Government of Western AustraliaDepartment of HealthWomen and Newborn Health Service

When to Come to Hospitaland Planning to go Home

yourvoice

WNHS

CommunityAdvisory Council

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Contents

WHEN TO COME TO HOSPITAL 3

WHAT TO BRING TO HOSPITAL 5

VISITORS DURING LABOUR IN HOSPITAL 6

VISITING TIMES 7

PLANNING TO GO HOME FROM HOSPITAL 7

GOING HOME 8

TESTS AND MEDICATIONS FOR YOUR BABY 9

WHEN YOU ARE AT HOME 10

VISITING MIDWIFERY SERVICE 10

COMMUNITY CHILD HEALTH NURSE 10

POSTNATAL CHECK 11

DAILY PRIORITES 11

OPEN HOUSE – POSTNATAL PROGRAM 11

BABY MASSAGE 12

BREASTFEEDING 12

TEN STEPS TO SUCCESSFUL BREASTFEEDING 12

THE PERRON ROTARY EXPRESS MILK BANK 13

FORMULA FEEDING 13

MEDICAL TERMS THAT MAY BE USED 14

OTHER SERVICES AVAILABLE AT KEMH 15

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When to come to hospitalDo not hesitate to phone the hospital for advice at anytime.

Please call Maternal Fetal Assessment Unit before coming to KEMH Phone: (08) 6458 2199

For women booked to Family Birth Centre Phone: (08) 6458 1800

For women under Team Midwifery care Phone: (08) 6458 2498

and ask the operator to page your team midwife Ruby - pg: 3344 Jade - pg: 3417

Please telephone the Maternal Fetal Assessment Unit (MFAU) if you experience any of the following:

Contractions

Your uterus (womb) has already been practising with toning up contractions called ‘Braxton Hicks’ contractions. These contractions can be either irregular or regular and may continue for hours without changing in strength, frequency or duration. These contractions don’t last very long but can be uncomfortable.

Contractions that mean labour has started are different. These early contractions are usually (though not always) short and mild. They can last 30 to 40 seconds (the gap between them may be as long as 15 or 20 minutes) and can be painful. However, some labours begin with contractions closer together and rather intense. As labour advances you will feel the contractions in your abdomen or in your lower back, or both. This pattern varies between women.

The length of time between contractions is from the start of one contraction to the start of the next. Contractions become stronger and last longer as labour progresses.

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During contractions you usually have to concentrate and use the relaxation techniques and positions of comfort you have learned at preparation for childbirth classes.

You may be asked to observe your contractions to see whether they are getting closer together. If you would like to discuss how your labour is progressing, please ring the hospital.

Your waters break (ruptured membranes)

This means the sac that your baby has been growing in has broken. The water that has been surrounding your baby now starts to come away. You may have either a sudden gush or a slow trickle. Once your waters have broken, the baby’s barrier against infection is gone. It is important to phone the hospital as soon as this happens. You will need to come in for assessment even if your contractions have not started.

Vaginal bleeding

It is not normal to bleed during pregnancy. If you experience any bleeding it is important that you phone the hospital and come in straight away. Please save and bring with you any pads or blood-stained clothing so the midwives and doctors can check the amount you have lost.

Change in activity of your baby

If you have noticed that your baby isn’t moving as much as it normally does please telephone the hospital.

Any persistent abdominal pain

Especially if this is associated with bleeding.

Symptoms of high blood pressure

Some swelling of the hands and feet is normal in pregnancy. If any of the following occur please phone the hospital and talk to a midwife:

• Significant and sudden swelling of your face and hands

• Headaches

• Blurred vision• Upper abdominal pain

What to bring to hospital

Valuables

Do not bring valuables. The hospital will not accept responsibility for the loss or damage to any property left in the ward. You may like to bring a small amount of money for telephone calls, newspapers or magazines etc.

For you:

• Current medications

• Medicare card and/or private health insurance membership information

• Health Care Card (if you have one)

• Loose, comfortable day clothes

• Nighties or pyjamas, dressing gown and slippers

• Nursing bras and one box of disposable breast pads

• Maternity (large) sanitary pads – five packets

• Toiletries including soap, shampoo, deodorant, toothbrush, toothpaste, brush/comb etc.

For your baby:

• Nappies (newborn size) for use during your stay in hospital

• Baby soap

• A packet of cotton wool balls and cotton buds

• Baby wipes - if you wish to use them

• Clothes and a blanket to take the baby home in

• A baby car seat/capsule of your choice must be fitted into your car before taking the baby home

• Formula – if you intend to bottle feed your baby

There is limited storage space available for your belongings in hospital, please consider this when packing.

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Bringing food from home

For the safety of our patients, the Women and Newborn Health Service Policy prohibits staff, patients or carers from reheating or storing any food brought onsite. You will NOT have access to microwaves or ovens and food will NOT be stored in ward refrigerators.

Shelf stable foods such as fruit, biscuits and chocolates can be kept in patient’s rooms who wish to keep extra food in their rooms. However, perishable items such as cold meats, custards, cream filled cakes, or cooked vegetable or meat dishes must be eaten immediately, or discarded in the bin.

During your stay the hospital or Birth Centre will supply:

• Sanitary pads and nappies for use following delivery only

• Clothes for your baby to wear

• Blankets for your baby

• Towels and other linen

Visitors during labour

Main hospital

You may choose to have up to two support people with you during your labour and birth e.g. your partner, relative or friend.

Your support people may stay with you until you are transferred from the Labour and Birth Suite to a postnatal ward or your home. It is not possible for a support person to stay overnight with you unless in exceptional circumstances.

Family Birth Centre

You may choose to have more than two support people with you during your labour and birth.

After birth, one person may stay with you until you and your baby are transferred home.

Planning to go home from hospitalBefore the birth of your baby it is helpful to plan ahead. Here are a few ideas:

For your baby

• Create a place in your home for the baby. It may be a nursery or it may be in your bedroom close to you.

• Buy essential baby equipment i.e. pram, cot, etc.

• Wash all baby clothes with a chemical free soap solution, especially new nappies and clothes that have been stored in mothballs.

• Arrange to buy or hire a baby capsule or car seat. Ensure this is fitted correctly in your vehicle. Kidsafe WA offer a fitting service phone (08) 6458 8509.

KEMH is a teaching hospital and helps train WA’s future health professionals. During your stay in hospital you may have student doctors, midwives, nurses and allied health

professionals as part of the team caring for you.

With your support our students gain valuable knowledge and experience for their future careers.

Visiting times

Visiting hours on maternity wards are between 3.00pm and 8.00pm. One nominated support person (i.e. your partner) may visit from 8.00am to 8.00pm.

There are no visiting restrictions during your stay in the Family Birth Centre.

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Support at home

When planning to go home from hospital it is a good idea to organise an extra support person to be with you for the first week. Talk to your partner and family about rearranging household tasks and making sure you find time to be together with the new baby. Try to accept any offers of help.

Your partner or support person can help with:

• Answering the phone/door

• Keeping visitors to a short stay

• Ensuring you get enough rest during the day

• Caring for other children and keeping their daily activities as normal as possible

• Preparing meals

• Shopping

• Housework

Going homeChildbirth is a natural process and one which mothers, family and friends share together. Planning to go home as soon as possible means that the experience of the new baby is shared in the comfort of your own home.

You can expect to go home around 24 hours after a vaginal birth and 72 hours after a caesarean birth, provided all is well. At the Family Birth Centre you can expect to stay up to 24 hours following the birth.

You may be transferred home to the care of the Visiting Midwifery Service (VMS) earlier if medically advised. During busy times, when bed shortages exist within the hospital, you may be required to transfer to another hospital closer to your home for postnatal care.

Once you and your baby have been checked, the doctor or midwife will inform you of when you may go home. We ask that you plan to leave your room by 11.00am on the day of discharge so that your room can be cleaned.

Tests and medications for your babyYou will be offered a number of medications and tests for your baby before you go home. You will be asked for your permission before any special treatments or tests are done. If you don’t understand why the test or treatment is needed, ask for more information.

Newborn Vitamin K

It is recommended that babies be given a single dose of Vitamin K within a few hours of birth. Newborns may be low in Vitamin K in the first eight days of life. Vitamin K is needed to help the blood clot and to prevent bleeding.

Hepatitis B immunisation

Hepatitis B is a disease caused by a virus that affects the liver. Hepatitis B is spread by infected blood and other body fluids such as saliva. It is recommended that babies are immunised soon after birth.

A Hepatitis B vaccine will be offered for your baby before you leave hospital. To complete the immunisation, more vaccinations are given up to four years of age.

Newborn screening test

It is recommended that all babies in WA have a test that checks for some very rare diseases that can be present at birth and which may cause serious complications. In most cases, if the diseases are found, they can be treated and the baby will grow and develop normally.

Hearing screen

A small number of babies are born with a hearing loss that could affect their speech and language skills. Hearing loss may not be obvious in the first few weeks of life, but can be detected by a hearing screen. You will be given the results as soon as the screen is completed. Ongoing hearing tests will also be part of your care in the community via your local Child Health Clinic.

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When you are at homeOnce you return home you can continue your care with the Visiting Midwifery Service, child health nurse and your local GP.

Visiting Midwifery ServiceThe Visiting Midwifery Service (VMS) is available to women attending KEMH and the Family Birth Centre who reside within approximately a 40km radius from the hospital. Women who live outside this limit can see their GP or local hospital for postnatal support.

The VMS midwife will answer any questions you may have and provide advice and support about care for you and your baby.

The midwife will visit you at home each day until your baby is five days old, or longer if needed. The community child health nurse will then be available to continue your care at clinic visits.

The service operates seven-days-a-week including public holidays. Please be available for the midwife’s visit between 8.00am to 4.30pm each day. Due to distance and time constraints we are unable to give allocated times for each visit. See page 15 for the VMS contact details.

Contact details

Visiting Midwifery Service (08) 6458 1530

Clinical Midwifery Manager (08) 6458 2222 page 3488

After Hours Midwifery Manager (08) 6458 2222 page 3333

Community child health nurseThe role of the community child health nurse is to promote the health and well-being of all family members. The nurse will help support you as parents in the important and challenging task of raising children.

Before discharge you will be given a purple personal health record for your baby.

This will contain information about:

• The address and telephone number of your closest child health clinic

• Details of your baby’s birth

This book is used to record details of your baby’s growth and development, immunisations and health care.

Postnatal checkIt is important to see your GP six weeks after childbirth to check the health of both you and your baby.

Daily prioritiesWhen planning your day with a baby you should try to be practical and flexible with your time. Some of the tasks you should plan to do each day include:

• Have some resting time

• Making sure you eat regular healthy meals and drink plenty of water

• Setting aside time to breastfeed/feed your baby

• Washing clothes

As your routine establishes, you can also enjoy some daily exercise.

Open House Postnatal ProgramAn invitation is extended to all new parents and their babies up to nine months old to join us to meet and socialise with other new parents and share experiences.

We have a variety of guest speakers who cover a range of topics relevant to parents.

The program is held at 1.30pm every second and fourth Tuesday of the month in Agnes Walsh House which is located next to the main hospital building.

For further details contact Parent Education on (08) 6458 1368, Monday to Friday between 8.00am to 9.00am and 3.00pm to 4.00pm, except Wednesday.

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Baby massageFor further details contact Parent Education as above.

BreastfeedingBreastfeeding is the healthiest way for you to feed your baby. Uninterrupted skin-to-skin contact immediately after birth allows your baby to follow their natural instincts to seek the breast. When medically possible you will be encouraged to keep your baby skin-to-skin on your bare chest as much as possible until your baby has fed well at the breast.

Use breastfeeding to soothe your baby for injections and any blood tests. Evidence shows that breastfeeding has a pain relieving effect in babies, so offer the breast before or after any painful procedures.

Ten Steps to Successful BreastfeedingThe Ten Steps to Successful Breastfeeding is recommended by WHO/UNICEF. These ten steps are followed to ensure that babies are given the best opportunity of initiating breastfeeding.

1. A written breastfeeding policy is available and is routinely communicated to all health care staff.

2. All health care staff receive training in the skills they need to implement the policy.

3. All pregnant women are informed about the benefits and management of breastfeeding.

4. Mothers are assisted to initiate breastfeeding within half-an-hour of birth.

5. Mothers are shown how to breastfeed and how to maintain lactation even if they are separated from their baby.

6. Newborn infants are given no food or drink other than breast milk, unless medically indicated.

7. Rooming in is practised so mothers and infants can remain together for 24-hours-a-day.

8. Breastfeeding on demand is encouraged.

9. No artificial teats or dummies are offered.

10. The establishment of breastfeeding support groups is fostered and mothers are referred to them on discharge from hospital.

Breastfeeding Centre of WA

The Breastfeeding Centre is located on the ground floor, Agnes Walsh House next to the main hospital building. Help is available if you are experiencing breastfeeding problems. Contact details are on page 15.

The Perron Rotary Express Milk (PREM) BankMothers producing more milk than their own baby requires may want to consider donating their excess milk to the Perron Rotary Express Milk (PREM) Bank located at KEMH.

Human milk is the best food for babies, especially when they are born sick or premature. Giving these babies breast milk helps reduce the number of gastro intestinal infections and supplies special immuno-protective properties to increase their chances of survival for long-term growth and development.

Before accepting milk from donors, we ensure they are healthy by screening them through completing a questionnaire and undertaking a blood test.

The PREM Bank welcomes all enquiries from women who are breastfeeding or planning to breastfeed in the future. For more information visit the website www.kemh.health.wa.gov.au and find the PREM Bank listed under ‘Services’ or call (08) 6458 1563

Formula feedingKEMH promotes and supports breastfeeding as advocated by the Baby Friendly Hospital Initiative.

If you are intending to formula feed your baby, ask the midwives inthe antenatal clinic about what you need to bring with you to hospital.Information will be provided individually to assist you in caring for yourbaby.

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Medical terms that may be used

Amniotic fluid500ml to 1000ml of fluid contained within the membranes (or sac) in which the fetus floats. The fluid acts as a “shock absorber” and enables the fetus to move freely.

Antenatal OR antepartum

Concerned with the care and treatment of the unborn child and of pregnant women.

Caesarean sectionSurgical incision of the walls of the abdomen and uterus for the birth of a baby.

Cardiotocograph OR fetal monitoring OR CTG

Electronic monitoring of the fetal heart rate and maternal contractions printed out onto a graph.

Cervix Neck of the uterus (womb) that can be felt through the vagina.

ContractionsSpasmodic painful tightenings of the uterus that may or may not cause the cervix to open.

DepressionA mood change or lowering of the spirits felt as sadness or melancholy, continuing over a period of time.

Fetus The term used for babies from nine weeks gestation to birth.

FundusThe top of the uterus, part of the womb that is furthest from the cervix or opening.

GestationLength of time from your last menstrual period. The normal gestation of pregnancy is 37 to 42 complete weeks.

Hypertension High blood pressure.

Induction The act of causing or bringing about labour.

Intrapartum During labour.

Labour Regular painful contractions of the uterus that open the cervix.

Membranes Two thin tissues that surround the fetus and amniotic fluid.

OedemaAn excess of fluid causing swelling, usually seen in feet and hands.

Palpation Systematic examination by touch usually of the abdomen.

Pap smearCollection of cells from the cervix that are examined for signs of development of cancer.

Postnatal OR postpartum

After the birth of the baby.

SpeculumAn instrument used to hold open the vagina to allow the cervix to be seen.

Spontaneous labour Labour that starts without artificial assistance.

Other services available at KEMH

Service Phone no.

Aboriginal liaison officer: Available to help Aboriginal women. (08) 6458 2777

Breastfeeding Centre: For help if you are experiencing breastfeeding problems before or after leaving the Hospital. This is via a telephone counseling service or appointment system.

(08) 6458 1844

Continence adviser: Offers advice and assistance for women who may have a ‘weak bladder’ (leaking urine).

(08) 6458 1062

Dietitian: For help with maintaining healthy food choices. (08) 6458 2795

Genetic counsellor (08) 6458 1525

Women and Newborn Health Library A public lending library that provides information on all aspects of women’s health, including pregnancy, childbirth, infant care and parenting.

(08) 6458 1100

1800 651 100

Occupational therapist: Provides assistance with transfer home and care of a newborn for or mothers with disabilities.

(08) 6458 2870

Pastoral Care: Provides help with spiritual and emotional issues, whatever your faith background.

(08) 6458 1036

Physiotherapist: For help with back, pelvic or leg pain in pregnancy Physiotherapy support is also available after your baby is born.

(08) 6458 2790

Psychological Medicine: You will be referred to a psychologist at KEMH if you have had postnatal depression or any depressive or anxiety-related problems in the past or at present.

(08) 6458 1521

Social worker: Contact for help with financial or welfare problems. (08) 6458 2777

Visiting Midwifery Service: A midwife may visit you in your home before or after you have had your baby if necessary.

(08) 6458 1530

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NOTES:

Compiled by: Obstetrics and Gynaecological Clinical Care UnitEmail: ogccu@health.wa.gov.au

Produced by: Women and Newborn Health ServiceWebsite: www.wnhs.health.wa.gov.au

© October 2004 WNHS 0012b Rev 10

Revised June 2015

Disclaimer: The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.

This document can be made available in alternative formats on request for a person with a disability.

WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

374 Bagot Road Subiaco WA 6008

Telephone: (08) 6458 2222