COLCHESTER EAST HANTS HEALTH CENTRE: WOMEN AND CHILDREN S HEALTH UNIT BIRTH PLAN Name: Obstetrical Physician: Family Physician: Congratulations on your pregnancy! As your Childbirth Team we want you to have the most satisfying birth experience possible. To help with this, we invite you to read this Birth Plan and add your comments /questions. Although completing a Birth Plan is optional we think it can help build trust and understanding between you and your support person(s) and the Childbirth Team. Birth Plans also help share information about the Women s and Children s Health Unit in our health centre. Birth Plans are available at your doctor s office, the Public Health office, and the Women s and Children s Heath Unit at Colchester East Hants Health Centre. When you complete your Birth Plan, review it with your doctor, and when it comes time for your labour, bring it with you to the health centre to discuss with your labour nurse. It is important to note that during labour things can change suddenly and without warning. In these situations, for your safety and that of your baby, the Childbirth Team may need to make rapid decisions which may be different from your original plan. You and your family will be included in all decision making. REGISTRATION Pre-registration is NOT necessary. You will already be pre-registered if you have had prenatal blood work or ultrasound done in Truro, or have seen a Truro obstetrician or family doctor who does deliveries. A tour of the Women and Children s Health Unit may be arranged by calling 902 893 5544. Please ask about our Virtual Tour resource, which contains a guided tour of the Women and Children s Health unit and other great information.
2 LABOUR When you think you are in labour or need to be assessed, come to the front entrance of Colchester East Hants Health Centre and proceed to the Women and Children s Health Unit on the second level (Wing D2). There, you will be registered and assessed by a nurse. If you are in active labour, you will be admitted to a Labour-Birth-Recovery-Post partum room (LBRP). You will be assigned this room for labour, delivery of the baby, and for your post partum stay with your baby and support person until you go home (usually one to three days). These are spacious private rooms with an ensuite bathroom and shower. There is a reclining sleeper chair for your support person to spend the night If you are not yet in active labour, you may return home, or (if you live at a distance) you may discuss the option of staying in our early labour lounge. SUPPORT IN LABOUR You are encouraged to have support people with you during your labour, such as your partner, a close family member, or a doula. It is a good idea to think about who you would like your primary support people to be before you go into labour. Those you choose to support you should be flexible and respectful of your wishes and we recommend no more than two support people. If you are considering more than this, please discuss it with your doctor. Your childbirth team can help you with decisions about your primary support people, and others you may choose to have visit you during your labour. Please tell your nurse and doctor if there is a person(s) you do not want with you during your labour Should you require a Caesarean Section (operation) to have your baby, only one support person may go with you to the Operating Room. Support People: Do NOT allow: ELECTRONICS 1. Your own cameras may be used in the LBRP and Operating Room, but their use should be discussed with your childbirth team in advance. Remember to charge your camera in advance, and bring your charger with you. 2. You may use your cell phone in the LBRP. 3. You may bring your own music (such as an ipod and speaker).
3 CHECKING YOUR BABY S WELLBEING IN LABOUR Your nurse will listen and record your baby s heart rate as needed during labour. This may be done with either a hand held device or a strapped on monitor. Your doctor may recommend continuous monitoring with either an external monitor or an internal lead a little clip that sits on your baby s scalp during labour. OTHER IMPORTANT POINTS IN LABOUR: 1. Food and Drink Food and drinks are provided but you may wish to bring your favourite food, juice, and water with you. In early labour you may eat normally. Later in labour, you may not feel like eating. The nurse may insert a tiny intravenous plastic catheter into a vein in your hand or arm to provide fluid or medications during or after labour. 2. Clothing You may wear your own clothes during labour, but hospital gowns are also available for your use. If caesarean section is needed, your primary support person will need to change into special operating room clothes (which will be provided). 3. Activity -Most women are encouraged to walk during labour. Mothers who walk often experience less discomfort, and labour may proceed more quickly. Showers are available in the Labour-Birth-Recovery-Post partum room (LBRP) for your comfort. Birthing balls are provided as well and some women find sitting on the ball quite comfortable in labour. 4. Prevention of Infection -- All people handling the baby will be asked to first wash their hands to reduce the risk of infection. Any visitors with coughs or colds are encouraged to stay away until they are well to reduce risks to mothers and babies. Breastfeeding also helps protect babies from getting many infections.
4 5. Learning The Colchester East Hants Health Centre provides learning opportunities for both medical and nursing students. It is your choice whether you wish to have a student doctor or nurse present during your labour and delivery. 6. Routine Orders When you are admitted to the hospital, the physician s routine orders include lab work: a CBC (complete blood count) and an extra tube of blood are taken from your arm vein. Your nurse may insert a tiny plastic catheter into a vein in your arm or hand for pain medication during labour or oxytocin to prevent extra bleeding after birth. If you have tested positive for Group B Streptococcus bacteria, you will receive intravenous antibiotics in labour. PAIN RELIEF IN LABOUR 1. The continuous presence of a support person who provides hands on comfort, praise, and encouragement may reduce the need for medication for pain relief. 2. Breathing techniques, relaxation techniques, meditation, music and massage make coping with pain easier. The labour nurse will assist you and your support people with these techniques. If you have a musical preference, you are encouraged to bring your device such as ipod and speaker or earphones with you. Many people request medication for pain relief in labour. If discomfort becomes too great, some methods for pain relief are: 1. Medication by injection: Narcotic medications used commonly include Morphine and Fentanyl. These may be ordered by your doctor while you are in labour. They occasionally cause some nausea, and may be given with another medication to reduce nausea. 2. Epidural Anaesthesia: This is the insertion of pain medication into your lower back close to the nerves of the spinal cord via a small plastic catheter. It may be ordered by your doctor and is given by an anaesthetist (a doctor who is specialized in pain management and sedation). An epidural medication can be used when other methods are not able to provide enough relief. Before you can have an epidural, you will require intravenous fluids and a catheter (tube) may be inserted into your bladder. Your mobility will be quite restricted with an epidural and you
5 may have to stay in bed for safety reasons. Epidurals may prolong labour, by making it harder to control pushing as well as having other possible side effects. Please discuss any questions or concerns you have concerning epidurals with your caregiver. 3. Nitronox (Nitrous oxide plus oxygen) This is a gas which you breathe through a mask or mouthpiece. The gas does not stay in your body, so it does not have much effect on the baby. It is most useful in the late stages of labour. If you are interested in this as an option, please speak to your obstetrician & \ or physician in advance. BIRTH OF THE BABY: 1. Position various birthing positions may be used (examples: Squatting, holding legs). You can find the position which suits you best. 2. Episiotomy this is a small cut in the tissue at the vaginal opening to allow the baby to deliver. It is not done routinely, but may be needed in some circumstances and will require stitches after delivery. You are encouraged to discuss this with your doctor. 3. Cord cutting If you or your support person wants to cut the umbilical cord, or if you want to touch the baby s head at the time of birth, inform your doctor or nurse before your delivery. 4. Forceps and Vacuum Forceps (metal tongs used to gently grasp the baby s head) or a vacuum extractor (a plastic suction device placed on the baby s scalp) may be needed to help deliver the baby s head. These may be used if the baby is having problems at the end of labour and needs immediate delivery, or if the mother is too tired to push any more.
6 5. Birth Registration- For your convenience, we have a birth registration kiosk on the unit; which gives you the opportunity to submit your child s birth information electronically, request a birth certificate and activate your child's health card number at any time during your admission. You will need your health card and social insurance number. 6. Infant Protection- For the protection of your new born, infants may be fitted with a Hugs tag on one of their ankles shortly following their birth. Every exit point on the Women and Children s Health Unit is electronically monitored to detect the tag. Once the tag is attached to the infant, the tag is automatically activated and enrolled in a software system. No one can remove the infant from the unit without staff being alerted. CAESAREAN SECTION DELIVERY: If caesarean section (an operation where the baby is delivered through an incision in the mother s lower abdomen) is needed, the mother is usually awake during the surgery. Surgery is done under either epidural or spinal anaesthesia; both methods numb the abdomen by insertion of local anaesthetic and other medication into the lower back nerves near the spinal cord. One support person only is permitted in the operating room for the operation. On the rare occasion where a general anaesthetic (when the mother is put to sleep) is required, the support person will remain in the waiting area. In the event of a caesarean section we suggest you have a plan in place regarding who you want to see the baby first and other wishes such as allowing skin-to-skin contact. POST-PARTUM (AFTER DELIVERY): Immediately after birth, mothers are given a medication called oxytocin to reduce the risk of bleeding. Babies are given 2 medications (eye ointment and Vitamin K) to prevent potential problems in newborns.
7 SKIN-TO-SKIN CONTACT During the first hour following delivery, Skin-to-Skin Contact is encouraged between you and your baby and between your partner and your baby. Benefits for your baby include: warmth, attachment, maintaining blood sugar, building immunity and producing a calming effect. It can also assist with the initiation of breastfeeding. PHYSICIAN CARE OF YOUR NEW BORN You can expect that a family physician will visit your baby while in hospital. This physician may not be your own family physician (as some family physicians do not have privileges or do not do baby care). It is your responsibility as a parent, to identify the physician who will be caring for your baby once you return home. By doing this before you deliver, it may assist in identifying which family physician will care for your baby while in hospital. BREASTFEEDING: Breastfeeding is the best way to feed your baby, and offers health benefits for both of you. We suggest that during your pregnancy you read as much as you can about breastfeeding and talk to your health care team and others that you trust, so that you can make the right choice for you and your baby. We encourage you to breastfeed soon after birth, usually within 30 minutes to an hour. Your baby will remain with you in the room unless he or she requires special care in the nursery. All healthy mothers and babies room together. This is an ideal time to learn your baby s hunger cues so you can breastfeed when your baby is alert and interested in nursing. Crying is a late hunger cue. Healthy full term newborns usually do not require anything but breast milk. If a supplement is medically indicated, this will be discussed with you, and should be given by either cup or syringe feeding rather than by bottle to avoid nipple confusion. It is recommended that all exclusively breast fed infants receive Vitamin D oral solution or drops once daily. Please speak with your physician to learn more. If you would like more information on breastfeeding, call Public Health Services (Truro 902-893-5820 or Elmsdale 902-883-3500), Maggie s Place (902-895-0200) or the East Hants Family Resource Center (902-883-4349)
8 WHAT IF I CHOOSE NOT TO BREASTFEED? If you make an informed decision to feed your baby with infant formula, please bring with you 30 ounces of ready to feed formula (not powder or concentrate). Bottles and nipples will be provided for your use and your nurse will show you how to feed and burp your baby. Your nurse will also give you information about formula preparation and amounts to feed your baby. VISITING POILICY: At Colchester East Hants Health Centre we are proud to offer a family centred approach to health. We recommend that you have a support person with you day and night throughout your entire stay and ask that you let your nurse know who this person is To support family centered care we allow open visiting hours, but do ask that you not allow more than 2 visitors at a time, unless this has been discussed and approved with the nurse assigned to your care. If our nursing staff or physicians have concerns about the safety and welfare of our patients or our care team, they may decide that visits should stop and will discuss this with you. Some families choose not to have visitors, but rather to use this time to rest following birth, to bond with their baby, to take advantage of the teaching support that our care team can offer and to adjust to the changes that come with parenting. If you do wish to have visitors we suggest that you avoid having visits in the morning, to allow for some quiet time and for teaching/learning opportunities with your nurse about things such as breastfeeding, bathing your baby and umbilical cord care.
9 NEWBORNS Needing extra supervision and care: If your baby is ill or premature, she or he may require a short period of care in our nursery, which is located close by the LBRPs (labour-birth-recovery-postpartum rooms). If your baby needs to be transferred to the IWK Health Centre, you will be discharged and sent to the IWK to be with your baby as soon as it is medically safe. We will do our very best to reunite you with your baby as quickly as possible. (Please identify who will go with your baby in your absence). Mothers planning to breastfeed will be encouraged to pump their breasts to stimulate milk production. Collected milk can be frozen and stored for your baby. Other Requests or WE HOPE YOU HAVE A WONDERFUL BIRTH EXPERIENCE AT OUR HEALTH CENTRE! Women and Children s Health Unit Team (902) 893-5544 June 2013
10 What to bring to the hospital.. To enhance and support your birthing experience; in addition to items you are already planning to bring with you, please also bring: Prenatal Records from your doctor (including your birth plan) 24 sanitary napkins (select a super absorbent one) 12 breast pads 24 disposable diapers (newborn size) Vitamin D oral solution or drops (for breast fed newborn) Suitable clothing for newborn babies (Sleepers etc). Front opening or nursing bra 3 pairs of panties Shampoo Toothbrush & toothpaste Brush/comb Tissues Rear facing infant car seat (CSA approved) Nightgown/slippers Housecoat Blue/black pen/notepaper Baby wipes Snacks (fruit, cheese/crackers) Nova Scotia Health card Health Insurance Cards/Information Cellular phones may be used on the Women and Children s Health Unit If you have made the informed decision not to breastfeed and have chosen to formula feed bring ready to feed formula; approximately 30 oz. (Avoid powder or concentrate). Powdered formula is not sterile and is not to be fed to an infant less than 2 months of age. The hospital will supply bottles and nipples. YOUR IDENTIFIED SUPPORT PERSON(S) PLANNING TO SPEND THE NIGHT WILL NEED TO BRING APPROPRIATE ATTIRE AND SNACKS. You are encouraged to leave your valuables at home. CEHHA waves liability for any lost or stolen items.