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WHAT TO EXPECT WHEN HAVING YOUR BABYwith Kaiser Permanente

Welcome toKaiser Permanente’sFAMILY –CENTEREDMATERNITY SERVICESThis booklet will give you information on what to expect when having your baby with KaiserPermanente Hawaii. From pregnancy resources to newborn care, you will find all the information youneed as you plan for your baby’s arrival.During your pregnancy, a team of health care professionals will care for you. We are committed toproviding you with healthy prenatal care and a safe birth experience.Our services include: A dedicated team of clinicians, including obstetricians, midwives, pediatricians, and/or familypractitioners. A variety of classes before and after birth (such as birthing, newborn care, and more). Family–centered care: We encourage participation from your partner or support person, andinvolve siblings through classes, tours, and visits. Obstetrically–trained advice nurses to answer questions. Open visiting hours for your support system. 24–hour "rooming–in" for mother/baby care. Lactation services for complete breastfeeding education and support. Neonatal Intensive Care Unit (NICU) for babies with special needs. Intensive Care Unit (ICU) for mothers with special needs. Mom and Newborn Center visits for early follow–up of mothers and newborns after discharge.We look forward to caring for you and are here to discuss any questions or concerns you may have.Remember, it is very important for your health and for your baby’s health that you make and keep allappointments.Congratulations! We look forward to caring for you.Sincerely,Kasier Permanente Departments of: Obstetrics and GynecologyFamily PracticePediatricsPerinatal Services

TABLE OF CONTENTSOur Philosophy 3The Hospital Experience 21Clinics and Clinicians 4Preparing to Go to Kaiser PermanenteMoanalua Medical Center Obstetrical Clinics 4Pediatric and Family Medicine Clinicians 4Labor and Delivery Certified Nurse–Midwives 5What You Can Expect 23Procedures and Your Birth Experience 24Your Care Team and the NICU 242123Pregnancy Resources 6Routine Tests 6Tips for Having a Healthy Baby 6Mother/Baby Care Healthy Weight Gain During Your Pregnancy 7The First Few Hours after Birth Nutrition During Pregnancy 8Breastfeeding 27Healthy Food Choices 9Welcoming Visitors 27Caring for Baby While in the Hospital 28Guide to Eating Fish Safely 11Newsletters, Online Tools, and Videos 12Recommended Classes 12Making Important Decisions 13Things to Consider in Your Second Trimester 13Things to Consider in Your Third Trimester 13Cord Blood Banking 14Vaginal Birth After Cesarean Section (C-Section) 14Working During Pregnancy 14Maternity Leave andTemporary Disability Insurance (TDI) 15Your Birth Plan 16Important Safety Information 19Counting Your Baby’s Kicks 19Non–Stress Test 19Pregnancy Danger Signs 20Preterm Labor Warning Signs 202525Preparing to Go Home 29Health Plan Coverage for Your Baby 29Infant Car Seat 30Discharge from the Hospital andSupport at Home 31Your First Month as a New Parent 32Postpartum and Newborn Visits 32Birth Control and Family Planning 32Important Contact Information 34Phone Numbers 34Obstetrical Clinic Locations 34Labor and Delivery Unit Location 34Kaiser Permanente Family-Centered Maternity Services1

Kaiser Permanente is committed toensuring that all mothers, babies,and families have a healthy and safebirth experience.2kpfamilybirthcenter.org

OUR PHILOSOPHYAt Kaiser Permanente Hawaii, we respect every woman’s individuality andpersonal preferences. We support women who would like a birth that is unmedicated, andadvocate for having persons present to help and support this decision. We support women who prefer a birth that is as pain–free as possible byusing medicine for pain or epidural anesthesia at a suitable time in labor. We strongly recommend childbirth preparation classes. Childbirth classeshelp develop the skills necessary to deal with early labor. We recommendclasses even if women plan on using pain medication during delivery. We support movement while in labor as it often helps labor to progress. We do not order routine enemas, shaves, or episiotomies. We recommend that you attend a tour of the Labor and Delivery unit tofamiliarize yourself with the hospital. We support skin–to–skin contact for mothers and babies during the firsthour after birth to help babies transition to life outside the womb. We promote breastfeeding, providing education and lactation support toevery new mother and baby.Kaiser Permanente Family-Centered Maternity Services3

CLINICS AND CLINICIANSObstetrical ClinicsFor pregnancy care, you may choose an obstetrics–gynecology (ob–gyn) clinician at these locations:Honolulu Medical Office1010 Pensacola StreetHonolulu, HI 96814Koolau Medical Office45-602 Kamehameha HighwayKaneohe, HI 96744Waipio Medical Office94-1480 Moaniani StreetWaipahu, HI 96797For appointments, call 808-432-2000.Most locations are open Monday through Friday,from 8 a.m. to 5 p.m.Kahuku Clinic56-565 Kamehameha HighwayKahuku, HI 96731Kailua Clinic201 Hamakua Drive, Building BKailua, HI 96734Kapolei Clinic599 Farrington HighwayKapolei, HI 96707Koolau Medical Office45-602 Kamehameha HighwayKaneohe, HI 96744Mapunapuna Medical Office(Family Medicine only)2828 Paa StreetHonolulu, HI 96819The ob–gyn clinician team is made up of apartnership between doctors, midwives, and nursepractitioners. Nutritionists, social workers, andother specialists may also play a part in your care.For more information about our doctors, go tokp.org/searchdoctors.Nanaikeola Clinic87-2116 Farrington HighwayWaianae, HI 96792Pediatric and Family Medicine CliniciansFor appointments, call 808-432-2000.Most locations are open Monday through Friday,from 8 a.m. to 5 p.m.For your baby’s care, you may choose a pediatric orfamily medicine doctor at these locations:Hawaii Kai Clinic6700 Kalanianaole Highway, #111Honolulu, HI 96825Honolulu Medical Office1010 Pensacola StreetHonolulu, HI 968144kpfamilybirthcenter.orgWaipio Medical Office94-1480 Moaniani StreetWaipahu, HI 96797Start thinking about your baby’s doctor early in yourpregnancy. We recommend that you choose yourbaby’s doctor by your seventh month of pregnancy.For more information about our doctors for keiki andfamilies, go to kp.org/searchdoctors. You may wantto make an appointment and meet with the doctorbefore your baby is born. And make sure to informyour obstetrical clinic about your choice.

Certified Nurse–MidwivesOur team of certified nurse-midwives works with the ob–gyn doctors to ensure you and your baby experiencethe safest and most satisfying “birth day” possible.Q: What is a Certified Nurse–Midwife?A: Certified Nurse–Midwives (CNMs) are registerednurses with master’s degrees in nursing. Thephilosophy of the maternity team is to listen topatients and respect their choices. Our CNMsare committed to providing you with a safe andhealthy birth experience that meets your personalgoals and expectations.Q: What services do CNMs provide?A: CNMs are highly trained professionals whoprovide a full range of primary health care servicesfor women — from adolescence through andbeyond menopause. This includes gynecologic,family planning, and obstetric care services.Obstetric services include: comprehensiveprenatal care, managing and delivery ofpregnancies, and providing postpartum follow–up. CNMs are also licensed to write prescriptionsfor certain medications and health care products.Q: Will I also see a doctor?A: Our ob–gyn doctors and CNMs are part of a fullyintegrated team and will provide the best carepossible for you and your baby.The CNMs work side-by-side with ob–gyn doctorstogether as a maternity care team. An ob–gyn isalways available at the Moanalua Medical Centerto assist if complications should occur.Q: Is there an additional copayment or feefor a CNM?A: If you have a routine pregnancy, there is no chargefor midwifery care.Q: How do I make an appointment to see a CNM?A: Call your clinic to schedule a prenatal or ob–gynappointment any time with one of our CNMs.Kaiser Permanente Family-Centered Maternity Services5

PREGNANCY RESOURCESRoutine Tests and Tips for Having a Healthy BabyVarious tests may be ordered depending on your condition. Talk with your clinician, and go tokp.org/pregnancy for more information. Let your clinician know if you have questions or concerns.WHENEarlyPregnancy15 to 18Weeks19 to 25WeeksROUTINE TESTS Blood type, Rh, antibody screen CBC, VDRL/syphilis . IgG Rubella screen Hepatitis B screen HIV screen (optional) Urinalysis Genital cultures Pap test TB test as needed Urine drug screen Early glucose screening (asdetermined by your clinician) Early genetic screening (asdetermined by your clinician) 26 to 28Weeks29 to 40Weeks6TIPS FOR HAVING A HEALTHY BABY Take a prenatal vitamin containing folic acid 0.4mg (400 mcg) daily to lower the risk of having ababy with spine or brain problems. Eat a variety of healthy foods. Limit caffeine intake. Quit tobacco. Support and medicines areavailable. Ask your clinician or call 808-643-4622. Do not drink alcohol or use illegal drugs. Do not take any medicines or over–the–counterdrugs without the advice of a clinician who knowsyou are pregnant. Get plenty of rest. Try eating smaller meals 4–6 times a daythroughout your pregnancyEarly genetic screening (asdetermined by your clinician) Drink 8–10 glasses of fluids a day.Water is recommended.Perinatal ultrasound:Fetal anatomy scan Exercise. Get regular prenatal care.Perinatal ultrasound:Fetal anatomy scan Wear low–heeled shoes or flats with arch support. If you must stand for long periods of time,wear comfortable shoes and make sure to takerest breaks. Tell your clinician about any travel plans. Attend pregnancy and childbirth classes. Do not skip meals; keep healthy snacks around toeat during the day. Average weight gain is about 1 pound per week. Minimize stressful situations in your life.Hemoglobin/hematocrit Glucose screening Blood test if Rh negative RhoGAM injection if Rh negative Group B strep culture Get extra rest. Don’t push yourself. Tdap vaccine Take a break every few hours during the day. Influenza(at any time during flu season) Do fetal kick counts daily. Watch for signs of preterm labor and pregnancywarning signs before 37 weeks.kpfamilybirthcenter.org

Healthy Weight Gain During Your PregnancyHow much weight should I gain during pregnancy?Healthy weight gain varies depending on your body mass index (BMI) beforeyou became pregnant. BMI helps to determine if your weight is appropriateaccording to your height. Find an online BMI calculator at kp.org/calculators.Pre–PregnancyBMILower than 18.518.5 to 24.925 to 29.5Recommended TotalWeight Gain (lbs.)28 to 4025 to 3515 to 25Rate of Weight Gain in 2nd and3rd Trimesters (lbs. per week)*110.611 to 200.530 or higherThe information inthe following sectionsare not intendedto diagnose healthproblems or to take theplace of medical adviceor care you receivefrom your clinician. Ifyou have existing healthproblems or specialconcerns, please consultwith your clinician.* This assumes a gain of less than 5 lbs. during the first trimester.YOUR TARGET WEIGHT GAINYour pre–pregnancy weightYour BMIWeight gain so farTarget total weight gain(for entire pregnancy)What “eating for 2” really means You may have heard the term “eating for 2,” but incalorie terms, it’s probably more accurate to saythat a pregnant woman is eating for 1.15 people. During pregnancy, your body only needs 200 to300 extra calories a day, which is about an extrahalf of a peanut butter sandwich and a glass ofskim milk. Gaining more weight than recommendedincreases your risk of having a larger baby. This can lead to serious complications duringvaginal delivery and an increased risk ofC–section. Excess weight gain can also lead to additionalhealth conditions. These include gestationaldiabetes and high blood pressure, which cancause complications. If you have a BMI of 30 or higher, eatingadditional calories is not necessary for the healthof your baby.Adapted with permission from copyrighted material ofThe Permanente Medical Group, Inc., Northern California.How to achieve a healthy weight duringyour pregnancy Try walking, swimming, or yoga to give youenergy and help control your weight gain. Avoid sweetened drinks (juice, soda, coffeedrinks), fried foods, and desserts. Watch our prenatal nutrition video atkp.org/mydoctor/prenatalnutrition.Healthy weight pregnancy meal plan During your pregnancy, eat 5 to 6 small, balancedmeals per day. Try eating a meal or snack every 3 or 4 hours. This meal plan is designed to keep your bloodsugar levels from going too high, which is oneof the most important things you can do tomanage your weight gain and prevent gestationaldiabetes for a safe pregnancy and a healthy baby.Kaiser Permanente Family-Centered Maternity Services7

Nutrition During PregnancyHealthy Pregnancy PlateA healthy pregnancy depends on ahealthy lifestyle. This includes: eating a balanced diet staying well hydrated and getting physical activitymost days of the week.Strive to build a plate like this atevery meal. Select a 9–inch plateand use this guide to help keepyour portions in control.GRAINS and STARCHESMake a little more than ¼ of yourplate whole grains or starches.PROTEINMake a little less than ¼ ofyour plate lean meat or otherprotein foods.FRUITS and VEGETABLESMake ½ of your plate fruitsand vegetables.123456789Healthy Habits 8kpfamilybirthcenter.orgPractice mindful eating-- Choose food that is satisfying and nourishing-- Sit at the table in a relaxed environment-- Tune into your hunger and fullness levels.Stay hydrated. Aim for 64 ounces ofwater per day.Move more. Exercise daily or most days of theweek. The benefits are endless.Choose fruit as your sweet treat. Limit foods andbeverages with added sugars.Adapted with permission from copyrighted material ofKaiser Foundation Health Plan, Inc. of the Northwest.

Healthy Food ChoicesExamples of mini–meals and snacks withapproximately 200 to 300 caloriesThinking for 2, versus eating for 1In general, most women need 1600 to 2000calories per day. During the second and thirdtrimester of pregnancy, your calorie needsgo up by only 200 to 300 calories per day.Eating a meal or snack every 3 to 4 hourscan help: Prevent nausea Control appetite Keep your energy levels up:-- Throughout pregnancy-- During labor and delivery-- After you have your baby 1 piece of fruit with 1 to 2 tablespoons peanut butter1 slice whole–grain toast with avocado¼ cup nuts or seeds with a piece of fruitCarrot sticks with ½ cup hummus½ of PB&J or tuna fish sandwichHandful of tortilla chips with ½ cup cottagecheese and salsaSmoothie — blend 1 cup yogurt with ½ cup berries4 to 6 whole–grain crackers with 1 ounce cheeseCarton of Greek yogurt with ¼ cup granolaand berriesFRUITS ANDVEGETABLESPROTEIN–RICHFOODSSTARCHES(grains and starchy vegetables)Choose6 or moreservings per dayChoose7 to 11 servingsper dayChoose5 to 8 servingsper dayOne serving is: 1 cup rawvegetables ½ cup cookedvegetables 1medium fruit 1 cup fruit 3–4ounces juiceOne serving is: ½ cup beans, split peas,or lentils ½ cup tofu or tempeh ¼ cup nuts or seeds 2 tablespoons peanut oralmond butter, or tahini 1 ounce pasteurizedcheese (Swiss, mozzarella,queso fresco, cheddar) ¼ cup cottage orChoose 2–3 fruitsricotta cheeseand 4 or more ½ cup Greek yogurtvegetables for 1 cup regular yogurtoptimal nutrition 1 eggand fewer calories 1 ounce fish, seafood,*skinless chicken or turkey,or lean cuts of beef or porkOne serving is: ½ cup beans, corn, peas,taro, or potatoes (Yukongold, red, sweet) 1 cup winter squash 1/3 cup cooked brown rice,quinoa, buckwheat, millet,or pasta/noodles (1 cupcooked 3 servings) 1 slice whole–wheat orsourdough bread ½ cup cookedcereal (oatmeal) 4–6 whole grain crackers 2–3 corn tortillas 1 whole–wheat tortilla 3 cups popped popcornCALCIUM–RICHFOODSChoose3 servings per day to getthe recommended 1000milligrams of calciumOne serving is: 1 cup (8 ounces) milk 1½ ounces cheese 8 ounces yogurt 1 cup calcium–fortified soy, rice, oralmond milk ½ cup calcium–set tofu 1½ cups cookedkale, bok choy, turnipgreens, mustardgreens, beet greens,or broccoli 1/3 cup soy nuts 2 cups white beansFATSChoose4 to 7 servingsper dayOne serving is: 2 tablespoons avocado 1 teaspoon olive,canola, or peanut oil 5 olives 1 tablespoonnuts or seeds 1 teaspoon peanut,almond, sunflowerseed butter, or tahini 1 tablespoonsalad dressing 1 teaspoon butter 2 tablespoons cream,half and half, orsour cream 1 tablespooncream cheese* Seafoods that are rich sources of omega–3 fatty acids include mackerel, salmon, albacore tuna, sardines, and lake trout. For more informationon safe and healthy seafood choices, visit seafoodwatch.org.Adapted with permission from copyrighted material ofKaiser Foundation Health Plan, Inc. of the Northwest.Kaiser Permanente Family-Centered Maternity Services9

REAKFASTThe chart below provides healthy ideas and serving sizes for snacks and meals. When you’re deciding whatto eat for your meals and snacks, be sure to choose a variety of items — and include plenty of vegetables andfruit. Try to limit excessive sugar, carbohydrates, and packaged food items. And as always, check with yourclinician if you have special health or dietary needs.Protein group1 egg OR2 egg whites OR1 cup nuts OR1–2 Tbsp. peanut butter OR1 oz. lean meat OR1–2 oz. cheese1 oz. lean meat, chicken, orfish OR¼ cup cottage cheese OR1 oz. cheese OR¼ cup paneer (Indiancheese)2 oz. meat, chicken, fish,or shellfish (crab, clams,lobster, or shrimp) OR½ cup cottage cheese OR2 oz. light tuna canned inwater OR1 cup tofu OR2 oz. cheese1 egg OR2 egg whites OR1 oz. lean meat OR1 oz. cheese OR¼ cup nuts OR¼ cup cottage cheese3 oz. chicken, turkey, beefor lamb OR3 oz. cooked fish OR1½ cups tofu OR¾ cup tempeh OR¾ cup paneer OR4 medium sardines OR2 Tbsp. grated parmesancheese1 oz. cheese OR1 oz. lean meat OR1–2 Tbsp. peanut butter OR¼ cup cottage cheeseVegetable group †As desiredAs desiredFruit groupMilk group1 cup milk OR1 cup low–fatplain or light soymilk with calciumOR6 oz. plain yogurt½ large banana OR½ cup mango OR1 small piece fresh fruit(tennis ball size) OR1 cup diced cantaloupe OR½ large grapefruit1 slice whole grain bread OR6 (2”) whole-wheat crackers OR1 (6”) corn or wheat tortilla OR1 (6”) chapatti OR½ (6”) pita OR1 cup poha (rice flakes)1 cup starchy vegetables* OR2 slices whole grain bread OR2 (6”) corn or wheat tortillas OR2/3 cup cooked pasta, cooked rice,or baked beans OR1 medium potato OR½ (8x2") naan OR2 (6”) chapattis OR1 cup cooked beans or lentils OR1/3 cup cooked taro or lotus root1 slice whole grain bread OR6 (2”) whole-wheat crackers OR1 (6”) corn or wheat tortilla OR1 (6”) chapatti OR1½ cups puffed rice OR½ (6”) pita2 cups raw leafyvegetables (lettuce,spinach, kale) OR1 cup raw or cookednon–starchy †vegetables2 cups raw leafyvegetables (lettuce,spinach, kale) OR1 cup raw or cookednon–starchy †vegetables2 cups raw leafyvegetables (lettuce,spinach, kale) OR1 cup raw or cookednon–starchy †vegetablesAs desiredStarch group1 slice whole grain bread OR½ cup cooked oatmeal OR1 (6") corn or wheat tortilla OR½ whole-wheat English muffin1 small piece fresh fruit(tennis ball size) OR17 small grapes OR1¼ cups cubed watermelon1 cup milk OR1 cup low–fatplain or light soymilk with calciumOR6 oz. plain yogurt2/3 cup cooked pasta, cooked rice,or baked beans OR1 whole-wheat dinner roll and½ cup cooked corn, peas, orwinter squash* OR1 small potato (tennis ball size)and ½ cup cooked starchyvegetables* OR1 cup cooked dhal (lentils)orlegumes1 cup milk OR1 slice whole grain bread OR1 cup low-fat plain 6 (2”) whole-wheat crackers ORor light soy milk½ cup cooked oatmealwith calcium* Starchy vegetables: corn, peas, winter squash, potatoes, beans, plantains, and yams.† Non–starchy vegetables: lettuce, cucumber, cabbage, radishes, celery, mushrooms, zucchini, bell peppers, chili peppers, bok choy, broccoli, spinach,eggplant, and okra10 kpfamilybirthcenter.orgAdapted with permission from copyrighted material ofThe Permanente Medical Group, Inc., Northern California.

Guide to Eating Fish SafelyADVICE ABOUT EATING FISHWhat pregnant women and parents should knowWhat is a serving?To find out,use the palmof your hand!Fish and other protein–rich foods have nutrients thatcan help your child’s growth and development.For women of childbearing age (about 16 to 49 yearsold), especially pregnant and breastfeeding women,and for parents and care givers of young children: Eat 2 to 3 servings of fish a week from the “BestChoices” list OR 1 serving from the “GoodChoices” list. Eat a variety of fish. Serve 1 to 2 servings of fish a week to children,starting at age 2. If you eat fish caught by family or friends, checkfor fish advisories. If there is no advisory, eat only1 serving and no other fish that week.*For childrenFor an adult(ages 4–7) 2 ounces4 ouncesAdditional guidelines: Eat healthy fats such as avocado, nuts, olive oil,and canola oil in moderation. Stay away fromfoods that have unhealthy saturated or trans fats. Avoid sugary foods such as jam, honey, syrup,regular sodas, Kool–Aid, lemonade, flavored milk,and all juices (including orange, apple, cranberry,grape, etc.). Do not eat swordfish, shark, king mackerel,tilefish, or raw fish. Limit canned white albacoretuna to 6 oz. per week only. These fish maycontain dangerous levels of mercury, which maybe harmful to your baby. Eat up to 12 oz. perweek of a variety of fish and shellfish that arelower in mercury. See the fish guide below.USE THIS CHARTYou can use this chart to help you choose which fishto eat, and how often to eat them, based on theirmercury levels. The “Best Choices” have the lowestlevels of mercury.Best Choices EAT 2 TO 3 SERVINGS A WEEKORGood Choices EAT 1 SERVING A WEEKTilefish shAtlantic croakerShadBuffalofishRockfishAtlantic mackerelLobster,American and spinyShrimpCarpSablefishBlack sea bassMulletSkateSmeltChilean sea bass/Patagonian toothfishSheepsheadButterfishOysterTuna, albacore/white tuna, cannedand fresh/frozenSnapperPacific chubmackerelSoleGrouperTuna, yellowfinCatfishSpanish mackerelHalibutWeakfish/seatroutSquidTilapiaMahi mahi/dolphinfishStriped bass(ocean)White croaker/Pacific croakerClamCodPerch, freshwaterand oceanCrabPickerelTrout, freshwaterCrawfishPlaiceFlounderPollockTuna, canned light(includes skipjack)HaddockSalmonHakeSardineWhitefishChoices to Avoid HIGHEST MERCURY LEVELSWhitingKing mackerelSharkMarlinSwordfishOrange roughy*Some fish caught by family and friends, such as larger carp, catfish, trout andperch, are more likely to have fish advisories due to mercury or othercontaminants. State advisories will tell you how often you can safely eat those fish.Tilefish(Gulf of Mexico)Tuna, THIS ADVICE REFERS TO FISH AND SHELLFISH COLLECTIVELY AS “FISH.” / ADVICE UPDATED JANUARY 2017Kaiser Permanente Family-Centered Maternity Services 11

Newsletters, Online Tools, and Videos Recommended ClassesGo to the Kaiser Permanente websiteon Pregnancy and Newborn Careat kp.org/pregnancy. See sampleinformation below. Healthy Beginnings newsletters keep youinformed about pregnancy every step of theway. Look under "Mom-to-be tools" or inthe search bar, type “Healthy Beginnings” toview topics including baby’s growth, bodychanges, medications, natural remedies,prenatal testing, getting ready, and stayinghealthy during pregnancy and beyond.There is also a special section called“Partner’s Corner” in each of the 10 differentissues that gives information on how yourpartner can stay involved.Interactive tools track your baby’sdevelopment week to week. See how mucha growing baby changes every few weeks.Read about what is new every month.Guided imagery podcasts (computeraudio or video presentations) on healthypregnancy and successful childbirthengage your mind, body, and spirit. Listento relaxing, gentle, but powerful guidedimagery programs. Podcasts are found inthe "Health & Wellness" section under"Live healthy."Newborn care videos teach you aboutbreastfeeding, bathing, changing diapers,and more. Videos are found under "Caringfor your baby."Links to helpful pregnancy relatedinformation, such as kp.org/maternity andour Hawaii–specific kpfamilybirthcenter.org.You can watch videos on what to expect ondelivery day, meet your Family Birth Centerteam, share maps and visitor informationwith your friends and family, and more.For early pregnancy and until the birthof your baby, use kp.org/pregnancy as atrusted resource.12 kpfamilybirthcenter.orgRefer to the “Healthy Living Classes & Resources” bookletfor class dates and times and other educational offerings.Call Prevention & Health Education at 808-432-2260 toregister or visit kpinhawaii.org/our-services formore information.16 to 18 WEEKS Centering Pregnancy This special program offersprenatal care along with support. Connect with otherpregnant women who are due during the same month.Meet as a group over a 10–week period to talk aboutpregnancy, birth, postpartum care, newborn care,and experience a hospital tour. Appointments arepreset, group based, and with one clinician. Partnerswelcomed. No fee.20 to 26 WEEKS Newborn Care Having a baby can be a wonderfuland yet overwhelming experience. Join this classto prepare for your new bundle of joy. Learn abouthow to care for yourself after birth, newborn care,infant safety, and breastfeeding. Partners welcomed.Fee charged. Childbirth Education Learn about your changing bodyand signs/stages of labor. Discuss your questions andconcerns with other pregnant women in a relaxedsetting. Review relaxation exercises, breathingtechniques, and comfort measures for labor. Connectwith your birth partner and discuss your birthingoptions, positions for labor, and pain management.Partners welcomed. Fee charged. Labor Epidural Class Review non–narcotic painoptions for labor and delivery. An anesthesia clinicianwill answer your questions in a friendly, stress–freeenvironment. Partners welcomed. No fee. New Sibling Tour Give your family the opportunity totour our birth center and learn what to expect whenmom is ready to have the baby. For children, ages 3 to12, accompanied by an adult. No fee. Birth Center Tour See where your baby will be bornand learn about the resources available to you andyour family. Partners welcomed. No fee. Keiki Passenger Safety Learn how to properly installyour child’s car seat or booster, and have it checkedby a child passenger safety technician. Partnerswelcomed. No fee.

MAKING IMPORTANT DECISIONSThings to Consider in Your Second Trimester14 to 27 WEEKSChoose a doctor for your baby’s care. Review the list of available keiki doctors. Lookfor detailed information about each clinician atkp.org/searchdoctors. It is important to choose a doctor before yourbaby is born. You may want to make an appointment andmeet with the doctor before your baby is born.Register for childbirth and early parentingclasses. See previous page for list of classes orkpinhawaii.org/our-services for more information.Choose a method of infant feeding. Learn all you can about breastfeeding. Find out why breastfeeding is a healthy choicefor you and your baby.Decide if you want to have your baby boycircumcised. Talk with your clinician if youhave questions.Decide if you want to donate your baby’s cordblood to a cord blood bank.Start thinking about a name for your baby — someparents prefer to wait until after the baby’s birth todecide upon a name.Decide on what type of birth control to use afteryou give birth.If you have had a C–section, find out if you canhave a vaginal birth after cesarean (VBAC). Discussbenefits and concerns with your clinician.Things to Consider in Your Third Trimester28 to 40 WEEKSPlan for the birth. Choose your support person. Create a birth plan based on your wishes andpreferences (see page 16). Share your birth plan with your clinician.Plan what you will do when you go into labor. How will you get to the hospital? How longwill it take?Who will take care of your other children?What do you do when you arrive atthe hospital?Have the necessary information for your baby’sbirth certificate. Practice writing out your baby’s full first,middle, and last name. You do not have to decide on your baby’sname before you and your baby go homefrom the hospital, although it may be moreconvenient to complete it before yougo home. Find out the father’s birth dateand birthplace. Call Vital Statistics at 808-432-8554 if thereare any concerns about putting the name ofthe baby’s father on the birth certificate.Include your child or children in getting readyfor the new baby. Go through your child’s baby pictures andtalk about when they were a baby. Let them feel the baby kick. Visit friends or family with a baby and talkabout life with a new baby. Sign up for the New Sibling Tour (designedfor ages 3 to 12). Invite them to think of potential baby names. Have them help you set up the baby’s roomor pick out clothes for the baby.Arrange for help at home after birth.Practice installing the car safety seat in your car. You must have a car seat to take your babyhome from the hospital.Set up a safe nursery. Go to kp.org/pregnancy and review the"Mom–to–be tools" section, which contains aNew Baby Checklist. Look at tips in the Healthy Beginningsnewsletter.Kaiser Permanente Family-Centered Maternity Services 13

Cord Blood BankingWorking During PregnancyDonating cord blood is a generous gift from you andyour baby. Before your baby is born, the umbilicalcord is a lifeline. After birth, your baby no longerneeds the umbilical cord. The blood that remainsin the umbilical cord and placenta could serve as alifeline for someone else.Most people can continue to work unt

Kaiser Permanente Family-Centered Maternity Services 3 At Kaiser Permanente Hawaii, we respect every woman’s individuality and personal preferences. We support women who would like a birth that is