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TABLE OF CONTENTS 1 IMPORTANT PERSONAL INFORMATION 3 WELCOME TO OAKWOOD 44OAKWOOD HOSPITAL – WAYNE 45 Visitor parking 5 CHAPTER 1 SO, YOU’RE PREGNANT! 45 Labor-delivery-recovery-postpartum rooms 5Having a healthy pregnancy 46 7Medications during pregnancy 46 Pre-registration information 7When to call your healthcare provider during pregnancy 47 8 47OAKWOOD HOSPITAL – SOUTHSHORE First trimester (week 1 to week 13) Neonatal support services Tours of the OB unit 13 Second trimester (week 14 to week 27) 47 Visitor parking 15 48 Labor-delivery-recovery rooms Third trimester (week 28 to week 40) 18Choosing a healthcare provider for your newborn 48 Mother-baby unit 19 49 Preparing for labor and delivery 19 Prenatal education 20 Car seat program 49 Pre-registration information Tours of the OB unit 50 CHAPTER 3 TIME TO GO HOME! 21 High-risk pregnancies — Maternal-Fetal Medicine 50 Discharge instructions 50 When to call mom’s doctor 22 Genetic-counseling services 51 When to call baby’s doctor 23 51 Breastfeeding information Newborn screening in Michigan 23 Transcultural services 55 Bottle-feeding your baby 24 56 Guide to mother and infant care 56 Mother care after delivery 59 Infant care after delivery Group B strep 27 CHAPTER 2 THE BIG DAY 27 Think I’m in labor 28 Things to bring to the hospital 29 Informed consents 29 Stage one of labor 30 Pain-management options 32 Stage two of labor 32 Cesarean section 60 Sleeping 63 Immunization schedule 64 Developmental milestones 65 Feeding schedule 67 Child safety 68 Medicine cabinet 32 Stage three of labor 70 GLOSSARY OF TERMS 33 Insurance billing and payment 74 OAKWOOD TELEPHONE NUMBERS 34 Room service 34 Cord-blood preservation 35 Visiting guidelines 36 Baby’s first picture 77 COMMUNITY TELEPHONE NUMBERS 80 WOMEN’S HEALTH WEB SITE oakwood.org/womens-health 37 Birth-certificate information 81 SUGGESTED RESOURCES 38 Paternity 84PREGNANCY WEIGHT GAIN CHART 39 Security instructions for parents 40 Gift shop, mail and flowers 85NOTES 40 OAKWOOD HOSPITAL – DEARBORN 40 Visitor parking 40 Labor-delivery-recovery rooms 41 Mother-baby unit 42 Neonatology services 44 Pre-registration information 44 Tours of the OB unit 2 WELCOME TO OAKWOOD We are very pleased that you have chosen a provider affiliated with Oakwood Healthcare during this very special time in your life. The OB Patient Resource Guide is designed to help you every step of the way for the entire nine months of your pregnancy. And we even give you some tips on how to take care of yourself and your baby after going home from the hospital. The information comes from various resources, most notable of which is the vast expertise of our very own physicians and clinical staff at Oakwood. This guide is targeted primarily for first-time parents; however, it most certainly can be used by the experienced parent as well. Please be advised that the issues addressed are common during a TYPICAL or AVERAGE pregnancy. It is best to consult your provider about specifics whenever you have a question or concern. This guide is organized into three major chapters: 1) So, You’re Pregnant, 2) The Big Day and 3) Time to Go Home. We have also included a list of important Oakwood and community phone numbers, along with a glossary of commonly used maternity terms. Should you run across a word or phrase with which you are unfamiliar, refer to the glossary at the back of this guide for the definition. Lastly, if you have not already done so, we invite you to visit our awardwinning Women’s Health Web site at oakwood.org/womens-health 3 for more information on all of the services mentioned within this guide. View pictures of the hospital delivery rooms, the staff you will encounter during your stay, babies born at each Oakwood Hospital and much more. Our Web site contains hundreds of pages of content, just waiting for you to explore. You can also sign up online for our Friends of Oakwood e-newsletter that contains health maintenance tips, notices of special events in the community, a schedule of routine health screenings and exams, descriptions of Oakwood Women’s Health services and more. We hope you find this guide and our Web site helpful and enjoyable to review. And we wish you and your baby a lifetime of happiness! 4 CHAPTER 1 SO, YOU’RE PREGNANT! HAVING A HEALTHY PREGNANCY By taking good care of yourself during pregnancy, you’re also nurturing the new life inside of you. Here are some dos and don’ts for a happy and healthy pregnancy: DOS • Be sure to see your doctor and get prenatal care as soon as you think you’re pregnant. It’s important to see your doctor regularly throughout your pregnancy, so be sure to schedule and attend all your prenatal care appointments. note: Generally, a woman will have about 12 – 13 total prenatal visits. • Be sure to discuss needed vaccinations (e.g., flu shot) with your provider. • Have a discussion with your physician about proper nutrition and weight gain. Weight gain of 25 to 35 pounds during pregnancy is appropriate for most women. However, weight-gain specifics depend on your individual circumstances and your prepregnancy weight. • Eat healthy foods to get the nutrients you and your unborn baby need. Your meals should include the five basic food groups. • Have a discussion with your provider about vitamins during pregnancy. Your provider may suggest that you 5 take a prenatal vitamin with folic acid (important even before you become pregnant), calcium, iron supplements and/or omega 3 fatty acids. It is best not to take your prenatal vitamin within two hours of consuming dairy products or antacids. • Research breastfeeding versus bottlefeeding options. Talk to your doctor, family and friends about how you will choose to feed your baby and how they can support you in your decision. The American Academy of Pediatrics recommends breastfeeding over bottlefeeding from birth to at least age one for most women. •D rink extra fluids (water is best) throughout pregnancy. Drink 6 to 8 eight-ounce glasses of water each day. • Talk with your provider about your personal and family history. Tell your provider if you’ve experienced problems with past pregnancies or have birth defects that run in your family. Medical conditions such as diabetes, epilepsy and high blood pressure should be treated and kept under control. Ask your provider about any current medications that may need to be changed or adjusted during your pregnancy. • Exercise. Physical activity during pregnancy can benefit both you and your baby by lessening discomfort and fatigue during delivery. Always check with your doctor before beginning any kind of exercise program, especially during pregnancy. • Wear a seat belt throughout your entire pregnancy whenever you are driving or riding in a car. • B e sure to get plenty of rest. Resting on your side, especially on your left side, is advised because it provides the best circulation to your baby and helps reduce swelling. Try not to sleep on your back or abdomen, especially later in pregnancy. • If you smoke, QUIT. Smoking during pregnancy passes nicotine and cancercausing drugs to the fetus. Smoking also keeps your baby from getting needed nourishment while in your uterus. Tobacco use raises the risk of fetal death, premature birth (a low-weight baby born too early), miscarriages and stillbirths. In fact, it is estimated that smoking during pregnancy accounts for approximately 10 percent of all infant deaths. 1 • Check with your provider regarding all prescription and over-the-counter medications before taking them. Some medications are not safe during your pregnancy. See the “Medication” section of this guide for more information. • Continue getting regular dental care. Having unhealthy teeth or gums during pregnancy can increase your risk of preterm labor and delivery. The American Dental Association recommends twiceyearly dental visits. Make sure to tell your dentist that you are pregnant. • Continue getting regular eye exams during pregnancy. DON’TS • Avoid exposure to toxic substances and chemicals, such as harsh cleaning solvents, lead, mercury, some insecticides and paint. Pregnant women should avoid exposure to paint fumes. • Avoid or limit your use of food products with chemicals and food additives, including artificial sweeteners (e.g., saccharin) and nitrites (found in bacon, deli meat, hot dogs and other products). • Do not take Accutane (an oral acne medication) if you may become or are pregnant. ® Also, sudden infant death syndrome (SIDS) is more common in newborns of mothers who smoke than in babies of nonsmokers. If you need help quitting, call Oakwood Healthline at 800.543.WELL or the Michigan Department of Community Health to obtain free smoking cessation materials and class schedules. Visit the “Community Telephone Numbers” section of this guide for contact information. • Avoid alcohol. A safe amount of alcohol a woman can drink while pregnant has NOT been established. Drinking during pregnancy can cause physical birth defects, growth problems and brain-development delays in a baby. • Limit caffeine found in tea, coffee, soft drinks and chocolate. 6 • Do not use any recreational drugs (such as marijuana, cocaine, etc.). The use of these drugs may cause very serious birth defects and/or learning disabilities in your infant. Visit the “Community Telephone Numbers” section of this guide for more information. • Attapulgite (Kaopectate ) for diarrhea continuing longer than 24 hours. • Avoid saunas, hot tubs and steam rooms during pregnancy. Excessive heat may be harmful during your pregnancy. • Simethicone (Mylicon ) for gas pains. • Do not eat raw or rare meat or fish (e.g., sushi or rare beef). Do not eat soft-cooked or raw eggs. Do not eat soft cheeses (such as brie or feta) or unpasteurized milk or juice/cider. •C hlorpheniramine antihistamine alone (Chlor-Trimeton ) for allergies. ® • Dextrose and levulose syrup (Emetrol ) for nausea. ® •C alcium carbonate (Tums ) for stomach upset. ® ® •H emorrhoid creams (Preparation H ) for hemorrhoids. ® ® •D iphenhydramine (Benadryl ) for insomnia. ® AVOID medications or products that contain aspirin (Bayer , Pepto Bismol ) or non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen (Advil , Motrin ) or naproxen sodium (Aleve ). ® • Do not handle cat litter. ® • Be sure to wear gloves when gardening, to avoid contracting toxoplasmosis. Toxoplasmosis is an infection caused by a parasite that can seriously harm an unborn baby. • Avoid X-rays. If you must have dental X-rays or radiology tests, tell your dentist or physician that you are pregnant, so that extra care can be taken to shield your baby from X-rays. MEDICATIONS DURING PREGNANCY ® Although these may be good general pregnancy tips, every pregnancy is different, and each deserves the personal attention of your provider. Report the following immediately (at any time during pregnancy): • Persistent, severe vomiting lasting longer than 24 hours. • Any vaginal bleeding or spotting, with or without pain. consider having the following medications on hand, although medication should be taken according to your physician’s specific instructions: • Elevated temperature (fever) above 100.6° F (38.1° C). ® • Acetaminophen (regular Tylenol ) for aches, pains and temperatures over 100.6° F. ® •D ocusate sodium (Colace ) for constipation. ® ® WHEN TO CALL YOUR HEALTHCARE PROVIDER DURING PREGNANCY You should always check with your physician before taking any over-thecounter or prescription medications during pregnancy. You may want to • Guaifenesin plus dextromethorphan (Robitussin DM ) for coughs/colds. 7 ® • Burning, urgent urination. • Abdominal pain or painful, persistent abdominal cramping. • If you are experiencing more than one contraction every 15 minutes before your 37th week of pregnancy. • Severe, continuous headache. • Changes in eyesight or vision, such as blurring spots. 1 • Sudden swelling of hands or face. • Sudden weight gain of more than five pounds in one week. • Any trauma (such as falling or auto accident). • Loss of fluid or leaking from vagina. • Any decrease in the amount of your baby’s movements. • Consistent, persistent heartburnlike pain. FIRST TRIMESTER (Week 1 to Week 13) Congratulations! Your journey to motherhood is under way. During the first three months of pregnancy, or the first trimester, many changes are happening to you. As your body adjusts to the growing baby, you may experience nausea, fatigue, backaches, mood swings and stress. Just remember that these things are normal during pregnancy. Most of these discomforts will go away as your pregnancy progresses, so try not to worry too much about them. HEALTH MAINTENANCE TIPS Water Water plays a key role in your diet during pregnancy. It carries the nutrients from the foods you eat to your baby, and also helps prevent constipation, hemorrhoids, excessive swelling, and urinary tract or bladder infections. Most important, drinking enough water, especially in your last trimester, prevents you from becoming dehydrated. Dehydration can contribute to contractions and preterm labor. Pregnant women should drink at least 6 to 8 eightounce glasses of water per day, and another glass for each hour of activity. You can drink juices for fluid, but juices also have a lot of calories and can lead to extra weight gain. Weight/Nutrition Try to make healthy food choices. Limit your consumption of sweets, junk food, fast food and fried or fatty foods. What you consume isn’t only important for your own health anymore, but for the current and future health of your baby! Appropriate weight gain during your pregnancy depends on your height and how much you weighed before you became pregnant. All weight gain during pregnancy should be gradual, with most of the weight gained in the last trimester. During 8 the first trimester, it is normal to gain only a small amount of weight, about one pound per month. If you are at your ideal weight before your pregnancy, you should gain between 25 and 35 pounds during your entire pregnancy. If you were underweight before becoming pregnant, your weight gain may need to be more. If you were overweight, your weight gain may need to be less. How should my diet change now that I am pregnant? Even before pregnancy begins, nutrition is a primary factor in the health of mother and baby. If you are eating a well-balanced diet before you become pregnant, you will only need to make a few changes to meet the nutritional needs of pregnancy. Eating a well-balanced diet while you are pregnant will help to keep you and your baby healthy. Most physicians generally agree that the Recommended Daily Allowances (RDAs) can be obtained through a proper diet. Generally, a woman needs approximately 300 more calories per day during her pregnancy to ensure that the baby gets enough nutrients. A plain baked potato has 120 calories, for example, so getting an extra 300 calories does not require much more eating or drinking. Make sure not to diet during your pregnancy because you might not be getting the right amounts of protein, vitamins and minerals that are necessary to properly nourish your unborn baby. What should I make sure to include in my diet? As a pregnant woman, you need extra nutrients to help your baby grow and be healthy. • Calcium: Pregnant and lactating adult women require about 40 percent more calcium each day. Almost all of the extra calcium goes into the baby’s developing bones. To get this extra calcium, four total 9 servings (four cups) of milk or other dairy products (cheese, yogurt) are needed. If you are lactose intolerant, you can still get this extra calcium. Several low-lactose or reduced-lactose products are available. In some cases, your doctor might even prescribe a calcium supplement. • Iron: All women of childbearing age should eat a diet rich in iron. Iron is found in foods such as beef (red meat), lima beans, peas, raisins, egg noodles and kidney beans. Iron helps to reduce the risk of anemia later in pregnancy and is essential to the formation of healthy red blood cells. • Folic Acid: Folic acid (a.k.a. folate) is found in many foods, including beans, leafy green vegetables, peas, whole-grain breads/cereals, orange juice and liver. Folic acid is especially important even before you become pregnant. Folic acid helps build healthy cells and helps prevent neural-tube defects. • Sodium: Sodium is important during pregnancy, to regulate the water in the body. Because salt is in most foods, the increased need for sodium during pregnancy is not difficult to fulfill. Pregnant women should avoid processed or junk foods that are high in sodium. To find out what other nutrients are important during pregnancy and how much you need, please ask your healthcare provider. Should I avoid caffeine? Caffeine is a stimulant found in colas, coffee, tea, chocolate, cocoa and some over-thecounter and prescription drugs. Consumed in large quantities, caffeine may cause irritability, nervousness and insomnia. Caffeine is also a diuretic and can dehydrate the pregnant woman’s body of valuable water. You should have a discussion with your provider regarding how to limit your caffeine intake. Should I avoid fish? Fish can be an important part of a healthy diet, supplying protein and omega 3 fatty acids to promote your baby’s brain development. The Food & Drug Administration and Environmental Protection Agency advise pregnant women and nursing mothers to avoid eating shark, swordfish and king mackerel, as well as mollusks or fish from the Great Lakes. They recommend eating up to 12 oz. (2 average meals) a week of a variety of fish and shellfish that are low in mercury, including shrimp, salmon, pollock, catfish, crab, cod and tilapia. Light canned tuna contains less mercury than albacore (white) tuna, so when choosing your two fish meals per week you may choose 6 oz. of albacore tuna per week. View michigan.gov/eatsafefish for information regarding safe amounts of freshwater fish consumption. Why do pregnant women crave certain foods? “Pickles and ice cream” and other appetite cravings of pregnant women may be reflections of the changes in nutritional needs. The fetus needs nourishment and the mother’s body begins to absorb and metabolize nutrients differently. These changes help ensure normal development of the baby and fill the demands of lactation (nursing) after the baby is born. 1 Do I really need to “eat for two”? While you are pregnant, you will need additional nutrients to keep you and your baby healthy. However, that does NOT mean you need to eat twice as much. To keep track of your weight gain throughout your pregnancy, see the “Pregnancy Weight Gain” section in this guide. What if I am diabetic? If you are diabetic before you become pregnant, you should be closely monitored to make sure your blood sugar levels are at or near normal. If maternal blood sugar rises too high, the increased sugar crossing the placenta can result in a large, overdeveloped fetus, birth defects or an infant with blood sugar level abnormalities. Diabetic women may also suffer from a greater loss of some nutrients. It is important to maintain tight control of blood sugar before and during pregnancy. Can I become diabetic during pregnancy? Your physician will probably have you do a test at about seven months gestation to test for gestational diabetes. 10 Gestational diabetes is a form of diabetes that begins during pregnancy and usually goes away after the birth of the baby. About five percent of pregnant women get gestational diabetes. If you have gestational diabetes, this means that you have a high amount of sugar in your blood. This form of diabetes may be controlled through diet, medication and exercise. If left untreated, gestational diabetes can cause health problems for both you and your baby. Your provider may ask you to closely monitor and record your diet and blood sugar if you have diabetes. Please closely follow your physician’s requests and recommendations. Exercise If you have no medical problems with your pregnancy, regular physical activity (30 minutes per day most days of the week), can help you have a more comfortable pregnancy and labor. It also helps to lower your risk for having pregnancy problems like high blood pressure and gestational diabetes. And you will have an easier time getting back into a healthy body shape and weight after the birth. Normal low-impact activities that don’t involve a lot of bouncing, like walking and swimming, are recommended. 11 If you haven’t exercised regularly before becoming pregnant, you can still begin an exercise program. Just start slowly and progress gradually. Talk with your healthcare provider first about what types of exercise or activities are best for you. One exercise that can help your muscles prepare for delivery, help support your uterus during pregnancy and help you to control your urine flow is called the Kegel exercise. It strengthens the pelvic floor muscles, the same ones you use to stop and start your flow of urine. You can do this exercise standing, sitting or lying down. To do this exercise, tighten the pelvic floor muscles for five seconds and then relax. Repeat 10 times. You can also talk with your healthcare provider about how to do this exercise. What should I be careful about when it comes to exercising? Be careful to avoid activities that increase your risk of falls or injury, such as contact sports or vigorous sports. Even mild injuries to the abdomen can be serious when you’re pregnant. After three months of pregnancy, it is best to avoid exercising while lying on your back, since the weight of the baby may interfere with blood circulation. Also avoid long periods of standing. When the • Brush teeth before eating (brushing can stimulate the gag reflex). 1 • Eat more frequent, small meals rather than a few large meals. • Avoid going long periods without food. Snack and drink beverages between meals to avoid nausea prompted by an empty stomach. • Eat easy-to-digest foods: crackers, cereal, rice, pasta, vegetables and fruit. weather is hot, exercise in the early morning or late evening to help you avoid getting overheated. If you’re exercising indoors, make sure the room has enough ventilation. Drink plenty of fluids, even if you don’t feel thirsty. DISCOMFORTS AND HOW TO MANAGE THEM “Morning” Sickness Queasy when you wake up and/or later in the day? That’s common in early pregnancy as hormone levels change. Between 50 and 70 percent of all women experience nausea and/or vomiting during the first trimester. • Keep crackers by your bed. Eat them before you get up to “jump start” your digestive process. • If you notice feeling nauseated after taking your prenatal vitamin, try taking it at bedtime. •D rink small amounts of clear fluids. • Wear acupressure wristbands (sold at most drugstores). • Try sports beverages (Gatorade ). They supply glucose and electrolytes. ® • Sniff lemons or snack on lemon-flavored foods and drinks. • Avoid foods with strong aromas or flavors if they bother you. • Try driving (instead of riding as a passenger) if being in a car makes you feel nauseated. • Avoid foods that are greasy, fried or highly spiced. • Enjoy an evening snack, such as nonfat yogurt or cereal with milk. • R est when you are tired. • Talk to your provider before taking antacid products. Refer to the “Medications during pregnancy” section of this guide for more information. • Ask your provider about various over-thecounter medications, vitamins and herbs that may help with nausea. • R emember, nausea usually ends by the end of the first trimester, and it is a normal sign of a healthy pregnancy. Severe vomiting in pregnancy is rare, but if it occurs, it may cause you to become dehydrated. If you feel that your nausea or vomiting is keeping you from eating right or gaining enough weight, consult your doctor. •D rink at least eight glasses of water each day. • Exercise to help alleviate nausea. 12 Constipation You may experience constipation during pregnancy. To keep your digestive tract moving: your baby beginning to move (usually somewhere between the 16th and 20th weeks). Generally you will have one prenatal visit per month during this trimester. •D rink plenty of fluids, at least 6 eightounce glasses per day. HEALTH MAINTENANCE TIPS Weight/Nutrition You will begin to gain weight during this trimester. A slow and steady weight gain is best for you and your baby. Consult with your healthcare provider concerning your weight gain based on your body type. This is not the time to diet. By the 26th week, your baby will weigh almost 1.5 pounds and will be about nine inches long. With this growth comes the development of your baby’s features, including fingers, toes, eyelashes and eyebrows. By the end of this trimester, all of your baby’s essential organs, including the heart, lungs and kidneys, are formed. Everyone gains weight at different rates, but on average, it is normal to gain about onehalf pound per week during this trimester. • Eat plenty of fiber-rich foods, such as whole-grain products (at least three whole-grain servings daily), cooked dry beans and bran, and fruits and vegetables with edible peels (at least five servings daily). You can benefit from natural laxatives in fruit, especially prunes and figs. • K eep active with a safe level of exercise, such as a daily walk. Stress/Work Try to keep stress to a minimum and practice relaxation techniques. Accept that your normal routine is changing. Most women continue working through pregnancy. Staying active might help you stay healthier. If you have a question about the safety of your particular job, talk with your healthcare provider. Prenatal Visits Visiting your physician is very important during these early stages. Your physician will perform several tests to check the health of both you and your baby. She will also be able to answer questions about any concerns you might have, and she will tell you what you can do to make your pregnancy as easy as possible. Generally, you will have one prenatal visit per month during your first trimester. SECOND TRIMESTER (Week 14 to Week 27) Most women find the second trimester of pregnancy easier than the first trimester. Before this trimester is over, you will feel 13 DISCOMFORTS AND HOW TO MANAGE THEM The second stage of your pregnancy brings more noticeable changes to your body, relief to problems caused in the first trimester and more exciting experiences. As your baby grows, you might notice that your posture has changed or that you are having backaches. Make sure to inform your physician of any changes you might have noticed. Morning sickness, fatigue and many other things that may have bothered you during the first three months may disappear as your body adapts to the growing baby. However, you may experience new symptoms, including: Aching Joints Your abdomen will expand as you gain weight and the baby continues to grow. You might feel pains in your abdomen, groin area or thighs. You also may feel backaches or aching near your pelvic bone from the pressure of the baby, your increased weight and the loosening joints in these areas. 1 Lying down, resting or applying warm heat on a low heat-pad setting can help resolve some of these aches and pains. If pains do not get better after rest, it is best to call your healthcare provider. Numbness and Swelling Tingling and numbness of the fingers and a feeling of swelling in the hands are common during pregnancy. These symptoms are due to swelling of tissues in the narrow passages in your wrists, and they should disappear after you deliver your baby. Itching It also is common to feel itchy as your pregnancy progresses. Pregnancy hormones and your stretching skin, especially over your abdomen, probably are to blame for most of your discomfort. About 20 percent of all pregnant women have some kind of itching. Many pregnant women experience red and itchy spots on the palms of their hands and on the soles of their feet. You should use gentle soaps and lotions, and avoid hot showers or baths that can dry your skin. Try not to get overheated, since heat rash can make the itching worse. Shortness of Breath As your baby gets bigger inside your body, there will be increased pressure on all of your organs, including your lungs. You might begin to notice that you are short of breath or might not be able to catch your breath as easily. Try taking deep, long breaths and try to maintain good posture so your lungs have room to expand. You might be able to breathe more freely at night by using an extra pillow or by sleeping on your side. PRENATAL VISITS/CLASSES You should be registering for prenatal classes by your 28th week of pregnancy. Oakwood offers a variety of classes taught by experienced registered nurse educators who specialize in childbirth, infant care, infant/child CPR and others. You can be assured you will find the answers you need to allow you to feel more confident about the birth process and parenting. Visit the perinatal eduction section of this guide for more information. 14 THIRD TRIMESTER (Week 28 to Week 40) You will probably be feeling a combination of excitement and nervousness as the birth approaches, mixed with an increasing desire to hurry things along. It’s normal to feel anxious, wanting to see and hold your new baby, but you may feel very unsure about the labor and delivery process. If possible, avoid traveling during the last month of pregnancy as labor might start early, and naturally you would like to be near your doctor and hospital at that time. Do not indulge in heavy manual work in the last trimester, but routine household chores may be continued unless you are advised otherwise by your doctor. HEALTH MAINTENANCE TIPS Body Changes Your baby is still growing and moving, but the conditions inside your uterus are much more crowded now. The fetus is moving around just as much but you may notice the kicks and other movements may feel less forceful. A sudden decrease in movement could signal a problem. If you notice any significant change in the frequency of your baby’s movements, you should contact your provider IMMEDIATELY. 15 During this final stage of your pregnancy, your baby is continuing to grow. Even before your baby is born it will be able to open and close its eyes, and might even suck its thumb. As your body starts to prepare for the birth, your baby will start to move into its birth position. You might notice the baby “dropping,” or moving down lower in your abdomen. This can reduce the pressure on your lungs and rib cage, making it easier to breathe. As you near your due date, your birth canal (cervix) becomes thinner and softer (effaces). This is a natural process that helps the cervix to open during the birthing process. Weight/Nutrition As you are now carrying a large amount of weight around, you will experience a number of symptoms related specifically to your increasing size. Your uterus will be carrying your baby, the placenta and amniotic fluid, so it is not uncommon for you to feel a bit uncomfortable. Everyone gains weight at different rates, but on average, it is normal to gain about one pound per week during this trimester. Typical weight distribution during pregnancy (assuming ideal weight prior to pregnancy): Retained water 4 pounds Breasts 2 pounds Blood 4 pounds Baby 7.5 pounds Placenta 1.5 pounds Amniotic fluid 2 pounds Uterus 2 pounds Fat and protein 7 pounds Total 30 pounds (25 to 35 pounds is typical) Is it difficult to lose weight after pregnancy? It can be if you gained too much weight during your pregnancy. During pregnancy, fat deposits may increase by more than a third of the total amount a woman had before she became pregnant. If the weight gain was normal, most women lose this extra weight in the birth process and in the weeks and months after birth. of chipped ice and sleep with extra pillows to alleviate heartburn. If your heartburn is severe and doesn’t improve with these tips, talk with your healthcare provider. Also talk with your healthcare provider before taking an antacid medication. Calcium carbonate (i.e., Tums ) is generally considered safe during pregnancy. ® Swelling As you near the end of your pregnancy, you might notice more swelling than you had before, especially in your ankles. Continue to drink lots of fluids (water is best) and rest when you can with your feet elevated. Swelling of your face and hands or excessive swelling in your ankles needs to be reported to your doctor immediately. DISCOMFORTS AND HOW TO MANAGE THEM The next three months will bring many changes. Your baby is growing and developing rapidly. You may still experience many of the same discomforts of the second trimester, as well as start to experience other discomforts of pregnancy, including: Heartburn As your baby gets bigger, your uterus pushes up on your stomach and can cause heartburn, especially after bedtime or right after you eat. Continue to avoid greasy, fried foods and try to eat six to eight smaller meals instead of three large meals. Try not to eat immediately before going to bed. You also can take small sips of milk, eat small pieces Hemorrhoids You might begin to experience more discomfort from hemorrhoids now from the increased pressure of your growing baby on the veins in your rectum. You might also be constipated, which makes hemorrhoids worse because you might strain for a bowel movement. Try to avoid these problems by drinking lots of fluids and eating plenty of whole grains, raw or cooked leafy green vegetables, and fruits. 16 Frequent Urination Frequent urination occurs when your uterus presses down on your bladder. Restrict your fluid intake in the evening to reduce the number of times you get up at night. But remember, it is important to drink 6-8 glasses of fluids daily. Urine Leaks A weakened pelvic floor below and the uterus pressing from above could cause occasional urine leaks, especially while you are coughing, laughing or sneezing. Take care of this problem by: • Doing your pelvic (Kegel) exercises regularly. • Emptying your bladder frequently. • Preventing constipation. • Avoiding heavy lifting. Energy Many pregnant women feel great in the last trimester and have lots of energy. But your energy may lessen as you enter your ninth month, and you may begin to slow down. This is completely normal. It’s important to get enough rest now, even though it might seem difficult to sleep as you get larger. Resting Your baby’s stretching movements, having to urinate often, leg cramping and an increase in your body’s metabolism might interrupt or disturb your sleep. You might have a better night’s sleep if you try to avoid eating large meals before going to bed. You can also try some mild exercise like walking, which can help relieve stress and may improve sleep. Avoid long naps during the day. If you can’t sleep because you are anxious about becoming a mother or about your labor and delivery, try talking with friends who’ve been through this. You 17 can also share your concerns with your healthcare provider. Try to sleep on your side for maximum comfort for both you and your baby. Talk to your provider before taking any sleep aids. PRENATAL VISITS Usually around week 28, your healthcare provider will change the schedule of your prenatal visits from monthly to every two to three weeks. After week 36, your prenatal visits will likely be scheduled once every week until delivery. Toward the later weeks of the pregnancy, a pelvic examination may be performed to determine the dilation and effacement of the cervix. Your healthcare provider will also ask you about BraxtonHicks contractions (a periodic or sporadic tightening of the abdomen that comes and goes in your third trimester), preterm labor and your delivery wishes. Other reminders: • Your childbirth classes should be scheduled or you should be calling to schedule soon. • If a hospital tour is not included in your class, be sure to schedule one. • S hop for baby furniture, a car seat and clothing for your new son or daughter. • Babyproof your home. See “Child Safety” section. • P repare your labor bag for the hospital. See “Things to Bring” section. • Finalize your plans to breastfeed or bottle-feed your baby. •C hoose a physician for your baby. Remember to keep in mind: • If the office is convenient and close to home. • If the physician is easily reachable in case of emergencies. 1 CHOOSING A HEALTHCARE PROVIDER FOR YOUR NEWBORN If you haven’t chosen a physician for your baby, you can ask your obstetrician, friends and neighbors for recommendations. A visit to children’s doctors during the pregnancy is recommended, preferably when both parents can attend, to help make an informed selection. Many offices will offer a predelivery visit at no charge. Quick Tip! You can call Oakwood Healthline for a physician referral at 800.543.WELL or go online to view a list of physicians with a specialty in pediatrics or family practice. We can match your location preference and insurance coverage to help you find a physician for your baby. The purpose of a prenatal visit with a child healthcare provider is to help you select a physician for your baby and to establish a long-term, supportive relationship. Physicians will introduce themselves and their staff to you to outline their child-care practices and philosophy. While individual styles may vary, all will emphasize family-centered care, continuity and accessibility. Physicians will outline schedules for wellchild visits and immunizations. You should feel comfortable discussing your concerns, anxieties and expectations for labor, delivery and the newborn baby. You may wish to take this time to discuss: • The advantages of breastfeeding. •C ircumcision. •H ow to reach the physician if your child is ill or if you have questions about the baby’s care. • P hysician’s office hours, after-hours arrangements, insurances accepted, fees, etc. • Timing and frequency of office visits and immunizations. Physicians caring for infants emphasize preventive healthcare. They will discuss ways to prepare older children for the new baby. They can also recommend books and community resources to help you gather information for your challenging new role as parents. 18 PREPARING FOR LABOR AND DELIVERY Toward the end of your pregnancy, you eagerly await the arrival of your child. If this is your first child, you may feel a mixture of excitement and nervousness when you think about the delivery. This jumble of emotions is completely normal and natural. As your due date draws near, you’ll want to know exactly when labor will start and when your baby will be born. Although the process of labor is well understood, no one knows exactly how it starts, and your healthcare provider won’t be able to predict either the start of labor or how long it will last. It’s helpful to know that only 5 percent of babies are actually born on their estimated due dates. Many are born before and many are born after. Many women are concerned about the pain involved in labor and delivery. Talk to your provider about the many options of pain control that exist and review the “Pain Management” section of this guide for more information. Be sure to ask questions in your childbirth classes for more information. MY PROVIDER SAYS THAT I MAY NEED TO HAVE MY LABOR INDUCED Sometimes your healthcare provider may have concerns about the baby’s and/or your health, and may think that labor needs to be induced. An elective induction means that there is no medical reason to have the procedure done right now. Elective deliveries should be done no more than one week before the due date (two weeks for twins). This gives the baby or babies the best chance to do well after birth. Inducing labor means that your healthcare provider will start your labor through artificial means. PRENATAL EDUCATION (CLASSES AND TOURS) Many parents enroll in Oakwood prenatal classes, wanting to learn all they can about their impending delivery and the days afterward. Prenatal classes will help parents understand the labor and delivery process. You will learn how mom’s position can help with labor and delivery, along with coping techniques for pain management, including breathing methods Growing Up Safe: It’s a four-step process. As children grow, how they sit in your car, truck or SUV should change. Save your child from injury or death by observing all four steps. 19 1 Rear-facing Seats: For the best possible protection keep infants in the 2 Forward-facing Seats: When children outgrow their rear-facing seats 3 Booster Seats: Once children outgrow their forward-facing seats (usually 4 Seat Belts: When children outgrow their belt-positioning booster seats, back seat, in rear-facing child safety seats, as long as possible up to the height or weight limit of the particular seat. The American Academy of Pediatrics recommends infants and toddlers should ride in a rear-facing car seat until they are two years old or reach the weight and height limits for their car seats. (at a minimum age 1 and at least 20 pounds) they should ride in forward-facing child safety seats, in the back seat, until they reach the upper weight or height limit of the particular seat (usually around age 4 and 40 pounds). around age 4 and 40 pounds), they should ride in booster seats, in the back seat, until the vehicle seat belt fits properly. Seat belts fit properly when the top lap belt lays across the upper thighs and the shoulder belt fits across the chest (usually at age 8 or when they are 4'9" tall). (usually at age 8 or when they are 4'9" tall) they can use the adult seat belt in the back seat, if it fits properly (lap belt lays across the upper thighs and the shoulder belt fits across the chest). and relaxation techniques. Coaches will learn different ways to encourage and support the laboring mother, along with other valuable information that will make you both feel more confident in your birth journey. Quick Tip! Visit us on the Web at oakwood.org/womens-health to register for classes, print class descriptions and schedules and delivery date. We require that you bring your car seat to the hospital immediately following the birth of your baby to ensure that your baby has a safe ride home. State law requires that you ALWAYS use a car seat when traveling in a car with your baby or child under eight years of age. You should follow the manufacturer’s expiration date that may be printed on the seat and never use a car seat that has been in a crash, even a minor crash. obtain cost information. Classes offered at various Oakwood locations: •C hildbirth Preparation (includes information on cesarean section) • Refresher Childbirth Class • Infant Care Class • Breastfeeding Class • Infant/Child First Aid • Infant/Child CPR and Airway Obstruction Class For more information on class offerings and hospital tours, please call: Oakwood Hospital – Dearborn 313.593.7694 INFANTS Oakwood Hospital – Wayne 734.467.5588 • S hould always travel in a car seat (infantonly seat [preferred] or convertible seat). Oakwood Hospital – Southshore 734.671.3950 • Should be in the back seat facing the rear of the car. During your stay in one of the Oakwood hospitals, a nurse will be available to assist you in your room with breastfeeding and other infant-care concerns. We also offer a 24-hour “Newborn Channel” on your hospital TV that addresses many different parenting topics. • S hould be in the middle of the back seat (if vehicle allows). CAR SEAT PROGRAM Keep children rear-facing until at least age two. It is five times safer than front-facing. Convertible seats fit up to 30-45 lbs. rear-facing. We strive to ensure that all parents are fully informed about car seat use. Studies show that most parents do NOT install car seats correctly, so we are happy to check it for you. Just call 313.586.5488 to schedule an appointment before your • Should be semi-reclined (at a 45-degree angle). • S hould NEVER be placed in the front passenger seat. 20 TODDLERS • S hould always travel in a car seat (convertible seat). • Should be in the back seat facing the front of the car. • Should be in the middle of the back seat (if vehicle allows). • Should NEVER be placed in the front passenger seat. • Convertible seats with a five-point harness system are preferred. • Place car seat in the upright position. Quick Tip! Call 313.586.5488 to schedule an appointment to help you install your car seat before your baby is born. Go to www.NHTSA.gov for more tips. HIGH-RISK PREGNANCIES— MATERNAL-FETAL MEDICINE (MFM) “High-risk” can mean anything from a multiple pregnancy to placenta previa (the implantation of the placenta at least partially covering the cervix). In those instances, both mother and child may need specialized care to ensure good health. FETAL DIAGNOSTIC UNIT (FDU) The Fetal Diagnostic Unit provides a wealth of services to support you and your baby. Services include preconception counseling, amniocentesis, fetal echo, nonstress testing, genetic counseling and screening, 3D/4D ultrasound scans, perinatal consultations, at the end of pregnancy-complications, follow-up, genetic testing, and first trimester screening just to name a few. Please visit oakwood.org/womens-health for a full listing of FDU services available to you. KIDS (usually four to eight years old AND between 40 and 80 pounds): • Should always travel in a booster seat. • Should be in the back seat facing the front of the car. • The backseat is always the safest place for children to ride. Children ages 13 and under should ride buckled up in the back seat. • Booster seats must be used with both lap and shoulder belts. Remember, it is important for many reasons that all passengers — adult and children — use their seat belts at all times. 21 Depending on your own situation, your provider may refer you for testing at the FDU office, after which you will return to your original provider. Or, in certain cases, your care may be transferred entirely to MFM. Talk to your provider about what is best for you and your baby. Locations/Hours Fetal Diagnostic Unit Oakwood Medical Office Building Suite 306 18181 Oakwood Blvd. Dearborn, MI 48124 313.593.7521 Monday – Friday 8 a.m. – 4:30 p.m. MFM Physician Office Oakwood Medical Office Building Suite 302 18181 Oakwood Blvd. Dearborn, MI 48124 313.593.5957 Monday – Friday 8 a.m. – 4:30 p.m. Quick Tip! A printable map, a glossary of commonly used terms, a list of tests that may be performed during your visit to MFM and pre-registration forms are available online. Just go to oakwood.org/womens-health. GENETIC COUNSELING SERVICES WHAT IS GENETIC COUNSELING? Genetic counseling is an educational process of providing information and support to individuals and families who have members with birth defects or genetic disorders, or who are at risk for a variety of medical disorders based on their family history or prenatal screening tests. GENETIC COUNSELING SERVICES • Family history/pedigree construction • Analysis of family history and risk assessment • Information on DNA testing options • Information on prenatal testing options • 1 st trimester screening before maternal serum screening • Maternal serum screening • Fetal ultrasound • Amniocentesis • Chorionic villus sampling (CVS) People who may benefit from genetic counseling are: Individuals who … •H ave, or are concerned that they have or might have, an inherited condition. •H ave a family history of a genetic condition. Expectant parent(s) or couples who … • Are 35 years or older at the time of delivery. •H ave an abnormal maternal serum screening result. •Have had an abnormal ultrasound examination. • Have an abnormal 1st trimester screening. •H ave experienced multiple miscarriages. •H ave concerns regarding a family and/or personal history of a genetic condition. • Are carriers of a genetic disease, such as cystic fibrosis or sickle cell anemia. •H ave a newborn diagnosed with a genetic condition. • Are concerned that their lifestyles, jobs or medical history may pose a risk to pregnancy, including exposure to drugs, radiation, chemicals, infection or medications. • Would like more information about genetic diseases that occur more frequently in their ethnic group. For further questions about genetic counseling services, call 313.593.8483. • Interpretation of genetic test results • Patient support/resources 22 TRANSCULTURAL SERVICES Quick Tip! Visit oakwood.org/womens-health to view more information on what to expect during your genetic counseling visit, test and procedure descriptions, or to view pictures of the staff. NEWBORN SCREENING IN MICHIGAN The Michigan Department of Community Health administers a state-mandated screening program for all babies born in Michigan. The screening program is designed to identify rare but treatable diseases. Presently, 49 disorders are screened for in Michigan’s program. The complete list of disorders is available at www.michigan.gov/newbornscreening. With early identification and treatment of these disorders, serious health problems can be prevented. Your baby will have a few drops of blood removed from her heel to screen for these particular disorders. The results will be sent to your baby’s doctor. Normal results are found in most babies; however, if a concern is identified, your baby’s doctor will be informed of the steps necessary to provide optimal care for your child. All infants are also screened for hearing loss prior to discharge. You will also be given information regarding Michigan’s Bio Trust For Health program. You will be asked to sign a consent to allow any unused blood spots, obtained from the newborn screening, to be used for research purposes. Blood spot research is used to • B etter diagnose childhood and adult diseases • B etter treat childhood and adult diseases • S tudy the effects of toxic chemicals Speak to your mother/baby nurse and refer to your booklet for more information. 23 Oakwood provides care for a diverse patient group. English may be a second language for some individuals, and they might need help understanding the American healthcare system. To help all patients make informed decisions about their care, Oakwood’s free interpretation services are available 24 hours a day, seven days a week by phone and in person. If you are a patient in need of translation, please advise your healthcare provider at registration or at admission. We will provide an interpreter for your visit, diagnosis, treatment or medical procedure. For further information, please call 800.543.WELL. GROUP B STREP WHAT IS GROUP B STREP? Group B strep (streptococcus) is a type of bacteria that can cause serious illness and death in newborns. WHY DO I NEED TO GET TESTED FOR GROUP B STREP DURING EACH PREGNANCY? Group B strep bacteria can be passed from a mom who is a carrier for the bacteria (tests positive) to her baby during labor. You need to be tested for group B strep every time you are pregnant. Toward the end of the pregnancy (35 – 37 weeks), the doctor will swab your vagina and rectum. This is sent to a lab, where they test for group B strep bacteria. The bacteria take a few days to grow, and the results are sent to your doctor. HOW CAN GROUP B STREP DISEASE IN BABIES BE PREVENTED? Most early-onset group B strep disease in newborns can be prevented by giving antibiotics (medicine) through the vein (IV) during labor to women who tested positive during their pregnancy. Because the bacteria can grow quickly, giving the antibiotics before labor has started does not prevent the problem. Any woman who has a positive test for group B strep during this pregnancy should get antibiotics. Also, any pregnant woman who has had a baby in the past with group B strep disease, or who has a bladder (urinary tract) infection caused by group B strep, should get antibiotics during labor. gastrointestinal tract (guts) and may move into the vagina and/or rectum. It is not a sexually transmitted disease (STD). About one in four women carry these bacteria. Most women never have symptoms or know that they had these bacteria without a test during pregnancy. WHAT DO I NEED TO DO DURING PREGNANCY OR LABOR IF I’M GROUP B STREP POSITIVE? Talk with your doctor and create a labor plan that includes getting antibiotics for group B strep prevention in your newborn. When your water breaks, or when you go into labor, make sure to get to the hospital at least four hours before delivery, to make sure there is enough time for the antibiotics to start to work. When you get to the hospital, remind the staff that you are group B strep positive. WHAT IF I’M ALLERGIC TO SOME ANTIBIOTICS? Women who are allergic to some antibiotics, such as penicillin, can still get other types of antibiotics. If you think you are allergic to penicillin, talk with your doctor. HOW DOES SOMEONE GET GROUP B STREP? Anyone can be a “carrier” for group B strep. The bacteria are found in the 24 25 26 CHAPTER 2 THE BIG DAY THINK I’M IN LABOR The beginning of labor is a very individual thing. Some women don’t even realize they are in the first stage of labor, mistaking it for gas, heartburn, backache or indigestion. Even though there are signs that labor has begun, they do not necessarily occur in any particular order, and they may occur in a different order with each pregnancy. SIGNS OF LABOR • E nergy burst — You may have a burst of energy several days before labor begins. • L ightening of abdomen — This is when your baby “drops.’’ You may feel as if your baby has dropped lower into your abdomen. Your clothes may fit differently. You may find it easier to breathe, but you may need to urinate more often. This can happen a few weeks to a few hours before labor starts. • B loody discharge — This can be in the form of “show’’ or “mucous plug,’’ a thick plug of mucus that forms in your cervix (bottom part of your uterus) during pregnancy. As your cervix gets softer and starts to open, this mucous plug will come out. You will see clear, pink or slightly bloody mucus coming from your vagina. This may happen long before labor begins or at the start of 27 labor. You shouldn’t be alarmed if this doesn’t happen, as some women never experience the loss of their mucous plug before delivering. If you feel you are losing your mucus plug prior to your 37th week of pregnancy, contact your physician immediately. • R upture of membranes — This is when your “water breaks.’’ The bag of water is the amniotic-fluid–filled sac that surrounds your baby during pregnancy. When it leaks or breaks, you may feel a slow trickle from your vagina or a sudden gush of warm fluid. This may happen before labor starts or any time during labor. Call your doctor or come to the hospital IMMEDIATELY when your bag of water breaks. • Contractions — Call your provider when your contractions are regular and you think you’re in labor. For the first child, the doctor will probably tell you to come to the hospital when they are about five minutes apart for one hour. Generally speaking, if you have had at least one baby, your labor will likely be shorter than with the first. When you notice the first signs of labor, complete the following: •C all your OB provider to get specific instructions. FOR YOU • P icture identification and health insurance cards • Advance directive (if you have one) • If necessary, finalize plans for the care of other children. • R obe and slippers • Arrange your transportation to the hospital. • B ras or nursing bras (2) • Try to conserve as much energy as possible. •U nderpants/panties (3 – 4) •C arefully get in the car for the ride to the hospital. Don’t forget to bring your hospital suitcase. (See below.) • Deodorant • Your driver should remain calm, driving slowly and safely. Your driver should not be nervous about getting you to the hospital in an overly hasty fashion … you may be in labor for many hours! Be sure to wear your seat belt. 2 •N ightgowns (1 – 2) • Toothbrush and toothpaste •C omb and hairbrush •C lothes to wear home • Watch • S lippers or socks (preferably with no-skid bottoms) THINGS TO BRING TO THE HOSPITAL Since trying to pack your suitcase between labor contractions can be difficult, we advise you to pack your suitcase about two weeks before your baby is due. Quick Tip! Visit us at oakwood.org/womens-health for a printable checklist of things you will need at the hospital. Pack one suitcase with the things you will need during your hospital stay. As a reminder to you or whomever may help you pack, tape to your suitcase a list of things that will have to be packed at the last minute (toothbrush, toothpaste, etc.). Also pack a small overnight bag with anything you will need during the actual labor process. FOR BABY • Warm blanket during cool weather •C ar seat •U ndershirts • L ight weight receiving blankets for the baby’s car seat • S weater and hat • S leeper with legs/sleep sack • S pecial outfit for first picture* *Read more in the “Baby’s First Picture” section of this guide. 28 OPTIONAL ITEMS • Soap/cleansers • Shampoo • Makeup • Hair dryer • Lip balm • Camera • WiFi available baby’s head to pass through). For the second-time mom, the cervix may begin to dilate in the last weeks of pregnancy; therefore, the first stage of labor may not last as long. Contractions are the strongest near the end of the first stage of labor. They will last for about a minute and may be only a minute apart, hardly leaving you time to recoup. You may feel like you have to urinate often or have a bowel movement. You feel this way because the baby’s head is pressing down on your rectum and bladder. Near the end of this stage, you have a strong desire to push the baby out (bearing down). It is very important not to push until your provider tells you to do so. Trying to push the baby out through a partially opened cervix makes the cervix swollen and less stretchable, thus making it more difficult to open and liable to tear during delivery. Will I need an IV? Almost all moms will have an IV placed sometime during labor. It is important to discuss this question with your provider. INFORMED CONSENTS On admission to Labor and Delivery, you will be asked to sign several hospital consents. Advance directives: By state law, we are required to ask our patients if they have an advance directive. If you have an advance directive, please bring it to the hospital with you. If you don’t have one, you will be given a copy of a brochure called My Voice My Choice on admission to Labor and Delivery. It explains advance directives and Patient Advocate Designation or Durable Power of Attorney for Health Care and how to obtain copies of the necessary forms. Visit us online to print a copy of the My Voice My Choice brochure. STAGE ONE OF LABOR — TIME TO GO TO THE HOSPITAL During the first stage of labor, your physician is waiting for your cervix to dilate to 10 cm (wide enough for an average-sized 29 Will I be able to get up and go to the bathroom? The ability to get up and move is affected by the method of pain control you choose. Alternative therapies and IV medications usually allow you to get up safely with assistance; an epidural or spinal block will require you to remain in bed. If you cannot empty your bladder, you may need to have a small catheter inserted in your bladder to empty it because you may not feel the urge to urinate. What kind of equipment will I need to have? This varies depending on your labor progress and you and your baby’s well-being. Most mothers will have an IV, a blood pressure monitor and a fetal monitor. If you and your provider choose an epidural, you will also have a tiny catheter in your back attached to a pump to deliver continuous medication, a pulse oximeter and a catheter for emptying your bladder. • Showers PAIN-MANAGEMENT OPTIONS Some women find the comfort techniques are all they need to cope with the pain of childbirth. Other women find they desire pain medications in addition to the comfort techniques. There are two main types of pain relief choices for birth: systemic and regional. Most pregnant women are concerned about how they will cope with the pain of childbirth. Planning ahead for how you want to approach pain relief will be helpful when the time comes. The following information is designed to give you some facts about different types of pain management — what they are, how they are given, what they do and what possible side effects might result. We have also included a short list of commonly asked questions regarding pain management. Keep in mind that usually your provider will not be able to choose exactly what type of pain relief will be best for you until you are in labor or ready to give birth. However, discussing this issue with her ahead of time will help your provider know what your wishes are. TYPES OF PAIN RELIEF AT OAKWOOD Each person’s perception of pain is unique. Labor sometimes hurts more or less than you might have expected. There are many techniques and medications available to you, but no perfect method for eliminating the pain of childbirth from beginning to end has been developed. Alternative Therapy or Comfort Measures can lessen the pain of childbirth. Many of these natural methods are taught in childbirth education classes. You will be encouraged to try these comfort measures if you choose to: • Relaxation techniques • Healing touch • Visual imagery and focusing • Music therapy • Breathing techniques • Birthing balls • Heat and cold therapy 2 Systemic Medications or Narcotics are generally given intravenously (although they sometimes may be given in the muscle) to provide pain relief. This medication will often cause drowsiness. Regional Medications or Anesthesia provide comfort by reducing or eliminating pain sensation. Below you will find a brief description of the various forms of anesthesia used during labor and delivery. • L ocal Anesthesia: A physician will inject a local anesthetic into your vagina or the area surrounding it to ease the pain during delivery. These pain medications usually affect a small area and are especially useful before an episiotomy or the repair of a laceration. One advantage of a local anesthetic is that it does not affect the baby. After it wears off, there are usually no lingering effects. The main limitation is it does not relieve the pain of contractions during labor. • S pinal Block: A spinal block is given as an injection into the lower back (does not touch the spinal cord itself). Spinal blocks are most often used for cesarean births. This is because the medication is short-acting and is usually given only once. A spinal block numbs the lower half of the body. It provides good relief from pain, starts working quickly and is effective in small doses. It also has the same possible low-occurrence side effects as an epidural block. • Position changes 30 •G eneral Anesthesia: This is a medication that causes temporary loss of consciousness for the mother (i.e., a deep sleep). It is rarely used for routine deliveries but may be used for an emergency delivery. These drugs are given in one of two ways: through a face mask or injected through an IV line. Once the drug is given, it works very quickly and is usually given just before delivery. After general anesthesia wears off, you may feel tired and slightly sick to your stomach. This feeling usually fades in less than 24 hours. Your throat may also feel sore from the tube that was inserted to provide oxygen. • E pidural: Epidural anesthesia is performed by an anesthesiologist or a certified registered nurse anesthetist (CRNA) and involves the placement of a small tube into the lower back through which anesthetic is given. This kind of anesthesia is helpful for easing the pain of uterine contractions, the pain of delivery and the pain of an episiotomy. You may lose slight muscle control in your legs, but you should still be able to push during contractions. Epidural blocks are also effective during cesarean birth. Epidural blocks can have some 31 side effects. In very few cases, it may cause the mother’s blood pressure to drop, which in turn may slow the baby’s heartbeat. It is important to understand that these side effects are reversible. With epidural anesthesia, the mother’s blood pressure and heart rate, as well as the baby’s heart rate, will be continuously monitored. When can I have an epidural? While the decision lies with each individual provider and depends on the clinical situation, most support an epidural when your cervix is somewhere between 3 and 5 cm dilated. Can I choose to have an epidural at the last minute? You can ask to have an epidural late in your labor; however, your provider may tell you that it may not have time to take effect before delivery. They may suggest other methods to help with pain relief at that late stage of labor. PAIN MANAGEMENT IS CUSTOMIZED Be prepared to be flexible. Some of the techniques may be more appealing than others. Your health and the health of your baby must be considered when it comes time to decide if a pain medication is needed and, if so, which one will work best. STAGE TWO OF LABOR — ARRIVAL OF THE BABY The second stage of labor occurs from the time your cervix has dilated to 10 cm until the baby is born. Many moms will feel an urge to push once their cervix has fully dialated. Your physician will tell you when it is safe to begin pushing. Your labor and delivery nurse will be with you to guide you through the process. If you took childbirth classes, be sure to use what you learned regarding breathing and positioning for pushing. Push smooth and steady during contractions and relax and try to conserve energy in between contractions. Do not worry about trying to control your bowels or about the leakage of urine as you push. As the baby’s head is emerging, your physician will tell you to stop pushing so that the head slides out slowly under the support of your doctor’s hand. If it seems that the emerging head may tear the surrounding skin, a small cut, called an episiotomy, may be made in the skin at the lower end of the opening, to prevent a tear. The baby’s eyes, nose and mouth are gently cleared. The shoulders and the rest of the body will follow, and the umbilical cord will be clamped and cut (this is not painful for the baby because there are no nerves in the cord). The change in temperature and touch provide enough stimulation for the baby to start breathing. The baby is cleaned, dried and wrapped up in a blanket. What should my labor partner do during the delivery? • E ncourage and praise you during this time. •U nderstand that you might be a little irritable! •H elp you with relaxation and breathing exercises. •G ive you sips of water, wipe your face, massage your back, hold your hand or hold your legs back while you push. •C ount off during pushes from one to 10. CESAREAN SECTION Should you require a cesarean section (also called a C-section) for the delivery, you should not worry. C-sections are done with minimal risk to mother or baby. About 25 percent of all deliveries occur via C-section. A C-section occurs when the baby is delivered through an incision in the abdomen. Your provider will explain what will happen to you during this process, should this be the determined plan of delivery. 2 In certain known conditions, a C-section is planned ahead. You should remember that having one C-section does not necessarily mean that subsequent pregnancies have to end in cesarean delivery. Talk to your provider about the option of vaginal birth after cesarean section (VBAC). STAGE THREE OF LABOR — THE NEWEST ADDITION The third stage of labor occurs from the birth of the baby to the delivery of the placenta (also known as the afterbirth). Although the baby has been born, the placenta is still inside. With much milder 32 contractions, the placenta and the membranes are pushed out. After the delivery of the placenta, you may receive an injection to prevent unnecessary loss of blood. You can now lie back and relax, or begin to hold your baby in your arms. Skin to skin contact will encourage your baby to initiate breastfeeding. Research confirms that mothers who put their babies to breast within the first hour of life are most successful with breastfeeding. AFTER THE DELIVERY It is not uncommon for some women to have a slight temperature or to shiver immediately after delivery, due to the tremendous physical effort put forth during the delivery. If you had a C-section or received an episiotomy, you may be given pain medication after the delivery. The vital signs of both you and your baby will be monitored closely. Postpartum recovery means different things for different women. Read more information on postpartum recovery in the “Mother Care” section of this guide. HOW LONG CAN I EXPECT TO BE IN THE HOSPITAL? Women who have a vaginal birth stay approximately 24 to 48 hours. Women who have a cesarean birth stay approximately 72 hours. INSURANCE BILLING AND PAYMENT Oakwood will bill your insurance company for you. Please bring a picture ID and all health insurance cards to the hospital. If you have multiple insurances, we will bill both primary and secondary payers, as long as we have adequate insurance information. If your insurer requires authorization for your hospital care, we will make sure that a referral has been obtained before billing. There may be separate bills for your maternity hospitalization and your baby’s care, depending on your specific insurance coverage. After your insurance company has paid its portion of the charges, you will receive a statement that identifies any outstanding balance still due at that time. You will be responsible for that amount owed. If you have difficulty paying an outstanding balance due reflected on your statement, please call the hospital patient-account specialist at your delivering hospital to make specific payment arrangements or to obtain assistance. If you are unable to pay your portion within three months, we offer a H.E.L.P. Loan Program if you meet the necessary qualifications. The H.E.L.P. Loan Program offers an easy payment plan with low interest rates. Uninsured Patients: Financial assistance may be available to you and your baby by the State of Michigan if you meet the necessary qualifications and requirements. During your stay at Oakwood, you can request that a patient-account specialist visit you to help determine your eligibility for state assistance. Or you can directly contact the Michigan Department of Community Health at 517.373.3500 or the Family Independence Agency at 517.373.2035 to inquire about free or low-cost healthcare coverage for both you 33 2 and your baby. Plans cover prenatal care, labor and delivery, newborn care and pediatric care. We encourage you to inquire about these plans early in pregnancy. QUESTIONS REGARDING YOUR BILL Should you have questions regarding hospital costs related to maternity and newborn care, please call the Patient Accounting Office of your delivering hospital so that we may assist you. Oakwood Hospital – Dearborn 313.593.7136 Oakwood Hospital – Wayne 734.467.4161 Oakwood Hospital – Southshore 734.671.3831 note: Most insurance plans require you to add your new baby to your insurance within the first 30 days after birth. Many plans also require a Social Security number for your baby and/or that you choose a physician for your baby. Please verify with your insurance company its requirements. COST OF DELIVERY AT AN OAKWOOD HOSPITAL All hospital stays include two components: 1) professional (doctor) bills, and 2) facility (hospital) bills. In terms of facility costs, your delivering hospital will bill your insurance company for costs associated with delivery, mother care, baby care and circumcision (if performed). In terms of professional costs, your OB provider, your baby’s provider and the anesthesiologist (if an epidural or C-section is performed) will send bills to your insurance company. ROOM SERVICE During your stay at Oakwood, you will receive your meals through room service during open cafeteria hours. This allows you more choices in food selection and meal times. A menu, found at bedside, will have the direct-dial extension to the kitchen of your delivering hospital. We offer a choice of hot or cold trays to satisfy your appetite. After placing your order, your selection will be delivered to your room in approximately 45 minutes or less. Your nurse or physician may place some restrictions on your diet (amount, timing, selection) based on your condition or status. Room service generally is available to you between the hours of 6 a.m. and 7 p.m. CORD-BLOOD COLLECTION OPTIONS Oakwood Healthcare System supports various options when it comes to collection and ultimate storage of umbilical cord blood. This blood may be 34 used at a future date to help treat patients afflicted with cancers of the blood and other diseases. Oakwood offers three options to patients: •Collect umbilical cord blood for storage at a private cord blood bank for potential future personal use. Cord banks should be contacted in advance of the delivery so that enrollment and fees can be processed. •Donate umbilical cord blood for public listing on the National Marrow Donor Program registry. The CORD: USE Cord Blood Bank coordinates this process to help anyone in need of life-saving stem cell transplantation. This Oakwood Hospital & Medical Center option is free, however it does require patient signature of consent prior to delivery. •Discard umbilical cord blood as medical waste. This option is the default unless you notify your physician of one of the above choices during your pregnancy, and then notify the staff upon arrival for labor and delivery. been immunized (chicken pox, polio, measles, mumps, etc.) • An adult other than their mother must accompany minor siblings of the baby at all times. • P lease remember, all Oakwood campuses are tobacco-free. DAILY VISITING HOURS FOR OAKWOOD BIRTHING CENTERS Father/Significant-Other Visiting Hours 24 hours General Visiting Hours 11 a.m. to 8 p.m. Who can be in the room during delivery? • F or a vaginal delivery, one coach and two other visitors may be in the delivery room. • F or a C-section delivery, only one person in the operating room. • In triage and the recovery room, only one person may be with you. • S iblings must be at least 14 years of age to attend a delivery. What about visitors after the delivery? note: Visiting hours and number of visitors for the Birthing Center may be changed at the discretion of the nurse or physician due to patient’s request or a change in patient’s medical condition. Other Labor and Delivery Visitor Guidelines • Visitors are allowed to eat in the patient’s room; however, patients should check with the medical personnel before eating anything. VISITING GUIDELINES In order to protect the health of our mothers and babies, we ask that you adhere to the following guidelines: •Family and friends should not visit if they have or have been exposed to contagious illness, communicable disease or recently 35 •Since mom and baby’s health and safety are primary concerns during the actual delivery, family and visitors are asked to take photographs and/or videotape only during antepartum and postpartum periods, and from the exterior of the nursery, unless the attending physician or staff request otherwise. • Children of visitors are not allowed in the labor rooms. Only the children of the patient may visit the labor-deliveryrecovery room. If children are in the room, an adult must be present for each child. Each child counts as a visitor. Children may be asked to leave based on the situation. • Visitors are asked not to congregate in the hallways outside the delivery room. For more detailed information regarding visiting hours, please call the Labor and Delivery unit at your delivering hospital. Oakwood Hospital – Dearborn Labor and Delivery 313.593.7500 Oakwood Hospital – Dearborn, a partnership between the hospital and Our 365 allows family and friends near and far to view your baby’s photo online, if you choose, via the Oakwood Baby Gallery at oakwood.org/womens-health. 2 HERE IS HOW THIS FREE SERVICE WORKS. IT IS AS EASY AS 1-2-3! 1. Your baby’s photo will be taken at the hospital the day after their birth. Your Quick Tip! If you desire your child to have a specific outfit on in the picture, you should put it in the crib that morning and notify the nursery nurse. Oakwood Hospital – Dearborn Mother Baby Unit 313.593.7630 photographer will come to your room and ask you to sign a consent that will allow Our 365 to gather your information and Oakwood Hospital – Wayne photograph your baby. Pictures will then Labor and Delivery be taken in your room right at your bedside 734.467.4266 and you will be able to select the poses you Oakwood Hospital – Southshore want to purchase. The photographer can Maternal Care Unit accept cash, checks, credit card or money 734.671.3950 order for payment. Look for the order to arrive at your home via first class mail BABY’S FIRST PICTURE approximately seven days after your order Oakwood Healthcare would like to thank was purchased. you for allowing us to share in this very Your photographer will also ask if you special time in your life. Your baby has would like to have your baby’s picture finally arrived, and family and friends are posted in the Oakwood Baby Gallery online anxiously waiting for a glimpse of your at oakwood.org/baby-gallery. If you say yes, newest addition. If your baby is born at 36 your baby’s picture will be available online within a few days. Only your baby’s first name and last initial will accompany the online photo. How do family and friends find your baby’s picture on the Oakwood Baby Gallery? Just point and click! • L og on to oakwood.org/womens-health. •C lick on the Patients and Families. • Click on Baby Gallery. •C lick on the hospital where your baby was born. • F ollow the easy online instructions to search for a particular baby (and enter password, if requested). Now that you’ve found your baby’s first photo on our Web site, you have the option to personalize/password protect it. •C lick on Parents Personalize My Baby’s Page (to the left of your child’s photo). • You will be asked for your password. Enter the mom’s last name and the receipt number from your order form. Now that you’ve gained access to your child’s Web page, you have several options: 37 • You can change your original password from your last name to a secret password of your choice. • You can also add a visitor password so only those with this password can view the photo. • You have the option to remove your child’s photo from the Web site at any time by clicking the “page unavailable” icon after entering your password. Lastly, while online you can view notes of congratulations posted by your family and friends! Your satisfaction is guaranteed. If for any reason you are not satisfied with your order, forget your password or have questions, just call Our 365 at 800.433.0855. We hope you take advantage of this easy, fun and free opportunity to share your baby’s picture with family and friends! BIRTH CERTIFICATE INFORMATION You will receive a registration worksheet after your baby’s birth. Fill it out as quickly and accurately as possible and return it to the unit secretary. Someone will then bring a typed copy of the form to your room to verify the information and obtain your signature. Please read the document carefully to check for errors (spelling of names, dates, etc.) before signing. After the birth certificate is signed, it will be sent to Dearborn City Hall for processing. note: There is a charge to have any changes made thereafter. The unit secretary will give you an order form for your baby’s birth certificate that can be taken or mailed to city hall. Birth certificates can be purchased from the city hall of your delivering hospital’s city approximately three to six weeks after birth. Security representative, you can call 800.772.1213. If a Social Security number is needed sooner than two months, you may obtain it yourself in approximately two weeks by presenting a certified copy of the birth certificate at a Social Security branch office. 2 PATERNITY For unwed parents, an Acknowledgment of Paternity can be signed at the hospital. This is a special form that needs both parents’ signatures and is notarized at the time it is signed. Both parents must have current, valid, government issued picture identification with them at the time of signing. Proper identification includes Oakwood Hospital – Dearborn Dearborn City Hall 313.943.2012 akwood Hospital – Wayne O Wayne City Hall 734.722.2204 akwood Hospital – Southshore O Trenton City Hall 734.675.8600 If you should leave the hospital before the birth certificate has been completed, you should call your delivering hospital to make an appointment to review and sign it. Phone numbers for the appropriate units are listed below. Oakwood Hospital – Dearborn Mother-Baby Unit 313.593.7630 akwood Hospital – Wayne O Health Information Management 734.467.4378 Oakwood Hospital – Southshore Medical Records 734.671.3846 At the bottom of the birth certificate work sheet you can request to have the state send the information to social security to initiate the process for issuing your child’s social security number. This is the state’s preferred way to obtain a social security number. This process can take two months or more. If you wish to speak to a Social a current driver’s license, identification card or record issued by a federal or state government that contains both the person’s photograph and signature. A notary may be available as a complimentary service provided by the hospital. The law specifically stipulates the process for naming the father on a child’s birth certificate. According to the law, if a child is conceived or born when the mother is legally married, the husband is the legal father of the baby, even if he is NOT the biological father, unless a court decides that it is not the husband’s child. If the child is born less 38 than ten months after the divorce is final, it may be necessary to re-open the divorce case. Please refer to michigan.gov for further information. If you were not married at either time, the father’s name may not be entered without the written consent of the individual to be named as the father (this can be done by completing an Acknowledgment of Paternity). This document can be completed at the hospital at the time of your baby’s birth. The last name of the child may be the last name of the mother or father. You may give the father’s last name even if he does not file an Acknowledgment of Paternity. SECURITY INSTRUCTIONS FOR PARENTS Your baby’s safety is a high priority at Oakwood. We take many precautions to be sure your baby is secure. You can help in the following ways: • Become familiar with the personnel who work on the OB unit at your delivering hospital. Your nurse, nurse assistant, OB provider, OB/GYN resident, nurse educator and your baby’s physician are the only persons who have any reason to take your baby anywhere. • You may encounter other hospital staff, such as housekeeping, who will be cleaning your room; lab and dietary personnel, who may enter your room for consultations and/or tests; and auxiliary workers, who may drop by to deliver flowers. Feel free to question anyone who comes into your room. • If you have questions or are unsure about any of the hospital staff, press your call light and someone from the nurses’ station will assist you. • Always check for proper identification before giving your baby to anyone. All OB staff members wear pink hospitalissued ID badges. • Never leave your baby alone or unsupervised in the room. If you leave your room, please take the baby with you in the crib or return your baby to the nursery. Newborns are continuously observed in the nursery. • As an added measure of security, a small Hugs band will be placed on your baby’s ankle to monitor his or her location at all times. Your nurse will give you instructions regarding the Hugs band. Do NOT remove the band. Your nurse will remove it prior to discharge. note: Each unit is locked down and under 24-hour video surveillance. All patients and visitors will need to be identified before being let into or out of the unit. Corresponding wrist bands will be worn by the baby, mother and father. GIFT SHOP HOURS AND DELIVERY INFORMATION Oakwood Hospital – Dearborn Oakwood Hospital – Wayne Oakwood Hospital – Southshore Monday – Friday 9:00 a.m. – 8 p.m. 10 a.m. – 6 p.m. 9 a.m. – 7 p.m. Weekends and holidays 12:30 p.m. – 5 p.m. 1 p.m. – 5 p.m. 11 a.m. – 3 p.m. The patient’s name The patient’s name The patient’s name 3rd Floor Skillman Building 2nd Floor Maternal Care Unit 2nd Floor Maternal Care Unit Oakwood Hospital – Dearborn Oakwood Hospital – Wayne Oakwood Hospital – Southshore 18101 Oakwood Blvd. P.O. Box 2500 Dearborn, MI 48123 33155 Annapolis St. Wayne, MI 48184 5450 Fort St. Trenton, MI 48183 313.593.7190 734.467.4169 734.671.3692 Address family and friends should use to send mail, gifts or flowers Phone number 39 GIFT SHOP, MAIL AND FLOWERS Oakwood Healthcare gift shops offer a wide choice of flowers, magazines, toys, baby clothes and other unique gift items to keep our patients connected with their greatest support system — their family and friends. Oakwood employees and volunteers distribute the U.S. mail and flowers delivered by florists each day. The Oakwood gift shops are open seven days a week. Family and friends are able to send flowers and notes via Oakwood’s online store by visiting www.oakwood.org/store. 2. Leave obstetric patient in Emergency Room area. Patient will be transported to the Third Floor, Skillman Building, Labor and Delivery Triage Unit. 3. S ecurity can advise you where to park. 2 Visitor Parking Visitors may park in a visitor-parking structure for a small fee. What Happens Next? Once you have been examined in the Triage Unit to determine that you are Special note regarding balloons: We don’t recommend latex balloons on the OB units. Babies, patients or visitors may have an allergic reaction to latex. MATERNITY SERVICES OFFERED AT OAKWOOD HOSPITAL – DEARBORN Oakwood Hospital – Dearborn (OH-D) is a full-service healthcare facility. Oakwood is one of the leading, most comprehensive birthing centers in southeastern Michigan, due to our outstanding physicians and exceptional care team’s family-centered approach to childbirth. Location/Directions Our address is: 18101 Oakwood Blvd. Dearborn, MI 48124 313.593.7000 We are located at the intersection of Oakwood Blvd. and Michigan Ave. (just off Southfield Freeway). GIVING BIRTH AT OH-D When it’s time to come to the hospital, we’d like you and your support person to be aware of some important details that will help ensure a smooth arrival. Tips for Your Driver 1. Drive vehicle to Emergency Room (ER) entrance. in labor, you will be transferred to a labor-delivery-recovery (LDR) room. Your husband or support person may join you and remain with you during all phases of labor, delivery and recovery. Labor-Delivery-Recovery Rooms Our private LDR rooms are designed to offer you an alternative to the standard delivery room. Here you’ll have all the comforts of home, plus the added security of well-trained hospital personnel and sophisticated equipment. The LDR rooms allow you to labor and deliver in one room and in one bed. After your baby is born, we encourage you to take some time to hold and become acquainted with your new son or daughter. After you have spent this special time together, you will be moved to the mother-baby unit. 40 Transition Nursery Close observation is important for a newborn baby. After the initial recovery period, your infant will be taken to our Transition Nursery for further evaluation. Here he or she will have their first bath and your pediatrician will be notified of your baby’s birth. The length of stay in this nursery depends upon how well your baby is adapting to her new world. Mother-Baby Unit We want you to know that Oakwood Hospital – Dearborn provides a Your nurse will provide care for both you and your baby. You will be asked to sign consents for the hepatitis B vaccine and circumcision if you choose to have these completed at the hospital. She will also teach you many of the things you will need to know to begin caring for your baby and yourself. OB/GYN Residents When obstetrics and gynecology patients are admitted to Oakwood Hospital – Dearborn, they are cared for by their attending physician; however, they also have access to OB/GYN residents. The OB/GYN residents work closely with the patients and attending physicians. Oakwood Lactation Center Certified lactation consultants staff the Oakwood Lactation Center. All have extensive experience working with breastfeeding mothers and are well prepared to help with questions or concerns while you are still in the hospital. Shortly after you leave the hospital, a consultant may call you to make sure you are adjusting comfortably. If necessary, you can arrange a personal consultation for additional support and guidance. note: Refer to the “Breastfeeding” section of this guide for more information. very supportive way of giving nursing care to you, your infant and family. This method of nursing is called “Mother-Baby Care Giving.” After your baby’s stay in the Transition Nursery, you and your baby will not be separated again, except for exams such as a hearing screening or upon your specific request. Your newborn will sleep right next to you in a bassinet located in your mother-baby room. This will give you a chance to get to know your baby and ask specific questions regarding his unique qualities. 41 Inpatient Nurse Educators Prior to your discharge you may be visited by an inpatient nurse educator who will review mom and baby discharge care instructions and be sure you have received your patient information folder. You may want to make a list of questions you want to ask before you go home. Your nurse educator will be happy to spend the time with you to be sure you are feeling confident and ready to go home with your new baby. 2 Nursery Pictures Your baby’s photo will be taken at the hospital the morning after her birth. Newborn pictures are taken at the mother’s bedside so they can see the photos and choose the ones they like. Our photographer goes room to room and has the parents dress the infant in their choice of outfits. Refer to the “Baby’s First Picture” section of this guide for more information. NEONATOLOGY SERVICES The Neonatal Intensive Care Unit (NICU) at OH-D is a 30-bed Regional Level III inpatient unit. We provide multidisciplinary care for the preterm and term neonate requiring a high level of technical support and observation. Approximately 500 babies are admitted to our NICU each year with a variety of medical and/or surgical conditions. The NICU Transport Team provides transport services for many area hospitals, including Oakwood Hospital – Wayne and Oakwood Hospital – Southshore. Along with the multidisciplinary team, the NICU staff provides compassionate, holistic care to all neonates, while promoting a supportive learning environment for their families. The unit is staffed in-house 24 hours a day with nurses, a neonatal nurse practitioner, a neonatologist and support staff. Our team also includes professionals such as social workers, respiratory therapists, neonatologists, a perinatal coordinator, care managers, nurses, physical therapists, lactation consultants and dietitians. Family conferences are arranged in response to complex care needs, to enhance family participation or are available at the family’s request. We promote family bonding in the NICU by having 24-hour visitation, Kangaroo care, infant CPR classes and rooming-in options. Our staff is specially trained to provide complex care for the NICU patient and to teach the family about discharge and potential home needs. Oakwood understands that parents and families of NICU babies may experience significant stress. The caring, competent staff in our state-of-the-art NICU will work with you to ensure the best care for your baby. 42 Visitation Guidelines for NICU • P arents may be with their baby at any time. It is best to come at feeding times. Please call first if you are coming to feed your baby. We can be reached at 313.593.7435. • All visitors must wash their hands with soap for three minutes before entering the NICU. If any visitor has a cold or other illness, please discuss visiting your baby with a nurse before entering the NICU. •O nly two visitors per baby, one of which is a parent, are allowed in the NICU at one time. • An adult must supervise all children in the NICU, the family waiting room and the hallway. • B rothers and sisters of the NICU patients who are 3 years of age or older may visit under certain conditions and days/ times. Arrangements must be made with the NICU staff prior to visit. Just call 313.593.7435. • An immunization card must be brought in for each visiting child. 43 •Visitation will be suspended if there is a community outbreak of disease or if the activity in the NICU prohibits it. • P lease respect other families’ privacy and do not wander about the NICU or ask questions about another baby. • P lease photograph your infant only. The NICU staff does not allow taping or pictures while they are caring for a baby. • A family waiting room is available for you. Please help us keep it tidy. • We offer a lending library with books you may find helpful. Please ask your nurse if you are interested in a book. Books are to be returned after two weeks or before discharge. • We offer a parent support program for NICU families. Parents Supporting Parents (PSP) links volunteer parents who have had a baby in the NICU with new NICU parents. This program is a free service. You can contact PSP at 313.593.8750. •O ften babies are moved from one area of the NICU to another. Don’t be alarmed if your baby is not in the same location when you arrive. We will direct you to your baby’s new location. • P lease ask your baby’s nurse any questions that you may have. • S tuffed animals are not allowed in the NICU. Please call the NICU at any time with questions at 313.593.7435. Please identify yourself by your last name and the ID number on your wristband. Ask to speak to the nurse taking care of your baby. Quick Tip! Visit oakwood.org/womens-health to meet the NICU staff, view screening tests that will be performed on your baby, read about parent-to-baby bonding details and gather parent support group information. Breastfeeding Instructions for Mothers Whose Babies Are in NICU • B reastfeeding will be initiated when the infant’s condition allows. • It is important that your milk supply be established by using a breast pump. • Your nurse and/or lactation consultant will help you begin the pumping process and answer any questions you may have. PRE-REGISTRATION INFORMATION Pre-registration will help minimize the amount of paperwork that needs to be done when you are admitted. Pre-registration may be completed online at oakwood.org/womens-health. 2 Should you have any questions about your upcoming admission, please contact OH-D admitting office at 313.593.8525. CAFETERIA HOURS FOR VISITORS Oakwood Hospital – Dearborn offers a walk-in cafeteria for your visitors to grab a snack. The hospital cafeteria vending area is open 24 hours a day, seven days a week with a few exceptions. TOURS OF THE OB UNIT We would love to show you our beautiful Birthing Center. Tours are held at Oakwood Hospital – Dearborn on the second Wednesday and fourth Thursday of each month from 5 p.m. to 6:30 p.m. Registration is not required for tours; just meet in the main lobby of the hospital. For more information, please call 313.593.7694. MATERNITY SERVICES OFFERED AT OAKWOOD HOSPITAL – WAYNE (OH-W) Oakwood Hospital – Wayne is a fullservice community hospital located in Wayne, Michigan. Oakwood Hospital – Wayne’s Family Birthing Center Unit offers • The neonatologist or the nurse clinician will let you know when they want you to begin bringing breast milk to feed your baby. If you need assistance breastfeeding the baby in NICU, you can call or have the nurse call the lactation consultant at 313.593.5929 for help. Lactation consultants are available daily. 44 a full range of obstetrical services to care for both mom and the newest addition to the family. We offer families the most advanced, specialized healthcare available with the personal touches of a community hospital. Our family-centered philosophy, combined with our medical and technical expertise in childbirth, will help ensure a safe and happy birth experience for you and your family. 2. L eave obstetric patient in Emergency Room area or West Lobby area. 3. The patient will be transported to the Second Floor, Family Birthing Center Unit. 4. P ark vehicle in Emergency Room parking lot or West Lobby parking lot. If you arrive between 8 p.m. and 5 a.m., park your vehicle in the Emergency Room parking lot only. Visitor Parking The parking at Oakwood Hospital – Wayne is free. Your visitors may park in the main entrance parking lot (located in front of the hospital) or the West Lobby parking lot. What Happens Next? Once you arrive in the Oakwood Wayne Family Birthing Center, you will be evaluated in our triage center and then taken to a private labor-delivery-recoverypostpartum (LDRP) room if you are in labor. Your husband or support person may join you and remain with you during all phases of labor, delivery and recovery. Location/Directions Our address is: 33155 Annapolis St. Wayne, MI 48184-2493 734.467.4000 Labor-Delivery-Recovery-Postpartum Rooms (LDRP) Our private LDRP rooms are designed to offer you an alternative to the standard delivery room. We are located at the intersection of Venoy Rd. and Annapolis St. Here you’ll have all the comforts of home, plus the added security of well-trained hospital personnel and sophisticated equipment. The LDRP rooms allow you to labor and deliver and recover in one room. After your baby is born, we encourage you to take some time to hold and become acquainted with your new son or daughter. After you have spent this special time together, your baby will be transferred to the nursery. Throughout your stay with us, you will have a chance to get to know your baby and ask specific questions about your baby. The nurses who care for you will also teach you many of the things you will need to know in order to begin caring for your baby and yourself. GIVING BIRTH AT OAKWOOD HOSPITAL – WAYNE When it’s time to come to the hospital, we’d like you and the individual bringing you to be aware of some important details that will help ensure a smooth arrival. Tips for Your Driver Relatives or other individuals bringing obstetric patients to Oakwood Hospital – Wayne should follow this procedure: 1. D rive vehicle to Emergency Room (ER) entrance or West Lobby Entrance. 45 Lactation Education Your nurse will show you how to breastfeed your baby before you leave the hospital. Please inform your nurse if you are uncomfortable with your ability to breastfeed your newborn. She is available to address any of your questions and/or concerns. If necessary, you can arrange a personal consultation for additional support and guidance by calling the lactation department at Oakwood Hospital – Dearborn at 313.593.5929. note: Refer to the “Breastfeeding” section of this guide for more information. Nursery Pictures Your baby’s photo will be taken at the hospital the morning after her birth. If you desire your child to have a specific outfit on in the picture, you should put it in the crib that morning and notify the Nursery nurse. Refer to the “Baby’s First Picture” section of this guide for more information. FAMILY PANTRY To help keep your family comfortable as they await the arrival of the newest member of their family, Oakwood Hospital – Wayne offers a waiting area with comfortable seating and a TV. We also offer a Family Pantry area — a mini kitchenette that is shared by the entire maternity unit. It offers complimentary hot and cold beverages, snacks and basic kitchenette amenities, such as a refrigerator, microwave oven and coffeemaker. The pantry is accessible 24 hours a day. 2 note: The Family Pantry is for the patient, support person and immediate family. A cafeteria located on the first floor is available for other visitors who may want to purchase something to eat or drink. CAFETERIA HOURS FOR YOUR VISITORS The Oakwood Hospital – Wayne offers a walk-in cafeteria and 24-hour access to vending machines for your visitors to grab a snack. TOURS OF THE OB UNIT We would love to show you our beautiful Birthing Center. Please call 734.467.4266 to schedule a tour. 46 MATERNITY SERVICES OFFERED AT OAKWOOD HOSPITAL – SOUTHSHORE (OH-S) The new Oakwood Hospital – Southshore is a full-service community hospital committed to providing excellent healthcare for you and your family. Our family-centered philosophy, combined with our medical and technical expertise in childbirth, will help ensure a safe and happy birth experience for you and your family. Location/Directions Our address is: Oakwood Hospital – Southshore 5450 Fort St. Trenton, MI 48183-4625 734.671.3800 We are located at the intersection of Fort St. and Vreeland Rd. GIVING BIRTH AT OAKWOOD HOSPITAL – SOUTHSHORE When it’s time to come to the hospital, we’d like you and the individual bringing you to be aware of some important details that will help ensure a smooth arrival. Tips for Your Driver Relatives or other individuals bringing obstetric patients to Oakwood Hospital – Southshore should follow this procedure: 1. D rive vehicle to Emergency Room (ER) entrance. 2. L eave obstetric patient in Emergency Room area. 3. The patient will be transported to the Second Floor, Maternal Care Unit. 4. P ark vehicle in Emergency Room parking lot or Main Lobby parking lot. Visitor Parking Parking at the Oakwood Hospital – Southshore is free. Your visitors may park in the Emergency Room or Main Lobby entrance parking lots. What Happens Next? Once you arrive in the Oakwood Southshore Emergency Room, you will be taken to our triage center. Once it is confirmed that you are in labor, you will be taken to a private labor-delivery-recovery (LDR) room. Your support person may join you and remain with you during all phases of labor, delivery and recovery. Labor-Delivery-Recovery Rooms Our private LDR rooms are designed to offer you an alternative to the standard delivery room. Here you’ll have all the comforts of home, plus the added security of well-trained hospital personnel and sophisticated equipment. The LDR rooms allow you to labor and deliver in one room. After your baby is born, he can remain with you in your room during your stay. 47 2 However, you have the option of asking your nurse to care for your infant in the nursery while you shower, take a nap or sleep through the night, if you wish. Normally, one nurse will take care of both you and your baby during your stay. Transition Nursery Once your infant arrives, she will be evaluated in the nursery. This will include a hearing screening. After evaluation, your baby can stay with you in your room as long as you want. At Oakwood Hospital – Wayne, infants recover in the LaborDelivery Rooms, unless there is a c-section, in which case the infant recovers in the nursery. Mother-Baby Unit After your delivery, you may be transferred to our Maternal Care Unit. In the Maternal Care Unit, you will have a chance to get to know your baby and ask us specific questions regarding his uniqueness. The nurses will provide care for you and will also teach you many of the things you will need to know in order to begin caring for your baby and yourself. Lactation Education Your nurse will show you how to breastfeed your baby before you leave the hospital. Please inform your nurse if you are uncomfortable with your ability to breastfeed your newborn. She is available to answer any of your questions and/or concerns. If necessary, you can arrange a personal consultation for additional support and guidance by calling the lactation department at Oakwood Hospital – Dearborn at 313.593.5929. For further details, refer to the “Breastfeeding” section of this guide. Nursery Pictures If you choose to have your baby’s picture taken, please dress them in the outfit of your choice and our staff will gladly take their pictures. If you desire your child to have a specific outfit on in the picture, you should put it in the crib that morning and notify the Nursery nurse. Read the “Baby’s First Picture” section of this guide for more information. NEONATAL SUPPORT SERVICES Occasionally, unexpected events may happen in a newborn’s life, which require advanced medical care. If a baby is born 48 prematurely or develops complications that need additional medical supervision, a “high-risk” pediatrician is available 24 hours a day. Should a baby require more intensive care, he or she will be transferred to the nearby NICU at Oakwood Hospital – Dearborn, where he will be under the expert care of our neonatology team. Refer to the “Neonatology Services” section of this guide for more information. PRE-REGISTRATION AT SOUTHSHORE Pre-registration will help minimize the amount of paperwork that needs to be done when you are admitted. Pre-registration may be completed online at oakwood.org/womens-health. Should you have any questions about your upcoming admission, please contact the Oakwood Hospital – Southshore Admitting Department at 734.671.3828 or the patient-account specialist at 734.671.3831. 49 CAFETERIA HOURS FOR YOUR VISITORS Oakwood Hospital – Southshore offers a walk-in cafeteria for your visitors to grab a snack. TOURS OF THE OB UNIT We would love to show you our beautiful Birthing Center. Please call 734.671.3950 to schedule a tour. 3 CHAPTER 3 TIME TO GO HOME! DISCHARGE INSTRUCTIONS After your discharge orders have been written, the following MUST occur before you and your child depart from the hospital. •M others and babies both must have discharge orders written by their physicians. • F ootprint sheet signed and ID bracelet removed. • B irth certificate must be completed. •C ircumcision, if applicable. If you desire circumcision for your newborn son, he will require additional observation and you will need additional teaching. • Infant cord clamp will be removed if it is completely dry and not moist. •N ewborn screening and blood tests required by the State of Michigan. • P lease bring your baby’s car seat — not the base — into the hospital before discharge). The infant must be properly secured in a car seat when leaving the mother-baby unit. •M om’s discharge instructions will be reviewed and signed. You will receive a copy. For further information regarding care for you and your baby once you return home, refer to the “Guide to Mother and Infant Care” section of this guide or your Patient Information Folder, given to you at the hospital. Your physician will give you specific discharge instructions regarding your activity, diet and self-care. Your physician will answer any questions that you may have at this time. WHEN TO CALL MOM’S DOCTOR Call your OB provider if MOM experiences any of the following: • F oul odor and drainage from episiotomy • B leeding or drainage from abdominal incision • F ever and chills — more than 100.5° F • S evere abdominal, chest or back pain • Inflamed or tender breasts • S hortness of breath • S welling, pain, redness or inflammation in one of your legs •D ifficulty urinating or burning during urination • The transport team will transport you via wheelchair to your vehicle. •D izziness, light-headedness or fainting • After you arrive home, you may have questions about you and your baby. • R edness, warmth, separation or foul odor at an incision site 50 • F eeling very sad, depressed, nervous or anxious for more than two weeks, and/or difficulty caring for self and/or baby WHEN TO CALL BABY’S DOCTOR Call your BABY’S provider if BABY experiences any of the following: • An underarm temperature above 99.5 or under 97.5 call MD (We discourage rectal temperature-taking and only teach underarm temperature-taking to parents.) • B reathing problems • Turning blue •U nusual rash the first five days of life for a formula fed baby or 3-4 seedy yellow stools per day for a breastfed baby, by day 4 •M om and/or dad’s emotions are getting out of control and you are worried about the safety of your child OAKWOOD LACTATION CENTER — BREASTFEEDING INFORMATION As professionals in the field of mother-baby care, we understand that the birth of your baby opens up a new world for women, complete with joys and fears, questions and concerns. One of the most sensitive issues new mothers face is learning how to breastfeed their babies. STAFFED BY CERTIFIED CONSULTANTS Certified lactation consultants staff the Oakwood Hospital – Dearborn Lacation Center. All have extensive experience working with breastfeeding mothers and are well prepared to help with questions or concerns. Breast feeding mothers who deliver at Oakwood Hospital – Dearborn will be seen by a certified lactation consultant after delivery. •C onstant crying or extreme fussiness; high-pitched cry •C hange in normal daily habits (sleeps a lot more or less; a good eater becomes a poor eater; poor sucking) • E xtreme lack of energy •C onstant cough • Yellowness of skin or whites of eyes •D rainage from eyes, nose, cord or circumcision area • Vomiting more than the usual spitting up • Vomiting blood or blood in stool • Watery stools (all of stool soaks through diaper like urine) or not having a stool at least once a day 51 PRENATAL SUPPORT You don’t have to wait until after you have your baby to visit the Oakwood Lactation Center. We provide support throughout your entire pregnancy by offering prenatal breastfeeding classes and personal consultations to prepare you before your baby is born. BREASTFEEDING GENERAL INFORMATION This section is intended to supplement the breastfeeding education you will receive during your postpartum stay. We encourage you to attend the Breastfeeding Class, as explained in the “Prenatal Education” section, and to ask the nurses taking care of you and your baby any questions you may have. After you are discharged from the hospital, you can call our Breastfeeding Helpline with your breastfeeding concerns. Breastfeeding Helpline In addition to followup calls and personal consultations, we have a Breastfeeding Helpline staffed by the lactation consultants. If you have any questions or concerns, you can call the free helpline at 313.593.5929. The helpline is answered: Monday through Friday 8 a.m. to 2 p.m. Personal Consultation Office Hours Consultants are available at the Oakwood Hospital – Dearborn campus. Please call 313.593.5929 to schedule an appointment Monday through Friday. Oakwood Personal Lactation Consultant Fees We also offer one-on-one consultations for interested mothers. • $ 55 for mothers who deliver their babies within the Oakwood Healthcare System • $ 70 for those outside of the Oakwood system • $ 30 for return visits Breast Pumps Oakwood Pharmacies with Medela Breast Pumps for PURCHASE ® Oakwood Hospital – Dearborn 313.593.7273 Oakwood Locations with Electric Breast Pumps For RENT Oakwood Hospital – Dearborn 313.593.7273 Breastfeeding Instructions • B reastfeeding can begin immediately following delivery. Colostrum is a thick, yellowish-colored breast secretion that is present during late pregnancy and for 24 – 72 hours after delivery. It is high in protein and antibodies. These antibodies help give the baby immunity to many illnesses. The production of breast milk follows the colostrum. 3 • Breastfeeding provides an opportunity for physical and emotional contact with the infant. During the first 24 – 48 hours, try to feed your baby at least every two hours. Mom should begin to monitor the length of time between feedings. Time from the beginning of a feeding to the beginning of the next feeding should be about two hours (e.g., The first feeding starts at 1 p.m., so the next feeding should begin on or before 3 p.m.). Interruptions and distractions should be minimized. • If your baby is sleeping when it is time to breastfeed, you can try to arouse the baby by opening her blanket, opening the diaper to see if a change is needed. Placing your baby skin to skin will encourage your baby to wake up and breast feed. Undress your baby down to their diaper, placing them on your bare chest and covering your baby with two receiving blankets to keep them warm. Soon you will be able to tell your baby’s 52 hunger signs: look for hand, eye and mouth movements. • It is very important to position your baby properly (you and your baby should be chest-to-chest) to prevent nipple soreness. It is recommended that you change nursing positions every few feedings. • You should support your breast with your fingers below the breast and your thumb above. Your fingers and thumb should not touch the areola (dark area surrounding nipple). • Gently touch your nipple to baby’s upper lip repeatedly until he opens mouth wide, then draw baby to breast. • Make sure that the baby is grasping most of the areola, not just the nipple. • Try to nurse on both breasts at each feeding, and begin each feeding on the breast on which you ended the previous feeding. •Before removing the baby from the breast, break suction on the nippple by slipping your finger into the corner of the baby’s mouth between the gums. 53 • Attempt to burp your baby before changing breasts and at the end of the feeding. • You may notice an increase in uterine cramping and vaginal discharge during breastfeeding. This is normal. • When showering or bathing, wash breasts with a clean washcloth, using plain water. Do not use soap. • Wear a properly fitted supportive nursing bra. Insert clean breast pads as needed. Do not use an underwire bra. • P lastic-lined breast pads have been associated with sore and/or cracked nipples and should therefore be avoided. Breastfeeding Discharge Instructions Once an adequate milk supply is established, allow the infant to feed for 10 to 20 minutes (or until infant has slowed swallowing) on the first breast and for as long as the infant desires on the second breast. Limiting nursing time may frustrate the infant and lead to engorgement. BREAST MILK STORAGE GUIDELINES (FOR A FULL-TERM, HEALTHY INFANT) Breast Milk Storage Method Length of Time Before Spoiling Freshly pumped or room temperature Up to 1 hour Refrigerated (never been frozen) Up to 48 hours Freezer inside of a refrigerator 3 weeks Freezer with a separate door from the refrigerator 3 months If milk is frozen in a separate freestanding deep freezer 5 – 6 months 3 Indicators you can use to determine an adequate intake of breast milk by your baby include: • B y day four, the baby’s urine should be pale amber, and there should be at least six to eight wet diapers in a 24-hour period. • B y about day four, breastfed babies should have at least three to four yellow seedy stools each day. Some babies pass a soft or liquid stool with each feeding, while others have bowel movements less frequently. • S wallowing is heard as the baby nurses. It may sound like a puff of air. Breasts should feel softer after feedings. Engorgement On the third or fourth day after delivery, the breasts may become hard, hot and uncomfortable. This swelling and discomfort is due to an abundance of breast milk and other fluids. Early and frequent feedings will help prevent engorgement. Sometimes it is necessary to remove a small amount of milk from the breasts in order to soften the areola so that the infant can latch onto the breast properly. To reduce the swelling of engorgement, you can: • Wear a supportive bra (no underwire). • F eed your baby or pump every two hours. To assist with milk let down prior to feeding or pumping. • If breasts are leaking, place warm compresses on them or take a warm shower for two minutes and/or massage breasts for five minutes. • If you are unable to express milk, apply cool compresses (ice, bags of frozen vegetables) no longer than 20 minutes. We discourage using frozen cabbage. Contact your physician regarding acetaminophen or ibuprofen for pain. Quick Tip! If you have any concerns regarding your baby’s intake, call the Breastfeeding Helpline at 313.593.5929 and/or baby’s doctor. Helpful Tips •D rink to thirst and eat a wellbalanced diet. •M ilk is produced on a “supply and demand” basis. Feed the baby on demand, initially every two hours (at least eight feedings in 24 hours). • B reastfeeding is not an effective means of contraception. You can get pregnant while nursing. Consult a physician when breastfeeding ... • B efore taking any medication (over-the-counter or prescription). Some medications can be passed to baby through breast milk. • If your breasts become red, warm or tender, and fever or flu-like symptoms develop. 54 • If nipples are cracked and bleed while breastfeeding and/or pumping. •N ever prop the baby’s bottle because she might choke as a result. • If baby does not have at least six wet diapers and three yellow seedy stools each day by four days. • B oth in the hospital and at home, discard any unused formula in the bottle after each feeding. Don’t store or add new formula to the same bottle. BOTTLE-FEEDING YOUR BABY • Your infant’s physician may recommend a specific formula for your baby. •D uring the first few days, most infants take about 1.0 to 1.5 ounces at each feeding. As the baby tolerates more formula, advance feedings by 0.5 ounce according to the infant’s needs (every three to four hours). • The bottle should be held so that the nipple and the neck of the bottle are kept full of formula. This helps prevent the baby from swallowing air. • If babies eat too much or too fast, they may spit up. If this happens, slow down the feeding by periodically removing the bottle from the infant’s mouth and by burping the baby more frequently. • B abies should be burped after taking each 0.5 to 1.0 ounce of formula. To burp, infant may be placed on your lap in a sitting position or in an upright position over your shoulder. 55 • After discharge, prepare the formula in accordance with the manufacturer’s instructions. • S terilization of bottles and nipples should be done in accordance with instructions from your infant’s physician. •N ever warm bottles in a microwave, because heating is not uniform and may result in hot spots or exploding bottles. • P repared formula should be refrigerated and used within the following time frames: • Formula prepared from powder should be refrigerated and used within 24 hours. • F ormula prepared from concentrated liquid or ready-to-use liquid should be refrigerated and used within 48 hours. • If a prepared formula bottle is unrefrigerated (left out at room temperature), it should be used immediately. • Always check expiration date on can of formula. •M any formula companies offer clubs for new parents. Check the manufacturer’s Web site for money-saving coupons. COLIC About one-fifth of all babies develop colic, typically between the second and fourth weeks of life. have someone else look after baby while you take a break and leave the house. No matter how frustrated you feel, never shake your baby. Shaking may cause blindness, brain damage or even death. GUIDE TO MOTHER AND INFANT CARE All of us at Oakwood extend our sincere congratulations on the birth of your little one! Use the following mother and infant care information as a guide during your transition as a new mother. However, it should not replace the instructions of your healthcare provider. 3 Colic is defined as crying that is intense and persistent (lasting more than a few consistent hours). It generally occurs in the evening hours and usually resolves or improves during the day. It can be accompanied by screaming, extending or pulling up legs, gas and distended stomach. As your baby matures, colic generally stops by three months. If you think your baby has colic, consult his doctor to rule out any medical reason for the crying. Your baby’s doctor may suggest one or more of these ideas. • If nursing, eliminate milk products, caffeine, onions, cabbage and other like foods from your diet. If bottle-feeding, baby’s doctor might suggest using a formula that does not contain cow’s milk. • Walk your baby in a body carrier to soothe her. • R ock him gently in your arms. • Introduce an orthodontic-friendly pacifier to your baby. • L ay your baby tummy down across your knee and gently rub the baby’s back. • Swaddle baby in a blanket. • Take her for a ride in the car, with your baby safely secured in her car seat. • When you are feeling tense or anxious, MOTHER CARE AFTER DELIVERY Immediately after the delivery of your baby, your body will begin working to return to its prepregnancy state. Following is a list of issues you can expect to experience as your body goes through this natural process. Nutrition and Breastfeeding It is important to eat a well-balanced meal with foods from all four food groups. If you are breastfeeding, you will need to add about 300 to 500 calories per day to your diet in addition to what you were eating before you were pregnant. Give your body time to get back to normal before worrying about shedding that pregnancy weight. Remember if you are 56 breastfeeding, what you ingest may be passed along to your baby in your breast milk. Therefore, please contact your provider if you have any questions about what is safe. Your physician will advise you regarding the use of vitamins. Weight Postpartum weight loss varies from woman to woman, but a 10-pound weight loss after delivery is about average. It may take up to six months to return to your prepregnancy weight. This is not the time to start dieting. Consult with your healthcare provider before trying to lose weight. If you want to diet and are breastfeeding, it is best to wait until your baby is at least three months old. During those first two months, your body needs to recover from childbirth and establish a good milk supply. Breastfeeding helps to deplete the fat deposited during pregnancy. Women who nurse their infants burn about 500 more calories per day than those who don’t. The woman who nurses her baby also has increased needs for specific nutrients. Rest Periods for Mom After hospital discharge, try to have someone to help with the cooking, housework and care of other children, when possible. It is important to get as much rest as possible to aid in your recovery. A good rule of thumb is to SLEEP WHEN YOUR BABY SLEEPS. A full return to normal activity should be restricted until at least six weeks. During this time, you should rest as much as possible and avoid strenuous work. Constipation To avoid constipation, an adequate fluid intake, along with proper diet and exercise (when permitted by your physician), are important. Your physician may order a stool softener while you are in the hospital. Be aware that pain medication that contains codeine can also be constipating. Urination The postpartum woman may find she is urinating frequently and in large amounts. This increased urinary output may last up to five days. Perspiration Episodes of profuse perspiring, which frequently occur at night, gradually subside and do not require any specific treatment. Postpartum perspiring can last as long as three weeks. Vaginal Discharge Your uterus will shed its thick lining in a discharge called lochia. This is similar to the flow during a menstrual period. Initially, the flow is red. After about three days, the flow lessens and becomes a pale pink or brown color. About 10 to 14 days (two weeks) after the delivery, the flow will turn a yellow-white color. Fluid Intake Nursing mothers should drink about 8 to 10 glasses of liquid (preferably water) per day, avoiding caffeine. Non-nursing mothers should also increase their fluid intake during the postpartum period. 57 Return of Menstruation If you are bottle-feeding, your menstrual periods will usually return in six to eight weeks after delivery. If you are breastfeeding, your periods may not return for several months, possibly not until you 3 stop breastfeeding. Breastfeeding is NOT a reliable source of birth control. Episiotomy Care A small incision may be made between the vagina and the rectum to enlarge the vaginal opening, so the baby can pass through the birth canal more easily. The episiotomy is repaired with stitches that dissolve in about four to five weeks. While in the hospital, the episiotomy site will be checked daily by your nurse to ensure that the incision is healing properly. During the first 24 hours, an ice pack may be used to decrease the discomfort and swelling of the incision site. You may be given Tucks pads (witch hazel) and Dermoplast spray to decrease discomfort of the episiotomy and/or hemorrhoids. ® ® Sitz Bath Your nurse will give you instructions on how to use the portable sitz bath. Written instructions from the manufacturer are included. You should start using it 24 hours after delivery. It is usually recommended that a sitz bath be used at least twice a day to promote healing and to decrease the discomfort of sutures and/or hemorrhoids. Peri-Bottle A peri-bottle is a plastic squeeze bottle used to direct a stream of warm water over the perineum (located near the vagina) each time you urinate or have a bowel movement. The bottle is held at a 45-degree angle above and two to three inches away from the perineum. Remember, the flow of water should go from the front of the perineum to the back. Sanitary Pads Sanitary pads should be changed often — each time you use the bathroom, after breastfeeding and whenever they are soiled. Baby Blues Sixty to 80 percent of new mothers get the “baby blues.” Symptoms include weepiness, irritability and fatigue (similar to PMS symptoms) and are related to shifting hormones. These symptoms can last up to two weeks. If these symptoms continue after two weeks, please consult with your physician. Ten to 20 percent of new mothers experience a more serious reaction called postpartum depression. Postpartum depression is treatable, so call your OB provider if you think you are experiencing any symptoms of depression. Symptoms can include fatigue, hopelessness, 58 irritability, sleep or appetite disturbances, poor concentration, confusion, agitation and being overly concerned for the baby. If you should experience feelings of harming yourself or your baby, go to the emergency department immediately. a reddened area with a yellow or white raised center. About 30 percent of newborns will develop a red bumpy rash on their face. It is normal in newborns and will disappear without treatment after a few weeks or months. INFANT CARE AFTER DELIVERY Diaper Rash Diaper rash often may be avoided by changing the infant’s diaper as soon as possible after each bowel movement or urination. When soiled, cleanse diaper area with very gentle soap and water or infant diaper wipes. If a diaper rash should develop, many physicians will recommend using soothing products, such as Desitin or A+D Original Ointment. If a diaper rash persists or becomes severe, contact your physician. Skin Care • When bathing, use a mild soap on infant’s body only; wash face with plain water. Powder, oils and creams are not recommended. ® ® Mongolian Spots Mongolian spots are dark blue or purple irregular spots usually located on the lower back and/or buttocks of dark-skinned infants of all races. These marks will disappear or lighten within the first four years on their own. Not all spots disappear. Milia Milia are tiny oil glands that are pinheadsized white spots mainly on the infant’s nose and/or chin. Do not pinch the spots or apply any harsh chemical or special soap. They disappear spontaneously within a few weeks. Erythema Toxicum Erythema toxicum, also called newborn rash, is a temporary rash that appears as •D ry, peeling skin is common for most babies. If your baby’s skin is very dry, you can use small amounts of nonperfumed, hypoallergenic lotions, although peeling may continue. If you see deep cracks in the skin, petroleum jelly works best on those areas. • Jaundice is the yellow color to the skin that is often seen in the first few days after birth. The yellow color is due to high amounts of bilirubin in the blood. It usually reaches the greatest intensity at two to four days of life. Please see your baby’s physician should visible jaundice increase after he has been discharged from the hospital. Sleeping Most newborns sleep at least 16 hours a day, though some sleep more and some will sleep less. As your baby grows older, the amount of sleep required will decrease. You may encourage longer periods of sleep at night by keeping your baby awake in the evening. HOW MUCH SLEEP BABIES AND TODDLERS NEED 59 Age Hours When 1 week 16 ⁄2Anytime 1 month 151⁄2Anytime 3 months 15 6 months 141⁄4101⁄2 at night, 33⁄4 during the day (3 naps) 9 months 14 12 months 13 ⁄4101⁄2 at night, 31⁄4 during the day (1 – 2 naps) 18 months 13 101⁄2 at night, 21⁄2 during the day (1 – 2 naps) 2 years 13 101⁄2 at night 21⁄2 during the day (1 nap) 1 10 at night, 5 during the day (3 naps) 101⁄2 at night, 31⁄2 during the day (2 – 3 naps) 3 The safest sleeping position for your baby is on the back — NOT on the stomach. Sleeping on the stomach increases the chance of sudden infant death syndrome (SIDS). Do not put any thick blankets or stuffed animals in the crib with the baby while she is sleeping. It is not recommended that baby sleep in the same bed with mom and/or dad. 3 In fact, recent studies found that the risk of baby’s suffocating is 40 times Safe Sleep Recommendations • In a crib, portable crib or bassinet, the mattress should be firm and tight-fitting. Only a tight-fitting sheet should cover the mattress. • Always place your baby on their back to sleep, even when they can roll over. •D o NOT place anything in the sleep area (no pillows, blankets, comforters, soft bumper pads, stuffed animals or toys). • K eep your baby’s face uncovered during sleep for easy breathing. Use a wearable sleeper or sleep sack to keep the baby warm and safe. •D o NOT smoke while you are pregnant and do not expose your baby to secondhand smoke after they are born. •D o not overheat the baby by dressing him or her in too much clothing or keeping the room too warm. •U se a pacifier at nap and night time for the first year. If you are breast feeding, delay pacifier use until good breast feeding has been established (usually about one month). • Allow for “tummy time” daily when your baby is awake and alert and you are watching them. If your baby falls asleep on their tummy, place them on their back in a safe place. higher if she sleeps in a bed with an adult rather than a crib. Also, keep the baby’s room on the cool side for sleeping (67° to 71° F). Cord • The infant cord clamp will be removed if it is completely dry and not moist. You likely will be advised to apply a cotton ball dipped in alcohol to the stump at least once or twice daily. Your physician will instruct you if he wishes you to care for the cord in a different way. • The infant’s diaper should be folded below the cord, to prevent rubbing and to promote drying. The skin around the cord should not be red, swollen or inflamed. There should be no yellow, green or foul-smelling drainage from the cord site. Report any of these signs of infection to baby’s physician. The cord usually falls off in ten days to three weeks. There may be a few drops of blood on the diaper when the cord falls off. Don’t worry; this is a normal occurrence for newborns. A sponge bath can be given until the cord falls off and the area is healed. 60 •D on’t be afraid to touch or move the cord; this will not hurt your baby. Your baby may fuss only because the alcohol feels cold. The cord usually falls off in approximately two weeks. Notify your baby’s doctor if it hasn’t fallen off by one month after delivery. • Anterior Fontanel: The “soft spot” is found on the top of the head, near the forehead. It is present to allow the brain to grow rapidly during the first year of life. This area normally closes over with bone between nine and 15 months of age. Head •M olding: During the birth process, to pass more easily through the birth canal, the head is molded due to the overriding of its soft, moveable bones. This molding often creates a temporarily elongated head. The normal shape of the head is usually regained after several weeks. Thrush Some babies develop a yeast infection in the mouth known as thrush. The baby will have white patches in the mouth, on her tongue and/or inside the cheeks. These white patches may appear to be formula but will not be easily removed. Contact your baby’s physician if you are unsure. If you are breastfeeding, contact your OB physician as well, because you will need to be treated also. • F acial Asymmetry: The uneven appearance of the face of some infants is caused by the position of the baby before birth. The lopsided appearance usually disappears spontaneously in a few weeks. •C ephalhematoma: Occasionally, a black and blue discoloration and swelling will be noted on the infant’s head several hours after birth. This is above the skull bones and does not affect the brain. This cephalhematoma takes a few weeks to disappear. 61 Burping Burping your baby helps to remove any swallowed air from his stomach. You can burp your child in the middle and at the end of the feeding, or just at the end, depending on how he is doing with feeding. To burp your baby you can either place him face down across your lap or you can put his head on your shoulder. Then rub or pat his back. It is not unusual to see a small amount of spitting up when the baby burps. Crying Crying is your baby’s way of saying she is hungry, tired, wet, too hot or cold, bored or frustrated. You may learn what each cry means for your baby. Nails and Ears Most babies need their nails cut or filed soon after birth. After you get home, you can trim your baby’s nails. You can use a soft emery board or baby manicure scissors with rounded tips. A good time to do this is when the baby is sleeping. Nails should be cut straight across (not rounded at the edges) to prevent infection. Clean your infants’ ears with a corner of washcloth — never use a cotton-tipped swab. Eyes •D rainage: The eye treatment given to the baby shortly after birth occasionally may irritate the infant’s eyes and result in some lid swelling or eye discharge. This usually lasts only a day or two and does not require treatment. When cleaning the infant’s eyes, wipe from the inside to the outside of the eye, using a clean area of the washcloth for each eye. •M ovements: Infants can see quite well at 12 to 18 inches. They can follow a face for a short distance after they have focused on it. • Subconjunctival Hemorrhage: Occasionally a small, curved, reddened area may be seen in the whites of the eyes as a result of the birth process. This is common and of no significance. The redness usually disappears within a week to 10 days. After discharge from the hospital, if your baby develops a yellow or greenish eye discharge, contact your physician. •C olor: Some babies will be born with either blue, brown or gray eyes depending on their skin color. Final eye color is not certain until the child is at least six months old. 3 Stools The dark, thick, tar-like substance in the newborn’s intestinal tract is called meconium. The baby will usually have this type of stool during the first several days of his life. The stool will then begin to turn a brownish-green color and by the fourth or fifth day will be a yellowish color. Breast-feeding babies normally have frequent, yellow, seedy stools that have little odor. Formula-fed infants have more of a formed stool than breastfed babies and usually have fewer bowel movements, about once or twice a day. Notify your baby’s doctor if baby seems to strain uncomfortably when passing a stool. Genitalia • Female: Baby girls often have swollen labia and may have a white mucous discharge from the vagina for several days after birth. Occasionally the discharge is blood-tinged from the effects of the mother’s hormones and is of no concern. •U ncircumcised Male: When cleaning baby boys, be sure to lift the scrotum and penis and remove any stool. No special care is needed for the newborn uncircumcised infant. Do not retract the foreskin. Your physician will instruct you when the foreskin can be retracted when the infant is older. 62 sleeping. NEVER put an infant to sleep on her stomach. Your infant should never be left unattended on any surface from which she might fall (such as a changing table). Remember, your baby needs “tummy time” everyday while she is awake. This helps her back and abdomen muscles develop equally and to reduce the likelihood for the head to develop a flat spot from always lying on her back. •C ircumcised Male: Wash the circumcised penis by gently sprinkling soapy water over the penis followed by clean rinse water. Typically you will be advised to apply petroleum jelly and a gauze pad to the penis after each cleaning and/or diaper change for a few days. A yellow substance may form on the tip of the penis and is part of the healing process. If your baby had a plastic ring applied to his penis during circumcision, it usually drops off five to eight days after the circumcision. Notify baby’s doctor if the ring does not fall off after 10 days. IMMUNIZATION SCHEDULE Below is a commonly used immunization schedule. Discuss needed immunizations with the baby’s physician. Please visit http:// www.immunize.org/cdc/schedules for the most current and detailed immunization schedule. Nose The bulb syringe is used to remove secretions from the infant’s nose and mouth. Your nurse will instruct you in its use. Infant Safety After discharge from the hospital, your infant should be placed on her back while DEPARTMENT OF HEALTH AND HUMAN SERVICES • CENTERS FOR DISEASE CONTROL AND PREVENTION Recommended Immunization Schedule for Persons Aged 0-6 Years – UNITED STATES 2012 Age Vaccine Hepatitis B Rotavirus Birth HepB 1 2 4 6 9 12 15 18 19–23 2–3 month months months months months months months months months years HepB 4–6 years HepB RV RV RV Diptheria, Tetanus, Pertussis DTaP DTaP DTaP Haemophilus influenzae type b Hib Hib Hib Hib Pneumococcal PCV PCV PCV PCV Inactived Poliovirus IPV IPV DTaP DTaP PPSV IPV Influenza IPV Influenza (Yearly) Measles, Mumps, Rubella Varicella Hepatitis A MMR MMR Varicella Varicella HepA Dose 1 Meningococcal HepA Series MCV4 Va M s Range of recommended ages for all children Range of recommended ages for certain high-risk groups Range of recommended ages and certain high-risk groups Visit http://www.cdc.gov/vaccines/recs/schedules for up-to-date immunization information. 63 DEVELOPMENTAL MILESTONES FOR YOUR CHILD By 18 months, most infants: •C an walk alone Each child varies in speed of achieving certain milestones. Average development for an infant or toddler is as follows: •D rink from a cup By 3 months, most infants: •M ake cooing sounds • S mile back at you • R espond to sounds •M ove limbs symmetrically • L ift head and chest when lying on stomach By 6 months, most infants: • R oll over • S ay 5 – 10 words • S cribble with crayons •C an stack 2 blocks By 24 months, most infants: • K ick large balls • S ay 2 – 3 word sentences •C an climb steps • Turn pages in a book • S it with a little help By 36 months, most infants: • Walk up stairs • B abble — make 2 sounds • Wash and dry hands • Transfer objects from hand to hand • R ide a tricycle • Turn their head toward sound •O pen doors By 9 months, most infants: • S it alone • Verbalize toilet needs •C rawl • S ay mama or baba 3 • P oint to familiar objects Please contact your child’s physician if you have concerns regarding baby’s development. • F eed self with fingers • R espond to their name By 12 months, most infants: • P ull themselves to a standing position • Walk with support • S ay 2 – 3 words • Wave bye-bye • F ollow simple directions 64 FEEDING SCHEDULE The following is an example feeding schedule for the introduction of food. There is some variability in advice among physicians and recommendations may vary with individual circumstances. Between four to six months is the ideal time to begin introducing solid foods to your infant. Food should not be introduced until a baby is at least 4 months old unless specifically directed by your baby’s physician. It may take a few days for your infant to become accustomed to the texture and taste of food. Remember, the amounts shown below are simply averages. You should always seek the advice of your baby’s physician if you have specific questions. 1– 4 Months: • B reast milk (preferable) or formula with iron • B reastfed newborns need to eat 8 to 12 times in a 24-hour period (usually once every 1.5 to 3 hours) with one longer interval of 4 to 5 hours •N ewborns will generally feed about 20 minutes on each breast 4 Months: • B reast milk (preferable) or formula with iron • Infant cereal (start with rice), 2 – 4 tablespoons (25 – 50 grams) per day. Add breast milk or formula to the cereal. Use a spoon. It’s best to wait until 12 months of age to introduce wheat-based cereals • Wait 4 – 5 days and then go to a different variety of cereal (oatmeal, barley) 6 – 7 Months: • B reast milk (preferable) or formula with iron •C ereals: (oatmeal, rice, barley) average 4 – 6 tablespoons (50 – 75 grams) per day • Vegetables: average 4 – 6 tablespoons (50 – 75 grams) per day. Begin with yellow and orange vegetables, then proceed on to other vegetables and noncitrus fruit SAMPLE FEEDING SCHEDULE FOR FORMULA-FED BABY 65 Age Amount Per Feeding Feeding Frequency Newborn 2 – 3 ounces On demand 1 month 4 ounces Every 3 to 4 hours 2 months 4 – 6 ounces 6 to 7 feeds every 24 hours 4 months 6 – 8 ounces 4 to 5 feeds every 24 hours 6 months 8 ounces 3 to 4 feeds every 24 hours 9 months 8 ounces 3 to 4 feeds every 24 hours 1 year Can replace formula with whole milk 3 • F inger foods, such as crackers or teething biscuits, may be started • K eep a bottle handy. A mouthful of dry snacks can cause a choking incident • F ruit or fruit juices: average 2 – 4 tablespoons (20 – 25 grams) of fruit and 2 ounces (60 mL) of noncitrus juice per day • Introduce baby to a “sippy” cup 9 – 10 Months: • B reast milk (preferable) or formula with iron •C ereals: average 6 – 10 tablespoons per day • Vegetables: average 10 – 12 tablespoons per day • F ruit: average 6 – 10 tablespoons per day 7 – 9 Months: • B reast milk (preferable) or formula with iron • J uice: 4 ounces per day •C ereals: average 6 – 10 tablespoons per day • S tarches (potato, rice, noodles, spaghetti): 1 ⁄4 cup a day • Vegetables: average 6 – 10 tablespoons per day • F inger foods, such as Cheerios , cheese, smooth yogurt •N oncitrus fruit: average 6 – 10 tablespoons per day • J uice: 2 ounces (60 mL) per day • E gg yolk (whites after 1 year of age) scrambled with breast milk or formula at an average of 2 tablespoons per day • F inger foods such as crackers, teething biscuits, bananas or toast • P uréed meat: 1 – 4 tablespoons • E gg yolk: on average 1 egg per day • P uréed meat: 1 – 4 tablespoons ® 10 – 11 Months: • B reast milk (preferable) or formula with iron •C ereal: average 8 tablespoons per day • Vegetables: average 12 – 14 tablespoons per day • F ruit: average 7 tablespoons per day • J uice: average 4 ounces per day 66 • E gg yolk: average 1 egg per day • R aisins •M eat: average 1 ounce ground meat per day • Whole peas and corn • Starches, such as potato, rice, noodles, and spaghetti, at an average of 1⁄4 cup per day • F inger foods, such as cheese, cottage cheese, Cheerios and smooth yogurt ® •C ontinue use of a “sippy” cup 1 Year: • B reastfeed as long as you and your baby are comfortable • F ormula can be replaced with whole milk (supplemented with vitamin D) • Any healthy food is usually fine as long as a child cannot choke on it. Keep a balanced diet •C ontinue to wean baby from bottle to “sippy” cup. The goal is to be fully weaned by 15 months of age Be sure to avoid potential CHOKING HAZARDS, such as: • P opcorn • Whole grapes and olives • P eanut butter • Sausage/hot dogs • Raw carrots or celery •N uts • Jelly beans •H ard candies • Apple chunks •C heese cubes • Untoasted bread •G um • Ice cubes •M arshmallows 67 These items should be avoided until your baby’s doctor advises you that these items are safe. Also, many physicians may recommend that you wait until your baby is at least 12 months old to feed him foods that could cause an allergic reaction. Common foods in this category are: • E gg whites • Wheat • Corn • S oy products •C itrus products (such as orange and lemon juice) • Dairy products (including milk) • F ish • S hellfish • P eanuts and peanut products • Tree nuts • F resh strawberries CHILD SAFETY BABYPROOFING YOUR HOME Over two million children are injured or killed by hazards in the home each year across the country. Many of these incidents can be prevented by using simple childsafety devices (see suggestions below). But remember that no device is completely childproof and that the best protection is to watch your child closely at all times. • S afety latches and locks (placed on cabinets and drawers). These help prevent children from gaining access to medicines and household cleaners, as well as knives and other sharp objects • B uy a crib that meets current safety standards, including slats no more than 23⁄8 inches apart. Cribs built after 1985 should meet this standard. Be sure your crib has not been recalled. New federal safety standards prohibit the manufacturing or sale of drop side rail cribs. Drop side rail cribs have been associated with infant suffocation and strangulation deaths. Please consider getting a new crib for your baby. If that is not possible, the AAP and CPSC encourage you to check the crib frequently to be sure all hardware is secured tightly and that there are no loose, missing or broken parts. •N ever put a baby to bed with a bottle since it’s possible she could choke • S afety gates. These keep children away from stairs and rooms that have hazards in them. Do not purchase accordion-style gates, however • Window-blind cord shortener. Use on any window-covering cord to help prevent strangulation from the loop of the cord (especially if you have a window near the crib) •D oor stops and door holders. Help prevent small fingers from being pinched. Make sure the rubber end of the door stop is securely fastened and cannot be removed (choking hazard) •C ooktop/stove protectors. Knob covers and stovetop shields help prevent burns • Toilet lock. Prevents child from obtaining access to the toilet (for drowning and sanitation purposes) • L earn how to introduce your baby to your pet(s) • P rominently display the number of Poison Control Center (800.222.1212) • WATCH YOUR BABY! The best defense is to watch your baby closely at all times •D oorknob covers and door locks MEDICINE CABINET • Anti-scald measures. Set water heater no hotter than 120° F to prevent burns from hot water. A bath thermometer ensures bath water is a safe temperature (or use your wrist to check temperature before placing child in the tub). Never fill the tub while the baby is inside. Keep your child away from hot beverages (don’t hold your baby while also drinking a cup of coffee) • S moke and carbon monoxide detectors. Essential safety devices for protection against fire-related injuries and furnace malfunctions. Alarms can double your chance for survival • Window guards and safety netting. These prevent falls on balconies and decks •C orner and edge bumpers. Use on tables and fireplace hearths to soften falls •O utlet covers or plates. Protect children against electrical shock. Watch children to make sure they do not remove individual plug covers 3 It is important to contact your baby’s physician before giving any medication. The following is a list of items that you might want to have readily available: • Infant/children’s acetaminophen (such as Tylenol ) or ibuprofen (Advil , Motrin ) ® ® ® Caution: In May 2011, a move to one standard concentration of acetaminophen (160 mg/ 5 ml) medication for infants and children was announced. Up to this point, two concentrations have been available (children’s syrup and infant drops). Both old and new concentrations may be found on store shelves and in homes. Please double check packaging carefully to find the correct concentration and dosage or contact your physician before dosing your child. Never give any medication without your physician’s permission. • R ehydration fluid (such as Pedialyte ) for treatment of diarrhea and/or vomiting ® •D igital thermometer 68 • Antibiotic cream for scrapes, etc. (such as Bacitracin or Neomycin ) ® ® •H ydrogen peroxide (for cleaning cuts) •C alamine lotion for itchy rashes • R ubbing alcohol, to clean thermometers and to dab on umbilical cord •C alibrated spoon or dropper for administering medicine (important to clean thoroughly with soap and water after each use) • P ABA-free sunscreen (high SPF) • S terile, easy-release bandages •N asal aspirator (bulb) to clear a stuffy nose • B aby teething-pain reliever gel •O ther items as recommended by your baby’s doctor 69 GLOSSARY OF TERMS AFTERBIRTH The vascular structure developed in pregnancy through which nutrition and excretion takes place between mother and baby. Also known as the placenta. AFTERPAINS The cramping discomfort felt by some women after the birth of a child, which is caused by contractions of the uterus. AMNIOCENTESIS Procedure to screen for Down’s syndrome, trisomy 18 and other chromosomal abnormalities. AMNIOTIC FLUID The water-like fluid contained in the amniotic sac (bag of water) surrounding the baby. It permits movement of baby, absorbs shock and prevents loss of heat. ANALGESIA Relief of pain without loss of consciousness. ANESTHESIA Loss of sensation in part or all of the body. ANESTHESIOLOGIST Physician who specializes in administering local and general anesthetics to produce varying types of anesthesia. ANTEPARTUM The period of pregnancy from conception to birth. ute and five minutes of age. A rapid assessment is made of color, respiratory effort, heart rate, muscle tone and reflexes. AREOLA The pigmented tissue around the nipple. BLADDER An organ that collects and discharges urine. BRAXTON-HICKS CONTRACTIONS Intermittent, irregular, painless contractions of the uterus occurring after the third month of pregnancy, which do not establish a pattern of regularity. They may be unnoticeable until near your due date. CATHETERIZATION Emptying of the bladder by insertion of a small, pliable tube through the urethra. CENTIMETERS Unit of measure used to describe progression in dilation of the cervix. CERVIX The neck of the uterus (womb), which thins (effaces) and opens (dilates) during the labor process. CESAREAN SECTION Surgical removal of the baby through the abdominal and uterine walls. ANUS Outlet of rectum located directly behind/below the birth outlet. CHLOASMA Areas of pigmentation that sometimes appear on the cheeks and forehead of the pregnant woman. Also called “mask of pregnancy.” APGAR Numeric expression describing the condition of the newborn at one min- CIRCUMCISION Surgical removal of the foreskin of the penis. 70 COCCYX Tailbone. The small bone at the end of the spinal column. COLOSTRUM The first secretions of the breast that may be expressed during pregnancy and a few days after delivery until milk comes in. It has a high protein content and provides some immunity properties for the baby. COMPLETE Refers to complete dilation of the cervix. A woman is said to be complete when the cervix is dilated to 10 centimeters. In terms of inches, the completely dilated cervix usually measures about four inches in diameter. CONTRACTION Tightening and shortening of the uterine muscles during labor causing effacement and dilation of the cervix and contributing to the downward and outward descent of the baby. CROWNING Appearance of the presenting part of the baby at the perineum during the second stage of labor. DELIVERY Expulsion, or birth, of the fetus with the placenta and membranes from the mother. DILATION Gradual opening and drawing up of the cervix to permit passage of the baby. EDC Expected Date of Confinement (due date). EFFACEMENT The flattening or thinning and shortening of the cervix during labor. EMBRYO The developing infant from conception to the end of the eighth week. ENDOMETRIUM The mucous membrane that lines the uterus. ENGAGEMENT The entrance of the presenting part of the fetus into the pelvic cavity. ENGORGEMENT An excessive fullness — usually referring to the breasts at the time a nursing mother’s milk comes in. 71 EPISIOTOMY An incision made into the perineum prior to delivery to enlarge the opening of the vagina for delivery of the baby. FALLOPIAN TUBES The two small tubes extending from either side of the uterus toward the left and right ovary. These tubes receive the ripened ovum from the ovary. Fertilization occurs here. FALSE LABOR Irregular uterine contractions that are not associated with progressive stages of labor. FERTILIZATION Fusion of the sperm and ovum normally occurring in the fallopian tubes; conception. FETAL HEART TONES (FHT) The baby’s heartbeat as heard through the abdominal wall in the later part of pregnancy. FETUS The developing infant from the ninth week after fertilization through the 40th week or until birth. FOCAL POINT A tool used during labor, which enables the laboring patient to externalize her attention, thereby reducing perception of pain. FONTANEL Soft spot on the head of all newborn babies, which allows for the molding necessary during birth. FORCEPS Obstetrical instrument used occasionally to aid in delivery. FUNDUS The portion of the uterus farthest from the opening. GBS Group B Streptococcus (GBS) is a type of bacteria present in the vagina or digestive tract in about 20 percent of pregnant women. GESTATION The condition or period of carrying a baby in the uterus. GLUCOSE SCREEN Test given to pregnant women between weeks 24 and 28 to test for gestational diabetes. GRAVID Pregnant. GROUP B STREPTOCOCCUS (GBS) This is a type of bacterium that is present in the vagina or digestive tract in about 20 percent of pregnant women. Usually the bacteria do not cause serious illness; however, they can be passed on to the fetus during delivery. HEMORRHOIDS Varicose veins of the rectum. HYPERVENTILATION Over breathing resulting in an increased amount of air and a reduction of the carbon dioxide level. IMPLANTATION The attachment of the fertilized ovum (egg) to the uterine wall. INDUCTION Initiation of labor by the use of medications. INVOLUTION Return of the female organs to their non-pregnant state after delivery. It takes approximately six weeks. IV Hospital abbreviation for intravenous. To give a sterile fluid into a vein for the purpose of nutrition, hydration or medication. JAUNDICE The yellow color to the skin that is often seen in the first few days after birth. The yellow color is due to high amounts of bilirubin in the blood. LIGHTENING The relief of pressure upon the diaphragm and upper abdomen as a result of the descent of the presenting part of the fetus into the pelvic cavity. May occur from two to three weeks before the onset of labor. LINEA NEGRA A dark pigmented line extending upward along the middle of the abdomen, found frequently in pregnant women. LOCHIA The vaginal discharge of blood and mucus following the delivery of the baby. It becomes paler and diminishes in quantity and finally ceases. MATERNAL SERUM SCREENING Screening available in the first or second trimester of pregnancy to evaluate risk of Down syndrome, trisomy 18/13, and spina bifida. MECONIUM The dark green or black substance present in the baby’s large intestine at birth that the baby passes for the first few days of life. MOLDING The shaping of the baby’s head to adjust itself to the size and shape of the birth canal. LABOR A three-stage process of childbirth. OBSTETRICS Branch of medicine covering care of women in pregnancy, childbirth and postpartum. FIRST STAGE OF LABOR From onset until the cervix has thinned (effaced) and opened (dilated) to 10 centimeters. OVARY The female glands of reproduction in which the ovum is developed and released. SECOND STAGE OF LABOR From full dilation of the cervix to birth of the baby. OVULATION Monthly release of ripe ovum from the ovary. THIRD STAGE OF LABOR From delivery of the baby to delivery of the placenta. OVUM The female egg cell. LACTATION Process of producing and supplying milk. LET-DOWN REFLEX The baby’s sucking causes the release of a hormone and results in muscle contractions that force milk into the ducts leading to the areola and nipple area of the breasts; milk is let down. OXYTOCIN Drug useful in starting or aiding in labor. Also used to stimulate uterine contractions. PARA The term used to refer to past pregnancies that have produced a viable infant whether or not the infant survived. 72 PELVIS The bony ring that joins the spine and legs. Its central opening forms the walls of the birth canal. PERINEUM External tissues surrounding the anus and vulva. PLACENTA The vascular structure developed in pregnancy through which nutrition and excretion takes place between mother and baby. Also known as the afterbirth. POSTMATURE Infant born at the beginning of the 43rd week of pregnancy or later. POSTPARTUM Following childbirth, usually referring to the first six to eight weeks after delivery. PREMATURE INFANT An infant born before the 37th week of gestation. PRENATAL Before giving birth. PRESENTATION The part of the baby’s body that appears at the cervix at the beginning of labor. PRIMIPARA Woman having her first baby. PUERPERIUM The period from delivery until the uterus has regained its normal size — usually about six weeks. QUICKENING The first feeling by the mother of fetal movement, usually occurring between the fourth and fifth month of pregnancy. RH FACTOR An additional blood factor that is present in 85 percent or more of the population. When it is absent, the person is said to be Rh negative. Rho GAM An injection given to certain mothers at 28 weeks of pregnancy AND within 72 hours after a birth, miscarriage or amniocentesis to prevent Rh sensitization in mother. SHOW A blood-tinged discharge from the vagina prior to labor. 73 SPERM A spermatozoon, the mature male cell. STATION Term used in labor to denote position of baby relative to mother’s bony pelvis (a measurement of the progress of labor). STRIAE GRAVIDUM White lines seen in the skin of the abdominal wall and, at times, in the upper thighs and breasts of the pregnant woman. TERM Completed cycle of pregnancy. TRANSITION The shortest and most difficult phase of the first stage of labor. It is characterized by long and strong contractions. TRIMESTER A stage or period of three months duration. UMBILICAL CORD Cord connecting umbilicus of baby to placenta. UMBILICUS Naval, belly button. URETHRA A tube that carries the urine from the bladder to the outside of the body. UTERUS Organ of gestation — consists of a pear-shaped fundus and a narrower, lower portion called the cervix or neck. VAGINA The curved canal, five or six inches long, from the vulva to the uterus. VERNIX CASEOSA A cheesy substance covering the skin of the baby. It provides protection and lubrication of the baby’s skin. VERTEX Top or crown of head. VIABLE Applies to the child at birth or at the point in fetal development when there is a possibility of survival outside the uterus. OAKWOOD TELEPHONE NUMBERS Apnea Clinic for Infants & Children 313.593.7135 Infant Bereavement Breast Pumps (Electric) for Rent 734.467.5588 Oakwood Hospital & Medical Center Oakwood Hospital & Medical Center 313.593.7273 313.593.7167 Breast Pumps (Medela) for Purchase Oakwood Southshore Medical Center Oakwood Hospital & Medical Center 313.593.7273 Car Seat Checks 313.586.5488 Center for Exceptional Families (program for children with special developmental needs) 313.966.1960 Development Assessment Clinic (DAC) for Infants and Children 313.593.7135 Oakwood Annapolis Hospital 734.671.3950 Lactation Center (Breastfeeding Helpline) 313.593.5929 Michigan Perinatal Associates, P.C. 313.593.5957 Midwest Medical Center – Dearborn 313.581.2600 “New Mom” Blues Program 313.436.2932 Oakwood Annapolis Hospital Durable Medical Equipment 800.752.2273 Administration Fetal Diagnostic Unit 313.593.7521 Admitting Foundation Billing and Patient Accounting (to make a donation to Oakwood) 734.467.4161 313.586.5234 Cafeteria Genetic Counseling 313.593.8483 734.467.4179 Our 365 734.467.4000 (baby pictures) 800.433.0855 Health Link Emergency Transportation 313.292.9981 Home Health Care Services 800.757.7711 734.467.4175 734.467.4062 General Information Gift Shop 734.467.4169 Guest Relations 734.467.4111 Labor and Delivery 734.467.4266 74 Maternal Care Unit Spiritual Support 734.467.4200 313.593.7200 Medical Records/ Birth Certificate Information Volunteer Services 734.467.4375 Nursery 734.467.4261 Pediatric Unit 734.467.4399 Spiritual Support 734.467.4057 Volunteer Services 734.467.4171 Oakwood Health Line/Physician Referral 800.543.WELL Oakwood Hospital & Medical Center Administration 313.593.7125 Admitting 313.593.8525 Billing and Patient Accounting 313.593.7136 Birth Certificate Information 313.593.7630 Cafeteria 313.593.3047 Oakwood Laboratories 800.245.3725 Oakwood Southshore Medical Center Administration 734.671.3802 Admitting 734.671.3828 Billing and Patient Accounting 734.671.3831 Cafeteria 734.671.3812 General Information 734.671.3800 Gift Shop 734.671.3692 Guest Relations 734.671.3643 Labor and Delivery 734.671.3950 Medical Records/ Birth Certificate Information 734.671.3846 General Information Mother-Baby Unit 313.593.7000 734.671.3950 Gift Shop Nursery 313.593.7190 734.671.3621 Guest Relations Spiritual Support 313.593.7160 734.671.3647 Labor and Delivery Volunteer Services 313.593.7500 734.467.4183 Medical Records Parents Supporting Parents 313.593.7781 Mother-Baby Unit (NICU support program) 313.593.8750 313.593.7630 Prenatal Education Classes & Tours NICU 313.593.7435 Oakwood Annapolis Hospital 734.467.5588 Nursery Oakwood Hospital & Medical Center 313.593.7855 313.593.7694 Pediatric Unit Oakwood Southshore Medical Center 313.593.7600 75 313.593.5865 734.671.3950 Transcultural & Interpreter Services 800.543.WELL The Center for Women’s Health 800.543.WELL Breast Care Center 313.438.7715 Children’s Services 313.593.5885 Fetal Diagnostic Unit 313.593.7521 Genetic Counseling 313.593.7521 Gynecology Oncology 313.593.8620 Healthy Hearts for Women 313.586.5496 Infertility Services 313.299.6650 Michigan Perinatal Associates, P.C. 313.593.5957 Neonatology 313.593.7490 NICU 313.593.7435 OB/GYN Medical Education 313.593.7819 Program for Minimally Invasive Gynecology 734.454.8001 Reproductive Endocrinology 313.299.6650 Urogynecology 313.982.0200 Women’s Health Web Site oakwood.org/womens-health 76 COMMUNITY TELEPHONE NUMBERS BIRTH CERTIFICATE/LEGAL AID/ PATERNITY City Clerk Office DEARBORN 313.943.2012 CHILD & INFANT SERVICES Autism Society of Michigan 517.882.2800 Baby Hotline 313.961.BABY WAYNE 734.722.2204 Child Care Coordinating Council 313.259.4411 TRENTON 734.675.8600 Children’s Special Health Care Services 800.359.3722 Social Security Administration 800.772.1213 DNA — Diagnostics for Paternity 800.613.5768 Family Medical Leave Act 866.487.9243 Friend of the Court Legal Aid 313.224.5300 (free to low-cost legal information) 313.964.4111 BREASTFEEDING Cord Blood Registry (cord blood preservation) 888.932.6568 Cord: Use (cord blood donation) 888.267.3873 Early On Program Referral (screening for children birth to three years) 800.EARLY-ON (327.5966) Family Parenting Helpline 313.961.BABY (2229) Great Start 866.667.8278 Oakwood’s Breastfeeding Helpline 313.593.5929 Head Start Program LaLeche League 800.525.3243 734.727.7612 Medela Breast Pumps 800.835.5968 NWHIC Breastfeeding Helpline 800.994.9662 (educational support for children three to four years old) National Association for the Education of Young Children (daycare referrals) 800.424.2460 Parent Help Line (answers questions about parenting issues) 800.942.HELP Viacord (cord blood preservation) 877.343.4698 77 COUNSELING AND SUPPORT DOMESTIC VIOLENCE Alcoholics Anonymous 313.831.5550 Family Violence Help Line (24 hour) 800.996.6228 Alcohol Treatment Hotline (24 hour) 800.ALCOHOL First Step American Cancer Society 800.227.2345 Big Brother Big Sister of Metro Detroit 313.309.0500 Depression After Delivery 800.944.4773 Development Centers, Inc. 313.531.2500 (shelter, crisis intervention, 24-hour help) 734.722.6800 Haven Crisis Line 248.334.1274 Child Protective Services 800.716.2234 EDUCATION AND UNEMPLOYMENT EVENSTART (tutoring for GED) Guidance Center 9 to 5 JOB PROGRAM HOTLINE 800.522.0925 734.785.7700 Downriver 734.785.7705 (ext. 7112) (postpartum support) Michigan Department of Community Health (general information) 800.537.5666 (phone counseling for smoking) 800.834.4781 Western Wayne County 734.728.3400 FOCUS HOPE (GED and training) 313.494.4600 Narcotics Anonymous 248.543.7200 or 800.543.HELP (4357) MEDICAL INSURANCE National Council on Alcoholism and Drug Dependence 800.622.2255 (low-cost or free health insurance for uninsured children and pregnant women) Postpartum Support International 805.967.7636 Pregnancy & Newborn Health Education Center 888.MODIMES SIDS — Michigan SIDS Alliance 800.331.7437 SIDS Institute 800.232.SIDS Smoking Cessation Material (free information to help individuals stop smoking) 800.537.5666 Starfish Family Services (counseling, crisis intervention) 734.728.3400 Healthy Kids/Pregnant Women/MI Child 888.MI.CHILD (888.988.6300) 313.961.BABY (2229) Medicaid Ombudsman for Wayne County 734.284.6999 Medicaid Assistance Program (free counseling and resources) 800.803.7174 Michigan Department of Community Health (low-cost/free health insurance for pregnant women) 517.335.8024 or 517.373.3500 Michigan Family Independence Agency (low-cost/free health insurance for pregnant women) 517.373.2035 Wayne County Health Department 734.727.7000 Wayne County Community Behavioral Health (24-hour mental health support) 313.224.7000 78 NUTRITION FOCUS HOPE (free food for children up to 6 years old) 313.291.4888 Women, Infants & Children Nutritional Service (WIC) 800.262.4784 RECREATION Positive Parenting infant massage 313.593.7694 Twins Magazine 888.558.9467 SAFETY Consumer Product Safety Commission 800.638.8095 Poison Control Center (24 hour) 800.222.1222 U.S. Product Safety Commission (recalls) 800.638.2772 TRANSCULTURAL Arab Community Center for Economic & Social Service (A.C.C.E.S.S.) 313.842.7010 English Language Institute (learn English as a second language) 313.577.2729 79 WOMEN’S HEALTH WEB SITE WHAT IS ON THE AWARD-WINNING OAKWOOD WOMEN’S HEALTH WEB SITE? OAKWOOD.ORG/WOMENS-HEALTH View these features: •O akwood Baby Gallery (newborn pictures of babies born at any Oakwood hospital) • Interactive tools and calculators (pregnancy weight gain, estimated due date, women’s cancer and cardiac risk assessments, ovulation timing estimator, etc.) • S ign up for the free monthly Friends of Oakwood eNewsletter •O rder flowers online and view Oakwood Gift Shop hours • F ind a Women’s Health physician — links to individual physician Web pages • S ee pictures of our OB units and staff • F requently asked pregnancy-related questions and answers • Ask us a question or contact us •G lossary of frequently used women’s health terms •N otice of special events sponsored by Oakwood •D escription of Oakwood Women’s Health programs and services •C hecklist of recommended annual Women’s Health exams and screenings •O nline preregistration for an admission, procedure, exam, test, etc. at the hospital •C hildhood immunization schedule • F ind a children’s physician at Oakwood • P renatal class offerings and schedules •M aps of Oakwood facilities (internal and external) •O B unit visiting hours and guidelines 80 SUGGESTED RESOURCES Title Planning Your Pregnancy and Birth Author American College of Obstetricians and Gynecologists Title Caring for Your Baby and Young Child (birth to age 5) Author American Academy of Pediatrics Title Baby Care for Beginners Author Frances Williams www.aap.org American Academy of Family Physicians 800.274.2237 www.aafp.org American College of Obstetricians and Gynecologists 800.762.2264 www.acog.org Title Baby Bargains (ways to save up to 50% on items for children ages 0 – 2) Author Denise and Alan Fields Car Seat Safety Title Toddler Bargains (ways to save up to 50% on items for children ages 2 – 5) Author Denise and Alan Fields Club Mom T he Nursing Mother’s Companion Author Kathleen Huggins Consumer Product Safety Commission Title Title Detroit Kids Catalog — A Family Guide for the 21st Century (family activities in southeast Michigan) Author Ellyce Field 81 American Academy of Pediatrics 847.434.4000 www.nhtsa.org/cps •G eneral information and installation tips. www.clubmom.com • F REE program to recognize and reward moms for what they do every day. www.cpsc.gov/cpsclist.asp • B e among the first to know about new recalls and consumer news (can designate children’s products only). Sign up here to get free notices delivered electronically. Cord Blood Registry 888.932.6568 www.cordblood.com Cord: Use Cord Blood Donation (free, for listing on National registry) 877.826.7387 www.corduse.com Viacord Cord Blood Preservation 866.565.2241 www.viacord.com Family Medical Leave Act www.dol.gov/esa/whd/fmla •C overed employers must grant an eligible employee up to a total of 12 workweeks of unpaid leave during any 12-month period for the birth and care of the newborn child of the employee. Free Magazines for Expectant Mothers/Parents • B aby Talk Magazine www.babytalk.com • American Baby Magazine www.americanbaby.com The Humane Society www.hsus.org/ace/13946 • Tips on introducing your baby to a pet. Michigan Education Savings Program www.misaves.com •O ffered through the Michigan Department of Treasury, provides families a smart and flexible way to save for their children’s futures. Program benefits include tax advantages, flexible, low-cost and experienced managers. National Women’s Health Information Center 800.994.WOMAN www.4women.gov • F ree support and information for women. Request a free women’s wellness datebook. Upromise www.upromise.com • A free program to earn dollars toward a tax-free college savings account just by shopping at local stores. You and Your Family www.youandyourfamily.com • F ree coupons and product discounts related to pregnancy and infants. 82 PREGNANCY WEIGHT GAIN 83 Keep track of your weight gain throughout your pregnancy (use same scale each week). Call your doctor if you experience sudden weight gain (more than five pounds in one week). Week Prepregnancy 4* 5 Weight FIRST TRIMESTER (week 1 – 13) Gain about 1 pound per month. 6 7 8 9 10 11 12 13 14 15 16 SECOND TRIMESTER (week 14 – 27) Gain about 0.5 pound per week. 17 18 19 20 21 22 23 24 25 26 27 28 29 30 THIRD TRIMESTER (week 28 – 40) Gain about 1 pound per week. 31 32 33 34 35 36 37 38 39 40 * Positive pregnancy test. 84 NOTES 85 86 87