MATERNAL CHILD HEALTH WINCHESTER HOSPITAL Maternal Child Health Advancing Health. Advancing Care.
Winchester Hospital has been providing exceptional care for new mothers and their babies for more than 100 years.
Congratulations on choosing Winchester Hospital s Maternal Child Health Services for the birth of your baby. Winchester Hospital is considered one of the most prominent obstetrical facilities north of Boston, and includes Maternal Fetal Medicine, the Labor and Delivery Unit, the Mother Baby Unit (where you and your baby will stay after delivery), the Special Care Nursery (should your baby need these services) and Pediatrics. Maternity Services Information Winchester Hospital has more than 200 beds and delivers approximately 2,000 babies annually. Our maternity program offers a comprehensive range of services, including: n Specialized nursing and medical care Winchester Hospital obstetrician onsite 24 hours a day, seven days a week Perinatologist consultation Neonatologist and anesthesiologist onsite 24 hours a day Social Services, if needed n Medical affiliations providing access to the specialists and technology found at leading Boston hospitals n Level IIB Special Care Nursery n Labor, delivery and recovery rooms (LDRs) n Mother Baby Unit n Tours of Maternal Child Health; to learn more visit winchesterhospital.org/events or call (781) 756-2625 n Childbirth and family education, including lactation consultants n Patient spiritual needs can be addressed by our hospital chaplains We are pleased you have chosen Winchester Hospital and look forward to serving you in the near future.
Preparing for Your Stay This pre-admission packet provides you with a variety of information regarding our maternity services. Please pay particular attention to the following: What to Bring Pre-registration Form Please fill out and return the hospital pre-registration form in the postage paid envelope as soon as possible. This will speed up your admission process. Healthcare Proxy Please read and complete the Massachusetts Healthcare Proxy form that is enclosed at the back of this packet. After completion, you can either bring a signed copy to the hospital with you when you come to deliver or mail a copy of the proxy in with your hospital pre-registration form. Birth Certificate Worksheet Please complete the enclosed Birth Certificate Worksheet and bring it with you to the hospital when you come for your delivery. Packing Your Overnight Bag We suggest that you pack a bag in advance with overnight necessities and going-home clothes for you and your baby. We recommend that you do not bring large amounts of cash, credit cards or jewelry. You may wish to bring the following when you come to the hospital to have your baby: For mother: q Health and beauty items, including deodorant, shampoo, toothpaste, shower cap, bra and nursing bra for breastfeeding. We will provide you with sanitary napkins and stretch panties after delivery. q Sports bra or two-piece bathing suit optional for hydrotherapy tub q Nightgowns, robe and slippers q Pen and paper For baby s trip home: q 1 undershirt q 1 light blanket (summer) q Car seat q 1 outfit q 1 bunting or heavy blanket (winter) For partner or support person: q Toothbrush, toothpaste, comb, deodorant, razor and shaving cream q Pajamas, sweatsuit, robe and slippers q Change of clothes rooms may be cool q Money for daily paper, meals q Phone numbers of friends and relatives q Cell phones are allowed q Wireless access is provided in some areas of the hospital Admission to the hospital for the birth of your child n After your health care provider instructs you to come to the hospital, please stop in Admitting before proceeding to Labor and Delivery on the second floor. n If you come before 6 a.m. or after 8 p.m., please enter through the Emergency Department entrance.
Parking Free valet parking is available for patients and visitors at Winchester Hospital s main campus. The service is offered Monday through Friday from 9 a.m. to 8 p.m., except on holidays. Drivers may access the valet parking service via the west entrance from Fairmount Street and then follow the orange colored signs to the drop-off/pick-up area (near the hospital s Emergency Department). When patients and visitors are ready to leave, they can simply return to the drop-off/pick-up area to request their car directly from the valet, or they can call the Service Response Center at extension 2500. The parking spaces on the garage s first level are dedicated to valet parking only. If You Are Being Induced n A Medically Indicated Induction means there is a medical reason to induce your labor. Some are more urgent than others. The prioritization of all inductions is done throughout the day by the in-house obstetrician and the charge nurse, in collaboration with your physician. n An Elective Induction means there is NO medical reason to induce labor. During high volume periods, elective inductions may have to be delayed or cancelled because laboring patients and medically indicated inductions are a higher priority. This is not an unusual occurrence. Please call Labor and Delivery at (781) 756-2242 at 6 a.m. on the morning of or one hour before the evening time you are scheduled in order to confirm there is room for you. You will be instructed to either come in as planned, call back in a few hours or reschedule for another day. If you are rescheduled, your physician will call you with an alternate plan. Smoking Policy Please remember, for your health and the health of others, Winchester Hospital is a smoke-free environment. Insurance Information In most cases, you need to inform your insurance company of your pregnancy for pre-approval of your hospital stay. The insurance company could deny your coverage if you fail to do this. Under normal circumstances, most insurance providers allow for a 48-hour, or two-day, hospital stay after vaginal delivery, and 96 hours, or four days, after a cesarean birth. If you have any questions, please contact your individual insurance carrier. Before admission, contact your insurance company/hmo so you can choose a pediatrician in your health plan. You will need your pediatrician s name upon admission. If you do not have insurance and feel that you may have a financial problem, it is suggested that you contact our Patient Financial Services office at (781)756-2427. preparing for your stay
Accommodations for Your Childbirth Experience Labor and Delivery You will begin in Labor and Delivery, located on the second floor. Labor and Delivery has private rooms, in which you will labor and deliver your baby. Each room offers accommodations for your support person s overnight stay, a private bathroom with shower, telephone and television service. If a cesarean section is needed, you will be moved to an operating room located on the Labor and Delivery unit. Throughout your childbirth experience, a highly-qualified nurse specializing in maternal child care will be with you to provide expert clinical care, guidance, non-invasive comfort measures and emotional support. In addition, for your safety and comfort, Winchester Hospital provides an in-house obstetrician should your primary obstetrician not be immediately available. Doulas are welcome. Your number of support attendants will be decided by you and your health care providers. Hydrotherapy/Therapeutic Tub For your comfort, we have a hydrotherapy tub available in Labor and Delivery. The tub is located in a private, relaxed setting with light dimmers and a variety of music for comfort and relaxation. The hydrotherapy tub promotes muscle relaxation and decreases discomfort. It enhances cervical dilation, increases the rate of fetal descent, decreases the use of pitocin augmentation and reduces the use of medication and epidurals. Anesthesia Pain-relieving medication and various forms of anesthesia are available. Members of our anesthesiology staff are onsite 24 hours a day. We urge you to discuss plans for anesthesia with your doctor prior to admission; however, the final decision can be made during labor. Your options for anesthesia include: y Local y Epidural vaginal birth and cesarean sections y Spinal cesarean sections (scheduled) y General anesthesia (in the event of an emergency)
Phone Calls Information about your condition will not be given to anyone. We recommend that you make arrangements and identify one person for all your relatives and friends to call for updates about your labor or delivery status. This way, only one person will be checking in with you during your labor. Videotaping Videotaping and photography (even on cell phones) are not permitted during the delivery process. To protect the privacy of other patients, no videotaping or photographs are permitted at the nursery window or in the hallways. Videotaping and photography are allowed in the privacy of your own room after the birth of your baby. Immediately after birth Our family-centered care concept allows for parent-newborn interactions in the early recovery period so you can get acquainted with your baby in the privacy of your room. Initial skin to skin contact is encouraged at birth. Support for your initial and ongoing breastfeeding experience is provided. We recommend that you and your significant other take the time in the initial hours after birth to bond with your newborn alone. A minimum of 30 minutes of uninterrupted skin to skin contact is recommended immediately after birth, or as soon as possible. We also encourage skin-to-skin contact throughout your stay. When you hold your newborn skin-to-skin you can: ywarm your newborn ysoothe your newborn yrelease mothering hormones that assist with bonding and healing The physical and emotional needs of newborns and their mothers are met when they are kept together as much as possible. Feedings should begin during the newborn s alert stage, which is usually the first one to two hours after birth. Peak sucking movements have been noted from 45 minutes to two hours of age and are mostly absent at 2½ hours of age. Keeping your baby with you during your stay is the best way for you to learn how to care for yourself and your newborn. Your caregivers will help you learn how to care for your baby and will offer assistance as needed. We encourage you to ask your family for help as well. When you keep your newborn with you: ynewborns cry less ynewborns feed better ynewborns feel less pain when held skin-to-skin for at least 20 minutes before painful procedures your childbirth experience
After your delivery Once you have recovered, you will be transferred to the Mother Baby Unit, also on the second floor, where you are encouraged to have your baby in the room with you. Research shows it is best for you and your baby to stay together in the same room. Parent-newborn interactions are vital to your newborn s development. During this time together you get to know your baby s unique personality and needs, and caregivers are there to assist and support you. Under normal circumstances, you will have a private room. We provide cots for the support person to spend the night, if desired. On occasion, because of the number of women in labor, we may have to utilize our semi-private rooms. Inpatient Lactation Service All our nurses are capable and qualified to assist and support you with breastfeeding. International Board Certified Lactation Consultants are available to provide information, answer questions and offer one-on-one assistance to patients requiring more comprehensive assistance and support. It is expected that all breastfeeding mothers will attend one of the daily breastfeeding classes while in the hospital. Newborn pacifier use: According to the American Academy of Pediatrics, Pacifier use is best avoided during initiation of breastfeeding and used only after breastfeeding is well established. Winchester Hospital does not provide pacifiers for healthy newborns. If you want your baby to have a pacifier, you may bring a pacifier with you to the hospital. Circumcision Circumcision is a personal choice that you should discuss with your partner, obstetrician and pediatrician before your son is born. Since circumcision is a surgical procedure, you will be asked to sign a consent form before the procedure. Visiting Hours We recommend limiting visitors while in the hospital to allow you and your newborn to recover. This time is also important for you to bond and learn how to care for yourself and your newborn prior to going home. yvisitors should be free of any illnesses (colds, flu, contagious diseases, etc.). ywe recommend you plan a quiet time each day and ask visitors not to come during that time. yplease note: Siblings are welcome to visit you and your baby in the hospital when accompanied by a responsible adult at all time. To ensure you and your baby have adequate time to bond and receive care, no siblings are allowed to remain at the hospital under your supervision alone. Additionally, for the health and safety of all our families, no children are allowed to spend the night. Stork Dinner to Celebrate This joyful occasion is cause for celebration! You can do that right here by ordering a gourmet dinner for two served in the privacy of your room. There is a charge for this meal. Please ask your diet aide for more information. We recommend you order this meal in the morning on the day before you are discharged.
Newborn Screening As you look to the future with your new baby, you will be happy to know that all babies born in Massachusetts benefit from a public health program called Newborn Screening. This program helps diagnose treatable diseases. Massachusetts began the program in 1962, and screened just one disease. Since that time, the number of treatable disorders screened for as part of the program has increased and newborn screening has been adopted worldwide as a routine standard of care. Massachusetts is a leader in newborn screening. The state offers routine screening for more treatable disorders than any other program. Massachusetts also offers optional screening services. After your baby is born, you can decide whether to take advantage of the optional services. What is the chance my baby has a disorder detectable by screening? The chance that your baby will have one of these disorders is very small. In the rare case that a disorder is found, early diagnosis and treatment can usually prevent problems associated with these disorders. How are the tests done? A small blood sample will be taken 48 hours after birth, or just before your baby is discharged from the hospital. Only a few drops of blood taken from your baby s heel are needed. Hearing Screening Winchester Hospital has a Newborn Hearing Screen program for all babies born here. As you know, good hearing is vital to the development of speech and language. Six out of 1,000 newborns have some hearing impairment. We feel it is important that hearing loss in babies is recognized as early as possible so appropriate interventions can be made. During the admission process, your nurse will ask you questions about family history and prenatal history. In addition to questions about general medical issues, you may be asked about hearing loss. Your baby will be routinely screened for hearing loss before being discharged from the hospital. The testing is quick, easy and non-invasive. Specific consent is not required for newborn hearing screening; in fact, the testing is mandatory in Massachusetts. Critical Congenital Heart Defects Screening Congenital heart defects account for 24 percent of infant deaths due to birth defects. In particular, there are seven Critical Congenital Heart Defects (CCHD) that pose significant risk for death or disability if not diagnosed and treated soon after birth. Low levels of oxygen in a baby s blood can be a sign of a CCHD. To test the amount of oxygen in the baby s blood and the baby s pulse rate, we use a machine called a pulse oximeter and place sensors on the baby s skin. The test is painless and takes only a few minutes. Screening is done when a baby is 24 to 48 hours of age, or as late as possible if the baby is to be discharged from the hospital before he or she is 24 hours of age. newborn screenings, vaccines and records
Vaccines Vaccines for Mom Your health is your baby s best defense against disease and illness. This is why staying up to date with your own vaccinations is so important. Please come to the hospital knowing your immunization history. We can provide some vaccines to you while you are here in order to ensure the health and safety of both you and your baby. Hepatitis Vaccine Hepatitis B is a severe liver infection that can lead to liver failure, liver cancer and death. A vaccine is available to prevent this disease. The United States Public Health Service has determined the best strategy to prevent the illness is to immunize all infants. Winchester Hospital participates in a program with the Massachusetts Department of Public Health to provide the initial dose of Hepatitis B vaccine at no charge. Complete immunization consists of three injections. The first vaccine is usually given in the hospital shortly after birth, followed by another about a month or two later in your pediatrician s office. Shortly after birth, nursing personnel will administer the vaccine in your infant s thigh. The vaccine dose will be recorded in an immunization record book, which will be given to you to be kept as your child grows up. This book should be brought with you each time your child visits the pediatrician. This is an opportunity to protect your child against a potentially life-threatening disease. The Department of Pediatrics supports this vaccination program at Winchester Hospital. Birth Certificates and Social Security Cards 1. Before you come to the hospital Please fill out and bring with you the enclosed, required Birth Certificate Worksheet as completely as possible. This form will help expedite the completion of your child s birth certificate. 2. While in the hospital A representative from Health Information Management (HIM) will come to your room before your day of discharge to complete your worksheet. HIM will then process the information and send it to Winchester Town Hall. 3. To obtain a copy of your child s birth certificate A copy of your child s birth certificate may be obtained at Winchester Town Hall or the town/city hall of your residence. Winchester Hospital does not issue a copy of the birth certificate. Births will not be recorded with the town hall until the birth certificate is signed. Your baby s social security card will be mailed to your residence in approximately one month. If you have any questions regarding the card, please contact the Social Security Administration at 1-800-772-1213.
Preparing for Discharge Notice of Your Rights If you and your physician determine that you and your baby are stable and decide upon discharge prior to 48 hours, the legislation states that you have the right to at least one home visit by a nurse. Winchester Hospital will help ensure the home visit is within 48 hours after you leave the hospital. This home visit is voluntary. If you do not want it, please let your nurse know. If you choose to leave early In collaboration with your physician, the Massachusetts legislation regarding maternity stays gives you the right to stay in the hospital with your baby for: 48 hours after a vaginal birth 96 hours after a cesarean section birth You cannot be discharged between the hours of 8 p.m. and 8 a.m.; however, you may choose to leave during these hours. If you decide to stay longer than your insurance and rights allow Your employer who determines your maternity benefits may not cover the extra day(s). You will be billed for each additional day your maternity benefits do not cover. Please note that some employers are self-funded and some employers are federally regulated. These are not mandated to abide by the state maternity-stay law. For more information If you have any questions about your legal rights, talk to your doctor or nurse, or call the Department of Public Health at (617) 624-6095 between 8:30 a.m. and 5 p.m., Monday through Friday. For complaints If you feel your rights have been denied under this law, you may call the Department of Public Health at (800) 436-7757 or TDD/TTY (800) 439-2370, 24 hours a day. preparing for discharge
On the day of discharge: You and your baby usually will be seen by your individual health care providers between 7 and 9 a.m. Once they have deemed you both ready for discharge, your nurse will complete the necessary paperwork and go over discharge instructions with you. Massachusetts state law requires that all children be restrained in a car seat. You must have an appropriate car seat for your infant prior to discharge. This car seat must be less than six years old. Since there are many car seat models, we recommend you read the instructions and practice installing the car seat in your vehicle prior to your baby s birth. For additional information, we recommend the Governor s Highway Safety Bureau website at www.mass.gov/ghsb. Don t forget you will need weather-appropriate clothing for both you and your newborn (T-shirt, stretch suit, sweater, coat, hat, blanket, etc.).
Level IIB Special Care Nursery The Special Care Nursery can treat infants with a wide range of clinical issues. We hope that each pregnancy ends with a healthy, full-term baby who goes home with mom. However, when circumstances prevent your baby from going home with you, Winchester Hospital s Special Care Nursery is here for your baby and your family. y Full-time board certified neonatologists Karen McAlmon, MD, medical director, and Kimberlee Chatson, MD, associate director, are joined by three other full-time neonatal physician specialists to provide around-the-clock, in-house care for infants in the unit. These doctors, through collaborative relationships, also provide care at Boston s Level III Neonatal Intensive Care Units at Boston Children s Hospital, Beth Israel Deaconess Medical Center and St. Elizabeth s Medical Center. y Our health care team consists of an in-house physician 24 hours a day. Registered nurses, lactation consultant services, social workers and our maternal/child case manager will be available to assist you with discharge planning and insurance concerns. y Our goal is to provide babies with continued, quality nursing and medical care. We also strive to prepare families and babies for life after the hospital. special care nursery
With a wide variety of programs, The Center for Healthy Living at Winchester Hospital is the perfect place to help you and your partner prepare for the arrival of your newborn. We offer childbirth education, infant and child first aid, CPR, yoga, massage and acupuncture. The Center is also home to the Lactation Center Boutique, which offers the highest quality of breastfeeding supplies and support. For more information about any of the below programs (class times, locations, etc.) or to register, call 781-756-4700 or visit www.winchesterhospital.org/events. The Parent Review Free email newsletter from Winchester Hospital sent weekly with information on your baby/child s development along with appropriate Winchester Hospital services. Sign up online at winchesterhospital.org/ maternity. Childbirth Classes and Tours Childbirth Classes These classes are designed to meet the needs of expectant parents. The focus is on labor processes, including relaxation and breathing techniques, stages of labor, and comfort measures. y All-day childbirth class: Classes are held on Saturdays from 9 a.m. to 5 p.m. All classes include a tour of the maternity unit. $190 y Prepared childbirth series: Meets once a week for five weeks from 7 to 9 p.m. All classes include a tour of the maternity unit at Winchester Hospital. $160 y elearning childbirth education course: This class allows expecting parents to learn at their own pace from the comfort of their home. $190 Hypnobirthing Session Hypnosis is an altered state of consciousness applied to reduce fear and tension. You will learn to focus, be relaxed and fully in control. Any anxiety or fear of birthing is removed with direct and indirect suggestions. You will learn visuals for a natural birth experience. You will receive a CD to practice before your delivery. $85 Maternity Tours Two tours of the maternity unit occur on the second and fourth Tuesday of every month. The first tour begins at 6 p.m. and the second at 7 p.m. Registration is required by visiting winchesterhospital.org/events. Baby Care and Safety Care of the Newborn Class Teaches parenting skills necessary to comfortably care for your new baby. Topics include: infant behavior, needs, safety, diapering, bathing and feeding. Meets on Mondays from 6 to 9 p.m. $60
First Aid and Safety for New Parents This class begins with a video-based safety tour of your home that will help you prevent injury by identifying common danger areas. We discuss common safety devices and where to locate these items. Problem areas in your yard and protecting children at play are also reviewed. The second part of the course is dedicated to common injuries and appropriate first aid, along with a discussion of more serious injuries and treatments. Class meets 6:30 to 9 p.m. on Fridays. $40/person or $70/parent couple CPR for Family and Friends Learn rescue skills in CPR and choke-saving for infants, children and adults. Class meets on Fridays from 6:30 to 9:30 p.m. This class is suitable for new parents, grandparents, aunts, uncles and friends. $45/person Sibling Class Prepares children for the arrival of their new sibling. Children will see the nursery and a room like mom will be staying in. Classes are offered on Saturdays from 10 to 11 a.m. and are for children ages 3 to 7. $25/child Breastfeeding Breastfeeding Class Provides education and support for women who plan to breastfeed. Tips on breast pumps, storing breast milk and weaning will be discussed. This class is taught by a registered nurse who is also an International Board Certified Lactation Consultant (IBCLC). $50 Lactation Boutique Our Outpatient Lactation Center runs a boutique which carries quality breastfeeding products and supplies at a reasonable price. To schedule a consultation or contact the boutique, please call 781-756-4788. Nursing Mother Support Group Breastfeeding mothers and their babies gather each week with a certified lactation consultant (IBCLC) who is also a registered nurse to ask general breastfeeding questions, meet other breastfeeding mothers, and gain breastfeeding support and information. The group is free to all participants and meets every Wednesday from 1:30 to 3 p.m. Care for Prenatal and New Moms Winchester Hospital s Center for Healthy Living is the leading provider for integrative therapies in the region, encouraging our communities to stay healthy through our wellness programs. New and soon-to-be moms can take advantage of these therapies, which include: ypre- and Postnatal Massage yprenatal Yoga ymommy & Me Yoga yacupuncture yreiki For more information on our products and services, please contact us at 781-756-4700. the center for healthy living
Information and Resources Information Massachusetts requires hospitals to disclose certain statistics to maternity patients so you better understand maternity care. The statistics (presented below) reflect the categories of care provided to our maternity patients during this past year. Maternity Statistics 2013 Number of Births (including multiples) 1,930 Statistical Category Inductions Total cesarean sections Primary cesarean sections Repeat cesarean sections Women who had previous cesarean section with subsequent vaginal birth (VBAC) Women internally monitored Birth utilizing epidural anesthesia Birth utilizing spinal anesthesia (usually for C/S) Births utilizing local anesthesia Births utilizing general anesthesia % of Annual Patients 36.0% 36.0% 20.0% 16.0% 8.0% <2% 63.0% 20.0% 8.0% <1.0% Definitions Births: Number of babies born at Winchester Hospital in the calendar year. Cesarean section(c/s): Infants delivered through a surgical incision in the mother s abdomen and uterus. Primary cesarean section: Infants delivered by cesarean section and the mother has had no previous cesarean births. It may or may not be her first birth. No. of VBAC VBAC rate: Calculated in the following way No. Repeat C/S + No. VBAC Internal fetal monitoring: Monitoring through cervical electrocardiogram by passage of electrodes through cervical opening. Induction: Intervention to begin labor using drugs (pitocin/cervidil) or by rupturing the membranes. Anesthesia: Includes anesthesia used by cesarean sections. These may add up to greater than 100 percent if more than one method is used. Resources For more information about Winchester Hospital s programs and services, please visit our website at www.winchesterhospital.org. Donna Sherrill, Director of Maternal Child Health Services (781) 756-2571 email: dsherrill@winhosp.org Susan Petrosino, Nurse Manager of Labor & Delivery (781) 756-7227 email: spetrosino@winhosp.org Geri Wilson, Nurse Manager of Mother Baby Unit (781) 756-2230 email: gwilson@winhosp.org Sharon Fitzpatrick, Nurse Manager of Special Care Nursery & Pediatrics (781) 756-2046 email: sfitzpatrick@winhosp.org
Resources Winchester Hospital main line (781) 729-9000 Center for Healthy Living (781) 756-4700 Lactation Consultation (781) 756-4788 Medical Records (781) 756-2170 Physician Referral Line n or go online to www.winchesterhospital.org for our physician database Postpartum Support International 1-866-WINHOSP www.postpartum.net Parental Stress Line 1-800-632-8188 American Academy of Pediatrics www.aap.org Your health care provider: Address: Phone: Your baby s health care provider: Address: Phone: information and resources
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41 Highland Avenue Winchester, MA 01890 (781) 729-9000 www.winchesterhospital.org