Rh Factor

The RH factor is a substance found on the red blood cells of most folks. Eighty-five percent of people have this and are said to be Rh positive (Rh+). Fifteen percent don’t and are Rh negative (Rh-).

There is no importance in most situations except if, by chance, the blood of an rh+ person gets into the blood of an Rh- person. The Rh- person would develop antibodies in his blood to fight off the strange “invader”. This would never happen except in a mismatched transfusion of in the case of an Rh- woman pregnant by an Rh+ man. Her unborn baby would often be Rh+ and under certain conditions, mainly during childbirth, their blood could mix. (Usually, it doesn’t). This would cause the mother’s blood to get sensitized and form antibodies against the substance in the baby’s blood. These antibodies destroy the baby’s red blood cells. This usually won’t harm a first baby because he would already be out by the time the antibodies were formed and they wouldn’t get back into the baby’s system. But the antibody response is stored in the body and the antibodies can pass from the mother’s blood to the baby’s blood through the placenta, and so could harm the blood of her next baby.

Fortunately, there is a way to control this. An Rh- mother with an Rh+ husband should have her blood checked for antibodies several times during pregnancy. Most likely, they will not show antibodies. Then, the day after birth, the Rh- mother will need a shot of Rhogam to prevent any antibodies from forming in case the blood did mix. Consult with your doctor on how to go about getting the Rhogam shot. This shot must be given with 72 hours after birth in order to be effective. If the Rh- mother’s baby is Rh- she won’t need the shot because their blood would not be antagonistic.

If she has had several children, miscarriages, or abortions and has a high antibody count or for some other reason her antibodies are high, she will need to deliver in a hospital where they can induce labor early to get the baby out of a hostile environment, and transfuse if necessary.

There is no complication from an Rh+ mother and an Rh- father. If the baby was Rh- like his dad, his blood would not have any extra substance in it to mobilize his mother’s defenses.

Miscarriage

Ok, I know the picture isn’t all that appropriate, but this topic needed a good laugh before I start. So, I’m not morbid, just as an FYI.
I wasn’t sure if I was going to post about this or not. I have about 10 other posts written, but this one kept popping into my head. I think there is a lot people don’t know about miscarriage, and it isn’t understood enough.
Miscarriages in the medical community aren’t mourned. You are scraped, and prodded, and told your baby has no heart beat anymore. Sometimes they do a D & C and clean you out, and that is all that is left of your baby.
And I know ‘technically’ it isn’t a baby yet, and it isn’t a stillbirth because it occurs before the 20th week, so you don’t even get to bury or your mourn your loss. No one understands why you are so upset, since it isn’t really a baby yet, and they don’t understand why you have to grieve.
Miscarriage in the medical profession is referred to as “Spontaneous Abortion” or SAB. What a GREAT name…
It happens when a pregnancy ends on its own withing the first 20 weeks of gestation.
The ACOG (American College of Obstetricians and Gynecologists) says that anywhere from 10-25% of confirmed and clinically recognized pregnancies will end in miscarriage. 50-75% of chemical pregnancies (lost shortly after implantation) end and women think that it is just their regular period.
These numbers both shock and amaze me. 50-75% of pregnancies aren’t recognized, but we still have babies born every 3 seconds. Considering how the odds are stacked against them, that is absolutely amazing to me!
Most miscarriages occur before 13 weeks gestation. It is a common thing to tell people that they shouldn’t announce their pregnancy before 13 weeks, but if they lose the baby, how will they have any support? They will be all alone in their grief, and no one will know why. I can understand only telling family and close friends, but you have to have someone besides you and your spouse if something happens.
The majority of miscarriages cannot be explained. It is said that something is wrong with the egg, so it is expelled on its own.
Other causes could be hormonal problems, infections, or maternal health issues, your lifestyle (smoking drinking, drug use, malnutrition, excessive caffeine, exposure to radiation/toxic substances), implantation does not occur properly, maternal age, and maternal trauma. Exercise and work do NOT factor into the causes of miscarriages. They can occur because you work too hard, but most time if you are going to miscarry, you could be on bedrest and still lose your baby.
The chances for miscarriage can range from 10-25% for healthy women in childbearing years. It doesn’t seem very high, but it happens everyday.
The increased risks for miscarriage are:
-Under age 35 is 15% chance
-35-45 yrs have 20-35% chance
-40 yrs is 50%
-Anyone that has a previous miscarriage has a 25% chance (slightly elevated from normal)
The odds are so terrifying if you are pregnant or TTC. Just the thought of losing your baby after you work so hard for it and get so excited breaks your heart. But, even with all this, people still have babies everyday.
The warning signs on miscarriage include:
-mild to severe back pain (worse than cramps)
-weight loss
-white/pink mucus
-true contractions (every 5-20 mins)
-brown or red bleeding with or without cramps
-tissue like clot with material passing
-sudden decrease in pregnancy signs
There are different types of miscarriage also.
Threatened Miscarriage: Some degree of early pregnancy uterine bleeding accompanied by cramping backache. The cervix remains closed. This bleeding is often the result of implantation.

Inevitable or Incomplete Miscarriage: Abdominal or back pain accompanied by bleeding with an open cervix. Miscarriage is inevitable when there is a dilation or effacement of the cervix and/or there is rupture of the membranes. Bleeding and cramps may persist if the miscarriage is not complete.
Complete Miscarriage: A completed miscarriage is when the embryo or products of conception have emptied out of the uterus. Bleeding should subside quickly, as should any pain or cramping. A completed miscarriage can be confirmed by an ultrasound or by having a surgical curettage performed.
Missed Miscarriage: Women can experience a miscarriage without knowing it. A missed miscarriage is when embryonic death has occurred but there is not any expulsion of the uterus. It is not known why this occurs. Signs of this would be a loss of pregnancy symptoms and the absence of fetal heart tones found on an ultrasound.
Recurrent Miscarriage (RM): Defined as 3 or more consecutive first trimester miscarriages. This can affect 1% of couples trying to conceive.
Blighted Ovum: Also called an anembryonic pregnancy. A fertilized egg implants into the uterine wall, but fetal development never begins. Often there is a gestational sac with or without a yolk sac, but there is an absence of fetal growth.
Ectopic Pregnancy: A fertilized egg implants itself in places other than the uterus, most commonly the fallopian tube. Treatment is needed immediately to stop the development of the implanted egg. If not treated rapidly, this could end in serious maternal complications.
Molar Pregnancy: The result of a genetic error during the fertilization process that leads to growth of abnormal tissue within the uterus. Molar pregnancies rarely involve a developing embryo, but often entail the most common symptoms of pregnancy including a missed period, positive pregnancy test and severe nausea.
The treatment of a miscarriage is to prevent hemorrhaging and/or infection. Most pregnancies in the first trimester expell themselves. If not, a D & C is performed and everything is scraped away.
The prevention of miscarriage is a common myth most times. You can try to stay healthy and safe, but if the egg is incomplete or something is wrong, there is nothing you can do to stop it.
I think this is the 2nd most terrifying thing that can happen in pregnancy, second only to stillbirth. To have your baby taken away from you is absolutely terrifying.
My only problem with the medical system and their treatment of miscarriages is that before you lose 3 babies, they will not do research to find out why. Until you are classified as a “recurrent aborter”, you cannot have workups done to see if it is a fixable problem or if it is something that will always happen to you.
So, instead of having women only losing one baby, they have to lose 3 to find out if they have a problem. It is so wrong. One miscarriage is hard enough. Three would be unbearable.
BUT, miscarriage is NOT your fault!! It may feel that way. You go for weeks after pondering and wondering what you did before you lost your baby. Did I make my bath too hot? Did I eat or drink something that could have hurt it? Did I bump into something without knowing? It is one of the worst times of your grieving process.
My only suggestion (one that I have found works AMAZINGLY well) is to join a support group. It could just be your family or your close friends, or an online group, or a group that meets monthly or weekly. You need to be able to let out your grief with people that understand and have been there. You did nothing wrong, and it may take some time to realize it, but it is NOT your fault.
I know I blamed myself for a very long time. This last week, one of the women in my group announced she is pregnant and has her first u/s scheduled for next week to make sure everything is ok. For the first time since I lost my first baby, I was truly happy for her. It has been a year this month since I lost my first, and I was so excited to be happy again. I never thought the day would come.
So, for anyone out there that is TTC, or has had a miscarriage, or is having a healthy pregnancy, just know that no matter what you have or haven’t had, if it ever happens to you, know that it does get better. The ache slowly lessens and you are able to smile again. And you are able to be around pregnant people again. The hole will always be there, but it doesn’t have to run your life. You can truly be happy again, whether or not you have a successful pregnancy and family.

Birth Story #9

So, I am super excited about the birth story this week. I asked my friends that had children if they wanted to put their stories on here, and they all agreed completely. I was thrilled!!

This one is my sister in law, Rachelle. Her son was born in January of 2008 and I love him to death.

The other day we were talking about choosing the birth you want, and I think this is one of the great examples of that. She didn’t have anyone telling her what to do, and she was able to make decisions based on what she wanted. It is one of the happiest ones I’ve read so far that takes place in a hospital ha ha.

I had never heard the full story before, so it was a first for me too! Hope you enjoy and thanks Rachelle for sharing it.

Teagan’s Birth


When I found out I was pregnant, I was thrilled. I knew right away that I wanted Dr. Hansen to be the person to deliver my baby. He is the doctor my mom had that delivered all her kids (including me) and he is a wonderful person and doctor. He is a big advocater of vaginal delivery and has a very low c-section rate. My mom did have to have a c-section with my younger sister due to severe complications but that’s another story. He later assisted my mother in a successful VBAC which is always good. I knew him and trusted him and felt great with my decision.

My pregnancy had a rocky start. At about 10 weeks, I thought I had miscarried. I bled worse than I ever had during any period and I just cried. I went to the doctor the next morning and after talking to the doctor, he said he was fairly confident that I had lost the baby, but there was a slight chance that I hadn’t so he ordered an ultrasound. I had the ultrasound and of coarse they weren’t able to find any heartbeat. The baby was too small. They had to do an intravaginal ultrasound. It was uncomfortable and very emotional for me. I laid there while they probed around trying to find a heartbeat. They finally found one and I cried I was so happy. They checked for placenta previa (later in my pregnancy when it was easier to determine) and to see if maybe I had lost a twin, but there were no signs of either. They told me it was due to excessive physical strain (which was certainly the case) and the doctor put me on bedrest.

After a few weeks of bedrest the bleeding stopped and my pregnancy continued without any complication. I actually enjoyed my time being pregnant. My husband spoiled me rotten (still does) and it was a very special time to bond with him while we planned for our baby’s arrival. As I got further along in my pregnancy, we found out the gender and we were going to have a boy! We were both too excited to wait until birth to find out the gender. I was glad I had the time to plan and buy clothes and things. It was a lot of fun preparing for the baby. I became obsessed with literature on pregnancy, delivery, and preparing for the baby. I read everything I could get my hands on. I learned a lot and was able to make an informed decision on how I wanted my baby delivered. I felt it was important to feel comfortable during my delivery and after much deliberation, I decided that I would feel most comfortable at the hospital.

I was growing right along schedule and measuring just right until about 36 weeks. Then my baby was growing quite a bit faster and larger. Dr. Hansen told me that the baby was going to be fairly big and he suggested scheduling an induction. He said my vaginal opening was smaller than average and my baby would be bigger than average so to avoid excessive tearing, he wanted to induce my labor if I didn’t go into labor before my due date.

My due date came and I went into the hospital at 6:00 a.m. and was having contractions by 7:00 a.m. I had never had any braxton hicks contractions or anything so it was a totally new experience. I had planned on having an epidural but I didn’t want it to slow my labor down so I was going to hold out as long as I felt I needed to be able to keep my labor at a decent pace. The nurse came in several times and asked if I wanted the epidural yet and I said that I didn’t. She wasn’t pushy or anything, she was actually a great nurse. She made me feel very comfortable and my husband was able to be there with me all day which was great. The nurse finally came back in and told me that I had progressed far enough and that my contractions were as intense as they were going to get and that I was almost ready to start pushing and said if I wanted the epidural at all that now was the time to get it. I thought about it for a while and figured that if the contractions were as bad as they would get, then I would be fine to go without. Then something kept nagging at me about not getting it. I was doing pretty well handling the pain on my own, but this feeling that I should get the epidural wouldn’t go away. I decided to get the epidural and soon found out why.

About an hour after I got my epidural, the nurse said I was almost ready to start pushing and she went to call the doctor. He was right in the middle of a delivery at a different hospital and couldn’t get there for about an hour. The nurse asked if I wanted to have another doctor deliver my son or asked if I wanted to wait. I was SO glad I had gotten the epidural! I decided to wait since I knew my doctor and trusted him so much, I didn’t want someone else to deliver my son. Because of the epidural, I felt no pain or pressure and I was able to relax until the doctor was able to arrive. It took longer than expected because of a huge snow storm but I was in no rush and my baby was doing great. Dr. Hansen arrived and I started pushing. I immediately started to tear and the doctor advised an episiotomy and then asked if I wanted one. Since I trusted him, (and didn’t want to tear clear to my rectum) I decided to do it. My delivery couldn’t have gone better. Everything went beautifully. He came out screaming and I got to hold him while my husband cut the cord. It was so special to finally get to meet him face to face. He was perfect and healthy and we couldn’t be happier. I was so glad I made the choices I did and that Dr. Hansen was able to deliver my baby. Despite the fact that many women frown upon epidurals, inductions, and episiotomies, I felt the decisions I made contributed to a wonderful birth experience.

Many women in America today don’t realize they have a choice in their birth experience. They are either told horror stories that alter their perceptions or aren’t told enough to help them make an informed decision. Giving birth to YOUR baby should be the way YOU want. I carefully chose my health care provider, researched my options and chose the hospital. I was given the choice all through my labor and delivery about what I wanted. I think that is one of the main reasons my labor and delivery went so smoothly. I wasn’t nervous, I was prepared. I knew what was ahead and there were no surprises. Giving birth is a very personal experience. It is different for every person. There isn’t a clear right or wrong choice. It’s important to know your options and do what’s best for you. Whether that’s home births, hospital births, or a birthing center with a midwife or doula, it’s YOUR choice. Do what’s best for you.

There is tragic part to this story. My doctor that I loved so much and trusted completely passed away unexpectedly when my son was only 2 months old. I was devastated. He was in his late 50’s so he was older, but certainly not close to death. He was always really healthy and all of the sudden had a massive heart attack and died almost instantly. My heart goes out to his family and the other women out there mourning the loss of this great doctor. Now I am struggling to find someone to replace him. I have decided to start over on my research to find the kind of health care provider I can trust as much as him. I doubt I will be able to find another doctor with a cesarean rate as low as his was, so I may go with a midwife. I am also considering a doula. I know someone who would make a great doula and she just might be ready to help when I get pregnant again. I’ll keep my fingers crossed. 🙂

Tearing Vs. Cutting

The idea of a routine episiotomies has been a real interest to me lately. I have a friend that had only paper cut tears during her two kids. If she had been cut during her delivery, she would have had to be sewn up and been in more pain just because ‘routine episiotomies’.

My sister-in-law and I were talking about episiotomies vs. natural tears after I wrote this post, so I decided to come back in and add a few comments that we talked about.

The major one in my head was always the idea of a piece of fabric. You won’t be able to tear it just by brute force strength. But if you make a small nick in the fabric and then tear it, you don’t need to exhert any strength at all. It rips right down the seam.

Since the world is turning more toward natural birth, though not a lot, a lot of people are coming out and asking their physicians point blank about their episiotomies. A lot are revising their views to be on a case by case basis, so routine episiotomies aren’t in fashion as much as they once were.

Episiotomies are done to keep a woman from getting 3rd or 4th degree tears, to stop urinary incontinance, and they are also done when forceps are needed.

The only thing with it stopping urinary incontinance is that you have already stretched before the baby crowns. An episiotomy is done on your perenium, not your birth canal. It just helps get the baby out faster to keep stretching at a minimum.

The negative sides to having an episiotomy are that you have a longer healing time, tears can actually get bigger (such as with the fabric above), increased pain when intercourse is resumed, and infection.

The good side about episiotomies are that they are a lot easier to stitch, they speed up the birth, and they can help keep vaginal tears to a minimum. Since it is a straight stitch, the doctors are able to find the pieces and fit them together faster so your time in the stirrups is lessened.

A lot of people say that your body will only tear enough to get the baby out. If it is a small baby, you will stretch to your limit, then tear. It all depends on if you prepared yourself during your pregnancy, and you use the positions that help to fan your perenium. Some people are naturally more elastic than others.

To prepare yourself to stretch during pregnancy, you can try doing the following things:

1. Adequate nutrition (healthy skin stretches more easily)
2. Kegel exercises during pregnancy
3. Discussing your concerns with your physician
4. Perineal massage during pregnancy
5. Controlled pushing, which allows more time for your tissues to stretch (you push very slowly. It takes longer, but your body stretches slowly so there aren’t any sudden movements to tear you faster)
6. Warm compresses during labor
7. Manual stretching by the physician/midwife during delivery

In the end, you can prepare all you want, and still have a 4th degree tear.

The one thing that is great about labor and delivery is that it isn’t the same for every person. It all comes down to doing what you are most comfortable with. If you are terrified of being cut, try doing it yourself. If you are terrified of tearing, have them cut you. The only person going through the labor is you, and only you can make it what you are most comfortable with. Your decision, no matter what it is, will empower you and you will feel great about your outcome.

Commons Cesarean Reasons

Since the cesarean percentage is going up every year, and it is considered a major surgery, you have to wonder why.

So, I reasearched the common reason for having a cesarean. (The practice will be in green, my commentary will be in red).

Placenta Previa: This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. 1 in every 200 pregnant women will experience placenta previa during their third trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option. This is a pretty scary thing. It involves bleeding while you are pregnant, and some people believe they are miscarrying. Once it is diagnosed, they can help you rectify it, but most times it is delivered by cesarean. It is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can come off during the process.

Placental Abruption: This is the separation of the placenta from the uterine lining that usually occurs in the third trimester. Approximately 1% of all pregnant women will experience placental abruption. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and depending on the severity, an emergency cesarean may be performed. This is if the placenta comes off before the baby comes out. It is dangerous to the baby and cesareans are what keeps these babies alive.

Uterine rupture: In approximately 1 in every 1,500 births the uterus tears during pregnancy or labor. This can lead to hemorrhaging in the mother and interfere with the babies oxygen supply. This is a reason for immediate cesarean. This is a HUGE problem. If it isn’t caught and repaired right away, it can lead to a hysterectomy and death.

Breech Position: When dealing with a breech baby, a cesarean delivery is often the only option, although a vaginal delivery can be done under certain circumstances. However, if the baby is in distress or has cord prolapse (which is more common in breech babies) a cesarean is necessary. A cesarean may also be done if the baby is premature. Tons of breech babies are born vaginally every year. They just stopped teaching how to do it in medical school, since it is “safer” for breech babies to be born by cesarean. If you use the right positions during labor to make you more ‘stretchy’ you can get a breech baby out without a tear. I know that here in Utah, the only hospital that still does breech deliveries is at the University of Utah.

Cord prolapse: This situation does not occur often but when it does an emergency cesarean is done. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born. When the uterus contracts it causes pressure on the umbilical cord which diminishes the blood flow to the baby. This is also a huge issue. The baby has to be out right away so that it can keep its oxygen level. If it is cut off for too, long it does lead to death or mental retardation.

Fetal distress: The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that your baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Most doctors say this is what is happening in your labor more often than not to get you to deliver faster, or to take you in for a cesarean section. There are numerous tests they can do to make sure the baby is ok before they jump the gun because your baby’s heart rate slows down a bit during a contraction.

Failure to progress in labor: This can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. This can be diagnosed correctly once the women is in the second phase (beyond 5 centimeters dilation), since the first phase of labor (0-4 centimeters dilation) is almost always slow. Once you reach active labor, more than 4 cms, they say you should open 1 cm every hour. Some women open faster, some much slower. Every labor is different. Unless there is a medical emergency to get your baby out, saying everyone dilates 1 cm an hour and then telling them they have to go in for a cesarean because they’re body can’t handle labor is just wrong. Women lose faith in themselves and it ends up as a bad birth experience.

Repeat cesarean: You may be surprised to find out that 90% of women who have had a cesarean are candidates for a vaginal birth after cesarean for their next birth (VBAC). The biggest risk involved in a VBAC is uterine rupture, which happens in 0.2-1.5% of VBACs. However, there is a criteria you must meet in order to have a VBAC. Consult with your health care provider about your current situation and your options. OB/GYNs and Midwives need to stress this more. A cesarean is a major surgery. The first isn’t as big of a deal as subsequent ones. Any number of things can go wrong in 2nd and 3rd cesareans. Most times a bowel is nicked and if it isn’t caught, infections set in and worse things happen. If you can have a VBAC, why would you want to have another surgery?

Cephalopelvic Disproportion (CPD): A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. If this is truly the case, that’s fine. Most times this is misdiagnosed. When they take your pelvic measurements, they can’t really tell how big you are. It is all an estimation. Most women’s body’s won’t make a baby bigger than they can push out. If you have had rickets or something else that has ruined your pelvic bones or something, then it can happen. But if you body made a baby too big for you to push out regularly, the human race wouldn’t exist.

Active genital herpes: If the mother has an active outbreak of genital herpes (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled to prevent the baby from being exposed to the virus while passing through the birth canal. A cesarean is necessary in this case. If you have an outbreak, would you want your baby to get it? It can be prevented, but would you take the chance?

Diabetes: If you develop gestational diabetes during your pregnancy or are diabetic, you may have a large baby or other complications. This increases your chance of having a cesarean. Large babies are very common in genstational diabetes. Some babies do get stuck and cesareans are performed. But this goes back to the baby won’t be bigger than you can push out. Your body knows what it’s doing!

Preeclampsia: Preeclampsia is a condition of high blood pressure during pregnancy. This condition could prevent the placenta from getting the proper amount of blood needed and decrease oxygen flow to the baby. Delivery is sometimes recommended as a treatment for this condition. Only with severe preeclampsia is a cesarean needed. This is a very severe condition. It isn’t as severe as eclampsia, but it still needs to be addressed. You are monitored closely if you are diagnosed, and most women with preeclampsia deliver vaginally. But there are those rare cases where a cesarean is mandatory to save the baby and mother.

Birth defects: If a baby has been diagnosed with a birth defect, a cesarean may be done to help reduce any further complications during delivery. I don’t agree with this one. Sometimes during deliver things happen. Things go wrong, just like with everything else. I don’t see how doing a cesarean is going to stop a baby from being Down Syndrome.

Multiple births: Twins may be delivered vaginally depending on their positions, estimated weights and gestational age. Multiples of three or more are less likely to be delivered vaginally. I don’t agree with cesareans for multiples. If they are transverse or breech or something, then it is a little better, but if both babies are down, or one is down and the other is breech, a woman does not need to deliver on an operating table with an IV “just in case”. And now in Utah, you can’t have multiples at home, no matter if you are the perfect candidate. They are now classified as “high risk”. And I know they are normally early, and home births can’t occur before week 38 and after week 42, so why did they have to ban it for multiples anyway? It is just another way that they tell you about your pregnancy and the “problems” that “could” arise.

Interviews and What To Ask

I got a new book the other day, Special Women by Paulina Perez and Cheryl Snedeker. It is made so that doulas can see exactly what their jobs will entail and if they are up for it. I am loving it.

In their book, they had questions that you can ask your doula or montrice before you hire them. I thought it was a great idea, and decided to come up with a list to ask your physician also. Choosing a doula and choosing the person that will deliver your baby are extreemly important decisions. You have to trust them to do what you want to do, and you have to feel comfortable with the advice and such that they give you.

First, the OB/GYN / Midwife interview process and questions:

1. Before you do anything, you have to get a list of providers from your insurance. If you belong to an HMO, you may need a referral from your physician for it to be covered.
2. Call at least 3 OB/GYNs and Midwives (depending on your preference) and schedule consulatation appointments. Make sure they are accepting new patients and they aren’t overbooked. (If you are going to use a home birth midwife, make sure she isn’t stretched too thin around your due date. Most choose only 3 or 4 clients a month).
3. Write down your questions before you go in. Write them in order of importance. Most consultations only last about 15 minutes, so you need to make sure you get your most important questions answered. Don’t ask aobut doctor vacations, call schedules, and wait times at the office until you get your other questions answered.
4. Bring your partner with you. You both have to feel comfortable, especially if they will play an active role in the delivery.
5. Give the physician the benefit of the doubt until you find out otherwise. Your job is to ask the questions, not talk about how much you know about childbirth.
6. Make them give specific answers. If you ask what their percentage for cesareans is, don’t let them answer with “it’s average”. Make them give you their percent.

-Some good questions to ask:
1. How many babies they have delivered.
2. Who you can contact in an emergency
3. Who covers if they are unavailable
4. How they handle high risk pregnancies
5. If they write a birth plan with you and help you with what you want to do
6. Ask about their percentages for:
-epidurals
-episiotomies
-cesareans
-inductions

It is so important that you feel comfortable with the person that will be delivering your baby. Even if they are only there for the catch, you will be seeing them multiple times during your pregnancy, and if they do not have the stats or state of mind you want, you do not have to go to them.

To interview your Doula/Monitrice (a nurse and support):

1. what type of practice do they have – doula, labor support, monitrice, midwife
2. Their educational background
3. Their training information
4. Do they help in hospitals, birth centers, home?
5. How many births have you attended? Over what time span? Average births per month?
6. Type of clients you normally take? Backup doulas or supoprt? When would your backup cover you?
7. The fees. When do I need to pay? Is it a sliding scale? Do you barter for a fee?
8. Can you get third party reinbursement for services?
9. Do you have any restrictions?
10. When can I call you? Is it 24 hours a day?
11. Will you come to my house while in labor?
12. How will you know if complications arise?
13. Do you listen to and interpret fetal heart tones?
14. Do you do vaginal exams?
15. Do you assess maternal well being?
16. What is your relationship with birth center/hospital personnel?
17. Have you ever worked with my physician/midwife? What was the experience like?
18. Are there any restrictions on you at the birth center/hospital? What are they like?
19. Do you get along with the hospital staff or my doctor? Any conflicts? Will it interfere?
20. If someone suggests an interventino you feel is unnecessary, what will you do or say?
21. How can you help us minimize the need for an episiotomy?
22. If cesarean is needed, will you accompany me?
23. Have you ever cared for someone with a poor outcome? What was the situation?
24. What do you provide that is different from the hospital staff?
25. What is different that what my partner can provide?
26. What is different than what my physician/midwife can provide?
27. Why did you become a professional labor support person?
28. What do you like best about your job?
29. What do you like least about your job?
30. why is labor support helpful?
31. ALWAYS ASK FOR REFERENCES!

Make sure you do not feel intimiated by your birth support. It is not their labor. It is yours. They are there to make sure you get the labor you want, not push their labor beliefs on you. Make sure it is someone you can trust and turn to.

Just some answers to a few questions

In one of my last posts on induction, a girl asked about stripping of membranes and breaking your water as means of induction and where they stand. I’ll start off with breaking your water, or amniotomy. In A Good Birth, A Safe Birth by Diana Korte and Roberta Scaer, they say

“95% of women with uncompliciated unmedicated labors will still have the bag intact until very late in labor or even up to the birth.”

The bag of waters is a benefit to mother and baby if left to break on its own. It provides a soft cushion for the baby’s head and umbilical cord, meaning they will be able to receive more oxygen during labor and be able to move around better for the delivery. The longer the bag stays intact, the longer without risk of infection. Once the water breaks, infection can get into the uterus. In hospitals, you are only allowed 24 hours maximum from the time your water breaks till you have to have the baby or you go in for a cesarean. On The Farm (see previous post), they have had people go days in labor after their water has broken. They monitor frequently for infection, and keep vaginal exams to a bare minimum.

If your water breaks naturally, you will feel a gush of warm fluid ora trickling of fluid. Rarely is it a huge floor puddle like on TV.

Amniotomy is used to speed up labor or induce labor in a ready woman (meaning your cervix is soft and ripe). It is also used to attach a fetal monitor to a baby’s head and can be broken to test for meconium, or your baby’s first bowel movement. If medonium is found, it means your baby is in distress and needs to be delivered.

The pros of doing an amniotomy during labor is for meconium testing and if you are dialated 7 cms or more, it speeds up the last 3 cms of dialation, which would mean a shorter labor for most women.

The cons of doing an amniotomy is it is often the start of birth interventions, often along with a pitocin drip and EFM (electronic fetal monitoring). There is an increase in cesarean usage, since you only have 24 hours to get the baby out. There is no cushion for the baby, so contractions are harder for the baby to handle, and most often times, the heartbeat will slow down and show the baby’s distress. The risk of infection increases, as stated above. The umbilical cord has a greater chance of being compressed and cutting off oxygen to the baby, requiring an immediate cesarean. It also stops a woman’s body from acting naturally and can actually slow down labor so pitocin is needed to keep it going.

In some countries, babies that are born in their bag of fluids are often considered lucky and are said to come directly from the gods or they have some special significance in their lives and the lives of others (which I think is pretty nifty).

Stripping membranes is the process of your doctor doing an exam, but instead of just feeling your dilation, they feel around just inside your cervix where the membranes are attached to the rim. In this process, they break the membranes (on a molecular level) and this allows the membranes to break and so release and turn into prostaglandins (which soften the cervix making it ready to open) to prepare for labor, but only if your cervix is RIPE and ready for labor. Before then it won’t be worth it.

This WILL NOT cause spontaneous labor. It is a slow process, most times taking more than one try to get labor to start.

This is often used on toxemia, diabetes, and other patients that need to deliver, but it isn’t necessary they deliver immediately.

There has been a lot of argument as to whether stripping the membranes regularly actually starts someone’s labor, or it was about to start anyway. If your body isn’t ready to go into labor, this will not start it like medications will. It just helps your body prepare.

I hope these answered the question from before!