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Important Information Before, During, & After Delivery

Here you may find answers to common questions and/or concerns, but if you don’t see what you’re looking for, don’t hesitate to ask us!  Congratulations and best wishes!

After-Hours, Weekend and Holiday Care           

After normal office hours, weekends or holidays, a physician is available by phone at all times to assist our patients with urgent medical needs.

If you need to speak with a physician after hours for any urgent needs, please call our main office # 919-788-4444.

If you haven’t heard from us within 15 minutes, please call back.  If after that 2nd call, you still have not heard from us, call the hospital at 919-784-3271.  They generally know where we are at any given time and who is on call.

Call us regarding all other issues during our normal office hours. Examples of non-emergency issues include requests for treatment of long standing problems, prescription refills, and results of laboratory testing. We’ll be able to address your needs more efficiently and accurately during normal office hours.

*Office Telephone Hours*

Monday – Thursday 8:00am to 4:30pm

Friday 8:00am to 12:00pm

 

Shared Call

At WHA Centre Ob/Gyn, we go to great lengths to be available to our patients even when the office is closed.  The providers at Centre Ob/Gyn share call daily amongst our own group so that there is always someone available for emergencies or urgent medical needs.  We also share call with WHA Capital Area Ob/Gyn for after hours, weekend and holiday call coverage.  We are fortunate to work closely with a group of doctors whom we trust to care for our patients.

 

REX OB Hospitalists & OB Emergency Department

UNC/Rex OB Hospitalists are also available 24/7 to provide patient care for our pregnant patients at the REX Women’s Center, Labor and Delivery and the Rex OB Emergency Department.  The hospitalists are highly skilled and board certified OB/GYN physicians who specialize in caring for patients while they are in the hospital.  Our office will partner with the OB Hospitalists to expedite your care and coordination of other services.  This means SOME of our pregnant patients who are over 20 weeks, may be seen, treated and/or cared for by an OB Hospitalist after hours, weekends and/or holidays.  This arrangement will assure that our patients receive quality care in a timely manner by a board certified physician, whom we trust.

*Note: Any charges generated during hospital visits will be billed to you and/or your insurance company as appropriate.  This may include charges from our office, UNC/Rex Healthcare and/or the OB Hospitalist Physician.

We are happy to discuss any of our after-hours care arrangements with you.  Our goal is to make sure all of our patients are aware of who may be available to provide OB care throughout your pregnancy.

 

Must Call Situations

There are several situations that we consider MUST CALL situations.   

  • If you have vaginal bleeding, like a period, you should call the office. Sometimes when the cervix begins to dilate, it develops tiny tears that may bleed.  This is sometimes called “bloody show”.  Bloody show is normal and we don’t need you to call us to let us know about it, but…if you are bleeding as heavily as you would bleed with a period or if you are actually soaking pads, that can be a sign of a very serious situation and you need to call us immediately.
  • If you experience decreased fetal movement, you should call the office. Because fetal activity is a good indicator of well-being, we are advising that you begin monitoring your baby’s movements at approximately your 34th gestational week.  You should feel at least 4 individual kicks or movements in a one hour period during the day.  This count should be done once daily, but in the event that less than 4 kicks are noted, repeat the count after your next meal while lying down on your left side.  If your total number of kicks after the second count remains less than 4, please call our office.
  • If you feel you may have ruptured your membranes, you should call the office. This is normally a dramatic event.  Many patients feel like they’re emptying their bladders continuously without control.  If you feel you may have ruptured your membranes, even if you have no contractions, you should call the office.  There are some tests we can do to try to confirm or exclude the diagnosis.  Once your bag of water has broken, both your uterus and your baby have lost their barrier to the outside world.  This is particularly important if you are a carrier of Group B Strep.  All patients will be screened for Group B Strep during the last month of pregnancy.  Group B Strep is a bacteria that 40% of all women have normally in the vagina.  Mothers who are carriers of Group B Strep don’t have a problem with it, but it can cause serious infections in newborn babies.  Babies are at risk for contracting Group B Strep during your labor and delivery.  If we find that you are a carrier of Group B Strep, we will treat you with IV antibiotics at the time of labor.
  • If you experience the onset of painful, uterine contractions, you should call the office. Many patients, particularly patients who have had babies before, will develop uterine contractions as early as the second trimester, called Braxton-Hicks contractions.  These contractions do not result in dilation or effacement (thinning) of the cervix.  Real labor contractions are painful in both your abdomen and back.  They are regular to the point that you can almost set your watch by them and they get more intense and closer together.  Braxton-Hicks contractions, in contradiction, may be uncomfortable in the lower abdomen but don’t hurt in your back and are very irregular.  To time your contractions, you should measure the time interval from the start of one contraction to the start of another – not from the finish of one contraction to the start of another.  When the interval is 5-7 minutes apart and painful, you should call the office.  Please don’t go to the hospital without calling us first.  If during office hours, we may be able to evaluate you in the office without generating a hospital charge for you.  If it is after hours or on a weekend or holiday, your call will be taken by our answering system and the doctor on-call will call you right back, usually within 15 minutes.

At any time, if you feel you need to come to the hospital, please call us before you come! (919-788-4444) That way we can at least notify the staff at Rex that you are on your way. 

 

Arrival to the Hospital

The Rex Hospital nurses are generally the first people you will see after arriving at the Rex Women’s Center.  They may also be the first person to actually check your cervix.  While we encourage activity and staying mobile, you and your baby will need to be monitored for at least 30 minutes, if possible, when you first arrive.  This is a hospital policy.  During that time the nurse will ask you a number of questions, including what you are allergic to, what medications you may be on, and whether or not you are Group B strep positive.

Pain Control Options:  Nursing staff will ask what you intend to use for pain control during labor.  You can always change your mind, but we also don’t want to bother you when you are going through the hardest part of labor asking “do you want your epidural now” if you have already told us you do NOT want pain medications.

Option 1: Breathing or Lamaze techniques.  You will breathe rhythmically with your contractions to help you deal with the pain, but it doesn’t really get rid of the pain.  This technique does not provide pain relief for the perineum at delivery, so the doctor may inject numbing medicine into the perineum numbing the area.

Option 2: IV Medication.  We typically use IV Stadol®, a rapid onset, short duration, synthetic narcotic.  It takes the edge off the labor pains better than breathing alone, but it doesn’t totally take the pain away.  We still may need to inject numbing medicine into the perineum.  Also, IV medicine crosses the placenta to the baby.  As long as enough time has elapsed since your last dose of medicine, the medicine will come back across the placenta and be metabolized by you.  If, however, you deliver soon after receiving a dose of medicine, the baby may still have some of the medicine in their system when the cord is clamped.  This may cause them to seem sleepy and drowsy.  We can reverse these effects in the baby by giving the baby a shot of medicine called, Narcan®.  For this reason, we are usually cautious about giving IV pain medicine if we suspect you will deliver soon.

Option 3: Epidural.  With an epidural, you are given IV fluids, a small injection to numb the skin on your lower back, and then the epidural needle is inserted into the epidural space in your spine.  A small catheter is inserted through the needle and the needle removed.  Numbing medicine is then injected through the catheter to numb the nerves from your navel to your knees.  This takes care of the pain of both labor and delivery and does so without the baby getting an appreciable amount of medicine.  The risk of an epidural involves a 1% chance of a headache the next day.  The risk of a serious complication is very rare, about 1 in 100,000.

When can I get my epidural and when is it too late? It takes about 20 minutes to get an epidural in place and functioning.  There is no dilation number beyond which an epidural is too late.  More importantly is how fast your labor is progressing. A patient that goes from 4 centimeters dilation to 8 centimeters dilation in 20 minutes may not derive much benefit from her epidural if it is placed at 8 centimeters.  On the other hand, a patient who has been 8 centimeters for 2 hours may get plenty of benefit.  As to the earliest that an epidural may be inserted, it is best to be in good labor and 3 or more centimeters dilated.  However, the patient who is less dilated and in severe pain may be best served by getting her epidural earlier, so she can conserve her energy for later.

Option 4: Nitrous Oxide (Laughing Gas).  This is a gas that you inhale for pain relief only when you decide you need it.  While it might not make you laugh through labor, it may help take the edge off of pain and anxiety.  Unlike an epidural, laughing gas won’t completely numb any parts of the body. It will not significantly relieve pain, like narcotics do. Laughing gas is more often described as a disassociation from pain.  You might still feel pain, but you won’t be as bothered or anxious about it.  Even if you think you want to try nitrous oxide, you’ll have to ask your physician whether it’s an option for you.

Remember, as far as choices for pain control in labor, you can change your mind.  It’s perfectly logical to go into labor planning to try breathing techniques first and then IV medicine if needed and then an epidural if that doesn’t work.

 

Can I Eat While I’m in Labor?

There are many things that lead to nausea and possible vomiting while in labor.  Once labor begins, digestion ceases for up to 24 hours.  If you have a full stomach, you will probably throw up at some point in your labor.  The pain associated with labor along with some of the IV medications used to alleviate that pain might also lead to nausea.  Vomiting is no fun at any time and particularly when you are in labor.  Since you are more likely to aspirate the vomit into your lungs while pregnant, leading to life-threatening pneumonia, we prefer that you limit your diet to non-particulate liquids while in labor.  Feel free to bring hard candy to have while in labor—but no chocolate until after delivery!  Also, it’s probably a bad idea to stop for take-out on the way to the hospital for a potential labor check. 

 

Episiotomies?

An episiotomy is an incision on the perineum that opens the vagina more to facilitate delivery of the baby.  It is not routine.  There are 2 reasons to perform an episiotomy:  to speed up the pushing stage of labor or to prevent a bad tear.  If the doctor feels that an episiotomy is indicated, he or she will discuss this with you at the time of delivery before performing one.

 

The Hospital Room

Rex allows patients to have three support people with you at any given time.  If any of these three people are children under the age of 12, there has to be an adult present as a caregiver for that child.  The purpose of the support person is to support the mother during her labor and her delivery.  It is not to witness the birth.  So, please try to remind your support people of this whether you are having a vaginal delivery or a C-section.

Rex does not allow videotaping of the actual delivery.  In the event of a C/Section, they will not allow any sort of photography or videotaping in the operating room.  For more information about the hospital’s policy on photography and/or video recording, please contact Rex Hospital.

 

Circumcision

If you would like your son circumcised, our doctors will do this on postpartum day 1 or 2, after the pediatrician has evaluated the baby and placed him on the “circ list”.  Our doctors will discuss the procedure as well as the pros and cons of injectable analgesia with you prior to doing the circumcision.  There are two basic techniques for doing circumcision and each doctor has a preferred method with which he or she is most comfortable.  Both are safe and effective techniques for removing the foreskin.  If the doctor performs the procedure using the Plastibell® technique, a plastic ring will be inserted under the foreskin and a suture tied tightly around the ring.  After a few days, the foreskin will fall off with the ring.  If the doctor uses the Gomco® technique, the foreskin is removed at the time of the procedure and the head of the penis (the prepuce) wrapped in Vaseline gauze.  Each time you change your son’s diaper, you should rewrap the prepuce with Vaseline gauze or dab a small amount of Vaseline onto the prepuce to keep it from sticking to his diaper.  After several days, the prepuce will be covered with a smooth, dry layer of cells that will not stick to the diaper and you can stop using the Vaseline. *Remember to wash your hands before and after cleaning!

 

When Will I Go Home After Delivery?

Following vaginal delivery, most patients go home on postpartum day 2.  Following c/section delivery, patients usually go home on postoperative day 3 or 4.

 

When Will You See Me for My Postpartum Visit?

Don’t worry about scheduling a postpartum appointment.  We will take care of that for you.  After you leave the hospital, we will contact you with your postpartum appointment either by phone, patient portal message or postcard.  If we choose a bad day for your appointment, feel free to contact the office to reschedule.

 

When Can I Return to Work Following Delivery?

Most patients require 6 weeks disability following delivery.  You may wish to take additional family or maternity leave, but this is something you should discuss with your employer.  If you need disability forms or FMLA forms completed, please bring these to the office early in your pregnancy, before delivery, to prevent delays. (There is a fee of $20 for completion of forms.)

 

What Kind of Activity Can I Do Following Delivery?

You may resume most of your usual activities once you feel up to them.  You should avoid driving for one week following a vaginal delivery and 2 weeks following a c/section and only if you aren’t taking narcotics for pain.  You can walk and go down steps.  You can shower.  No heavy lifting after a c/section for 2 weeks. If you tire during an activity, stop to rest.  If you are breastfeeding, you should drink a glass of water or milk each time you feed the baby, otherwise you may get dehydrated and decrease your milk supply.  You should put nothing in the vagina until after your postpartum visit. Remember, your vaginal bleeding will gradually decrease, but may last 6-8 weeks.

 

Postpartum Depression

Postpartum depression can affect anyone.  Women who have a history of depression are at an increased risk.  Postpartum depression has also been known as baby blues or postpartum blues.  During the first 5-10 days after delivery, many women develop baby blues or postpartum blues.  Symptoms can include mild depressive symptoms such as generalized dissatisfaction with life, insomnia, exaggerated changes in mood and decreased concentration. If you experience any of this, it is normal and will usually last a few days.  If you have experienced any of these that are persistent and occur nearly every day, please contact our office.  There are things we can do to help.  Don’t be afraid to reach out.

Reviewing the questions below, may also help you determine if you need a little extra help.

How often have you been bothered by any of the following problems?

  1. Little interest or pleasure in doing things?
  2. Feeling down, depressed, or hopeless?
  3. Trouble falling or staying asleep or sleeping too much?
  4. Feeling tired or having little energy?
  5. Poor appetite or overeating?
  6. Feeling bad about yourself or that you are a failure or have let yourself or your family down?
  7. Trouble concentrating on things, such as reading the newspaper or watching television?
  8. Moving or speaking so slowly that other people could have noticed? Or the opposite, being so fidgety or restless that you have been moving around a lot more than usual?
  9. Thoughts that you would be better off dead or of hurting yourself in some way?

Let us know if you feel you need help!

 

UNC/REX Healthcare Pre-Registration

Don’t forget!  Please make sure you have completed your pre-registration information at Rex Hospital.  The last thing you want to do when you are in active labor is recite your mother’s maiden name and social security number to hospital staff.  Plus, if you plan on having an epidural during your labor, you must have all of your blood work results back and evaluated prior to getting that epidural. Rex will not perform any blood work until your registration is complete. 

Visit www.rexhealth.com/maternity to pre-register online or you can download and mail completed registration forms. Registration is due at least 60 days prior to your due date. For information, call (919) 784-3257.

 

Please let us know if there any questions we haven’t answered for you in at this point.  We wish everyone a healthy, happy labor and delivery.

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