OH
Baby!A Consumers Guide to Having a Baby in Northeast Ohio
OH
Baby!
A
Consumers Guide to Having a Baby in Northeast Ohio
Introduction:
OH Baby! A Consumers’s Guide to
Having a Baby in Northeast Ohio by Mary Rizk MSW, MBA, and Marilyn Benjamin RN, MSN, was
originally published in 1989 by the Cleveland Regional Perinatal Network. OH Baby!
was written to help consumers navigate the maze of birthing options available in
Northeast Ohio. Due to the rapidly changing health care system, revisions in
printed form have not been practical. This 2003 condensation and update for the
Internet is made possible by the group efforts of multidisciplinary staff from several
institutions listed below.
Acknowledgments:
From the Cleveland Regional Perinatal
Network:
Avril Albaugh LISW; Monica Fundzak RN,
MSN; Sharon Groh-Wargo PhD, RD,
LD; Bev Michel RN, MSN; Lynn Barabach RN, MSN.
From Fairview Hospital; Bethany Berry,
CNM, MSN.
The information contained here regarding perinatal resources is self reported by the hospitals and service agencies listed at the time they were surveyed. The Cleveland Regional Perinatal Network bears no responsibility for accuracy. Since no attempt has been made to verify the information, the reader should attempt to verify the information personally.
Choices. You can’t make them unless you know what your options are. The pregnant woman will need to decide on the maternity care that best meets her health needs and those of her baby. The health care needs of the mother and baby are the key concerns that should influence all other maternity care decisions. They should determine whom the mother chooses to provide maternity care and where she chooses to deliver her baby.
OH Baby! can help you
· identify some of the factors that
contribute to problems in pregnancy
· choose your health care provider
· choose where you deliver
· participate in cooperative decision
making with your health care provider.
Contents
OH Baby!
A Consumers Guide to Having A Baby in
Northeast Ohio
Contents
Chapter 1.
How the System Works
Regionalization, Levels
of Care, Transport
Chapter 2.
Where to Go for Care
Types of Providers,
Settings for Prenatal Care
Chapter 3.
How Healthy Are You?
Preparing for
Pregnancy, Health Factors Checklist
Chapter 4.
Why Prenatal Care is
Important
Education Resources,
Prenatal Visits
Chapter 5.
What Are the Childbirth
Options?
Settings for Labor and
Delivery, Options to Make Labor More Comfortable
Chapter 6.
Whom to Choose for
Maternity Care
Questions to Ask Your
Health Care Provider
Chapter 7.
How to Choose Your
Hospital
Questions to Ask on the
Hospital Tour, Hospital Chart
Chapter 8.
After the Baby Is Born
Questions to Ask Your
Baby's Health Care Provider, Newborn Hospital Care, Going Home
Chapter 1
Regionalization:
How the System Works
To begin, a consumer will need to understand the Northeast Ohio hospital system of regionalization and how health care providers function within that system. Regionalization is the term that describes Ohio's system of maternity hospitals. Regionalization was established by the Ohio Department of Health to:
· promote quality care
Ohio designates maternity hospital as Level I, Level II or Level III.
Maternity hospitals differ in the services they offer for maternity and newborn care. Levels of care are described in the Ohio State Perinatal Guidelines (1977), Quality Rules for Obstetric and Newborn Services under Ohio Administrative Code Chapter 3701-84 (1997), the March of Dimes publication by the Committee on Perinatal Health, Toward Improving the Outcome of Pregnancy: the 90s and Beyond (1993), and Guidelines for Perinatal Care, fifth edition, by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.Level I community hospitals specialize in caring for uncomplicated pregnancies, but also should have the capabilities to detect and manage unexpected complications and some selected conditions. Level 1 nurseries care for healthy newborns or for newborns who need closer attention for minor difficulties that are expected to resolve rapidly. Very premature or severely ill newborns may be transferred to a Level II or Level III hospital.
Level II hospitals are often larger than community hospitals and provide a full range of maternal and newborn services for uncomplicated, selected complicated and selected high risk patients.
Level II nurseries care for normal newborns, and have Special Care Nurseries to care for moderately ill and some extremely ill newborns. Some Level IIs receive limited transports of moderately ill patients from Level I hospitals. Most will still transport very sick or extremely premature infants to a Level III.
Level III hospitals
are large centers which, in addition to caring for uncomplicated patients, are specially
staffed and equipped to care for most types of maternal, fetal and newborn illnesses and
abnormalities. Level III hospitals have normal newborn nurseries as well as Neonatal
Intensive Care Units (NICUs) with sophisticated equipment and the availability of
specialists.
Level IIIs receive
transports of critically ill mothers and newborns from other hospitals.
Transport
All hospitals within
each level are not necessarily equal. There may be variation in the kinds of complications
that are routinely cared for. This depends on the expertise of the staff, and the
availability of specialized equipment and support services that are uniquely available at
each institution. In highly specialized cases, infants may even need to transferred
between Level IIIs. Also, your medical insurance my dictate your transport options.
Regardless of Level, though, each maternity hospital should be able to manage
emergencies and should have access to the consultation (by phone or in person) of
specialists when needed.
Maternal transport,
the transfer of the mother before she gives birth may be necessary when a mother develops
severe complications which need to be managed at a higher level facility.
Transporting the mother prior to delivery
allows the utilization of more specialized skills and equipment to treat the mother and
baby while it is still in the mother's uterus. Also the healthy survival of the
infant born after a complicated pregnancy or labor may depend on the immediate
availability of neonatal intensive care services.
Neonatal transport, the transfer of the baby after delivery, occurs when an infant is born with or develops complications that require specialized technology and care in a Special Care Nursery or Neonatal Intensive Care Unit.
Methods of transport differ. Level I and II hospitals my contract with a local ambulance company or may call for the ambulance or helicopter services of the Level III. In the event your labor becomes unexpectedly complicated or your baby needs help after delivery, be prepared to take an active role in the decision to transport.
Most women and babies do not need the advanced interventions that are available today. But when they are necessary, regionalization assures that "high tech" consultation and care are available within a reasonable geographic area.
Teaching Hospitals are those hospitals that sponsor or participate in active medical residency programs. Attending physicians at these hospitals are often on the faculty of a university medical school. Because of this, patient care may be an integrated part of research and the education of medical and nursing students, interns and residents. The involvement of residents or students in the care of you or your baby is something to discuss with your health care provider.
Understanding the system and the differences between hospitals will help you select the services that are right for you and your baby.
Chapter 2
Where
to Go for Care
Health care during pregnancy is the single most important factor in having a healthy baby. Prenatal care, beginning early in each pregnancy, is vital for all pregnant women.
Your choice of a health care provider, where you go for prenatal care, and where you deliver may be influenced by your financial resources. If you have health insurance through your place of employment, you can call the benefits office to check what maternity care your policy covers. If you belong to a health maintenance organization (HMO) or have an insurance plan that specifies which physicians or hospitals to use, call your health insurance consumer service department. The important thing to remember is that prenatal care is crucial for each pregnancy and is available regardless of your financial resources.
Health care professionals that provide maternity care:
Obstetrician:
a physician who has served a residency in obstetrics and gynecology (OB/GYN), which
includes training in normal and high risk maternity care, immediate care of the newborn,
family planning, infertility and diagnostic procedures.
Maternal-Fetal
Specialist: an obstetrician who has received additional education to provide
consultation or care to patients with complications of pregnancy.
Family Practice Physician:
a physician who has served a residency in order to care for the total health of an
individual or family. Training includes some obstetrics and gynecology.
Note: If a physician is board certified,
he or she has passed board examinations in his or her medical specialty in addition to
completing a residency. If you need the names of private physicians who
provide maternity health care in your area, look in the Ohio Bell Yellow Pages under:
"Physicians and Surgeons, Grouped by Specialty", or call one of the maternity
hospitals listed in Chapter 7. The Hospital List..
Nurse-Midwife: a
registered nurse who completed an educational program to provide maternity care, including
delivery. CNMs are licensed by the state and most have master's degrees. Nurse
midwifery practices provide for physician consultation and referral when needed. For
more information about nurse-midwives, go to www.midwife.org.
Women's Health Nurse
Practitioner: a registered nurse who has additional training to
provide prenatal care, not including delivery. These patients must transfer to a
nurse midwife or physician for delivery.
Others who may be involved in your care:
Social Worker:
a mental health professional who is trained to assist women and families with problems
that affect their lives (such as excessive stress, unemployment, domestic violence, drug
abuse). Most hospitals and clinics have social workers available. In the Resource list there is a list of local
social service agencies that may be of assistance to you during and after your pregnancy.
Dietitian/Nutritionist:
a health professional whose expertise is in nutrition. Services include counseling
during pregnancy and infant feeding. Dietitians are available at most hospitals and
clinics, and on a fee for service basis in the community.
Lactation Consultant: a health care professional ( may be a nurse, dietitian or physician) who is specially trained to work with families to prevent and solve breast feeding problems. Lactation Consultants are available at most maternity hospitals and clinics, and on a fee for service basis in the community.
Doula: a woman, (not necessarily a health care professional) trained in providing comfort measures during childbirth. Some hospitals have a doula service available as an option, others are available in the community on a fee for service basis.
On any services above, check with your health insurance to see which are covered in your plan.
Prenatal care may be obtained in a variety of settings:
The cost for prenatal visits, delivery, and postpartum care varies.
In Ohio, prenatal care is available to all women. There are many prenatal programs available for women who have no health insurance and meet specific income guidelines. Clinics exist in many neighborhood locations and provide comprehensive prenatal care. In addition to prenatal care many clinics also offer:You may be eligible to participate in publicly funded programs such as
Healthy Start or WIC.Healthy Start is a program that provides free medical services to pregnant women with moderate to low income and to children who are less than 19 years old whose families have moderate to low income. Persons qualifying for the Healthy Start program can join one of several Health Maintenance Organizations approved by the state, and can receive the following free services:
Call the Healthy Start Information Line at (216) 987-7346 in Cuyahoga County for more information. In other counties, call the Department of Human Services for that county and ask about Healthy Start. See Resource List.
The WIC (Women,
Infants, and Children) Program is a supplemental nutrition program. WIC helps
income eligible pregnant and breast feeding women, women who recently had a baby, infants
and children who are at health risk because of inadequate nutrition. WIC provides
supplemental, highly nutritious foods and infant formula; referral to prenatal and
pediatric health care and other programs such as Medicaid and Food Stamps. WIC
clinics are located in every county in Ohio. For more information about this program inquire at your
local clinic or hospital or
call (216) 961-2233 or 1-800-755-GROW and ask for the location of the WIC office nearest
you.
Back to Contents
Chapter 3
How
Healthy Are You?
Preparing for Pregnancy:
Preparing for pregnancy is important for your health and the health of your baby. Ideally, you should allow for 3 months to properly prepare your body for pregnancy. Talking with your health care provider before pregnancy can help you give your baby the safest possible environment for the amazing developments that occur before you may even realize that you are pregnant. During this time, it is important to avoid hazards that can hurt your baby and pregnancy. These hazards include:
Remember: what goes in your body goes into your baby! Be sure to eat well-balanced meals while attempting to become pregnant; your diet is very important. Safeguard your baby's early development by caring for yourself while you are attempting to conceive. You should consume 400 mcg of Folic Acid per day to reduce your risk of having your pregnancy affected with Spina Bifida or other neural tube defects.
Another important way to prepare for pregnancy is to be aware of any health problems you may currently have that could complicate your pregnancy. Certain health conditions that exist prior to conception that may place a woman's pregnancy at risk include:
Health problems:
Other Possible Factors:
Written educational materials on preparing for and taking care of yourself during pregnancy are available from the March of Dimes Birth Defects Foundation
Genetics:
We know that some prenatal defects are
inherited, transmitted by the genes passed from parent to child. Other genetic
disorders are caused by a problem in the gene or by damage to the chromosomes.
Genetic counseling can help you determine factors that may influence your pregnancy and
baby. It is preferable to seek genetic counseling before attempting or very early in
your pregnancy. If you can say "yes" to any of the following factors you
should discuss them with your physician or a genetic counselor:
For information on testing and counseling services, call the Department of Genetics at MetroHealth Medical Center (216) 778-4323, University Hospitals of Cleveland (216) 844-3936, or Cleveland Clinic Foundation (216) 445-5686.
Infertility:
Infertility is the
inability of a couple to conceive after six months to one year of frequent intercourse
without birth control. Physicians who specialize in the treatment of infertility are
called reproductive endocrinologists. Improved technology has made
identification and treatment more effective. See your health care provider for
information or referral.
Remember, early detection and proper care of health complications during pregnancy is essential for the well-being of a mother and baby! Proper management can only be achieved through continuous prenatal care and communication between you and your health care provider!
Next: Chapter 4 Why Prenatal Care is Important
Chapter 4
Why
Prenatal Care Is Important
Prenatal care:
It is essential for the
health of you and your baby to begin prenatal care as soon as you think you are pregnant.
Women who start prenatal care early in their pregnancies deliver healthier babies
than women who delay care or have none at all. Early and continuous care during
pregnancy keeps you and your baby healthy.
Signs of Pregnancy:
Possible
Probable
Prenatal Visits:
Weeks 15-28
During the second
trimester, you will continue to see your provider 1-2 times/month. They will
continue to check your blood pressure, weight, urine and will begin to measure your
abdomen to make sure the baby is growing properly. You will be able to hear the
baby’s heart beat! You will be asked about movement of the baby. The heartbeat
and movement are both reassuring signs that the baby is well. (Movement will first be felt
like fluttering or a paint brush in your abdomen. These sensations will become
stronger and more frequent as your pregnancy progresses). You may have some repeat
or new tests done to check on the health of you and the baby.
Weeks 29-40
During the third
trimester, you will have an office visit every one to two weeks. Continue to expect
measurements of blood pressure, weight, urine, fetal movement, baby’s heart rate and
abdominal size. Your provider may perform internal examinations to check for
cervical changes that may indicate the start of labor as well as the position of the
baby. If you are having any complications, you may require additional laboratory
tests, ultrasounds, or fetal monitor non-stress tests.
A full term pregnancy lasts between 38 and 41 weeks. If a baby is born before 37 weeks, it is called premature. Prematurity is still one of the biggest problems in maternity care because it is associated with the majority of newborn illnesses and deaths. Some women may be more at risk than others for going into preterm labor. In general all pregnant women should practice good nutrition, avoid becoming overly stressed or tired and ask their health care providers to explain the signs and symptoms of premature labor. In recent years, prompt recognition and treatment of premature labor has prevented many of the problems of being born too soon.
Classes:
A good understanding of
what to expect and how to prepare for birth and baby is important. Various classes
are offered throughout your pregnancy by your hospital or an education center in your
community. Often, they are flexible and are held in the evenings or on
weekends. Fathers/support persons are encouraged to attend in order to take a more
active role in the pregnancy and to share their concerns and experiences. Check with
your health care provider or hospital for lists of available classes.
Before pregnancy - Some hospitals are now offering preconception counseling/public forums. These will discuss pregnancy risk factors, healthy lifestyle behaviors, early fetal development, signs of pregnancy, proper nutrition and exercise.
Early pregnancy - Taken during your first or second trimester, these classes include information on the growth of the baby, nutrition, exercise, and emotional changes.
Childbirth preparation - These are usually taken during the last 2 or 3 months of pregnancy. They help you understand the labor process and give you relaxation and breathing techniques to use during childbirth. You will enter labor with a good knowledge base.
VBAC - Vaginal birth after cesarean. This class includes information on laboring and delivering vaginally after a previous cesarean birth.
Sibling preparation classes - These help prepare children emotionally for a new baby. They focus on the unique role of being the older child through creative activities. Children are familiarized with the hospital setting and tour the maternity floor.
Breast feeding preparation - Getting started at breast feeding is discussed, prevention of problems, and common misconceptions. Ongoing breast feeding support groups may also be available.
Infant care -Baby bath demonstration, circumcision and cord care, thermometer use, feeding and comforting techniques, and infant safety are usually included.
Next: Chapter 5 What are the Childbirth Options
Chapter 5
What are the Childbirth Options
Room Settings Hospital
Procedures Labor and Delivery Options
Options are the services the hospital
provides regarding setting, hospital procedures and personnel. Not all hospital
offer all the options described here. Health care providers also differ in their
preferences for these options. You can discuss these topics with your health care
provider and ask about them on your hospital tour.
Room Settings For Labor and Delivery:
Over the years, hospitals have reopened positively to consumers requesting that childbirth be a more relaxed, shared experience. Many hospital settings have changed to provide a more homelike environment coupled with the availability of skilled personnel and technology when necessary.
Traditional - Years ago this was the only option. The hospital stay involved 4 separate rooms; one for labor ( usually a private room), one for delivery ( looking like an operating room), one for recovery (often for more than one mother at a time), and a different room for your postpartum stay (usually a semiprivate).
Labor Room. 
Delivery Room
Recovery Room 
Birthing Rooms - A private room that looks like a labor room except that it is also equipped to be used for delivery so that labor, delivery and recovery can occur in the same room. They are set up so that only a vaginal delivery can be done in a birthing room. After the baby is born, you are moved to a postpartum room.
Birthing Room 
LDR
(Labor/Delivery/Recovery)Rooms - Labor,
delivery and recovery all occur in the same room but it is larger than a Birthing
room and can be equipped to accommodate any kind of delivery. After the baby is
born, your postpartum stay may be in a different room.
Labor Delivery Recovery Room 
LDRP
(Labor/Delivery/Recovery/Postpartum) Rooms - Also called Single Room Care, allows you to spend your entire hospital stay in
one room.
Single Room 
Hospital Procedures:
Depending on the hospital and preferences of your provider, some of these procedures may be optional and some may be routine. You are encouraged to read more about these topics, talk to your health care provider and ask friends who have recently had babies.
Electronic Fetal Monitoring - A machine that monitors the baby’s heartbeat and the mother’s contractions during labor. It may be external ( belts around your abdomen) or internal (a tiny electrode attached to the baby’s scalp and small catheter inside the mother’s cervix). It may be used continuously or intermittently (only at specific times). Ask your provider about the circumstances that determine the use of monitoring.
Options to Make Labor More Comfortable:
Breathing and Relaxation -Techniques taught in childbirth education classes to reduce pain and help you work with your body throughout labor. Nurses in labor and delivery can assist you (and your support person) in using these techniques.
Positioning- Sitting up, moving around, walking often helps in early labor. Even later in labor, side lying or sitting up puts the uterus in better position than lying flat on your back. Your hospital or provider may offer other aids, such as sitting in the shower or using a labor ball. Find out what options are available to you should you desire them.
Medication - In addition to breathing and relaxation, many women also choose medications to help manage discomfort. Drugs that are used to relieve pain in labor are narcotic analgesics, sedatives or tranquilizers, or a combination. They are usually given by injection or intravenously. Used judiciously, they can enhance relaxation, decrease anxiety and nausea. Large doses could cause drowsiness and even slow the baby’s reposes. Care is given to administer the smallest possible doses at the right times to achieve the desired effect.
Anesthetics - Hospitals may
differ in the anesthetic choices they offer. They also differ in the
availability of the health care professionals qualified to administer certain anesthetics.
Anesthesiologists are physicians who have
additional training and experience in anesthesia.
Nurse Anesthetists are Registered Nurses
who have additional education and are certified to administer anesthetics under the
direction of a physician. Some
hospital have anesthesiologists and/or nurse anesthetists in the hospital at all
times (in house), some hospitals they may be off the hospital grounds but available to
come in if they are called (on call). Ask your health care provider or hospital
about the anesthesia services at your delivering hospital.
Regional Anesthetics - are medications like novocaine that are injected into a specific part of the body. They permit you to remain awake while relieving pain in the part of the body where they are injected. Some of the regional anesthetics used are:
Epidural - Medication is given through a thin tube (called a catheter) inserted through the lower back into an area just outside the spinal canal. The tube is left in place during labor and delivery making it possible to adjust the amount of anesthetic for the different stages. Since sensation can be blocked from the waist down, epidurals can also be used for cesarean delivery. Epidurals are given by an anesthesiologist or nurse anesthetist.
Spinal - Used for delivery only, medication is injected into the spinal canal through the lower back. The needle is removed but the medication blocks sensation and movement completely from the waist down long enough for vaginal or cesarean delivery.
Local and Pudendal Blocks - Used for delivery, medication is injected around the vagina to alleviate discomfort from delivery and/ or episiotomy. (Episiotomy is an incision that may be made to enlarge the vaginal opening to facilitate delivery and requires a few stitches to close after the delivery.)
General Anesthesia - Medications given intravenoulsy or inhaled that cause loss of consciousness. Rarely used for vaginal deliveries anymore and only sometimes used for cesarean deliveries in special situations like emergencies or if the mother’s condition prevents the use of regional anesthetics
Other Labor and Delivery Options:
· Inducing Labor - Sometimes labor needs to be started up or helped along. Ask your provider what methods and medications are used and the risks and benefits of each should they be necessary.
· Episiotomy - The procedure in which a small incision is made to enlarge the vaginal opening at the time of delivery. Some providers do this routinely, especially if you are a first time mother. Others wait to see if the vaginal opening stretches enough on its own. This can be done with or without anesthesia. If you have an episiotomy, the incision will be closed with a few stitches after the baby is born.
· Instrument Delivery - forceps or vacuum extractor- one or the other of these may be used or to speed the delivery if you are having difficulty delivering due to position of the baby or if you are unable to push. Forceps look similar to shoe horns with handles. A vacuum extractor consists of a cup which is applied to the baby’s head. Either may be used to help extract or turn the baby’s head to facilitate delivery.
· Cesarean Birth - When the baby is surgically removed through an incision in the mother’s abdomen. Cesarean may be used to deliver babies in abnormal positions, babies who are too large for the mother’s pelvis, or in situations where the health of the mother or baby would be endangered by continuing the normal labor process.
· VBAC - Vaginal Birth After Cesarean - Since vaginal deliveries are more natural and require less healing, the American College of Obstetricians and Gynecologists has recommended that VBAC be considered for most women who have previously had a cesarean delivery. Guidelines have been established to help decide which women would be good candidates. If you have previously had a cesarean, check with your provider to see if VBAC would be an option for you. If so, your delivering hospital can refer you to VBAC classes.
Next: Chapter 6 Questions to Ask your Provider
Chapter 6
Whom to Choose for Maternity Care
Questions to Ask your Health Care
Provider
One of the most important health care decisions you make is choosing the health care provider who guides the course of your pregnancy. There are no set rules on how to choose. You may start with your insurance customer service department or employer benefits office to obtain a list of providers who are included in your plan. Some women decide on their hospital first and then select a provider who delivers there. Others select a provider first. Some change providers. Talk to your friends and relatives who just had babies to get their recommendations.
Here are some issues you may want to discuss with your provider, or questions you may want to use to determine if you and a provider are in agreement on most topics.
Prenatal:
What are your credentials?
Physician:
Certified Nurse Midwife:
What health insurance do you accept?
Hospital Affiliation
Labor
Delivery
Postpartum
Personalized Questions for Your Care
Next Chapter 7 How to Choose Your Hospital
Chapter 7
How to
Choose Your Hospital
Hospital Tours
One of the most effective ways to choose your delivery hospital is to take advantage of the tours that are offered to the public. By touring the hospitals that interest you, you can see the actual settings that are used for labor and delivery. Tours also provide an opportunity to ask the hospital representative about policies that govern the use of different settings and that determine if procedures are routine or optional.
Remember that your choice of hospitals will probably be influenced by your insurance contract, so you may want to start by asking which maternity hospitals are included in your plan. The following suggested questions will help you determine hospital policy concerning the areas and issues that are most important to you. Many of these questions should be asked of your managed care company or insurance provider's customer service department also.
Questions to ask on a hospital tour
The answers to these questions may help you decide if your childbirth philosophy is compatible with the hospital’s available services. The service options available to you may also be influenced by your insurance coverage.
Maternity Hospital List
Perinatal Region V: Cuyahoga, Lake, Lorain, Ashtabula, Geauga Counties
Level III
Fairview Hospital
18101 Lorain Ave., Cleveland, OH, 44111
(216) 476-7000
www.fairviewhospital.org
MetroHealth Medical Center
2500 MetroHealth Dr., Cleveland, OH, 44109
(216) 778-7800
www.metrohealth.org
University Hospitals of Cleveland
University MacDonald Womens Hospital
11100 Euclid Ave., Cleveland, OH, 44106
(216) 844-1000
www.uhhospitals.org
Level II
EMH Regional Medical Center
630 East River St., Elyria, OH, 44035
(440) 988-6280
www.emh-healthcare.org
TriPoint Medical Center
7590 Auburn Road, Concord, Ohio 44077
(440) 375-8100
www.lakehealth.org/tripoint-medical-center
Hillcrest Hospital
6780 Mayfield Rd., Mayfield Heights, OH,
44124
(440) 459-4500
www.hillcresthospital.org
Community Health Partners
3700 Kolbe Rd., Lorain, OH, 44053
(440) 960-4000
www.ehealthconnect.com/regions/lorain/
Huron Hospital
13951 Terrace Rd., East Cleveland,
OH, 44112
(216) 761-3300
www.huronhospital.org
St. John Medical Center
29000 Center Ridge Rd., Cleveland, OH, 44145
(440) 835-8000
www.sjws.net
Level I
Ashtabula County Medical Center
2420 Lake Ave., Ashtabula, OH, 44004
(440) 997-2262
www.acmchealth.org
University Hospitals Conneaut Medical Center
(formerly Brown Memorial Hospital)
158 West Main St., Conneaut, OH 44030
(440) 593-1131
www.uhhospitals.org
UHHS Geauga Regional Hospital
13207 Ravenna Rd., Chardon, OH, 44024
(440) 285-6000
www.uhhospitals.org
Lakewood Hospital
14519 Detroit Ave., Lakewood, OH, 44107
(216) 521-4200
www.lakewoodhospital.org
West Medical Center
36000 Euclid Ave., Willoughby, OH, 44094
(440) 953-9600
http://http://www.lakehealth.org/west-medical-center
Marymount Hospital
12300 McCracken Rd., Garfield Hts, OH,
44125
(216) 581-0500
www.marymount.org
Parma Community General Hospital
7007 Powers Blvd., Parma, Oh, 44129
(440) 743-3000
www.parmahospital.org
Southwest General Heath Center
18697 Bagley Rd., Middleburgh Hts, OH,
44130
(440) 816-8000
www.uhhospitals.org
Next: Chapter 8 After the Baby is Born
Chapter 8
After
the Baby is Born
Whom to Choose for Your Baby’s Care
Pediatricians, family practice physicians, and pediatric nurse practitioners all perform well child examinations, make assessments of illness, an provide health education for new parents.
As you did in your search for a
prenatal health care provider, you can interview your tentative pediatric choices to
determine your compatibility. This should be done preferably before you
have your baby.
Examinations and immunizations are
necessary for every baby and are available regardless of the ability to pay. Check
with your local hospital or health department for pediatric services.
Types of Pediatric Providers
Pediatrician is a physician who has trained to specialize in treating infants and children.
Family Practice Physician is a physician who cares for individuals and his or her family. Part of his or her training includes pediatrics.
Pediatric Nurse Practitioner is a registered nurse who received additional training and certification to provide well child care and manage minor pediatric problems.
Questions To Ask Your Baby’s Provider
Newborn Hospital Care
Delivery Room Care: After your baby is born, he or she will be examined, weighed, have antibiotic drops or ointment put in the eyes to prevent infection, and get an injection of Vitamin K to prevent newborn bleeding disorders.
Parent Education: Almost all
hospitals in Northeast Ohio allow your baby to be at your bedside as often and as long as
you want. This gives you a chance to get to know your baby and to ask any questions
of the hospital staff before you go home. All the hospitals provide instruction
on how to care for yourself and your baby. Most pediatricians also stop in to
examine the baby and to talk to you before you go home. Since hospital stays are so
short (about 2 days for an uncomplicated vaginal delivery and about 4 days for a cesarean
delivery), many hospitals or insurance companies offer a nursing postpartum home visit
shortly after you arrive home to be sure you and your baby are doing well and to answer
your specific questions.
Circumcision: If you have a boy,
you will need to make a choice about circumcision. Since the final decision is
yours, ask your health care provider about the pros and cons. If you decide to have
your baby circumcised, your obstetrician usually performs it before you leave the
hospital.
Metabolic Screening: All babies in Ohio receive a screening test for inborn metabolic disorders (including PKU and others) before they are discharged from the hospital. This involves the nurse or laboratory technician taking a few drops of blood from the baby’s heel which is sent to the state for testing. Although these are rare diseases, early diagnosis and treatment prevent serious consequences. If you are discharged early (before 48 hours), this test may need to be repeated to be accurate. In that event, the home visit nurse can get the sample when she comes to your home, or you can bring the baby back to the hospital or your provider.
Newborn Jaundice: Newborn jaundice, or hyperbilirubinemia, is a fairly common newborn condition. If your baby’s skin has a yellowish tinge, your health care provider may take a few drops of blood from your baby’s heel to determine the bilirubin level. Depending on the results, your baby may or may not need medical intervention. In most cases, newborn jaundice goes away by itself. In some cases, the health care provider places the baby under special lights, called phototherapy. This procedure helps reduce the bilirubin level by transporting it from the skin to the blood where it is excreted by the body. Occasionally, a mother may be ready to go home but the baby needs phototherapy treatment. In these cases, many hospitals provide the mother with a "hotel" or "boarding" room in the postpartum unit. Although this room does not provide nursing care or meals, it allows a mother to remain near her baby. Some home care agencies offer phototherapy services in your own home. If phototherapy becomes necessary after you are discharged, check with your baby’s health care provider and your insurance company to see if this is an option.
Car Seats: Because it is Ohio law, your baby’s ride home needs to be in an infant car seat. These are specially constructed rear facing safety seats for infants which are to be used in the back seat of your vehicle.
Going Home: When you return home from the hospital, the most important thing you can do is to continue the special relationship you have with your baby. Your top priorities should be caring for your infant and yourself. Labor and delivery are major processes for your body and you will need time to heal. Once you are completely recovered, you can resume other household responsibilities. In the meantime, pamper yourself and your baby. If at all possible, arrange a support system for the first few weeks you are at home. If friends and family ask what they can do to help, don’t hesitate to tell them. Have them prepare meals, run errands or do household chores. They’ll feel useful and you can use the extra time to rest.
Help Me Grow
Help Me Grow is a coordinated program for families with children age birth to three that provides health and developmental services. The Help Me Grow program has three components:
1. Welcome Home: A nurse visit for all first time and teen mothers.
2. Early start: Home visits, parent mentoring, education, and support for families with children under three at risk for abuse, neglect, or developmental delay due to the social environment.
3. Early Intervention: Education, support and service coordination for families with children under three who have a developmental delay or are at risk for delay due to a medical or mental health condition.
Help Me Grow Intake Sites:
Ashtabula County: (440) 992-2111 or (800) 676-7016
Cuyahoga County: (216) 736-4300
Geauga County: (440) 285-1100 or (866) 975-1100
Lake County: (440) 350-2433 or (800) 899-5253
Lorain County: (800) 729-8687
Questions to ask if Your Baby is in
the
Neonatal Intensive or Special Care Unit:
1. What is my baby’s
condition? Are there other concerns? How long before you will know?
2. What other tests will my baby be
having? What are they for?
3. Is this covered by insurance?
4. What other programs are there
that can help pay for this?
5. Can you explain what is going on
in plain language that I can understand?
6. Can you give me the name of a
parent who I can talk to? Are there family/parent support groups that are
available to me as resources?
7. Can you suggest some things that
I can read?
8. Now that I know what the
diagnosis is - what now? What does that mean? If there is no diagnosis, can
you describe the specific concerns you have identified?
9. Can I choose the doctor and the
primary nurse who takes care of my baby in the Neonatal Intensive Care Unit (NICU)?
10. Who is my baby’s
doctor? When can I meet and talk with the doctor who is taking care of my baby?
11. Will my baby have to be
transferred/sent to another hospital?
12. When can my baby go home?
13. Is this a routine
test/procedure? Can I be with her during the test? If not, why not?
Why is it necessary? What will you
find out from the test?
14. Who do I talk to about other
programs (help at home, visiting nurses, money)?
15. How often can I visit? Can
my other children, grandparents, or other family members visit? Can I stay here
overnight?
16. What is this medication and what
is it for? Are there any side effects?
Questions To Ask When Your Baby Goes Home From The NICU :
1. When will I meet with the
doctors and nurses / early intervention service coordinator to plan for going home?
2. Who should I call if I am worried
about my baby when I go home?
3. Who can I talk with about
services to help when we get home (baby-sitting, money, nursing at home, food)?
4. What do I need to know or learn
before going home? Who will teach me?
5. What equipment or special food
will he/she need at home? Will my baby need a special bed? Special food?
Therapy? Will my baby need oxygen at home?
6. What do I do in an emergency?
7. Will the same doctors here at the
hospital see my baby after he/she is discharged? How soon? Are there doctors
in my own community who are closer who can provide for my child’s medical needs?
8. Can my friends and family see and
hold the baby at home?
9. Would my baby/ family benefit
from an Early Intervention services? Can you give me a local phone number for Early
Intervention resources?
10. Can I get help in coordinating
all the various medical and early intervention services when I get home? How will
service coordination help me and my family?
11. Does my baby need to have a
pediatrician back home? Can she go to the same doctor my other children see?
12. Who should I talk to if I notice
a problem later on?
adapted from "Transition from Hospital to Home" Ohio Department of Health - Division of Maternal and Child Health, Bureau of Early Intervention
A family is a living, breathing entity that is always changing. One of the most profound changes that a family experiences is the birth of a baby. There are many resources in the community to contribute to and support the health of the new family. Don’t hesitate to call any of the maternity departments on the hospital list or call United Way First Call For Help in the following counties:
Ashtabula County: (440) 998-4141
Cuyahoga County: (216) 436-2000
Geauga County: (440) 285-2261
Lake County: (440) 953-5465
Lorain County: (440) 282-1338
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