Welcome Packet Updated 9.21 2017 Northwest Hospital Midwives Clinic 10330 Meridian Ave N., Suite 190 Seattle, WA 98133 PHONE: (206) 668-6670 (use option 8 to talk to clinic staff during clinic hours ) FAX: (206) 668-6171 Website: www.nwmidwivesclinic.com Office hours: Monday through Friday, 8:30 a.m.- 4:30 p.m. Download our UW Baby app for Follow Us! educational materials and helpful tip @nwhmidwives and to track your progress. Northwest Hospital Midwives Clinic 2 TABLE of Contents Introduction to our Practice Welcome & Overview .......................................... 6 How To Reach the Midwives ................................... 8 What to Expect at Your Appointments........................ 9 Billing & Fees ..................................................... 12 Early Pregnancy Pregnancy Nausea ………………………………....... 16 Weight Gain During Pregnancy ………...………….... 18 Nutrition During Pregnancy …………...………….... 19 Exercising During Pregnancy ……………………...... 21 Prenatal Yoga ………………………………………. 23 Misc. Pregnancy Information ………………………... 25 Over The Counter Medications For Pregnancy ……….. 26 Influenza …………………………………………... 27 Genetic Testing: Screening and Diagnostic Tests …....... 28 Later Pregnancy & Birth Preparation Labor: Contacting the Midwife & Warning Signs ……… 37 Fetal Movement ……………………………………. 38 Pertussis and Tdap ………………………………….. 39 Childbirth Classes ………………………………….. 40 Our Labor and Birth Practices ………………………. 41 Your Birth Plan …………………………………….. 43 Birth Doulas ………………………………………. 44 Vitamin K ………………………………………….. 45 Cord Blood Options ……………………………….. 46 GBS (Group Beta Strep) testing……………………... 47 Perineal Massage……………………………………. 48 After your baby’s birth Postpartum Care at Home ..................................... 52 Postpartum Visits & Warning Signs .......................... 53 Breastfeeding .................................................. 54 Postpartum Breast Care ........................................ 58 Postpartum Mood Problems .................................. 59 Pelvic Floor Exercises .......................................... 62 Abdominal muscles/Diastasis Recti………………….. 63 3 4 Introduction to our Midwifery Practice 5 Welcome to the midwives clinic at Northwest Hospital Thank you for choosing us to care for you and your baby. We look forward to getting to know you and your family during the next several months. We understand how very special and precious your baby is, and we will strive to make your pregnancy, labor, birth, and postpartum experience as healthy and satis- fying as possible. This booklet, our website resource list, the UWBaby mobile app, and our recom- mended book (Pregnancy, Childbirth, and the Newborn: The Complete Guide, by Penny Simkin, Janet Whalley, Ann Keppler) should give you the information you need to navigate this journey with us. A few notes about our practice: Group Practice Model We are a group practice of five midwives. This means that, with few exceptions, we share our patients. This model allows us to have one of the midwives “on call” at all times, to be available for women in la- bor and any other urgent patient needs. We are all experienced midwives with a similar philosophy of pregnancy and birth as normal, natural processes. We also have good communication systems in place so that any one of us can easily pick up your story where one of the other midwives left it off. At the same time, the five of us are unique individuals and we each contribute to the practice in special ways. We recommend that you see the same midwife for your first few visits while we are getting to know one another, and then start meeting the others. A typical pregnancy will have 12 to 16 visits, so you should be able to meet all five midwives during your prenatal care. We want you to know the midwife who will be there with you when you go into labor and have your baby. Students We enjoy helping to educate midwifery graduate students from the University of Washington and Seat- tle University. You may have a chance to work with a student midwife during your clinic visits or at your birth. We also occasionally have a UW medical student with us in the clinic. You will always a choice as to whether to have a student participating in your care. Per diem midwives We currently have three wonderful per diem midwives who fill in for us on sick days or vacations. You can see photos and profiles of all the midwives on our website. 6 Physician Consultation Midwives are expert in normal pregnancy, labor, birth, and newborns. We practice within the scope of practice determined by our education and experience, as well as hospital, state, and federal regulations. Most of our clients never need to meet an obstetrician, but we have a system in place to obtain medical consultation and support whenever your condition might require them. An obstetrician from North- west Hospital is available to us at all times for consultation, co-management, or referral. We can also consult as needed with a variety of medical specialists throughout Northwest Hospital and UW Medi- cine, in order to provide you with the best possible care. If you have questions at any time, please do not hesitate to ask us. We look forward to working with you! Your midwives, aditi Grandy Deborah Blue Mary Bolles Holder Mary Lou Kopas Cindy Rogers 7 HOW TO reach the MIDWIVES Our office number is 206-668-6670. Please listen to all the options listed. During office hours, if you do not hear what you need or need to reach someone right away, please push “8”. Your mes- sage will be sent to the clinic nurse and she will call you back to discuss your concerns and determine if the midwife needs to be called or if you need to be seen. There is always a midwife on call available to patients 24/7. After hours, when the clinic is closed, you still call the same number 206-668-6670 and listen to the message. PRESS 1 to reach the midwife on call after hours. The answering service will take your message and call the on-call mid- wife. Your call should be returned within 15-20 minutes after you call the answering service. Please at- tempt to stay off your phone while waiting for a return call. If you have not heard from a midwife within 20 minutes, please call back and tell them this is your second time calling. It is possible that the on-call midwife may be in a delivery or in surgery and cannot return your call immediately. If your second call is not returned, call the Northwest Hospital Childbirth Center at 206-668-1882. If you are calling about a medical emergency, call 911 E-care We encourage you to sign up for e-care to communicate about test results or NON-URGENT questions. If you need a same-day response, please call. Warning signs Please call us for any of the following or any urgent problems or concerns: contractions that occur 6 or more times in an hour Vaginal bleeding or other fluids leaking from your vagina if you fall or are in a motor vehicle accident Any symptoms of an infection or fever headache that does not get better with Tylenol, rest, and drinking water vision changes such as seeing spots or floaters decreased fetal movement after fetal movement has become regularly noticeable abdominal pain, nausea, or loss of appetite feeling sick or unwell 8 WHAT TO EXPECT DURING YOUR PRENATAL CARE Schedule of visits After your initial prenatal visit, your appointments usually last about 20 minutes. The nurse or medical assistant will check your weight and blood pressure at each visit. (Some women would prefer not see their weight or have it discussed, so let us know if that is the case for you.) Starting at around 10 weeks, the midwives will listen to your baby’s heartbeat with a small ultrasound instrument called a Doppler. The midwife will also measure the size of your uterus and talk to you about any concerns or questions you might have. A full physical exam is usually only needed at your first visit and at your 6 week postpartum visit. We typically like to see you every 4 weeks up until 28 weeks, then every 2 weeks from 28 to 36 weeks, then weekly until the birth. Ultrasounds Early Dating Ultrasound (6-10 weeks): You may or may not need an early ultrasound to check via- bility and dating. If you want an early ultrasound to confirm viable pregnancy and dating, we can offer this in the clinic. We will discuss dating and early ultrasound at your first visit. Nuchal Translucency (11-14 weeks): If you choose to do genetic testing, a special ultrasound called nuchal translucency will be ordered and performed at Radiology Department at the hospital. This is a measurement of the thickness at the back of the baby’s neck, which if enlarged, can be associated with some anomalies. Anatomy Scan (19-21 weeks): We order the standard anatomy scan ultrasound for everyone. This is done to look at all parts of the baby to assess for any abnormalities. The ultrasound technician will also look at your kidneys as well as the placenta, cord, amniotic fluid, and measure growth/size of the baby. If you want to know the sex of your baby, they will tell you. If you want to keep it a surprise, they will not tell you. If you prefer to have no ultrasounds, you should discuss this with the midwife. Additional ultrasounds are performed only if/when medically necessary. Ultrasounds are usually done at the Radiology Department on the main campus of Northwest Hospital, but the midwives can do certain types of ultrasound exams in the clinic. 9 WHAT TO EXPECT DURING YOUR PRENATAL CARE Lab tests There are several blood tests performed during your pregnancy. Early in the pregnancy, we will check your blood type. We also check for anemia, hepatitis, syphilis, HIV, herpes, and immunity to German measles (Rubella). We also do standard screenings for chlamydia and gonorrhea and a urine test for bladder infection. There are additional testing options available if you want to check your risk for having a baby with Down’s syndrome, or other types of trisomy, or neural tube defects.