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WelcomeA guide to your pregnancy & delivery careLandstuhl Regional Medical CenterGermany

MissionYour partner in care; the first choice for comprehensivewomen’s health and newborn care in theEuropean military community.VisionTo maximize the patient experience throughcollaboration; building relationships and nurturing trust.2

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Table of ContentsTabletoofClick belowgo Contentsdirectly to section Obstetrics & Gynecology Clinic . . 5 Visitation Policy & Hours of Operation 22When to Come in to L&D. . 23Hospital Checklist . . . 26Options for Pain Control . . . . . 28Cesarean Section Information . . 30What to Expect after Delivery . 31Lactation Services 32Mother Baby Unit (MBU) . 33 67101113141618Labor and Delivery (L&D) . 21 Useful Phone Numbers & Hours of Operation .Directions & Parking .OB Appointment Schedule .Immediate Concerns Your Birth Plan . . . . Group Prenatal Care Pre– Birth Registration . .Frequently Asked Questions .Visiting Hours & General Information. . 34Infant Safety . 35Postpartum Care. . . . . 36Caring for Baby . . 40Feeding (Breastfeeding & Formula Feeding). . 41Routine Testing for Baby . 44How to Swaddle . . 46Follow Up Appointments . 47Signs & Symptoms to Watch Out For . 48Car Seat Safety Tips . 49Neonatal Intensive Care (NICU) . 50 Introduction . . 51NICU Staff . . . 524

OB/GYN ClinicLandstuhl Regional Medical CenterPhone: 06371-9464-5839DSN: 590-58395

Useful Phone Numbers andHours of OperationEmergency Dept. 06371-9464-6322Urgent care before 20 weeksOpen 24/7Labor & Delivery 06371-9464-6343Urgent care after 20 weeksOpen 24/7LRMC Ancillary ServicesLab06371-86-7500Monday—Friday 0630-1630Pharmacy06371-9464-5223Monday—Friday 0800-1900UltrasoundSaturday0900-1300Training days0800-170006371-9464-5280Monday—Friday 0730-16306

Welcome to LRMC OB/GYN Clinic Hours of OperationMonday — Friday 0730-1630Closed Federal Holidays Directions to the hospital can be found tions.cfmThe clinic will also close for hazardous roadconditions (black category) as noted taff org/safety/road conditions/default.aspx Expectant Mother parking is available closest toOB/GYN Clinic on the Southeast/back side ofLRMC.Additional patientparking is locatedwithin the greenperimeter fencingsurrounding thehospital7

LRMC OB/GYN provides a full rangeof patient services to include: Routine Prenatal Care Group Centering Prenatal Care High Risk Prenatal Care - MFM Clinic Genetics Counseling & Screening Infertility Care Women’s Care Clinic Complex Gynecology Care8

Your TeamClinic staff consists of a team of professional providers andsupport staff who are committed to serving your health careneeds and hope to provide you the best experience possible!Obstetrician/Gynecologist (OB/GYN) - Specialized physicianswho provide comprehensive reproductive and gynecologichealth and treatment needs throughout a woman’s lifespan.Maternal Fetal Medicine (MFM) Specialist - Provider who isavailable, by referral, for certain health history or conditionsthat could complicate pregnancy, for consultation or closermonitoring in pregnancy.Certified Nurse Midwife (CNM) - Master-prepared orDoctorate-prepared practitioners who specialize in preconception and prenatal care, intrapartum labor anddelivery, and follow up postpartum health.Women’s Health Nurse Practitioner (WHNP) - Masterprepared or Doctorate-prepared practitioners who provide awide range of women’s health services, including routinegynecological and reproductive care throughout a woman’slifespan.The Division of Women’s Health & Newborn Care Teamincludes registered nurses (RNs), certified sonographers,health technicians, and medical support assistants (MSAs)who all work closely together to meet your health careneeds.9

Routine OB Appointment Schedule 8-10 weeks: Nursing Appointment (health history,basic patient education, and introduction to care) 10-12 weeks: First Provider Appointment (completephysical exam, dating ultrasound, lab results, reviewhealth history, and discuss pregnancy plan of care) 16-18 weeks: Routine check-up, *formal ultrasoundordered by provider, scheduled by patient:*18-22 weeks formal anatomy and growth scan byRadiology Department (06371-9464-5280) 24 weeks: Routine check-up, lab test/screening forgestational diabetes (Glucose Tolerance Test) 28 weeks: Routine check-up, Rhogam administeredif needed, fetal kick-counts and pre-term laborprecautions discussed 32 weeks: Routine check-up 36 weeks: Routine check-up and GBS screening 38 weeks until delivery: Weekly routine check-ups,additional appointments as needed10

Immediate ConcernsShould you have any medical concerns or problemsduring your pregnancy that need evaluation, pleaseconsider the following: Prior to 20 weeks gestation: If you develop acute pelvicpain, vaginal bleeding, persistent cramping, or for otherurgent or emergent care, please go to the EmergencyDepartment. If you have bleeding that saturates morethan 1 pad an hour please do not drive yourself; if you donot have another driver, call 112 for emergency medicaltransfer (EMT) transfer. After 20 weeks gestation: If you develop acute pelvicpain, vaginal bleeding, decreased fetal movement, or pre-term contractions please go to Labor and Delivery.When possible, please call L&D at 06371-86-8208 prior toyour arrival. For other urgent care not related topregnancy, please go to the Emergency Department. Routine Care: You will continue to address any concernsnot related to pregnancy with your primary care provider(PCM) (such as cold and flu symptoms, fatigue, generalinjuries, etc.). For pregnancy– related questions orconcerns, you may call or come in to the clinic to speakwith a nurse.11

Planning AheadPregnancy can mean many different thingsfor different individuals or families and mayinclude very personal choices. It is importantto discuss any special considerations withyour providers and nurses early in pregnancy.Some Considerations May Include: Optional Genetic ScreeningEducation and counseling from a provider to help informyour decision on genetic screening is provided. Cord Blood BankingPatients are encouraged to research ahead and coordinateearly in pregnancy to ensure the kit will arrive in time fordelivery. Staff may assist with the collection of samples. Disposition of PlacentaPatients requesting the option for placenta release shouldnotify the provider and begin coordination by the 28-weekappointment, signing a “Release of Placenta and Waiver ofLiability” form and planning any specific instructions.12

PLEMSAYour Birth PlanA birth plan is a simple and clear document that informsyour medical team of your labor and birth preferences. Ifyou choose to provide a written plan, please discuss thiswith your providers in advance so we can plan ahead tosupport your preferences as best possible!13

Group Prenatal CareSome Highlights Include: Small groups of 8-10 moms/couples with close duedates; spouses are encouraged to attend!Longer group appointments that allow for sharedlearning and getting to know each otherAppointments scheduled for the duration of pregnancyand postpartum follow upGuest speakers to cover special topics such asnutrition, physical activity, breastfeeding, and yourlocal community resourcesComprehensive education in a group setting followedby a shorter, individual appointment14

Storknest ProgramLRMC OB/GYN Clinic is honored to support a specialhost-program for the management of pregnancy,labor, and delivery for patients throughout Europeand Africa for routine or high-risk OB care.For details, follow .cfm?MTFinfo id 834Communication TechnologyArmy Medicine Secure Messaging Service(AMSMS, Relay Health)1. Register at: http://www.relayhealth.com/ with yourPrimary Care Clinic.2. PCM refers you to OBGYN Clinic.3. OB/GYN Clinic accepts you to our practice.4. Begin messaging with your health care team for anyroutine needs. (Such as: prescription refills, lab results,appointment requests, or other clinical questions asneeded)15

Pre-Birth RegistrationPatient Administration OfficeIt is important to pre-register the birth anytime duringyour pregnancy. Please contact the PAD Office to makean appointment.Landstuhl Regional Medical CenterBirth RegistrationBldg. 3766 Patient administration Division (PAD)Commercial: 06371-9464-7053DSN: 590-7053Hours of Operation:Monday-Friday0900-1145 & 1300-1600Walk-ins available; appointments RTHREGISTRATION@MAIL.MILIf you deliver off-post, you must contact the local Rathaus toschedule an appointment for a German birth certificate andare not required to register with LRMC Birth Registration.16

PAD InstructionsStep 1: Make an appointment to pre-register for labor*Completing this paperwork will ensure that when you comein to the hospital to deliver, the Admissions Office will have allof your admission paperwork completed and ready for birthregistration.Step 2: Fill out Form AE 40-400B Report of Child Born Abroadof American Parent(s) sections I and II.This is the hospital notification of the newborn’s birth. It isrequired to register your child in DEERS, TRICARE, Passport,Consular Report of Birth, and Command Sponsorship.Step 3: Please bring the below required documents to yourpre-birth registration appointment.Required Documents: Military ID Cards Passports (for both parents) Marriage Certificate (original certified copy) Birth Certificate (if you do not have a passport) Affidavit for Mother/Affidavit of Parentage (single parent) Denial of Paternity –Affidavit (husband is not the father) AE 40-400B –Please have filled out prior to appointmentStep 4: After delivery, Birth Registration will visit you in thehospital to complete the process. If it is the weekend, you willneed to make an appointment to complete the process.17

Frequently Asked QuestionsIs there another way to contact the OB/GYN clinic?Please call us at 06371-9464-5839 or DSN 590-5839. We are openfrom 0730 to 1630, Monday through Friday. We are closed on federal holidays and weekends. Clinical questions or concerns will betriaged by a RN; urgent issues will be addressed within 24 hours orsooner if indicated, and more routine calls are returned within 72hours. For emergencies, please call 112 for Emergency MedicalServices or proceed to the nearest Emergency Room.Is there any information on classes available for new parents?Yes. There are many LRMC and KMC resources available. Pleaseask one of our MSAs at your next appointment, and they can giveyou an updated handout of current offerings. If you would like thissent to you via email, please contact us through AMSMS/RelayHealth and we will forward the information.Can I bring my child to my appointment?Yes, but for routine appointments only. Children are not permittedin NST clinic, for BPP or sonographer appointments, or for any complex appointments such as LEEP or colposcopy procedures. Wealso ask that you please not bring children to genetics classes orcounseling appointments. Contact Army Child Youth Services regarding hourly childcare.Can I see another provider?Absolutely. After your appointment, please speak with a MSA andthey will be happy to assist you in scheduling an appointment withanother provider.18

Frequently Asked QuestionsI have been waiting on hold for a long time. Is there another wayto get hold of your office?Yes, there is! Please sign up for AMSMS/Relay Health to emailyour care team for routine needs such as lab results, to request anappointment, or for other simple questions. This is a useful optionfor secure communication at your convenience!Why is the phone wait time sometimes so long?Clinic MSAs check-in patients, verify and update patient contactinformation and insurance records, and schedule appointments viatelephone and during check-out for all OB/GYN patients and newreferrals. MSAs also enter telephone (TCON) messages to the RNsfor any clinical questions or concerns, as well as direct all othercalls appropriately. Calls may often take up to five minutes eachand can result in longer wait times. Routine Well Woman and Papexams can also be scheduled by the central appointment line ifyou are experiencing delays.Who can I talk to if I have a concern?Please ask to speak with the Clinical Nurse Officer in Charge or theAssistant Nurse Manager. If they are not available, please contactthe Landstuhl Patient Advocacy Office for assistance. You may alsosubmit an ICE comment, which will be forwarded to our PatientAdvocacy Office, as well as the Officer in Charge. You have theoption to leave contact information if you would like a response.19

Frequently Asked QuestionsI received a survey after my appointment. Do I really need to fillthis out?We hope you do! The surveys provide useful feedback for ourclinic, in which we use to improve processes and make it a betterplace for you and fellow patients. Additionally, each returnedsurvey generates revenue specifically for the OBGYN patientexperience. We are able to use this extra funding for improvementprojects suggested by you!How do I get my records from a civilian provider here to LRMC?Please contact the Patient Administration Office/Medical Recordsdepartment at 06371-94645204. You will need to know theHospital and provider’s name and location, as well as the dates youreceived care.I am getting ready to PCS. How do I get my records transferred?Your records can be accessed electronically immediately at the nextMilitary Treatment Facility (MTF). If you are separating ortransferring to a location without a military hospital or clinic, pleasego to the Patient Administration Office within three weeks of yourPCS and they can provide you with a printed record.20

Labor and Delivery Unit (L&D)Landstuhl Regional Medical CenterPhone: 06371-9464-6343DSN 590-634321

BLDG3711Welcome to L&DWe are located on the 2nd floor in building 3711, just above theEmergency Department. Calling before you arrive allows us to beprepared for your visit.VISITATION POLICY AND HOURS OF OPERATION:We have a 24 hour open visitation policy for patients on L&D. Thisincludes your support person and siblings, depending on thepatient’s desires. All other guests are at the discretion of L&D staff.Visitors must sign in at the front desk and provide identification.Children are allowed in the room as long as there is anothercaregiver other than the patient. Please coordinate childcarearrangements prior to admission if necessary.22

When to Come in to L&DWe encourage all patients to visit us if there is a concern aboutthemselves or their baby. Please feel free to call L&D anytime ifyou have concerns: 06371-9464-6343. Patients less then 20weeks gestation will be seen in the Emergency Room.Call L&D unit if you experience any of these symptoms: Change in vaginal discharge (such as change in color of mucous,especially blood tinged) with persistent low, dull backache orlow back pain or pelvic pressure 4 or more contractions per hour, if less than 37 weeks Regular painful contractions every 3-5 mins, if over 37 weeks(after 1 hour of rest and increased water intake) If you think your water broke (small continuous trickle, or biggush of fluid) Decreased fetal movement (make sure to perform kick counts;see next page for how to) A headache that does not resolve with Tylenol, increased waterintake, and rest. Vaginal bleeding Thoughts of harming yourself or others Any other urgent situations23

Fetal Kick CountsHow to perform fetal kick counts:Ensure you have adequate intake of water, lay on your side, andcount the number of fetal movements.Call L&D if: If you are less than 28 weeks and you experiencedecreased fetal movement that is enough to causeconcern You are over 28 weeks and you feel less than 10 kicks in a2 hour period24

What to Expect on L&DLocated in each room:Wireless internet TV and DVD player Private bathroomwith shower Recliner with seat for a guest Closet for storage of2-3 medium size bags Both 110 and 220 volt outlets25

Hospital ChecklistSUGGESTED PACKING LIST FOR L&DMOTHERSUPPORT PERSONCosmetic:Apparel:Cell Phone & ChargerBrushBath RobeCamera & ChargerHair TiesSocksMagazine or BookChapstickSlippersChange of Clothes x2ToiletriesComfy ClothesToiletriesFlip FlopsComfortable ShoesNursing BraID Cards/ WalletPaperwork:Birth PlanBABYJournalComforts from Home:Pen/pencilPillowGoing Home ClothesBlanketReceiving BlanketSnacks/ TreatsCar SeatBoredom Busters:Magazine or BooksBaby Book (for footprints)Laptop/iPadBaby Hat/ BowMittensWe will provide sanitary napkins i.e. peri-pads, meshpanties, peri-bottles, Dermoplast numbing spray,witch hazel pads, nipple cream, gowns, robes,towels, & washcloths for mother. For baby, weprovide baby wipes, diapers, hats, baby shampoo,and blankets for use during your hospital stay.26

DOULASA doula is a nonmedical person who assists themother-to-be before, during, and/or afterchildbirth, as well as her spouse, if needed byproviding physical and emotional support.RULES OF ENGAGEMENTDOULAS ON THE LABOR AND DELIVERY UNIT27

Options for Pain ControlThree main pain relief options include relaxation/breathingtechniques, IV pain medication, and epidural placement. Our staff can provide you with information regardingpositions, breathing techniques, and relaxation options.All labor rooms are equipped with a birthing and peanutball, squatting bar, and shower for hydrotherapy. If yourbirth plan involves specific strategies or requires specificequipment, we suggest you bring it with you. For many patients IV pain medication may be anexcellent option for short term pain control. L&D has full anesthesia services 24 hours a day.Anesthesia will visit and consent every patient perhospital policy, but this is not a contract binding you toany of their services. If requested and medically cleared,epidurals are available during labor.28

Meals provided while on L&D During latent “early” labor you may be allowed to eatregular meals. During active labor or on Pitocin: Clear liquids are offered,to include ice, water, broth, jello, and popsicles. After Delivery: Regular meals, as tolerated, are providedfrom our hospital menu.Labor and delivery unit provides ice, water, juice, jello,popsicles, broth, crackers, peanut butter, and milk.Ask your nurse about what is available.Other snacks may be available for purchase from a snack baror the vending machines.29

Scheduled Cesarean SectionStep 1: Pre-Register with PAD prior to scheduled C-sectiondate.Step 2: Call L&D the morning prior to your scheduledC-section to see what time is available for your pre-op.Pre-op includes lab work, meeting with Anesthesia toanswer any questions that you may have, and a meetingwith a nurse to ensure all of your pre-op paperwork iscompleted and review what to expect the day of surgery.Step 3: Call L&D at 0500 on the day of surgery to confirmyour arrival time.Step 4: Upon arrival to the hospital, the staff members willprepare you for the C-section.Note: We ask you to please not shave the night before, asthis increases your risk of post op infection. Your lowerabdomen and upper pubic area will be shaved withclippers prior to the surgery.**IN CASE OF AN EMERGENCY C-SECTION, staff will doeverything they can to keep you informed and provideyou the opportunity to ask questions30

What to Expect After Delivery After delivery of baby and your placenta, you will be givenPitocin through your IV to

counseling appointments. ontact Army hild Youth Services re-garding hourly childcare. an I see another provider? Absolutely. After your appointment, please speak with a MSA and they will be happy to assist you in scheduling an appointment with another provider. Frequently Asked Questions

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