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Interviewing Obstetricians

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Life circumstances and changes in our choices can lead us to seek out a new obstetrician. The provider you used for your gynecological or fertility care may not be who you feel comfortable with for your obstetrical care. You may want a different experience if you are no longer a first time mom and longed for something different during your birth. Your insurance may have changed and no longer covers your original ob/gyn and hospital as in network. Maybe your friends or mommy group are raving about a different practice in town and you want to investigate. Whatever your reasons, feel open to the idea of interviewing a different provider.

This post is focusing on in hospital providers because the majority of women do give birth in hospitals and there are many articles and posts about interviewing home birth providers. It is also titled Interviewing Obstetricians because our country has a majority of obstetricians providing prenatal care. In hospital providers are typically obstetricians or certified nurse midwives but may include family practitioners in some areas.

You will begin by calling the office of the practice or provider you want to interview and asking for a pregnancy consultation or a “meet and greet”. This appointment will give you a chance to meet the provider and ask questions — it is not an exam. Having a list can help you focus and maximize the time afforded to you.

The list below is a starting point of questions you may want to ask and is by no means all inclusive to every scenario or your individual circumstances.

  • Is your practice suited to my wishes and desires for birth? (I want to go natural, I want an epidural upon request, is delayed cord clamping or immediate skin to skin encouraged and available?)
  • What sorts of prenatal tests do you offer or require?
  • What tools are available to help me achieve the birth I desire? (birth balls, peanut balls, squat bars, showers, tubs, wireless monitoring or intermittent monitoring, heating pads or a community microwave for hot packs, iv narcotics, nitrous oxide, anesthesiologists available all hours, etc.)
  • What are hospital policies regarding freedom of movement, nurse ratio to patient, triage, acceptance of doulas, photography rules, eating and drinking, and how would those change if medicine was used or not used?
  • Will I be staying in the same room I birth in or moving to a postpartum floor? (both scenarios have pros and cons).
  • What is your on call schedule like? Will I have a chance during my pregnancy to meet anyone who may be delivering my baby or can I request a specific provider to catch my baby?
  • Are there time limits on my labor or pushing if mom and baby are doing okay? What is your epidural/cesarean/natural rate (keep in mind that numbers may only reflect they are a higher risk practice or hospital, but this can lead to more questions about their philosophy.
  • How do you feel about up to date evidence based recommendations made by ACOG (American Congress of Obstetricians and Gynecologists)? Should an issue arise that requires a decision will we make time to discuss risks/benefits and discuss alternatives (barring an outright emergency).
  • What level NICU is available on site or would there be a transfer of baby if there was a serious problem?

Again, this list is not exhaustive and you may want to tweak or add more questions but it will hopefully get your thinking cap on so you can make the most of your interview. You may want to ask more details about postpartum policies or cesarean policies if those are important to you and depending on how much time you have with the provider. Whatever your list of questions becomes, listen carefully to the answers and then pay attention to what your intuition tells you as you process the visit.

Kimberly Sebeck, CLD, CCCE, HCHD  Knoxville Doula 2016

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Friends & Family At Births

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This post might not be popular with some people, especially if you are a family member or friend who finds they resemble some of these descriptions. However, I work for my doula clients to make sure their birth experience is one they can cherish and this needs to be said:

If your pregnant daughter, friend, niece, granddaughter, cousin (or any imaginable relationship) requests that you not come to the place of birth while she is in labor — respect her wishes.

I can hear the excuses now. But we want to be there. But we want to see baby be born. But we want to be the first in the family to hold the baby. But she is my (insert relation). But the partner is (insert relation). But, but, but.

She said she didn’t want you there. Actually, she probably didn’t say I don’t want you to be there. She probably said something polite and nice like, please respect our privacy. I will be working hard to bring a child into the world. We would like our privacy. We will call you once we want you to come or once baby has arrived. It may take a long time and we don’t want you hovering. Please respect our privacy.

Please listen and respect her wishes. Please know this is an important day and if she has made any attempt to ask you to not intrude on her privacy and concentration, she has thought long and hard about how to convey this to you without hurting your feelings.

Let me tell you what happens in some scenarios when people don’t listen to and respect a laboring woman’s wishes. At worst, you can cause her labor to stall or completely stop or contribute to a dysfunctional labor that can put her at risk for interventions she has been wanting to avoid. This is especially true when a woman is attempting a natural birth, but it can happen even with an epidural for pain relief. On a less serious level you are disrupting her concentration and possibly creating a memory she would rather not have attached to the day her baby and your (insert relation) is born.

Why do I sound so harsh about this? Because after 16 years of being a doula I can tell you I have seen some family members behave in peculiar ways. Yes, I understand you are coming from a place of love and concern but it boils down to people making choices to disrespect what a laboring woman has requested. Here are some scenarios I have witnessed:

  • A laboring woman tells her family she is going to the hospital to be checked out and she will give them an update. Upon her arrival, she finds there is a room full of family eagerly asking private details she may not want to share and interfering with the staff assessments. Her labor stalls or stops and she is sent home, only to return a few hours later and this time to keep it to herself.
  • Despite clear instructions and a sign on the door that the laboring woman does not want visitors, family members continue to come in because they “just have to know what is going on.”
  • Family members falling down and wailing on the hospital floor when they hear a woman requires a cesarean for safety, disrupting the precise and necessary care from the medical providers.
  • Family members physically grabbing me and shaking me for updates.
  • A laboring woman finally getting a break from her labor either via a natural spacing in her contractions or some medicinal pain relief and taking a well deserved and needed nap only to have family members barge in wanting updates even though they had been told she is napping.
  • Family members bringing cheeseburgers and fries into the room of a laboring woman who hasn’t eaten in 12 hours.
  • Family members threatening to sue the staff if the baby isn’t here soon.
  • Family members accosting all staff, doulas, partners, and even the woman if any of them come out of the room and going so far as to be standing in the hallways eavesdropping with their ear against the door.
  • Family members making comments that they have never seen such a large belly, telling her to get an episiotomy, random myths and outdated advice, asking her why she is trying to go natural, telling their own birth horror stories, or one of the worst, saying I just don’t know what I would do if you or the baby died.

Are you thinking this is fabricated? It isn’t. This actually goes beyond a case of bad manners. These sorts of behaviors can be dangerous, especially if there is a medical situation going on. When an emergency cesarean is needed, staff needs to move fast. As a doula, I move out of the way and let them do their job when something becomes medical. Family members falling down in the hallway is hindering the staff and the well-being of mother and child, and possibly even other mothers and children. People expressing their love and projecting their fear by voicing that the process is taking too long or they are bored or that something negative will happen to the mother and baby is not only not helpful, it is harming the process and the persons you profess to love. Showing up at a hospital when you have been asked to wait for instructions is crossing a boundary of respect and can make a woman feel like she needs to hurry up. Speaking of, many family members actually say, can you hurry up and have this baby? I have had women hiding in their bedroom or hospital room and sometimes locking themselves in a bathroom simply to find the privacy she desperately requires.

Each woman is different on how she views the need for privacy during labor. In the early stages of labor, a room full of chatter and excitement may be helpful for some and unhelpful for others. As active labor begins, most women prefer a quiet and private environment. There are times I will step out and allow partners to work privately during labor. There is a reason nurses, midwives, and doctors do not sit and stare at their patients. We know that disruptions are disrupting, it is as simple as that. Childbirth is not glamorous and is usually messy. We have not arrived at a point in our society where it is acceptable or comfortable for women to ooze bodily fluids in front of others. Would you want someone to watch you moving your bowels? No, you would probably try to wait until you had a private moment and birth is much the same. Women need to feel supported and one way to support them is by listening to their wishes. If you have been asked to respect their privacy, please listen.

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As the mother of an adult daughter, I have often wondered how difficult it would be for me to know she is in labor and to have been asked to not participate in or view my grandchild being born. I understand it must be hard. I understand that our society has created much fear about birth. I understand that Hollywood makes it seem that a woman’s water releases/breaks and we have a baby born at the hospital mere minutes after a screeching ambulance races her there.

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That’s not how it works. That’s especially not how it works for first time moms. Average labor time is approximately 15 hours. Average pushing time is 2 hours for first time moms.The placenta may take several minutes or longer to be birthed after the baby.  Unless you live many hours away, there will be time for you to arrive. After a baby is born we want mom, partner, and baby to have a minimum of one hour for bonding and breastfeeding and that is after the clean up, physical assessment of baby and mother, and any repairs. Your loved one just birthed a baby into the world and needs that time to de-escalate and bond with and nurse her baby. You could be notified the moment the baby is born and if you live locally would still have time to be waiting to see the baby.

The baby will not grow 2 heads or horns or grow up and go to college before you get there. I promise. And you might be able to bring that new mama a wonderful favorite meal on your way to visit (don’t forget daddy or partner!).

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If you are anxious, excited, nervous, antsy (and who wouldn’t be) I have a list of suggestions for you.

  • If you are crafty, work on creating something for baby
  • Go grocery shopping or cook freezer meals for the new family
  • Clean their home (with permission of course)
  • Walk their dogs, do any errands they may need
  • Write a letter to your loved one(s) and the new baby arriving
  • Go shopping for last minute essentials or just for fun
  • Assemble any baby items that need assembling (swings, bouncers)
  • Make every attempt to send peaceful and positive thoughts, prayers, and vibes
  • Trust that her request for privacy is in her best interests and what she needs

If you simply must be at the place of birth, find the waiting area and occupy yourself with something and wait for more information. Family members can be a wonderful source of encouragement. I am in no way advocating that family and friends be kept out of the loop or prohibited from being at the birth if the mother wants their support and company. I have seen mothers, sisters, cousins, best friends, brothers, fathers, mother in laws, etc., be a positive and useful source of support and encouragement– but please be invited.

Kimberly Sebeck, AKA Knoxville Doula, 2016

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Pelvic Floor Therapy Guest Blog

Please enjoy this guest blog from a Pelvic Floor Therapist in the Knoxville, TN, area.

This does not have to be your current or future experience.

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Hello! My name is Autumn Synowiez and I am a pelvic floor therapist.

A pelvic floor therapist (PFT) can help treat many different types of problems that women have such as:

  • urinary incontinence (it is not normal to wet ourselves)
  • stress incontinence (when we cough, laugh, exercise) or urge incontinence (always feeling a strong urge to go).
  •  pelvic organ prolapse (yes we can reduce prolapse without surgery by two stages!).
  • perineal/episiotomy scars, cesarean scars.
  •  diastasis recti
  • pelvic pain, pressure, dyspaurenia (painful sex)
  • preparing your pelvic floor for birth to reduce these symptoms after birth and help coordinate your pelvic floor for optimal pushing.
  • postpartum check ups to make sure you truly are ready for exercise and have sex again (if not we will set you up with all the exercises needed to get you on the right path, surprisingly most women are not ready for either).

    Countries like France and Sweden have women going after their 6 week postpartum check up with their OB as the norm to make sure women are healing properly after child birth. These countries have much better outcomes for women long term (fewer women suffering from incontinence, pelvic pain, organ prolapse, etc).

    Do you have to have had a baby to need pelvic floor therapy? No! Most of us are unaware of our pelvic floor and how it works with our everyday movement. A lot of women who run, heavy weight train, cross fitters, etc.,  are not coordinating their pelvic floor properly when exercising and actually causing injury and weakness in that area.

    Having chronic pelvis or back pain? No one can fix it? Could be in your pelvic floor! We have success stories of people seeing multiple doctorss and physical therapists with no relief and sometimes after just one visit with PFT they have relief.

    C section only? Yep! Pregnancy alone can weaken your pelvic floor muscles and with your abdominal muscles being cut into, that can lead to an even more weaker pelvic floor and core. They go hand in hand.

    PFT is amazing cutting edge stuff that most women know nothing about. Women in our country have been neglected in this area or are ashamed/embarrassed to talk or look down there! It’s time to change that! You are not alone I can promise you that! There’s a whole set of muscles that are very important that we need to be exercising regardless of our age or whether we have had kids or not. These muscles are our center and help hold our organs in! Can’t wait to discuss more about this soon and offer awesome workshops with Kimberly! Please feel free to ask any questions! I’m sure I left a lot of info out!

    Yours truly-
    Autumn Synowiez OTR/L
    Women’s Health Pelvic Floor Therapist
    asynowiez@gmail.com

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All Rights Reserved, Knoxville Doula, Kimberly Sebeck, 2016

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Knoxville Doula Is Growing

Knoxville Doula is growing! I will be joining a fantastic massage therapist and a fertility and pregnancy acupuncturist at our beautiful office in West Knoxville. I will still be at my current location through the end of this month. We look forward to serving the community as a whole for your fertility, pregnancy, birth, and postpartum needs! You can check out their info atTransformations Massage and Wellness Center and Tennessee Center for Reproductive Acupuncture. ‪#‎knoxvilledoula‬ ‪#‎doula‬ ‪#‎knoxvilletn‬‪#‎professionalsworkingtogetherforyou‬ ‪#‎fertility‬ ‪#‎pregnancy‬ ‪#‎reproductive‬‪#‎massage‬ ‪#‎acupuncture‬ ‪#‎childbirthclasses‬

Knoxville doula is

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What Would You Tell Ina May to Include in a Book?

I stumbled across a fabulous podcast with Ina May. The interviewer did not have a natural birth and felt as if there was missing information in Ina May’s books — at first I thought this was going to be simply a critical viewpoint of Ina May.. but it’s not.

If you have ever struggled with disappointment or a feeling of failure because you didn’t have the candle lit, in a birth pool, 100% intervention free birth — please listen to this.

At the end you are given options of how to let Ina May know what you would like included in her current or forthcoming books.

 

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Q&A With A Mentee

For over a year I have been offering a mentorship program for newer doulas. Please enjoy this Q&A with one of them, Emily Gentry.
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Q:  Can you tell us a little about yourself and your services?
A: I have two great kids, an amazing husband, and tons of support to chase my dreams of being a doula from our family. I had two really amazing, empowering births which was a huge factor in becoming a doula. The services I provide are birth and postpartum planning assistance, labor support, postpartum doula services, babywearing education, mother’s blessing celebrations, and cloth diapering education. I also work with a local photographer to offer discounted rates for maternity, birth, and newborn pictures.
Q:  What made you want to be a doula?
A: When I first started, it was because I had a very strong desire to see women be empowered by their births. I had two amazing experiences with my births and I really wanted to help other women feel like I did. I believe that child birth is a crucial part of becoming a mother and how you feel about your birth can have either a positive effect or negative effect on the first few days, weeks, months, or even years of motherhood. For me, being empowered by birth meant achieving a completely natural childbirth. As a brand new doula, it was my opinion that the worst that could happen was that a mother would end in a C-section. That opinion quickly changed when the very first birth I attended as a doula ended in an emergency C-section. The mother understood that having a cesarean was the safest option for her and her baby. She was still empowered with her birth even after MY worst fear came true. Today, I still want women to view their birth as an empowering event in their journey into motherhood. But empowerment for women varies as much as favorite flavors of ice cream. Each woman is different, each birth is different, but each desired outcome is the same. Each woman deserves to be empowered by their birth, and that is why I want to be a doula.
Q: Who did you train through?
A: I trained through DONA International.
Q:  What inspired you to become an apprentice versus striking out on your own?
A: I actually tried striking out on my own when I was young and naïve and thought that I knew all the secrets to being an amazing doula. Like I said in an earlier answer, that perspective changed rather quickly after my first few births. I realized real fast that being a successful doula meant more than having achieved a natural child birth or two on your own. My experience with child birth is not the same as what everyone else experiences. I can still draw from my own experiences and help my clients. But using that alone really limits how I can connect with my clients. Even after training I still felt that I had a lot to learn and who better to learn from than someone who has been doing it for 16 years! I wanted to see first hand what it looks like to be a veteran doula and learn as much as I could so that I could better serve my clients.
Q:  What would describe as your birth philosophy and main area of interest?
A: My birth philosophy is that every woman deserves an empowering birth as defined by her. Some women are empowered by having a cesarean. Some women are empowered by achieving a natural child birth. Some women are completely happy not knowing what they want. My philosophy can be summed up by my business motto: “Supporting Women, Supporting Labor”. I support women in what they want out of their labor and child birth. My main area of interest is definitely hospital births. I feel like that is where women need the most support for their child birth choices.
Q: What has been your favorite thing so far about being a birth professional?
A: Honestly, my favorite thing so far is the look and feeling of a mother and her partner after birth while they are getting those first precious snuggles with their baby. The way she smiles as she is looking into her baby’s eyes, smelling their sweet little head, nursing or feeding her baby for the first time and just soaking in her perfect prize. It’s a feeling that is contagious. No matter how tired I might be from supporting a laboring mom, after that baby is born there is rush of adrenaline and suddenly I’m very awake!
Q:  Where can people find out more info or contact you?
A: The best way to contact me is by email or Facebook. My email address is blessedassurancebirthdoula@gmail.com and my busness page www.facebook.com/blessedassurancebirthdoula
Thanks, Emily! We know you are going to help so many women and families with all of your services and your desire to become a CNM (certified nurse midwife). I look forward to watching this journey unfold.
All Rights Reserved, Kimberly Sebeck AKA Knoxville Doula, 2016