The Family Childbirth & Children’s Center AT MERCY

Family Education and Resources Guide

Welcome to The Family Childbirth and Children’s Center at Mercy

It is our pleasure to take care of you during this very special time. We are dedicated to providing excellent patient care in an atmosphere of safety, comfort, courtesy, and respect. Please feel free to ask us any questions during your stay.

This Family Education and Resources Guide provides information you or your family may need during your stay as well as for when you go home. Our nursing staff will point out the items that pertain specifically to you.

On behalf of all the doctors and health professionals of The Family Childbirth and Children’s Center, thank you for choosing Mercy for your care.

1 2 Table of Contents

About Your Stay...... 5 Patient Information...... 9 Post Partum Care...... 21 • Your Room • Visiting Hours • Normal Physical Appearance - Linen Changes - Labor & Delivery • Cramping - Housekeeping (8th floor, The Bunting Center) • Bleeding - Wireless Internet Access - Mother/Baby • Stitches - GetWell Network (10th floor, The Bunting Center) • Cesarean Section - The Mothers Gardens - NICU (8th floor, The Bunting Center) • Controlling Pain Levels - Shift Change - Overnight Visitors • Breast Pain • Your Safety - Brother and Sister Visits • Uterine or Abdominal Pain - Mother and Baby Identification • Chapels • Emptying your Bladder - Fall Prevention - McAuley Chapel • Bowels - Infant Safety Instructions - Chapel of Light • Hemorrhoids • Your Meals • Gift Shops • Constipation - Meal Selection - The Bunting Lobby • Breast Care - Patient Meal Times - The McAuley Lobby • Mood Swings • Understanding MRSA • Cafés • Your Weight and Staying Healthy - What is MRSA? - Corcoran Café - What is infection vs. colonization? - The Bistro Infant Care...... 29 - Is MRSA treatable? - The Coffee Kiosk • Medications and Tests for All Babies - How does MRSA spread? - Baggot Street Café • What is Maryland’s Newborn Screening Program - What will happen in the hospital? • Parking and Valet • Newborn Hearing Screening - What can you do to prevent the • Smoke-Free Campus • Screening for Critical Congenital Heart Defects spread of MRSA? Labor and Delivery...... 15 Medications...... 39 • Labor and Delivery Process • Induction of Labor Resources...... 41 • Preterm Labor/PPROM • New Mom Support Group • Preeclampsia • Recommended Reading for Breastfeeding Mothers • Helpful Websites 3 4 About Your Room Your Safety Linen Changes Mother and Baby Identification Your Stay Linens are changed every other day. If you would like Mercy Medical Center uses a four-bracelet identification your linens changed more frequently, please notify the system: two bracelets for the baby; one for the mother; and nursing staff. one for the adult support person.

Housekeeping Fall Prevention Your room will be cleaned every morning. Trash will be During pregnancy, there are some changes that can put you removed at least one additional time during the day. If you at an increased risk for falling: need your room cleaned between these times, please let • Changes in your center of gravity as your body changes your nurse know. • Loosening of the joints at the end of pregnancy Wireless Internet Access Internet access is a free service in every patient room for While you are in the hospital, some fall risks include: our patients and their visitors. Please use the sign-on • Fetal monitors attached to you “mercyguest”. • Other attached equipment, such as IVs GetWell Network • Pain medication The GetWell Network is an interactive system that gives • Epidural or spinal anesthesia instant access to nursing staff, medical information, and entertainment. It is available in each patient room. Please do not get out of bed after delivery until a nurse is in the room with you. Your nurse will perform an The Mothers Gardens assessment to determine your ability to walk and care for Located on the 8th floor of The Bunting Center, these yourself. Please let your nurse or another staff member gardens provide a place for rest and relaxation for our know if you need help getting out of bed at any time during patients and visitors. With the permission of your doctor or your stay. health professional, you may visit the gardens throughout your stay. Infant Safety Instructions Your nurse will review the following safety tips to enable you Shift Change to safely care for your infant during your stay in the hospital Nursing shift change occurs at 7:00 am and 7:00 pm every and when you return home. day. During this time, you can expect your nurse to visit • Always place your baby on his/her back in the crib. you and introduce you to your on-coming nurse. They “BACK TO SLEEP” to help prevent Sudden will discuss with you your plan for pain control and your Remember: Infant Death Syndrome (S.I.D.S.). expectations for your care. 5 • Avoid placing loose blankets and stuffed toys near your • Do not hold anyone else’s baby while you are in the baby’s face or head. hospital. This helps prevent the spread of germs. • Only staff wearing a pink Mercy ID badge should be • Your baby’s brothers and sisters are welcome to visit the allowed to take your baby from your room. The pink new baby. For infection control purposes, children who badge identifies Mercy staff who care for babies and their are not the baby’s brothers and sisters must be older than mothers. If you are not sure who is in your room with 12 years of age to visit the new baby. your baby, CALL YOUR NURSE. • The infant sensor on your baby’s ankle must be kept on at all times. This is a security device to help prevent infant abduction. • You and your visitors should always wash your hands Your Meals before handling your baby, after changing a diaper, and after using the bathroom. Meal Selection A member of our Nutrition & Food Service staff will visit • Hold your baby while feeding. Do not lay your baby on you each day to help you select your meal choices for the the bed or in the crib for feeding. following day. If your doctor or health professional orders • Your nurse will teach you how to use the blue bulb diet restrictions, your menu selections will be changed. syringe. Use it to clear your baby’s nose and mouth if necessary. Patient Meal Times • Remember, when holding your baby, give him/her Your meals will be served around the following times: your full attention. Even at home it is recommended • Breakfast: 8:15 am that you do not talk on the phone, hold hot drinks, or • Lunch: 12:45 pm smoke while holding your baby. Second hand smoke is dangerous to your baby’s health. • Dinner: 5:45 pm • Your baby should never be left alone in your bed or in your hospital room. Even newborns can fall. If you have a special request or if your meal does not meet your expectations, please contact the Dietary Director • If you have taken something for pain and you feel sleepy, at 410-332-9303. put your baby in the crib. It is not safe for your baby to sleep with you in your bed or sleep chair. • If you are able to walk in the hallways, your baby must be in a crib and may be rolled along with you as you walk.

6 What will happen in the hospital? Understanding MRSA If you are tested for MRSA, a swab will be inserted into each (Methicillin-Resistant Staphylococcus) nostril to test for the presence of MRSA. All patients who have a history of MRSA or a positive culture for MRSA will be placed in During your stay at Mercy, you may be tested for the bacteria, Contact Isolation. Isolation is used to keep you and other patients Methicillin-Resistant Staphylococcus. safe. If you are admitted to the hospital again, you will be placed in isolation and tested again. What is MRSA? Staphylococcus aureus (pronounced: staff-ill-oh-KOK-us AW- What happens in contact isolation? ree-us), or “Staph” is a very common germ that one (1) out of • Everyone (including your visitors) who enters the room every three (3) people have on their skin or in their nose. This must wear gown and gloves germ does not cause problems for most people who have it on • When visitors leave the room, the gown and gloves must their skin. For some people, it can cause serious infections such be put in the red trash bags as skin or wound infections, pneumonia, or infections in the blood. MRSA is a type of Staph that is resistant to some of the • Hands must be washed thoroughly with either soap and water antibiotics that are often used to treat Staph infections. If you or the alcohol hand foam when entering and exiting the room are diagnosed with a Staph infection, your doctor or health professional will work with you for appropriate treatment. What can you do to help prevent the spread of MRSA? • Wash your hands thoroughly What is infection vs. colonization? • Encourage your family and friends to wash their hands MRSA can cause infection or colonization: • Have your family and friends wear gowns and gloves • Infection: germs are in or on the body and make you sick. when entering an isolation room There are signs and symptoms such as fever, pus from a wound, or pneumonia. When you go home • Colonization: germs are in or on your body but do not make • Wash your hands often. The people who visit or live with you sick. There are no signs or symptoms. you should wash their hands often. • If you have a bandage, it is especially important to wash Is MRSA treatable? your hands before and after changing the bandage. Keep Yes. Although MRSA is resistant to a number of antibiotics and the area clean and change bandages as instructed. is often difficult to treat, there are a few antibiotics that can be • Avoid sharing personal items such as towels or razors. used. If there are no signs or symptoms, treatment is not needed. • Wash and dry your clothes and bed linens in the warmest temperatures recommended on the labels. How does MRSA spread? MRSA is spread by skin-to-skin contact as well as touching • Tell your healthcare providers, including doctors, nurses, things, such as bed linens, bed rails, bathroom fixtures, and home health nurses and aides, therapists, and personnel in medical equipment, that a person with MRSA has touched. your doctors’ offices, that you have MRSA. 7 8 Patient Visiting Hours Information All visitors should stop at the Bunting Information Desk located in The Bunting Center Lobby to be directed to The Family Childbirth and Children’s Center at Mercy.

Labor & Delivery (8th floor, The Bunting Center): Visiting hours are 24 hours a day. Five (5) visitors, including the husband or support person, may visit at one time. If you have chosen a doula, the doula does not count as one of these visitors.

Mother/Baby (10th floor, The Bunting Center): Visiting hours are 8:00 am – 8:30 pm. Five (5) visitors may visit at one time. This limit includes the patient’s husband or support person and the newborn’s brothers and sisters. One (1) adult is welcome to spend the night in the mother’s room.

NICU (8th floor, The Bunting Center): Visiting hours are 24 hours a day. Three (3) visitors may visit at the baby’s bedside at one time. Two (2) visitors may stay in the NICU waiting area on the 8th floor. One (1) parent may stay overnight with the baby. Brother and Sister Visits: The newborn’s brothers and sisters can visit in the Labor & Delivery room on the 8th floor and Overnight Visitors: One (1) adult is welcome to spend the Mother/Baby room on the 10th floor of The Bunting the night in: Center. Brothers and sisters who are in good health may visit • The Mother/Baby rooms on the 10th floor of during appropriate visiting hours when accompanied by a The Bunting Center responsible adult other than the delivering mother. Brothers and sisters are included in the limit of five (5) visitors who • The private NICU rooms on the 8th floor of are allowed to visit the mother at one time. The Bunting Center

Five (5) visitors, including the husband or support person, may stay overnight in the Labor & Delivery rooms on the 8th floor of The Bunting Center. 9 Bunting Center Visiting Hours Number of Visitors Overnight Visitors Brother and Sister Visits Floor #

Labor & Delivery 8th Floor 24 hours 5 visitors 5 visitors Must be accompanied by a day an adult other than the delivering mother.

Mother/Baby 10th Floor 8:00 am – 5 visitors, includes 1 visitor During regular visiting hours. 8:30 pm support person and Must be accompanied by the newborn’s an adult other than the brothers and sisters delivering mother.

NICU 8th Floor 24 hours 5 visitors 1 parent Must be accompanied by a day includes brothers and sisters an adult other than the 3 at the bedside delivering mother. 2 in waiting area 10 Chapels

McAuley Chapel • Located in McAuley Plaza • Open 6:00 am - 8:30 pm each day • Mass Schedule - Weekdays: 6:25 am and 12 noon - Saturday: 6:25 am and 5:30 pm - Sunday: 6:25 am • Interfaith Services - Sunday: 10:00 am • Praise & Worship Services - 2nd and 4th Wednesdays of the month at 1:00 pm

Chapel of Light • Located in The Bunting Center Lobby • Open 6:00 am - 8:30 pm Gift Shops • For prayer, meditation, and quiet solitude Mercy offers two gift shops.

Locations: • The Bunting Center Lobby • McAuley Plaza Lobby

Hours: • 7:30 am - 9:00 pm, Monday - Friday • 9:00 am - 8:00 pm, Saturday and Sunday

Baby Items: Available in The Bunting Center Gift Shop

11 12 Cafés Parking and Valet

Mercy offers a variety of locations for guests to enjoy Mercy offers numerous parking options: something to eat: • Valet parking • Corcoran Café Available at all three Mercy entrances: - Location: The Bunting Center Lobby - The Bunting Center - Hours: 7 days a week, 6:30 am – 8:00 pm and - McAuley Plaza 12:00 am – 2:00 am - Eat In or Take Out: brick oven pizzas, calzones, - The Weinberg Center strombolis, deli sandwiches and subs, soups, salads, entrees and sides, desserts, and more • Self park Available in all three Mercy garages: • The Bistro - The Bunting Garage – open 24 hours a day, - Location: McAuley Tower, 6th Floor 7 days per week - Hours: Monday – Friday, 6:30 am – 3:00 pm - The McAuley Garage – open 5:00 am – 9:30 pm, - Eat In or Take Out: burgers, chicken, hot subs and Monday – Friday fries, soups, salads, wraps, paninis, entrees and sides, and sushi - The Weinberg Garage – open 5:00 am – 9:30 pm, Monday – Friday • The Coffee Kiosk - Location: McAuley Plaza Lobby Parking tickets must be validated to receive the - Hours: Monday – Friday, 7:00 am – 2:00 pm discounted rate. Parking validation stamps may be - Take Out: gourmet coffee, to-go sandwiches, fruit obtained from each nursing station. cups, cold beverages, yogurts, desserts, and snacks

• Baggot Street Café - Location: The Weinberg Center Lobby - Hours: Monday – Friday, 6:30 am – 2:00 pm - Eat In or Take Out: Starbucks coffee, to-go Smoke-free Campus sandwiches, to-go salads, cold beverages, yogurts, The Bunting Center and its surrounding sidewalks are desserts, soups, and snacks smoke-free. The Emergency Department deck enclosure is the ONLY designated smoking area at Mercy.

13 14 Labor Labor and Delivery Process

Labor is the process that a woman goes through to deliver the process naturally or use the assistance of medication and her baby. Labor involves both uterine contractions and for pain management. cervical dilatation. Expectations During Labor Delivery Length of Labor • Based on the preference of your doctor or health The length of labor varies greatly for each woman. A professional, you may not be allowed to eat during woman who is having her first baby will most likely have a labor. However, ice chips and clear liquids may be longer labor then a woman who already has had a child. permitted. Please feel free to discuss with your doctor or health professional. Labor Assessment • The fetal heart rate and your contraction pattern will Cervical exams are used for the three step process of labor be monitored constantly throughout the labor process, assessment: unless intermittent monitoring is ordered by your • Dilatation: Opening of the cervix, which ranges from doctor or health professional. 1-10 cm. Ten (10) centimeters (cm) is considered fully • Vaginal exams are kept to a minimum and are dilated at which time the pushing process may begin. performed when necessary. The average rate of dilatation for a first time mother is 1 cm per hour. The average rate of dilatation for a • Please let your nurse know how you wish to control mother who already has had a baby is 1.5 cm per hour. any discomfort during the labor process. • Effacement: Thinning of the cervix needed prior to • Let your nurse know if you prefer to stay in bed or dilatation of the cervix. It ranges from 0 – 100%. walk during labor. 100% is considered fully effaced. • In most cases, an IV will be started and blood drawn • Station: How close the baby’s head is to the mother’s when you come to Labor and Delivery. pelvic bone. It is measured from -5 station (head is high above pelvis) to +5 (baby is crowning). Words You May Hear During Labor and Delivery The Pushing Process Your doctor or health professional may use the The pushing process will vary in duration, depending on following terms: how many babies a woman has delivered and the position • Oligohydramnios: refers to amniotic fluid volume that of the baby’s head in the mother’s pelvis. is less than expected for gestational age. The average amniotic fluid index (AFI) ranges from 8-18. Assistance in the Childbirth Process There are many different ways to assist a woman in the • Polyhydramnios: refers to excessive accumulation of childbirth process. A woman may choose to go through amniotic fluid. The average amniotic fluid index (AFI) ranges from 8-18. 15 • Biophysical profile (BPP): The fetal biophysical profile score (BPP) refers to the assessment of four fetal variables by sonogram: - Fetal movement: At least three (3) movements in 30 minutes - Fetal tone: At least one (1) movement of extension and flexion in 30 minutes - Fetal breathing: At least one (1) episode of 30 seconds or more in 30 minutes - Amniotic fluid volume: Sufficient amniotic fluid surrounding the baby PLUS: - Non-stress testing: at least two (2) fetal heart rate accelerations in 20 minutes that last 15 seconds

Please note: Each of these five parameters is given a score of 0 or 2 points, for a possible total of 10/10.

• Intrauterine Pressure Catheter (IUPC): A device placed in the uterus, next to the fetus, to measure the exact intensity of contractions. The membranes need to be ruptured for this to be used. It also can be used to replace intensive care facility where our specially trained doctors lost amniotic fluid. treat the most complex conditions in newborns. Mercy offers private NICU rooms for our babies and their families. • Internal Scalp Electrode (ISE) or Fetal Scalp Electrode • Let your nurse know: (FSE): A device that is placed on the scalp of the baby - If you would like your baby to be cared for on your when close monitoring of the fetal heart rate is necessary. chest or under the radiant warmer - If you would like to begin breastfeeding immediately - If you would like to have the normal infant medications Following the Birth of Your Baby delayed. Normally, the baby receives antibiotics in the The goal is to keep mother and baby together following eyes and a Vitamin K shot in the thigh within the first delivery. There may be times that your baby may need to go hour of life. to the well-baby nursery or to the NICU. The NICU is the • We encourage you to ask questions about your baby’s care. Neonatal Intensive Care Unit. Mercy’s NICU is a Level III-B • Please ask your nurse for any support you may need.

16 Induction of Labor

Induction of Labor is the stimulation of uterine contractions Medications Used For Induction to accomplish delivery prior to the onset of spontaneous • Cytotec: A small pill placed in the cervix. It lasts for labor. Labor may be induced for either maternal or fetal four (4) hours. This may be used several times to soften indications, preferably after 39 weeks gestation. Induction at the cervix. an earlier gestational age (less than 39 weeks) is performed • Pg Gel: A small applicator is used to insert a gel-like when the risk of harm to the mother or fetus is greater than medication directly into the cervix. It lasts four (4) to the benefits of waiting until 39 weeks. six (6) hours. Used to soften the cervix. Augmentation of Labor is similar to induction. This is a • Cervidil: A thin, tampon string-like medication placed process that increases the length, duration, and intensity in the cervix. It remains in place for 12 hours. May be of contractions that have started naturally. repeated every 12 hours until the cervix is soft and/or dilated. What you can expect if you have an induction • Pitocin: An IV medication started slowly and increased Labor does not begin until contractions are in a consistent in small increments, usually every 30 minutes, until a pattern and changing the state of the cervix. This may take desired contraction pattern is reached. one (1) to three (3) days to occur depending upon the pre-induction cervical exam. Additional Induction Information • Vaginal exams are kept to a minimum and are performed Mechanical methods also may be used for induction of when necessary. labor, such as: • The fetal heart rate and your contraction pattern will be • Foley Bulb: A foley catheter balloon is placed in the constantly monitored throughout the induction process. cervix and saline solution is added to inflate the balloon. This is pulled snug to place pressure on the cervix to cause • Depending on the preference of your doctor or health it to dilate. It remains in place until it spontaneously falls professional, you may not be allowed to eat or drink out when the cervix reaches 4 or 5 centimeters dilation. during the induction process. Ice chips and IV fluids will be given to keep you hydrated. • Laminaria: A dried seaweed medication placed in the cervix to initiate softening of the cervix.

17 Preterm Labor/ PPROM

Preterm labor (PTL) is labor that starts before 37 weeks Preterm PROM (PPROM) refers to membranes that rupture gestation. Preterm labor can be diagnosed only by when the pregnancy is less than 37 completed weeks of finding changes in the cervix when you are having regular gestation. contractions. This means your doctor or health professional will have to examine you. To help diagnose preterm labor What to expect for PTL/PPROM your doctor or health professional may use the following • Continuous fetal monitoring tests: • Strict bed rest with possibility of flat or head-lowered • Fetal Monitoring: These tests are used to record the positioning heartbeat of the fetus and the contractions of your uterus. • Close monitoring of maternal temperatures They are very important in determining the frequency of (every 2-4 hours) to detect the presence of infection your contractions. • IV fluids and medications • Ultrasonography: This exam may be used to measure the length of the cervix and estimate the size, age, and • NICU consult position of the fetus. You may be observed for a time and then examined again to see whether your cervix changes. Medications Used to Treat Preterm Labor • Fetal Fibronectin: This test is used to measure the • Terbutaline: Typically a small injection in the arm, or a amount of a certain protein that helps predict the risk small pill, taken daily to prevent contractions of preterm delivery. • Magnesium Sulfate: IV medication given to stop preterm labor and to relax the uterine muscle You also may have a pelvic exam and tests to look for • Betamethasone/Dexamethasone: Steroid injection given infections of the vagina or cervix. to help develop the baby’s lungs Premature rupture of membranes (PROM) refers to • Nifedipine: Pill taken daily to prevent uterine contractions membranes that rupture before the onset of uterine • Indocin: Pill taken daily to slow uterine contractions contractions.

18 Preeclampsia

Preeclampsia is the new onset of elevated blood pressure and the presence of protein in your urine after 20 weeks gestation. Signs of preeclampsia can appear any time during the last half of pregnancy (after 20 weeks of pregnancy) or in the first few days postpartum. Preeclampsia typically resolves within a few days after delivery.

Possible signs and symptoms of preeclampsia are: • Persistent elevated blood pressures • Consistent headaches • Vision changes • Increased swelling

Please note: The only known cure for preeclampsia is delivery of the baby.

Eclampsia: The major risk associated with preeclampsia is What you can expect if you have preeclampsia seizures from the high blood pressure. This is known as eclampsia. • Frequent blood work, urine catheterization/urine cultures • Continuous fetal monitoring Medications Used to Treat Preeclampsia • Bed rest • Nifedipine: Pill taken daily to decrease blood pressure • Possible diet restrictions • Magnesium Sulfate: IV medication given to prevent • Ultrasonography seizures from elevated blood pressures • Frequent vital signs • Labetalol: Pill taken daily to decrease blood pressure • IV fluids • Hydralizine: IV medication given to decrease very high blood pressures • Possible induction of labor • Betamethasone/Dexamethasone: IM steroid injection • Frequent assessment (listening to your lungs, performing given to help to develop the baby’s lungs – usually reflex checks) for symptoms of worsening preeclampsia administered between 24 and 34 weeks gestation 19 20 Many things happen to your body after the birth of a baby. for a period of time. The blood pools in the uterus and then Post There will be various discomforts. Most are normal and will gravity works to empty the uterus of the blood when you go away in time. The common changes and discomforts stand up. It will slow down over 7 to 10 days, going from are described below. Your doctor or health professional can bright red to pink to a brownish discharge. Some women Partum explain any things you might experience. They are happy to experience some amount of bleeding for up to six (6) weeks answer your questions. following delivery. Every woman is different and each post-partum period is different, so what you experienced Care Normal Physical Appearance with your last delivery may not be the same as what you are It will take several weeks for your body to return to its experiencing with this delivery. You may notice that bleeding pre-pregnancy state. You may notice your body never fully increases when you are breastfeeding because of the uterine returns to the size it was before you became pregnant, which contractions that occur. You also may notice increased is a result of the growth that occurred in your body during bleeding when you are very active, which is your body’s way the growth of your baby. This is normal. You should not of telling you to slow down. try to lose weight immediately after the birth of your baby because your body needs good nutrition to heal properly. Stitches Additional information about staying healthy can be found You may have stitches in your bottom (perineum) as a result on page 26. of an episiotomy (surgical incision made in the perineum) or a laceration or tear in the perineum. You also may have Cramping stitches or staples in your lower abdomen as a result of a You may experience cramping while your uterus shrinks. The c-section. If you have stitches in your bottom, it will take uterus shrinks about ½ inch per day. These “after pains” may about three (3) weeks to heal. The stitches dissolve and will be similar to menstrual cramps and will last about a week. not have to be removed. It is normal for the area to be itchy. They might be stronger if this is not your first baby or if you You may notice small pieces of your stitches on your sanitary are breastfeeding. Every time the baby breastfeeds, the uterus napkin. This is normal. With or without stitches, you may contracts causing these after pains. Lying on your stomach, be sore. It will help to soak in a warm sitz bath several times deep breathing exercises, and mild pain relievers, such as a day and to use witch hazel pads on your bottom. Sit on a Ibuprofen, will help to relieve this discomfort. firm chair rather than a soft couch to prevent the edges of the perineum from spreading. The application of ice for the first Bleeding 24 hours following delivery helps to decrease the swelling in The uterus must contract to keep you from bleeding too the perineum. The application of warmth following the ice much. The bleeding that you experience is called lochia. helps to increase the amount of circulation to the perineum Initially, it will be a bit heavier than a menstrual period and and promotes healing. will be heavier when you stand up after sitting or lying down

21 Cesarean Section You can help us by rating your pain on a scale of one to ten, If you had a Cesarean section, you will be sore where you with zero (0) being no pain, five (5) being moderate pain, were cut. You may use analgesics for this discomfort. If the and ten (10) being the worst pain possible. When you rate incision was closed with staples, they generally are removed your pain, your nurse will be able to help you choose a pain within seven (7) days of delivery and replaced with small intervention that will work best for you. If you know what strips of adhesive tape called steri strips. If your doctor used pain level is acceptable to you, then when you start to get sutures to close your incision, the steri strips are already in near to that pain level, you should let your nurse know that place. These steri strips will fall off naturally as you bathe you will need something for pain soon. For example, if your over the next few weeks. Do not pull them off. Allow them acceptable pain level is 4 and you are currently at a level 3, to fall off naturally. It is important to keep your incision you will want to plan for receiving pain medication soon so clean and dry as it heals. Wash the area with soap and water that your pain does not go above a level 4 without some type as you shower and pat it dry. You may wish to place of intervention. a sanitary napkin over the incision to keep it cushioned and to keep moisture from accumulating on the incision. ASK YOUR NURSE ABOUT PAIN CONTROL Controlling Pain Levels It is important to control your pain level following the birth of your baby. You will feel much better and be able to participate more fully in the care of your baby if you are comfortable. It is important for you to “stay on top of” your pain level – that is, do not wait too long to ask for pain 0 1 2 3 4 5 6 7 8 9 10 medication because it does take up to one hour for the pain No Moderate Worst Pain medication to take its full effect. Pain Pain Possible

Wong-Baker FACES Pain Rating Scale

22 Breast Pain Bowels If your pain is in your breast, your nurse may suggest non- Your bowels also may become irregular following the birth medication treatments such as an ice pack, a supporting of the baby. Hemorrhoids may develop as a result of all the bra, warm compresses, or change in breastfeeding positions. pressure downwards at the end of pregnancy and during Medication treatments, such as Tylenol, may be suggested. delivery. Possible side-effects, such as abdominal pain, nausea, or unusual bleeding, will be discussed. Hemorrhoids Hemorrhoids can be very painful and may be relieved by Uterine or Abdominal Pain taking a sitz bath – soaking in warm water to help relieve the If your pain is in your uterus or belly, such as you would itching and burning associated with hemorrhoids. As your have with cramping and bloating, or incisional pain from a stitches heal and the swelling goes down, your hemorrhoids c-section, your nurse may suggest non-medication treatments will shrink. Do not use “donut” rings for hemorrhoids as such as a heating pad, walking, supporting pillow, back they actually can make the hemorrhoids swell even more. massage, or position change. Medication treatments, such as Tylenol, Motrin, Percocet, or Toradol, may be suggested and Constipation the side-effects of allergic reaction, hives, difficulty breathing, Constipation is common after giving birth. To avoid swelling of your face, lips, tongue, or throat will be discussed. constipation, drink 8-10 glasses of water every day, take Each pain experience is different and may require different a short walk a few times a day, and eat foods with lots of interventions. fiber. Fresh fruits, raw vegetables and salads, whole grain breads and cereals, as well as bran, are good sources of fiber. Emptying Your Bladder Drink milk if you are not lactose intolerant. You may need You may have difficulty emptying your bladder for the first a laxative or stool softener if you have not had a bowel few days following delivery. This is a result of the effects of movement within two (2) or three (3) days after giving birth. the pregnancy hormones along with the pressure exerted Call your doctor or health professional for advice. on the bladder and urinary tubes during the delivery of the baby. If you experience a feeling of fullness and cannot empty your bladder, please let your nurse know so you can be catheterized to allow you to feel more comfortable. The natural sensations of going to the bathroom will return in time. Some women have difficulty controlling the flow of urine and will dribble urine on their way to the bathroom. This will correct itself in time, as the muscles in the floor of your perineum get stronger following the birth of your baby.

23 24 Breast Care painful. It is important to keep your breasts well supported Breast care is important for all mothers following delivery. with a tight bra or binder 24-hours a day. Release the bra or binder three times a day for an hour each time. You may • For the breastfeeding mother, please refer to the booklet place ice packs wrapped in a washcloth under your arm pits on breastfeeding that you have received. It will provide for approximately 15 minutes several times a day to help you with information on some of the minor problems decrease the amount of milk that is produced. of breastfeeding, such as sore nipples, engorgement, clogged ducts, and difficulties establishing nursing. When you take a shower, allow the water to hit your back, not your breasts, to prevent the “let down” of milk. “Let Breastfeeding is encouraged because of the benefits to down” will cause you to make even more milk. The pain both the mother and baby. Breastfeeding provides: and heaviness of engorgement will last only 3-4 days. It will – A special bond between mother and baby take 2-3 weeks for your milk to dry up completely. Be sure – Natural antibodies to help strengthen the baby’s to wear a bra day and night. You may leak fluid for a week immunity and fight infections or two. Just put a pad inside your bra and change it when it – Easily digestible milk that changes over time to becomes damp. Take a pain reliever, such as Ibuprofen, for provide all the nutrients the baby needs to grow pain or discomfort. Do not hand express milk from your breasts since doing so will cause more milk to be produced. Breastfed babies typically are healthier than bottle-fed It is normal for your temperature to rise a bit when your babies. The health benefits for mothers who breastfeed breasts are engorged. If your temperature goes above include: 100.6 °F or if you have extreme tenderness or red streaks – Reduced risk of developing osteoporosis, anemia, on your breasts, call your doctor or health professional. and breast and ovarian cancers – Improved recovery time Mood Swings – Faster return to a healthy weight It is normal to have a short period of mood swings or “baby blues” sometime during the first two weeks after giving birth. • For the bottle-feeding mother, you will not want to Your hormone levels change a lot during this time and can encourage the production of milk that naturally occurs cause mood swings. You may feel irritable and cry for little or following the birth of a baby. no reason. These should not last more than about three days. Getting enough sleep will help decrease how strongly or how Milk comes between the second and seventh day after giving often you have these feelings. Try to nap every time the baby birth, dependent upon how many babies you have had. You does. Meanwhile, discuss your feelings with your husband, will want to wear a tight-fitting bra that is 1-2 cups sizes significant other, or close family member or friend. Call your larger than normal. Your breasts will become firmer and doctor or health professional if your feelings do not go away heavier a little at a time. When you are fully engorged, they after a few days, if you feel you cannot take care of yourself, will be sore and hard. You may feel like you have marbles or if you are afraid you will hurt yourself or your baby. in your breasts or under your armpits. This can be very 25 Your Weight Before beginning an exercise program or diet, please What Is Your Body Mass Index (BMI)? consult your doctor or health professional. There are Body Mass Index (BMI) indicates if you are underweight, and Staying many physiological changes that occur during and normal weight, overweight, or obese. It can be used as an immediately after pregnancy (6-8 weeks). Your doctor or indicator of health and wellness. Your pre-pregnancy BMI Healthy health professional can recommend appropriate exercise will allow you to estimate how much weight you should gain and diet according to your individual needs. For example, during your pregnancy in order to stay healthy and reduce women who have had a cesarean section may need to avoid risk of postpartum weight retention. stretching exercises until the incision has healed.

Postpartum Weight Retention Pre-pregnant Weight Recommended There are many factors that can contribute to BMI Classification Pregnancy Gain postpartum weight retention, including: <18.5 Underweight 28-40 lbs • Pre-pregnancy Weight: A high pre-pregnancy weight can make it harder to lose weight after delivery. 18.5-24 Normal 25-35 lbs • Gestational Weight Gain: Excessive weight gain during 25-29 Overweight 15-25 lbs pregnancy can cause postpartum weight retention. >29.0 Obese At least 15 lbs • Race and Ethnicity: Minority women, especially African- American women, have a higher risk for postpartum weight retention. • Not Breastfeeding: Women who choose not to breastfeed Importance of Eating Healthy after Delivery may have a harder time losing weight following delivery. • It is important to eat healthy foods after your baby is • Psychosocial Factors: Feeling distressed, anxious, and born. Eating well will help you get rid of your pregnancy depressed during pregnancy along with having personal pounds. and economical burdens are associated with higher • Your body goes through a lot of changes during postpartum weight retention. pregnancy. It needs good nutrients and vitamins to help • Nutrition and Activity: Weight retention can depend on it get back to where it was before you had your baby. eating behaviors and physical activity prior to, during, • Children are twice as likely to suffer from obesity and and after pregnancy. develop Type 2 Diabetes if their mothers are obese.

26 Understanding Calorie Intake • Intensity: You should change the level of intensity A good way to get your calories for the day is to eat a throughout the exercise session. Aim for moderate to high variety of foods, including vegetables, fruits, and whole intensity. Speeding up or slowing down your movements grains. In general, 2,000 calories a day should include: will help you change intensity. Your exercise intensity can be monitored using the “talk test”. You should be able to • Carbohydrates = 900 to 1,300 calories talk without effort if you are doing a moderate activity. • Protein = 200-700 calories For more high intensity activities, you will need to take a breath after a few words. • Fat = 400-700 calories • Amount of Exercise: The goal is to exercise for For mothers who are bottle feeding their babies, this is a approximately 2 hours and 30 minutes per week. Begin good guideline to follow. each session with 5 to 10 minutes of low intensity warm-up. Follow with about 15 minutes of moderate to Breastfeeding mothers should: somewhat high intensity activity. Finish with a 5 to 10 minute low intensity cool down. To avoid becoming too • Eat more calories (around 2,330 calories per day) until tired, add some rest periods as needed during your session. her milk is well established. The calories then can be reduced to help promote weight loss. • Suggested Activities: Activities can include walking while pushing a stroller, jogging, aerobic dance, • Eat a higher percentage of carbohydrates to help make swimming, tennis, cycling, or activities that exercise milk and provide the baby with proper nourishment. the major muscle groups. • Get more vitamins A, B, C, and E as well as zinc and iodine. Exercise for Breastfeeding Mothers Mothers who are breastfeeding should: Dangers of Dieting • Exercise after breastfeeding (or when breasts are empty) Skipping meals or reducing calories prevents weight loss. to decrease breast discomfort. The lack of calories makes the body slow down resulting in the lack of weight loss. • Wear a bra that offers good support. Avoid sports bras since they can cause breast compression. Exercise Following Postpartum Is Necessary • Maintain good hydration and nutrition to refuel after Prepregnancy exercise can be resumed gradually. Remember breastfeeding and exercise. it is important to drink plenty of water to remain hydrated. It is important to first discuss with your doctor or health professional if the exercise guidelines below are appropriate for you: • Frequency: Begin slowly and increase exercise as tolerated (start exercising 3 days per week and then increase to 4-5 days per week) 27 28 Infant Medications and Tests for All Babies Care All babies born at Mercy receive a variety of medications Prevention of Serious Bleeding and tests to prevent infections and/or diagnose medical A shot of Vitamin K in the thigh muscle is given to all conditions. These medications and tests are outlined below babies to prevent bleeding. Vitamin K, which is made in with the reasons they are performed. You may discuss any the intestines, allows blood to clot and prevents abnormal of these medications and tests with your doctor or health bleeding. Some babies are born without enough Vitamin K professional. If you do not want your baby to have a specific and cannot make enough in the first few days of life. Since medication or test, you will be asked to sign a form stating babies who do not have enough Vitamin K cannot be easily your wishes. identified, one dose of Vitamin K is administered, which is enough to keep a baby from bleeding until they can produce Eye Infection Prevention their own Vitamin K. A strip of erythromycin antibiotic eye ointment is placed in each eye within one hour after birth. As babies pass through Hepatitis B Infection Prevention the birth canal, they pick up bacteria, which is normal in The Hepatitis B vaccine should be given to all babies. The the delivery process. Most often these bacteria are helpful first of three doses is best given in the nursery with the to the baby, but occasionally, some of the bacteria may remaining two doses given after one month of age. Hepatitis be dangerous. The erythromycin antibiotic prevents any B is a virus that can cause severe liver disease. The vaccine dangerous bacteria from growing and causing eye infection, helps those babies whose mothers may carry the virus. which could be serious. Since it cannot be certain which mothers may pass on the dangerous bacteria, all babies are Urine Test for Drugs given this safe treatment as a precaution. All mothers admitted to Mercy take a urine test for drugs to detect not only illegal drugs but also medications the Prevention of Umbilical Cord Infection mother should be taking. The drugs found in the test may The baby’s umbilical cord (navel) will dry naturally and be perfectly justified but may have a potential effect on the should fall off within two weeks of delivery. To prevent baby. Therefore, when a mother’s test is positive, the baby’s infection of the umbilical cord area, cleanse the skin around urine also is tested. Any positive results are shared with the the cord with soap and water during the baby’s bath as mother and include a discussion of any potential effects on demonstrated by your nurse. To keep the umbilical cord dry the baby. It is important for the baby’s pediatrician to be and promote faster healing, fold the top flap of the diaper advised about the test results. down and away from the cord and secure the diaper snuggly with the self-stick adhesive tabs.

29 What is Maryland’s Newborn Screening Program has two parts: Maryland’s • Newborn Blood Spot (Metabolic) Screening Newborn • Newborn Hearing Screening Please feel free to ask your nurse about these programs and Screening this very important screening process. Program? Metabolic Newborn Screening

The Maryland Department of Health and Mental Hygiene offers metabolic newborn screenings as a service to families with new babies. This program finds newborn babies with certain rare, serious disorders of body chemistry. These disorders can be treated when detected early. Before your baby can be tested, you, as the parent, must agree and give What disorders can metabolic newborn screening identify? consent for the testing. The Maryland program now tests babies for 35 conditions, which include: Why is my baby tested? The testing is done to make sure your baby will be as healthy • Cystic Fibrosis (CF): a problem with moving salt in and as possible. The Newborn Screening Program finds babies out of cells causes thick, sticky mucus in the lungs, leading who may have one of several rare disorders and alerts the to lung infections and problems with breathing. Some doctors to this possibility. Serious illness usually can be babies with CF also have problems digesting (breaking prevented with early diagnostic and medical treatment. down) the food they eat, causing slow growth. CF is diagnosed with a test that measures the amount of salt in How is my baby tested? the sweat. CF is treated with breathing treatments and Once you give permission, your baby’s heel will be pricked antibiotics for the lungs and with medicine and a special to get a few drops of blood. This blood will then be placed diet for babies with digestion problems. on special paper, dried, and mailed to the Maryland State Laboratory. The laboratory needs just a tiny bit of blood to • Fatty Acid Oxidation Disorders: the body usually gets do all the tests described here. The heel prick feels no worse energy from sugars and fats. The sugar is used first but than being stuck by a pin. Problems from the test, such as when the sugar is all used up, the body must use fats. In infection of the heel, are rare. this group of disorders, the body cannot use fats because of the lack of one of several enzymes. The disorders in this group do not have common names. They usually are described by the length of the fatty acid that cannot be 30 used. The most common of these disorders is a Medium Most of these disorders do not have common names and Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency. are described by the name of the organic acid found in the Because they cannot use stored fat for energy, babies with urine. Screening for most of these disorders is very new. these disorders may develop seizures, comas, and life- There are 13 organic acidurias that are included in the threatening complications. Treatment includes making Maryland Newborn Screening Program. sure the baby eats regularly and avoids fasting. A special diet and medications also may be used. Screening for these • Phenylketonuira (FEN-nil-KEE-tone-u-ree-ah) or disorders is very new. There are 11 fatty acid oxidation PKU: the body cannot use a part of the protein in food disorders that are included in the Maryland Newborn (the amino acid phenylalanine) because of the lack of an Screening Program. enzyme. A special diet low in phenylalanine can prevent the brain damage that would otherwise result. • Galactosemia (ga-LAK-toe-see-me-ah): the body cannot use a sugar in milk (galactose) because of the lack of • Sickle Cell Anemia: this is a serious blood disorder. Under an enzyme. A diet low in galactose can prevent life- certain conditions, the abnormal blood cells can clog the threatening complications. Babies with the most severe small blood vessels causing painful “crises”. Babies with form of this disorder can get very sick very fast. sickle cell anemia have less resistance to infections, which may be life threatening. A regular treatment program • Homocystinuria (HO-mo-SIS-tin-u-ree-ah): the body using penicillin and special immunizations helps avoid lacks an enzyme in the liver that is needed to handle serious complications. sulfur. This can lead to mental retardation and other changes in the body. A special diet, and sometimes Newborn screening is a rapidly growing service. The number vitamin B6, can prevent mental retardation and other of disorders included in the program recently has expanded complications. from nine (9) to 35 disorders. The number of disorders included in the testing is not a judge of the quality of a • Hypothyroidism (HI-po-THI-royd-ism): the body newborn screening program. Different programs count the cannot make enough thyroid hormone (thyroxin). This number of disorders in different ways. Maryland screens for leads to mental retardation and slow growth. These all of the disorders recommended by the March of Dimes problems can be prevented by giving thyroxin pills. and the American College of Medical Genetics.

• Organic Acidurias: the body cannot use the branched Tests still are being developed for other serious disorders. chain amino acids from the protein in food because of the Your baby may be tested for these as well. You will be told lack of one of several enzymes. The breakdown products if any of these new tests suggest that your baby might of these amino acids are organic acids. The organic acids have a problem. build up to dangerous levels in the blood damaging the nervous system. Babies with some of these disorders can become very sick very fast. Symptoms can sometimes be reduced with special diets low in protein and medications. 31 From time to time, the State Laboratory does studies on These disorders do not always show symptoms in the same other important health problems using these samples. These way. Some babies may become dangerously ill within the only are done after all the other tests are finished. These first days or few weeks of life. Others may appear healthy for studies show how many babies are affected by the problem months or even the first year of life. In either case, serious being studied. They do not tell which babies have the harm is occurring that could be prevented in most cases, problem because the samples are not identified by name. with early treatment. Once the damage has occurred, it can never be repaired. Is my permission required? Most parents want to know what is important to their baby’s How much will these tests cost? health so they can be sure that their baby gets good care. The State Laboratory charges a small fee for doing the Testing newborn babies for these disorders is an important screening tests on your baby’s blood sample. In addition, the part of good baby care. The State of Maryland requires that doctor, clinic, or hospital may charge a small fee to do the you be asked to give permission before metabolic newborn heel prick. No baby will be refused testing because a family screening tests are done. You will need to sign the permission cannot pay. form after your baby is born. This will give you the chance to say “yes” or “no”. Please say YES! How does a baby get one of these disorders? Except for hypothyroidism, a baby inherits the disorder from My baby seems healthy. Are the tests still needed? both parents. Parents and relatives usually show no sign of Yes, the tests are needed. Most infants with conditions found the disorder. In most cases of hypothyroidism, the thyroid by the Newborn Screening Program have no obvious signs gland does not develop, is too small, or is in the wrong place of illness right after birth. However, each of these disorders in the body. These problems are usually not inherited. In a can cause serious problems if not found early and treated. few cases, there is an inherited defect in the gland’s ability to Many of these disorders can cause brain damage and mental make thyroxin. retardation. Others, like sickle cell disease and CAH can cause severe physical illness. These disorders are quite rare and the chances are excellent that your baby will not have one of them. The few babies There are many causes of mental retardation. The who are born with these problems are generally from healthy information in this section deals only with the disorders for families. Testing every baby after birth will make sure that which there are good screening tests. Effective treatment each infant who has a disorder will be identified and started is available for most of these disorders. A few disorders on early treatment. recently added to the program are not yet well understood and treatment may not be effective. But every baby with a disorder deserves the best treatment that is available.

32 When is the best time to test my baby? Each baby should be tested twice. The first test usually is What if I am told that a “retest” is necessary? done shortly before the newborn baby leaves the hospital. A retest may be needed for a number of reasons. It does not For the most reliable results, it should be done after the baby mean there is anything wrong with the baby. It usually means has received at least 24 hours of breast or formula feedings. that another sample is needed so all tests can be completed. In some cases, babies leave the hospital before they are Rarely, the first test indicates a possible problem. In this case, 24-hours old or have had milk for 24 hours. They should a new blood sample is requested, and the tests are repeated or be tested before they leave the hospital, but some of the test the baby is sent to a specialist. results will not be accurate. The test should be repeated when the baby is two (2) to three (3) days old. If you are asked to have your baby retested, please schedule the test quickly. If your baby was not born in a hospital, the first test should What if my baby has one of these disorders? Is there a cure? be done when your baby is two (2) to three (3) days old. Because most of these disorders are inborn problems of Most doctors routinely will obtain a second blood sample the body chemistry, they cannot be “cured” – just as eye when the baby is a little older (about 2 weeks), even if the color or height cannot be permanently changed. However, first test was ideal and normal. This second test gives another the serious effects of the disorder usually can be controlled chance to find the babies with problems. It is especially and sometimes completely prevented by early treatment. important for finding babies with CF and hypothyroidism. Effective treatment is available for most of these disorders. The treatment is usually a special diet or medication. A few How soon will I know the results? disorders are not yet well understood and treatment may In most cases, the test results will be normal and you will not be effective. However, every baby with a disorder not be notified personally. Your doctor will get the report. deserves the best treatment that is available. Your doctor Results are usually available in about 10 days. Generally, or the Health Department will make arrangements for parents are notified only if there is a problem. You should referral and treatment. ask about the results when you bring your baby to the doctor for a regular checkup. If this child has a disorder, will my future children also have it? Although “no news is good news”, it is important to The answer to this question will depend on your child’s remember that these tests only find the disorders listed in diagnosis. It can best be answered by a genetic counselor. this information. There may be other medical problems With your help, the counselor can study your family’s health that cannot be picked up by these tests. Therefore, it is very history and explain the chance of this happening again. This important for your baby to have regular checkups and good process is called genetic counseling. If you would like more general medical care. information about genetic counseling, your doctor or Health Department will help you get it.

33 What types of hearing loss can the newborn hearing screening Newborn Hearing Screening identify? The Maryland program identifies the two basic types of The second part of Newborn Screening in Maryland is hearing loss: screening of your baby’s hearing. This program is designed 1. Sensorineural hearing loss is caused by problems in the to help find babies who may have hearing loss and need baby’s inner ear. Although this type of hearing loss cannot early intervention. be cured, it can be treated. Why is my baby tested? 2. Conductive hearing loss is caused by problems in the There are two reasons that the State screens all babies for baby’s middle ear. This type of hearing loss sometimes hearing loss: goes away by itself. If not, it can be successfully treated medically or surgically. 1. If a baby with a hearing loss is helped before six (6) months of age, the baby will have a very good chance of The screening tests indicate whether the problem is in one having normal communication skills. ear or both ears. 2. Twice as many babies with hearing loss are found when all babies are tested rather than just those who are “at risk” for hearing problems.

How is my baby tested? Since doctors or nurses at the hospital cannot ask your baby if he or she hears, they have to use computers to help them. Two methods are used: 1. Auditory Brain Stem Response (ABR test): measures the response of your baby’s brain to sound. This is the method used at Mercy Medical Center. 2. Otoacoustic Emissions (OAE test): measures the response of your baby’s ear to sound. Both tests are completely painless and can be done while your baby is asleep.

34 Is my permission required? If you are asked to have your baby retested, please schedule The State does not require parental consent for newborn the test quickly. hearing screening. But we want you, as a parent, to It is important that we give your baby the best possible understand why hearing is tested. chance to develop speech and language. Studies show that if hearing loss is not diagnosed and treated before six (6) How much will these tests cost? months of age, language development is delayed by almost There are no fees for a hearing screening at Mercy. 50%. This means that a 4-year old may only have the language skills of a 2-year old. When is the best time to test my baby? Your newborn baby’s hearing will be tested before leaving How can I make it easier for doctors to help my baby? the hospital. The best time to screen is when your baby is Please make sure your doctor has your current contact quiet and comfortable. If your baby did not pass the first information, including telephone number and address. screening, you will be asked to return with your baby for If your contact information changes, remember to update another screening before the baby is one month old. your doctor.

How soon will I know the results? If your doctor asks you to bring the baby in for retesting, In most cases, you will know the results of the hearing do so as soon as you can. If your child does have a disorder screening before you leave the hospital. Also, you and your or a hearing loss, your prompt action in following the baby’s pediatrician will receive a letter from the Health doctor’s instructions can be very important. Department that explains the results. As a parent, you can help to assure the health of your child What if I am told that my baby needs a “retest”? by your cooperation with Maryland’s Newborn Screening A retest will be needed if your baby did not pass the first Program. screening test. This does not mean that your baby has a hearing loss. If the baby does not pass the retest, the baby will need further evaluation.

35 The Importance of Screening for Critical Congenital Heart Defects

Some babies born with critical congenital heart defects (CCHD) can appear healthy at first and can be sent home before their heart defects are detected. These babies are at risk for having serious complications within the first few days or weeks of life and often require emergency care. Newborn screening using pulse oximetry can identify some infants with a CCHD before they show signs of the condition. Once identified, babies with a CCHD can be seen by cardiologists and can receive specialized care and treatment that could prevent death or disability early in life. Treatment can include medications and surgery. The most common CCHDs are: • Hypoplastic left heart syndrome • Pulmonary atresia (with intact septum) • Tetralogy of fallot • Total anomalous pulmonary venous return • Transposition of the great arteries • Tricuspid atresia • Truncus arteriosus

36 How Are Babies Screened for CCHD? Newborn screenings for CCHD are conducted using pulse oximetry, which is a simple bedside test to determine the amount of oxygen in a baby’s blood and to take the baby’s pulse rate. Low levels of oxygen in the blood can be a sign of a CCHD. The test is done using a machine called a pulse oximeter and sensors are placed on the baby’s skin. The test is painless and takes only a few minutes. Pulse oximetry screening does not replace a complete history and physical examination, which sometimes can detect a CCHD before the development of low levels of oxygen in the blood. Pulse oximetry screening should be used along with the physical examination.

When Are Babies Screened for CCHD? Screening for CCHD 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.

CCHD Screening Results If the results are negative (pass or in-range result), it means testing is needed. The baby’s doctor might recommend that that the baby’s test results did not show signs of a CCHD. the infant get screened again or have more specific tests, like This type of screening test does not detect all CCHDs, so it an echocardiogram (an ultrasound picture of the heart), to is possible to still have a CCHD or other congenital heart diagnose a CCHD. Babies who are found to have a CCHD defect with a negative screening result. also might be evaluated by a clinical geneticist. This could help identify genetic syndromes associated with CCHDs and If the results are positive (fail or out-of-range result), it means inform families about future risks. that the baby’s test results showed low levels of oxygen in the blood, which can be a sign of a CCHD. This does not always Both tests are completely painless and can be done while mean that the baby has a CCHD. It just means that more your baby is asleep.

37 38 Medications may need to be prescribed for you and/or Medications your baby. Your nurse will provide you with a Medication Information Sheet detailing: • Name of the medication • Why the medication is being prescribed • What the expected results of the medication are • What side effects should be reported immediately to your doctor or health professional

39 40 Resources Recommended Reading for Breastfeeding Mothers for The ABCs of Breastfeeding: Everything a Mom Needs to Know for a Happy Nursing Experience by S. Rubin; Breastfeeding Amacom Books (2008)

Adventures in Tandem Nursing: Breastfeeding through Moms Pregnancy and Beyond by H. Flower; LLLI (2003). (Featured in New Beginnings May-June 2003).

The Black Woman’s Guide to Breastfeeding by K. Barber; Sourcebooks (2005)

Breastfeeding and Natural Child Spacing by S. Kippley (2008)

The Breastfeeding Café: Mothers Share the Joys, Challenges and Secrets of Nursing by B. Behrmann; The University of Michigan Press (2005)

The New Parent Support Group Breastfeeding: Keep It Simple by A. Spangler (2004) Breastfeeding Made Simple by N. Mohrbacher and The New Parent Support Group, facilitated by a Mercy K. Kendall-Tackett; New Harbinger (2005) Lactation Consultant, offers a time to: • Discuss concerns and questions about breastfeeding, Eat Well, Lose Weight While Breastfeeding by E. Behan; infant care, infant development and behavior Ballantine Books (2007)

• Discuss parental/family adjustments after the birth A Medication Guide for Breastfeeding Moms by T. Hale and of a baby G. McAfee; Pharmasoft (2005) • Meet other new parents Milk Memos: How Real Moms Learned to Mix Business with For more information about the New Parent Support Babies and How You Can, Too! by C. Coburn-Smith and Group or Mercy’s Lactation Services, please call the A. Secrette; Tarcher-Penquin (2007) Warmline at 410-332-9060. 41 Helpful Websites for Pregnant and Breastfeeding Mothers

Mothering Multiples: Breastfeeding and Caring for Twins or www.breastfeedingmadesimple.com More by K. Gromada; LLLI 3rd ed. (2007) www.kellymom.com Nonprescription Drugs for the Breastfeeding Mother by F. Nice; Hale Publishing (2007) www.breastfeeding.com (multiple resources on breastfeeding, nutrition etc.) The Nursing Mother’s Companion by K. Huggins; Harvard Common 6th ed. (2005) www.llli.org

The Nursing Mother’s Guide to Weaning by K. Huggins and www.promom.org L. Ziedrich; Harvard Common Press (2007) www.multiplebirthsfamilies.com/breastfeeding The Nursing Mother’s Herbal by S. Humphrey; Fairview Press (breastfeeding in special circumstances) (2004). (Reviewed in New Beginnings, May-June, 2004). www.lowmilksupply.com Nursing Mother, Working Mother by K. Pryor and G. Pryor; Harvard Common Press (2007) www.bfar.org (breastfeeding after breast reduction, augmentation, etc.) Straight from the Heart: A Torah Perspective on Mothering through Nursing by T. Baranov; Targum Press (1990) www.mypyramid.gov (nutrition) Why Should I Nurse my Baby? by P. Wiggins; LA Publishing Co. 3rd ed. (2005)

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The Family Childbirth & Children’s Center at Mercy 345 St. Paul Place Baltimore, MD 21202 410-332-9000 1-800-MD-Mercy www.mdmercy.com