labor and delivery Mother-Baby Resource Guide

Transcription

1 labor and delivery Mother-Baby Resource Guide

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3 NEW BEGINNINGS FAMILY BIRTH CENTERS The birth of a baby is an extraordinary experience for any parent. St. Luke s New Beginnings Family Birth Centers are proud to be trusted by more Lehigh Valley-area patients than any other hospital in the region. Our state-of-the-art birthing units, in Allentown and Bethlehem, offer parents the comforts of a safe family-centered atmosphere to welcome their new babies into the world. The units consist of patient labor-delivery-recovery (LDR) rooms along with patient postpartum rooms, Jacuzzi for moms in labor, a triage area, a family waiting area and operating and recovery rooms for Caesarean deliveries. To encourage family time and support for new parents, visiting hours are unlimited, and a multi-tiered infant security system is in place for the safety of the newborns. The nursing staff is highly skilled in labor, postpartum and newborn assessment and care. They are also specially trained in Advanced Fetal Monitoring. Board-certified anesthesiologists are available 24 hours a day, and board-certified obstetricians make daily rounds. Once your baby is born, pediatricians also make daily rounds and internationally board-certified lactation consultants and Mother/Baby Educators are available to help new mothers who choose to nurse their newborns. Where do I Come When I am in Labor? First, call your doctor, and follow his or her directions. When you are told to come to the hospital, you may be instructed to come through the Emergency Department. If so, parking is available across the street in the emergency overflow area (Bethlehem Campus). The staff of the New Beginnings Family Birth Center will come to take you to the unit or the Emergency Department staff will bring you to us. Your partner or support person can stay with you. Comfortable clothing for them is advised. Where Will I Go in the Hospital During Labor? You will be in labor in one of St. Luke s private birthing rooms. Your support person may stay with you. Fetal monitoring will be done for at least some portion of your labor. The amount of monitoring you will need is determined by your doctor and your nurse. Where Will Delivery Occur? Your delivery may happen in the birthing room, or in the delivery room (surgical suite). This decision will be made by your doctor. Your support person may stay with you. The type of delivery (vaginal or Caesarean birth) will be determined by your doctor. The type of pain management you may use will be determined by you and your doctor. Caesarean births happen in the delivery room (surgical suite) on the birthing unit. The presence of your support person during a Caesarean birth will be determined by you, the reason for the Caesarean birth, and your doctor along with the anesthesiologist and the neonatologist. LABOR AND DELIVERY G-1

4 What Does Bonding Mean? Bonding means that you and your baby will be given time to get to know each other shortly after birth. Who May be Present During the Birth? Your partner or other support persons, your children, grandparents or others of your choice. Please discuss the number of people who can be present for the birth with your doctor. Those present should be healthy (free of fever, rashes, colds and flu). Children must have their own support person. Having Your Baby in Your Room After you transfer to your postpartum room, you are encouraged to keep your baby with you as much as you want. The baby can go to the Newborn Nursery as you desire. Your rest is important after the birth of the baby. Your nurse will check with you frequently and will be available to assist you in the care of yourself and your baby. Your baby s doctor may want your baby in the nursery in the morning so he or she can examine the baby. Visiting Policy Visitors are permitted at any time. People visiting should be free of any illnesses. Plan to have another adult with your other children when they come to visit. Please let your visitors know that you need to rest and ask them to keep their visits short. Smoking is prohibited in all areas of the hospital for patients and visitors. Visiting children should not be in the hallways or waiting room unattended. Learning About Caring for Yourself and Your Baby On-unit classes are offered daily in the Family Waiting Room on the Bethlehem Campus. Attendance at classes is strongly encouraged by your doctor and your nurses. Classes offered are: Mom/Baby Care, Bottle Feeding, and Breastfeeding. These classes provide you with your discharge instructions. Your nurse and the Mother/Baby Educator (at Bethlehem Campus) will be available to help with questions or special needs. Written discharge instructions are given to you before you go home. The nurses at the Allentown Campus will provide you with individualized information about your care and that of your baby. G-2 LABOR AND DELIVERY

5 PACKING FOR THE HOSPITAL CHECKLIST For labor: Prepared Childbirth book Socks Lotion or oil for massage Tennis balls in sock (for back labor) Hair bands, etc. Camera, video camera Phone list (including work and home) Lip balm (non-scented) Extra pillows (no white cases please) Cornstarch Completed birth plan, as discussed with your health care provider (see form on next page) For baby: Outfit for pictures (optional) Outfit to go home in (including a hat) Rear-facing car seat Blankets for the ride home Basket for footprints, etc. (optional) Baby book (optional) Baby announcements (optional) Toy or photo for in crib (optional) For mom: Nightgown/pajamas Robe Slippers Toiletries (shampoo, conditioner, brush, makeup, deodorant, toothbrush, toothpaste) Nursing bra/regular bra Comfortable maternity clothes to wear home LABOR AND DELIVERY G-3

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7 birth plan guide Dear Expectant Mom: These are some things that will be helpful for you to think about during your pregnancy. Please give these things some thought and fill in the information below. Your doctors, nurses and educators who you will come in contact with during your pregnancy will give you information that will help you make these decisions. Call your insurance company to assist you in completing the discharge information (see page B-9). Be aware that circumstances may arise that could change your plan. Please review this birth plan with your doctor and bring it to the hospital for review by our staff at your pre-birth visit to share with those who will be taking care of you. Your Name: Due Date: Doctors: No. of Children: Inquiries from others about your admission to the hospital or present condition will be handled by: My support person Nursing staff Other: Other requests: During labor, if your condition allows, would you be interested in: Having intermittent fetal monitoring Listening to music Being up and/or walking Having anesthesia Having medication Using a birthing ball Using the shower/jacuzzi Using a squatting bar for pushing Take time to consider who you will want to support you through your labor and birth and who you want to share your birth experience with. Discuss these needs with your doctor. My support person(s) in labor will be: You will be asked to share this information with the nurse who admits you to the birthing unit. The support person(s) you choose to be present during your birth will be asked to sign a consent that explains his or her role. LABOR AND DELIVERY G-4

8 birth plan guide During the birth of my baby, I have the following requests: To use a mirror while pushing To have my children present (Children need their own support person separate from the person who is supporting you.) To have my children in the room soon after the baby is born To have immediate skin-to-skin contact with my baby To not be separated from my baby To initiate breastfeeding immediately To initiate breastfeeding within the first hour after birth To have my support person help the nurse with giving my baby its first bath During my hospital stay, I have the following requests: To have my baby with me at my request To return the baby to the nursery at my request To breastfeed on demand and 7-12 times in 24 hours To have footprints in my baby s book To have my male infant circumcised Not to have my male infant circumcised Other requests related to my baby: My pediatrician is aware of my wishes Comprehensive mom and baby care education is provided during your hospital stay. Please list any individualized needs you may have. Normal discharge after an uncomplicated delivery is on Postpartum Day 2, Cesarean birth is on Postpartum Day 3. If you have any special needs related to discharge or know what time you plan to go home, please let us know. Sincerely, The Staff of St. Luke s New Beginnings Family Birth Center You may contact St. Luke s Mother/Baby Educator (Bethlehem Campus) at or Please feel free to call with any questions. PATIENT SIGNATURE : PHYSICIAN SIGNATURE : REVIEWED BY: DATE: G-5 LABOR AND DELIVERY

9 CONSENT FOR BIRTHING ROOM ADMISSIONS Allentown Campus Bethlehem Campus Quakertown Campus Other Regulations governing admission of birthing room support persons Support persons who meet the following conditions may be present during the birth of the baby, except as hereinafter provided. 1. He/she has the approval of the attending physician and/or anesthesiologist for the delivery. 2. He/she will accept the directions and decisions of the attending physician. 3. If general anesthesia is indicated in the delivery room, the support person may accompany the patient to the delivery room with approval of the birthing team. 4. If requested to leave the delivery he/she must accept that decision of the attending physician. 5. He/she must sign the following agreement and the patient must consent here to. 6. He/she agrees that Hospital personnel are not responsible for breakage or damage of camera/video equipment during use. He/she understands that no pictures or videos of the birth are allowed. 7. He/she has been offered the opportunity to wear protective attire for the delivery. I, as the mother, approve of the support person s attendance. Witness to Signature Signature Patient I agree to the above regulations and absolve the hospital, its employees and staff and the attending physician of any liability caused by my presence in the Delivery Room. Witness to Signature Witness to Signature Witness to Signature Witness to Signature Witness to Signature Signature Signature Signature Signature Signature Father of the Child Support Person (when applicable) Support Person (when applicable) Support Person (when applicable) Support Person (when applicable) LABOR AND DELIVERY G-6

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11 IS THIS LABOR? How will you know when labor has begun? A woman s body usually gives clues that labor is beginning. You must learn to recognize these clues. As your baby matures, your body prepares for labor and birth. You may notice several signs. These may be different for each woman or even for each pregnancy. They can happen in any order and take place in a few hours or over several days. Some of the more common signs are: A sudden burst of energy, perhaps after feeling very tired. No one knows why this happens. It could be that you want to prepare a place for your baby, or it could be the energy to get you through labor. Lightening (dropping), or the baby moving down into the pelvis. Your baby seems lower; you may breath more easily; you may need to urinate more often. If this is not your first pregnancy, your baby may not drop until you are actually in labor. An upset stomach or diarrhea. These may be signs that your body is getting ready for labor. Blood-stained show. A plug of mucous fills your cervix (the opening to the uterus) during pregnancy. This plug, called show, may look cloudy. It could be streaked with either bright red or darker, dried-looking blood. You might notice show before labor begins. Sometimes, after a vaginal (internal) exam by your caregiver, some mucous may be discharged. This can also happen during labor. Preterm Labor (labor before 37 weeks) Babies need about 40 weeks to grow, mature and be ready for birth. Before this time, the lungs and other important organs may not work properly. If you have signs of labor before 37 weeks, it could mean your baby may be born too soon. Contact your caregiver right away. You and your baby may need special care. Do not wait to see what will happen in a day or two. If you have contractions that come closer than ten minutes apart for over an hour, call your caregiver you may need to go to the hospital. Early Labor Late in your pregnancy, your caregiver may check for some signs of approaching or beginning labor. You might also be checked for these in early labor: Ripening (softening) of the cervix. During pregnancy, your cervix remains firm and closed. The cervix must soften, or ripen, before it can thin and open for your baby to pass through. Ripening usually takes place several days or weeks before labor begins. Sometimes this can happen in a few short days. Effacement (thinning) of the cervix. This is the shortening or taking up of the cervix. The muscles around the opening to the uterus are pulled up into the lower part of the uterus. It is something like the shortening of the neck of a balloon as it is inflated or the shortening of a turtleneck sweater. Effacement is measured in percentages from 0 percent (thick) to 100 percent (very thin). Sometimes as the cervix becomes thinner, or effaced, it begins to dilate or open. LABOR AND DELIVERY G-7

12 Dilatation (or opening) of the cervix. When your cervix has softened and thinned out, it then opens for your baby to pass through. Dilatation is measured in centimeters. One centimeter means that the cervix has just begun to open. At 10 centimeters, the cervix has opened completely so your baby can move down into the vagina (birth canal). Early effacement and dilatation (up to two to three centimeters) may take place before labor begins, or it may not happen until you are actually in labor. Often women having their second or later baby will efface and dilate at the same time. Most caregivers will do pelvic exams to determine effacement or dilatation. Some do them beginning around the 36th week of your pregnancy and others wait until later. Check with your caregiver if you have questions about when or if pelvic exams are done. Labor Contractions During your pregnancy, you might have noticed your uterus (womb) becoming tight and hard. For some women, this feels like the baby is balling up. These tightenings are called Braxton-Hicks contractions. Like with any muscle contraction, the uterus shortens and becomes hard. The Braxton-Hicks, or practice, contractions prepare your uterus for labor. As your pregnancy progresses, these contractions can become stronger, longer, more frequent and more uncomfortable until you recognize them as labor. To decide if labor has started, keep track of how long your contractions are and how often they come. Put your hand on your abdomen to feel for hardness. Write down the time when a contraction begins and when it ends. Note when the next contraction begins to see how many minutes pass between the beginning of one contraction and the next. Your caregiver will want to know how long it is from the start of one contraction until the start of the next and how long your contractions are lasting. Contractions farther than 10 minutes apart or those that are irregular (with no pattern of how far apart they are) may just be more Braxton-Hicks contractions or very early labor contractions. Go about your regular routine until they either stop, become closer together or more regular. If this is your first baby, your caregiver may want you to call when the contractions have been about five minutes apart, lasting about 60 seconds, for over an hour. If you have had a baby before, you will probably be asked to call sooner. Ask your caregiver when you should call if you think you are in labor. G-8 LABOR AND DELIVERY

13 One of the hardest things about deciding if you are in labor is the mixed messages your body may send. You may have heard of false labor. Your body acts as if it is in labor, only to stop later. Some ways you can tell the difference between true and false labor are: True Labor Contractions get stronger, longer and closer together. Contractions are in a regular pattern or regularly get stronger, longer and closer. Walking or changing position makes them stronger. Usually felt beginning in the back, moving around to the front and low down in the abdomen. Cervix thins and opens (as determined by pelvic exam done by caregiver). Water may break. Bloody show can occur and increase throughout labor. False Labor (Braxton-Hicks) Contractions remain same strength, length, distance apart. Contractions may be irregular. Walking or changing positions does not make them stronger and can make them go away. Usually felt mainly in the front and up high. Many women wonder whether or not labor is beginning. They worry about when to call their caregiver. Contact your caregiver if you have concerns or questions. Rupture of Membranes Sometimes labor begins when the membranes or bag of waters breaks. This does not usually happen until a woman is having regular, strong contractions. But it can also happen before labor begins. If your water breaks, your may notice a trickle of fluid. It can come and go as you walk or change position. Or you may notice a sudden gush of fluid from the vagina. It can be hard to decide if your membranes are leaking or if it is urine. Remember that the odor of urine is different from the odor of amniotic fluid. Even if you don t know what amniotic fluid smells like, you will recognize the smell of urine. Let your caregiver know right away if you think your water has broken or is leaking. He or she will want to know what time it broke, the amount of fluid, the color and if a specific odor was noted. All women will have some of the same sensations during labor, yet each woman will be different. Labor, while it is similar for all, it a unique experience for each woman. Some women will have many signs that labor is getting closer. Others will suddenly find themselves in labor. Whatever your situation, you can be aware of what is happening to your body. Childbirth preparation classes will help answer the questions you have about labor and birth. All the preparation your body does for labor may seem to take forever. It may seem as if nothing is happening and labor will never begin. Remember that the final days your baby grows and matures are important. These last few days are a time to enjoy this pregnancy and the special time with this baby. LABOR AND DELIVERY G-9

14 THE FACTS ABOUT INDUCTION AND AUGMENTATION OF LABOR Like many women, you are probably hoping for a fast, easy labor. But as you know, every labor is different and presents its own challenges. Sometimes labor needs assistance either getting started or becoming more effective. Beginning a labor that has slowed or stopped is called augmentation. Starting a labor is called induction. Why is Labor Induced? The most common medical reason for inducing labor is going past your due date, or post-dates. It is important that the due date is reliable. Induction too early can mean a premature birth, which carries risks of its own. Current medical guidelines recommend that induction not be done before the 39th week of pregnancy, except for very specific medical reasons. Many caregivers recommend induction one or two weeks past a reliable due date. Others do tests to make sure the baby is doing well, and if so, take a more wait-and-see approach. If your bag of waters breaks (membranes rupture) and you don t have contractions, there is a small risk of infection. If you are near term, some caregivers recommend inducing labor right away. Some wait from 12 to 24 hours to see what will happen naturally. Others monitor for infection, and induce if signs appear. It would be helpful to discuss ahead to time what your caregiver would recommend if this situation should happen to you. Then you know your options. Diabetes, pre-eclampsia, heart disease or kidney problems are conditions that may influence your caregiver to suggest inducing labor. Sometimes fetal testing shows that the baby is stressed or not getting enough nutrients through the placenta to grow well. If you have genital herpes and there are no active lesions, some caregivers recommend induction at term. If you have had difficult deliveries, fetal loss or your baby might have special needs after birth, induction may be considered. If it appears you or your baby would benefit from an induction of labor, you should discuss the risks and benefits with your caregiver. Over the last decade the induction rate has nearly doubled. Part of the reason for the increase has to do with the way in which doctors are handling post-date pregnancies. Inductions are generally not done for convenience. It is better to let your baby decide when it is time to come. Induction is not a routine procedure, and should be done only for sound medical reasons. Current medical guidelines recommend that induction only be done when the benefits of delivery outweigh the risks of continuing pregnancy. Methods of inducing or augmenting your labor will be individualized to your needs and will be explained by your doctor. Why is Labor Augmented? Your labor may be augmented if your contractions are not close enough or strong enough to cause timely dilating or effacing of your cervix. This may be done by breaking your water or with medication. G-10 LABOR AND DELIVERY

15 CAESAREAN BIRTH A Caesarean birth is delivery of the baby through an incision in the lower part of your abdomen. In most cases this will be done on the birthing unit. St. Luke s makes every effort to make your birth special, no matter how your baby is delivered. The decision for a Caesarean birth can be made by your doctor prior to labor or when you are in labor. The reasons that a Caesarean birth may be performed include: The baby is in the wrong position, including not head down (breech), face presentation or transverse presentation (lying side-to-side). Changes in the baby s heartbeat, which can mean that the baby is not tolerating labor. The bag of water is broken for an extended amount of time and the baby has not been born. Medical conditions of the mother, including diabetes and hypertension. Baby is too large to fit through the pelvis, or the pelvis is too small. The opening to the uterus will not dilate (open). The placenta covers the opening to the uterus (placenta previa) or comes away from the wall of the uterus before delivery (placenta abruption). The umbilical cord comes through the birth canal in front of the baby (prolapsed cord). If you have a planned Caesarean, you will arrive on the birthing unit about two hours prior to the time your surgery is scheduled. (See the PAT Admission Instruction sheet that follows.) One of our staff will prepare you for your birth. Preparations may include: Completing of admission information. Taking your vital signs. Listening to your baby s heartbeat. Shaving or clipping the hair on your lower abdomen and upper pubic area. Inserting an intravenous line. Placing the elastic stocking (worn prior to and after surgery). Placing a catheter (tube) in your bladder. Taking a blood sample. A visit from your anesthesiologist. Performing an ultrasound to check your baby s position. Your support person may stay with you during your preparation and will join you again in the operating room after you have your anesthesia, as long as you are able to have anesthesia such as an epidural or spinal, which allows you to be awake for the birth. Your doctor will give you general anesthesia (where you are asleep for the surgery) if the need arises. If you have general anesthesia, your support person will not be in the operating room for the birth, but will still be able to go to the nursery with your baby, as long as the baby goes to the newborn nursery. LABOR AND DELIVERY G-11

16 In the operating room, you will be covered with surgical drapes and will have a heart and blood pressure monitor connected to you. There will be several doctors and nurses in the room to care for you and your baby. The room is usually cool, and you may hear sounds such as heart monitors and suction. There will be a warm bed prepared for your baby. Your support person will be brought into the room once the drapes are in place and your doctor is ready to start your surgery. You will spend one to two hours in the birth room recovery area (Bethlehem Campus). Your family may visit you there. At the Allentown Campus, you will recover in your postpartum room. The nurse caring for you will check your vital signs and the dressing on your abdomen often. The nurse will communicate with your anesthesiologist about your need for pain medication. After your time in the recovery room (Bethlehem Campus), you will be taken to your postpartum room where you will spend the rest of your hospital stay. After your baby is born, your support person can accompany your baby and your baby s nurse to the newborn nursery. He/she can make phone calls, relax or admire your baby until you are brought out of the operating room. You can reunite in the PACU (post anesthesia care unit). After the birth, as long as your baby is healthy, you and your support person can see and touch the baby. You may also see and hold the baby in the recovery room. You also may breastfeed if you desire. We encourage you to breastfeed the baby at this time, as your baby is usually awake and interested in feeding at this time. Your nurse will help you get started. G-12 LABOR AND DELIVERY

17 Admission Instructions PAT Caesarean Births Day of Surgery Bethlehem Campus Report directly to the Priscilla Payne Hurd Pavilion (PPHP) 3rd floor by utilizing the PPHP elevators. PPHP-3 is a locked unit. Ring the button outside the unit and someone will let you in and direct you from there. Allentown Campus Report to Admissions. You will be directed to the birthing unit from there. Date: Time: Dietary Restrictions: (It is vitally important that you follow these instructions exactly). Scheduled for morning surgery: DO NOT eat or drink anything after midnight (NO WATER!). You may have light dinner early in the evening up to 9 pm and then liquids until midnight. Scheduled for afternoon surgery: Clear liquids between 12:00 midnight and 8 am. DO NOT EAT ANYTHING AFTER MIDNIGHT. (Clear liquids consist of 7-Up, ginger ale, tea, black coffee, Jello, broth or Tang. You may use sugar. NO milk or milk products or orange juice. NO chewing gum or candy. Failure to follow these instructions could result in the cancellation of your surgery. Do not smoke or drink alcohol for 24 hours before surgery. LABOR AND DELIVERY G-13

18 Personal Belongings: Do NOT wear makeup, lipstick or nail polish (on fingers or toes). Leave valuables, such as jewelry and money, at home. Bring a bathrobe, slippers and personal care items. Medications: Check with your doctor about taking any medicines. Your doctor may want you to continue your routine medications (e.g., blood pressure, heart pills, etc.) the day of the surgery. Pills may be taken with a few sips of water (if so ordered). Inform the nursing staff upon your arrival about any medications taken the day of surgery. If you have diabetes and are taking medicines, including insulin, please be sure to contact your doctor for insulin dosage and other orders prior to admission to the hospital. Other: If your spouse, partner or significant other plans to attend your Caesarean birth and has any questions, you may call our Just-In-Time Information Line at Inform your doctor if you develop a cold, sore throat, cough, fever or other illnesses before your surgery. If you have any questions regarding these instructions, please call: Pre-Admission Testing Center at (Bethlehem Campus) or (Allentown Campus) or the Priscilla Payne Hurd Pavilion (PPHP) 3rd floor (Bethlehem Campus) at G-14 LABOR AND DELIVERY

19 CONSENT FOR ADMISSION OF SUPPORT PERSON TO OPERATING ROOM IN CESAREAN SECTION DELIVERIES I, hereby apply for permission of to be present for the Cesarean Birth. In support of such application, we agree to the following: I agree to follow all instructions from the attending Obstetrician and Anesthesiologist, Neonatologist and nursing personnel of the delivery/operating room, and will do nothing which in the sole judgement of that person would interfere with the proper patient care. I understand that if my presence in the delivery/operating room at any time appears to the attending Obstetrician, Anesthesiologist, and Neonatologist to be detrimental to the care of the patient or the functioning of the Hospital, I will leave at once on request. I understand and release St. Luke s Hospital and the physicians and nursing personnel in the delivery/operating room of all claims with respect to injury or damage sustained by me in the delivery/operating room, including, but not limited to any injury or damage resulting from fainting, cardiac difficulty, or nervous reaction. I as the mother approve of the support person s attendance. I understand that Hospital personnel are not responsible for breakage or damage of camera/video equipment during use. I understand that no pictures or videos are allowed during the birth. I have been offered the opportunity to wear protective attire during the surgery. Signature Date Witness to Signature (Signed) Support Person Signature Date Witness to Signature (Signed) Mother of Child LABOR AND DELIVERY G-15