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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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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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Comfort Measures Class in Knoxville

The next Comfort Measures Class is Saturday, May 7th at 9 – 12 pm at Knoxville Doula’s ofice — 1400 N 6th Avenue, Knoxville, TN 37917

Cost is $50.00 per couple. We discuss the stages and phases of birth and how to stay comfortable as well as how your partner and birth team can help.

 

Tickets available: http://www.eventbrite.com/e/comfort-measures-for-childbirthrefresher-course-may-2016-tickets-22819606056?aff=ehomecard

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“Natural” Induction — My Thoughts

I wish people would stop using the term “Natural Induction”. There is nothing natural about an induction, no matter how you accomplish it. Perhaps the term “non-medical induction” or “cervix ripening exercises” would sound better. Medical personnel usually view Pitocin as “natural” since it a synthetic oxytocin. I tend to disagree but at least they are trained and familiar with it. I see on so many internet forums people telling women to do nipple stimulation with no guidelines or informed consent about the risks/benefits. Same with evening primrose oil..and just about anything (herbs, foley catheter, etc.).

Are there reasons for induction? Absolutely. There are reasons for “hard” medical inductions. Would I choose to drink a pineapple/parsley/basil/oregano smoothie along with eggplant parmesan if I were facing medical intervention I did not want? Absolutely. Would I consider castor oil (I say consider because I feel castor oil has serious side effects) vs a repeat cesarean because I was over 42 weeks? Probably.  There are appropriate times to mess with things. But let’s call it what it is — messing with things.

I always wonder about the “success” stories with  nipple stimulation, rupture of membranes, eggplant — would the woman have gone into labor within hours anyway? For every success story there is a woman sitting there burping up parsley. Setting up in her mind that her body isn’t listening.

I’ll restate that induction has its place. Non medical methods can be effective and sometimes more gentle. The method and the necessity should be the choice of the mother and made with informed consent if waiting for baby to pick the day of birth is not an option.

All Rights Reserved, Knoxville Doula 2014

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How to Make Suppositories for Yeast, Endometriosis, or Hemorrhoids

Whether you are trying to conceive, or dealing with some common pregnancy or postpartum issues, there is herbal help! Below is a tutorial for making vaginal or rectal suppositories.

For one suppository:

Mix 1 tsp of natural, 100% cocoa butter (pure with no additives) with the herbs of choice. Shape into a suppository about the size of the first joint of your ring finger. Roll in wax paper and place in the refrigerator to harden. Remove the wax paper before using! Insert cold or else it will soften. It may be a good idea to make up several suppositories at once and store in the refrigerator.

Endometriosis:

  • 100% cocoa butter
  • 10 drops FEM-L (from Good Herbs) OR mixture of Red Raspberry Leaf, Dong Quai, Marshmallow, Ginger, Golden Seal, and Partridge Berry
  • 10 drops Marshmallow
  • 10 drops Lapacho
  • 10 drops Slippery Elm or Slippery Elm powder

Yeast:

  • 100% cocoa butter
  • 10 drops each of Mathake and Lapacho

Alternatively, you can use a vaginal plunger and insert pure, natural plain yogurt containing acidolphilus directly into the vaginal area to restore natural bacteria. Garlic has also been used, but can cause a burning sensation.

Hemorrhoids:

  • 100% cocoa butter
  • 10 drops Dandelion Leaf
  • 10 drops Garlic
  • 10 drops Bilberry

It is recommended you use organic, non-irradiated herbs in liquid form. I use herbs from Good Herbs, inc. www.goodherbs.com

 

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Disclaimer: This information is not intended to replace your medical provider’s instructions or to diagnose medical conditions. Always do your own research and consult your provider if you have questions. Never use herbs if you are pregnant or breastfeeding unless you have consulted your physician.

All Rights Reserved, 2011, Kimberly Sebeck, Knoxville Doula

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Avoiding Traumatic Birth

We’re hearing a lot about traumatic birth lately. It’s always been around, but more women kept quiet about it or maybe didn’t realize there was any other way to give birth. With the explosion of the internet and social networking, women are discovering they had unnecessary, potentially or actually harmful, and often traumatic interventions and events on one of the most important days of their life — birthing their child.

Know your options!

Did you know that in the Knoxville, TN, area you have genuine options to help avoid a traumatic birth? Some are:

  • Natural Childbirth Classes (not hospital sponsored ones, but true learning experiences, such as Bradley or Hypnobirthing)
  • Doulas. Antepartum, birth, and postpartum doulas are available — and our numbers are increasing to give you options
  • Home Birth Midwifery
  • Free-standing Birth Centers
  • ICAN of Knoxville (International Cesarean Awareness Network) local meetings for support, education, and information
  • Knoxville Birth Network meetings, a division of Birth Network), also for information and support
  • Chiropractors and massage therapists (along with other professionals) trained to optimize pregnancy and birth

These are a few of the options available to help you avoid a traumatic birth in the first place, or recover and heal from a previous one or ones.

The question is: Are you taking advantage of these resources?

Every week, I get numerous emails or phone calls from women who say, “If I’d known inducing for non-medical reasons would have led to a cesarean section”, or “I thought about taking a class but didn’t find the time”, or “I thought about using a doula but we didn’t”, or “My doctor said I couldn’t VBAC (vaginal birth after cesarean), so I just scheduled another surgery” or “My doctor said my pelvis was too small/baby too big/ why even try labor”… and on and on.

The emails make me sad for many reasons. They make me sad a woman didn’t get the birth experience she wanted and deserved, but they also make me sad that the useful and wonderful resources available are not being utilized. This is not to say it is a woman’s fault if she is suffering from birth trauma–not all births will go the way we desire them even after making the most concerted efforts. However, if you’re on the fence about seriously exploring your options, your chances of ending up unhappy with your birth experience are going to be far greater.

Interview some midwives, interview some doulas, take childbirth classes. In the U.S., women regrettably educate themselves more about buying a car, or a purse, or finding a good daycare than they educate themselves about the birth of their baby. Interview different OB/GYN’s and hospitals, even. Don’t take your neighbor’s or sister-in-law’s recommendation just because they “liked” their OB/GYN or because he or she was “nice”. Ask questions. What is their cesarean rate? What is nursery and newborn policy? I cannot list here all the interview questions to ask different birth professionals, so research what you desire and make sure your birth team is in line with your desires.

If you have not yet seen some eye-opening films, take the time to do so. The Business of Being Born, Gentle Birth Choices, Pregnant in America are all good starting points. Have your significant other read, “The Birth Partner” by Penny Simkin, a book I advise all of my clients to read. Look into different information about doulas, which can easily be found on well-known and reputable sites such as DONA, CAPPA, and The American Pregnancy Association. Attend one of the often free meetings held by birth organizations.

We’re here to help you have the best birth experience possible.. please take advantage of what’s offered and make the time, make the investment so you don’t later send an email saying, “if only…”. Perhaps there will still be something you didn’t like or that was traumatic during your birth experience, but you will have the satisfaction and empowerment of knowing your options and having done your research. No one can tell you what is the best scenario for you, your baby, and your family. Invest in knowledge.

Resources:

www.pennysimkin.com
www.knoxvillehomebirthservices.com
www.cappa.net
www.ican-online.org
www.dona.org
www.birthnetwork.org
http://www.facebook.com/group.php?gid=170751447099
www.doulamatch.net
www.thebusinessofbeingborn.com
www.waterbirth.org
www.icpa4kids.com
www.knoxvilledoula.com
www.bradleybirth.com
http://www.americanpregnancy.org/labornbirth/havingadoula.html

All Rights Reserved, 2011, Kimberly Sebeck, CLD, CCCE, Knoxville Doula