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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. 1 2 Table of Contents About Your Stay...........................5 Patient Information.............................. 9 Post Partum Care..................................... 21 • • • • • 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 • • • • Medications and Tests for All Babies What is Maryland’s Newborn Screening Program Newborn Hearing Screening Screening for Critical Congenital Heart Defects Resources................................................. 41 • • • New Mom Support Group Recommended Reading for Breastfeeding Mothers Helpful Websites 3 4 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.). 5 • 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. 6 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. 7 8 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. 9 10 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 • 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 11 12 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. 13 14 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. 15 • 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 16 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. 17 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. 18 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 19 20 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. 21 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 36 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. 37 38 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 39 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) 41 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) 42 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