How To Care For A Pregnant Woman At Women And Infants Hospital

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1 we Prenatal guide welcome you

2 Welcome from the President Preparing for Your Hospital Stay Interpreter Services Childbirth Education Classes Childbirth Options Anesthesia Antenatal Care Unit Neonatal Intensive Care Unit Choosing a Pediatric Care Provider Parenting Newsletter Website Arriving at the Hospital When to Arrive Checking In What to Bring Parking Admissions Forms Cord Blood Banking During Your Stay Patient Information Length of Your Hospital Stay Visiting Hours Hospital Safety Patient Representative Women & Infants Auxiliary Use of Video and Photography Equipment Smoke- and Tobacco-Free Campus Participation in Research Programs Baby Care Reference Guide Rooming-In Feeding Your Baby Treatments and Vaccinations Car Seat Safety Legal and Business Information Basic Daily Charge Itemized Charges Insurance Coverage Financial Counseling Consent Forms Campus Map Telephone Directory

3 Dear Patient, Congratulations on your pregnancy, we are so pleased that you have chosen Women & Infants Hospital for your birth. We know the birth of a baby is a very special occasion, and we are honored to be a part of it. We have created this book to help you prepare for your stay. We want to help you prepare for the birth of your baby and offer a full range of pregnancy and parenting classes. For more information or to arrange a tour of the hospital, call Health Education at (401) A virtual tour is available at womenandinfants.org/havingababy. Our goal is to exceed your expectations. We believe that caring for you means including your family in the process. It s our patient- and familycentered approach to health care. If you have concerns or suggestions, we d love to hear them. Please call the Patient Representative at (401) , ext Also you may be randomly selected to receive a survey at home asking your opinion of Women & Infants. Please let us know what we are doing well and where we can improve. We look forward to caring for you and wish you a pleasant stay at Women & Infants Hospital. Sincerely, Mark Marcantano President and Chief Operating Officer 1

4 Preparing for Your Hospital Stay Interpreter Services We want to communicate with you in the language in which you are most comfortable. If you prefer to use an interpreter, we will provide one at no cost. Sign language interpreters and auxiliary aids are also available. Childbirth Education Classes Women & Infants offers classes taught by experienced, certified educators at various times and locations. If you have not received a registration form, visit womenandinfants.org/havingababy or call (401) Childbirth Options Alternative Birthing Center (ABC) The ABC is a cozy setting that offers minimal hospital intervention, but maximum assurance of safety. It features a comfortable bedroom where the birth takes place, and you can include older children and others. After you deliver in the ABC, you can recover for four hours there and transfer to a motherbaby unit, or recover for six to 12 hours there and go home once you and your baby meet discharge criteria. This early discharge includes a home visit from a nurse who will assess you and the baby and offer support. For more information on the ABC, call (401) , ext If you have been approved by your health care provider to deliver in the ABC, you may register for a class by calling (401) Labor/Delivery/Recovery Unit (LDR) Whether you arrive in labor or are being induced for a medical indication, you will be cared for by your labor and delivery nurse in one of our 19 private labor/ delivery/recovery rooms. Throughout each phase of your labor, we are here to answer any questions you may have, support you, and monitor your baby closely. Each room has the amenities needed to help you stay relaxed and comfortable, including ambient lighting, a rocking chair, birthing balls, warm packs, and an ipod docking station. We also have birthing bars that allow squatting during labor and childbirth and birthing beds that adjust to 22 different positions. There is also a soaking tub room nearby. Cesarean Birth Having a cesarean birth can be an anxious time for new and experienced moms, but Women & Infants staff make this experience a little easier by offering a gentle cesarean birth. The purpose of a gentle cesarean birth is to create a peaceful environment and to allow bonding between mom and baby to begin as soon as possible. We do this by providing a quiet room, free from noise and conversations, and filled with mom s choice of music. We dim the lights and encourage the dad or significant other to be in the room during the delivery. We encourage skin-to-skin 2

5 contact right away minimizing the time mom and baby are separated after birth. Women & Infants is pleased to provide a gentle cesarean birth at the request of the patient and with the permission of the delivering obstetrical provider. Here are our Cesarean rates for the past three years, reporting as required by state law Primary 23.1% Repeat 83.3% Total 32.8% 2011 Primary 23.3% Repeat 84.2% Total 33.3% 2012 Primary 22.1% Repeat 86.0% Total 31.8% Anesthesia Women have several options when coping with the discomfort of labor and childbirth. Delivering naturally is when no anesthesia is used. Many women, through the support of their significant other or labor partner, their nurse, midwife or physician, choose this option and feel empowered by this experience. Some women choose to have pain medication given either through an intravenous line or injection. This option will ease the pain of the contractions and can be helpful in early labor. Another type of medication is epidural anesthesia which allows mom to feel only mild to moderate contraction intensity and pressure during labor and childbirth. Whatever your choose, our exceptional labor and delivery nurses, midwives, and physicians will guide, support, and encourage you through each phase of your labor and ultimately the birth of your baby. You can learn more about anesthesia through childbirth education classes. Antenatal Care Unit Some women must be hospitalized before delivery to monitor their health and the health of their unborn baby. These women are cared for in our Antenatal Care Unit. Rooms here are larger with private bathrooms. The unit also features an amenities suite with exercise equipment, a washer and dryer, and a hairdressing sink and massage table for appointments. Carter Family Neonatal Intensive Care Unit We operate one of the nation s largest single-family room neonatal intensive care units (NICU), offering outstanding care for more than 1,200 premature and sick babies each year. Each room offers the latest technology and most advanced care in a quieter, more private setting. The care team includes: parents, care managers, neonatal nurse practitioners and nurses, neonatal-perinatal fellows, neonatologists, nutritionists, occupational therapists, pharmacists, respiratory therapists, and social workers. The unit offers lounges, a kitchen and shower facilities for parents. Choosing a Pediatric Care Provider You must choose a pediatric care provider - a family practitioner, pediatrician or nurse practitioner before you are 35 weeks pregnant. To help, we can send you our brochure Choosing a Pediatrician. For a copy, go to womenandinfants.org/ pediatrics or call our Physician Referral Health Line at Tell the hospital when you choose a provider so we can call him/her when the baby is born. If the provider does not come to Women & Infants, our team of doctors will care for your baby. 3

6 Parenting Newsletter Our free parenting e-newsletter, The Parent Review, can help you prepare for the birth of your baby. To sign up, go to womenandinfants.org, under More patient resources. Website Our website (womenandinfants.org) offers information about hospital services, a virtual tour of our birthing facilities, an updated list of classes and support groups, a health encyclopedia, a pregnancy planner, and so much more. 4

7 Arriving at the Hospital When to Arrive If you think you may be in labor, call your doctor/midwife, who may tell you to come to our Obstetric Evaluation unit to be checked. Also, call our Admitting Office at (401) , ext , to let them know you are on your way. Checking In When you arrive at the hospital, use the Emergency/Triage entrance and check in at the Triage desk.you will be taken to a private area where you will be evaluated by a physician or a midwife. Patients are seen according to their medical need. Depending upon how your labor is progressing, you may spend some time in the Triage area or you may be transferred to the Labor/Delivery/ Recovery Unit. Your labor partner may stay with you. What to Bring During your stay, Women & Infants will provide hospital gowns for you and clothing for your baby. You may also want to bring: Toothbrush and toothpaste Deodorant Shampoo Soap Nightgown Robe Slippers Shower shoes Breast pads Comfortable bras and underpants Clothing for you and the baby to wear home and for baby s first photo Baby Pacifier Pacifier use is optional and is not recommended for the first four weeks or until breastfeeding is well established. For your peace of mind, never bring large sums of cash, credit cards or other valuables such as jewelry and personal electronic devices, such as cell phones and ipods. The hospital cannot store your valuables, and is not responsible if they are lost. Parking Valet Services Our complimentary valet service is available for anyone coming for outpatient surgery and for people picking up patients being discharged. Valet parking is available from 7:30 am to 4:45 pm, Monday through Friday. Use the main drive in front of Women & Infants main entrance on Dudley Street. Staff will park your car and get it for you when you are done. If your surgery lasts beyond 4:45 pm, please return to the valet area. One of our security officers will be 5

8 available and drive you to your vehicle. Please note: for the safety of children that require a car seat, we are unable to transport them in our security vehicles. Please have them stay with another adult while we take you to your vehicle. If you are unsure where to park or have any questions, call Security at (401) , ext Public Parking Parking is available in the public lot which is located opposite the Emergency Triage entrance of the hospital. There is a fee for parking in this lot. Patients with either a United Health card with an anchor in the upper right hand corner, a white Rhode Island medical card with an anchor in the center, or a Neighborhood Health Plan card, or a state welfare card are eligible for free parking. In order to receive free parking, the patient must go to the exit gate in the parking lot, push the HELP button, and display their card and proof of appointment or surgery. Patients who display a Handicapped placard may also park for free. Visitors are not eligible for free parking and may pay using the kiosk in the South Pavilion lobby near the Nursing Mom s store. Admission Forms Admitting staff will ask you to verify the personal and financial information submitted by your health care provider. You must also sign admission forms and provide: Positive identification, such as a license Your insurance card(s) Name of the pediatric care provider Consent for first portrait of your baby You may also provide copies, if you have them, of a Living Will (written document stating your wishes for withholding or withdrawing medical care or treatment if your condition becomes terminal) or Durable Power of Attorney (written document that appoints someone to make health care decisions for you). You can get these forms through the Admitting Office, (401) , ext Contact your attorney with any legal questions. Cord Blood Banking Patients may choose to donate their cord blood to a private cord blood banking program. Please have the appropriate materials when you deliver, and we will make every attempt to collect the sample from the cord for you. You would then be responsible for sending this to the bank. 6

9 During your stay Patient Information Due to the Patient Privacy Act, we do not give out specific information about patients care or condition. Your family and friends can call (401) , ext , to find out if you are a patient here. If you do not want even that information released, tell your doctor or nurse. Length of Your Hospital Stay How long you stay in the hospital depends on your medical condition and health insurance plan. Discharge time is by 11 am. Please arrange transportation in advance so you will be ready. Visiting Hours To respect the comfort of all our patients, it is usually best to limit visitors to six or less at a time. We encourage families to discuss scheduling their visits in order not to overwhelm the patient by visiting all at one time. While support from loved ones is important, we also ask that visitors respect the patient s need for rest and to provide the new family uninterrupted time to bond and practice breastfeeding. Discuss any unusual visiting circumstances with the patient s nurse, so that the health care team might accommodate any special arrangements based on the patient s specific situation. All visitors except the siblings of the new baby must be 14 years of age or older. Please visit our website at womenandinfants.org for more information regarding our visiting hours. Neonatal Intensive Care Unit Follow unit guidelines. Labor Room For the comfort of our families only the father of the baby/labor partner may be present in the labor Room. To help keep our patients healthy, please ask your visitors to stay home if they have any symptoms of a cold or diarrhea, or have recently been exposed to chicken pox, measles, mumps, rubella or the flu. Overnight Visitors We encourage you to have a support person with you at night. The chair in your room reclines to accommodate one guest. Nurses can provide blankets and pillows. In addition, the showers are for patient use only. A shower room is available for family members to use. We supply clean towels, but guests must bring their own toiletries. Hospital Safety The hospital follows measures to protect your safety, including: having staff identify patients by asking their name and checking the identification bracelet; having staff mark the procedure/surgery site; and having staff ask what procedure you are having. 7

10 Handwashing is the best way to prevent passing colds or infection. Everyone, including children, should wash their hands using soap and water if visibly dirty, or use the hand-gel dispensers located throughout the hospital. Electronic devices such as heating or cooking devices, electric fans, portable air conditioners, and coffee pots are prohibited in the hospital so we can maintain a safe environment for everyone. Women & Infants is not responsible for lost or damaged electronic devices. Patient Representative To help promote patient- and family-centered care throughout your hospital experience, Women & Infants provides a manager of patient and family centered care who acts as a liaison between you, your family, hospital staff and administration. The patient representative addresses your rights, concerns and complaints, answers questions, and lets you and your family know about the services that are available to you. Contact the manager of patient experience at , ext At night and on weekends, call the Patient Service Line at ext and leave a message. The manager of patient experience will return your call on the next business day. Women & Infants Auxiliary This group offers several services, including baby s first photo by Mom365, Lori s Zen & Now Gift Shop, Au Bon Pain café and the Nursing Moms, Etc. store for nursing mothers and newborns. All proceeds from these businesses are donated to the hospital. For more information, go to womenandinfants.org or call (401) , ext Use of Video and Photography Equipment At the request of our medical staff, we cannot allow the use of video and audio equipment during delivery or a medical procedure. You can use such equipment during labor and after the birth or procedure. Still photography is allowed at any time. Please do not videotape or take still photos of babies in the nursery or through the nursery window. Smoke- and Tobacco-Free Campus Women & Infants is a smoke- and tobacco-free campus. Smoking and the use of tobacco are not allowed within 50 feet from the entrances to our buildings or in our parking lots. Participation in Research Programs As a Brown University teaching hospital, Women & Infants is involved in important medical education and research programs, and you may be asked to participate. The hospital s Institutional Review Board reviews all studies. You will be asked for permission before you are involved in any research activity, and you have the right to say no. 8

11 Baby Care Reference Guide Rooming In At Women & Infants, we encourage rooming-in, the practice of keeping your baby in your private hospital room with you for your entire hospital stay. You may find it helpful for your significant other/father of the baby or mother, sister or friend stay with you overnight to assist you as you learn to care for your baby. Rooming in gives you time to become more confident as you provide all of the baby s care, while help is readily available if needed. Evidence has also shown that breastfeeding goes more smoothly, you will sleep just as well, your baby will cry less and sleep better, and the transition home will be easier with rooming-in. Feeding Your Baby The American Academy of Pediatrics recommends that all newborns be breastfed exclusively for the first six months. There are many benefits to breastfeeding. For you, benefits include: lower risk of breast and ovarian cancer; lower risk of osteoporosis later in life; faster return to pre-pregnancy weight; and cost savings. For your baby, the benefits include: fewer ear or respiratory infections; less diarrhea; increased intelligence; and less risk of obesity, diabetes, childhood cancers, allergies, asthma, and sudden infant death syndrome (SIDS). All nurses and certified nursing assistants on the mother-baby floors are trained to help you breastfeed. If necessary, your nurse will arrange to assist you with a certified lactation consultant in the hospital. Once you go home, you can call the Warm Line at for breastfeeding support. Visit our website (womenandinfants.org/havingababy) for breastfeeding tips and information about our classes. Treatments and Vaccinations The following treatments are part of your baby s routine care in the hospital: Skin-to skin is routinely done right after delivery, and we protect the golden hour for healthy mothers and their newborns. We wait at least one hour, until the first feeding is complete, before the baby receives any treatments or is weighed. Eye drops or ointment is placed in your baby s eyes shortly after of birth to protect the eyes from infection. A vitamin K injection is given shortly after birth to improve the baby s blood clotting ability. Without it, some babies can bleed the first few weeks. A Hepatitis B vaccination is given as a single dose in the hospital, followed by a shot at two, four and six months of age. It is important to finish the series for complete protection against this virus, which can cause liver problems and even cancer later in life. 9

12 If you have any questions about these treatments, you can discuss them with your pediatric care provider before delivery. Car Seat Safety A car seat is the single most important piece of baby equipment but, unfortunately, most of them are not installed properly. You should learn how to install your baby s car seat before coming to the hospital. Some of our valet attendants and security personnel are certified to install and check your baby s car seat when you are discharged. 10

13 Legal and Business Information Basic Daily Charge The basic daily charge, which begins the day you are admitted, includes room, meals, the availability of our medical staff, and nursing care. Depending on the length of your stay, there is no charge for the day you are discharged. Itemized Charges Your account will also reflect separate charges for care and services not included in the basic daily charge, including: Laboratory tests Medication Special examinations (x-ray or EKG) Special medical supplies Use of operating and labor/delivery/recovery rooms Blood transfusions Anesthesia supplies Pediatric attending at delivery The professional fees of your health care provider, radiologist and anesthesiologist are not included in your hospital bill. You may want to ask your health insurer if these fees are covered. Insurance Coverage Based on information from your health care provider, we try to verify your insurance coverage before you are admitted. You are responsible for following your policy. Some policies want to pre-approve or certify all hospitalizations or require that you call when you are admitted. If you do not follow the policy rules, your insurance company may not pay your bills. If you are admitted for an emergency, a financial counselor will contact you during your stay to make the necessary arrangements. Financial Counseling Many insurance plans apply your co-payments and deductibles, or exclude coverage of certain services for you or your baby. In such cases, a financial counselor will contact you about your financial responsibility. You are expected to make advance payment based on your estimated responsibility for things that are not covered by your insurance plan. You may qualify for full or partial free care based on your income. If you have questions about payments, call our financial counselors weekdays from 8 am to 4:30 pm, and from 7 am to 3:30 pm on weekends and holidays, at (401) , ext or

14 Consent Forms Your health care provider will talk to you about your treatment, discussing advantages, disadvantages and alternatives. You will be asked to sign a consent form stating you understand and agree with the procedure. If you do not understand the information you are given, ask your provider to explain. You will be asked to sign consent forms at the time of admission and for some procedures performed on your newborn. Emergency treatment will still be given even if a consent form has not yet been signed. If your infant is admitted to the Neonatal Intensive Care Unit or Special Care Nursery, you will need to sign a separate consent for treatment. Our goal is to exceed every patient s expectations. We care about your experience here at Women & Infants Hospital. Our manager of patient and family centered care is here to assist you and your family if you have any questions, concerns, complaints, or if you would like to tell us about someone who made your experience special. Let us know if we are not meeting your expectations, and we will work hard to remedy the situation. To assist us, please share any concerns and suggestions with us at any time by calling (401) , ext , to speak with the manager of patient experience. In addition, a hospital administrator is on-call 24 hours a day to assist you by calling the hospital operator. The Rhode Island Department of Health also has a concern line you may call at (401) If you have a complaint under the Americans With Disabilities Act, please submit that complaint in writing to the Risk Management Department at Women & Infants or call (401) and ask to speak with the Risk Management Department. Women & Infants is accredited by The Joint Commission (TJC). This hospital continuously strives to provide the highest levels of quality and safety in all that we do. We encourage you to discuss any concerns or issues you may have about your care or service with us directly so we may resolve them as quickly as possible. You may also contact The Joint Commission directly at jointcommission.org, complaint@jointcommission.org, or (630) or (800) In accordance with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 2000d et seq.), Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. S794), and the Age Discrimination Act of 1973, as amended (42 U.S.C et seq.), Women & Infants Hospital of Rhode Island does not discriminate on the basis of race, color, national origin, age or handicap in admission or access to, or treatment in, its program or activities. In addition, the hospital s president has been designated to coordinate the efforts of Women & Infants Hospital of Rhode Island to comply with the U.S. Department of Health and Human Services regulations (45 C.F.R. Parts 80, 84 and 91). For further information concerning the regulations and grievance procedure for resolution of complaints alleging discrimination, contact Women & Infants Hospital at , ext Hearingimpaired persons may call (TTY) * 12 * The hospital has made arrangements with the Greater Rhode Island Chapter, American Red Cross, to share its 24-hour TTY service.

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18 Telephone Directory The main hospital number is (401) These are some of the numbers you may find useful. If you are calling from outside of the hospital, dial (401) , and then the five-digit extension. If you are inside the hospital, you can dial the five-digit extension. Business Office Carter Family Neonatal Intensive Care Unit & Food and Nutrition Services Gift Shop & Medical Records Mom365 Baby Photography Nursing Moms, Etc Patient Access Center (Admissions) Patient Information Patient Representative Security Service Response Center (food, room temperature, etc.) Spiritual Care Warm Line WIC Program/Nutrition Services Driving Directions From north of Providence, Rhode Island Take Interstate 95 South to Exit 18, Thurbers Avenue. At the set of lights, turn right onto Eddy Street. Proceed down Eddy Street approximately 1 mile, until reaching the lights at Dudley Street. Take a left at the lights, onto Dudley Street. Women & Infants is approximately.2 miles on the right. From south of Providence, Rhode Island Take Interstate 95 North to Exit 18, Thurbers Avenue. Bear to the left off the exit ramp. At second set of lights, turn right onto Eddy Street. Proceed down Eddy Street approximately 1 mile, until reaching the lights at Dudley Street. Take a left at the lights, onto Dudley Street. Women & Infants is approximately.2 miles on the right. From Interstate 195, heading west Merge onto Interstate 95 South to Exit 18, Thurbers Avenue. At the set of lights, turn right onto Eddy Street. Proceed down Eddy Street approximately 1 mile, until reaching the lights at Dudley Street. Take a left at the lights, onto Dudley Street. Women & Infants is approximately.2 miles on the right. 16

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20 Women & Infants Hospital of Rhode Island A Care New England Hospital Affiliated with The Warren Alpert Medical School of Brown University 101 Dudley Street Providence, Rhode Island womenandinfants.org