About Your Stay in the Special Delivery Unit
We hope this information about what to expect during your time in the Garbose Family Special Delivery Unit (SDU) will help alleviate some of your concerns in the days and weeks ahead. Our staff members are happy to answer any individual questions you may have.
Who you’ll meet during your stay in the SDU
When you visit the Center for Fetal Diagnosis and Treatment, you will tour the Special Delivery Unit and — depending on your baby’s condition — either the Newborn/Infant Intensive Care Unit (N/IICU) or Cardiac Intensive Care Unit (CICU) where your baby will be cared for after birth.
Many different individuals will be involved in your care, all specially trained to care for you and your baby. Your care team will include obstetricians, maternal-fetal medicine specialists, nurses, nurse practitioners, midwives and others.
- Maternal-fetal medicine specialist (MFM) — A physician who is board certified in obstetrics and then completes a fellowship program in maternal-fetal medicine, leading to board certification in maternal-fetal medicine. These physicians have advanced, specialized training in identifying and caring for high-risk pregnancies.
- Pediatric general and fetal surgeon — A physician who is board certified in general surgery, then receives additional training in children's surgery to earn pediatric surgery subspecialty certification. Pediatric surgeons are primarily concerned with the diagnosis, preoperative, operative and postoperative management of surgical problems in children. They utilize their expertise in providing surgical care for all problems or conditions affecting children that require surgical intervention.
- Anesthesiologist — A board-certified physician specializing in providing anesthesia, sedation and pain management for mothers, fetuses and newborns. At Children's Hospital, anesthesiologists have additional certification in pediatric anesthesiology, after completing training in adult anesthesia.
- Genetic counselor — Genetic counselors have a master's degree and special training to help families learn about birth defects and conditions passed down through a family. Genetic counselors ask questions about family history and pregnancy history. They explain technical information and review prenatal screening and testing options available.
- Advanced practice nurse — Advanced practice nurses (APNs), nurse practitioners, nurse midwives and clinical nurse specialists are registered nurses who hold master's degrees in nursing. All APNs have advanced training — some specifically in the care of women throughout pregnancy, labor, delivery and their hospital stay; others in the care of critically ill neonates; others in pediatrics.
- Nurse coordinator — Nurse coordinators are registered nurses who coordinate all aspects of your care at the Center for Fetal Diagnosis and Treatment. As soon as you are referred to the Center, a coordinator will assist you with pre-consultation services, during your initial consult and for the duration of your care. These nurses will also coordinate ongoing care during your pregnancy — including relocation, scheduling appointments, and ensuring you and your family receive the support services you need.
Fetal surgery and the SDU
If you undergo fetal surgery at The Children’s Hospital of Philadelphia, you’ll likely be a patient in the SDU twice — first for your prenatal surgery, and then for delivery of your child. You will need to remain close to the Hospital before and after surgery, up to delivery, and it is extremely important to have at least one person stay with you for the entire time you are in the Philadelphia area. Learn more about the fetal surgery experience at CHOP.
Planning for delivery
Your delivery plan is tailored for your and your baby’s needs. In many cases, the decision is determined by your baby’s condition and diagnosis. For example, many babies with cardiac conditions or gastroschisis can be delivered vaginally, while babies with conditions such as spina bifida or giant omphalocele are generally delivered by c-section.
If you or your baby have any trouble tolerating labor, we will deliver by C-section to speed the safe delivery of your baby.
For C-section deliveries, you can have one support person in the delivery room with you. For vaginal deliveries, there is more flexibility with the number of people who can be in the birthing room to support you and witness the birth. Please discuss your plan with your nurse or midwife. She can answer any specific questions you have.
We encourage most women to go as close to full-term in their high-risk pregnancy as possible, but there are many factors that could result in an earlier delivery. For example, your baby’s diagnosis, condition and the course of his or her illness may indicate an earlier delivery. Anything that impacts your health as the expectant mother can also impact the timing of your delivery. We will closely monitor you and your baby throughout your pregnancy and delivery and will adjust our plan as needed for the safety and well-being of you and your baby.
If you go into labor before you’re scheduled to give birth, the course of action depends on where you are located.
If you live in the Philadelphia area or have relocated to this area for the remainder of your pregnancy, you should call the Special Delivery Unit. An obstetrician or midwife will do an initial assessment, and then ask you to come into the SDU to be evaluated.
If you are far from the Hospital, you should call the SDU and speak to the obstetrician or midwife who will encourage you to go to your local doctor or hospital to be evaluated to determine if it is safe for you to travel. If you can travel, we’ll ask for a maternal transport to CHOP. If travel is not safe for you or your baby at that time, we will provide instructions to your local hospital for your delivery and the care of your newborn.
We have obstetricians and certified nurse midwives here 24 hours a day/7 days a week. If you have a question or concern about your baby — whether you are in labor or not — you can call and speak directly with an obstetrician or nurse midwife.
Getting admitted for your stay in the SDU
During the admissions process, we will ask you if you would like to choose a “lay caregiver.”
A lay caregiver is an adult friend or family member who would be willing to help you with your healthcare needs at home. The lay caregiver is different from your support person. Your support person is used in labor and for certain procedures. If you relocate to Philadelphia to receive your care in the Garbose Family Special Delivery Unit, you may need to bring a support person. In the event of relocation to the Ronald McDonald House or a host family, the support person is required to be with you.
Obstetrical anesthesia is available in the hospital 24 hours a day. For women planning a vaginal delivery, we offer epidural anesthesia to ease some of the discomfort of labor. For c-section deliveries, we generally use spinal anesthesia. For fetal surgery or any type of fetal procedure — such as prenatal repair of spina bifida or treatment for twin-twin transfusion syndrome — we use anesthesia as indicated to ensure the safety and comfort of both you and your baby.
When your birth is getting close, the SDU staff notifies the Neonatal Surgical Team, which includes a neonatologist, neonatal surgical nurse practitioner, several nurses and a respiratory therapist, all experienced in treating babies born with birth defects. The team assembles in an infant stabilization room next to your birthing room where they are ready and waiting to receive your baby. The two rooms are connected by a pass-through window so your baby can be easily transported for assessment, stabilization and any procedures that may be required.
Once your baby is stabilized, we typically bring her back into the delivery room so you can see her. Then your infant is transferred to the N/IICU or to the CICU. All teams involved in the care of your baby work closely together and are well-prepared with all the information about your baby’s diagnosis and condition.
What to expect after your baby is born
After delivery, most babies will go to the N/IICU. Babies with cardiac conditions will go to the CICU. Both ICUs are located in the same building as the SDU; the N/IICU is an elevator ride to the second floor, and the CICU is next to the SDU.
On rare occasions, there is a well twin who will initially go to the N/IICU for a recovery phase and may return to the Special Delivery Unit to stay with you.
Most moms are able to see and touch their babies immediately after birth. In some cases — when the baby is stable — you may be able to see your baby in the birthing room for a short time before she is taken to the N/IICU or CICU.
Once your baby is transferred and settled into the N/IICU or CICU, you will be able to visit your baby there. It is our goal to get you to your baby’s bedside as soon as possible. Generally, dads and partners are able to get to the baby’s bedside in intensive care sooner than moms because moms have a recovery period after birth and need to be monitored closely during this time. Our goal is to make sure you are safe and stable so you can better support your new baby. If your baby’s condition is unstable, we will do whatever it takes to get you to your baby’s bedside.
You can spend as much time with your baby as your medical team allows. In some cases, an OB nurse may accompany you to the N/IICU or CICU when you visit your child to ensure you are getting the postpartum care you need.
How soon you can hold your infant depends on your baby’s condition. Some babies can be held fairly soon after birth and others can’t be held for days or weeks after birth. It depends on your child’s diagnosis, condition and the type of monitoring equipment they have.
Even if you can’t hold your baby, you can always touch her or hold her hand and do other supportive things for your child. You can talk, sing or read to your baby.
Your baby’s length of stay at Children’s Hospital will depend on her condition, response to treatment and gestational age at the time of delivery. For example, a baby with gastroschisis may undergo surgical repair within a few days of birth, but the N/IICU team still has to work with the baby to feed orally and ensure the bowels are working properly, which can take weeks to months.
Your baby’s treatment will depend on her condition. In addition to specific clinical specialties, her care may include the following services:
- Respiratory therapy
- Physical therapy — A team of certified clinical specialists helps families recognize an infant’s physical cues and behavior, such as signs the baby is tired or overwhelmed. Our physical therapists also assess motor and sensory skills, encourage development through positioning and handling techniques, and assist with family education.
- Occupational therapy — Occupational therapists help you bond with your baby and help your child develop skills that will lay the groundwork for achieving future developmental milestones.
- Speech-language pathologists — Speech-language pathologists evaluate and treat babies and children who have difficulties with communication and swallowing. They will help assess your baby’s readiness to feed by mouth, help your baby feed safely and promote early communication skills.
Your doctors and nurses will talk with you about your baby’s specific treatment plan. Rest assured, when your baby is ready to leave the hospital, you will be prepared to care for her.
Visiting your baby
Visiting hours for parents are 24 hours a day. Visiting hours for family members and friends are generally 10 a.m.-9 p.m. in the N/IICU and CICU. Initially, a parent may need to accompany visitors to visit the baby. If you want grandparents or others to be able to visit your child when you are not there, you will be able to create a list of approved visitors for your child. Your child’s nurse can help you with this.
In some cases, siblings can visit your new baby in the intensive care environment, but because the N/IICU or CICU can be intimidating to children, we encourage you to first talk to our Child Life specialists. These healthcare professionals can meet with your children during your pregnancy, engage in some play therapy, and introduce them to the tubes, wires and monitoring devices helping the newest member of your family. Talk to your nurse in the SDU or your child’s nurse in the N/IICU or CICU to initiate this process.
We welcome you to be at your baby’s bedside as much as you want, but we also want to make sure moms who’ve recently delivered get the rest and proper nutrition they need to heal.
There are several options for parents to stay overnight in Children’s Hospital. Sleep rooms are generally granted on a first-come, first-served basis and are intended for families most in need — such as if a baby is unstable.
- The N/IICU has some overnight sleep rooms for parents, including showers. These rooms are assigned daily. Sleeping hours are from 11 p.m. to 7 a.m. To request a room, families sign up in the family lounge. There are also sleep chairs in the unit. One parent may use the sleep chair overnight, if your baby’s condition permits.
- The CICU also has several sleep rooms on the sixth floor of the Hospital, which are assigned daily. The 16 single-patient rooms in the CICU also have sleep space to accommodate one parent.
- The Connelly Resource Center for Families has sleep rooms, available at no cost to families on a one-night-at-a-time basis. These rooms are assigned by a family resource coordinator by mid-afternoon each day and are available from 7 p.m. to 7 a.m. The Connelly Center is located on the eighth floor of the Main Building.
- There are also reclining chairs at all bedsides in the N/IICU and couches in some of the CICU rooms where one parent may sleep.
Breastfeeding babies born in the SDU
Our research shows that mothers’ milk makes a difference to all babies — especially babies born with birth defects and those recovering from surgery. Breast milk acts as both food and medicine, helping to protect babies from illness and infection, and providing essential nutrients to help them grow, develop and recover.
Even if your baby is unable to breastfeed due to her condition, we still encourage you to provide milk to your baby by pumping. Children’s Hospital’s Breastfeeding and Lactation Program can help you learn about pumping, providing milk to your child and transitioning to breastfeeding.
There are breast milk refrigerators in the Special Delivery Unit, the N/IICU and the CICU where you can store your milk at the correct temperature until it can be used for your baby. Each mom has her own bin and every bottle is labeled with mom’s name and baby’s name.
In addition to our certified lactation specialists, many of the nurses in the intensive care units are trained breastfeeding resource nurses and can answer questions about breastfeeding, pump rentals and insurance coverage for pumps after you are discharged from the Hospital.
Resources and support services for families in the SDU
Children’s Hospital provides a variety of support services that can help you and your family before, during and after your time in the Special Delivery Unit.
- Social work
- Child life specialists
- Perinatal palliative care
- Pregnancy resources — general information about high-risk pregnancy care and delivery, as well as tips for coping with bed rest during pregnancy, breastfeeding, postpartum depression and more
- Visitor resources — practical details, such as housing options, directions and parking information for your trip to The Children's Hospital of Philadelphia
Bringing your baby home
You’ll get to know your child very well in the Hospital. You will be touching your baby, and helping to diaper and bathe her with the help of nurses in the N/IICU or CICU.
You will also learn about your child’s unique care needs. You will become comfortable with the special devices or equipment your baby needs and learn how to provide specialized care for your child.
You can learn basic and specialized skills needed to help care for your child in the Hospital and at home in the Connelly Resource Center for Families, located on the eighth floor of the Hospital.
All parents receive education on infant CPR and car seats, but additional classes are customized to the needs of your child and could include tube feeding, injections, central line care and more. Education sessions are scheduled with a nurse who is able to answer your questions and address specific concerns.