The Birth Center: Holistic Women’s Health Care Client Manual Updated: May 5, 2020 The Birth Center: Holistic Women’s Health Care, LLC 620 Churchmans Rd, Suite 101, Newark, DE 19702 Telephone: 302-658-2229 Fax: 302-658-2382 ©The Birth Center, Women’s Holistic Health Care 1 Introduction 10 Communicating with The Birth Center 10 Routine Communications 10 Calling TBC after Hours 11 When You Need to Speak with a Physician 11 Examples of Calls That Need to Come to TBC, Not Your Physician 11 Philosophy of TBC 11 Services 12 Our Staff 13 Certified Nurse-Midwives (CNMs) 13 What is a CNM? 13 Philosophy of the American College of Nurse-Midwives 13 Responsibilities of the CNMs 14 Registered Nurses (RNs) 14 Responsibilities of the RNs: 14 Consulting Physicians 15 Our Clients 15 Pre-Enrollment Condition 15 Your Responsibilities after Enrollment 16 Prenatal Office Visits 16 Frequency 16 Procedures 17 Family Involvement 17 Routine Laboratory Studies 18 Blood Type 18 Rh Factor 18 Antibody Screening 18 Rapid Plasma Reagin (RPR) 19 Urinalysis and Urine Culture 19 Rubella Antibody Screen 19 Gonorrhea Culture (for detecting Gonococcal infection) 19 Chlamydia Culture 19 2 Complete Blood Count (CBC) 20 Pap Smear 20 Hepatitis B Surface Antigen and Hepatitis C Antibody Screen 21 Human Immunodeficiency Virus (HIV) 21 One-Hour Blood Sugar Screen at 28 Weeks 21 Other Studies 21 First Trimester Screening for Trisomies 21 Cell-free Fetal DNA Testing 22 CVS at 9-11 Weeks 22 Cystic Fibrosis Carrier Screen 22 Alpha-Fetoprotein (AFP) at 16-18 Weeks 22 Amniocentesis (Amnio) at 16 Weeks 23 Toxoplasmosis 24 Herpes Culture as Indicated 25 Group B Streptococcus (GBS) 26 Ultrasound 26 Non-Stress Testing (NST) 27 Fetal Movement Counting 27 Biophysical Profile (BPP) 28 The Waterbirth Option 29 Effects of Water Labor and Waterbirth 29 Pregnancy Nutritional Guidelines 31 Food Group and Recommended Serving 31 Serving Size 31 Dairy Foods (4 servings) 31 Protein Foods (6 servings) 31 Vitamin A-Rich Fruits and Vegetables (1 serving) 31 Vitamin C-Rich Fruits and Vegetables (1 serving) 31 Other Fruits and Vegetables 32 (3-7 servings) 32 Bread and Cereals (6-11 servings) 32 Fats 32 Fluids 32 3 What are Healthy Fats? 33 Essential Fatty Acids 33 Nutrition, the Basics 34 Basic Principles 34 Sources of Protein 35 Nutritional Smoothies 36 Sources of Iron 37 Average Recommended Daily Dietary Allowances 38 Non-Pregnant 38 Pregnant 38 Red Raspberry Leaf and Nettle Tea 39 Detoxification and Your Health 40 Why Should I be Concerned about Pesticides?1 41 What if I Wash and Peel My Fruits and Vegetables? 41 Is there a difference between domestic and imported produce? 41 How does EWG make the Shopper's Guide™? 42 Weight Gain Recommendations for Women Pregnant with One Baby 42 Pregnancy Danger Signs and Symptoms 43 Common Complaints of Pregnancy 43 Discomforts of Pregnancy 43 Psychology of Pregnancy 48 Psychological Characteristics of Pregnancy (Mother) 48 1st Trimester 48 2nd Trimester 48 3rd Trimester 49 General 49 Mother 49 Partner 50 Relaxation 50 Exercise 51 General Exercise Guidelines 51 Specific Areas to Exercise 51 Warm-ups (5-10 minutes) 52 4 Arm, Shoulder, and Back (to maintain posture and build strength) 52 Pelvic Tilts (Standing or on all fours) 52 Modified push-ups 52 Abdominals 52 Legs (perform exercises while standing) 52 Additional 53 Cool Down (5-10 minutes) 53 Relaxation 53 Summary 53 Sex (Prenatal and Postpartum) 53 Alcohol 55 Drugs during Pregnancy 55 Blood Pressure 56 Blood Pressure During Pregnancy 56 How to Take Your Blood Pressure 56 Perineal Massage 57 What Is Preterm Labor? 58 What does preterm labor feel like? 59 When Labor Begins 59 Calling TBC 60 Bloody Show or Mucus Plug 60 Birth Supply List 61 Labor Chart 62 Touch 67 Massage 67 Acupressure 68 Yongquan KID-1 (Relaxation) 69 Acupuncture Point HeGu (Large Intestine 4) – Union Valley (Labor Stimulation) 70 Acupuncture Point SanYinJiao (Spleen 6) – The Intersection of Three Yin (Labor Stimulation) 70 Kunlun BL-60 (labor stimulation) 71 Acupressure Technique 71 Acupressure Point for Pain Relief in Labor - Jianjing GB-21 71 Ciliao BL-32 71 5 Hand Points (Pain Relief) 72 Supporting the Laboring Woman 72 Comfort Aids for Labor (P U R E*) 73 Back labor 73 Additional Aids for Labor 74 Episiotomies 74 Postpartum Guidelines for Mothers 75 Keeping TBC Informed 75 Rest 75 Baths and Showers 76 Urinating 76 Bowel Movements 76 Cramps 76 Vaginal Bleeding 76 Stitches and Hemorrhoids 77 Breasts 77 Activity and Exercise 77 Intercourse 77 Postpartum Examination 77 Postpartum Blues and Depression 78 What can you do 78 Postpartum Anxiety and Depression Resources* 78 Newborn Guidelines for Parents 79 Keeping TBC Informed 79 Newborns’ Breathing Patterns 79 Color 80 Temperature 80 Feeding 80 Urine 81 Bowel Movements 81 Body Movements 81 Jaundice 81 Cord Care 81 6 Eyes 82 Circumcision 82 Bathing 82 Baby Appointment 82 Safe Sleep Environment 82 What Does a Safe Sleep Environment Look Like? 82 Cord Blood Collection 83 Circumcision Information for Parents 84 If newborn circumcisions are not medically necessary, why are they done? 84 How are newborn circumcisions done? 85 Does the baby feel the circumcision operation? 85 Are there any complications with circumcision? 85 Care of the Uncircumcised Penis 85 Smegma 86 Cleaning 86 Physical Attributes of Your Newborn 86 Color of Skin 86 Cry 86 Activity 87 Reflexes 87 Scalp and Skull 87 Fontanels 87 Eyes 87 Nose and Mouth 87 Ears 88 Thorax 88 Breasts 88 Clavicles 88 Heart 88 Lungs 88 Abdomen, Liver, Spleen, and Kidneys 88 Jaundice in the Newborn 89 What is Jaundice? 89 7 How to Assess Jaundice 90 How to Control Jaundice 90 If Jaundice Gets Severe 90 Nursing Your Newborn: What to Expect in the Early Weeks 91 The First Week 91 Weeks Two through Six 92 Milk Supply 93 Common Problems 94 Hand Expression 94 Engorgement 95 Breast Compressions 96 Nipple Care 97 Nipple Shields 98 Plugged Ducts 100 Mastitis 101 Supplementation 101 Fussy Times and Cluster Feeding 103 Checklist for Sibling Support Person 104 Once at the Birth Center 105 Glossary 106 What is a doula? 110 The Birth Center Doulas 110 Benefits of Having a Doula 110 Childbirth Education at The Birth Center 111 Early Pregnancy 111 Nutrition & Movement for a Healthy Pregnancy 111 Prenatal Yoga 111 Preparing for Birth 111 Childbirth Full Series: Healthy Birth (Required for First Time Moms) 111 Optimal Birth Experience 112 Childbirth Refresher 112 HypnoBirthing 112 Preparing for Baby 112 8 Mother Infant Assessment (**Required for All**) 112 Breastfeeding Basics 112 Sibling class 112 After Baby Arrives 113 Baby Wearing Class 113 Breastfeeding Support Group 113 Breastfeeding Mom’s Back to Workshop 113 Infant Massage 113 Cloth Diapering 114 What’s Next: Set Realistic Goals for the Second Half of Breastfeeding 114 Weaning Workshop 114 TBC Breastfeeding Services 114 Community Breastfeeding Resources 114 Online Breastfeeding Resources 115 Pregnancy and Family Support Services 115 The Family Workplace Connection/Children and Family First 115 Parents as Teachers 115 Women, Infants and Children (WIC) 116 Door of Hope Pregnancy Center 116 9 Introduction Welcome to The Birth Center (TBC)! We are pleased you have selected us to provide your maternity care. We enjoy working with our clients and their families and look forward to serving you during this special time in your lives. This handbook is a collection of information we hope you will find helpful. We encourage you to read it through and refer to it during the course of your pregnancy. It covers topics that will be important to you, including A listing of the services offered at The Birth Center (TBC). The philosophy of care that provides the basis for the certified nurse midwives (CNM) and TBC’s service. An explanation of the CNMs’ education, licensure, and relationships with the consultant physicians. Details of your prenatal and postpartum support. Educational materials on topics we feel are essential to you for decision-making and self-directed healthcare. This material is a supplement for your healthcare and is by no means a replacement of the many excellent books on maternity, well-woman and infant care, many of which are available in TBC’s library. This handbook does not replace your questions and our answers. It is simply a resource and may clarify discussions regarding various topics. For more information and resources visit www.thebirthcenter.com, “Like” us on Facebook at www.facebook.com/TheBirthCenterWilmington, and follow us on Instagram @thebirthcenterde. Communicating with The Birth Center Routine Communications The Birth Center phone: 302-658-2229 To make routine appointments during normal business hours call the main number and press option 6. To leave a non-urgent message for a nurse or midwife, call the main number during normal business hours and press option 3. 10 If you are in labor or need immediate attention, call the main number and press option 2. If you cannot get through hang up and call the answering service directly at 302-300-3551. Please note that this service is to be used only for emergencies, (such as labor and illness) and also for pressing concerns that should not wait for the next day. Calling TBC after Hours If you need to contact TBC after hours the answering service number is 302-300-3551, will be available to take your call. Please do not use the service to leave messages regarding routine questions or appointments. When You Need to Speak with a Physician Sometimes you may need to speak with a physician. If this need arises, please contact your CNM first, who will make the arrangements for this.