Tuesday, January 24, 2012

Natural/Intervention/Med-Free Birth Discussion with OB

I mentioned the other day that I planned to write about my discussion with my OB about a natural childbirth.

I had a different OB up until about 20 something weeks with this pregnancy... I adored him and I still think VERY highly of him, and we had an insurance blip and I had to switch doctors and hospitals... which again, God works all things for the good of those who love Him... and this was no exception :)

With my first OB, like I said, I really really liked him a lot.  Except when I brought up a few natural/intervention free birthing methods.  He got a strange look on his face and definitely had a change of attitude.  I asked him a few questions about what interventions are normal for a vaginal delivery and what are standard practice for his practice and he didn't give me a very straight forward answer.  I mentioned meeting a midwife and talking to her a little bit about a natural delivery and he stiffened up immediately and clammed up about his answers.  I was just asking him about an episiotomy!  At this point, I had basically ZERO knowledge about labor and delivery and I was just trying to learn!  He definitely had a strange attitude about it.

And now, a few months into seeing my NEW OB, I have been reading a LOT and educating myself a LOT about labor and delivery and natural childbirth vs. a typical childbirth in a U.S. hospital setting.

So I wrote out a list of questions to ask at my next appointment.  I will list the questions and my doctor's responses and my opinions of those responses. (Get ready. because it's a long list!)
  
1. What are your thoughts on an un-medicated labor and delivery?
 Before I even had a chance to ask my doctor what her thoughts were, she was measuring my fundal height and asking me if I had gone on a hospital tour yet.  When I said not yet, that it was in a couple weeks, she gushed on and on about the hospital and that in the labor and delivery suites that they have jacuzzi tubs that are AMAZING for pain management... then she stopped and looked at me and said, well, you're a first time mom, so if you want to get an epidural that is also available... but I'm telling you what, these jacuzzi tubs are really amazing.  Moms get in them to labor and they get out and they are ready to have a baby!

So really, before I had a chance to ask, she shared her very positive opinion of a medicine free/intervention free/epidural free labor and delivery!

2.  No epidural
Like I said above, she had already expressed her opinion about this before I had a chance to pull out my notepad with my questions on it.  I did share with her when I was going over my list that I didn't wish to have an epidural unless I asked for it, but that my plan was to go without.  I explained that I do not want a catheter, I do not want to be confined to my bed, I do not want to not be able to hop right out of bed after delivery.  She was very supportive of this decision and said that she would do her best to help me figure out different methods of pain management.


3.  No pitocin... and also no pitocin for delivering the placenta.
 I asked her about using pitocin during delivery and she looked at me like I had two heads.  She assured me that there would be zero pitocin being administered unless I was being induced in the event that we both agreed it was medically necessary.  There is no routine pitocin administered with her practice.

When I asked about pitocin to help deliver the placenta, she again looked even more bewildered.  No, she assured me, that is a case by case basis.  If you NEED pitocin, then it will be discussed and administered, it is NOT routine.  She explained that the skin to skin contact and breastfeeding after birth released oxytocin which was a natural pitocin that will work just fine on most women.

I was INCREDIBLY pleased to hear her answers.  I fully agree that pitocin should NOT be routine and that it should be a case by case basis where the pros outweigh the cons.  And also, most importantly, I was so happy to hear that she understood how the woman's body is designed to work and to release oxytocin by breastfeeding after birth.

4.  I want to use the tub to cope with pain.
Obviously, she covered this before I ever got to it.  She was super encouraged and happy that I was voicing my want to labor and deliver unmedicated and was happy to see that I would be utilizing the tubs.

5.  Walking around in labor.
I asked if I would be permitted to walk around in labor and she sort of laughed and said she highly encouraged it.

Basically my worst nightmare for a labor and delivery would be one where I was confined to my bed and not allowed to move around and not allowed to find a position that worked better for me because of the convenience of the nursing staff to monitor me.  I want to be able to walk the halls, I want to be able to do jumping jacks if I decide that is what might help me cope or manage the pain better!  I was super happy to hear that she was very encouraging of doing whatever you can to manage each contraction.

6.  Eating / drinking in labor.
My OB told me that she preferred her patients to have a clear liquid diet while in the hospital and in labor.

I pretty much plan to bring high protein snacks like string cheese and maybe yogurt and bananas with me.  If I feel like eating, or if I am losing energy and want to eat... I am going to eat.  Marathon runners aren't refused food before they run their marathon... Neither should a woman in labor be.  (I understand the risks and why they don't want you to... This was first implemented when they used to make women give birth using general anesthesia and the worry was that they would aspirate... now with the use of spinal blocks and epidurals, women can be conscious during an emergency c-section and would be much much less likely to aspirate... therefore I believe this is an outdated practice.)


7.  I want to exclusively breastfeed... so no formula or bottles or pacifiers.
My doctor was SUPER supportive of this and thought it was great.  She also said that most of that care would be the nursing staff but that what I can do is write out an entire birth plan and they (the doctors) will sign off on it and put it on my chart and also allow me to bring a signed copy with me to the hospital to present to my nursing staff.  She seemed incredibly supportive of this and had already previously mentioned that they find it incredibly important to have skin to skin contact for the mother and baby immediately after birth and that the baby be breastfed immediately to induce contractions of the uterus by releasing oxytocin in the body.  I was really happy about this conversation!


8.  I would like the umbilical cord to stop pulsing before being clamped and cut.
She said that it was standard practice now to allow the baby to get all of the rest of their blood that is being stored in the placenta and umbilical cord before clamping and cutting it.  She said that it was standard practice that it takes 15-20 minutes more to deliver the placenta after delivering the baby.

I was really happy with this.

9.  I would like immediate skin to skin contact and breastfeed immediately.
Again, the same things were covered over and over... she was fully supportive of this and had mentioned that it was how things worked in their practice before I even brought it up.


10.  I would like to push when I feel the urge, not on command.
As I was starting to sense a trend here... I was realizing that I was exactly where I should be.  My OB nodded and said that they definitely realize that it's more exhausting to push immediately when you hit 10 cm dilated than if you wait until your body is ready and you get the urge to push.  She also explained that since I wouldn't be having an epidural that the urge to push would be much more evident for me and that I would be to the pushing stage much faster than someone who had an epidural since an epidural can slow down your labor.


11.  No episiotomy.
She was very clear that episiotomies are not standard practice with this OB practice.  That an episiotomy will only be given in a situation that warrants it, but that it is better to tear and that you won't know if you will tear until you do, so there is no reason to cut if you aren't going to tear at all.  I was super happy to hear her opinions on it.

12.  Can I push in any position? 
I have read over and over that laying on your back as is often required in a hospital birth is onlyyy convenient for the medical staff.  That this is one of the most uncomfortable ways to deliver a baby.  So I asked her if I could push in any position.  She said yes, whatever would safely get the baby out.  Obviously gravity helps a lot, especially when pushing something that is 6-10lbs.  I was very happy to hear that I have the freedom to move and push in whatever position I feel is most comfortable or effective.  She also said she would offer suggestions to see if any position might work better.


13.  When should I come to the hospital? 
Since I had already expressed my wishes to have an intervention free birth, she explained that I would be most comfortable laboring for as long as possible at home.  This is also what I have read in all of my research and all of the books I have read, as well as reading individuals' birth stories on the internet.  I can eat and drink freely at home and I will be in a comfortable environment.
The only exception to this would be if I test positive for group B strep, and in that case, I will need to come to the hospital when I am in labor so that I can be given 2 rounds of IV antibiotics so that they are in 4 hours before birth.  She said in that situation that after the IV is through that they will remove the IV port and that I will be free to labor however I wish and that they will leave me be and not put a time limit on it or anything.  (Obviously barring any complications, but that goes without saying.)

So if I start having contractions, basically to wait as long as I feel is humanly possible to come to the hospital since the drive to the hospital normally stalls labor a little bit and we have a 35-45 minute drive to the hospital depending on the day and time of day for traffic.  I think they say 5-1-1, so contractions 5 minutes apart, 1 minute long and for a duration of 1 hour at that rate.

14.  Fetal Monitoring?
Will I be chained to a bed and strapped to fetal monitors?  (Okay seriously, this is the last time I am going to say this... ALL of these answers are dependent on it being a healthy and safe delivery for both baby and I.) She said that they will do intermittent monitoring with a doppler so that I will be able to labor in the tub or walking (or doing jumping jacks, whatever.)  Bottom line, I didn't want to be stuck in a bed for the convenience of the medical staff... they can and will chase me around to monitor the baby.

15.  How long after delivery can I be discharged?  Can I be discharged any time of day? 
She said she likes to keep mom and baby at least 24 hours after delivery and 48 hours if I do test positive for group B strep even if I get the antibiotics.  That was not at all what I wanted to hear... I would like to be out of the hospital AS SOON AS POSSIBLE after delivery.  Obviously they monitor for a few hours for bleeding and other complications, but if everything goes as swimmingly as I am dreaming (haha, let a girl dream please) I want to be out of there.  I am having a baby, not going on vacation.  I want to be in my own bed.  I'm also afraid that the longer I am in the hospital, the more interventions I will have to be fighting off. 

I want my baby in my room with me and I'm afraid that the longer I am there, the more they will be obligated to check on both of us and testing and monitoring on the baby.  (AGAIN, OBVIOUSLY if there is something wrong with the baby, I would be more than happy to have things be taken care of!)  I'm afraid that I will constantly be battling to get to breastfeed or fighting off nurses and doctors who might not be supportive of breastfeeding and who believe babies should be supplemented with formula right away.  I just don't want to be in the hospital if we don't need to be.

I also know I won't be getting any rest not in my own bed and not in my own house.  Who gets good sleep at a hospital?? There's no resting or relaxation with monitors and beeping and nurses coming in 24/7 to check you and the baby.

I forgot to ask her if I can be discharged any time of day... Oops.

16. No IV fluids or IV port.
Again this comes with wanting freedom in labor.  I do not want to have to push around an iv stand just to have fluids.  I want to be able to eat and drink freely during labor and I want to be able to stay hydrated by drinking.  From everything that I have read, unnecessary IV fluids leave you OVER hydrated and over hydration leads to a higher birthweight for the baby (read: bigger baby to push out) and a higher weight loss percentage for the baby after birth because they are dropping that water weight from being over hydrated.  It also can lead to difficulty breastfeeding where your breasts are engorged with extra water and it affects your nipples too in being able to have the baby properly latch. 

My doctor was fully supportive of this.  She even explained that if I was GBS+ (group B strep +) that after my IV for my antibiotics was done that they could take the IV out and I could labor through the rest of it without any other IV fluids.

17. What's with the eye ointment and Vitamin K shot? 
The eye ointment is given to babies to prevent blindness if the mother has gonorrhea.  Since I don't have any STD's, she said that I could decline this.   The vitamin K shot is to promote clotting and to prevent brain bleeds.  She said this is not necessary and that I could decline this as well.

18. Is the recovery time shorter with a natural birth? 
Everything that I have read says that you bounce back from a natural birth much faster than if you have any interventions at all, including just having an epidural.  I wanted to see what she had to say about this.  She sort of hemmed and hawed a little and then said that yes, the recovery time is usually much faster if you can give birth without any interventions at all.


19.  Students/Teaching/Residents etc? Performing procedures on me or my child.
I asked if this was common practice and was this something that I was going to have to state my preferences on.  She said that she would NEVER have a student come in without first running it by her patient and asking permission.  She also mentioned that since it was a Henry Ford hospital and that since this OB practice wasn't HF doctors they were a little bit different and that the Henry Ford doctors have their students.  And, interestingly enough, she told me that the only residents that she knew of that performed any procedures were the anesthesiologists who performed the epidurals.  YIKES! No THANK you.  I understand they need to learn on someone, but NO thank you ma'am.


20.  All child checks being done with me or in the room.
She said that this was common practice at the hospital and that this would be something to discuss with the doctor but that it wasn't something I should be concerned about.


21. Sweeping membranes or breaking water... when do these interventions come into play?
Along with having a natural labor and delivery, I was also curious about what kinds of natural inductions were common with this practice.  She said that unless they NEEDED to induce, that these sorts of interventions would not be done.  Exactly what I wanted to hear.  From everything that I have read, labor happens easier and progresses faster if it happens on it's own.  But I was also happy to hear that these were methods that they were willing to try before trying to start inducing labor with drugs.


22. Being commanded to stop pushing... when and why does that happen?
One of the things that Ina May touches on in her books is being barked at to push and not to push.  Another thing that I have heard horror stories from my friends about was if the doctor isn't there to catch that the nurses will tell you to wait... My friend had her baby crowning for minutes while they searched for the doctor and her son was born with bruises around his head.  She said it was the most horrifying feeling to prevent pushing him out and that she hated what happened to his head.  So, naturally, this was something that was of interest to me.


The doctor told me that the only instances where they would tell you when to push is if you were asking for help and didn't know what to do.  Otherwise, they have found (which I have read over and over) that delivery happens best when the mother feels the urge to push and works with her body and with her contractions and that this baby is coming out so there is no need to waste energy pushing when your body isn't quite ready to push yet.  She also said the only time she ever tells a mom to stop pushing is if she is trying to prevent a tear and the mother is a little overzealous in her pushing.  I liked her answers.

23. Is there a time limit after water breaks to induce/ c-section? Minimal internal exams?
This question I was very interested in.  She said that if mom and baby are doing fine, that they will just continue to monitor and let you labor as it comes.  If a situation arises where something else needs to be done, they will address it then, but if there is no health concerns that labor may continue naturally.  (Fever or reduced/distressed heart rate are signs of problems.) 
She agreed that especially with minimal internal exams, there was minimal exposure to bacteria and that labor could be drawn out further.

I didn't mention this to her since it hasn't come up yet, but I plan to decline internal exams.  I will get the GBS test but it's just a cotton swab.  I do not want an internal exam because it really is not an accurate indicator of when you will go in to labor.  It also introduces unnecessary bacteria and puts you and your baby at risk for a higher intervention birth.  As far as I know, they don't do internals at my doctor's practice / hospital until you show up thinking you are in labor. (or if there is a problem or suspected problem, obviously!)



That's all I have as far as questions go.  I had quite a few more but they were repeats and I covered it all so far in what I wrote.

Over all, I was very happy with the practices of the hospital and my OBs.  I'm even more looking forward to L&D and I'm really excited to try the jacuzzi tub and really work with my doctors instead of feeling like I'm trying to work against them.  

(The jacuzzi tubs and bathrooms at my hospital.) 




3 comments:

  1. Woohoo--you go girl. Birth Warrior! That's a hospital bathroom? Amazing. I can't wait to read all about your birth experience. Just a few more weeks until you'll meet your little boy!

    P.S. I'm stealing these questions for my midwife appointment on Monday.

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  2. I hope your birth goes according to plan. I know most births don't go the way expected. But one can hope like you said. :) Wishing for the best for you! Hope you blog about it when you are home so we can know how it went. :-)

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  3. Sounds a lot like my birth plan! Get yourself some Hibiclens wash to use before your Group B strep swab.

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