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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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A Home Birth Transfer Story

We hear a lot about birth plans. What happens when a planned home birth doesn’t go the way it was planned? Please enjoy this birth story shared by my friend, Sarah Haselton, a fellow doula and midwifery student about her home birth transfer.

You’ve heard it said the best laid plans of mice and men go awry. While I wouldn’t say Samuel’s birth went awry, it certainly didn’t go as I had envisioned it to be. You see, in my mind I had this beautiful home birth vision with my baby slipping gently from my body into the water and being laid upon my chest. I had dreams of birthing my placenta, baby still attached, photos of the glorious moment, and in my mind it was mandatory that I birth without medication. I had this huge expectation in my mind since my first son’s birth went so beautifully that my second home birth would be no different. Boy was I wrong in just about every aspect. The only thing that DID go as I had planned it was that I birthed my baby through my vagina and not a cesarean cut.
I had been anxiously and excitedly awaiting the moments of birth for months. I knew Samuel’s birth would be beautiful and I knew exactly what I wanted. When I found myself pregnant again I carefully considered who our midwife would be, taking into account that we would be using insurance that often doesn’t pay for a home birth and rarely pays for a birth center birth. There simply was no question, Kim was to be our midwife and I knew I could count on her and trust her advice after having worked with her before and she was the assistant on Nathaniel’s birth. It just made sense for us to employ her again.
A few days before things began, I spent several hours preparing our bedroom for what would be our birth space. I was anxious about giving birth in my living space, but what little anxiety I had disappeared once I thought about my goals for our birth. Looking back, this should have been my first clue that things may not go as I had hoped. My instincts were trying to tell me something but I wrote it off as pre-birth jitters. I just knew Sammy was coming in that bedroom space I had so lovingly prepared. The thought of birthing in the hospital was always immediately written off as my anxiety disorder playing tricks on me, and I wasn’t about to let that bring me down.
Two nights after I prepared our room, doing a test run with the birthing tub, I started to have contractions. They were mild, erratic and didn’t quite feel like labor to me but I knew from my training as a doula and my previous experience that this could happen, so I waited for things to change and napped or went back to bed. I didn’t feel the need to call anyone in at this time. I was coping well and actually enjoying the sensations, knowing that labor could pick up at any moment. I had so desperately hoped that our son would make his way earth side the following weekend anyhow, so I just patiently (okay not so patiently!) waited for my labor to kick in, fully convinced that the full moon would call him out next week anyhow. I wanted to share a birthday with him, but he had other plans.
The following Tuesday, the one after the super moon, my sensations became strong enough and close enough together that I decided I needed to call in my doula and friend to help my husband and to help with our older children. (It should be noted at this time that THIS also played a huge factor in my labor story!) My friend/doula, who ultimately stayed with me the most throughout this month long ordeal, brought along her camera, some essential oils and her awesome take out ordering skills to the party. She fed me, making sure I was staying well hydrated and was quick to fetch either myself or my husband anything. She was our fairy godmother of the birthing world. She sat quietly and timed my contractions, being sure to only speak to me when I was not in the middle of a contraction. When she finally remarked about how close together the contractions were (after doing some acupressure points and my intensity level almost immediately picking up!) I looked at her and gave the signal to call our midwife. I kept thinking to myself, this is happening! We are really having this baby tonight.
I asked the girls (we had two helpers, one for photos/support and the other to help with support for all around) to start getting together the hose and items to fill the tub, all the while knowing in the back of my mind that I probably wasn’t as dilated as I had hoped. I remember Amanda saying to me, are you sure you don’t want me to fill up the tub? I insisted that I wanted to wait to be checked but that I felt like it could be soon. Yet another clue in my story that I should have been listening to my intuition! I knew, yet I didn’t know! Kim arrived and checked me, only to announce that I was 25% effaced and dilated to a 2. I was so disappointed that almost immediately my contractions vanished. It just wasn’t time yet.
“Okay” I thought to myself “you’re still a little more than a week out from your due date and Nano (what we call our middle child) was almost two weeks past his due date, you still have time. Relax!” I was so tired of being pregnant that I just built up my expectations that Sammy would come early. My birthday, September 25, came and went without a baby. I was disappointed, a little annoyed and a little sad but I still was in good spirits about being pregnant. Then the super moon weekend came and went, the weekend I was SURE our babe would be arriving on. Another week rolled around though and I was less than thrilled. I still was having contractions this whole time, with a few small bloody shows, but nothing major was happening. I was beyond annoyed now. My frustration was starting to build and this played a huge role in how much I started to doubt myself, yet my friend Amanda kept on encouraging me and a few other trusted doula friends were offering me advice and encouragement along the way as well.
My due date of October 2 came and went with no baby. At this point my brain started to flip a switch. My own self-doubts began to creep in and a remark that my husband made MONTHS prior to this kept replaying in my head. (I will get to that in a bit, it is quite relevant to my story.) I spoke with my midwife about my husband’s concerns, his (seemingly) unsupportive attitude and my own frustrations. I also started to play scenarios over and over in my own head about what would happen if baby did not make it out by 42 weeks. Again, this should have been another flag not to be ignored by myself, yet I was overly cocky about my previous birth experience and did not want to admit that a transfer could happen to me. Screw what I knew to be true (that every birth was different!) I was not about to let that get in my way. (Can you tell I can be radically stubborn?!)
Another week passed and fear began to set in. My midwife agreed that if by 42 weeks I did not have the baby, she would send me for a biophysical profile. I was overly familiar with these ultrasounds, as I had them frequently with my oldest child and I never doubted that I would pass with flying colors. My baby was active, I was doing well with keeping myself hydrated and for the most part eating a sound diet. I was also staying active, so I felt I was doing everything in my power to stay as healthy as I could. I probably could have done a bit better, especially in the end, but I have a lot of struggles with keeping a healthy view of food and some days I just didn’t care enough to fight myself and take better care of my body.
The Wednesday prior to turning 42 weeks my midwife saw us for a regular office visit. By this point we were nearly a month in with the stop start contractions and I was getting frustrated. She checked me for progress and I was getting closer to active labor, but still not enough progress to be there yet. By this point my own mother was asking me when we would be breaking my water, thinking that would be the magic solution to speeding along my process. She was worried about my well-being but also frustratingly persistent concerning my plan. I am a planner too when it comes to the big events, so I understand. I always want to know what the plan is but I am also okay with flying by the seat of my pants. My midwife knew this about me and could read me well enough to know when I needed to have a plan and when it was okay to just let things happen.
We talked to great lengths about what my plans were and what her recommendations were with proceeding forward. The big thing she kept saying was that we did have a small time crunch, but a lot can happen in a week. Give it time and relax. She knew something was bothering me but I had not voiced it to her. (Remember that comment I mentioned earlier?) She suggested I watch something funny, have an emotional release and to do some fear releases. She knew I struggled with anxiety and could sense that was playing a big role in what was going on with my labor. Maybe because I “know too much” and maybe because I get inside of my own head too much, but I needed to let some things go before I could birth my baby. I was holding him in, so we marched our not so happy little butts home and did just that.
Hypnobabies became a sometimes multiple times a day routine and I was thankful for it. Upon getting home I decided that I would finally address my thoughts with my husband. I cried a lot during this conversation but I shared with him how scared I was of another cesarean birth. I did not want to have my baby cut out of me, especially since I knew I could birth vaginally, but that I feared this was where my birth was headed. I shared with him about a remark he made when he had newly found out I was pregnant about having a feeling this birth would end up in a C-section. I shared, very tearfully, that he could not make remarks to me like this because I was in a sensitive place and these remarks wreaked havoc on my already frayed mental state. He felt awful and from that point on, unless he had major concerns that were needing validated, he kept his thoughts quiet.
This helped some and my contractions did in fact pick up again, but still no luck. My biophysical profile came and went. As I had suspected all was well and healthy. There were no concerns about baby or myself, so we were cleared to continue on a little longer. Sunday I was at the end of my rope and I met with the midwife again for a check. Some changes were being made again, but nothing major. She offered me some homeopathies to help move labor along and we agreed that we would meet Wednesday afternoon if labor did not kick in by that point to further discuss my options. I was determined that come hell or high water I was having this baby vaginally and by this point I didn’t give a rat’s ass where that occurred. I sure as hell wasn’t going to let any doctor boss me around though and I set forth to making a new plan should I land in the hospital. (Remember those little warning flags?! Here was yet another one!)
I barreled into Monday morning with a renewed sense of purpose. I was going to get this baby to come out, or at least some kind of meaningful labor to happen before Wednesday. My contractions picked up as soon as I started in with pumping and the cohoshes. My friend Amanda was given a heads up about our plan (this woman is seriously a saint!) and my husband made arrangements with work to be with me as much as humanly possible. We determined he would not take off work until things got going for real, but he would be there when I needed him. By Monday evening I was having contractions closer together and certainly more intense. Amanda came and I was ready to get this party started but when bed time rolled around things tapered off. I texted Kim and we chatted a little bit and determined we would throw castor oil into the mix as discussed at my last visit. Amanda camped on my couch, phone at the ready to call our midwife and our extra helper when the time came. The kids went to stay with my husband’s parents for the night and arrangements had been made for them to be picked up the next day by my mother, who had taken time off of work to help out with our little ones.
Tuesday in the wee hours of the morning my labor picked up again. I was awoken by strong contractions and I was elated! This was what I had been waiting for, yet something felt off. Since the kids were gone we were in communication with our families about what was happening. We assured them that this time was not a drill and we were for real having this baby. I was so excited I could hardly contain myself. I knew I had a lot of work ahead of me, but I was one determined woman. I had my husband call off work, since I knew we would be needing him around, especially once I started the castor oil as I had been instructed to continue on with. That stuff is NASTY! I mean it! Unless you are down to desperate measures, try to avoid it! The side effects, while desirable, are less than enjoyable. I found myself vomiting along with taking multiple trips to the bathroom.
My contractions continued all day long and that afternoon they became close enough together that we decided to call in the extra helper. While she wasn’t entirely needed, I felt like an extra set of hands would be helpful since Amanda had been with us for nearly 24 hours and could probably use a small break. She arrived and lent a hand getting things together. I had a few household chores that needed attending to and the girls were able to get them done for me so that I could focus on the task at hand.
My contractions kept on coming and showed no signs of stopping. I kept on with the routine of pumping, taking the cohoshes, walking and doing general self-care. Any time I would break from the methods listed above my contractions continued. After a while I was overwhelmed by everyone around and suggested I take some time to just be alone with my husband so I could refocus. I would call everyone back when the time was right or when I needed them again. A few hours later things got intense again, so I called back our photographer. I needed her doula support and she made the phone call to our midwife a bit later.
Once again the midwife came, but I wasn’t making any progress. I knew it was because I had too many people around earlier and she agreed that keeping it small seemed like a good idea. I didn’t need the added stress of trying to stay present when what I needed to be focusing on was getting my body to open and allow myself to birth. Prior to the midwife coming, I had Amanda fill the tub for me and once the midwife checked me, so agreed it was okay for me to labor in the pool for a little while, even though we all knew my contractions would slow down some once I hit the water. Slow they did, but the water felt amazing and I was able to relax and even hold a conversation with everyone for more than a few minutes. I needed that time, if for nothing else then to boost my moral and keep me present for the work ahead.
Kim stayed for a while and suggested I try and get some rest. She would stay for a little while but would let me sleep for as long as I wanted. At some point she headed home but she left assurance that she would be in contact with me first thing in the morning, unless I needed her before then. The next morning I was to do another round of castor oil and continue with all of the pumping and herbs. At this point I had made peace with the idea of transferring to the hospital, but wanted to give myself the rest of the night and the majority of the day Wednesday to gain some more progress. I knew, without saying it, that come evening we would be headed to the hospital. The tone of our labor shifted at this point from sheer determination to acceptance and preparation.
Amanda stuck around, sleeping in one of our children’s rooms while I rested, but was close at hand should I have needed her. I awoke Wednesday bright and early, showered, ate some eggs, started pumping, took a dose of castor oil and set about the day. Kim contacted me around 8am to check in. She stated she would be by sometime that afternoon but to please call her if she was needed. She would check in around lunch time and she assured me I was in her thoughts and would be close by if I needed her. Amanda forced me to walk stairs, feed me and I was encouraged to walk the block, taking special care to hike up the hill next to our house as much as possible. At one point in early afternoon, after a particularly rough time I started to exhibit classic transition symptoms. I was laughing and crying all in one sentence. I even said I just knew I couldn’t do this. My husband, bless him, knew what he was seeing and suggested a phone call be made to Kim to get her opinion. I have no idea what was said during that time, but I knew I was quite out of it. I was even getting sick. I had been having lots of bloody show that day, so we all knew my cervix was making changes in the right direction, and from what I could tell it was happening in spurts.
I proceeded to hang out in the bathroom for a while. Sitting on the toilet felt good, but as soon as I had that one meltdown, things went back to the pattern they had been in for two days by this point. If I had to use one word to describe it, erratic is probably my best choice. While sitting on the toilet I had one particularly difficult contraction where I felt like my water had broken. It was such a little amount though, I remarked to David and Amanda that it couldn’t have possibly been my water because it felt like urine. Both of them agreed it was probably just that because I wasn’t leaking anything, and we wrote it off.
Around 4 in the afternoon Kim called and said she was on her way over. We would talk about our plan for the evening and our options. I knew what this meant but I felt an amazing sense of peace wash over me. I knew I was heading to the hospital, but I wanted to talk through everything with Kim first. When she arrived she checked me. I was between 7-8 cm, what I had been the previous night, but I was now 90-95% effaced. Great news since I had only been at 50% the previous night! We talked over our options and breaking my water was discussed, however we both agreed that would be a poor choice since I was group b strep positive and did not want to risk infection. At this point the only other option was for us to wait a little longer or head to the hospital. With absolute mental clarity I agreed that transferring was the best option given my labor history with my son and the fact that I was a VBAC.
Bags were packed, the pool was drained and preparations were made to transfer. It was low stress, easy and a good choice I felt. There was no emergency or sense of urgency for me or baby, we just knew we needed to be there to have him. We loaded my car, headed over and I was checked in. I spoke with the nurses, where they got my personal and medical history and I met the doctor. I was quite firm with him that I wanted to VBAC and that I did not want antibiotics for baby or myself. (Maybe a little too firm, but my point was made and we came to agree to disagree.)
Once I was moved to a regular room the doctor personally checked me, where he declared that my water seemed to already be ruptured, because of this he strongly urged the antibiotics. It was then that we remembered the sensation I felt earlier in the day, but still he urged us. I asked for a minute to discuss it with my husband and he agreed to give us a few minutes. David, Kim, Amanda and myself all very briefly discussed it and everyone was in agreement that antibiotics, given my GBS status, would not be a bad choice. I consented and they were administered.
Dr. Selman was somewhat reluctant at first to offer Pitocin, since my contractions were so spread out and mild, but I pressed the issue and continued to ask for them. I knew what my body needed was just a little extra help to nudge it into active labor. Once the Pitocin hit my blood stream, the contractions became extremely intense. It should be noted that the doctor inserted a scalp electrode to ensure that my waters were in fact ruptured. We saw clear fluid and it was determined for certain now that my waters were broken. Since my waters were in fact ruptured the intensity was somewhat more challenging to deal with, but I continued to press on. I labored at this point with my whole body. I was also given the option to try out a new device that would eliminate the belts around my belly and give me some more mobility that the previous fetal heart monitors did not allow for. Since I originally wanted to move about, I jumped at the opportunity. It was torture to lay on my side for the ten minutes, but I’m glad I did it!!
Once I was able to get back up I labored on the bed, leaning over the back. I also labored beside the bed and even attempted the birth ball for a while. That said, I was exhausted and after five hours of enduring some of the most intense labor I have ever experienced I begged for the epidural. I will spare you the details of that experience, but suffice it to say I cried a lot during the insertion but profusely thanked the doctor once it was inserted.
It was agreed upon by my midwife and friend that they would head home for the time being. Amanda had been with us almost consecutively for three days by this point and needed to get back to her family. Kim wanted to nurse her son and get a little bit of sleep while I too rested. I was to call as soon as I started feeling the pressure most women experience with an epidural. I kid you not it was not fifteen minutes after they walked out the door that I started to feel that pressure! I remarked to my husband that I knew pushing was getting close but it wasn’t quite time yet. He should rest and I would wake him when it was time.
Roughly 10 to 15 minutes after that I felt the urge to push. I called my nurse in and told her what I was feeling. She agreed to check me, but I was only between an 8 or 9 and that I still had a little ways to go. I thought to myself, but I KNOW what I am feeling. Maybe if I get a bed pan and sit on it and have a stool I may feel better. As soon as I said that she sat me on only to think twice and check me again because I was uncontrollably pushing. She immediately calmly stated “Sarah, don’t push. The baby is right there.” I practiced what I had been taught as a doula to do and blew candles, but it really didn’t help. In my mind it was rather comical because the doctor was rushing in while gowning up and throwing on gloves. My epidural was turned off, but I still felt quite a lot. Our midwife was going to miss it, but David was able to call her and tell her briefly what was happening. We all had a good laugh about it later, because she even thought it would be longer before Sammy arrived!
Moments later I was given the go ahead to push. Almost immediately I felt the ring of fire. My baby was coming!! I felt a surge of determination and two beautiful pushes later I reached my arms up to grab my precious baby. He let out a lusty cry and immediately relief and pride washed over me. I cried as I looked at his perfect face and my husband kept telling me “good job Sarah! I’m so proud of you!! You did it!” I of course did all of the things a new mom does in the moments after birth. I checked to be sure he was still a boy. The nurses swooped in to wipe him off, but I was able to ask them to please leave him be. I did not want him bathed, he cord was still pulsing and he seemed like he was perfectly content parked on my chest. After a moment was had with our new baby, I looked up from my new son to apologize to the doctor for being so demanding and to thank him for being so patient with me. I told him he was fantastic and that I was glad he was the doctor on call when I came in. He knowingly nodded.
I had to have a few stitches to repair a small tear but otherwise everything looked good. I was sat up, nursed my baby, but then I started to feel hungry and extremely tired. Something didn’t quite feel right, but I figured I had been in labor for three days by this point, I was probably exhausted! Something deep down kept telling me that it wasn’t quite right, and it was confirmed moments later by my nurse who announced “I’m a bit concerned with your bleeding. I am going to run the Pitocin wide open if you are okay with that.” I consented knowing I had already nursed and if that didn’t slow my bleeding, a little medication was probably needed. I messaged my uterus and the nurse came back in to check on me about 2 minutes later. Still she wasn’t happy with how much blood I was losing and remarked my uterus felt “boggy.” Having attended quite a few births, but never having encountered that term before I knew it couldn’t be good. She said she needed to consult with the doctor. My husband looked at the other nurse in the room with a bit of concern in his eyes, yet he wasn’t saying much. I knew something was up. It was THEN that I realized why I had transferred to the hospital. I was bleeding more than I needed to, but I wasn’t in dangerous territory yet.
The nurse walked back into the room and looked at me very seriously. She was such a calm presence but I sensed the urgency in her voice. “Sarah, the Pitocin isn’t working and I need to see this bleeding go down quite a bit more before we send you to mother baby. Do you consent to Cytotec?” Oh gosh I thought, not THAT drug! I have always been terrified of that drug. (Remember how I said I know too much earlier, this is one of those cases where it is both a blessing and a curse….) I asked her if there were any other options and she calmly stated that short of a D&C or another drug that had worse side effects she would strongly suggest this drug. She gave me all of my options, but urged me to make a choice quickly. I elected to go ahead and take the cytotec and within minutes my bleeding slowed down to an acceptable level. I was safe now and I could relax with my baby by my side. David was able to breathe a sigh of relief too.
Everything from there was routine as usual. I was weaker than I had been after giving birth to Nathaniel. Most likely due to the blood loss and the length of my labor, but recovery was easy. I had very few problems nursing, although baby took some time to learn how to properly latch, Samuel still did well. I was treated with respect and even though it wasn’t where I wanted to be, I was able to appreciate that I needed to be in the hospital.
I learned from Sammy’s birth that we can often plan all we want, but that births will go differently than we planned, no matter how picture perfect your labor or birth is. I also learned that we are given instincts for a reason. We may not always know why they are there, but that trusting those instincts can be crucial. I also learned that trusting your care provider is critical as well. We have to work together as a team and if you can’t trust them, then it may be wise to consider other options. I trusted Kim’s opinion all throughout my pregnancy, labor and birth and because of that I was fully supported when it came time to transfer to the hospital. I also learned that pride about a previous birth experience does not guarantee where you will give birth. And I learned that a doula is an absolute must in the birthing experience! Especially when things do not turn out the way you planned them!
All in all my birth experience, while long, was exactly what I needed. I learned just exactly how strong I am and I learned that not all hospital births are bad. While my first birth shaped my second birth, my second birth equally shaped this one. Because of Allie and Nathaniel’s births I can proudly say “I had a C-section, a home birth after cesarean and a home birth transfer.” All three of my birth experiences shape me as a mother and hopefully will continue to shape me as a doula, adding humility in there as well.

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Congratulations on your little Sammy and thank you for sharing your story about being flexible when it comes to birth!

All Rights Reserved, Kimberly Sebeck, Knoxville Doula, 2015

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Choosing Where To Give Birth Is Not One Size Fits All

Who will you choose to care for you?

As with most options and choices in pregnancy, childbirth, and parenting, the choice of where to give birth is a tough one for many to make and is subjected to your own anxieties and others criticisms. Tell family that you are having a home birth and you can receive a reaction of mouth hanging open and disbelief to outright animosity and threats they will not attend your birth or call the authorities on you. Mention elsewhere that you are birthing in a hospital and inevitably someone will pipe up that you should watch a popular DVD about the birth business and warn you everyone and anyone who steps in the hospital will end up with an unnecessary cesarean section (and wear a gown someone died in the day before). Unassisted birth? That’s not something you can discuss unemotionally at your local playgroup.  These reactions can be bewildering, stressful, and even hurtful. Couples may find themselves arguing over the pros and cons of where to give birth.

I’m not going to tell you which is better. I trust you. I trust you to make the best choice for yourself. I trust that with the wealth of evidence based information available these days that you can think for yourself and calculate the risks and benefits. There is a lot of misinformation out there as well as rabid opinions on both sides so be careful when you’re on your search and rely on trusted sources and your own thinking ability and intuition.

The fact is, there is no OSFA (one size fits all) answer. If everyone had to have a hospital birth or everyone had to have a home birth we wouldn’t have any choice at all. There are women who feel going to a hospital will subject themselves to unnecessary interventions or inhibit the natural birth process (and that’s okay to come to that decision). There are women who feel giving birth at home is unsafe or anxiety producing (and that’s okay to come to that decision). There will be women who plan for one or the other and end up unexpectedly birthing their baby in their bathroom before ever getting to the hospital and there will be women who painstakingly plan for a home birth or birth center birth and risk out beforehand or are transferred during labor. There will be women who feel disappointed if their birth plan and place of birth go according to plan and decide to do it differently the next time and there will be women who have nothing go according to their plan and adjust their choices accordingly.

But Kimberly, “I hear some people saying, “what about rogue midwives with no real training and greedy obstetricians who can’t wait to slice women open to get to their round of golf?” Those are absolutely valid points but that in actuality comes down to who you are choosing as your provider. One surgery happy obstetrician does not mean the entire hospital is that way (but it could). One irresponsible midwife with no accountability does not mean there aren’t very well trained and competent midwives (but it could). Do your research. I say this over and over. Choosing a provider in line with your childbirth wishes is one of the most important things you can do. I cannot stress this enough. When you have a good provider you can have confidence in the suggestions and care they give you, as well as any backup plan or transfer of care that may come along. If your provider cannot find the time to sit down and have a real conversation with you without just giving canned answers (‘I never have to transfer to a hospital”, “so long as everything is ok”, “let’s just play it by ear”) that may be a red flag that you need and deserve to find a new provider who can make the time to answer the hard questions. Listing all the important questions will have to wait for another blog but a starting point would be to ask if they follow the advice of their own certifying organizations (ACOG — American College of Obstetricians and Gynecologists or MANA (Midwives Association of North America) for example) as well as complying with any state or local laws.

Sadly, not all areas like the one I live in have a multitude of hospitals, midwives, midwives in a hospital setting, home birth providers, freestanding birth centers, etc. to choose from. For those of you in such a difficult circumstance, I feel for you. Planning your birth may be choosing between two less than optimal choices. Until we have more collaboration between hospital providers and home birth/freestanding birth center providers some of us will struggle with gaps in care. In that situation hiring a doula is even more important to ensure a smoother and happier experience.

In some ways it can seem unfair that expectant parents have to put so much work into researching providers, hospitals, out of hospital options, cesarean rates in the area, laws and policies instead of just joyfully preparing for their new little one. Ultimately though, all the research and knowledge leads to a greater involvement in yourself and a sense of empowerment and pride in your choices.

I wish you the best birth possible, wherever you give birth.

 

All Rights Reserved, Knoxville Doula, Kimberly Sebeck, 2014

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I Don’t Have My Hospital Bag – Now What?

Occasionally a woman ends up at the hospital in labor or for an induction without her hospital bag she so carefully packed. It could be due to membranes releasing at work or on errands, something that warrants being sent from a doctor appointment straight to the hospital, or a labor that comes on quickly with no time to go back home. It could be you were a home or birth center birth with an unexpected transfer.  No need to fret, however, because here are some suggestions for comfort measures that can be used straight from the hospital room.

  • Ask for the hospital yoga/birth ball, heating pads, and/or squat bar
  • Heat a moistened towel to hot in the microwave and wrap in a chux underpad for a quick hot pack
  • Use protective gloves as a last minute ice pack — simply fill with ice cubes and cold water and tie the end off
  • Double layer a second gown around your back to act as a robe
  • Wear non skid/slip hospital socks instead of your packed and forgotten slippers
  • Forget your Rebozo? A sheet tied with knots in it will do in a pinch
  • Instead of massage tools you can get a soda can from the family refrigerator and use for counterpressure (don’t open it later!)
  • A hairbrush or comb in your purse can also be used for acupressure or massage techniques
  • Take advantage of the shower or tub if there is no medical reason to prevent you from water relief
  • Check to see if the hospital TV has a relaxation channel with soothing images and music (in lieu of your Ipod)
  • See if your hospital provides mesh panties for comfort and possibly leaking membranes
  • Use an emesis basin (pictured below) to keep ice and cold water in and multiple washcloths for cooling relief on your head and neck

emesis

A few precautions: when using heat or ice always be sure you have a protective layer such as a towel or gown between the pack and your skin. In the throes of labor try to be conscious if something is feeling too cold or hot or ask whoever is with you to check in occasionally.

In addition to the above suggestions ask for extra towels and pillows. You are paying for the hospital room and any amenities so go ahead and use them!  Most hospitals have additional tools like birth balls, you may simply  have to ask for them.

Has this happened to you? Share your suggestions in the comments!

All Rights Reserved, Kimberly Sebeck, Knoxville Doula, 2014

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July 2011 Events

ICAN of Knoxville will be holding their regular monthly meeting on Wednesday, July 6th, at 6p.m. Location is the Earth Fare in Turkey Creek. Topic: “Home Birth in the Hospital” and the speaker is Kendra Smith, ICAN of Knoxville Co-Leader. Cost of the meeting is free, however, donations are accepted on behalf of the 501c non-profit organization. Childcare is not provided, but babes in arms welcome, as well as partners or family members. For more information about the organization, go to www.ican-online.org. For ICAN of Knoxville questions, please email icanknoxville@yahoo.com

 

Classes scheduled for July:

Comfort Measures/Refresher Course. Stages/phases of labor and birth, comfort measures, partner involvement, affirmations, and more. Handouts provided.
Date/Time: Saturday, July 9th, 10 am – 2 pm
Location: Upper Cervical Health Center, 1508 Coleman Rd, Suite 107, Knoxville, TN 37909
Cost: $50.00 per couple unless you are a doula client of mine, then it is included in your fees
Pre-Registration Required: Email beautifulbirths2003@yahoo.com

Prep for VBAC (Vaginal Birth After Cesarean). Had a C-section? Pregnant or planning to become pregnant in the near future? Come to this class to learn about the safety of VBAC, facts, statistics, along with preparing for a successful VBAC. Topics are: informed consent, comfort measures, choosing a provider, emotional component of a previous c-section, etc.
Date/Time: Tuesday, July 26th at 5:00 pm
Location: Upper Cervical Health Center, 1508 Coleman Rd, Suite 107, Knoxville, TN 37909
Cost: $50.00 per couple, unless you are a doula client of mine, then it is included in your fees
Pre-registration Required: Email beautifulbirths2003@yahoo.com
You do not need to be currently pregnant to take this class! This information can help you decide how to best proceed with pregnancy, choosing providers, and planning for VBAC. Partners strongly encouraged to attend.

 

Can’t make these dates? I offer in-home and private classes as well and can work around your scheduling needs. Have a suggestion for a class? Let me know!

All Rights Reserved, Kimberly Sebeck, CLD, CCCE, Knoxville Doula

 

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Holiday Babies and the Pressure to Induce

Sadly, one of the issues surrounding pregnant women who are due around major holidays like Thanksgiving, Christmas, and New Year’s, is a pressure to schedule an induction. There can be many factors regarding this, such as your personal caregiver being out of town for certain periods of time, hospital staff trying to contain overflow, even wanting or hoping to get a tax deduction before the year runs out.

If you are one of these women due around the holiday season, consider carefully the risks of non-medical induction. If you are pressured into an induction with a medical sounding reason, be sure you ask your “Informed Consent” questions:

What is the procedure being recommended? (Such as, what type of induction would be used?)

Why is the procedure being recommended? (Is your doctor planning a trip to see family? Are the common, yet medically unreliable reasons of  “baby’s getting too big”, “fluid is too low”, “we don’t want you going post-date” being used? If so, research, research, research in order to make an informed decision!)

What are the risks of the procedure? (Failed induction, distress for the baby, greater (up to 2x) risk of surgical interventions such as cesarean, forcep/vacuum delivery, an early full-term or even pre-term baby?)

Is the reason for an induction considered an emergency? (True emergency reasons for induction of labor are very, very rare and do not include scheduling a week or more ahead)

What happens if we just wait and see? (This will also help you determine if there is a true medical need)

What alternatives could be used? (Walking, sexual intercourse, acupressure/acupuncture, certain herbs — with any and of all of these, again, do your own research and weigh the risks and benefits)

Hopefully, early on in your visits with your caregiver, backup plans and caregivers were discussed and preferably, you have met one or all of the caregivers who may be on call should your own doctor or midwife be unavailable. If this hasn’t happened, make it happen.  Be certain to have a copy of your birth plan in your chart, and extras to bring to the place of birth.

A doctor or hospital’s schedule shouldn’t dictate when your baby is born or your having to assume a higher risk of medical interventions and surgical birth. You can always politely decline the offer of scheduling your baby’s birth for non medical reasons.

Best of wishes to you through the holiday season!

For more information, please go to www.ican-online.org. As always, these statements are not intended to replace decisions made by you and your health care provider.

All rights reserved, 2010, Kimberly Hall Sebeck, Knoxville Doula