Ask Us Anything About…Having a Baby Now

Barbara Schindo – Thank you so much for joining us here today. You are watching Ask Us Anything About Having a baby now. I’m Barbara Schindo. Preparing for the birth of a baby can be very, very exciting, but also can be very overwhelming, a lot of things to think about, a lot of decisions to make. Joining us here today to talk about what to expect when you’re expecting is Dr. Christina DeAngelis. She is an obstetrician gynecologist at Penn State Health Milton S. Hershey Medical Center. Dr. DeAngelis, thank you so much for joining us today. And we —

Dr. Christina DeAngelis – Thank you, Barbara.

Barbara Schindo – We welcome your questions for Dr. DeAngelis. If you have any questions about having a baby, getting ready to deliver a baby, please feel free to post your question in the comment field below the post and we will ask Dr. DeAngelis is going to answer it for you. So let’s start off by kind of starting at the beginning. Let’s say, you know, somebody is trying to get pregnant or just found out they’re pregnant. What’s the first thing they should do?

Dr. Christina DeAngelis – Well, many women who intend to get pregnant will come in [inaudible] visit and mention that to their doctor. It’s good to discuss it ideally before pregnancy even occurs because we can give them some advice that will get them off to a good start from really the first day that they’re pregnant. Mostly, we’d like to review with them any immunizations, maybe, that they need to get prior to getting pregnant, talk to them about any genetic conditions that could be present in the family to help — put them in touch with a genetic counselor. It’s something that could be an issue in a pregnancy. And also to remind them to take their vitamin. When you take a multivitamin, all multivitamins have folic acid. And very early in the pregnancy, from the time women are roughly five to eight weeks in their pregnancy, if they have normal and healthy folic acid levels, you can prevent a birth defect where sometimes it has issues with spinal cord formation and [inaudible] spina bifida. So that’s the ideal situation. And we’re happy to talk to them about nutrition and exercise, which is to optimize before getting pregnant. We all know that’s not the case. You know, women get the good news that they’re pregnant, typically they’ll call whatever physician’s office they’ve been getting their OB-GYN care through. And I’d say most offices would set them up for an appointment relatively early in the pregnancy, usually when they’re around eight weeks pregnant, to do an ultrasound to confirm that everything’s healthy with their pregnancy, to come up with a definite due date so that they know when to expect to meet their baby. If they haven’t had the opportunity to discuss taking vitamins and doing different types of preparatory things, they will review that at that point.

Barbara Schindo – That is some very helpful advice and good to know, too. So it sounds like kind of the important things from the onset are going to be nutrition, immunizations, genetic counseling, if necessary. So, let’s talk about — I’m sure that you might hear this kind of question from a lot of expectant moms as they’re kind of going through pregnancy and getting ready for, you know, delivery. Do you give them kind of a checklist? You know, how can they be sure they’re doing everything they can to best prepare?

Dr. Christina DeAngelis – So again, most OB offices have essentially exactly what you’re talking about, kind of a checklist, each trimester topics that we like to discuss with them for their education, to prepare for childbirth, or to prepare for the needs that they would have for their baby. The first trimester I’d say most of the focus is just getting them for that first trimester because for some women, the first trimester is really tough. Some women unfortunately experience a lot of nausea and vomiting and their energy level, usually, isn’t fantastic and they’re not always sleeping well. So, more of the focus, I would say, in the first trimester is on the mother, you know, just getting her to feel better and making sure everything’s off to a good start. In the second trimester, I’d say, you know, we start providing some education related to the baby. We’re talking about childbirth classes, they’re ideal to do either towards the end of the second trimester or the beginning of the third trimester. So it’s kind of fresh in your mind that information. We talk to them about immunizations that they should get in pregnancies, specifically, the pertussis vaccine. Pertussis can be very serious. If the newborn gets the whooping cough, or pertussis as we call it, and the newborn can’t be immunized until they’re several months old. So we recommend getting the mother really immunized at the end of her second trimester or the beginning of the third trimester so she can pass on those antibodies to her baby. We talk to them again about nutrition. We screen them for diabetes in pregnancy at the end of the second trimester. And then on the third trimester, we really start to focus more on again preparing for the birth, talking to our patients maybe about a birth plan if they’re interested in a birth plan, talking to [inaudible] some of the care for the baby. You know, a lot of times when we’re pregnant, we’re just really excited about the pregnancy and, you know, we take care of mother and baby when the baby is in the uterus, however, once the baby delivers, I always tell the patients what do they know about baby cares, what I know for myself as a parent and I’m far from [inaudible]. So, we talk to them about finding either a family medicine doctor or a pediatrician to continue care for their baby.

Barbara Schindo – So, it’s important to be thinking about what they need during the pregnancy, but also thinking about what are you and the baby going to need after delivery.

Dr. Christina DeAngelis – Absolutely.

Barbara Schindo – So you’re watching Ask Us Anything About… Having a baby now with Dr. Christina DeAngelis, obstetrician gynecologist at Penn State Health Milton S. Hershey Medical Center. So something that you had mentioned was talking, you know, with expectant moms about birth plans and for a lot of women that includes delivering in a hospital. So, I’m sure it’s a very important decision about where am I going to have my baby. What, you know, what women need to think about when they’re making that decision?

Dr. Christina DeAngelis – I would say that probably the majority of women do have babies [inaudible] hospital or in a birth center for several reasons. I think most women have a little more comfort knowing that there’s, you know, more than just a midwife or a physician there with them. You would have all the resources that a birth center or a hospital could offer. In a hospital like Hershey, we have a NICU, and no one ever wants their baby to go to the NICU. But unfortunately, sometimes you can’t predict a complication that could occur at birth. So, I would say we don’t have a lot of patients in this region who plan on home births. Some patients who are in the Amish community, you know, plan for it and other patients may. It can also be, unfortunately, an insurance issue. Most insurance companies will not pay for home births. So, that can be a factor as well. I think it’s good to be at the place that you feel most comfortable in to have your baby. And, again, as an obstetrician, I’m always seeing unusual things and sometimes, you know, the worst things. So, of course, for myself, I would recommend being in a facility where you would have resources like NICU and pediatricians available if there’s any unexpected complications.

Barbara Schindo – Yes. And I’m glad that you brought up the unexpected complications. I mean, I don’t know from personal experience, but I know a lot of girlfriends who have, you know, something has happened and, you know, not necessarily good or bad, but something unexpected happens the day of delivery. So, it’s a good idea for a lot of women to be in a facility like Penn State Health Children’s Hospital. Can you talk a little bit about, you know, what is it that we may offer at Penn State that can help for those kind of unexpected things that might happen in the delivery day?

Dr. Christina DeAngelis – So there’s a few resources we have at Penn State, I think, that allow for a very safe birth experience almost no matter what happens. First is that we have anesthesia providers available 24 hours a day, seven days a week. That’s very important because if you need to do an urgent type of C-section, we have them available so they can provide anesthesia so that we can safely and quickly deliver a baby if it’s necessary. It’s also important because there may be patients who have had a C-section before and the second time around they want to try for a vaginal delivery. It’s only recommended that women do so in a facility where there is the availability to do an urgent C-section essentially immediately if necessary. So you need 24-hour, seven-day a week anesthesia providers in the hospital available urgently. The other issue that I mentioned would be the NICU. Again, most babies, thank God, are born and transition very easily. But some babies, for whatever reason, do not make a smooth transition, they’re not breathing easily on their own. And we’re grateful to have such a great NICU team that are able to be there immediately to assess the baby, to provide any respiratory support to help the baby’s lungs transition or if the baby had an issue with their heart that was unaware before birth, they’re also available.

Barbara Schindo – So, it must be very comforting for moms who are delivering, you know, at Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital to know that there are resources there to make sure that, you know, everything will be safe and comfortable, you know, should something unexpected happen during delivery. But speaking of delivery, so you [inaudible] yourself and you’re ready for baby and it’s time to deliver, you know, you’re coming to the hospital, what kinds of things should women or families be thinking, you know, I should have to, like, go-bag, if you will. What should they bring with them to the hospital?

Dr. Christina DeAngelis – Yeah, that’s a great question and that’s something I like to review with my patients again in their third trimester. I usually encourage them to start putting a bag together around 30 weeks. So, when they come into the hospital, a lot of supplies will be provided for both the mother, their support person, and the baby. Essentially for their baby, really the only thing that they need to bring in is an outfit to go home in and if they choose to have pictures of their baby, usually, they’ll dress them in their cute outfit, take the pictures and then they can go home. And a car seat for the baby. But really, all the baby’s supplies are otherwise provided, you know, baby wash, diapers, onesies, all of that’s provided. For the mother, I always encourage women just wear the — not very attractive, but relatively functional and comfortable hospital gown while they’re laboring. I have had some patients order like on Amazon or through maternity websites these really cute gowns to labor in. They do look really nice. I just personally wasn’t — it didn’t really matter to me. But I do encourage them to wear something comfortable to wear after delivery. I usually encourage them, like, treat themselves a new pair of pajamas, maybe one size bigger than they would wear. If they were [inaudible] — probably don’t need to be as big as what they were wearing at the end of the pregnancy. Nursing bras can be nice or like a supportive cami you need to wear. Flip-flops just to wear around the room can be nice. The one thing that all hospitals have that is not fabulous are the pillows. Because again, we care about sterility, we have plastic pillows that have like no support [inaudible]. They had to be plastic so we can wipe them down, sanitize them. So, we need like a good pillow. My neck sometimes hurt. So, I’ll tell them, you know, you may bring one of your pillows from home for you and your support person. Then old pillow case because labor can be a messy process, you know. So if like you don’t want to [inaudible] pillowcase on it, but bring some pillows in. A lot of patients like to bring like an iPad in. We have Wi-Fi in the hospital that patients can connect to for free. So it’s nice opportunity for them to show off their baby, you know, to family and friends. I usually encourage them to bring like a fun magazine or a book in because babies are not on the schedule at all at first. So there’s a good chance they’re going to be up at like 3 o’clock in the morning where there’s literally nothing to watch on TV. So, you know, it’s good time to catch up in your celebrity gossip, like a People Magazine, something along those lines. Any of their toiletries stuff, you know, their toothbrush and, you know, shampoo, any of that stuff is good. But all their meals will be provided. Motrin, Tylenol, anything for aches and pains, that’s provided. Pads, you know, after giving birth, women are going to have bleeding for a while and so we have, you know, industrial size pads for our moms to use. We also have these mesh underwear, they’re not very pretty but they’re very functional and they get the job done. So, that’s provided. And then really just an outfit to go home in.

Barbara Schindo – Mm-hmm. I just —

[ Inaudible ]

I was just going to say I’m sure that a lot of, you know, if it were be — if it were me, what I’d be thinking of is probably that after baby photo op, like, you know, I want my cute outfit to go home and a cute outfit for my baby. But that’s good, you know, bring your comfy clothes, a pillow, a couple extra things that you might want. I’m sure that’s very helpful for new moms to know. Sorry. Again, you’re watching Ask Us Anything About Having a baby now with Dr. Christina DeAngelis at Penn State Health Milton S. Hershey Medical Center. If you are expecting or soon to be expecting, if you have any questions about, you know, what to expect when you’re going to be having a baby, please feel free to post your questions in the comment field below this post, whether you’re watching this live or watching on playback and we will get an answer for you. Dr. DeAngelis, let’s talk about, you know, right now, is, you know, we hear this phrase over and over again, is we’re kind of living in a new normal now, you know, with the COVID-19 pandemic, and that may cause a lot of anxiety for women that are going to deliver, you know, having to deliver during a pandemic. So can you talk a little bit about, you know, what are we doing to ensure the safety of all, you know, moms and babies while — for those that are delivering babies during the pandemic?

Dr. Christina DeAngelis – Yeah, that’s a great question, and I do feel bad. I think this is a very stressful time for everyone. But especially for families that are expecting a baby, obviously, you know, they want their baby to be healthy and they’re understandably concerned about getting an infection around the time they deliver. So I think Penn State has done a very good job at balancing, making a nice experience, birth experience for our patients while doing our best to minimize or reduce the risk of exposure to COVID-19. So, from the time that really things shut down in March, we always — we’re very grateful that we were able to allow our obstetrical patients to have a support person with them. And some who are watching this might be aware, there are regions in the country, particularly New York City and some other areas where it was just so bad at the time that women were laboring alone, they weren’t even allowed to have a support person. We were never in that situation. We do minimize it to one support person. So, it has to be the same support person. In other words, you can’t have, like, your mom one day and then your partner the next day and grandma on the next day, so same person with you the whole time. We do screen all of our obstetrical patients, either before they come into the hospital. So for a situation where a woman knows she’s going to have a C-section on a certain day, or if she’s going to have labor induced on a certain day, we have her go a few days before she comes into the hospital for COVID testing. And we encourage her to try and quarantine herself after she’s tested on until she can come to the hospital. If a woman just comes in in labor, then we test her as soon as she arrives. And we have the ability at Penn State Hershey to do in-house rapid testing, so we get those results back typically within two hours. We don’t test their support person, but the idea is that they’re almost like a cohort. Typically, that’s the person they’ve been living with. So one would expect that the patient herself was negative, probably her partner would be negative as well. So I think that helps a lot. We try to limit traffic coming in and out of the hospital. It’s only been more recently that we’ve allowed other hospital patients to have a support person with them. And again, only just one person that they can have and the same person. Of course around the hospital, all of the staff, when we’re in a situation where there’s, you know, other people [inaudible] we’re all wearing masks 100% of the time. So I think all of these measures help. We’ve always had very good sterility. You know, that’s never been a problem here in the institution. So I say the difference is trying to limit flow in and out of the hospital during the COVID testing and [inaudible].

Barbara Schindo – And I’m sure, too, that the goal of you guys and the families is to still give everybody, you know, the best birth experience they can have, even though it’s a little bit different, some things are changed and, you know, they got to do a couple extra steps. But you’re still committed to making sure all of your moms and families have a good experience.

Dr. Christina DeAngelis – Yeah, we’ve received a lot of nice feedback. Again, the care we provide to our patients is very important to us. We — it is our goal every day to make it the best experience. I always say there should be nothing happier than welcoming your child. So, we give surveys to our patients who have been here to have their baby or to have any type of obstetrical or GYN care and we look at those very carefully and we do feel very fortunate that we’ve gotten a lot of very positive comments from our patients. So, you know, I think that’s a good testament to the fact that we’re doing our best to make it a good experience. The patients appreciate that.

Barbara Schindo – Mm-hmm. Oh, yeah, I’m sure they very much appreciate the commitment on your end. So something that, you know, a little exciting to talk about here is that there’s going to be a new labor and delivery unit, you know, in the coming months for the expansion of Penn State Health Children’s Hospital. Can you talk a little bit about, you know, what’s going to be new in that unit and what’s exciting about it?

Dr. Christina DeAngelis – Yeah. So it always makes you want to have a third child, Barbara. I’m 40 years old, that’s not going to happen. But it’s very nice. So, the idea is that it’s kind of like a mother-child unit/ building. We have our children’s hospital, which is one of — it’s the newest facility here at Penn State. And so, it’s ideal to have mom-baby child issues in the same vicinity. And the hospital [inaudible], always have the capability to add on top. So, the sixth floor is going to be our new labor and delivery unit and the seventh floor will be the new NICU. So they’ll literally just be one floor above us. They can easily, you know, run down the stairs or take the elevator down if they need a transporter for a baby. But they’re very nice. They’re all private rooms, which, you know, we have now but they’re brand new, they have the new technology in them, the newest monitors. There — I haven’t seen the final decorations because it’s due to be completed in November. But all the colors, I’ve seen the artwork, it looks very nice. It’s a very welcoming place. You know, the lounge is very nice and very comfortable for families to wait in. So, it’s really going to be very, very nice.

Barbara Schindo – Mm-hmm. It sounds like it’s going to be very exciting, very, you know, as you said state-of-the-art, new equipment, beautiful new portions of the building and we’re all very excited about it. I think for me, I think you saying it makes you want to have another kid is probably the highest praise you could give it.

Dr. Christina DeAngelis – Yeah. The other thing that I just mentioned to you that’s unique is the new NICU, which is the new neonatal intensive care unit. Almost all of the rooms for the babies are private rooms with a bed for parents to stay and room in with their child. That’s very unique. Traditionally, all NICU units were what we call the open units, where essentially it was one big room and they had bassinets for the babies that would, you know, go down in a row. So this is unique, I don’t think there are many institutions in the country that have this. But the idea is that if you have a child who’s born preterm, say, the mother is only 28 weeks, that baby’s going to be in the NICU until close to when she would have been full term, it could be several months. And particularly for families who live far away, it’s great to have that option to stay there with their baby. So that’s, I think, a very unique feature of our new NICU. I was jealous. I looked at those rooms, I’m like, oh my gosh.

[ Inaudible ]

Barbara Schindo – Not only does it make you want to have another baby, it makes you maybe want to have twins or triplets so that you —

Dr. Christina DeAngelis – Right, right. Well, it’s interesting. They have — the only rooms that they have where there’s more than one baby is they have a room for — one or two rooms for twins and one for triplets and they’re all [inaudible] together, but they still have a bedroom for parents to stay.

Barbara Schindo – That sounds great. That sounds very accommodating. And we’re very excited to see it. And as you said that [inaudible] fall that that will be open, so about November. So we will wrap up here in just a moment. But I just wanted to point out, too, that, you know, what — you went over a lot of information during this Ask Us Anything About Having a baby, but there’s still probably plenty of things I didn’t touch on. But we do have some resources for women who are interested in learning more, right? There’s an upcoming virtual event. And I believe that’s called What to Expect When You’re Expecting on September 16th. Can you talk a little bit about what that events like and how people might join?

Dr. Christina DeAngelis – Sure, I’d be happy to. So we started this opportunity for patients to learn a little bit more about Penn State and the care providers who will be with them during their labor and delivery and postpartum period. We started it last September. Now clearly, what changed between then and now is COVID. So, we had a few sessions. We used to do them in our auditorium at the hospital. Patients could come in with however many people they wanted. We did a tour. COVID obviously changed that. Our June session, we did as a Zoom, like, webinar, and that’s what we’re set up for next week. So, in a sense, it’s nice, actually, because, again, it seems people commuting to the hospital, getting parking, they still get all the same information, work or, like, they came from work, they can just sign in, you know, when they are able to. So, what we like to do is just to give an overview to patients, particularly if it’s your first baby, I think, it can be a little intimidating, just not knowing how things are going to happen. So, we go over with them even basic information. OK, when you call in, you think you’re in labor, where are you going to park? Where are you going to get into the hospital at 2 a.m., you know. Particularly, the support people. Like, they view it — that’s their job, they got to get you there. So, they’re [inaudible] that information. Then we explain to them, you know, when you come up to labor and delivery, how do we monitor you during the labor? What kind of equipment would we use? How long does it take for the average labor to go from starting labor to when you deliver? How many days will you be in the hospital? What kind of care and support will you be given? We talk about the lactation consultants who come around every day and, you know, offer our patients encouragement and help with breastfeeding. Our midwives talk a little bit about how they can participate in the patient’s care. A lot of people view Penn State Hershey as a place to go if you have very complicated pregnancy. We have a lot of very healthy low-risk patient [inaudible] appreciate the care they can get from our midwives who are outstanding, very experienced individuals. So they talk about what they can offer. Our family doctors, a few of them provide obstetrical care. So they talk about what it’s like to have an OB care from the family and community medicine doctor. We talk about circumcision for patients that might have a male infant, how the procedure is done, what to expect. And then a little bit about the care for the baby afterwards, when they’re going to follow up with a pediatrician. And then one of our new neonatologists gives a brief overview and talks to patients about what it’s like if their baby is in the NICU, you know, how often they can get updates, when they can go visit the baby. So I’d say it’s a really nice overview of pretty much anything that can happen once they’re in the hospital. And it’s free and we love to have as many people participate as they want. One of our anesthesiologists also talks and talks to them about the anesthesia they can provide. And we like to give our email information. So again, if patients have follow up questions, they can email us and we’re very happy to respond.

Barbara Schindo – Well, that sounds like a really nice, informative, you know, encapsulating session. And that’s something that any, you know, any expectant mom or a family that’s looking to have babies or even thinking about having babies and wondering what it’s like to do so at Penn State, that sounds very helpful. And again, the date on that is going to be Wednesday, September 16th, 6 o’clock in the evening. And we will post a link to that event. We’ll post some more information in the comment field below this post here. So, if you are watching this and you’re interested in that event, learning more, you can find the information in the comment field. And as far as Ask Us Anything About Having a baby, if you are watching this on playback and you have another question that Dr. DeAngelis has not answered here, please feel free to post that in the comment field and we will make sure to get an answer for you even if you are watching this on playback. But for those of you watching live, thank you so much for joining us. Dr. DeAngelis, thank you very much for your time. This has been a very informative and a fun conversation. So thank you.

Dr. Christina DeAngelis – Thank you, Barbara.