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Understanding the unique healthcare needs of you and your baby during pregnancy.

Maternity Passport

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We are pleased that you have chosen the Seton Family of Hospitals for the birth of your baby. The experienced staff at each location is committed to helping you achieve a memorable birth experience. We offer attentive and personal nursing care, on-going patient education and a family-centered approach. Our maternity services are available at:

· Seton Medical Center Austin · Seton Medical Center Williamson · Seton Northwest Hospital · Seton Southwest Hospital · University Medical Center at Brackenridge

As part of our maternity services, we offer you the expertise of our staff in the OB High Risk Outpatient Case Management Program, and this Passport, your guide to our maternity services. This Passport provides a written introduction to our services and helps to prepare you for your hospital stay. We hope that it answers most of your questions. Please take a moment to complete and return the "Case Management Survey" enclosed. The maternity case managers in this program are eager to assist you with any additional questions or other prenatal needs you may have. The information you provide will be treated with utmost confidentiality. After you read through this Passport book of information, please feel free to call us for questions at the phone numbers listed below. Other important phone numbers for the Seton Family of Hospitals and community services are located in the resource section of this Passport. Thank you again for choosing Seton for the birthplace of your baby. We think you will be pleased with the expert care we give our new parents and babies. We look forward to serving you. Sincerely,

Seton Medical Center Austin OB Outpatient Case Manager.......................................................................................................... (512) 324-1000 ext. 18205 Seton Medical Center Williamson OB Outpatient Case Manager.......................................................................................................... (512) 324-4000 ext. 20911 Seton Northwest Hospital OB Outpatient Case Manager.......................................................................................................... (512) 324-6000 ext. 67302 Seton Southwest Hospital OB Social Worker .............................................................................................................................. (512) 324-9000 ext. 89109

University Medical Center at Brackenridge OB Outpatient Case Manager..........................................................................................(512) 324-7147 or (512) 324-7299

Seton Family of Hospitals OB Social Worker ...........................................................................................(512) 324-7347 or (512) 324-1000 ext. 18205

To help you find your way to Seton's Labor & Delivery · Seton Medical Center Austin · Seton Medical Center Williamson · Seton Northwest Hospital

· Seton Southwest Hospital · University Medical Center at Brackenridge

· Special rooms for special deliveries · Photography and Video Cameras · Visitors · Infant security

· Meals · Classes and tours · Pre-registration with the hospital · Financial concerns

· Checklist for pregnancy · Choosing a doctor for your baby · Choose a car seat early

· Organize your household · Pack a bag for labor and delivery · Birth plans

· Prenatal care · Depression and Mental Health · Healthy eating during pregnancy

· Alcohol use during pregnancy · Street drugs during pregnancy · Smoking when you are pregnant

· Nausea and vomiting · Heartburn · Backache · Increased vaginal discharge · Constipation · Hemorroids

· Leg cramps · Varicose leg veins · Swelling of the feet, hands or ankles · Shortness of breath · Stress and mood swings

· What normal changes will usually happen before labor begins? · How can I tell if I'm having contractions?

· Signs of pre-term labor · Signs of possible complications of pregnancy · Signs of full-term labor

· Circumcision Decision · Layette List

· Arrival to the labor unit · Cesarean section · Labor induction and augmentation · Delivery

· Immediate recovery · Postpartum recovery · Breastfeeding and bottle feeding

· Things to do before you leave the hospital · Vaccinations and well-baby check-ups

· Baby safety at home

· Rest in the early weeks after delivery · Emotional adjustment · Stress reduction for parents · Fatherhood

· Becoming a couple again · Sibling adjustment · Choosing child care

· Single parenting · Teen parenting · Depression and Mental Health · Parenting multiples · Parenting an infant with special needs

· Spiritual support · Bedrest during pregnancy · Family violence and abuse · Budgeting for baby and financial concerns · Support groups

· Before labor begins · Early labor · Active labor

· Transitional labor · Pushing until birth · Ideas for comfort and relaxation during labor

1201 West 38th Street · Austin, TX 78705 · Phone: (512) 324-1000

· IH35 to 381/2 th St. · 38th St. west to Medical Parkway (one block west of Lamar Blvd.) · Medical Parkway south one-half block to SMCA's Emergency/South Entrance

· Mopac to 35th St. exit · 35th St. east (it becomes 38th St. at Jefferson) to Medical Parkway (you will drive past SMCA) · Medical Parkway south one-half block to SMCA's Emergency/South Entrance

Overview of Area Surrounding Seton Medical Center Austin

The maximum daily parking fee in the garage is $9.00 (this price is subject to change). Maternity Services departments are not able to validate parking.

Enter the building through the Emergency Room entrance on the south side of the hospital. If you are admitted to the hospital Monday through Friday between the hours of 6am and 2pm, you should go immediately up to the second floor. Once you are on the second floor, follow the signs to the Labor and Delivery Admissions and Triage area which is on the east end of 2 South. If you are admitted to the hospital outside the hours listed above, proceed immediately to Labor and Delivery Nurses' Station on the second floor. · Be sure to notify your doctor that you are on your way to the hospital. · Be sure to bring your insurance or Medicaid card for check-in.

201 Seton Parkway · Round Rock, TX 78665 · Phone: (512) 324-4000

· IH35 to University Blvd. (Exit 256) · Drive east on University Blvd. (past IKEA) · Turn right into hospital campus and follow signs to Women's Center

· SH130 to Chandler Rd. (Exit 419) and drive west · Chandler turns into University Blvd. · Turn left into hospital campus and follow signs to Women's Center

Seton Williamson has a private, separate entrance into the Women's Center. Free parking is conveniently located on the north side of the hospital. Free parking is also conveniently located outside of the Emergency Department entrance on the south side of the hospital for emergency room visits.

Overview of Area Surrounding Seton Medical Center Williamson

Between 5am and 8pm, enter through the Women's Center. Check in at the front desk with a patient admissions representative. Between 8pm and 5am, enter through the emergency room, where you will be checked in by an admissions representative. Once admitted, you will be escorted to the Women's Center. · Be sure to notify your doctor that you are on your way to the hospital. · Be sure to bring your insurance card or Medicaid card for check-in.

11113 Research Boulevard · Austin, TX 78759 · Phone: (512) 324-6000

· IH35 to Braker Lane, or 183 North · Braker Lane exit · Follow access road to SNW entrance

· Mopac North to 183 North · Braker Lane exit · Follow access road to SNW entrance

Free parking is conveniently located on the northwest side of the building near the Emergency Room entrance. Handicapped parking is located immediately outside the Emergency entrance.

Overview of Area Surrounding Seton Northwest Hospital

Enter Seton Northwest from the Emergency Room entrance on the ground level. Check in at the Emergency Room admitting area. Once admitted, you will be escorted to the second floor where the Labor and Delivery Department is located. · Be sure to notify your doctor that you are on your way to the hospital. · Be sure to bring your insurance or Medicaid card for check-in.

7900 FM 1826 · Austin, TX 78737 · Phone: (512) 324-9000

· · · ·

Travelling South on Mopac Exit Hwy 290 W Take a left at FM 1826 Take a right into the first entrance to go to the front of the building; take a right into the second entrance to go to the Emergency Department

Ample free parking is available in the front and rear of the Hospital.

Overview of Area Surrounding Between the hours of 8 a.m. and 5 p.m., enter the facility from the Seton Southwest Hospital front entrance and check in at the front desk. You will be escorted to the Labor and Delivery Unit. Between the hours of 5 p.m. and 8 a.m., enter the facility from the rear entrance and check in at the Emergency Desk. You will be escorted to the Labor and Delivery Unit.

· Be sure to notify your doctor that you are on your way to the hospital. · Be sure to bring your insurance or Medicaid card for check-in.

601 East 15th Street · Austin, TX 78701 · Phone: (512) 324-7000

· IH35 to 15th Street · 15th Street exit · UMBC is one half block west of IH35 on 15th Street, on the south side of the street

· · · ·

Mopac North to Enfield Enfield exit Enfield becomes 15th Street as you cross downtown Austin UMBC and Parking Garage is on the south side of the street immediately after the traffic light at Red River

Overview of Area Surrounding University Medical Center at Brackenridge

The maximum daily parking fee in the garage is $9.00 (this price is subject to change). Maternity services departments are not able to validate parking. Between the hours of 6a.m. and 9p.m., enter the hospital from the Parking Garage level "4", and take the walkway to the second floor lobby of the hospital. Follow the signs to the Labor and Delivery Unit on the second floor. Check in at the admitting office located to the left just inside the Labor and Delivery Unit. Between the hours of 9 p.m. and 6 a.m., enter the hospital at the emergency entrance on the ground floor from the Parking Garage. (All other hospital doors are locked after 9 p.m.) Check in at the Emergency Room Desk. You will be escorted to the Labor and Delivery Unit. · Be sure to notify your doctor that you are on your way to the hospital. · Be sure to bring your insurance or Medicaid card for check-in.

LDR Delivery Suites -- Comfortable and pleasing surroundings are an important part of the birthing experience in our family-centered units. Each Labor/ Delivery/Recovery (LDR) room is designed with a birthing bed, a cozy recliner or sofa bed for your support person, a television to help pass the time, and a telephone to connect you to your family and friends. A private bathroom with a shower is also conveniently located in every LDR room. The LDR rooms are fully equipped to accommodate women who plan to have a vaginal delivery. Cesarean Delivery Room -- If you require a cesarean delivery, you will be moved from the labor room to a special surgical delivery room. The surgical delivery rooms are conveniently located near the Labor and Delivery unit. Mother/Baby Rooms -- Postpartum Mother/Baby rooms provide more privacy and fewer interruptions from the close medical monitoring that is necessary in Labor and Delivery. A new mother and her support person are able to room-in with baby. Mothers may keep their baby in their room at all times (as long as mother and baby are healthy and have no complications). Each room has a bathroom and telephone with a direct dial phone number to give to family and friends. A color television in each room provides education programming with 24-hour access to instructions for mother and baby care both in English and Spanish. The nurturing staff is available for mother and baby when needed. All of our nurses are trained to attend to all your mother, baby and basic breastfeeding education needs. Lactation Consultants (breastfeeding specialists) are also available to assist with special breastfeeding concerns. Neonatal Intensive Care Unit (NICU) -- The nurseries at Seton Northwest and Seton Williamson are Level II designated. Dell Children's Medical Center of Central Texas, Seton Medical Center Austin and University Medical center at Brackenridge each have a Level III Neonatal Intensive Care Unit to provide extra support for babies who need special care or some extra time to grow before going home. If the need arises, babies born at Seton Northwest or Seton Williamson may be transferred to one of these Level III NICUs. The NICU staff embraces a family-centered approach to care and provides special family visiting hours. The NICU team includes board certified neonatologists and skilled nurses who provide care 24-hours a day. Additional support services include physical, occupational and respiratory therapy, pastoral care, social services and lactation support services. You are welcome to take photos and videos of your newborn baby and family after the baby has been safely welcomed into mother's arms. Camera equipment and photography are not allowed during labor and delivery due to the unpredictability of events that may require a rapid response by the attending healthcare team. Your doctor will be able to give you more information about their preferences in regard to photography. Please respect the privacy of staff and other patients by asking permission before they are included in any photos or videos.

Baby's father and your chosen primary support person(s) are welcome to visit at any time you choose. Siblings may visit with mother and baby in mother's room. (Visitors will be asked to wait in designated waiting areas as hallways must remain open for safety reasons.) General visiting hours are 10 am to 8 pm daily. Visitor's children under the age of 12 are discouraged. (Young children may unknowingly bring childhood diseases to our newborns.) All visitors must wash their hands before handling baby. Getting rest can be a challenge after delivery. It is such an exciting time for family and friends, but it is important for mothers to save plenty of time to learn how to care for themselves and baby before going home. Please let us know if we may be of assistance in helping you to limit your visitors.

Our staff considers the comfort and safety of you and your baby as one of our top priorities. You need to be aware of the important security measures in place to protect your family. All employees wear a photo identification badge.

Only employees with a pink photo identification badge are allowed to handle your baby. Infant footprints are recorded. We use a 4-band identification system. There will be four bands with identical information that will be matched to mother and baby at delivery. One band will be placed on baby's wrist, one on baby's ankle, one on mother's wrist, and one on the wrist of the mother's choice of "significant other". If the fourth band is not used, it will be locked away in a secure place. No one will be allowed to move the baby from the mother's room or the nursery without a matching wrist identification band or bright pink photo identification. Some of the things you can do to ensure your baby's safety and security in the hospital: · Feel free to ask questions. Use your nurse call light if you have any questions about staff, or any situation about which you are unsure. · Do not leave your baby unattended. Call for your nurse if you are going to be away from your baby. · Be sure to have your identification bands checked with the baby's band whenever you have been separated from your baby. · Ask for proper photo identification from anyone entering your room or attending your baby. · Ask for an explanation any time your baby is removed from your room. · Always place your baby in the crib if you want to walk in the hallway with your baby.

out on the classes and tours you want. See our website at www.goodhealth.com/classes for further information or to register. (See resource listings for phone numbers.) · Comprehensive Childbirth and Newborn Care -- 12-hour class A thorough preparation for the labor and birth process. This class includes presentation and practice of Lamaze breathing and relaxation techniques, labor and delivery expectations, medical interventions and baby care basics. Video presentation and qualified instructors offer excellent visual and practical content. · Essentials of Prepared Childbirth -- 7 1/2-hour class A condensed version of our popular childbirth preparation class. This class covers the essentials to prepare you for the hospital Labor and Delivery experience. (Baby care and Breastfeeding are not included!) · Prepared Childbirth Refresher -- 3-hour class This class is for couples that have had a previous childbirth class. It includes a review of the birth process and Lamaze breathing and relaxation skills. · Breastfeeding -- 2 1/2-hour class This class is a must for families who choose to breastfeed and includes practical information to prepare parents for breastfeeding. Dads are strongly encouraged to attend! · Baby Care Basics -- 3 1/4-hour class This class focuses on care of the newborn in the first weeks. It is recommended as additional content for those enrolled in childbirth classes that do not include newborn care. A practical, hands-on approach to newborn care is presented. You will practice newborn bathing, diapering, and daily care using a baby doll. Video and slide presentations are included in the class. · Big Brother/Big Sister -- 1-hour class An opportunity to prepare your other child(ren) for what to expect with a new baby. Includes a minitour of the Maternity Unit. Bring a baby doll or stuffed animal for role-playing and diapering. Age three is a suggested minimum. A parent or adult must accompany the child(ren) in class. · Maternity Tours -- Free A tour of the maternity facilities will introduce you to the physical layout of our maternity unit and the services offered. Your tour guide will answer questions on types of rooms available, parking facilities, visiting hours and where and how to check in and out of the hospital. Maternity tours are recommended for adults only.

Meals are served to postpartum mothers three times a day and brought to your room by a staff member. Snacks are also available for mothers by request. Meals may be restricted according to your doctor's recommendations for laboring mothers and after cesarean section delivery. Family members are welcome to visit the hospital cafeteria or café, or bring food from outside the hospital for themselves. Some families enjoy bringing special food for the new mother (unless she is on a restricted diet).

We have several great classes to help you prepare for your delivery, for baby care and for breastfeeding. Classes tend to fill up quickly, so we recommend that you register for classes early in your third to fourth month of pregnancy and begin attending classes by the sixth month of your pregnancy. We also offer tours of our maternity areas so you will know what to expect when you arrive at a Seton facility. Seton offers classes at various locations for your convenience. Remember to register early to avoid missing

· If you are a young mother covered under your parent's insurance policy you should not assume the policy will cover your baby. Many insurance companies will not pay for the hospital bill, newborn care in the hospital or any immunizations for a grandchild. Some insurance companies may pay for some care for a grandchild, but only if the grandparents are able to claim the grandchild on their income tax, or other very specific reasons. · Please call in plenty of time before the baby is born to find out what the insurance will pay. Call the Member Services department of the insurance company, or the Human Resources department of the workplace that offers the insurance. · Make a note of the phone number(s) you call and the name of the person(s) you speak with. This will help if there is a problem or question in the future. It is very important to pre-register with the hospital well ahead of your due date. We encourage you to register in your third to fourth month of pregnancy. There are two easy ways to pre-register: 1. You can use the enclosed pre-registration form for the hospital that you have chosen, or obtain one from your health care provider's office. Simply complete and mail to the address listed on the form. No confirmation will be sent, but you are welcome to confirm that the hospital received your form by calling the hospital admissions office. 2. You may walkin to your hospital admissions office to pre-register during usual business hours Monday through Friday. Bring a copy of your insurance or Medicaid card. Call your hospital admissions office for business hours and directions. · Ask specific questions like "Will this policy cover the baby's hospital bill at delivery?", "Will it pay for circumcision is we choose to have the baby circumcised?", "Will it pay for the baby's newborn care during the hospital stay?", "Will it pay for the baby's immunizations after baby goes home from the hospital?" · If you have Medicaid or cannot afford health insurance, health care for your baby is also available through the Austin-Travis County Health Department or the Seton Community clinics. Insurance Pre-certification Many insurance companies require pre-certification or pre-approval. It is important that you contact your health insurance company to find out what your maternity benefits are and how to get pre-approved. Your employer may also have information about your benefits. Please note that failure to pre-certify with your insurance company can reduce the insurance payment, leaving you responsible for paying the balance.

Payment Methods Seton has friendly, experienced financial counselors to discuss payment options and cost estimates. Payment for bills, co-payments and deductibles are accepted in cash, check, or credit card (Visa, Mastercard, and American Express). Payment is expected at time of service prior to your hospital discharge. Insurance for Your Baby · Please note that once your baby is born you must call your insurance carrier to add the baby to your policy (usually within 30 days after birth).

There are many things you can do to get ready for your hospital stay and the birth of your baby. Using the following checklist may help you to feel more prepared.

During your 3rd to 4th month of pregnancy Pre-register for the hospital. Register for childbirth and baby care classes. Register for breastfeeding class. Register for a tour of the hospital. Begin your search for a doctor or clinic for your baby. During your 5th to 6th month of pregnancy Make a decision about circumcision if you have a boy. Choose a car seat and learn how to use it safely. Learn about options for pain management in labor. Register for a sibling class. Make a final choice for baby's doctor or clinic. At least a month before your due date Organize your household. Arrange for help with household chores and for help after the baby comes. Pack a bag for mom. Pack a bag for baby. Safely secure the car seat into your car. If you plan to return to work or school, begin your search for child-care. Make sure your baby's doctor's office knows about your choice of doctor for your baby.

· Fees -- What type of insurance does the office take? Does the doctor see babies with Medicaid insurance? How much does a routine well-baby check-up cost? How much for baby's shots? Does the doctor charge for talking with you on the phone? · Office staff -- Are the people answering the phone friendly, courteous, and helpful? Are telephone nurses available to answer basic questions and concerns? · Other -- What other services does the office provide (x-ray, laboratory, breast-feeding counselors, etc)? What are the doctor's views on issues that are important to you (breastfeeding, circumcision, childcare, etc.)? Is the office calm or rushed? Are there separate waiting areas for sick and well children? If possible, schedule an interview with the doctor(s) on your final list. Please note that some doctors may choose not to participate in an interview, and some may require a fee for the interview. Ask yourself these questions after the interview. · Did the doctor seem interested in talking to you? Friendly and comfortable with your questions? · Did you feel comfortable asking the doctor questions? Did the doctor have the same views on breastfeeding, circumcision, childcare etc? By choosing the right doctor early, you and your family should be off to a healthy start and may avoid delays during your hospital stay!

It is important to choose your baby's doctor or clinic as soon as possible. Do not wait until you deliver. To begin your search for a doctor for your baby: · Ask for a list of pediatricians or family practice doctors from your health insurance company. · Ask your friends, family, co-workers, and your health care provider for a recommendation. · Call the Seton Physician Referral service or visit the website at www.seton.net. · If you have Medicaid and are having trouble finding a doctor for your baby please call the number listed on your Medicaid letter. Factors to consider: · Location -- Do you want a doctor/clinic who is closer to your home, your office, or your day care provider? Will the doctor see your baby in the hospital you have chosen for delivery? Which local hospital does the doctor visit to see ill babies? · Hours -- When is the doctor's office/clinic open? Who can you call and what happens if your baby becomes ill when the office is closed?

There are many styles to choose from, but the most important thing is to choose a car seat that is safe and that you know how to use correctly. Call SafeKids Austin for information on car seat inspection programs (324-8009). · Register for a car seat safety education class. Practice using the seat by buckling a teddy bear or doll into it. Be sure that both you and your partner know how to use the car seat correctly. · Follow the manufacturer instruction's carefully. · Learn how to use a locking clip to safely secure the car seat if you have seatbelts with a shoulder restraint. · Make a note to bring the car seat, base if available, locking clip, and instructions to the hospital on the day you go home. · If you cannot afford a car seat for your baby, you may qualify for assistance through Safe Riders. Call 1-800-252-8255 for more information.

Four to six weeks before your due date is a good time to stock up on household goods and foods that won't spoil. Make double portions and wrap the extra portion to freeze so that you won't have to cook as much in the busy days after your baby's birth. If you have other children, arrange childcare and meals for them. Your other children are not allowed in the hospital without an additional friend or family member to care for them. It is helpful to write down important phone numbers, a schedule of naps and bedtimes, and school or day care plans so that your baby-sitter has the most up-to-date information. Family and friends are always anxious to know how they can help after the baby has arrived. The help you need will be mainly cooking and cleaning and having someone to "mother" you.

For your suitcase for labor This "Passport" booklet of information (especially the "Labor Notes" for your coach located in the back of the booklet) Lip balm for dry lips (breathing techniques dry the lips) Toothbrush and toothpaste Contact lens case, solution, and eyeglasses Slippers and socks for cold feet (almost everyone has cold feet in labor!) Hairbrush, hair band and clips for long hair Focal point (if you have taken a prepared childbirth class you may have learned how helpful it may be to have a picture or stuffed animal to focus on during contractions) Two large pillows (no plain white cases please -- they get mixed up with ours!) For your suitcase for the rest of your stay We suggest the following in a separate bag: Robe, slippers and nightgown 1-2 bras (nursing bras without under wires if you plan to breastfeed) Extra panties (one pair of mesh panties will be provided) Toiletries, shampoo, cosmetics Baby book Telephone list and calling card Camera with extra batteries and film Baby clothes and blanket for going home (be sure to wash items first) Going home clothes for you--loose fitting is best Make sure to bring your car seat on the day baby goes home!

There are several things you can bring with you to the labor room that may make you more comfortable. Please do not bring any valuables or jewelry to the hospital. We suggest the following necessities:

L Learn as much as you can about options you may have during l labor. We suggest classes or books on pregnancy and labor t to help you with decisions about some of these options. It i is important to discuss options with your doctor or clinic p provider. Remember that the availability of some of the o options depends on your physical health and how the baby i is tolerating labor. R Relaxation Techniques for Labor T The ability to relax during labor may not only help you to f feel better, it may shorten the length of labor and help you t to avoid complications. Learning about ways that may help y you to relax will help you to cope with the discomfort of l labor. A copy of "Labor Notes" is provided in this Passport f for you to study and use as a reminder during labor. "Labor N Notes" is a list of helpful hints for you and your coach that m may help you to relax and stay more comfortable during l labor. Prepared childbirth classes offer instruction in b breathing and relaxation techniques and are highly r recommended.

Pain Management During Labor The choice of anesthesia or pain medication is based on your needs and wishes, and the judgment of the doctor attending your delivery. Many women labor without anesthesia and instead choose to take medication or use relaxation techniques. Anesthesia means "absence of sensation". Epidural or spinal anesthesia is sometimes used in labor to produce a loss of sensation extending from the waist to the toes. Please note that there are additional charges for anesthesia. Please ask your doctor or clinic for more information about anesthesia and medication choices, risks, and benefits. Coach Options/Doulas You may be able to have more than one coach (support person) in your labor room if your doctor approves. Only one coach is usually allowed to go to the surgical delivery area with you if you need to be transferred from a Labor/Delivery Recovery Room (LDR).

case problems develop. If you are currently being treated for depression or other mental health conditions, your treatment may need to be adjusted during pregnancy. Do not hesitate to talk to your health care providers about any concerns you may have. It is not unusual to develop mixed feelings or resentments during pregnancy or while adjusting to life with a new baby. However, if you develop symptoms of depression you should report them to your doctor. Symptoms include significant changes in anxiety, guilt, mood, appetite, sleep patterns, and ability to concentrate. Crying spells and irritability are common, but should lessen within 2 weeks following delivery. Lack of sleep/extreme exhaustion has been linked to more serious symptoms of postpartum depressions, so you should allow others to help with household chores and care of children whenever possible. At any time, if you develop thoughts of harming yourself or your baby, seek medical attention immediately. The Austin area 24-Hour Crisis hotline is 472-HELP (4357).

Early and regular prenatal care is important to make sure you have a healthy baby. If you do not have insurance or cannot afford private prenatal care, there are many clinics that provide prenatal care at a lower cost. Regular check-ups by your doctor or health care provider will measure your baby's growth, and detect complications of pregnancy such as high blood pressure and preterm labor. Prenatal care should begin as soon as you learn that you are pregnant. Contact the Austin/Travis County Health Department Primary Care Division if you need a referral to one of these low cost clinics.

Pregnancy is a time of major change that affects both your body and your mind. Many of the physical and hormonal changes of pregnancy can affect your mental well-being. Risk factors for developing depression during pregnancy and postpartum include: · a family or personal history of depression, bipolar disorder or other psychiatric diagnoses, · stressful life events (such as death of a loved one, separation, or divorce) · history of physical or sexual abuse · lack of marital or social support If you have a history of depression, or other mental health conditions, your health care provider needs to be aware in

During pregnancy, your body needs extra calories, protein, vitamins, and minerals to feed your growing baby. A diet based on the food guide pyramid can help you meet these needs. Try to eat the recommended daily servings from each food group. It is up to you to make healthy food choices for you and your growing baby.

pounds in the first 3 months and about 3/4 to 1 pound per week after that. Pregnancy is not the time to lose weight, even if you are overweight. A pregnant woman needs about 300 extra calories a day, approximately the same number of calories supplied by 21/2 cups of skim milk, or a bagel with cream cheese, or a tuna sandwich. Some expectant mothers may be tempted to "eat for two," or double the amount they normally eat. This is likely to result in excessive weight gain.

It is important to take only the vitamins or minerals prescribed and no more. Large doses may be harmful. Never take any medication, including herbal remedies, without consulting with your doctor. Your body's need for certain nutrients greatly increases during pregnancy. In addition to taking your vitamin, make sure you are getting plenty of:

Breads, Cereal, Rice and Pasta Group Fruit Vegetable Meat, Poultry, Fish, Dry Beans, Eggs, and Nuts* Milk, Yogurt, and Cheese Fats and Sweets Alcohol

6-11 servings 2-4 servings 3-5 servings 3-4 servings

red meat, dried beans, peanut butter, dried fruits, broccoli, peas green leafy vegetables, fortified cereals and grains, black-eyed peas, brussels sprouts, asparagus, cabbage, kidney beans milk products, yogurt, collard greens, kale, mustard greens

3-4 servings Use sparingly Avoid

Visit www.mypyramid.gov for more information *Pregnant teens may need even more protein

Remember to drink at least 6 to 8 glasses of liquids (mostly water) each day. Drinking plenty of fluids will help to reduce the risk of preterm labor.

A special concern during pregnancy is foods that may be contaminated by harmful bacteria, such as Listeria, which can cause serious illness. To prevent infection, do not eat: · Hot dogs, luncheon meats, or deli meats unless they are reheated to steaming hot · Soft cheeses such as feta, Brie, Cambert, blue-veined cheeses, and Mexican-style cheeses such as "queso blanco fresco." Hard cheeses, semi-soft cheese such as mozzarella, processed cheeses, cream cheese, and cottage cheese are safe to eat. · Refrigerated pate or meat spreads. Canned products can be eaten. · Refrigerated smoked seafood, most often labeled as "nova-style," "lox," "kippered," "smoked" or "jerky". · Raw (unpasteurized) milk or juice, or foods that contain them.

The Women Infant and Children (WIC) program assists low-income pregnant or breastfeeding women and children under age 5. They offer classes on healthy eating, coupons for nutritious food,breastfeeding education and support, free immunizations for children, and assistance with contacting other health services. Call 800-942-3678 for more information.

The average weight gain during pregnancy for a normal weight female is 25 to 35 pounds. You should gain 1 to 3

Mercury Contamination: Some fish have harmful amounts of mercury, which can harm the developing brain and nervous system of your growing baby: · Do not eat shark, swordfish, king mackerel or tilefish · Limit consumption of freshwater fish caught by family and friends to one meal per week. You may safely eat 12 ounces per week of other types of fish. Choose a variety from shellfish, canned fish, smaller ocean fish, and farm-raised fish. Artificial Sweeteners: Use artificial sweeteners such as aspartame Sucralose and saccharine (more commonly known as Equal, NutraSweet, Splenda or Sweet-N-Low) in moderation.

If you smoke, your baby will not get all the food and oxygen needed to grow properly. When you smoke: · Your blood vessels carry oxygen and food to your baby. Nicotine from cigarettes makes these blood vessels smaller. Smaller blood vessels means there is less blood and oxygen getting to your baby. · The carbon monoxide in cigarettes is a poisonous gas. Carbon monoxide replaces some of the oxygen in your blood and keeps your baby from getting all the oxygen. Smoking when you are pregnant can cause the following: · Low birth weight · Baby born too early to survive · Baby born early and with many health problems The sooner you quit smoking, the better your chances are for a healthy, normal weight baby. Babies in the same room as a smoker breathe in second hand smoke. This smoke is filled with more tar, nicotine, and poisonous gases than the smoke inhaled by the smoker. Babies exposed to second hand smoke may have: · more illness · more risk for Sudden Infant Death Syndrome (SIDS)

Discuss your nutritional concerns with your doctor, especially if you are having trouble eating, taking your prenatal vitamin, gaining weight too fast, or are experiencing cravings for non-food items. You may want to talk to your doctor about a referral to a dietician if needed.

Alcohol easily crosses into the placenta during pregnancy and goes into your baby's bloodstream. Drinking alcohol (beer, wine, wine coolers, liquor, most cough syrups, and some medications) can cause birth defects in your baby. These birth defects include physical, mental and behavioral abnormalities known as Fetal Alcohol Syndrome (FAS). Babies with Fetal Alcohol Syndrome may have: · small heads and malformed facial features · abnormal arms or legs · heart defects · poor muscle coordination · mental retardation · hyperactivity, nervousness, and short attention spans Do not drink while you are pregnant. There is no known level of alcohol that is considered safe during pregnancy.

Marijuana, cocaine, heroin, and other street drugs damage growing babies. Babies who are exposed to one or more of these drugs while their mother is pregnant may have: · low birth weight · tremors and jitteriness after birth · a high-pitched cry · serious medical problems requiring intensive care · retarded growth · problems with vision and muscle coordination · permanent learning disabilities

· Eat smaller meals and eat more often. Morning sickness is worse if your tummy gets empty. · Avoid foods that trigger nausea and foods with strong smells. Also avoid smoking and alcohol. · Morning sickness is usually gone by the 3rd month of pregnancy. · Never take any medication or herbs for morning sickness without talking to your doctor or clinic first.

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Eat smaller meals and eat more often. Avoid high-fat or greasy foods, and foods that are spicy. Avoid caffeine and beverages that are carbonated. Try not to eat at bedtime. If you have heartburn at bed time, try sleeping in a more upright position (propped on pillows) and sleep on your side. · Wear loose, comfortable clothing. · Never take medicine for heartburn without asking for your doctor or provider's approval.

· Wear comfortable, supportive shoes. · Avoid standing or sitting for long periods of time. · When you are walking or standing, tilt your lower pelvis forward to help prevent "swayback". · Try wearing an abdominal support made especially for pregnancy. · Report unresolved backache to your healthcare provider. Backache may indicate pre-term labor.

Calcium and phosphorus are two minerals that should be present in about equal amounts in your body during pregnancy. Too much phosphorus (from too many soft drinks) or not enough calcium can cause leg cramps. To avoid leg cramps: · Eat more calcium-rich foods (milk, cheese, yogurt, dark green leafy vegetables, and corn tortillas). · Avoid soft drinks. · If there is severe pain in back of your lower leg that lasts for more than a few minutes, be sure to call your doctor or clinic. (Call the emergency number given by your doctor's office or clinic if it is closed).

· Avoid sitting or standing for long periods of time. · Elevate your feet and legs when possible (avoid pressure behind the knee). · Ask your nurse or doctor about wearing support hose. · Mild exercise such as walking may also help.

· Wash more often with mild bath soap. · Do not douche as this may cause an infection. Notify your doctor or clinic if the discharge smells bad or if it doesn't go away.

· Eat high fiber foods: fruits (prunes and raisins) and whole grain breads and cereals. · Drink 6-8 glasses of fluids each day (water, juice or milk). · If your doctor allows it, get plenty of exercise such as walking. · Never take a medication for constipation without asking your doctor or clinic first.

· Elevate legs when possible. · Avoid salty foods. Drink plenty of fluids. · If you also have a severe headache, which does not go away, or if you are seeing spots, call your doctor or clinic immediately. (Call the emergency number given by your doctor's office or clinic if it is closed.)

· In late pregnancy, use a few extra pillows under your head and upper back when you are sleeping to avoid being short of breath. · If shortness of breath is sudden or severe, notify your clinic or call the hospital immediately.

· Get plenty of rest. · Talk with your family and friends about how you are feeling. · Ask for and accept help whenever you need it. Take breaks whenever you feel tired. When in doubt, call your doctor's office or clinic.

· Avoid constipation. · Try gauze pads soaked in witch-hazel to reduce burning and itching. · Never take any medicine for hemorrhoids without your doctor or clinic's approval.

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You baby may drop lower into the pelvis. You may lose 1-3 pounds. You may need to urinate more often. You may have a burst of energy. You may have several painless "practice" contractions each day (Braxton-Hicks). · You may have slightly more vaginal discharge.

A contraction is a tightening of the uterus or womb. Contractions help your baby to be born. When you have contractions, it might feel like: · Your tummy gets tight and hard. · You may have pain in your lower back that comes and goes. · You may have cramping in your vaginal area like you are going to start your period. · You may have pelvic pressure like the baby is pushing down.

What to do for symptoms of pre-term labor: · Lie down on your left side for one hour · Drink 4 to 5 cups of caffeine-free fluid during that hour · Feel your abdomen for contractions and check for other signs of pre-term labor (see above) · If you have four or more contractions in 1 hour or any of the other warning signs after rest and drinking fluid, call your clinic or doctor. Do not wait any longer than one hour for the symptoms to go away. You need to go to the hospital for treatment to stop pre-term labor.

Call your doctor immediately if you have any of these symptoms: (Labor 3 weeks or more before your due date) · Uterine contractions (often painless); 4 or more in an hour · Menstrual-like cramps (may be constant or they may come and go) · Dull lower backache (lower back pain that may move to the sides or front and does not go away when you change positions) · Pelvic pressure (may be mild or may feel like the baby is going to fall out) · Stomach cramps (like gas pains, with or without diarrhea) · Increase in vaginal discharge (may become pink or brown, mucousy or watery) · Bleeding (small amount; if large amount call 911) Pre-Term Labor Because the warning signs of pre-term labor may not be painful, check yourself every day for contractions. Twice a day for 30 minute periods lie down on your left side and place both of your hands on your abdomen. If your uterus is contracting, you will feel your entire abdomen get hard or tight and relax or soften. Note the time each contraction starts, how long it lasts, and when the next tightening occurs. Check for any of the other warning signs of preterm labor every day.

· Pre-term labor signs (see above). · Headache, which doesn't go away (especially if severe or if you also have nausea or blurred vision, or are seeing spots) or lots of swelling in your face, hands or feet. · Leaking of fluid from the vagina (regardless of the amount). Note color and smell. · Vomiting and/or prolonged diarrhea (can cause dehydration and preterm delivery). · Pain or burning on urination, chills, or fever greater than l00 degrees F (38 C). · Dizziness or chest pain. · Baby is moving less than usual. · Any bleeding or spotting from the vagina (may be brown, pink, or red; if blood is red and large amount, call 911.) · Any fall or injury to your abdomen.

· Contractions that are 5 minutes apart for an hour, and do not go away with rest. (If this is not your first baby, or if you have had fast labors in the past, call when contractions are 10 minutes apart). · Any amount of watery fluid leaking from the vagina. · Bleeding from the vagina. Also call if you have a feeling that something is just not right.

Muscles of the utrus tighten and relax. True Labor · Contractions occur at regular intervals, last 30 to 60 seconds. · Contractions get gradually closer together and stronger. · Contractions may be felt in your back and lower abdomen. · Contractions continue or increase with walking. · There is increasing discomfort. · Your cervix softens, shortens and dilates. False Labor · Contractions usually not regular. · Contractions do not get closer together; may stop after an hour or so. · Contractions not usually felt in your back. · Contractions stop with walking. · Discomfort does not increase. · Your cervix does not change. What To Do If you think you are in labor: · Rest, if possible, or your side · Time your contractions with a watch. (If one contraction starts at 9:10 and the next starts at 9:16, then they are 6 minutes apart) · Eat or drink only light foods · Come to the hospital when your contractions are 5 to 6 minutes apart (or if you have symptoms of preterm labor or you are instructed to by your healthcare provider)

Pink slightly bloody or mycous discharge from vagina. True Labor · Show is present in small to moderate amount due to cervical changes. False Labor · Show is not present. What To Do · Tell your doctor or clinic. · Wear a pad if you wish.

A trickle or gush of fluid f r om the vagina after the sac around the baby breaks; the fluid is usually clear, but may be green or white. True Labor · Bag of waters may break before you feel any contractions. · Fluid usually continues to leak, especially during a contraction, which may become stronger. False Labor · Bag of waters does not break What To Do · If you think your water has broken, call your doctor or healthcare provider right away and go to the hospital. · Do not take a bath or put anything into your vagina. · Wear a pad, if necessary, until you arrive at the hospital.

In addition to choosing a doctor for your baby, there are other important things you can do during your pregnancy to prepare for your baby. Baby care and feeding classes are offered by Seton and may also be offered through your doctor's office or clinic. Now is the time to begin "childproofing" your home and planning for car safety. We recommend that all parents take a yearly cardiopulmonary resuscitation (CPR) class. To find a CPR class, call the American Heart Association CPR referral line or check the class schedule on-line at www.seton.net. The following information may help you make the decisions and other arrangements you will need to make to get ready for baby. Clothing: 4-6 t-shirts 4-6 sleepers or nightgowns socks or booties hat or bonnet (warm for winter, shade for sun) winter suit sweater or jacket Diaper Supplies: diaper wipes or 1 dozen small washcloths diaper ointment (optional for diaper rash) For Cloth: 3-4 dozen cloth diapers (newborn size) diaper liners (optional) 2-4 waterproof pants 4-6 diaper pins or clips diaper pail For Disposable: 80-100 diapers a week Bedding: 2-4 crib or bassinet sheets 2 waterproof crib pads (optional) 2-4 receiving blankets or crib quilts crib bumper pads Bath Supplies: towels (hooded optional) 2-4 baby washcloths mild baby soap and shampoo baby bath tub or sponge (optional) brush and comb baby nail clippers and scissors (optional)

If you have a baby boy you will need to decide whether or not to have him circumcised. Circumcision is a surgical procedure in which the foreskin covering the end of the penis is removed. The decision whether or not to circumcise is a very personal one. Discuss the risks and benefits with your doctor or provider so that you may make an informed decision. · Insurance does not usually cover the cost of circumcision. There will be a separate fee for circumcision from the hospital and the doctor. · Pain medication is recommended by the American Academy of Pediatrics. Ask your baby's doctor for more information.

The following layette list may be helpful in planning for your baby's arrival. These are suggested items and you may not need all items. Check consignment stores and yard sales for affordable baby items, but be careful that everything (especially car seats, playpens, and cribs) meets current safety standards before you buy. Crib or play pen bars should be no farther apart than 2 3/8 inches. Many playpens, car seats, and other baby items have been recalled by the manufacturer due to safety issues, but are still in use because people missed the notification. Check with the U.S. Consumer Product Safety Commission (CPSC) Recall Hotline to find out if a baby product has been recalled.

Bottle Feeding Supplies (optional): 8-10 bottles with caps and nipples bottle brush disposable liners (optional) measuring cups, can opener and large container to mix formula Outings: stroller front carrier or sling (optional) diaper bag car seat and locking clip Health and Safety: infant thermometer electrical outlet covers nursery monitor infant safety gate Other Optional Items: baby book and First Year calendar birth announcements camera and film

Consent Forms Upon admission to the labor unit you will be asked to read and sign the following consent forms: · Admission and treatment · Vaginal and/or cesarean delivery (although most women are expected to deliver vaginally, sometimes the medical condition of the mother or baby require a cesarean delivery) · Blood transfusion (in the unlikely event that it becomes necessary) · HIV testing (as required by Texas law) · HIPPA-Health Insurance Portability and Accountability Act Notification of The Baby's Doctor You will be expected to name your baby's doctor so the staff can notify the doctor after the baby is born. If your chosen doctor does not admit babies to the hospital where you deliver, a doctor will be assigned to your baby during your baby's stay and you will follow up with your chosen doctor after discharge. L Labor N Nursing care and procedures to expect: · Your nurse will ask questions about your pregnancy and check the vital signs of you and your baby. · You will be asked to sign consent forms for admission, treatment and both a vaginal or surgical (cesarean section) delivery. · Your blood will be drawn and you will be asked for a urine sample for routine lab tests. · An IV (intravenous fluid line) may be started. · You may be allowed to walk in the halls and shower (as long and you and baby are progressing without problems) · Your contractions will be monitored (either intermittently or continuously by electronic monitor) to make sure you are progressing without problems. · Your cervix will be checked periodically by the nurse or doctor. · Your vital signs, and your baby's heart-rate, will be monitored (intermittently or continuously as needed). · Your contractions may get longer and stronger as the time for delivery nears. · Labor is a natural process that can be painful. The maternity staff believes that managing your pain is an important part of your care. To help us manage your pain we will ask questions and have you rate your pain on a scale from zero (no pain) to ten (the worst pain you

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have had). Breathing and relaxation techniques, massage, showers, rocking, and frequent position changes are some of the choices you have for coping with labor pain. You may also choose an epidural, or medicine in your IV to help with the pain. If you choose an epidural for vaginal delivery, you will first receive a bag of IV fluid and will need to have your bladder emptied periodically by catheter. The length of each person's labor is very individual to that person's history and unique circumstances. An average length of labor to expect is 12 to 24 hours. When your cervix is fully dilated (10 centimeters), you will be asked to begin pushing with each contraction. Pushing may last as short a time period as 5 minutes or as long as 3 hours. Your chosen "significant other" will be allowed to stay with you during labor and delivery, or cesarean section. (Exceptions are when an epidural or spinal anesthesia is being inserted, during delivery with general anesthesia, or at the discretion of hospital staff when unexpected circumstances arise. Your significant other will be asked to wait outside during these times.)

When the time comes for you to enter the hospital to deliver your baby, you will be faced with some choices concerning whether or not to have anesthesia, and if so, what type of anesthesia. You will need to make rational choices about your anesthesia and to understand the decisions made by your obstetrician and anesthesiologist. If you desire or need anesthesia while having your baby at a Seton hospital, it will most likely be administered by a physician from Capitol Anesthesiology Association. If you have a question and would like to talk to a nurse in the anesthesia department, you can call 324-1153. The choice of anesthesia is based on your needs and wishes, the needs of your obstetrician, and the judgment of your anesthesiologist. Our main concern is the safety of you and your baby. The most common types of obstetrical anesthesia delivered by Capitol Anesthesiology are epidural and general anesthesia. Epidural Anesthesia Epidural anesthesia is the most frequently used form of obstetrical anesthesia because it may be used during labor, and then extended for vaginal delivery or Cesarean surgery. A medication is placed in the epidural space by an injection. The epidural space is an area on your back between the tough ligament that connects the vertebra and the lining of the spinal canal, the dura. Epidural anesthesia may be used for relief of labor discomfort or as the complete anesthestic for a Cesarean section.

To receive epidural anesthesia, you will be asked to roll into a tight ball and to arch your back outward. The more effective you are in this maneuver, the easier it is for us to administer the anesthesia. A local anesthetic, or numbing medicine, will be injected into the area where the epidural is to be placed. A larger needle will then be used to access the epidural space. There may be some discomfort during this part of the procedure, but it is generally mild. Once the needle is in place, a small plastic tube or catheter is threaded through the needle and into the epidural space. The needle is then removed and you will receive medicine through the small tube. If the epidural is for management of pain during labor, we will inject the medication into the epidural space once the labor is progressing well. Your blood pressure and the progress of your labor will be monitored closely while the anesthestic is administered. Generally, the epidural takes 10 to 15 minutes to take full effect. If the epidural anesthesia is for a Cesarean section, you will receive oxygen as part of the routine care. During the Cesarean section we will continue to monitor your vital signs closely. During surgery you will be aware of the movement of your body and the pressure on your abdomen as the baby is delivered, but you should be comfortable during the Cesarean surgery. If you, your obstetrician, and your anesthesiologist concur, your epidural pain relief may be extended to the postoperative period by injecting morphine into the epidural space. This highly purified morphine will be administered through the catheter just before it is removed after surgery.

blood stream. On rare occasions a numbness or tingling in one leg may persist after the anesthestic wears off. Levels of anesthesia which are high can occur and may require some assistance in breathing until the anesthestic dissipates. Another problem which can arise is an incomplete or unsuccessful block. In this case, some other form of anesthestic may be required. The successful management of these potential problems requires the anesthesiologist to remain available in the hospital for the full course of the anesthestic. The anesthesiologist will confer with the obstetrician concerning the anesthestic to be administered for each individual patient.

Most women experience good continued pain relief f i d i d i li f for eight to twelve hours after surgery. Although some women experience itching of the skin, most feel that it is a minor discomfort in light of the pain relief they gain from the epidural morphine. The management of this service will result in an additional charge.

General anesthesia will put you "to sleep." It is used for cesarean sections or occasionally for other obstetrical procedures. First, you will be prepared for surgery. When the surgical team is ready, you will be put to sleep by an injection into your vein through the IV. We use a small amount of anesthesia during the beginning of a cesarean section to minimize the amount of drug which the baby receives. Side Effects of General Anesthesia Usually the side effects of general anesthesia are minor and mild. Nausea and vomiting can occur and occasionally require treatment with anti-nausea medications. Some patients experience a sore throat after general anesthesia, but this is usually mild. Risks of General Anethesia Risks of general anesthesia for cesarean sections are similar to those of general anesthesia for other surgeries. Additionally, in pregnant patients it takes longer for the body's normal mechanisms to empty the stomach. Therefore, there is greater risk of vomiting and aspirating gastric contents into the lungs when anesthesia is induced. Because the baby is exposed to the anesthestic agents which are injected into your body to put you to sleep, we use the smallest possible amounts of these drugs. As a result, women occasionally hear loud noises or have vivid dreams during the early part of anesthesia.

In general, epidural anesthesia for labor does not make you totally numb, and occasionally some discomfort continues. Infrequently you may feel a "hot spot", a small spot of discomfort. We can try a number of things to relieve a hot spot. sometimes replacing the epidural catheter is necessary. Occasionally, however these hot spots cannot be helped.Your blood pressure may fall after administration of the anesthetic agent; occasionally some nausea and vomiting may occur. In many instances patients get "the shakes" after receiving an epidural. These are somewhat distracting but rarely uncomfortable. During labor we will supply additional medication through the catheter as you need it. Occasionally labor progresses very fast after the epidural medication is administered. There may not be enough time for you to get adequate pain relief before the baby is born. If labor proceeds rapidly after the epidural is placed, the obstetrician may need to supplement your anesthesia by infiltration of local anesthestic in order to do an episiotomy or to use forceps.

Although epidural anesthesia is a widely accepted form of obstetrical anesthesia, it is not without possible complications. These are uncommon and in general are easily treated. With epidural anesthesia there is a possibility of residual backache and/or spinal headache. Also, rarely a seizure can occur from too rapid absorption of local anesthestic into the

A normal uncomplicated epidural anesthesia has virtually no effect on the newborn infant. As mentioned above, general anesthestics have varying effects on the newborn depending on the duration of exposure. Exposure is usually minimal and the anesthestics do not cause developmental or congenital problems when exposed during delivery. For more information, visit www.capanes.com.

*Information provided by Capitol Anesthesiology Association.

Cesarean delivery is delivery of your baby through an incision or surgical opening in your abdomen. Cesarean section may be needed due to certain conditions of the mother or baby. If you need to have a cesarean delivery your doctor or clinic provider will explain the reason. If you are scheduled for a cesarean section: · Plan to arrive at least 2 hours before your scheduled start time. · You will need to consult with an anesthesiologist to discuss options for anesthesia (preferably before your scheduled date). · Follow your doctor's specific instructions for eating and drinking before surgery. Most doctors specify no food for at least eight hours before surgery. For all cesarean deliveries: · Your abdomen will be washed, and shaved. · A catheter will be inserted to keep your bladder empty. · You will receive an epidural, spinal, or general anesthesia. (Your partner will be asked to wait outside the delivery room if a general anesthesia is used) · You will be in the surgical area for delivery about 1 hour. (The baby is usually delivered in the first 5 to 15 minutes, and the rest of the time is spent closing your uterus and abdomen). · The type of incision you receive will depend on the reason for the cesarean, the position of the baby, position of the placenta, and your doctor's preference. You will most likely receive a "bikini cut" (low, horizontal line across your lower abdomen) unless it is an emergency delivery and a "classic incision" (vertical line between your umbilicus and your lower abdomen) may be faster.

Labor augmentation is use of medication (Pitocin) to improve the progress of your labor. Your doctor may recommend augmentation to increase the strength and frequency of your contractions if your labor is progressing slowly.

As soon as the baby's head is delivered, baby's nose will be suctioned. As soon as your baby's body is fully delivered and appears healthy, your baby will be laid at your breast or dried and wrapped in blankets for warmth. Baby's footprints will be imprinted onto paper, matching identification bands will be placed on mother, baby, and mother's choice of significant other. You will be encouraged to cuddle and feed your baby as soon as possible after delivery.

A labor induction is a procedure that artificially starts labor. Labor may be induced by giving a medication (intravenously or vaginally), or by physical stimulation (stripping or artificial rupture of your membranes by a doctor). Sometimes a pre-induction treatment is required. Your doctor or clinic provider will explain procedures and reasons for induction. If a labor induction is planned for you: · You and your doctor or clinic provider will schedule a start time with the hospital. · You generally are not allowed to have anything to eat or drink after midnight the evening before your scheduled induction. · You should notify your doctor or clinic provider of any changes in your health as soon as possible before your scheduled induction.

(within the first two hours after delivery) Your nurse will continue to check your condition after delivery. · Your nurse will check your blood pressure and other vital signs frequently. · Your abdomen will be massaged periodically to minimize bleeding to make sure your uterus stays firm. · If you delivered vaginally, an ice pack may be applied to your vaginal area to minimize swelling. · Your IV will stay in place for about 1 to 2 hours for a vaginal delivery and usually up to 24 hours for a cesarean section (until your vital signs and bleeding are stable). · Your significant other will be allowed to stay with you during the recovery time, or go to the nursery with the baby if necessary. · Your baby will be weighed, measured, and bathed. · Your baby will be given a Vitamin K shot to aid in blood clotting, and an antibiotic eye ointment to prevent eye infection. · You will be encouraged to breastfeed your baby as soon as possible after delivery. (Babies are generally the most

alert and ready to feed in the first 1 to 2 hours after birth). Your nurse will assist you with positioning and feeding. · Be sure to wait for a nurse or nurse assistant to help you out of bed the first time or two. You will be encouraged to walk in your room as soon as your condition allows (1to 2 hours after vaginal delivery and 8 to 12 hours after cesarean section). Your nurse will let you know when your condition allows you to get out of bed without nurse assistance. · Postpone visitors until after the immediate recovery so that the nurse may monitor you and your baby closely.

You will be asked to sign the following consent forms after the birth of your baby: · Hepatitis B vaccine for your baby · Circumcision (if you plan this choice for your baby boy) It is a good idea to discuss circumcision and vaccinations with your baby's doctor or clinic provider during your pregnancy. If you make the decision before you enter the hospital, you will feel less pressured for time to make your decision before you go home. Routine Baby Care You will enjoy more opportunities to learn basic baby care before you go home while you room in with your baby. The nursing staff is available to provide hands-on assistance. You will be given written instruction to take home as a reference. Take advantage of every opportunity to learn while there are staff members available to answer questions. Your baby's crib will be stocked with all the basic diapering and daily care supplies you will need. Clean blankets and t-shirts are provided for your baby while in the hospital, but are not to be taken home. · The baby's nurse will be monitoring baby's health and vital signs periodically. · Your baby will receive a blood test called "Newborn Metabolic Screen" which is required by law. · Circumcision, if chosen for your baby boy, is usually done on the day you go home. · A newborn hearing screening will be offered for your baby as required by Texas Law. There is a fee for the screen that is generally covered by insurance. · The first Hepatitis B vaccine may be given before baby goes home (depending on the preference of your baby's doctor). Parents Will Be Given Instructions On How To · Change diapers as soon as possible when dirty or wet. Use a soft, clean, warm, wet cloth. Fold the diaper so that it does not cover the umbilical cord. · Clean and care for the circumcision site. · Give a baby bath. · Dress baby in layers for comfort. Babies are usually comfortable dressed as you are, with one extra light layer. (A baby with too much covering may become over heated.) · Place baby on back to sleep. (Crib death most often happens to babies sleeping on their stomach). Do not leave the baby alone without side rails up or in a crib. · Feed baby according to instructions and baby's unique needs. (Please refer to complete instructions for breast and bottle-feeding.) · Keep a record of baby's feedings and diaper changes. · Begin learning when baby needs something, and learning ways to comfort baby (holding, feeding, cuddling, rocking, walking, etc.).

(2 hours or more after delivery) Once you are past the immediate recovery period of 1 to 2 hours, your condition may not require such frequent monitoring by the nurses. You will be transferred to the Mother/ Baby Unit for the rest of your hospital stay. You will be allowed more privacy and time to rest and recover with your new baby and family. The staff is readily available when called to assist you and teach you all you need to know about mother and baby care. This is the time to learn all you can about what you need to know to care for yourself and baby at home. Take advantage of all the available reading materials, television programming, and one-on-one instruction from the staff. Routine Mother Care · Your nurse will periodically monitor your recovery. Your uterus will be checked for firmness, and your vital signs will be monitored. · An ice pack may be used in the first 12 to 24 hours to minimize swelling and discomfort in your vaginal area. · Pain medication is available at your request for any dis comforts. Please don't hesitate to ask for pain medication by pushing your nurse call button. · All new mothers should rinse with warm water each time they go to the bathroom for up to 6 weeks after delivery. This rinses away germs and vaginal discharge. A plastic squeeze bottle is provided for this purpose. · A sitz bath (warm water soak) and TUCKS® (witch hazel pads) are available to soothe and cleanse your episiotomy stitches or hemorrhoids. · If you had a cesarean section, bandage changes will be necessary after showering. If your incision was closed with staples, the staples may be removed by your nurse or doctor before you go home, or in the doctor's office at your first visit. · Expect to stay in the hospital 24 to 48 hours after the baby is born by vaginal delivery, and 3 to 4 days by cesarean section.

· Use a bulb syringe and how to position your baby in case of choking or congestion. · Use a thermometer to check baby's temperature. · Recognize common signs of illness in a baby (jaundice, fever, rash, vomiting, diarrhea, dehydration etc.). · Recognize baby's cries and signals (cold, hungry, wet, tired, bored, uncomfortable, etc.). · Comfort and calm your baby as needed. · Recognize when baby will need vaccinations and checkups.

· Don't use a pacifier to delay a feeding when baby is showing hunger cues. Feed baby as soon and as often as baby asks. Baby Hunger Cues Hungry babies will: · bring their hands to their mouth and suck on fingers or fist. · begin to fidget, fuss, or make faces. · begin "rooting" or searching (baby will turn his head when he thinks food is near or when you touch baby's cheek). · cry (this is a late sign of hunger). It is best to look for cues and feed baby before crying begins.

Breast milk is perfectly designed for growing human babies. The American Academy of Pediatrics recommends breast milk the entire first year of your baby's life. Breast milk is the only food your baby needs the first 4 to 6 months of life. One of the best things you can do to prepare for baby is take a breastfeeding class. Seton offers excellent classes. You may also find out more about breast-feeding by attending the free "First Friday Film Fest" offered by Seton, or searching the library or bookstores for current books. The Women, Infant, and Children's Program (WIC) is a free program offered by the Texas Department of Health. The WIC program provides free breastfeeding education and food vouchers for pregnant and breastfeeding women that are Medicaid eligible and enrolled in their WIC program. Breastfeeding Facts - For babies: · helps babies grow · helps to reduce the chances of allergies and infections · promotes straighter teeth, proper development of facial bones and helps to prevent speech problems · protects against cancer and diabetes · may protect against crib death (SIDS) · provides a ready supply of the most easily digested milk · less chance of over-feeding · promotes brain development · reduces incidence of obesity in children For mother: · releases calming "mothering" hormones · protects against breast and cervical cancer · helps uterus get back to pre-pregnancy size and shape · allows mother to miss fewer days of work due to baby's illness · eliminates time spent preparing bottles · no cost involved · reduces incidence of diabetes

No matter which feeding method you choose, feeding time is a great opportunity to get to know your baby. The first few days after your baby's birth is a time for you and your baby to get to know each other. Because newborns can't talk, you will begin to learn your baby's language by reading your baby's cues. Baby feeding and hunger cues are some of the most important things to learn. By learning your baby's cues and responding quickly to them, you are teaching your baby to trust that his needs will be met in the world. You cannot spoil a newborn. Studies show that when a baby's needs are met quickly, the baby will cry less and be happier in general. · Baby will enjoy being held, and skin-to-skin contact has been proven to help mother and baby bond more quickly. · Rooming-in at the hospital will help you to learn your baby's cues more quickly. · Hold baby facing you in a comfortable position during feeding. Use pillows to support the baby's weight. Skin to skin contact is very helpful in getting baby ready to feed, and for warming baby. · Never prop a bottle. (Propping a bottle may increase the possibility of choking, ear infections and dental caries.) Interacting with your baby during feeding is important to your baby's development. · Learn how to tell when the baby is satisfied. Let baby tell you when the feeding is finished. Don't try to feed more than baby wants from a bottle.

Breastfeeding Myths You may hear a lot of conflicting information from wellmeaning friends and family about breastfeeding. Much of this information is not actually true, it is a myth. Ask your doctor or a breastfeeding specialist if you have questions about being able to breastfeed. Combining Breastfeeding with Work or School Many mothers are able to combine going to work (or school) with breastfeeding. Most mothers say it is well worth the time and energy. The baby receives all the health benefits, and mothers miss less work due to a sick baby. Mothers enjoy the extra time to be close and provide the unique gift of breast milk. Compare the cost of formula for a year to the cost of buying or renting a breast pump for a year. You can choose from several ways to handle feedings while you are away from baby. · You can provide all breast milk. This will usually require pumping 3 times per day if the baby is 6 weeks old, or 2 to 3 times per day if the baby is 3 months old. · You can provide some breast milk and some formula. If you can only pump once a day at work, this may be a good choice. · Your baby can receive all formula while you are away, and you can continue to breast feed during your time together.

(not true):

· You can arrange to see your baby to nurse for one or more feedings during work hours, and either provide pumped milk or formula the rest of the time. Tips for Nursing Mothers in the First Few Days · Nurse as soon as possible after birth, within 2 hours if possible. · It is okay to put the baby to the breast as often as the baby wants and as long as he/she wants. It is not necessary to limit frequency or length of feedings. Frequent feedings help keep the baby's blood sugar stable, lessen weight loss, and help the baby have less jaundice. · Let baby finish the first breast first. When baby is done you may offer the other breast. Allow your baby to come off the breast by himself when he is ready. Baby should be sleepy and content. · Your early milk, called colostrum, is very good for your baby. It is produced by the 16th week of your pregnancy and continues to be produced until about 10 days after birth. You will not feel it, but your baby will get the colostrum by suckling. · New babies usually have their nights and days mixed up, and may be very fussy at night. This does not mean you do not have enough milk. Feel free to nurse your baby often at night and to put the baby in skin-to-skin contact on your chest after feedings.

I heard that breastfeeding hurts.

You may feel some tenderness or strong tugging in the first seconds as the baby latches on. Breastfeeding should not hurt. If it is hurting, it is probably because the baby is not latched on correctly. If it hurts, ask for help right away to find out how to correct the problem. It is very rare that food mother eats will affect the baby. You should start off eating what you like, eat a well balanced diet and continue to take your prenatal vitamins while breastfeeding. If foods you are eating seem to bother your baby (rash, excessive fussiness or gas), call a breastfeeding specialist for help. There is no proof that breastfeeding changes the shape of your breasts. Your breasts may swell and fill with milk, but the initial fullness will soon go away. Pregnancy may cause some changes in the shape of your breasts, as does aging and gravity. Your body takes nutrients from all the foods you eat and drink to make breast milk. You do not need to drink milk to make breast milk. A good rule to follow is to drink when you are thirsty and eat nutritious foods when you are hungry. If you choose not to drink milk, ask your doctor about other ways to get enough calcium. Your body will make breast milk in response to how often your baby nurses. The size of your breasts is not important. The more often you nurse, the more milk you will make. The best time to wean is when either Mom or Baby decides it is time. The American Academy of Pediatrics recommends breast milk for the first full year of life. Your baby may try to bite by mistake or in play when first teeth come in. Immediately removing the baby from the breast can stop the biting if it happens.

I heard that I can't eat spicy food or chocolate if I breastfeed.

I heard that breastfeeding might make my breasts get out of shape. I heard that I must drink a lot of milk to make good breast milk.

I might not be able to make enough breast milk. I heard that you should wean when a baby gets teeth.

· Most newborns nurse well during the first hour or two after the birth and then sleep for many hours. Attempt to awaken your baby by partially undressing your baby, talking to your baby, sitting your baby up, gently moving your baby's arms and legs, or gently massaging your baby's head. · A baby shows early hunger cues by turning the head and searching with an open mouth or putting the fist in the mouth. Crying is a late sign. It is best to respond to early hunger cues. · If baby routinely shows hunger cues after feedings, get help with the feedings to make sure the baby is latching and suckling well. Instead of asking for a pacifier or bottle, ask for help. · If baby routinely falls asleep within the first few minutes of feeding, or comes on and off the breast often during a feeding, or never really latches, ask your nurse for help. · Babies often cluster-feed, which means they may have 2 or 3 feedings close together and then a long rest. This is normal. · The "Babywise" method or "parent-led" feeding has caused alarm amongst health professionals. Dehydration and failure-to-thrive have been associated with it. These methods are strongly discouraged. Learn how to tell your baby is getting enough to eat. Ask for a feeding log at the hospital so you can keep a record of how often baby nurses and the number of wet and dirty diapers. Lactation Consultants Don't hesitate to ask for additional help if you need it for a breastfeeding problem. All of the maternity nurses and clinical assistants are trained to assist with common breastfeeding concerns, but occasionally problems arise that require more specialized expertise. A visit by a Lactation Consultant (a breastfeeding specialist) may be ordered by your doctor, or arranged by your special request, during your hospital stay. Growth Spurts and Breastfeeding Growth spurts are periods when a baby suddenly wants to nurse more often because he or she is getting ready to grow a lot. Mothers may worry about whether or not their baby is getting enough milk during these periods because the baby seems to want to nurse all the time. Nurse as often as the baby requires, and your milk supply will increase within a day or two. Growth spurts usually occur at 10-14 day, 4-6 weeks, and at 3 months.

Many parents use a bottle for feeding breast milk or formula. Breast milk or formula is the only food a baby needs the first 4 to 6 months of life. Cow's milk should not be used until the baby is at least one year old. Your baby's doctor will let you know when to add solid foods or cow's milk. Most babies will need 1 to 2 ounces every 2 to 4 hours the first week. · Do not give any liquids besides breast milk or formula (including water), until your baby's doctor says it is okay. · Hold the bottle so that the nipple is completely filled with fluid, not air. · Do not prop bottle. Hold your baby for feeding. Interacting with your baby during feeding is important to your baby's development. · Check the temperature of the fluid to make sure it is not too hot. · Do not heat bottles in a microwave. Warming milk in a microwave oven may burn your baby and destroy some of the important nutrients in the milk. Heat under warm running tap water or place bottle in a bowl of warm tap water. · Wash bottles and nipples thoroughly with hot soapy water or in the top rack of a hot dishwasher. (It is only necessary to sterilize bottles and nipples in boiling water before you use them the very first time, unless your baby's doctor recommends it.) · Do not save unfinished contents of the bottle for later feedings. Throw contents away if baby does not drink it within one hour. Old milk can make your baby sick. · Do not use honey in bottles or pacifiers. Honey can make your baby very sick. · Burp baby in the middle and at the end of a feeding. · Keep a record of how often and how much your baby eats, and the number of wet and dirty diapers for the first month. Using Formula: · Follow package directions for preparing the formula your baby's doctor recommends. · Do not add more water than is recommended. · Do not use well water to mix with the formula.

When the day arrives to take your baby home, you will want things to run as smoothly as possible. It helps to be prepared before you go home: 1. You are required by Texas law to have completed the birth certificate before going home. If you want your baby's name on the official birth certificate, you must call the birth certificate office at your hospital before the baby is five days old. You will receive a complimentary certificate from the hospital as a keepsake (this is not an official copy). 2. If you have any concerns or questions about paternity issues (legal father) during your pregnancy you may contact the Texas Attorney General's Office. The Attorney General's Office has forms and information for acknowledgement of paternity by your baby's father. Acknowledgement of paternity is very important to ensure that your baby becomes eligible for benefits such as Social Security, veterans benefits, child support, and health care. 3. Your baby will be registered for a social security number when the birth certificate information is completed. You will need to ask for a receipt of the application especially if you are currently on, or will be applying for, any public assistance such as Medicaid or WIC. The social security card will be mailed to your home address in 3 to 4 months. 4. Arrange for someone to drive you home. 5. Check with the business office before you leave the hospital to make sure all the billing records are accurate. 6. Make sure you get clearance from your nurse before you leave. Your nurse will need to make certain you have signed all the necessary forms, have completed and signed the birth certificate, and that you have been given written instructions on mother and baby care at home. You must be discharged by your doctor, and your baby must be discharged by baby's doctor before you both go home. 7. Make two follow-up appointments, one for yourself and one for your baby. Mother will need an appointment with her doctor or clinic provider 6 weeks after a vaginal delivery or 2 weeks and 6 weeks after a cesarean section delivery. In addition, an appointment for staple removal may be required if you had a cesarean section and your staples were not removed prior to discharge. You will be instructed by your discharge physician when to make your appointment. Baby will need an appointment with your chosen doctor prior to

discharge. The baby will need an appointment anywhere from 1 day to 2 weeks after discharge. Again, you will be instructed by the baby's discharge physician when to make the appointment. It is best to call before leaving the hospital to arrange your baby's appointment. 8. You will be given the choice of walking to your car, or of having an escort to push you to your car in a wheelchair. 9. Buckle your car seat securely in the car so baby will ride safely home.

Your baby will need regular check-ups and vaccinations at the doctor's office or clinic you have chosen. Baby's first check-up should be scheduled for one to fourteen days after going home. Each baby is different, so you will be given instructions before going home on how soon your baby will need a checkup. The doctor's office or clinic will check the progress of your baby's growth and general health. Check-ups usually need to be scheduled at the same as the vaccinations, but your doctor or clinic will tell you if your baby needs them more often. Check-ups are free from the Austin-Travis County Health Department clinics if your baby qualifies for these services.

Welcome to parenthood! Over the next weeks, months and years, you can expect to have times of joy and excitement, but also some times of worry and anxiety. You may also have many questions. Learning about the four topics covered in this brochure: newborn screening; immunizations, emotions after delivery and caring for a crying baby, may help answer some of your questions.

*The following info was provided by Texas Department of State Health Services and can be found on their website www.dshs.state. tx.us/mch

The Newborn Screening Program finds those few infants who have certain serious birth defects. Finding these infants and giving them early treatment prevents serious problems, such as developmental delays or even death. All the blood-screening tests are done on tiny samples of blood taken from your baby's heel about two days after birth, before your baby leaves the hospital. The tests are repeated one to two weeks later by your baby's health care provider. If the screening tests show a possible problem, the baby needs a follow-up test. For some of the very serious conditions, the health care provider starts treating the baby right away before any more testing is done. If your health care provider asks you to bring your baby in for a follow up test, do it as soon as possible! If your child has a health problem, acting early is important. Be sure to give your correct address and phone number to the hospital or health care provider. If you don't have a telephone, leave the phone number of a friend, relative or neighbor with the health care provider or hospital. If you move soon after your baby is born, let your health care provider know right away so they can reach you if your child needs a follow up test. The goal of the Newborn Screening Program of Texas is to DETECT newborns with health problems that can be treated, help to start TREATMENT early in life and PREVENT developmental delays or other problems. You can help! Make sure your baby is screened before he or she leaves the hospital and take your baby to your health care provider or clinic for a second screen at 7-14 days of age.

"Refer" means that your baby needs to have more testing. Refer does not mean that your baby has a hearing loss. It is important to test your baby again. The hospital or your baby's health care provider will help you get this testing. You may want to talk to your doctor about other newborn screening blood tests that can be done by private laboratories. Resources for Newborn Screening and Newborn Hearing Screening are at the end of this booklet.

Immunization happens when a person or animal gets a vaccine for a certain disease and then becomes protected against that disease. When you get a vaccine, your body reacts to it by making antibodies. These antibodies stay in your body and help protect you from that disease. Sometimes a vaccine can protect against two or three diseases. Vaccines can prevent diseases that can have terrible lifelong effects, and even lead to death. Parents can help keep their children healthy by making sure they get all of their vaccines on time. Ask your health care provider about the importance of vaccines.

A hearing screening is important for your newborn baby because hearing loss occurs for 3 out of 1,000 babies. It is one of the most common birth disabilities. Language learning starts at birth! If your baby can't hear, learning language is hard. A hearing test lets you catch the problem early. If you find hearing loss early, your baby can get help. If you start before your baby is 6 months old, he or she may learn language like babies who do not have hearing loss. After your baby's hearing is screened you'll get the results. You will be given either a "Pass" or a "Refer." "Pass" means that your baby can hear well enough to learn language. It is important to keep track of how your baby's language develops. Sometimes, an older baby can have trouble hearing. You can get a "Hearing Checklist" from DSHS (See Resources Section at the end). Use the checklist as a guide to know if your baby continues to hear well.

Required Immunizations Texas law says that children must have certain vaccines before they start childcare or school. If parents work with their child's health care provider to be sure that the child gets vaccines according to the recommended schedule, chances are that the child will meet the vaccination requirements set by law. Some vaccines are not required until the child reaches a certain age. Required Immunizations and Medically Recommended Schedule (see chart below) Other Immunizations As a child gets older, he or she will need a tetanus and diphtheria (Td) booster every ten years to protect against these diseases. He or she should also get a flu vaccine once a year, beginning at age 6 months. Parents should also talk to their health care provider about the meningococcal vaccine for teens. This can prevent a type of severe brain infection. If a person travels to another country, some other vaccines may be needed. Resources for Immunizations are at the end of this booklet.

Required Immunizations and Medically Recommended Schedule

Vaccine Birth 2 mos. 4 mos. 6 mos. 6-23 mos. 12-15 mos. 12-18 mos. 15-18 mos. 24 mos. 30-36 mos. 4-6 years 14 years

Hepatitis B Diptheria,Tetanus Toxoid (lockjaw) and Pertussis (whooping cough) (DTaP) Haemophilus influenza, Type b (HIB) Polio (IPA) Pneumococcal (PCV7) Influenza (flu) Measles, Mumps, Rubella (German Measles) (MMR) Varicella (Chicken Pox) Hepatitis A Tetanus/Diptheria (Td) PLEASE NOTE: Check with your baby's healthcare provider for any changes or revisions in immunization schedules.

Flu vaccine should be given every year after the first one

After your baby is born, you may feel: · Joyful · Excited · Nervous · Worried These are normal feelings. Many women have them. Some women have more upsetting feelings such as: · Extreme fear and worry · Great sadness · Not feeling normal

baby blues enjoy being a new mother from the start. Others may not enjoy being a mother for several days or weeks. This is normal. If the baby blues are really bad, the mother should check with her health care provider. This may mean she is more likely to have postpartum depression after a few weeks. Postpartum Depression For many women, the baby blues go away after a few days or weeks. If they do not, or if they get worse, the mother may have postpartum depression. This is a common illness in new mothers. It occurs in 1 out of 10 women after having a baby. Signs may include: · Sadness · Having a short temper · Crying · Problems sleeping, even when the baby is sleeping · Not wanting to hold or touch the baby (not enjoying the baby) · Feeling tired · Changes in eating patterns · Thoughts about her own death or the death of her baby Postpartum Anxiety It is normal for new mothers to worry about their babies. But worry that takes over your life is not good for you or your baby. Signs that a mother may be worrying too much are when she is: · Afraid that something will harm her baby · Afraid that she will hurt her baby · Spending most of her time trying to get these ideas out of her head or trying to protect her baby · Afraid to be alone with her baby Postpartum Psychosis This is an illness that happens to 1 out of 1,000 women having a baby. It is an emergency. The mother needs medical help right away. A mother may: · Become confused · Be nervous or very quiet · Hear voices · See things · Have thoughts about hurting herself or her baby

*Developed in collaboration with Mental Health of Greater Houston.

Please check all that apply to you: I feel worried or afraid a lot. I have not been able to think clearly. I am afraid to be alone with my baby. I feel cut off from the world or like I do not know what is real anymore. I have trouble sleeping even when my baby is sleeping. I have not been taking good care of myself (not eating or sleeping). I do not enjoy being with my baby. I do not want to get out of bed. I do not want to be around my friends or family. I have had thoughts about death or killing myself. What Can You Do To Feel Better? If you are having any of these feelings, please talk to your friends, family, or health care provider. If you are afraid you may harm your baby or yourself, call your health care provider or go to an emergency room right away. Help is available. You are not alone. Many women feel like you do. Your life will get better when you get help. Here is more information about the feelings you may have after having a baby. Baby Blues Up to 8 out of 10 new mothers have the "Baby Blues." Signs include: · Crying · Mood swings · Having a short temper · Being very sensitive · Feeling irritable or frustrated This is like what some women feel before their periods. The signs start about three days after having a baby. They should go away on their own in about two weeks. Support from your family and friends can help. Some women with

Whether your children are babies, preteens or teens, as a parent, you will have good times and bad times. Sometimes, the bad times can be very hard. If you are ever worried that you might hurt your children or yourself, there are places you can go for help. Some people find that books and

websites on parenting can give them useful ideas. Others prefer to talk with other parents, their children's teachers, clergy members, health care provider or parenting experts. Some parents find classes helpful. Resources for Your Emotions After Delivery are at the end of this booklet.

baby, but it can be very stressful and hard for the parents or caretakers. Sometimes, your health care provider can help with changes in the baby's diet or may have other ideas to help you deal with colic. Shaken Baby Syndrome A baby's brain is more delicate than an adult's brain. Shaking the baby or treating him or her roughly can cause brain damage, blindness, hearing loss, and even death. Shaken Baby Syndrome is the medical name for all the different problems that can happen when a baby is shaken. If your baby is crying and you feel like you are losing control, put your baby in a safe place and walk away. Take some deep breaths and try to calm yourself down. If you don't think you can calm down, call a friend, neighbor or family member to care for your baby. Calling 911 is another option. If someone else is caring for your baby, talk to him or her to be sure they know about Shaken Baby Syndrome and that they know ways of calming a baby. If you have any concerns about a person who is caring for your baby, talk to him or her or find a different person. If your baby is in day care, talk to the director. DO NOT leave your baby with someone you don't know well. If you are worried about someone else's baby, offer to help. You may be able to show some new ways of calming the baby, or may be able to give the parent or caretaker a break. If you think someone is hurting a child, you need to report it. You can call 1-800-252-5400 or use the Department of Family and Protective Services secure website: https://www. txabusehotline.org. If it is an emergency, call 911. Symptoms of Shaken Baby Syndrome These may be some signs that a baby or small child has been shaken: · The baby is very sleepy or very fussy. · The baby vomits or does not want to eat. · The baby is not smiling or making noises like usual. · The baby's arms and legs are rigid or stiff for any period of time -- this may mean a seizure or something worse. · The baby has a hard time breathing. · If the baby's eyes look different or if you think the baby's eyes may have been hurt. If you see signs like these, contact the baby's health care provider or the emergency room right away. Make sure to tell them if you think your baby has been shaken -- this can save precious time! Resources for Babies and Crying are at the end of this booklet.

Babies and young children tell us what they need in different ways. One way is by crying. It is normal for babies to cry every day. At times, babies cry more. Some babies cry more than others. Many babies cry more in the evenings. Often babies cry even when you are trying to help them. Sometimes it is not easy to know what a baby needs and it can take some time to figure it out and to calm the baby down. This can be hard on parents and others who care for the baby. When a baby cries for a long time, it can be stressful and may make you feel helpless and angry. But remember, no matter how you feel, NEVER SHAKE the baby. Ways to Calm a Crying Baby · Change the baby's diaper. · Feed or burp the baby. · Check every part of the baby to see if something is hurting: Are the baby's clothes too tight? Is a diaper pin poking the baby? · Check to see if the baby may be sick: Does the baby have a stuffy nose? Does the baby have a fever? · Make sure the baby is not too hot or too cold. · Try to settle the baby for a nap. · Give the baby a pacifier or a teething ring. · Take the baby for a walk or a car ride. · Talk or sing to the baby, or play music. · Give the baby a bath. · Take the baby outside for a few minutes. · Show the baby some toys or a mirror. Young babies often like black and white toys or patterns. · Change the way you are carrying the baby. · Gently rub the baby's back or tummy. · Try a baby swing. · Call someone else ­ sometimes a new face or voice can calm the baby. · If nothing else works, put the baby in a safe place and walk away. Check on the baby every five minutes or so. Endless Crying and Colic If your baby cries for a very long time or repeatedly, you may want to take him or her to your health care provider. Your baby may have a health problem or colic. Colic is when a baby cries for more than three hours every day for more than three days a week. With some babies, colic can sound like screaming instead of crying. Colic will not hurt the

Sleep Safety · Crib and play pen bars should be less than 2 3/8 inches (6 centimeters) apart. · Remove fluffy pillows, toys, quilts and blankets from your baby's bed. Don't use a loose plastic sheet. These things could block your baby's breathing. · Place your baby on his back to sleep. Allow "tummy time" only when baby is awake and you are watching. Bath Safety · Never leave baby unattended in tub. · Turn hot water heater down to 120 degrees or less. · Keep one hand on your baby at all times-bathing is slippery! Kitchen Safety · Never hold the baby while cooking or drinking hot liquids. · Use rear stove burners and turn pot handles to the rear of the stove. Never leave the stove unattended while cooking. · Never leave children unattended in the kitchen. · Make sure children cannot reach electrical cords. Dressing Safety · Avoid clothes with notions (buttons, bows, snaps, threads) that could become loose or be pulled off and become a choking hazard. Avoid tight elastic and over dressing. · Never leave baby alone on a changing table. · Never tie a pacifier or anything around your baby's neck. This could cause your baby to strangle. Household Safety · Install smoke alarms and check batteries at least twice a year. · Do not allow smoking inside your home. · Put poisons out of reach and lock the cabinet. Keep the Poison Control Hotline number near your telephone. · Install child safety locks on all cabinets within baby's reach. · Keep baby away from window coverings and curtain cords. · Install quality electrical outlet covers. · Contact the U.S. Product Safety Commission though the hotline or website for more information on safety for all baby products and recalled baby products.

General Safety · Keep medication locked and out of reach of baby. Do not give baby any medication (including Tylenol) without first asking baby's doctor. Remember that many medications may affect baby through your breast milk. · Never shake a baby. A child can be injured and braindamaged for life in a matter of seconds. Make sure anyone who cares for your child knows that children should never be shaken for any reason (including rough play and tossing into the air). · Avoid yard signs, newspaper announcements or other public birth announcements. These types of announcements have been shown to increase the risk of infant kid napping. Car Seat Safety Why does my baby need a car seat? · A car seat can save your baby's life in a car crash. · A car seat can prevent your baby from being hurt and going to the hospital. · If used 100% correctly, car seats would save 500 babies from death and 53,000 babies from being hurt each year. · The law says you must use a car seat. What does the Texas law say? · All children under age four or less than 36 inches tall must be restrained in a car seat. · If you do not properly buckle your baby in a car seat, you may be fined. What is my responsibility as a parent? · Provide a car seat that is safe and the right size for your baby. Beware of a previously used car seat. Look for cracks or damage. A used car seat will not be safe if it was in a previous crash. · Read the instructions that came with your seat. Do not buy a car seat unless it has the original manufacturer's instructions and label with model number. · Know how to safely install the seat in your car. Follow the car seat manufacturer's instructions and your car owner's manual. · Mail in the manufacturer's warranty card. The manufacturer will then be able to let you know if there is a recall or problem with your car seat. · Place your baby safely in the car seat. Properly buckle the seat into the car when you leave the hospital. The hospital staff cannot assist you with car seat installation. · Never leave your child alone in a car, not even for a minute. · Never allow anyone under the influence of alcohol or drugs to drive with your baby in the car.

What else do I need to know before taking my baby home the first time? · Your baby should ride facing the rear of your car. Your baby should face the rear until he/she is one year old and weighs more than 20 pounds. · The middle of the back seat is generally the safest position in the car. Consult your car seat and auto manual for exceptions. · Never place the car seat in front of an airbag. · Read your car seat manual and auto manual to see if a "locking clip" is needed when using a lap and shoulder seat belt combination. · The American Academy of Pediatrics believes that if you take your baby home from the hospital safely the first time, then you are more likely to continue the habit. A habit of safely buckling your baby in the car can prevent injury and possibly save your baby's life.

are normal and it is estimated that 80% of women develop "baby blues" following delivery, Factors such as stress, hormonal changes, and exhaustion may cause temporary depression. Some women develop more severe postpartum depression after the first two to three weeks characterized by more intense feelings of sadness, anxiety, or despair and possibly suicidal thoughts. These feelings interfere with the new mother's ability to take care of herself or her baby. However, some women develop a condition known as postpartum depression following the birth of a baby. This is a more serious condition than "baby blues" as symptoms are ongoing for longer than two weeks following delivery. Postpartum depression is characterized by more intense feelings of sadness, anxiety, or despair, and possible thoughts of harming yourself, the baby, or your other children. These feelings interfere with the new mother's ability to care for herself or her baby. If you develop any signs of postpartum depression, you should seek medical attention right away. Do not wait, hoping that the feelings will go away, as symptoms are likely to continue to worsen without help. The Austin are 24-hour crisis hotline is 472-HELP (4357). If you develop any signs of postpartum depression, you should discuss this with your doctor or health care provider and take steps right away to get the support and help you need.

· Call Safe Riders for car safety and car seat recall information, 800-252-8255. · Take a car seat safety class offered through Safe Kids Austin, call 324-8009. · Attend a free car seat fit and safety inspection (see resource section for phone numbers).

Most parents feel extremely tired in the early weeks after delivery. Planning ahead can help you through this time. You may want to accept help from family and friends, but it is important to know what kind of help you will need. The best help from family or friends is usually help with meal preparation and housework. The early weeks after your baby is born is a special time for you and your partner to learn how to care for your baby while others can do chores. Some helpful advice for getting rest: · Take naps when your baby does. · Use paper plates and cups to save cleanup time after meals. Order take-out or choose prepared meal options offered by some grocery stores and delicatessans. · Accept help from family and friends. Be clear and specific about the chores you need help with.

You will experience times of great joy with your new baby, but you may also experience wide and sudden changes in mood. Many new mothers may develop "baby blues" after childbirth. Most women experience some feelings of sadness, as well as, crying spells and fatigue. Symptoms may also include feeling irritable, anxious, overwhelmed, and angry toward your partner, baby, or other children. These feelings

New fathers will experience enormous personal growth. Your role as a father will allow you to contribute to the shaping of a human being. You will have the experience of being protector, teacher, nurturer, and transmitter of culture. There are many things a father can do to help your child grow and learn: · Become the most significant male figure in your child's life. Be a role model for what you want your son or daughter to become. · Develop your own style of relating to your baby and providing care. · Be there at bedtime. Kiss and hug your child goodnight. · Hold, rock, cuddle and sing lullabies to your baby. · Help with bath time and diaper changes. · Read books or tell stories to your baby. · Comfort baby when baby is upset or crying. Assure your child that you are there for him or her.

· Look for local groups and classes that help new dads with fathering. Also look for books on fathering from the public library. (See Resource section). · Have fun and spend playtime with your baby. Watch and enjoy your child's first steps, words, and more. Enjoy fathering!

Because of fatigue and all of the demands of parenthood, it is sometimes difficult to maintain a healthy relationship with your partner. It is usually helpful for couples to divide household chores so that neither of you feels overwhelmed. It is very important to keep the lines of communication open and to plan some "couple time" alone together. Many couples find marriage counseling to be helpful when their children are young.

Siblings may have a period of adjustment after the arrival of their brother or sister. Seton offers a Big Brother/ Big Sister tour. The following tips may help you ease the adjustment period for your child: Before the new baby comes: · Encourage your child to feel the baby move · Talk about feelings and how things will change after the baby comes · Teach about the importance of washing hands and gently holding baby · Arrange for childcare while you are in the hospital. Write down routines and phone numbers for the caregiver. While you are in the hospital: · Encourage your child to draw pictures so you can put them up in your hospital room. · Encourage your child to visit you and baby in the hospital. Have a surprise gift waiting (i.e. a book or small toy). Let visitors or family hold the baby while you hold and hug your older child. · Call your child at home during the day just to tell them hello and that you miss them. After you are home: · Plan special time each day to spend with your child. Each child needs time alone with each parent (even if it is just reading a book or taking a walk around the block). · Try to plan for your older child to nap at the same time as the baby (and you!). For older children, plan a quiet activity if they don't nap. · When the baby is 2 to 3 months old, have the older child "read" or tell stories to the baby. Babies at this age are very responsive which will make your older child feel important.

If you will be returning to work or school after your baby is born, choosing a good day care provider is very important. You will want to be sure that your child is safe and happy while you are away. Thoroughly check out the center or provider you are considering. The National Association for the Education of Young Children (NAEYC) accredits facilities that voluntarily provide excellent care above the minimum standards. Drop by unannounced several times to check for yourself: · How many children are being watched by each adult caregiver? · Is the facility clean and "childproofed" for safety hazards? · What are the qualifications and experience of the caregivers? · Does the staff seem friendly and nurturing? Are they supportive if you plan to provide breast milk? · Is the facility or caregiver licensed or accredited? (Licensing means minimum standards are met, accreditation means care above minimum standards). Plan ahead. Many day care centers will take your name on a waiting list even before your baby is born.

There are many special circumstances that new parents may experience. If you need more information on any of the special circumstances related to your pregnancy, please do not hesitate to call the OB Case Manager for your hospital. Also, check the Resources section of this Passport or visit the SETON website at www.seton.net for more information. Another excellent resource for information and referrals is 211 Texas. By dialing the phone number 211 in Texas, 24 hours a day, you can get information on everything from affordable healthcare and food, to education, employment and support groups. Information on some of these special circumstances is included in this section, but more detailed information is available upon your request.

If you and your doctor anticipate that your baby may have special needs, or if your older child has special needs, be sure and speak with a social worker in the hospital before going home.

The Seton Pastoral Care department is available to offer spiritual and emotional counseling to you and your family during your pregnancy or after delivery if needed. Please call the Pastoral Care department for assistance from one of our chaplains.

Occasionally, pregnant women are confined to bed rest for a possible complication of pregnancy such as pre-term labor or high blood pressure. If you are required to be on bedrest during your pregnancy and need additional resource information on coping with bedrest, call your OB Case Manager. (Please refer to the section on pregnancy complications and preterm labor for warning signs).

There are many resources available for single parents. A list of support groups and other community resources is available on our resources page.

There are many agencies that help teen parents with staying in school, finances, housing, and other support and information. Two resources are 211 Texas (211) and Family Connections (478-5725).

Family violence and abuse may sometimes become a problem during pregnancy. No one wants to believe their partner could be abusive, but if you are confused or feeling uneasy about your relationship, ask yourself the following questions: · Does your partner try to control your behavior, dictate what you wear, what you say, or who your friends are? · Are you repeatedly attacked, threatened or criticized? · Is your partner extremely jealous and possessive? · Does your partner damage your possessions or torment and hurt your pets? · Are you afraid when your partner gets angry? · Does your partner blame you for everything that goes wrong in the relationship? · Does your partner prevent you from seeing your family and friends? If you answered "yes" to any of these questions, you may be involved in a potentially violent relationship. Do not hesitate to call 911 in an emergency. There are many resources for help in abusive or violent circumstances. Safeplace also has a 24-hour Hotline for information and assistance (267-SAFE, 267-7233).

If you have a history of, or are being treated for, depression or other mental health conditions, your health care provider needs to be aware in case problems develop or your treatment needs to be changed. Do not hesitate to talk to your health care providers about any concerns you may have.

If you are expecting twins (or more!), there are additional resources to help you. Contact the local Mothers of Multiples Club for information on their meeting times, newsletter, and baby equipment exchange program.

If you are in urgent need of basic necessities (food, clothing, or shelter) call the OB social workers before you deliver at 324-7347, or 324-1000 x 18205, or speak with a social worker in the hospital before you are discharged. · If you have concerns about your upcoming hospital costs, call the hospital where you plan to deliver and speak with the Financial Counselor.

- (1-3 weeks before delivery) How you may feel: · Baby may drop lower in the pelvis. · You may have more Braxton-Hicks (pre-labor) contractions. · Your weight may level off or you may lose weight. · You may have a burst of energy. · You may have a little more vaginal discharge. · You may need to urinate more often. What you should do: · Take a nap each day and go to bed early each night (labor is easier when you are rested). · Pack clothes for you and baby. · Have your family help with housework. - (Cervix 0-3 centimeters dilated; contractions 5-20 minutes apart and usually lasting 30-45 seconds) How you may feel: · You may feel excited, talkative. · Contractions are easier. What you should do: · Begin relaxation (shower, nap, listen to music). · Urinate often to keep your bladder empty so baby can move down. · Drink clear liquids only (juices: apple/grape/cranberry; other: sprite, ginger ale, popsicles). · Do not eat food unless your doctor or clinic says it is okay. · Partner can time contractions (from the beginning of one contraction to the beginning of the next). Call your doctor or midwife or clinic. It may be time to go to the hospital when: · contractions have been 5 minutes apart for 1 hour (sooner if you have a history of fast labors), OR · you are leaking fluid from your vagina, or having vaginal bleeding, OR · the doctor or midwife tells you to come in, OR · you have any of the symptoms listed in this Passport under "When to Call for Help"

- (Cervix 4-7 centimeters dilated; contractions 2-5 minutes apart and usually lasting 45-60 seconds) How you may feel: · You may have to concentrate more during contractions. · Usually not as talkative. What you should do: · Continue to rest. · Take a short walk inside if allowed. · Urinate often to keep your bladder empty so baby can move downward more easily. · Go to the Hospital when ready. · Partner can give massage, pace your breathing, give ice chips; help you to focus on relaxation.

- This phase is usually less than 2 hours (Cervix 7-10 centimeters dilated; contractions 90 seconds to 2 minutes apart and lasting 60 - 90 seconds) How you may feel: · You may feel irritated or panicky. · You may not like to be touched. · You may have nausea or vomiting. · You may have shaking or trembling. · You may feel like sleeping between contractions (be sure to sleep if you can!) What you should do: · Take one contraction at a time. Continue relaxing as much as possible. · Do not push until the nurse or doctor has told you to push. (Pushing too soon can cause your cervix to swell.) · Try to sleep between contractions. · Partner should encourage mom; keep calm; do not leave her during this time; breathe with her; keep her from pushing; help her to focus on relaxation (see ideas below). - Pushing phase may be as short as 5 minutes or as longs as 3 hours (Cervix completely dilated; contractions 3-5 minutes apart and lasting 60 seconds) How you may feel: · You may have a very strong urge to push (and feel relieved to push). · You may feel energetic again. What you should do: · Get in the most comfortable position for pushing (your partner and your nurse can help you). · Push only during a contraction (rest in between contractions). · Partner should pace breathing for pushing; help you get into comfortable position; continue encouraging; remind you to keep your eyes open to see the birth. · Look at a "focal point" (sonogram picture of baby, picture of your other children or picture of a beautiful place). · Cool, cloth to forehead. · Eat ice chips. · Use hand fan. · Keep bladder empty (to make room for the baby to move down the birth canal). · Change positions often (helps the baby move down more easily). · Keep the room cool, quiet, lights dim.

· · · · · ·

Take a walk. Take a shower. Take a nap. Listen to music. Do relaxation breathing (nurses can help show you how). Have a massage.

Admissions Seton Medical Center Austin ...........................................................................................................................................324-1126 Seton Medical Center Williamson ...................................................................................................................................324-4262 Seton Northwest Hospital ................................................................................................................................................324-6002 Seton Southwest Hospital ................................................................................................................................................324-9005 University Medical Center at Brackenridge...................................................................................................................324-7126 Anesthesia Capitol Anesthesia .......................................................................................................................................... 324-1000 ext.14026 Classes All Seton locations.............................................................................................................................................................324-4252 www.goodhealth.com/classes Seton Community Clinics (adult and infant healthcare and vaccinations) Seton McCarthy ................................................................................................................................................................324-4930 Seton South .......................................................................................................................................................................324-4940 Seton Topfer ......................................................................................................................................................................324-6850 Children's Health Express (mobile clinic program of Dell Children's Medical Center of Central Texas) ...............324-0260 Financial Counselors Seton Medical Center Austin ...........................................................................................................................................324-1137 Seton Medical Center Williamson ................................................................................................................ 324-4000 ext. 21165 Seton Northwest Hospital ............................................................................................................................. 324-6000 ext. 67323 Seton Southwest Hospital ................................................................................................................................................324-9606 University Medical Center at Brackenridge...................................................................................................................324-7126 OB Case Managers Seton Medical Center Austin ...........................................................................................................................................324-1277 Seton Medical Center Williamson ................................................................................................................ 324-4000 ext. 20911 Seton Northwest Hospital ............................................................................................................................. 324-6000 ext. 67323 Seton Southwest Hospital ................................................................................................................................................324-9606 University Medical Center at Brackenridge...................................................................................................................324-7126 OB Social Worker ........................................................................................................................324-7347 or 324-1000 ext. 18205 Physician Referral................................................................................................................................................................324-4444 www.seton.net/doctor Tours (maternity) Seton Medical Center Austin ...........................................................................................................................................324-4252 Seton Medical Center Williamson ...................................................................................................................................324-4252 Seton Northwest Hospital ................................................................................................................................................324-4252 Seton Southwest Hospital ................................................................................................................................................324-9043 University Medical Center at Brackenridge...................................................................................................................324-7260

211 Texas (information and referral hotline that can assist .............................................211 or 973-9203 (choose option #2) with basic needs, counseling, and pregnancy related services)...................................www.unitedwaycapitalarea.org/gethelp Breastfeeding La Leche League (www.laleche.org) ................................................................................................................................272-8042 Mom's Place Clinic ............................................................................................................................................................719-3010 Statewide Lactation Support Hotline................................................................................................................... 1-800-514-6667 Childcare/Other Family Connections (www.FamilyConnectionsOnline.org)..........................................................................................478-5725 (prenatal and parenting classes, support goups, and assistance with childcare locating) Child Inc. (child care referral service) (www.childinc.org) ............................................................................................451-7361 National Association of Education of Young Children (www.naeyc.org) .......................................................... 1-800-424-2460 Worksource Childcare Solutions (childcare assistance) (www.worksourceaustin.com) .............................................302-0710 Classes Family Connections (prenatal and parenting classes) (www.FamilyConnectionsOnline.org) ...................................478-5725 Seton Parent Education (maternity and baby care) (www.goodhealth.com/classes) ..................................................324-4252 CPR Classes - American Hear Association (www.americanheart.org/cpr) ....................................................... 1-877-242-4277 American Red Cross (www.centex.redcross.org) ............................................................................................................929-1294 Health Care For Your Baby Austin-Travis County Health Department (free vaccinations "Shots for Tots") .........................................................972-5520 Austin-Travis County Health Department (infant care) Call center to schedule appointment for healthcare .......972-4278 Seton Community Clinics (infant care and vaccinations) Seton McCarthy ................................................................................................................................................................324-4930 Seton South .......................................................................................................................................................................324-4940 Seton Topfer ......................................................................................................................................................................324-6850 Children's Health Express (mobile clinic program of Dell Children's Medical Center of Central Texas) ................324-????? Social Services and Special Circumstances 211 Texas (information and referral hotline) (www.unitedwaycapitalarea.org/gethelp) ...............................211 or 973-9203 Alcoholics Anonymous (www.austinaa.org) ....................................................................................................................444-0071 Any Baby Can (support for at risk and special needs children) (www.abcaus.org) ....................................................454-3743 ARC of the Capitol Area (support for children with disabilities) (www.arcofthecapitalarea.org) ............................476-7044 Austin Child Guidance (counseling and parenting groups) (www.austinchildguidance.org) ....................................451-2242 Family Forward (warm line for child abuse prevention) (www.familyforward.org) ...................................................459-5490 Lifeworks (services for teen parents) (www.lifeworkseb.org) .......................................................................................735-2400 March of Dimes (education and birth defect prevention) (www.marchofdimes.com) .................................................477-3221 Safeplace (sexual assault and family violence hotline) (www.austin-safeplace.org) .............................267-SAFE (267-7233) Texas Attorney General's office (paternity issues) (www.oag.state.tx.us) ........................................................ 1-800-252-8014 WIC (women, infants, and children program ) nutrition (www.dshs.state.tx.us/wichd) ................................. 1-800-942-3678 Psychiatric Emergency Services (www.atcmhmr.com) ..................................................................................................454-3521 24-Hour Mental Health Crisis Hotline ...........................................................................................................................472-4357

Safety Car Seat Fit and Safety Inspections Georgetown Hospital ................................................................................................................................................ 512-942-4115 Safe Kids Austin (car seat inspection program).......................................................................................... 324-0000 ext. 86829 Safe Riders (child passenger car seat and safety programs) (www.dshs.state.tx.us/saferiders) .................... 1-800-252-8255 Parenting Support Austin Child Guidance (counseling and parenting groups) (www.austinchildguidance.org) ....................................451-2242 Austin Mothers of Multiples (www.austinmoms.org) ....................................................................................................703-6174 Austin Newcomers Support Group ..................................................................................................................................314-5100 Center For Successful Fathering .....................................................................................................................................335-8106 Men and Fathers Resource Center ............................................................................................................ 472-DADS (472-3237) Postpartum Support International (postpartum depression) ............................................................................ 1-805-967-7636 Family Connections (www.FamilyConnectionsOnline.org)...........................................................................................478-5725

Additional Numbers and Questions

Department of State Health Services (DSHS):..........................................................................................1-800-252-8023 ext. 2129 National Newborn Screening and Genetic Resource Center: .................................................................................... 512-454-6419 DSHS: ................................................................................................................. http://www.dshs.state.tx.us/newborn/default.shtm

DSHS: ...........................................................................................................................................................1-800-252-8023 ext. 2600 DSHS: ......................................................................................................................................................www.dshs.state.tx.us/audio/

Your health care provider can give you more information about vaccines and immunization. Immunization Information Line, ............................................................................................................................... 1-800-252-9152 DSHS: ..........................................................................................................................................................www.immunizetexas.com

Local: Texas ....................................................................................................................................................................................2-1-1 National: PPD Moms: ..............................................................................................................1-800-PPD-MOMS (1-800-773-6667) Websites: · DSHS Pregnancy, Parenting and Depression Resource List: ..................... http://www.dshs.state.tx.us/mch/depression.shtm · Depression After Delivery, Inc.: .............................................................................................. www.depressionafterdelivery.com/ · The National Women's Health Information Center: ................................................................... http://www.womenshealth.gov · Postpartum Support International (PSI): ......................................................................................... http://www.postpartum.net/ · Parents Anonymous: ....................................................................................http://www.parentsanonymous.org/paIndex10.html

Local: .............................................................................................................................................................................................. 2-1-1 Shaken Baby Alliance: ......................................................................................................................... http://www.shakenbaby.com/ National Telephone: · Childhelp USA: ..........................................................................................................................800-4-A-CHILD (1-800-422-4453) · National Committee to Prevent Child Abuse: ....................................................................... 800-CHILDREN (1-800-244-5373) Websites: · The National Center on Shaken Baby Syndrome: ............................................................................ http://www.dontshake.com/ · National Shaken Baby Syndrome Campaign: ................................................. http://www.preventchildabuse.com/shaken.htm

There are many things you can do to get ready for your hospital stay and the birth of your baby. Using the following checklist may help you to feel more prepared.

During your 3rd to 4th month of pregnancy Pre-register for the hospital. Register for childbirth and baby care classes. Register for breastfeeding class. Register for a tour of the hospital. Begin your search for a doctor or clinic for your baby.

During your 5th to 6th month of pregnancy Decide about circumcision if you have a boy. Choose a car seat and learn how to use it safely. Learn about options for pain management in labor. Register for a sibling class. Make a final choice for baby's doctor or clinic.

At least a month before your due date Organize your household. Arrange for help with household chores and for help after the baby comes. Pack a bag for mom. Pack a bag for baby. Safely secure the car seat into your car. If you plan to return to work or school, begin your search for child-care. Make sure your baby's doctor's office knows about your choice of doctor for your baby.

Congratulations on the soon-to-be new addition to your family! You

have a lot of "to do's" in the next coming months. When you make your checklist, don't forget about the health care of your child. That means, finding a pediatrician for all those baby wellness checks and knowing which hospital to go to if your child becomes ill.

Dell Children's Medical Center of Central Texas is the only

dedicated pediatric hospital in the region. A hospital designed just for young patients, Dell Children's has pediatricians, pediatric subpecialists, specially-trained nurses and staff who are committed to providing the highest level of care for everything from sore throats and sprained ankles to chronic childhood illnesses and complex conditions. And the Dell Children's Emergency Center is staffed full-time with board-certified pediatric physicians prepared to treat a variety of emergencies ranging from the flu to trauma. To find a pediatrician and for more information about our truly unique hospital, please visit our website.

4900 Mueller Blvd. (off IH-35 and East 51st St.) Austin, TX 78723 (512) 324-0000 Emergency Department: (512) 324-0150

Dell Children's Medical Center of Central Texas has been awarded Magnet Designation, the highest award for nursing excellence given by the American Nurses Credentialing Center (ANCC). The ANCC is an independent subsidiary of the American Nurses Association, the nation's largest organization of nursing professionals.

www.dellchildrens.net

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Hospitals * Dell Children's Medical Center of Central Texas Seton Edgar B. Davis Seton Highland Lakes Hospital *Seton Medical Center Austin Seton Medical Center Williamson Seton Medical Center Hays (opening late 2009) *Seton Northwest Hospital Seton Shoal Creek Hospital Seton Southwest Hospital *University Medical Center at Brackenridge Community Health Centers Seton Kozmetsky Community Health Center Seton McCarthy Community Health Center Seton Topfer Community Health Center Regional/Outpatient Care Centers Highland Lakes Home Health and Hospice Seton Cedar Park Healthcare Center Seton Marble Falls Healthcare Center Seton Pflugerville Healthcare Center

*The Seton Family of Hospitals has been awarded four Magnet Designations, the highest award for nursing excellence given by the American Nurses Credentialing Center (ANCC). The ANCC is an independent subsidiary of the American Nurses Asssociation, the nation's largest organization of nursing professionals.

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