Sunday, March 4, 2012

10 things you won't learn at the OB's office

Your doctor went to medical school for years, I understand he is one smart cookie. But, truth be told, he doesn't know everything. AND, there are sometimes that you may know more than he does, because nobody knows your body like you do.

With that said, I have compiled a list of ten things that I have come to learn from other mom friends, trial and error, or just "knowing" something is/isn't right.

This is going to be a 2 part chronological series. Next post will pertain more to the pediatrician's office for baby and child information. Feel free to follow this post and check back regularly :)

#10 Your due date is not an expiration date.

Many times, a woman's due date will come and go, leaving mom to be frustrated and anxious. But the thing they don't tell you, is that 40 weeks is just a round, pretty number...nothing for you to base your pregnancy on. Anything from 37-42 weeks is not only completely normal, but also average. Some people may go slightly earlier than that, and some people may still be trucking at 43 weeks. Not to mention, unless you can pinpoint the exact date of conception, your due date may be off by a week or two anyway.

#9 Your due date can't change.

Okay, well maybe it does...but not for all of the reasons you think, so let me explain. The only time your due date can accurately change is if you weren't sure of the date of conception or last menstrual period.
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What I am talking about in this section is more about late changes. I don't know how many times I have heard that somebody's OB changed their due date because they were measuring big. This is like weighing your child and saying "wow, you've gotten big! You're not 2 years old anymore, you're 3!" Doesn't make sense when you look at it that way, does it? The age of a child, or a fetus, does not change just because they are growing at a faster rate than "average."

Even my own OB is guilty of this. She told me 3 different times my due date had changed, even though I could tell her exactly what day, and time I got pregnant (the perks of seeing a fertility doctor who could tell you what day you were ovulating). When I would get an ultrasound that showed the baby being bigger than average, she would change the due date to fit the measurements. This is NOT okay to do. The later the ultrasound, the less accurate it is for them to base your due date off of it. For an ultrasound to be accurate at determining the due date, it needs to be done early in the first trimester, the later you do it, the less accurate it will be. Just because your baby is growing faster than normal, does not mean they are developing their lungs and other organs faster than average.

#8 Your doctor works for YOU


If at any point during the pregnancy, you feel uncomfortable with your choice of OB, you have the option of switching doctors or midwives. Your body, your choice. You may also refuse any "routine tests" if you deem them unnecessary, whether that be ultrasounds, glucose tests, blood draws or strep B. As long as you have a reason for your choices, most doctors will respect your decisions, just hold your ground.

#7 Gravity is your friend

Most often, as soon as you are in labor, an IV is started and you are confined to a bed, to labor on your back. This is what causes most women to feel they need an epidural. Walking during labor not only speeds up the process, but helps the pain, as does bouncing on a birthing ball. One thing you don't want to do during labor is lay down.

The same thing holds true for delivery. Birthing on your back goes against basic anatomy.
http://naturalchildbirthworld.com/


As you can see in the picture, your canal is actually shaped like a “J” meaning the baby doesn’t just slide straight down and out- it comes down, then up and over the pelvis.

Lying on your back during the birth closes up your pelvic area about 30%. Often times, I have heard a woman say she was rushed to an emergency c-section because her doctor told her that her pelvis was not wide enough. Laying on your back also increases your risk of tearing or "needing" an episiotomy. Imagine she had been on all 4's, squatting, or even laying on her side. This could have been prevented-the tearing, the c-section etc. I have seen size 0 women birth 9-10lb babies with no problem at all!

"Plus if you think about it – you’ll also have gravity working against you. This means when you’re trying to push bub out, you’re pushing down and then UP before he comes out – Can anyone say CRAZY!!!!!" -Tracey Rose (naturalchildbirth.org)

#6 Definitely have a birth plan written, decide exactly how you want your birth to go. You'll need to remember that rarely, emergencies do happen and you'll need to stray from your plans, but this is a good guideline to go by. Outline every one of the aspects of your birth that is important to you: pain relief, newborn care. Childbirth.org has a birth plan builder if you need a place to start, then you can copy and paste it into a word document and add the things that were not mentioned. A birth plan is great to act as your "voice" when you are too tired from labor, napping after birth etc. These are your written wishes and without your permission, the nurses may not go against anything in it.


This is a sample birth plan from my 3rd child:

This birth plan is intended to express the preference and desires we have for the birth of our baby. It is not intended to be a script. We fully realize that situations may arise such that our plan cannot and should not be followed. However, we hope that barring any extenuating circumstances, you will be able to keep us informed and aware of our options. Thank you.

First Stage (Labor):

  • Dim lights.
  • Peace and Quiet.
  • Would prefer my own clothes to gown.
  • Maintain mobility (Walking, rocking, up to bathroom, etc.)
  • Clear fluids.
  • Heparin lock.
  • Intermittent Monitoring (ACOG Standards) with a Doppler.
  • Please do not offer me pain medications, I will ask for them if I want them.
  • Relaxation techniques (breathing, focusing, etc.).
  • Positioning as desired.
  • Water (Shower or Tub).
  • Heat or Cold packs.
  • Ultra low dose epidural (walking epidural) if I request any.

Induction:

  • I would prefer to use natural methods to start labor, if necessary.

Augmentation:

  • I would prefer to walk to speed labor, if necessary.
Second Stage (Birth):

  • Choice of position
  • Directed Bearing Down
  • I would prefer no episiotomy, but please use compresses, massage and positioning.
  • Local Anesthesia (for repair)

Baby Care:

  • Delay the cord cutting
  • Prefer partner to cut the cord.
  • No eye medication
  • Breast feeding only
  • No pacifiers or glucose water
  • Separation only after recovery period

Other Baby Care Requests:

  • No vaccinations or medications to be administered
Cesarean Birth:

  • Spinal/epidural anesthesia
  • Partner present
  • Partner to cut the cord
  • Breast feeding in recovery room

Sick Baby:

  • Breast feeding as soon as possible
  • Unlimited visitation for parents
  • Handling the baby (Kangaroo care, holding, care of, etc.)
  • If the baby is transported to another facility, move us as soon as possible

Now, yours doesn't need to look exactly like this, but it is always ALWAYS a good idea to have your hopes and wishes outlined so that when you are at your weakest and most vulnerable state during labor or immediately afterwards, you won't be pressured into anything you don't want. If a pushy nurse comes in repeatedly to try to get you to change your mind or consent to something, just point her in the direction of your birth plan.

#5 A doula can be your best friend during birth!

I'll be the first to admit that when I initially heard about a doula, I laughed. I mean, really...I don't need some strange woman standing in the room telling me to calm down or try to relax when I'm pushing a bowling ball out of my vagina- I want to be able to yell and scream all I want. This attitude continued through to the first trimester of my 3rd pregnancy. At that point, I was friends with all of these "crunchy" and "natural" weirdos. Shhh...Don't tell them I said that!! (Then again, I can guarantee you that's how lots of my friends describe me now) I had decided I definitely wanted to have this baby naturally and the thought of a doula was very appealing. Fast forward 9 months and sadly, the pregnancy moved too fast and I was extremely busy with everything else that I never got one :(

However, I do know the perks and all of my friends swear by it.

In the words of a good friend, Melinda:

These are my reasons why I had a doula, and will always have one at my births:


-when hubby, nurses, and doctor are away, your doula is always there.
-She can help you distinguish the different stages of labor.
-She was my voice when my husband and I didn't have one-I looked at her to help me make choices for my labor once I got to the hospital because she knew my birth plan in and out, she knew our wishes for the birth we wanted. The midwife and nurses didn't have time to look at my birth plan and couldn't understand why we wanted the things we did. My doula did.
-We had wonderful visits (2 before and 2 postpartum). She was the one who guided me with breastfeeding, not the nurses or the hospital lactation consultant.
-She made me feel empowered at my birth.
-I call her instead of my doctor for natural remedies for anything, she always is there.

#4 Your doctor can't tell you how big your baby is.

No matter how many years your OB has been doing their job, they can not tell you by a simple fundal height or ultrasound, how big your baby is going to be....and if they try, they are usually wrong. The only way to know for sure how big the baby is, is to birth him. Do not let yourself be pressured into c-section because your baby is "too big."

#3 Elective inductions are unnecessary and unsafe.

Simply put, a baby will come when it is ready. Currently, there is nobody in the world that has been ever been pregnant forever- I promise. Occasionally, women will go to 43-44 weeks if allowed, but the average is 37-42 weeks. This means you are not overdue until 42 weeks and 1 days. In the majority of cases, 42 weeks is completely normal and perfectly safe to go to, especially for 1st time moms! So please, skip the herbs and spinning around on your head, nothing is going to make that baby come before he is ready to. Instead, enjoy the time you have with your husband and get a few extra naps in, because soon enough, sleep will be a distant memory.

#2 Give your baby all of its blood!!

Chances are, you've probably done a little bit of research on cord blood banking. You also by now, probably already figured out that it costs a TON. If you are like me, you probably felt bad not being able to afford to bank it, but did you know there is something that you could do that may be even better for your child??

Delayed cord clamping.

Whenever a pulsating umbilical cord is clamped, 20-60% of the baby's total blood volume is trapped inside the placenta. A 9 pound baby manufactures only 10 ounces of blood during gestation. It will take over 6 months for the baby to replenish the volume of blood lost by early cord clamping. So in simpler terms, a newborn becomes an involuntary blood donors as up to half their blood volume is lost when their cords are early clamped.

In some instances, doctors early cord clamp so the placenta and its cord blood can then be sold to the highest bidder. When parents sign consent allowing the hospital to "dispose" of the placenta and other remnants of birthing, they can be sold for medical research as opposed to being burned, for as much as $30,000 each.

The decrease in necessary blood volume causes babies to become anemic and in most cases, the anemia is left undiagnosed for some time, causing the baby to be susceptible to a host of complications, including SIDS.Restricted umbilical cord problems associated with anemia are Autism, heart perforations, brain tumors, leukemia, hormonal imbalances, thyroid disorders, liver/kidney disease.

Baby boys suffer more than girls. They have higher metabolisms that require 10% more blood. This trend is also seen in that boys have a higher rate of disabilities such as ADD, behavioral issues, and Autism.


Currently, 1 in 16 babies require some degree of resuscitation after birth to which early cord clamping is a contributing factor. Perhaps this is just one more reason why the United States ranks 29th for infant mortality in the world and is one of the only countries still routinely practicing early cord clamping.

When an umbilical cord is clamped early, the placenta retains too much blood, a direct threat to the mother and any future pregnancies. When the blood flow is restricted by clamping, the blood can pool in the placenta, causing it to rupture or backflow the baby's blood into the mother's. This cause lead to serious side effects, such as maternal hemorrhage and can even prohibit future pregnancies due to blood mixing.

So with all of the benefits and obvious risks, why do we clamp/cut early?

The first reason and most common is ignorance. Many doctors are unaware of the risks of early cord clamping. This is in part due to poor training. Early cord clamping was first documented as harmful in 1801 and again in 1957. It wasn't until after 1923 that it began to be mainstreamed. Some commonly-used medical texts still detail the use of early cord clamping. However, ACOG guidelines now refute the routine practice of early cord clamping.

Another is time management and convenience for the doctor. They want to be in and out of the hospital as quickly as possible. Waiting an extra 20 minutes for the cord pulsation to stop naturally and the placenta to detach on its own may not fit into their schedule for the day.

Many times, your doctor may say that they NEED to cut the cord, but for most reasons, this is completely untrue.

Short cord, maternal hemorrhage, c-section, and respiratory distress are just a few reasons doctors give for needing to clamp/cut the cord early. A baby in distress can and should most often be revived with the cord intact. All of the restricted umbilical cord problems are usually the result of drugs given during labor, including pitocin, IV fluids, and pain medications, not a result of leaving the cord intact.

The only situations in which a cord should be early clamped is when the cord has torn or with a placenta previa. Babies born via c-section can be delivered with their cord and placenta intact. Multiples can also be delivered without risk of restricted umbilical cord problems.

#1 It's your baby!

This is easily the most important tip for you to remember. Do not be bullied into doing things you do not feel comfortable with, nobody can tell you what to do to your child. They can not take the child out of your arms or perform any "routine" newborn procedures without your permission. If it makes you feel uncomfortable, or you are unsure...then just say no!

This can be ANYTHING from something as simple as the first bath (which is unnecessary, the vernix can and should be instead, rubbed into the skin to protect and moisturize it instead) to something as big of a deal as the Hepatitis B shot (as long as your newborn isn't planning on shooting up drugs into their arms or having unprotected sex in day care, then this really isn't needed, and does much more harm than good)

###BONUS TIP###

ALWAYS research everything. There is never harm done in being fully informed of your choices, or just the procedure. ASK questions, make your own choices. You will never hear a mom say "I wish I wouldn't have known ______" but every single day, I encounter women who say "I wish someone would have told me." You will never regret doing research.


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