Download Family Education and Resources Guide

The Family Childbirth
& Children’s Center
AT MERCY
Family
Education
and
Resources
Guide
Welcome
to The Family Childbirth and Children’s Center at Mercy
It is our pleasure to take care of you during this very special time. We are dedicated
to providing excellent patient care in an atmosphere of safety, comfort, courtesy,
and respect. Please feel free to ask us any questions during your stay.
This Family Education and Resources Guide provides information you or your
family may need during your stay as well as for when you go home. Our nursing
staff will point out the items that pertain specifically to you.
On behalf of all the doctors and health professionals of The Family Childbirth and
Children’s Center, thank you for choosing Mercy for your care.
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Table of Contents
About Your Stay...........................5
Patient Information.............................. 9
Post Partum Care..................................... 21
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•
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•
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Visiting Hours
- Labor & Delivery
(8th floor, The Bunting Center)
-Mother/Baby
(10th floor, The Bunting Center)
- NICU (8th floor, The Bunting Center)
- Overnight Visitors
- Brother and Sister Visits
•Chapels
- McAuley Chapel
- Chapel of Light
• Gift Shops
- The Bunting Lobby
- The McAuley Lobby
•Cafés
- Corcoran Café
- The Bistro
- The Coffee Kiosk
- Baggot Street Café
• Parking and Valet
• Smoke-Free Campus
• Normal Physical Appearance
•Cramping
•Bleeding
•Stitches
• Cesarean Section
• Controlling Pain Levels
• Breast Pain
• Uterine or Abdominal Pain
• Emptying your Bladder
•Bowels
•Hemorrhoids
•Constipation
• Breast Care
• Mood Swings
• Your Weight and Staying Healthy
Labor and Delivery..............................15
Medications............................................. 39
Your Room
- Linen Changes
-Housekeeping
- Wireless Internet Access
- GetWell Network
- The Mothers Gardens
- Shift Change
Your Safety
- Mother and Baby Identification
- Fall Prevention
- Infant Safety Instructions
Your Meals
- Meal Selection
- Patient Meal Times
Understanding MRSA
- What is MRSA?
- What is infection vs. colonization?
- Is MRSA treatable?
- How does MRSA spread?
- What will happen in the hospital?
- What can you do to prevent the
spread of MRSA?
• Labor and Delivery Process
• Induction of Labor
• Preterm Labor/PPROM
•Preeclampsia
Infant Care............................................... 29
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Medications and Tests for All Babies
What is Maryland’s Newborn Screening Program
Newborn Hearing Screening
Screening for Critical Congenital Heart Defects
Resources................................................. 41
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New Mom Support Group
Recommended Reading for Breastfeeding Mothers
Helpful Websites
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About
Your Stay
Your Room
Your Safety
Linen Changes
Linens are changed every other day. If you would like
your linens changed more frequently, please notify the
nursing staff.
Mother and Baby Identification
Mercy Medical Center uses a four-bracelet identification
system: two bracelets for the baby; one for the mother; and
one for the adult support person.
Housekeeping
Your room will be cleaned every morning. Trash will be
removed at least one additional time during the day. If you
need your room cleaned between these times, please let
your nurse know.
Fall Prevention
During pregnancy, there are some changes that can put you
at an increased risk for falling:
Wireless Internet Access
Internet access is a free service in every patient room for
our patients and their visitors. Please use the sign-on
“mercyguest”.
GetWell Network
The GetWell Network is an interactive system that gives
instant access to nursing staff, medical information, and
entertainment. It is available in each patient room.
The Mothers Gardens
Located on the 8th floor of The Bunting Center, these
gardens provide a place for rest and relaxation for our
patients and visitors. With the permission of your doctor or
health professional, you may visit the gardens throughout
your stay.
Shift Change
Nursing shift change occurs at 7:00 am and 7:00 pm every
day. During this time, you can expect your nurse to visit
you and introduce you to your on-coming nurse. They
will discuss with you your plan for pain control and your
expectations for your care.
• Changes in your center of gravity as your body changes
• Loosening of the joints at the end of pregnancy
While you are in the hospital, some fall risks include:
• Fetal monitors attached to you
• Other attached equipment, such as IVs
• Pain medication
• Epidural or spinal anesthesia
Please do not get out of bed after delivery until a nurse
is in the room with you. Your nurse will perform an
assessment to determine your ability to walk and care for
yourself. Please let your nurse or another staff member
know if you need help getting out of bed at any time during
your stay.
Infant Safety Instructions
Your nurse will review the following safety tips to enable you
to safely care for your infant during your stay in the hospital
and when you return home.
• Always place your baby on his/her back in the crib.
Remember: “BACK TO SLEEP” to help prevent Sudden
Infant Death Syndrome (S.I.D.S.).
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• Avoid placing loose blankets and stuffed toys near your
baby’s face or head.
• Do not hold anyone else’s baby while you are in the
hospital. This helps prevent the spread of germs.
• Only staff wearing a pink Mercy ID badge should be
allowed to take your baby from your room. The pink
badge identifies Mercy staff who care for babies and their
mothers. If you are not sure who is in your room with
your baby, CALL YOUR NURSE.
• Your baby’s brothers and sisters are welcome to visit the
new baby. For infection control purposes, children who
are not the baby’s brothers and sisters must be older than
12 years of age to visit the new baby.
• The infant sensor on your baby’s ankle must be kept on at
all times. This is a security device to help prevent infant
abduction.
• You and your visitors should always wash your hands
before handling your baby, after changing a diaper, and
after using the bathroom.
• Hold your baby while feeding. Do not lay your baby on
the bed or in the crib for feeding.
• Your nurse will teach you how to use the blue bulb
syringe. Use it to clear your baby’s nose and mouth if
necessary.
• Remember, when holding your baby, give him/her
your full attention. Even at home it is recommended
that you do not talk on the phone, hold hot drinks, or
smoke while holding your baby. Second hand smoke is
dangerous to your baby’s health.
• Your baby should never be left alone in your bed or in
your hospital room. Even newborns can fall.
• If you have taken something for pain and you feel sleepy,
put your baby in the crib. It is not safe for your baby to
sleep with you in your bed or sleep chair.
• If you are able to walk in the hallways, your baby must be
in a crib and may be rolled along with you as you walk.
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Your Meals
Meal Selection
A member of our Nutrition & Food Service staff will visit
you each day to help you select your meal choices for the
following day. If your doctor or health professional orders
diet restrictions, your menu selections will be changed.
Patient Meal Times
Your meals will be served around the following times:
• Breakfast: 8:15 am
• Lunch: 12:45 pm
• Dinner: 5:45 pm
If you have a special request or if your meal does not meet
your expectations, please contact the Dietary Director
at 410-332-9303.
Understanding MRSA
(Methicillin-Resistant Staphylococcus)
During your stay at Mercy, you may be tested for the bacteria,
Methicillin-Resistant Staphylococcus.
What is MRSA?
Staphylococcus aureus (pronounced: staff-ill-oh-KOK-us AWree-us), or “Staph” is a very common germ that one (1) out of
every three (3) people have on their skin or in their nose. This
germ does not cause problems for most people who have it on
their skin. For some people, it can cause serious infections such
as skin or wound infections, pneumonia, or infections in the
blood. MRSA is a type of Staph that is resistant to some of the
antibiotics that are often used to treat Staph infections. If you
are diagnosed with a Staph infection, your doctor or health
professional will work with you for appropriate treatment.
What is infection vs. colonization?
MRSA can cause infection or colonization:
What will happen in the hospital?
If you are tested for MRSA, a swab will be inserted into each
nostril to test for the presence of MRSA. All patients who have a
history of MRSA or a positive culture for MRSA will be placed in
Contact Isolation. Isolation is used to keep you and other patients
safe. If you are admitted to the hospital again, you will be placed in
isolation and tested again.
What happens in contact isolation?
• Everyone (including your visitors) who enters the room
must wear gown and gloves
• When visitors leave the room, the gown and gloves must
be put in the red trash bags
• Hands must be washed thoroughly with either soap and water
or the alcohol hand foam when entering and exiting the room
What can you do to help prevent the spread of MRSA?
• Wash your hands thoroughly
• Encourage your family and friends to wash their hands
• Have your family and friends wear gowns and gloves
when entering an isolation room
• Infection: germs are in or on the body and make you sick.
There are signs and symptoms such as fever, pus from a
wound, or pneumonia.
When you go home
• Colonization: germs are in or on your body but do not make
you sick. There are no signs or symptoms.
• Wash your hands often. The people who visit or live with
you should wash their hands often.
Is MRSA treatable?
Yes. Although MRSA is resistant to a number of antibiotics and
is often difficult to treat, there are a few antibiotics that can be
used. If there are no signs or symptoms, treatment is not needed.
How does MRSA spread?
MRSA is spread by skin-to-skin contact as well as touching
things, such as bed linens, bed rails, bathroom fixtures, and
medical equipment, that a person with MRSA has touched.
• If you have a bandage, it is especially important to wash
your hands before and after changing the bandage. Keep
the area clean and change bandages as instructed.
• Avoid sharing personal items such as towels or razors.
• Wash and dry your clothes and bed linens in the warmest
temperatures recommended on the labels.
• Tell your healthcare providers, including doctors, nurses,
home health nurses and aides, therapists, and personnel in
your doctors’ offices, that you have MRSA.
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Patient
Information
Visiting Hours
All visitors should stop at the Bunting Information Desk
located in The Bunting Center Lobby to be directed to
The Family Childbirth and Children’s Center at Mercy.
Labor & Delivery (8th floor, The Bunting Center):
Visiting hours are 24 hours a day. Five (5) visitors,
including the husband or support person, may visit at one
time. If you have chosen a doula, the doula does not count
as one of these visitors.
Mother/Baby (10th floor, The Bunting Center): Visiting
hours are 8:00 am – 8:30 pm. Five (5) visitors may
visit at one time. This limit includes the patient’s
husband or support person and the newborn’s brothers
and sisters. One (1) adult is welcome to spend the night
in the mother’s room.
NICU (8th floor, The Bunting Center): Visiting hours
are 24 hours a day. Three (3) visitors may visit at the
baby’s bedside at one time. Two (2) visitors may stay in the
NICU waiting area on the 8th floor. One (1) parent may
stay overnight with the baby.
Overnight Visitors: One (1) adult is welcome to spend
the night in:
• The Mother/Baby rooms on the 10th floor of
The Bunting Center
• The private NICU rooms on the 8th floor of
The Bunting Center
Brother and Sister Visits: The newborn’s brothers and sisters
can visit in the Labor & Delivery room on the 8th floor and
the Mother/Baby room on the 10th floor of The Bunting
Center. Brothers and sisters who are in good health may visit
during appropriate visiting hours when accompanied by a
responsible adult other than the delivering mother. Brothers
and sisters are included in the limit of five (5) visitors who
are allowed to visit the mother at one time.
Five (5) visitors, including the husband or support person,
may stay overnight in the Labor & Delivery rooms on the
8th floor of The Bunting Center.
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Bunting Center Floor #
Visiting Hours
Number of Visitors
Overnight Visitors
Brother and Sister Visits
Labor & Delivery
8th Floor
24 hours
5 visitors 5 visitors a day
Must be accompanied by
an adult other than the
delivering mother.
Mother/Baby
10th Floor
8:00 am –
8:30 pm
5 visitors, includes
1 visitor
support person and the newborn’s brothers and sisters
During regular visiting hours. Must be accompanied by an adult other than the delivering mother.
NICU
8th Floor
24 hours
a day
5 visitors
Must be accompanied by
an adult other than the
delivering mother.
1 parent
includes brothers and sisters
3 at the bedside
2 in waiting area
Chapels
McAuley Chapel
• Located in McAuley Plaza
• Open 6:00 am - 8:30 pm each day
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Mass Schedule
- Weekdays: 6:25 am and 12 noon
- Saturday: 6:25 am and 5:30 pm
- Sunday: 6:25 am
• Interfaith Services
- Sunday: 10:00 am
• Praise & Worship Services
- 2nd and 4th Wednesdays of the month at 1:00 pm
Chapel of Light
• Located in The Bunting Center Lobby
• Open 6:00 am - 8:30 pm
• For prayer, meditation, and quiet solitude
Gift Shops
Mercy offers two gift shops.
Locations:
• The Bunting Center Lobby
• McAuley Plaza Lobby
Hours:
• 7:30 am - 9:00 pm, Monday - Friday
• 9:00 am - 8:00 pm, Saturday and Sunday
Baby Items: Available in The Bunting Center Gift Shop
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Cafés
Parking and Valet
Mercy offers a variety of locations for guests to enjoy
something to eat:
Mercy offers numerous parking options:
• Corcoran Café
- Location: The Bunting Center Lobby
- Hours: 7 days a week, 6:30 am – 8:00 pm and
12:00 am – 2:00 am
- Eat In or Take Out: brick oven pizzas, calzones,
strombolis, deli sandwiches and subs, soups, salads,
entrees and sides, desserts, and more
•
The Bistro
- Location: McAuley Tower, 6th Floor
- Hours: Monday – Friday, 6:30 am – 3:00 pm
- Eat In or Take Out: burgers, chicken, hot subs and fries, soups, salads, wraps, paninis, entrees and sides, and sushi
• Valet parking
Available at all three Mercy entrances:
- The Bunting Center
- McAuley Plaza
- The Weinberg Center
• Self park
Available in all three Mercy garages:
- The Bunting Garage – open 24 hours a day,
7 days per week
- The McAuley Garage – open 5:00 am – 9:30 pm, Monday – Friday
- The Weinberg Garage – open 5:00 am – 9:30 pm, Monday – Friday
•
The Coffee Kiosk
- Location: McAuley Plaza Lobby
- Hours: Monday – Friday, 7:00 am – 2:00 pm
- Take Out: gourmet coffee, to-go sandwiches, fruit cups, cold beverages, yogurts, desserts, and snacks
Parking tickets must be validated to receive the
discounted rate. Parking validation stamps may be
obtained from each nursing station.
•
Baggot Street Café
- Location: The Weinberg Center Lobby
- Hours: Monday – Friday, 6:30 am – 2:00 pm
- Eat In or Take Out: Starbucks coffee, to-go
sandwiches, to-go salads, cold beverages, yogurts,
desserts, soups, and snacks
Smoke-free Campus
The Bunting Center and its surrounding sidewalks are
smoke-free. The Emergency Department deck enclosure
is the ONLY designated smoking area at Mercy.
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Labor
and
Delivery
Labor and Delivery Process
Labor is the process that a woman goes through to deliver
her baby. Labor involves both uterine contractions and
cervical dilatation.
the process naturally or use the assistance of medication
for pain management.
Expectations During Labor
Length of Labor
The length of labor varies greatly for each woman. A
woman who is having her first baby will most likely have a
longer labor then a woman who already has had a child.
Labor Assessment
Cervical exams are used for the three step process of labor
assessment:
• Dilatation: Opening of the cervix, which ranges from
1-10 cm. Ten (10) centimeters (cm) is considered fully
dilated at which time the pushing process may begin.
The average rate of dilatation for a first time mother
is 1 cm per hour. The average rate of dilatation for a
mother who already has had a baby is 1.5 cm per hour.
• Effacement: Thinning of the cervix needed prior to
dilatation of the cervix. It ranges from 0 – 100%.
100% is considered fully effaced.
• Station: How close the baby’s head is to the mother’s
pelvic bone. It is measured from -5 station (head is high
above pelvis) to +5 (baby is crowning).
The Pushing Process
The pushing process will vary in duration, depending on
how many babies a woman has delivered and the position
of the baby’s head in the mother’s pelvis.
Assistance in the Childbirth Process
There are many different ways to assist a woman in the
childbirth process. A woman may choose to go through
• Based on the preference of your doctor or health
professional, you may not be allowed to eat during
labor. However, ice chips and clear liquids may be
permitted. Please feel free to discuss with your doctor
or health professional.
• The fetal heart rate and your contraction pattern will
be monitored constantly throughout the labor process,
unless intermittent monitoring is ordered by your
doctor or health professional.
• Vaginal exams are kept to a minimum and are
performed when necessary.
• Please let your nurse know how you wish to control
any discomfort during the labor process.
• Let your nurse know if you prefer to stay in bed or
walk during labor.
• In most cases, an IV will be started and blood drawn
when you come to Labor and Delivery.
Words You May Hear During Labor and Delivery
Your doctor or health professional may use the
following terms:
• Oligohydramnios: refers to amniotic fluid volume that
is less than expected for gestational age. The average
amniotic fluid index (AFI) ranges from 8-18.
• Polyhydramnios: refers to excessive accumulation of
amniotic fluid. The average amniotic fluid index (AFI)
ranges from 8-18.
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• Biophysical profile (BPP): The fetal biophysical profile
score (BPP) refers to the assessment of four fetal variables
by sonogram:
- Fetal movement: At least three (3) movements
in 30 minutes
- Fetal tone: At least one (1) movement of extension and flexion in 30 minutes
- Fetal breathing: At least one (1) episode of
30 seconds or more in 30 minutes
- Amniotic fluid volume: Sufficient amniotic fluid surrounding the baby
PLUS:
- Non-stress testing: at least two (2) fetal heart rate accelerations in 20 minutes that last 15 seconds
Please note: Each of these five parameters is given a score of 0
or 2 points, for a possible total of 10/10.
• Intrauterine Pressure Catheter (IUPC): A device placed
in the uterus, next to the fetus, to measure the exact
intensity of contractions. The membranes need to be
ruptured for this to be used. It also can be used to replace
lost amniotic fluid.
• Internal Scalp Electrode (ISE) or Fetal Scalp Electrode
(FSE): A device that is placed on the scalp of the baby
when close monitoring of the fetal heart rate is necessary.
Following the Birth of Your Baby
The goal is to keep mother and baby together following
delivery. There may be times that your baby may need to go
to the well-baby nursery or to the NICU. The NICU is the
Neonatal Intensive Care Unit. Mercy’s NICU is a Level III-B
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intensive care facility where our specially trained doctors
treat the most complex conditions in newborns. Mercy offers
private NICU rooms for our babies and their families.
• Let your nurse know:
- If you would like your baby to be cared for on your chest or under the radiant warmer
- If you would like to begin breastfeeding immediately
- If you would like to have the normal infant medications delayed. Normally, the baby receives antibiotics in the eyes and a Vitamin K shot in the thigh within the first hour of life.
• We encourage you to ask questions about your baby’s care.
• Please ask your nurse for any support you may need.
Induction of Labor
Induction of Labor is the stimulation of uterine contractions
to accomplish delivery prior to the onset of spontaneous
labor. Labor may be induced for either maternal or fetal
indications, preferably after 39 weeks gestation. Induction at
an earlier gestational age (less than 39 weeks) is performed
when the risk of harm to the mother or fetus is greater than
the benefits of waiting until 39 weeks.
Medications Used For Induction
Augmentation of Labor is similar to induction. This is a
process that increases the length, duration, and intensity
of contractions that have started naturally.
• Cervidil: A thin, tampon string-like medication placed
in the cervix. It remains in place for 12 hours. May be
repeated every 12 hours until the cervix is soft and/or
dilated. What you can expect if you have an induction
Labor does not begin until contractions are in a consistent
pattern and changing the state of the cervix. This may take
one (1) to three (3) days to occur depending upon the
pre-induction cervical exam.
• Pitocin: An IV medication started slowly and increased
in small increments, usually every 30 minutes, until a
desired contraction pattern is reached.
• Vaginal exams are kept to a minimum and are performed
when necessary.
• The fetal heart rate and your contraction pattern will be
constantly monitored throughout the induction process.
• Depending on the preference of your doctor or health
professional, you may not be allowed to eat or drink
during the induction process. Ice chips and IV fluids will
be given to keep you hydrated.
• Cytotec: A small pill placed in the cervix. It lasts for
four (4) hours. This may be used several times to soften
the cervix.
• Pg Gel: A small applicator is used to insert a gel-like
medication directly into the cervix. It lasts four (4) to
six (6) hours. Used to soften the cervix.
Additional Induction Information
Mechanical methods also may be used for induction of
labor, such as:
• Foley Bulb: A foley catheter balloon is placed in the
cervix and saline solution is added to inflate the balloon.
This is pulled snug to place pressure on the cervix to cause
it to dilate. It remains in place until it spontaneously falls
out when the cervix reaches 4 or 5 centimeters dilation.
• Laminaria: A dried seaweed medication placed in the
cervix to initiate softening of the cervix.
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Preterm Labor/ PPROM
Preterm labor (PTL) is labor that starts before 37 weeks
gestation. Preterm labor can be diagnosed only by
finding changes in the cervix when you are having regular
contractions. This means your doctor or health professional
will have to examine you. To help diagnose preterm labor
your doctor or health professional may use the following
tests:
• Fetal Monitoring: These tests are used to record the
heartbeat of the fetus and the contractions of your uterus.
They are very important in determining the frequency of
your contractions.
• Ultrasonography: This exam may be used to measure
the length of the cervix and estimate the size, age, and
position of the fetus. You may be observed for a time and
then examined again to see whether your cervix changes.
• Fetal Fibronectin: This test is used to measure the
amount of a certain protein that helps predict the risk
of preterm delivery.
You also may have a pelvic exam and tests to look for
infections of the vagina or cervix.
Premature rupture of membranes (PROM) refers to
membranes that rupture before the onset of uterine
contractions.
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Preterm PROM (PPROM) refers to membranes that rupture
when the pregnancy is less than 37 completed weeks of
gestation.
What to expect for PTL/PPROM
• Continuous fetal monitoring
• Strict bed rest with possibility of flat or head-lowered
positioning
• Close monitoring of maternal temperatures
(every 2-4 hours) to detect the presence of infection
• IV fluids and medications
• NICU consult
Medications Used to Treat Preterm Labor
• Terbutaline: Typically a small injection in the arm, or a
small pill, taken daily to prevent contractions
• Magnesium Sulfate: IV medication given to stop preterm
labor and to relax the uterine muscle
• Betamethasone/Dexamethasone: Steroid injection given
to help develop the baby’s lungs
• Nifedipine: Pill taken daily to prevent uterine contractions
• Indocin: Pill taken daily to slow uterine contractions
Preeclampsia
Preeclampsia is the new onset of elevated blood pressure
and the presence of protein in your urine after 20 weeks
gestation. Signs of preeclampsia can appear any time during
the last half of pregnancy (after 20 weeks of pregnancy) or in
the first few days postpartum. Preeclampsia typically resolves
within a few days after delivery.
Possible signs and symptoms of preeclampsia are:
• Persistent elevated blood pressures
• Consistent headaches
• Vision changes
• Increased swelling
Please note: The only known cure for preeclampsia is delivery
of the baby.
What you can expect if you have preeclampsia
• Frequent blood work, urine catheterization/urine cultures
Eclampsia: The major risk associated with preeclampsia is
seizures from the high blood pressure. This is known as
eclampsia.
• Continuous fetal monitoring
Medications Used to Treat Preeclampsia
• Bed rest
• Nifedipine: Pill taken daily to decrease blood pressure
• Possible diet restrictions
• Ultrasonography
• Magnesium Sulfate: IV medication given to prevent
seizures from elevated blood pressures
• Frequent vital signs
• Labetalol: Pill taken daily to decrease blood pressure
• IV fluids
• Hydralizine: IV medication given to decrease very high
blood pressures
• Possible induction of labor
• Frequent assessment (listening to your lungs, performing
reflex checks) for symptoms of worsening preeclampsia
• Betamethasone/Dexamethasone: IM steroid injection
given to help to develop the baby’s lungs – usually
administered between 24 and 34 weeks gestation
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Post
Partum
Care
Many things happen to your body after the birth of a baby.
There will be various discomforts. Most are normal and will
go away in time. The common changes and discomforts
are described below. Your doctor or health professional can
explain any things you might experience. They are happy to
answer your questions.
Normal Physical Appearance
It will take several weeks for your body to return to its
pre-pregnancy state. You may notice your body never fully
returns to the size it was before you became pregnant, which
is a result of the growth that occurred in your body during
the growth of your baby. This is normal. You should not
try to lose weight immediately after the birth of your baby
because your body needs good nutrition to heal properly.
Additional information about staying healthy can be found
on page 26.
Cramping
You may experience cramping while your uterus shrinks. The
uterus shrinks about ½ inch per day. These “after pains” may
be similar to menstrual cramps and will last about a week.
They might be stronger if this is not your first baby or if you
are breastfeeding. Every time the baby breastfeeds, the uterus
contracts causing these after pains. Lying on your stomach,
deep breathing exercises, and mild pain relievers, such as
Ibuprofen, will help to relieve this discomfort.
Bleeding
The uterus must contract to keep you from bleeding too
much. The bleeding that you experience is called lochia.
Initially, it will be a bit heavier than a menstrual period and
will be heavier when you stand up after sitting or lying down
for a period of time. The blood pools in the uterus and then
gravity works to empty the uterus of the blood when you
stand up. It will slow down over 7 to 10 days, going from
bright red to pink to a brownish discharge. Some women
experience some amount of bleeding for up to six (6) weeks
following delivery. Every woman is different and each
post-partum period is different, so what you experienced
with your last delivery may not be the same as what you are
experiencing with this delivery. You may notice that bleeding
increases when you are breastfeeding because of the uterine
contractions that occur. You also may notice increased
bleeding when you are very active, which is your body’s way
of telling you to slow down.
Stitches
You may have stitches in your bottom (perineum) as a result
of an episiotomy (surgical incision made in the perineum)
or a laceration or tear in the perineum. You also may have
stitches or staples in your lower abdomen as a result of a
c-section. If you have stitches in your bottom, it will take
about three (3) weeks to heal. The stitches dissolve and will
not have to be removed. It is normal for the area to be itchy.
You may notice small pieces of your stitches on your sanitary
napkin. This is normal. With or without stitches, you may
be sore. It will help to soak in a warm sitz bath several times
a day and to use witch hazel pads on your bottom. Sit on a
firm chair rather than a soft couch to prevent the edges of the
perineum from spreading. The application of ice for the first
24 hours following delivery helps to decrease the swelling in
the perineum. The application of warmth following the ice
helps to increase the amount of circulation to the perineum
and promotes healing.
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Cesarean Section
If you had a Cesarean section, you will be sore where you
were cut. You may use analgesics for this discomfort. If the
incision was closed with staples, they generally are removed
within seven (7) days of delivery and replaced with small
strips of adhesive tape called steri strips. If your doctor used
sutures to close your incision, the steri strips are already in
place. These steri strips will fall off naturally as you bathe
over the next few weeks. Do not pull them off. Allow them
to fall off naturally. It is important to keep your incision
clean and dry as it heals. Wash the area with soap and water
as you shower and pat it dry. You may wish to place
a sanitary napkin over the incision to keep it cushioned
and to keep moisture from accumulating on the incision.
You can help us by rating your pain on a scale of one to ten,
with zero (0) being no pain, five (5) being moderate pain,
and ten (10) being the worst pain possible. When you rate
your pain, your nurse will be able to help you choose a pain
intervention that will work best for you. If you know what
pain level is acceptable to you, then when you start to get
near to that pain level, you should let your nurse know that
you will need something for pain soon. For example, if your
acceptable pain level is 4 and you are currently at a level 3,
you will want to plan for receiving pain medication soon so
that your pain does not go above a level 4 without some type
of intervention.
ASK YOUR NURSE ABOUT PAIN CONTROL
Controlling Pain Levels
It is important to control your pain level following the
birth of your baby. You will feel much better and be able
to participate more fully in the care of your baby if you are
comfortable. It is important for you to “stay on top of ”
your pain level – that is, do not wait too long to ask for pain
medication because it does take up to one hour for the pain
medication to take its full effect.
Wong-Baker FACES Pain Rating Scale
22
0
No
Pain
1
2
3
4
5
6
Moderate
Pain
7
8
9
10
Worst Pain
Possible
Breast Pain
If your pain is in your breast, your nurse may suggest nonmedication treatments such as an ice pack, a supporting
bra, warm compresses, or change in breastfeeding positions.
Medication treatments, such as Tylenol, may be suggested.
Possible side-effects, such as abdominal pain, nausea, or
unusual bleeding, will be discussed.
Uterine or Abdominal Pain
If your pain is in your uterus or belly, such as you would
have with cramping and bloating, or incisional pain from a
c-section, your nurse may suggest non-medication treatments
such as a heating pad, walking, supporting pillow, back
massage, or position change. Medication treatments, such as
Tylenol, Motrin, Percocet, or Toradol, may be suggested and
the side-effects of allergic reaction, hives, difficulty breathing,
swelling of your face, lips, tongue, or throat will be discussed.
Each pain experience is different and may require different
interventions.
Emptying Your Bladder
You may have difficulty emptying your bladder for the first
few days following delivery. This is a result of the effects of
the pregnancy hormones along with the pressure exerted
on the bladder and urinary tubes during the delivery of
the baby. If you experience a feeling of fullness and cannot
empty your bladder, please let your nurse know so you can
be catheterized to allow you to feel more comfortable. The
natural sensations of going to the bathroom will return in
time. Some women have difficulty controlling the flow of
urine and will dribble urine on their way to the bathroom.
This will correct itself in time, as the muscles in the floor of
your perineum get stronger following the birth of your baby.
Bowels
Your bowels also may become irregular following the birth
of the baby. Hemorrhoids may develop as a result of all the
pressure downwards at the end of pregnancy and during
delivery.
Hemorrhoids
Hemorrhoids can be very painful and may be relieved by
taking a sitz bath – soaking in warm water to help relieve the
itching and burning associated with hemorrhoids. As your
stitches heal and the swelling goes down, your hemorrhoids
will shrink. Do not use “donut” rings for hemorrhoids as
they actually can make the hemorrhoids swell even more.
Constipation
Constipation is common after giving birth. To avoid
constipation, drink 8-10 glasses of water every day, take
a short walk a few times a day, and eat foods with lots of
fiber. Fresh fruits, raw vegetables and salads, whole grain
breads and cereals, as well as bran, are good sources of fiber.
Drink milk if you are not lactose intolerant. You may need
a laxative or stool softener if you have not had a bowel
movement within two (2) or three (3) days after giving birth.
Call your doctor or health professional for advice.
23
24
Breast Care
Breast care is important for all mothers following delivery.
• For the breastfeeding mother, please refer to the booklet
on breastfeeding that you have received. It will provide
you with information on some of the minor problems
of breastfeeding, such as sore nipples, engorgement,
clogged ducts, and difficulties establishing nursing.
Breastfeeding is encouraged because of the benefits to
both the mother and baby. Breastfeeding provides:
– A special bond between mother and baby
– Natural antibodies to help strengthen the baby’s immunity and fight infections
– Easily digestible milk that changes over time to
provide all the nutrients the baby needs to grow
Breastfed babies typically are healthier than bottle-fed
babies. The health benefits for mothers who breastfeed
include:
– Reduced risk of developing osteoporosis, anemia, and breast and ovarian cancers
– Improved recovery time
– Faster return to a healthy weight
• For the bottle-feeding mother, you will not want to
encourage the production of milk that naturally occurs
following the birth of a baby.
Milk comes between the second and seventh day after giving
birth, dependent upon how many babies you have had. You
will want to wear a tight-fitting bra that is 1-2 cups sizes
larger than normal. Your breasts will become firmer and
heavier a little at a time. When you are fully engorged, they
will be sore and hard. You may feel like you have marbles
in your breasts or under your armpits. This can be very
painful. It is important to keep your breasts well supported
with a tight bra or binder 24-hours a day. Release the bra
or binder three times a day for an hour each time. You may
place ice packs wrapped in a washcloth under your arm pits
for approximately 15 minutes several times a day to help
decrease the amount of milk that is produced.
When you take a shower, allow the water to hit your back,
not your breasts, to prevent the “let down” of milk. “Let
down” will cause you to make even more milk. The pain
and heaviness of engorgement will last only 3-4 days. It will
take 2-3 weeks for your milk to dry up completely. Be sure
to wear a bra day and night. You may leak fluid for a week
or two. Just put a pad inside your bra and change it when it
becomes damp. Take a pain reliever, such as Ibuprofen, for
pain or discomfort. Do not hand express milk from your
breasts since doing so will cause more milk to be produced.
It is normal for your temperature to rise a bit when your
breasts are engorged. If your temperature goes above
100.6 °F or if you have extreme tenderness or red streaks
on your breasts, call your doctor or health professional.
Mood Swings
It is normal to have a short period of mood swings or “baby
blues” sometime during the first two weeks after giving birth.
Your hormone levels change a lot during this time and can
cause mood swings. You may feel irritable and cry for little or
no reason. These should not last more than about three days.
Getting enough sleep will help decrease how strongly or how
often you have these feelings. Try to nap every time the baby
does. Meanwhile, discuss your feelings with your husband,
significant other, or close family member or friend. Call your
doctor or health professional if your feelings do not go away
after a few days, if you feel you cannot take care of yourself,
or if you are afraid you will hurt yourself or your baby.
25
Your Weight
and Staying
Healthy
Before beginning an exercise program or diet, please
consult your doctor or health professional. There are
many physiological changes that occur during and
immediately after pregnancy (6-8 weeks). Your doctor or
health professional can recommend appropriate exercise
and diet according to your individual needs. For example,
women who have had a cesarean section may need to avoid
stretching exercises until the incision has healed.
What Is Your Body Mass Index (BMI)?
Body Mass Index (BMI) indicates if you are underweight,
normal weight, overweight, or obese. It can be used as an
indicator of health and wellness. Your pre-pregnancy BMI
will allow you to estimate how much weight you should gain
during your pregnancy in order to stay healthy and reduce
risk of postpartum weight retention.
Postpartum Weight Retention
There are many factors that can contribute to
postpartum weight retention, including:
Pre-pregnant
BMI
Weight
Classification
Recommended Pregnancy Gain
<18.5
Underweight
28-40 lbs
18.5-24
Normal
25-35 lbs
25-29
Overweight
15-25 lbs
>29.0
Obese
At least 15 lbs
• Pre-pregnancy Weight: A high pre-pregnancy weight can
make it harder to lose weight after delivery.
• Gestational Weight Gain: Excessive weight gain during
pregnancy can cause postpartum weight retention.
• Race and Ethnicity: Minority women, especially AfricanAmerican women, have a higher risk for postpartum
weight retention.
• Not Breastfeeding: Women who choose not to breastfeed
may have a harder time losing weight following delivery.
• Psychosocial Factors: Feeling distressed, anxious, and
depressed during pregnancy along with having personal
and economical burdens are associated with higher
postpartum weight retention.
• Nutrition and Activity: Weight retention can depend on
eating behaviors and physical activity prior to, during,
and after pregnancy.
26
Importance of Eating Healthy after Delivery
• It is important to eat healthy foods after your baby is
born. Eating well will help you get rid of your pregnancy
pounds.
• Your body goes through a lot of changes during
pregnancy. It needs good nutrients and vitamins to help
it get back to where it was before you had your baby.
• Children are twice as likely to suffer from obesity and
develop Type 2 Diabetes if their mothers are obese.
Understanding Calorie Intake
A good way to get your calories for the day is to eat a
variety of foods, including vegetables, fruits, and whole
grains. In general, 2,000 calories a day should include:
• Carbohydrates = 900 to 1,300 calories
• Protein = 200-700 calories
• Fat = 400-700 calories
For mothers who are bottle feeding their babies, this is a
good guideline to follow.
Breastfeeding mothers should:
• Eat more calories (around 2,330 calories per day) until
her milk is well established. The calories then can be
reduced to help promote weight loss.
• Eat a higher percentage of carbohydrates to help make
milk and provide the baby with proper nourishment.
• Get more vitamins A, B, C, and E as well as zinc and
iodine.
Dangers of Dieting
Skipping meals or reducing calories prevents weight loss.
The lack of calories makes the body slow down resulting
in the lack of weight loss.
Exercise Following Postpartum Is Necessary
Prepregnancy exercise can be resumed gradually. Remember
it is important to drink plenty of water to remain hydrated.
It is important to first discuss with your doctor or health
professional if the exercise guidelines below are appropriate
for you:
• Frequency: Begin slowly and increase exercise as tolerated
(start exercising 3 days per week and then increase to 4-5
days per week)
• Intensity: You should change the level of intensity
throughout the exercise session. Aim for moderate to high
intensity. Speeding up or slowing down your movements
will help you change intensity. Your exercise intensity can
be monitored using the “talk test”. You should be able to
talk without effort if you are doing a moderate activity.
For more high intensity activities, you will need to take a
breath after a few words.
• Amount of Exercise: The goal is to exercise for
approximately 2 hours and 30 minutes per week. Begin
each session with 5 to 10 minutes of low intensity
warm-up. Follow with about 15 minutes of moderate to
somewhat high intensity activity. Finish with a 5 to 10
minute low intensity cool down. To avoid becoming too
tired, add some rest periods as needed during your session.
• Suggested Activities: Activities can include walking
while pushing a stroller, jogging, aerobic dance,
swimming, tennis, cycling, or activities that exercise
the major muscle groups.
Exercise for Breastfeeding Mothers
Mothers who are breastfeeding should:
• Exercise after breastfeeding (or when breasts are empty)
to decrease breast discomfort.
• Wear a bra that offers good support. Avoid sports bras
since they can cause breast compression.
• Maintain good hydration and nutrition to refuel after
breastfeeding and exercise.
27
28
Infant
Care
Medications and Tests for
All Babies
All babies born at Mercy receive a variety of medications
and tests to prevent infections and/or diagnose medical
conditions. These medications and tests are outlined below
with the reasons they are performed. You may discuss any
of these medications and tests with your doctor or health
professional. If you do not want your baby to have a specific
medication or test, you will be asked to sign a form stating
your wishes.
Eye Infection Prevention
A strip of erythromycin antibiotic eye ointment is placed in
each eye within one hour after birth. As babies pass through
the birth canal, they pick up bacteria, which is normal in
the delivery process. Most often these bacteria are helpful
to the baby, but occasionally, some of the bacteria may
be dangerous. The erythromycin antibiotic prevents any
dangerous bacteria from growing and causing eye infection,
which could be serious. Since it cannot be certain which
mothers may pass on the dangerous bacteria, all babies are
given this safe treatment as a precaution.
Prevention of Umbilical Cord Infection
The baby’s umbilical cord (navel) will dry naturally and
should fall off within two weeks of delivery. To prevent
infection of the umbilical cord area, cleanse the skin around
the cord with soap and water during the baby’s bath as
demonstrated by your nurse. To keep the umbilical cord dry
and promote faster healing, fold the top flap of the diaper
down and away from the cord and secure the diaper snuggly
with the self-stick adhesive tabs.
Prevention of Serious Bleeding
A shot of Vitamin K in the thigh muscle is given to all
babies to prevent bleeding. Vitamin K, which is made in
the intestines, allows blood to clot and prevents abnormal
bleeding. Some babies are born without enough Vitamin K
and cannot make enough in the first few days of life. Since
babies who do not have enough Vitamin K cannot be easily
identified, one dose of Vitamin K is administered, which is
enough to keep a baby from bleeding until they can produce
their own Vitamin K.
Hepatitis B Infection Prevention
The Hepatitis B vaccine should be given to all babies. The
first of three doses is best given in the nursery with the
remaining two doses given after one month of age. Hepatitis
B is a virus that can cause severe liver disease. The vaccine
helps those babies whose mothers may carry the virus.
Urine Test for Drugs
All mothers admitted to Mercy take a urine test for drugs
to detect not only illegal drugs but also medications the
mother should be taking. The drugs found in the test may
be perfectly justified but may have a potential effect on the
baby. Therefore, when a mother’s test is positive, the baby’s
urine also is tested. Any positive results are shared with the
mother and include a discussion of any potential effects on
the baby. It is important for the baby’s pediatrician to be
advised about the test results.
29
What is
Maryland’s
Newborn
Screening
Program?
Maryland’s Newborn Screening Program has two parts:
• Newborn Blood Spot (Metabolic) Screening
• Newborn Hearing Screening
Please feel free to ask your nurse about these programs and
this very important screening process.
Metabolic Newborn Screening
The Maryland Department of Health and Mental Hygiene
offers metabolic newborn screenings as a service to families
with new babies. This program finds newborn babies with
certain rare, serious disorders of body chemistry. These
disorders can be treated when detected early. Before your
baby can be tested, you, as the parent, must agree and give
consent for the testing.
Why is my baby tested?
The testing is done to make sure your baby will be as healthy
as possible. The Newborn Screening Program finds babies
who may have one of several rare disorders and alerts the
doctors to this possibility. Serious illness usually can be
prevented with early diagnostic and medical treatment.
How is my baby tested?
Once you give permission, your baby’s heel will be pricked
to get a few drops of blood. This blood will then be placed
on special paper, dried, and mailed to the Maryland State
Laboratory. The laboratory needs just a tiny bit of blood to
do all the tests described here. The heel prick feels no worse
than being stuck by a pin. Problems from the test, such as
infection of the heel, are rare.
30
What disorders can metabolic newborn screening identify?
The Maryland program now tests babies for 35 conditions,
which include:
• Cystic Fibrosis (CF): a problem with moving salt in and
out of cells causes thick, sticky mucus in the lungs, leading
to lung infections and problems with breathing. Some
babies with CF also have problems digesting (breaking
down) the food they eat, causing slow growth. CF is
diagnosed with a test that measures the amount of salt in
the sweat. CF is treated with breathing treatments and
antibiotics for the lungs and with medicine and a special
diet for babies with digestion problems.
• Fatty Acid Oxidation Disorders: the body usually gets
energy from sugars and fats. The sugar is used first but
when the sugar is all used up, the body must use fats. In
this group of disorders, the body cannot use fats because
of the lack of one of several enzymes. The disorders in
this group do not have common names. They usually are
described by the length of the fatty acid that cannot be
used. The most common of these disorders is a Medium
Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency.
Because they cannot use stored fat for energy, babies with
these disorders may develop seizures, comas, and lifethreatening complications. Treatment includes making
sure the baby eats regularly and avoids fasting. A special
diet and medications also may be used. Screening for these
disorders is very new. There are 11 fatty acid oxidation
disorders that are included in the Maryland Newborn
Screening Program.
• Galactosemia (ga-LAK-toe-see-me-ah): the body cannot
use a sugar in milk (galactose) because of the lack of
an enzyme. A diet low in galactose can prevent lifethreatening complications. Babies with the most severe
form of this disorder can get very sick very fast.
• Homocystinuria (HO-mo-SIS-tin-u-ree-ah): the body
lacks an enzyme in the liver that is needed to handle
sulfur. This can lead to mental retardation and other
changes in the body. A special diet, and sometimes
vitamin B6, can prevent mental retardation and other
complications.
• Hypothyroidism (HI-po-THI-royd-ism): the body
cannot make enough thyroid hormone (thyroxin). This
leads to mental retardation and slow growth. These
problems can be prevented by giving thyroxin pills.
• Organic Acidurias: the body cannot use the branched
chain amino acids from the protein in food because of the
lack of one of several enzymes. The breakdown products
of these amino acids are organic acids. The organic acids
build up to dangerous levels in the blood damaging the
nervous system. Babies with some of these disorders can
become very sick very fast. Symptoms can sometimes be
reduced with special diets low in protein and medications.
Most of these disorders do not have common names and
are described by the name of the organic acid found in the
urine. Screening for most of these disorders is very new.
There are 13 organic acidurias that are included in the
Maryland Newborn Screening Program.
• Phenylketonuira (FEN-nil-KEE-tone-u-ree-ah) or
PKU: the body cannot use a part of the protein in food
(the amino acid phenylalanine) because of the lack of an
enzyme. A special diet low in phenylalanine can prevent
the brain damage that would otherwise result.
• Sickle Cell Anemia: this is a serious blood disorder. Under
certain conditions, the abnormal blood cells can clog the
small blood vessels causing painful “crises”. Babies with
sickle cell anemia have less resistance to infections, which
may be life threatening. A regular treatment program
using penicillin and special immunizations helps avoid
serious complications.
Newborn screening is a rapidly growing service. The number
of disorders included in the program recently has expanded
from nine (9) to 35 disorders. The number of disorders
included in the testing is not a judge of the quality of a
newborn screening program. Different programs count the
number of disorders in different ways. Maryland screens for
all of the disorders recommended by the March of Dimes
and the American College of Medical Genetics.
Tests still are being developed for other serious disorders.
Your baby may be tested for these as well. You will be told
if any of these new tests suggest that your baby might
have a problem.
31
From time to time, the State Laboratory does studies on
other important health problems using these samples. These
only are done after all the other tests are finished. These
studies show how many babies are affected by the problem
being studied. They do not tell which babies have the
problem because the samples are not identified by name.
Is my permission required?
Most parents want to know what is important to their baby’s
health so they can be sure that their baby gets good care.
Testing newborn babies for these disorders is an important
part of good baby care. The State of Maryland requires that
you be asked to give permission before metabolic newborn
screening tests are done. You will need to sign the permission
form after your baby is born. This will give you the chance to
say “yes” or “no”. Please say YES!
My baby seems healthy. Are the tests still needed?
Yes, the tests are needed. Most infants with conditions found
by the Newborn Screening Program have no obvious signs
of illness right after birth. However, each of these disorders
can cause serious problems if not found early and treated.
Many of these disorders can cause brain damage and mental
retardation. Others, like sickle cell disease and CAH can
cause severe physical illness.
There are many causes of mental retardation. The
information in this section deals only with the disorders for
which there are good screening tests. Effective treatment
is available for most of these disorders. A few disorders
recently added to the program are not yet well understood
and treatment may not be effective. But every baby with a
disorder deserves the best treatment that is available.
32
These disorders do not always show symptoms in the same
way. Some babies may become dangerously ill within the
first days or few weeks of life. Others may appear healthy for
months or even the first year of life. In either case, serious
harm is occurring that could be prevented in most cases,
with early treatment. Once the damage has occurred, it can
never be repaired.
How much will these tests cost?
The State Laboratory charges a small fee for doing the
screening tests on your baby’s blood sample. In addition, the
doctor, clinic, or hospital may charge a small fee to do the
heel prick. No baby will be refused testing because a family
cannot pay.
How does a baby get one of these disorders?
Except for hypothyroidism, a baby inherits the disorder from
both parents. Parents and relatives usually show no sign of
the disorder. In most cases of hypothyroidism, the thyroid
gland does not develop, is too small, or is in the wrong place
in the body. These problems are usually not inherited. In a
few cases, there is an inherited defect in the gland’s ability to
make thyroxin.
These disorders are quite rare and the chances are excellent
that your baby will not have one of them. The few babies
who are born with these problems are generally from healthy
families. Testing every baby after birth will make sure that
each infant who has a disorder will be identified and started
on early treatment.
When is the best time to test my baby?
Each baby should be tested twice. The first test usually is
done shortly before the newborn baby leaves the hospital.
For the most reliable results, it should be done after the baby
has received at least 24 hours of breast or formula feedings.
In some cases, babies leave the hospital before they are
24-hours old or have had milk for 24 hours. They should
be tested before they leave the hospital, but some of the test
results will not be accurate. The test should be repeated when
the baby is two (2) to three (3) days old.
If your baby was not born in a hospital, the first test should
be done when your baby is two (2) to three (3) days old.
Most doctors routinely will obtain a second blood sample
when the baby is a little older (about 2 weeks), even if the
first test was ideal and normal. This second test gives another
chance to find the babies with problems. It is especially
important for finding babies with CF and hypothyroidism.
How soon will I know the results?
In most cases, the test results will be normal and you will
not be notified personally. Your doctor will get the report.
Results are usually available in about 10 days. Generally,
parents are notified only if there is a problem. You should
ask about the results when you bring your baby to the
doctor for a regular checkup.
Although “no news is good news”, it is important to
remember that these tests only find the disorders listed in
this information. There may be other medical problems
that cannot be picked up by these tests. Therefore, it is very
important for your baby to have regular checkups and good
general medical care.
What if I am told that a “retest” is necessary?
A retest may be needed for a number of reasons. It does not
mean there is anything wrong with the baby. It usually means
that another sample is needed so all tests can be completed.
Rarely, the first test indicates a possible problem. In this case,
a new blood sample is requested, and the tests are repeated or
the baby is sent to a specialist.
If you are asked to have your baby retested, please schedule
the test quickly.
What if my baby has one of these disorders? Is there a cure?
Because most of these disorders are inborn problems of
the body chemistry, they cannot be “cured” – just as eye
color or height cannot be permanently changed. However,
the serious effects of the disorder usually can be controlled
and sometimes completely prevented by early treatment.
Effective treatment is available for most of these disorders.
The treatment is usually a special diet or medication. A few
disorders are not yet well understood and treatment may
not be effective. However, every baby with a disorder
deserves the best treatment that is available. Your doctor
or the Health Department will make arrangements for
referral and treatment.
If this child has a disorder, will my future children also
have it?
The answer to this question will depend on your child’s
diagnosis. It can best be answered by a genetic counselor.
With your help, the counselor can study your family’s health
history and explain the chance of this happening again. This
process is called genetic counseling. If you would like more
information about genetic counseling, your doctor or Health
Department will help you get it.
33
Newborn Hearing Screening
The second part of Newborn Screening in Maryland is
screening of your baby’s hearing. This program is designed
to help find babies who may have hearing loss and need
early intervention.
Why is my baby tested?
There are two reasons that the State screens all babies for
hearing loss:
1.If a baby with a hearing loss is helped before six (6)
months of age, the baby will have a very good chance of
having normal communication skills.
2.Twice as many babies with hearing loss are found when all
babies are tested rather than just those who are “at risk”
for hearing problems.
How is my baby tested?
Since doctors or nurses at the hospital cannot ask your baby
if he or she hears, they have to use computers to help them.
Two methods are used:
1.Auditory Brain Stem Response (ABR test): measures the
response of your baby’s brain to sound. This is the method
used at Mercy Medical Center.
2.Otoacoustic Emissions (OAE test): measures the response
of your baby’s ear to sound.
Both tests are completely painless and can be done while
your baby is asleep.
34
What types of hearing loss can the newborn hearing screening
identify?
The Maryland program identifies the two basic types of
hearing loss:
1.Sensorineural hearing loss is caused by problems in the
baby’s inner ear. Although this type of hearing loss cannot
be cured, it can be treated.
2.Conductive hearing loss is caused by problems in the
baby’s middle ear. This type of hearing loss sometimes
goes away by itself. If not, it can be successfully treated
medically or surgically.
The screening tests indicate whether the problem is in one
ear or both ears.
Is my permission required?
The State does not require parental consent for newborn
hearing screening. But we want you, as a parent, to
understand why hearing is tested.
How much will these tests cost?
There are no fees for a hearing screening at Mercy.
When is the best time to test my baby?
Your newborn baby’s hearing will be tested before leaving
the hospital. The best time to screen is when your baby is
quiet and comfortable. If your baby did not pass the first
screening, you will be asked to return with your baby for
another screening before the baby is one month old.
How soon will I know the results?
In most cases, you will know the results of the hearing
screening before you leave the hospital. Also, you and your
baby’s pediatrician will receive a letter from the Health
Department that explains the results.
What if I am told that my baby needs a “retest”?
A retest will be needed if your baby did not pass the first
screening test. This does not mean that your baby has a
hearing loss. If the baby does not pass the retest, the baby
will need further evaluation.
If you are asked to have your baby retested, please schedule
the test quickly.
It is important that we give your baby the best possible
chance to develop speech and language. Studies show that
if hearing loss is not diagnosed and treated before six (6)
months of age, language development is delayed by almost
50%. This means that a 4-year old may only have the
language skills of a 2-year old.
How can I make it easier for doctors to help my baby?
Please make sure your doctor has your current contact
information, including telephone number and address.
If your contact information changes, remember to update
your doctor.
If your doctor asks you to bring the baby in for retesting,
do so as soon as you can. If your child does have a disorder
or a hearing loss, your prompt action in following the
doctor’s instructions can be very important.
As a parent, you can help to assure the health of your child
by your cooperation with Maryland’s Newborn Screening
Program.
35
The Importance of
Screening for Critical
Congenital Heart Defects
Some babies born with critical congenital heart defects
(CCHD) can appear healthy at first and can be sent home
before their heart defects are detected. These babies are at
risk for having serious complications within the first few days
or weeks of life and often require emergency care.
Newborn screening using pulse oximetry can identify
some infants with a CCHD before they show signs of the
condition. Once identified, babies with a CCHD can be
seen by cardiologists and can receive specialized care and
treatment that could prevent death or disability early in life.
Treatment can include medications and surgery.
The most common CCHDs are:
• Hypoplastic left heart syndrome
• Pulmonary atresia (with intact septum)
• Tetralogy of fallot
• Total anomalous pulmonary venous return
• Transposition of the great arteries
• Tricuspid atresia
• Truncus arteriosus
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How Are Babies Screened for CCHD?
Newborn screenings for CCHD are conducted using pulse
oximetry, which is a simple bedside test to determine the
amount of oxygen in a baby’s blood and to take the baby’s
pulse rate. Low levels of oxygen in the blood can be a sign
of a CCHD. The test is done using a machine called a pulse
oximeter and sensors are placed on the baby’s skin. The test
is painless and takes only a few minutes. Pulse oximetry
screening does not replace a complete history and physical
examination, which sometimes can detect a CCHD before
the development of low levels of oxygen in the blood. Pulse
oximetry screening should be used along with the physical
examination.
When Are Babies Screened for CCHD?
Screening for CCHD is done when a baby is 24 to 48 hours
of age, or as late as possible if the baby is to be discharged
from the hospital before he or she is 24 hours of age.
CCHD Screening Results
If the results are negative (pass or in-range result), it means
that the baby’s test results did not show signs of a CCHD.
This type of screening test does not detect all CCHDs, so it
is possible to still have a CCHD or other congenital heart
defect with a negative screening result.
If the results are positive (fail or out-of-range result), it means
that the baby’s test results showed low levels of oxygen in the
blood, which can be a sign of a CCHD. This does not always
mean that the baby has a CCHD. It just means that more
testing is needed. The baby’s doctor might recommend that
the infant get screened again or have more specific tests, like
an echocardiogram (an ultrasound picture of the heart), to
diagnose a CCHD. Babies who are found to have a CCHD
also might be evaluated by a clinical geneticist. This could
help identify genetic syndromes associated with CCHDs and
inform families about future risks.
Both tests are completely painless and can be done while
your baby is asleep.
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Medications
Medications may need to be prescribed for you and/or
your baby. Your nurse will provide you with a Medication
Information Sheet detailing:
• Name of the medication
• Why the medication is being prescribed
• What the expected results of the medication are
• What side effects should be reported immediately to
your doctor or health professional
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40
Resources
Recommended Reading for
Breastfeeding Mothers
for
Breastfeeding
Moms
The ABCs of Breastfeeding: Everything a Mom Needs to
Know for a Happy Nursing Experience by S. Rubin;
Amacom Books (2008)
Adventures in Tandem Nursing: Breastfeeding through
Pregnancy and Beyond by H. Flower; LLLI (2003).
(Featured in New Beginnings May-June 2003).
The Black Woman’s Guide to Breastfeeding by K. Barber;
Sourcebooks (2005)
Breastfeeding and Natural Child Spacing by S. Kippley (2008)
The Breastfeeding Café: Mothers Share the Joys, Challenges
and Secrets of Nursing by B. Behrmann; The University
of Michigan Press (2005)
The New Parent Support Group
The New Parent Support Group, facilitated by a Mercy
Lactation Consultant, offers a time to:
Breastfeeding: Keep It Simple by A. Spangler (2004)
Breastfeeding Made Simple by N. Mohrbacher and
K. Kendall-Tackett; New Harbinger (2005)
• Discuss concerns and questions about breastfeeding,
infant care, infant development and behavior
Eat Well, Lose Weight While Breastfeeding by E. Behan;
Ballantine Books (2007)
• Discuss parental/family adjustments after the birth
of a baby
A Medication Guide for Breastfeeding Moms by T. Hale and
G. McAfee; Pharmasoft (2005)
• Meet other new parents
For more information about the New Parent Support
Group or Mercy’s Lactation Services, please call the
Warmline at 410-332-9060.
Milk Memos: How Real Moms Learned to Mix Business with
Babies and How You Can, Too! by C. Coburn-Smith and
A. Secrette; Tarcher-Penquin (2007)
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Helpful Websites for Pregnant
and Breastfeeding Mothers
Mothering Multiples: Breastfeeding and Caring for Twins or
More by K. Gromada; LLLI 3rd ed. (2007)
www.breastfeedingmadesimple.com
www.kellymom.com
Nonprescription Drugs for the Breastfeeding Mother by F. Nice;
Hale Publishing (2007)
The Nursing Mother’s Companion by K. Huggins; Harvard
Common 6th ed. (2005)
The Nursing Mother’s Guide to Weaning by K. Huggins and
L. Ziedrich; Harvard Common Press (2007)
The Nursing Mother’s Herbal by S. Humphrey; Fairview Press
(2004). (Reviewed in New Beginnings, May-June, 2004).
www.breastfeeding.com
(multiple resources on breastfeeding, nutrition etc.)
www.llli.org
www.promom.org
www.multiplebirthsfamilies.com/breastfeeding
(breastfeeding in special circumstances)
www.lowmilksupply.com
Nursing Mother, Working Mother by K. Pryor and G. Pryor;
Harvard Common Press (2007)
Straight from the Heart: A Torah Perspective on Mothering
through Nursing by T. Baranov; Targum Press (1990)
Why Should I Nurse my Baby? by P. Wiggins; LA Publishing
Co. 3rd ed. (2005)
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www.bfar.org
(breastfeeding after breast reduction, augmentation, etc.)
www.mypyramid.gov
(nutrition)
The Family Childbirth & Children’s Center at Mercy
345 St. Paul Place
Baltimore, MD 21202
410-332-9000
1-800-MD-Mercy
www.mdmercy.com