A New Beginning

A New Beginning Your personal guide to mom and baby care

The All-In-One Tool You Need If You’re a Parent To Be! The Northside Baby Bump App is designed to give you convenient access to the tools and support you need at every stage of pregnancy and beyond. Educational content covers pregnancy, labor and birth, postpartum, breastfeeding, and newborn care, while tools include a contraction timer, kick counter, feeding log, diaper log, journal, and more!

MILESTONES personalized to your baby’s development through each week of pregnancy.

REGISTER FOR THE PROGRAM Visit northside.com/ babybumpapp to sign up.

TOOLS to help you keep track of kicks, contractions, feedings, and more.

CHECK YOUR EMAIL Look for an email from noreply@yomingo.com with login instructions.

EVIDENCE–BASED INFORMATION so you know

DOWNLOAD THE YOMINGO ® APP Sign in using the username/password from the email.

Visit northside.com/ babybumpapp to register today! OR Scan this QR code

what to expect at every stage.

Download the FREE YoMingo ® App from iTunes or GooglePlay.

When to Call 911 for Mother

Make sure to tell 911 you had a baby

• Difficulty breathing (Severe shortness of breath)

• Seizures

• Chest pain, tightness or pressure

• Thoughts of hurting herself, baby or others

• Unresponsive

• One-sided muscle weakness or paralysis (Slurred speech)

Always follow mother’s hospital discharge instructions!

A NEW BEGINNING Your Personal Guide to Mom and Baby Care

Welcome and congratulations to you and your family! Thank you for choosing Northside Hospital to experience one of the most important times of your life. We pledge compassionate support, personal guidance and uncompromising standards as you start your New Beginning with baby. Have this guide available while you are with us. Your nurses will refer to it often while educating you about both you and your newborn’s care. A New Beginning is yours to take home and refer to when you have questions or concerns. The information in this book does not replace advice given to you or your baby by your health care providers.

YOUR NORTHSIDE HEALTHCARE TEAM

Digital Companion to Your Book

Looking for a fun way to learn new things? The Baby360 Scan + Play app is a FREE tool that makes it fast and easy to watch helpful videos on several interesting topics in this book. You can also use the app to enjoy more great interactive features:

EDUCATIONAL VIDEOS

BREATHING EXERCISES

STICKERBOOK

They say a picture is worth a thousand words. That’s why we added several educational videos to enhance your learning experience as you read this book. All video content is medically accurate and up to date with the latest medical standards.

Stress reduction and relaxation are very important throughout your pregnancy and childbirth journey. Use breathing exercises in our app to help reach calm and focus.

Embellish your special moments with Stickerbook. Whether announcing the gender of your baby or just capturing a sweet moment, our beautiful hand-drawn stickers are a great addition to your photos.

HOW TO USE APP

SCAN + PLAY

DOWNLOAD Visit baby360.com/ ScanAndPlay and download the Baby360 Scan + Play app or scan this icon.

FIND Look for the blue Scan + Play icons throughout this book.

SCAN Use the Baby360 Scan + Play app to scan the blue icons.

PLAY Sit back, get

comfortable, and enjoy your video!

VIDEOS IN THIS BOOK

TABLE OF CONTENTS

YOUR HOSPITAL STAY Congratulations!.........................................................................7 Welcome to Family Centered Care..............................8 Communication.................................................................. 8 Visitors.....................................................................................9 Visitor Parking...................................................................9 Nutrition.................................................................................9 Patient Rights............................................................................10 Your Clinical Care......................................................................11 What to Expect from Your Clinical Care...........11 Be an Active Participant in Your Care........................11 Nurse Bedside Shift Report.......................................11 Postpartum Medications...................................................12 Your Responsibilities.......................................................12 Medications While in the Hospital.......................12 Medications Brought in From Home................12 Medications When You are Discharged..........12 Differences Between Allergies and Side Effects........................................................................13 Postpartum Medication......................................................14 Postpartum Pain......................................................................15 Managing Your Pain is Important........................15 Communicating Your Pain........................................15 Scheduled Pain Medications...................................15 Important Safety Information.........................................16 Falls.............................................................................................. 16 Preventing Infections...........................................................16

Hand Hygiene..........................................................................16, 62 Uterus Changes...............................................................................18 Postpartum Perineal Care.......................................................19 The Bottom Line on Hemorrhoids..................................20 Cesarean Birth Care....................................................................30 Postpartum Emotions...............................................................32 Edinburgh Postnatal Depression Scale.......................38 Rest and Sleep................................................................................46 Jaundice................................................................................................66 Baby Behavior..................................................................................76 Shaken Baby Syndrome..........................................................78 Skin-to-Skin........................................................................................82 Umbilical Cord Care....................................................................84 Diapering............................................................................................ 86 Swaddle.................................................................................................87 Safe Sleep...........................................................................................89 Bathing Your Baby........................................................................91 Milk Production..............................................................................96 Feeding Cues...................................................................................98 Breastfeeding Positions..........................................................101 Breastfeeding Latch.................................................................102 Burping Baby.......................................................................103, 126 Hand Expression.........................................................................106 Formula Preparation................................................................132 Car Seat Safety...............................................................................145

A New Beginning: Your Personal Guide to Mom and Baby Care is for general reference purposes only and cannot be relied upon as a substitute for medical care. You and your baby should have regular checkups with your health care provider. You should also consult with your health care provider about any special questions or concerns.

Copyright 2000, 2019 by Customized Communications, Inc. All Rights Reserved Updated: 8/2016, 3/2018, 9/2019, 6/2022, 1/2024

V100.0765

Arlington, Texas | 800.476.2253 www.baby360.com | info@baby360.com

Edinburgh Postnatal Depression Scale.........................38 Edinburgh Postnatal Depression Scale Questionnaire.................................................................................. 39 Postpartum Support International..................................40

CHAPTER 1 Physical Changes

Postpartum Changes Beyond the First Day................18 Uterus............................................................................................... 18 Involution and After-Birth Pains.................................18 Vaginal Discharge (Lochia)..............................................18 Showering..................................................................................... 19 Perineum....................................................................................... 19 Bladder...........................................................................................20 Hemorrhoids..............................................................................20 Fluid Shifts and Swelling..................................................20 Bowel Elimination..................................................................21 Breast Engorgement..........................................................22 Muscle and Joint Discomfort.......................................23 Skin Changes.............................................................................24 Eye Hemorrhages..................................................................24 Varicose Veins...........................................................................24 Hair Loss........................................................................................24 Bed Rest .......................................................................................25 Urinary Catheter......................................................................25 Deep Breathing.......................................................................25 FAQs about Catheter-Associated Urinary Tract Infection...............................................................26 Cesarean Pain..................................................................................27 Managing Your Pain............................................................27 Getting Out of Bed for the First Time...................28 While Out of Bed, You Are at Risk for Falling.....29 Gas...................................................................................................... 29 Your Cesarean Incision.......................................................30 Showering....................................................................................30 Perineum......................................................................................30 Emotional Highs and Lows......................................................31 Emotional Changes..............................................................32 Postpartum Blues.................................................................32 12 Tips for Dealing with the Baby Blues.........................33 Perinatal Mood and Anxiety Disorders...........................34 Symptoms of Perinatal Mood and Anxiety Disorders [PMADs].....................................................35 Perinatal Mood and Anxiety Disorders: Is This Normal?................................................................................36 PMADs are Treatable...........................................................36 Partners Can Experience Postpartum Depression Too.........................................36 Postpartum Post-Traumatic Stress Disorder (PTSD).......................................................37 Postpartum Psychosis.......................................................37 Speak Up!......................................................................................37 CHAPTER 2 Cesarean Care CHAPTER 3 Emotional Changes

CHAPTER 4 Mom’s Discharge

TABLE OF CONTENTS

You’re Planning to Go Home..................................................41 Your Hospital Discharge...........................................................42 Discharge Planning Starts When You Arrive.....42 Before You Leave the Hospital....................................42 Baby’s Discharge....................................................................42 Important Questions to Ask About Your Discharge........................................................42 Expected Physical and Emotional Changes at Home...............................................................................................43 Cesarean Incision...................................................................43 Activity........................................................................................... 44 Discomfort & Pain.................................................................44 Family Planning & Resuming Sex............................44 Emotions & Mood Swings..............................................44 What You May Expect Over the Next Few Weeks.............................................................................45 My Plan for Help at Home the First Few Weeks......46 Help Your Family Transition..........................................46 Eat Healthy to Keep Up Your Energy...............................49 Set Realistic Expectations and Be Flexible..................49 Heart Disease...................................................................................50 Positive Lifestyle Changes..............................................50 Gestational Diabetes............................................................51 High Blood Pressure.............................................................51 Delivered Before 37 Weeks.............................................51 Postpartum Preeclampsia..............................................51 Warning Signs of Postpartum Preeclampsia.............52

CHAPTER 5 Warning Signs for Mother & Baby

• v

OB Inpatient Warning Signs..................................................53 POST-BIRTH Warning Signs...................................................55 When to Call 911 & When to Call Your Baby’s Health Care Provider...................................................57

CHAPTER 6 Your Baby’s Hospitalization

Your Baby’s Care.............................................................................59 Hospital Routines..........................................................................60 Baby’s Clinical Care Team...............................................60 Baby’s Clinical Care Routines......................................60 Choosing Your Baby’s Health Care Provider............................................................61 Newborn Identification and Security...............................61 Newborn Identification......................................................61 Hospital Security Measures............................................61 Preventing Infections.................................................................62 Hand-Washing is Important.........................................62

When Mother is Ill and Contagious.........................62 Cold Sores.....................................................................................62 Preventing Newborn Falls.......................................................62 Northside Hospital Circumcision Process....................63 If You Choose to Circumcise Your Baby Boy...........................................................................63 Newborn Pain Management.................................................63 Routine Newborn Procedures and Medications.............................................................................64 Apgar Score...............................................................................64 Erythromycin Eye Ointment........................................64 Vitamin K.....................................................................................64 Hepatitis B..................................................................................64 Other Newborn Medications.................................................64 Dextrose Gel..............................................................................64 Tylenol............................................................................................ 64 Important Newborn Health Screenings........................65 Jaundice...............................................................................................66 Risk Factors for Jaundice.................................................66 Signs & Symptoms of Jaundice..................................66 Types of Jaundice...................................................................66 Screening and Testing for Jaundice.................................67 Treating Jaundice..........................................................................67 Feedings........................................................................................ 67 Phototherapy.............................................................................67 Blood Sugar and Car Seat Screening for High Risk Newborns............................................................68 Welcoming Baby!..........................................................................69 Baby’s Appearance.......................................................................70 Birthmarks......................................................................................... 72 Baby Senses......................................................................................73 Your Baby’s Behavior..................................................................74 Sleep Patterns..................................................................................74 Tips for Waking a Sleepy Baby....................................74 Crying or Fussing...........................................................................75 Temperament........................................................................... 75 Crying.............................................................................................. 75 Ways to Soothe a Fussy Baby......................................75 Overstimulation.............................................................................. 76 What is Colic?...................................................................................77 Coping with Colic...................................................................77 Period of PURPLE Crying................................................77 Never Shake a Baby.....................................................................78 Late-Preterm Babies...................................................................79 Feeding Tips for Late-Preterm Babies.................80 CHAPTER 7 Getting to Know Your Baby

What to Do If Baby Gags or Spits..............................83 Newborn Resources............................................................83 Umbilical Cord................................................................................84 Wet Diapers.......................................................................................85 Bowel Movements........................................................................85 Diaper Changes..............................................................................86 How to Change a Diaper..................................................86 Diaper Rash................................................................................86 Dressing and Swaddling..........................................................87 Rooming-in........................................................................................88 Safe Sleep............................................................................................89 ABCs of Safe Sleep........................................................................89 Tummy Time.....................................................................................90 Tummy Time Tips..................................................................90 The Power of Play..........................................................................90 Tips.................................................................................................... 90 Bathing Your Baby.........................................................................91 Tub Bathing Baby..................................................................92 Cradle Cap....................................................................................93 Nail Care.........................................................................................93 Caring for a Circumcision........................................................93 Plastibell Circumcision Procedure...........................93 Other Circumcision Procedures.................................93 Caring for an Intact Penis........................................................93 Taking Baby’s Temperature....................................................94 Only Digital Multiuse Thermometers are Recommended for Newborns...........................94 How to Take an Axillary Temperature....................94 How to Take a Rectal Temperature..........................94 Welcome to Your Breastfeeding Journey.....................95 Physiology of the Breast...................................................96 Milk Production.......................................................................96 Colostrum..................................................................................... 97 Exclusive Breastfeeding...................................................97 How Do I Know My Baby is Ready to Breastfeed?..................................................................98 Newborn Tummies Are Very Small!..................................99 Cluster Feeding.............................................................................100 Normal Newborn Feeding Patterns...............................100 Breastfeeding Positions...........................................................101 Latch-On............................................................................................ 102 Signs of a Proper Latch-on...........................................102 Baby-Led Latch.....................................................................102 Burping............................................................................................... 103 How Do I Know My Baby is Getting Enough to Eat?..........................................................104 In the Early Days...........................................................................105 Breastfeeding and Formula Supplementation...........................................106 Expressing Breast Milk.............................................................106 Hand Expression...................................................................106 How to Hand Express.......................................................106 Breast Pumps and Hands-On Pumping.....................108 Pre-owned Breast Pumps...........................................108 Frequency of Expressing..............................................108 CHAPTER 9 Breastfeeding

CHAPTER 8 Caring for Your Baby

Learning About Your Baby.......................................................81 How to Pick Up and Hold Baby............................................82 Skin-to-Skin Contact...........................................................82 If Baby Gags or Chokes..............................................................83 How to Use a Bulb Syringe.............................................83

Collection of Breast Milk.................................................109 Storage of Breast Milk......................................................109 Thawing or Warming Breast Milk...........................109 Cleaning Your Breast Pump Parts....................................110 Washing By Hand.................................................................110 Dishwasher................................................................................ 110 Optional Step............................................................................110 Store Safely.................................................................................110 Cleaning Rental Pumps...................................................110 Returning Rental Pumps................................................110 Care of the Breasts.......................................................................111 Sore Nipples.................................................................................111 Engorgement.............................................................................111 Growth Spurts...........................................................................111 Frequently Asked Questions about Breastfeeding What You May Feel While Breastfeeding, Breastfeeding a Preterm Baby ........................................... 112 Frequently Asked Questions about Breastfeeding Others Feeding Baby, Pacifier Use ....................................113 Frequently Asked Questions about Breastfeeding Breast Surgery, Taking Certain Medications ............. 114 Frequently Asked Questions about Breastfeeding Artificial Sweeteners, Alcohol and Caffeine, Mother’s Diet While Breastfeeding ...................................115 Marijuana and Breastfeeding..............................................116 Breastfeeding Logs.....................................................................117 Feeding Your Baby a Bottle...................................................125 How Do I Know My Baby’s Ready to Eat?........125 What Are Proper Bottlefeeding Techniques?..........................................125 Paced Bottle Feeding......................................................126 Burping Your Baby.....................................................................126 How Much Should My Baby Eat?.....................................127 Formula Feeding Your Baby................................................128 Choosing Formula for Your Baby............................128 Formula Comes in 3 Forms..........................................129 Formula Package Safety................................................129 How Is Formula Regulated?........................................129 Unsafe Milk Options...........................................................129 Homemade Formulas......................................................129 Imported Formulas............................................................130 Counterfeit Formulas........................................................130 Choosing Bottles and Nipples for Your Baby...........130 Cleaning Bottles, Nipples and Parts.................................131 By Hand........................................................................................131 By Dishwasher.........................................................................131 Extra Sanitizing.......................................................................131 Storing Supplies.....................................................................131 Preparing Formula for Your Baby.....................................132 For Powdered Formula...................................................132 For Liquid Concentrate...................................................132 For Ready-to-Feed Formula.......................................132 Normal Newborn Feeding Patterns................................133 Frequently Asked Questions about Making Formula Types of Water for Mixing Formula ..................................133 CHAPTER 10 Formula Feeding

Frequently Asked Questions about Making Formula Heating, Storing, and Milk Storage Guidelines ....... 134 Cronobacter Infection...............................................................135 Prevention of Cronobacter Infection....................135 Frequently Asked Questions...............................................136 Formula Feeding Logs..............................................................137

CHAPTER 11 Baby’s Discharge

TABLE OF CONTENTS

Taking Your Baby Home..........................................................141 Planning to Take Baby Home Starts at Birth...........142 While You’re in the Hospital........................................142 Important Questions to Ask About Your Baby...................................................................142 Get All of Your and Your Partner’s Questions Answered ........................................................142 Choosing a Car Seat...................................................................143 Get Your Car Seat Inspected.......................................143 General Rear-Facing Car Seat Installation Tips......................................................................143 Used Car Seats.......................................................................143 Car Seat Instructions and Safety Information.........144 How Long Should Baby Stay in a Rear-Facing Car Seat?...........................................144 Baby’s Car Seat..............................................................................145 Before Your Baby is Discharged...............................145 Can Hospital Staff Put My Baby into the Car Seat?.................................................................145 Hot Car Safety................................................................................146 Look Before You Lock...............................................................146 Arriving Home...............................................................................147 Pets.................................................................................................. 147 Siblings......................................................................................... 147 Baby’s First Doctor’s Office Visit........................................148 Immunizations.............................................................................. 149 Recommended Immunizations, Birth–6 Months..............................................................................150

CHAPTER 12 Your Patient Experience

Your Patient Experience............................................................151 We Value Your Insight and Comments................151 Thank You!....................................................................................151 Press Ganey Survey Sample...................................................152

CONGRATULATIONS! Welcome to the Women’s Center at Northside Hospital. While you are here, you and your baby will be cared for by a team of medical and nursing professionals that specialize in maternity and newborn care. This chapter has useful information to help you feel more comfortable during your stay.

YOUR HOSPITAL STAY

7

Your Hospital Stay

Welcome to Family Centered Care

When you arrive at the Family Centered Care Unit, you and your family will be greeted by a mother-baby nurse. The nurse’s goal is to help you recover from the birth, assist with feedings, and provide education about post-delivery and newborn care. Each FCC room is equipped with an individual temperature control, television, and phone. It also has a daybed for your support person and a bassinet with all of the supplies needed to care for your baby.

COMMUNICATION You may use the telephone in your room any

time during the day or night. • Dial “9” to get an outside line.

• To allow you to rest, no incoming calls will come through between 9 p.m. and 9 a.m. • You may use your cellphone. • We cannot charge any long-distance calls to your hospital bill. • Please use a calling card if you wish to call outside the Atlanta, Cherokee, or Forsyth areas.

Main Hospital Numbers: • Atlanta: 404.851.8000 • Forsyth: 770.844.3200 • Cherokee: 770.224.1000

8 A New Beginning

NUTRITION Our goal is to provide you and your baby with optimal nutrition during your hospital stay. Meal selections are based on the orders of your physician. A catering associate will come to your room daily and offer you choices from the menu. If you have any questions about your dietary orders, please ask your physician. Family members are also welcome to bring you food, as long as it adheres to your dietary orders. Pantry: You’ll find coffee, ice water, and juice in the pantry, as well as a microwave and refrigerator. Use orange labels located on top of the refrigerator to label food with your name, room number and date. Food in the pantry refrigerator is discarded after 3 days, so you must relabel any items on the third day that you want to keep. Guest Meal Voucher: Our guest meal voucher program will allow friends and family to enjoy a meal of their choice with their loved one. How to get a meal voucher: Visit the cafeteria cashier and purchase a $3 guest voucher, or at the Atlanta campus, you can visit the Lotus Blossom Café (also known as the coffee shop) in the Atrium. How to order a guest meal: When a catering associate comes to the room to get the patient’s meal order, present the voucher and order the guest meal too. The meals will be delivered at the same time for your convenience. What comes with the $3 meal voucher: The voucher entitles you to a full patient meal (chef selection either #1 or #2 for that meal), or you can use it for the $3 face value in the cafeteria.

VISITORS Please discuss Northside’s current visitation policy with your nurse because it is subject to change. You may invite one adult as your support person to be with you 24 hours a day. This person is welcome to spend the night with you in your room. This is a great opportunity for your support person to ask questions and learn how to best help you at home. VISITOR PARKING Atlanta: Available in the PINK parking deck across from the Women’s Center on Hollis Cobb Drive (per hourly fee). Daily parking passes can be purchased at the kiosk in the parking garage. Cherokee & Forsyth: Available at no charge in the open lot in front of the Women’s Center.

9

Your Hospital Stay

Patient Rights

The Joint Commission is a U.S.-based nonprofit organization that evaluates and accredits thousands of health care organizations and programs, both in the United States and around the world. According to its standards, every patient must receive respectful medical care that is free from bias or racism of any kind. As a maternity patient, your relationships with the people on your care team should be characterized by empathy, support, trust, confidence, and empowerment. Similarly, your communications with them should always be gentle, effective, and respectful, on both sides of every conversation. Pregnancy and childbirth are universally recognized as significant life events as well as times of increased vulnerability. Today’s health care teams are strongly encouraged to work together to consistently provide patients with the highest levels of support, security, and physical and emotional care possible. As a patient or a member of a patient’s family, you should never be afraid to speak up for yourself. Your opinions matter, and you have the right to be involved in all decisions that may affect the health of you and your baby. Northside Hospital strives to provide satisfactory care; however, if you have a concern that you feel was not satisfactorily addressed, you have the right to contact a Patient Relations representative. You also have the right to file a concern with the Georgia Department of Community Health. You may reach them at 404-656-4507 or by mail at 2 Peachtree St. NE, Atlanta, GA 30303. Patient safety concerns can be reported to The Joint Commission: • At www.jointcommission.org , using the “Report a Patient Safety Event” link in the “Action Center” on the homepage • By fax to 630-792-5636 • By mail to Office of Quality and Patient Safety, The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181

10 A New Beginning

Be an Active Participant in Your Care

We believe that you need to be an active and full partner in your care. To help prevent medical errors: • Be sure all the health care professionals involved in your care have important information about you. • Ask your partner or family member to stay with you while you’re in the hospital to be your advocate (someone who can help get things done and speak up for you when you cannot). • Know that “more” is not always better. It is a good idea to find out why a test or treatment is needed and how it can help you. • If you have a test, don’t assume no news is good news. Ask for results of all tests. • Learn about your condition or treatments. Use this book as a reference. NURSE BEDSIDE SHIFT REPORT When your nurse goes off duty — between 7 to 7:30 a.m. and 7 to 7:30 p.m. — they will introduce the next nurse who will be caring for you and your baby. The two will meet at your bedside for 5-10 minutes and share important information about you and your baby’s care. Take this opportunity to share your goals and expectations for the upcoming shift.

Your Clinical Care

WHAT TO EXPECT FROM YOUR CLINICAL CARE Your physician has written specific orders for your care. These orders may include: • Assessment of you and your baby’s body. • Lab work specific to you and your baby’s condition. • Type of diet and level of activity. • Medications specific to your diagnosis. • Consultations with other health care professionals, including lactation specialists. What to Expect After Delivery • Your vital signs will be taken at least once per shift — or more frequently, depending on your diagnosis and physician’s orders. • Your activity level will depend on your condition. Most patients can get out of bed and walk after delivery if they are stable. • Vaginal deliveries may take a shower daily if you are stable. Our staff will be happy to help with your hygiene needs. Cesarean deliveries may shower depending on your type of incisional dressing. • If your physician orders lab work, a technician will collect the specimens needed. Please discuss all lab results and questions you may have with your physician. • During your stay, a nurse “leader” will stop to visit you to discuss your hospital experience. You may ask to speak to them to discuss questions or concerns any time during your hospital stay.

Listen You are an important part of your health care team. Listen to your nurses’ report to ensure that they have complete and timely information. Speak Up Ask any questions or raise any concerns you may have. If you do not understand a medical term, feel free to ask them to explain. Participate and Ask Questions Your involvement helps us ensure that you receive the high-quality, individualized care you deserve.

11

Your Hospital Stay

Postpartum Medications

MEDICATIONS WHEN YOU ARE DISCHARGED

Your physician will review all your medications — those you took before the birth and those prescribed after — to prevent any negative drug interactions. Your nurse will also review each of the prescribed medications you will be taking at home and give you written instructions on their use. Make sure you ask any questions you have and discuss any concerns.

YOUR RESPONSIBILITIES • Make sure all your health care providers know about every medication you are taking. This includes prescription and over-the counter medicines and dietary supplements such as vitamins and herbs. • Make sure your health care providers know about any allergies and adverse reactions you have had to medicines. • Ask for clarification if you can’t read the physician’s handwriting on any prescription. • Ask your health care provider to explain your home treatment. Your obstetrical provider will prescribe all medications based on your medical history, if you have a history of any drug allergies or reactions, your type of delivery, and clinical condition. Your nurse will review all these medications with you. Review the medication table on page 14 and ask questions about each medication prescribed. Your nurse can provide more detailed written information about your medications. Let your nurse know anytime you have concerns, questions, or are unsure about your medications. It is important that you understand your medications and are comfortable taking them. MEDICATIONS WHILE IN THE HOSPITAL

Questions to ask before taking a new medication

• What is the name of the medicine and what is it for? • How and when do I take it? • How long do I take it? • Will this work safely with other medicines I’m taking? • Is it safe for me to take this if I’m breastfeeding? • What food, drinks, activities, and dietary supplements should I avoid while taking it? • When should I expect this medicine to begin to work, and how will I know if it is working? • Are there any side effects, what are they, and what do I do if they occur? • What symptoms do I need to be sure to report? • What should I do if I miss a dose? • What is the most important thing I should know about this medication? • Where can I get written information about this medication?

MEDICATIONS BROUGHT IN FROM HOME

The use of any home medications (prescribed, over the-counter, herbs, or vitamins) is discouraged during your hospital stay. This policy helps decrease the risk of any prescription and drug-to-drug interactions. Please have your support person take home any medications you brought to the hospital.

DO NOT TAKE a new medicine until...

• You have ALL your questions answered • You have discussed your history of allergies and medication side-effects

12 A New Beginning

Differences Between Allergies and Side Effects

ALLERGY

SIDE EFFECT

QUESTIONS TO ASK

What is it?

Abnormal immune reaction

Undesired secondary effect of a drug

Body mistakes the medicine for a harmful substance

Part of the drug’s known properties that occur a certain amount of the time

What causes it?

• Hives, rash, fever, swelling, difficulty breathing, itching, dizziness, vomiting, runny nose • Shortness of breath

What are the signs and symptoms?

• Varies for each medicine • GI symptoms – nausea, upset stomach

Is it serious?

Can be life-threatening

Mild to very serious

• Varies from 1 hour to a few weeks • It may not happen the first time you take a medicine, but after taking it several times later.

When does it happen?

• Varies from 1 hour to a few weeks • A lower dose may relieve symptoms

• Antibiotics • Pain relievers • Chemotherapy drugs • Autoimmune disease drugs • History of other allergies • Family history of drug allergy • Prolonged use • High doses • HIV or Epstein-Barr disease

Which common types of medicines cause it?

All medications have potential for side effects

• Elderly • Children • Pregnant women • Patients with immune diseases

What are the risk factors and who can it affect?

What should I do?

Understand a drug’s side effects Report any new symptom

• Alert all providers of your allergies • Wear a bracelet

Tell your nurse if you have: • Difficulty breathing • Shortness of breath • Wheezing • Light-headedness • Vomiting

• Fever • Hives • Increased itching or rash • Swelling of your face, lips, tongue, or throat • Runny nose

13

Your Hospital Stay

Postpartum Medication This is not an all-inclusive list.

Your health care provider will prescribe pain medications based on your individual history and needs to help you feel comfortable. Not all side effects are listed on this table; your nurse will provide you with a medication education handout that includes the side effects if you request it or at the time of discharge.

COMMON POSSIBLE SIDE EFFECTS NOTE: List does not include all side effects.

COMMON REASON PRESCRIBED FOR POSTPARTUM MOTHERS

GENERIC NAME

BRAND NAME

Acetaminophen, Injection

Ofirmev

Stomach pain, dark urine, yellow eyes/skin

Acetaminophen, oral (by mouth)

Tylenol

Stomach pain, dark urine, yellow eyes/skin

Pain

Morphine sulfate

Dizziness, fatigue, constipation, difficulty breathing

Ketorolac Tromethamine Toradol

Swelling, constipation, nausea, headache

Nonsteroidal anti-inflammatory drug (NSAID)

Advil, Motrin, Proprinal, Ketorlac

Stomach/intestinal bleeding

Inflammation

Heart attack/stroke if taken in high doses or if you have heart disease

Metoclorpramide hydrochloride

Reglan

Headache, fatigue, drowsiness, dizziness

Ondansetron

Zofran

Fever, itching, fatigue, constipation, diarrhea, headache

Nausea/Indigestion

Famotidine

Pepcid

Headache, dizziness, constipation, diarrhea

Gas

Simethicone

Mylanta, Gas-X

Diarrhea, nausea, vomiting

Senna

Ex-Lax, Senokot

Stomach pain, diarrhea, nausea, low potassium, joint pain

Constipation

Witch Hazel topical pads

Tucks

Mild itching or burning

Hemorrhoids

Hydrocortisone, topical

Anusol

Mild itching or burning

Hydrocortisone-Pramox, topical

Analpram

Mild itching or burning

Perineum Discomfort

Diphenhydramine

Benadryl

Drowsiness, adverse CNS effects

Itching

Nicotine, transdermal

Habitrol

Anxiety, insomnia, fatigue, dizziness, restlessness

Smoking Cessation

Prenatal multivitamins

Upset stomach, headache, unpleasant taste in your mouth

General Health

14 A New Beginning

Postpartum Pain

MANAGING YOUR PAIN IS IMPORTANT Helping you manage pain is a priority because it makes it easier for you to recover and care for your newborn. Although everyone reacts differently, most women will have some pain or discomfort after childbirth. If your pain is severe or worsens, it may be a sign of another problem. Pay attention to your body — if something doesn’t seem right, it probably isn’t. Let your nurse know immediately. COMMUNICATING YOUR PAIN You can help your nurse by telling her your level of pain. They will ask several times a shift how you are feeling. If you are in pain, you will be asked to rate your pain on a scale of 0-10. Zero means you have no pain and 10 means the worst imaginable pain. Try setting your pain goal at a number at which you feel you need to take pain medication. This pain goal can be raised or lowered at any time during your hospital stay.

01 2345678910

Worst Pain Possible

Severe

No Pain

Mild

Moderate

Very Severe

0 1-3

4-6

7-9 10

Tell your nurse if your pain is: • Persistent • Unusual • Worse than what it was previously • Prevents you from doing things you were able to do earlier • Located in the right upper area of your abdomen or just below your breastbone • A headache with any vision changes or confusion • A severe headache that does not respond to pain medication or rest • Located in the back of either of your legs

Your nurse will support whatever pain goal number you choose to receive pain medication. If you are uncomfortable or in pain, let your nurse know. One hour after you receive pain relief medication, your nurse will ask you to rate your pain. This helps staff to know if your medications are working appropriately or if a different medication is needed. Tell your nurse as soon as you begin to feel uncomfortable. Always be sure to tell your nurse or provider if your pain becomes worse or does not respond to the medication. SCHEDULED PAIN MEDICATIONS Your obstetrical provider may prescribe Tylenol, Motrin, or both depending on your clinical situation. These may be the only pain medications that you need. Both are safe to take while breastfeeding.

15

Your Hospital Stay

Important Safety Information

FALLS Even though you may not have a history of falling, you are at risk for falling while in the hospital. When you can safely get out of bed on your own depends on your type of delivery, anesthesia, and clinical condition. Do not get out of bed the first time without help. It’s important to notify your nurse to make sure you can safely walk and stand. Walking is an important part of your recovery, but labor analgesia, pain medications, IVs, and different surroundings put you at risk for falling.

Preventing Infections

Preventing infections is important to your healthy recovery. Let your nurse know if you or your partner have been exposed to an infection. Report any symptoms you may have as soon as possible. Remember, handwashing is the single most important way to

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prevent an infection. Handwashing Tips

• Wash your hands before and after you go to the bathroom, breastfeed, touch someone else, sneeze, cough, prepare a bottle, change a diaper or blow your nose. • Remove your jewelry before washing your hands. • Wash hands for 30 seconds cleaning your whole hand, under nails, between fingers and up to your wrist. • Turn the water off with a clean paper towel. • Dry with paper towel, clean cloth but not your clothes. • If using a hand sanitizer, use an adequate amount to cover your hands and rub until it dries.

Tips to Prevent Falls • Wear nonslip socks • Keep your hospital bed in the lowest position with the side rails up • Keep the nurse call bell and any items that you frequently need within reach • Do not fall asleep in the chair; if you’re tired, lie on your bed • Keep the path from your bed to the bathroom clear

Tell your nurse immediately if you: • Feel or become lightheaded • Become dizzy • Need help • Fall

Chapter Resources

• Lexicomp Online Drug Reference https://go.wolterskluwer.com/lexicomp-drug-reference LexiCom Mobile App

• National Institutes of Medicine (NIH) Drug Information Portal https://druginfo.nlm.nih.gov MD on Tap Mobile App

16 A New Beginning