be done on a daily basis until delivery:

The mother needs to ask herself, “Is the baby moving?” If the answer is yes, good. No further action is required. If the answer is “I don’t know” or “No”, take the following steps:


1. Drink 20 ounces of water

2. Eat a meal (not a snack)

3. Go to a quiet room: no TV, radio, children, etc. and take a pen and paper with you

4. Count fetal movements


The baby needs to move 10 times in 2 hours. If the baby moves less than 10 movements during this time, contact the doctor immediately. It is imperative that directions for kick counts are followed exactly.


Childbirth & Early Parenting Classes

At 24 weeks, it’s time to send in all hospital registration information. We also recommend setting up a tour of Overlake Hospital Childbirth Center. This is where you can register for courses. We prefer that you attend class when you are approximately 30 weeks into your pregnancy. Classes fill rapidly, so please make sure you enroll at around 24 weeks of pregnancy to ensure your place.

Baby Doctor

After 34 weeks of pregnancy, a choice for a baby doctor should be made. There is a list of pediatricians on the Overlake Hospital website (search "Pediatrics"). Also, some parents choose to have their family practice doctor care for their newborn and the rest of their family. Contact your family practice doctor prior to delivery if this is your choice.


Good nutrition is critical for good health of mom and baby. Please pay special attention to your diet. Take your prenatal vitamins through pregnancy and breastfeeding. Drink lots of water. Add an additional serving of protein to your diet daily. An additional serving size of meat is the equivalent to the size of a deck of cards. Vegetarians may wish to add one protein drink daily to your diet. There are many protein powder sources available at grocery stores, health food stores, Costco, etc. Use only organic sources. The obstetric websites linked through The Women's Center site have excellent additional dietary information.


Please review the "Nutrition and Weight" category at This portion of their web site has excellent information on nutrition and related subjects.


If you are concerned that your nutrition is not optimal, please write down everything you eat and drink for one week and present this to your doctor for evaluation. Nutrition is proving to be of great importance in pregnancy. This is a very good time to build excellent nutrition and lifestyle habits. When baby comes, good habits are in place.


Nausea, vomiting, and morning sickness are very common in pregnancy. This is especially true in the first 13 weeks. These changes happen because of hormone changes in pregnancy.

This does not hurt the baby in any way unless persistent weight loss occurs, the mother becomes dehydrated, or mother is unable to keep her prenatal vitamins in her system. The the fitamin you are taking is causing you nausea or vomiting, contact the office. We will change the type of vitamin you are taking. Emotional stress, traveling, or certain foods or odors can aggravate the problem. 


Home care for nausea:

  • Eat a few soda crackers or dry toast when you first wake up, even before you get out of bed

  • High protein snack and bedtime and if you rise in the middle of the night

  • Eat small snacks every 1-2 hours and avoid full meals

  • Drink lots of fluids: warm, sweet liquid tends to work better than water

  • Avoid foods high in fat and salt and low in nutrition

  • Try foods that are high in protein (peanut butter, cheese, nuts, meat) or bland foods

  • Ginger: capsules, ginger ale, ginger tea, or candy

  • Hard candy to suck on (brush teeth often!)

  • Vitamin B6: 100 mg up to 3 times daily in addition to your prenatal vitamins

  • Take prenatal vitamins at night

  • "Sea Brands" for acupuncture points. Available at drug stores.

  • Instant mashed potatoes with butter


You can use benefiber, 1 teaspoon 3 times daily, for constipation. Make sure you are drinking lots of fluids.

If symptoms do not improve despite trying the above conservative measures, or if you vomit blood or coffee ground-like material, if you lose more than 2 pounds, or if you are not able to tolerate food or liquid, call The Women's Center.


Vitamin D

The mother’s level of Vitamin D in pregnancy is emerging as an important factor for mother/baby health. A significant association is present between low Vitamin D levels and lower child bone density, higher risk for autism-spectrum disorders, eating disorders in female children, and respiratory disease due to an impact on lung development as well as smaller baby weight at birth. If your doctor recommends you supplement your diet with Vitamin D, please be sure and follow this plan.


Sexual Activity

Sexual activity is acceptable in pregnancy unless otherwise recommended by your provider.


We strongly encourage you to walk every day for 20-30 minutes. This is one of the best exercises you can do while pregnant. If you are used to heavier pre-pregnancy exercising (like swimming), please follow this rule: you need to be able to speak in a normal voice without losing your breath while exercising. If you are not able to speak easily, slow down or stop exercising. But it is important to stay active during pregnancy.




There is a link between maternal exposure to toxins and fetal health. We recommend eating organic grains and cereals. Avoid environmental toxins. Let someone else paint the new baby furniture. Do not change cat litter boxes while pregnant or attempting pregnancy. If you eat fish and shellfish, please review the specific information regarding mercury below. Please go to for more information on healthy, low toxic living.


Nine Tips to Prevent Infections during Pregnancy:

  1. Wash hands with soap and water often

  2. Try not to share forks, cups and food with young children

  3. Cook meat until well done

  4. Avoid raw milk and soft cheese (brie, feta, queso fresco, etc. unless it is pasteurized)

  5. Do not touch dirty cat litter

  6. Stay away from wild or pet rodents and their droppings

  7. Get tested for sexually transmitted diseases and protect yourself from them

  8. Talk to your doctor about vaccinations

  9. Avoid people who have an infection


Seafood: Fish & Shellfish

Fish and shellfish are rich in protein and offer beneficial nutrients including health omega-3 fats, vitamin B12 and vitamin D, iron, and other minerals like selenium, zinc, and iodine. However, it is important to limit mercury in the diets of women who are pregnant and breastfeeding. 

The 2015-2020 Dietary Guidelines for Americans recommends women who are pregnant or breastfeeding consume between 8 - 12 ounces of a variety of seafood per week, from choices that are low in mercury. More information is available at Mercury Fish & the Facts.

10 BEST SEAFOOD CHOICES: (2-3 servings per week)

  • Anchovy

  • Black Sea Bass

  • Cod

  • Crab

  • Oyster

  • Salmon

  • Sardines

  • Scallops

  • Shrimp

  • Squid


  • King mackerel

  • Marlin

  • Orange Roughy

  • Shark

  • Swordfish

  • Tuna Sushi/Bluefin Tuna

  • Canned Albacore Tuna

  • Fresh/frozen tuna


When it comes to travel, keep in mind where you are and where your doctor (or any doctor) is. The riskiest time in pregnancy is from 24 weeks until 34 weeks. After 36 weeks, most airlines do not allow you to fly. Please make note of this and plan trips accordingly.


Medications and Vaccines During Pregnancy and Breastfeeding

For more information about these topics, visit or call (877) 311-8972

Musculoskeletal Pain

If you are experiencing pain in your muscles, joints or back, please let us know. We can help! Dr Katharine Barrett-Avendano is trained in Osteopathic Manipulative Therapy. This service is available to you regardless of which of our physicians you chose to work with during your pregnancy.  These OMT visits are separate from your OB visits, and are billed as an office visit with an osteopathic medicine charge. All insurances pay for this service. Please check with this office or your insurance company for your specific coverage.


More Information for Pregnancy

  • Do not smoke during pregnancy. Please stay away from second hand smoke as well.

  • It is recommended that no alcohol be consumed during pregnancy.

  • Do not use any recreational drugs during pregnancy.

  • Flu and tDap vaccinations are universally recommended for pregnant women. Please call Healthy Mothers Healthy Babies at 1-800-322-2588 to obtain your flu shot if you don’t receive it in this office. Flu shots are safe in all trimesters of pregnancy.

  • For more information on pregnancy, text BABY to 511411 for regular informational texts on pregnancy.

  • Do not use Tylenol during pregnancy. New data suggests that there is a link between Tylenol use and ADHD if taken in 2nd or 3rd trimesters. Claritin can be used for allergies. Any other medication should be reviewed with the doctor.

  • Seat belts are another must in pregnancy. Position the lower strap under, not across, your abdomen near where your legs bend.



The Women’s Center does not perform circumcisions. Information about circumcisions is available in the above named books.


A note to parents choosing circumcision: Overlake Hospital does not perform circumcisions and will not assist you in arranging this procedure for your infant. Please make sure your arrangements are in place prior to delivery.

Emergency Calls 

If you feel you have a medical emergency, dial 911. If you feel you need to speak with your doctor due to a current emergency, please call the office telephone number, 425-827-0100. If you call outside of our office hours, follow directions given on the recorded message. Non-emergent issues reported after office hours will be billed as telephone office visits to the patient.

Your Current Telephone Number

Please keep in mind that we may need to reach you on short notice if the doctor is called out of the office for deliveries or other emergencies. Please make sure we have a “first call” number to reach you quickly if necessary.

Additional Online Pregnancy Resources and FAQ
Image by Sidney Pearce