L&D Q&A with Dr. H

Warning: this is a LONG one, but I know at least one person who’s interested! Plus I need the documentation. :)

I had my monthly prenatal appointment this morning. One more and I go to every two weeks, ZOINKS!

Stats:

B/P: 124/76 – What the heck? I didn’t bother having them re-check it this time. It’s bogus, I think the nurse is just screwing it up.

Weight: 172

Baby’s heart rate: 142

When Dr. H came in, he comes over to me and points at the chart and goes “I have to check, did this really happen??” According to my chart my LAST weight was 163. I said no, I am pretty sure that should say 168. According to my own calculations I’ve only gained 4 lbs since last time. He said well that is good, you’ve only gained about 14 lbs this whole pregnancy and 9 of it in the last 4 weeks is not good.

One of our goals for today was to get some questions answered about labor and delivery & how that’s going to go, especially considering our hopes to do it naturally. So here is a very paraphrased version of that conversation as I remember it. My doctor talks A LOT, so I’ve tried to boil down his main points and I am absolutely not quoting him word for word. I’m probably going to make him sound like kind of a jerk, but I promise he’s not. It’s really just my spin on what he said. We were actually laughing a lot during this conversation.

Me: If we want to have as natural a childbirth as possible, are we in the right place? When you research natural childbirth basically most of the advice out there is to stay away from hospitals and OB/GYNs and get a midwife and a home birth or birth center birth. Since we’re comfy in the hospital and with you as our doctor, we’d like to know your approach to L&D and natural childbirth in general.

Dr. H: In general, I do feel that labor and delivery these days is over-medicinized. Most of our patients here are healthy and under normal circumstances there shouldn’t be any problems with wanting to have an unmedicated birth. However, I find that a lot of people who want to do natural childbirth hear these fuzzy stories about easy labor and having this beautiful baby handed to them at the end with all sunshine and rainbows. Then their labor starts and they find out those people lied. Labor is hard and things don’t always go as planned. Those breathing techniques are very difficult and draining. It’s fine to do that for a few hours but once you’ve done it for 12 or 14 hours you’re going to be really exhausted. Another thing I see is these people who come in with a birth plan that is 3 pages long single spaced – that say things like “I will do this” and “I won’t do this” and “under no circumstances…” – these ones you can almost predict they are going to end up with a section because they are just so uptight and rigid that their labor doesn’t progress. I would just recommend going to the classes, understanding all your options, and having a plan in mind but also above all be open minded and flexible.

Me: So on the flip side of that, if I have to be flexible… then how flexible are you and the hospital in terms of the rules and time limits you set on a woman in labor? Are there hard and fast policies that state that once you’ve gone X number of hours you’re going to start pressuring women to get Pitocin going or have a C section?

Dr. H: It all depends. There have been a lot of people who have done a lot of research and plotted exactly what a “normal” labor should look like. But those are all averages and I tend to feel that when you look at the “norm” there’s usually a standard deviation of +/- 2 in every situation. Usually once your membranes rupture (water breaks) we like to have that baby within 24 hours because the longer you go the more risk there is for infection. As for Pitocin, again, it just depends on the timing and how things are progressing. If your water breaks at 4am and things aren’t moving along then we might be recommending Pitocin at noon. (I got a little confused on this part … he offered another timing scenario up but I can’t remember exactly how it went. But what it came down to is that once you start the Pitocin you might still have 8 or 10 hours of contractions to go before the baby is born and they want you to have some energy left for pushing at the end) As for “how you’re progressing” again, we like to see that you’re dilating at a certain rate, but it’s not set in stone. For example, if we expect you to go from a 4 to an 8 in X amount of time, and you’ve only gone from 4 to 6… well that’s not great but at least you’re going somewhere, so in that case it would be less likely we’d try to speed things up.

Me: Well I’m glad that’s how you feel, but what about these guys? (picture me gesturing to the wall where there are pictures of all the doctors in the practice) It looks to me like I’ve only got a 1 in 6 chance that you’ll even be there.

Dr. H: I think you’ll find that we all pretty much agree. And historically, there’s about a 60% chance that you’ll have me on the day.

Eric: What about the cutting, how often do you do that (and picture Eric making a little scissor motion with his hand, SO CUTE!)?

Me: How often do you do episiotomies?

Dr. H: About 20% - In fact I probably do fewer than I should. Often times I’ll look back and think, hmm, I really should have done one.

Me: What about an IV, is that standard?

Dr. H: Yes, absolutely, that is my one non-negotiable.

Eric: Can we just get the IV prepped but not actually hooked up?

Dr. H: Yes, that is fine but you should know that well hydrated labor is usually faster labor.

Eric/Me: What about fetal monitoring, what type is standard?

Dr. H: Usually right when you get to the hospital we’ll do continuous external monitoring for awhile. If you don’t want that on the whole time then as long as everything is going okay then we can move to periodic monitoring.

Me: So I’ll be able to move around if I want?

Dr. H: Yes, we encourage people to be as active as possible during labor. Unless of course you have an epidural. There’s this myth about a “walking” epidural, but really you can’t walk with an epidural.

Me: Well I really don’t want an epidural.

Eric: Who can we have in the room with us?

Dr. H: Anyone you want, although I’d recommend keeping it to just a few people. Laboring women can sometimes be, how should I say this, “cranky.” And you might think at first that you want 23 people in the room but then when the time comes you won’t want anyone around.

Me: Will I be in the same room the whole time?

Dr. H: Yes, you won’t move until after the baby is born. We tried to do the LD&P but people really didn’t like it. It’s better to have a change of scenery, and get out of the room where all that “stuff” happened. The labor rooms are really nice though, they have tubs (but we do not do underwater births). The women find that during labor the jacuzzis are REALLY helpful for relaxation. The beds are nice and they move up and down and into all kinds of positions, but they really aren’t any good for postpartem and recovery.

Me: What if I am planning to breastfeed, will the baby be with me the whole time?

Dr. H: Yes, as long as baby is doing okay, I like to put him on mom’s tummy right away. Of course he’ll be all gooey and slimy and gross, but you won’t care.

Eric: She’ll probably be all gooey and slimy and gross, too.

Me: Okay, what if my labor hasn’t started, water hasn’t broken… at what point do you induce?

Dr. H: We usually do not induce until about 41 weeks, at least 40. It just depends on how big the baby is getting and how mom is doing. In my experience bad things start happening after 41 weeks. And women’s feelings on induction change throughout the pregnancy. You ask someone at 24 weeks and they say absolutely not. 28 weeks they might consider it. At 34 weeks they say “can we do it tomorrow?”

Me: Well I think that is about it.

Dr. H: Again, try to be open minded and flexible. Know what you want ahead of time, and it’s probably a good idea to have it in writing so the nurses can read it and understand where you’re coming from. But more than a page is probably too detailed, and don’t feel like a failure if it doesn’t go exactly how you planned it.

One other thing he said, but I can’t remember when, was that he doesn’t like people to eat during labor. He said we’re not super strict about it but generally your stomach just shuts down once labor starts because your whole body is focused on getting that baby out. And if you eat you just usually throw up anyway. I’m not too concerned about that.

So my next appointment is October 29^th with – the Nurse Midwife! Yay! Kind of a fluke but I’m glad. I might ask all these questions again and see what her take on it is.