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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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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

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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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Breastfeeding Class for August

Date: Tuesday, August 23rd, 2011 at 5:30 p.m.

Location: Upper Cervical Health Centers of Knoxville — 1508 Coleman Rd, Knoxville, TN 37909

Topics: Basic physiology of breastfeeding, benefits and savings, partner support, getting started, overcoming obstacles. A currently breastfeeding mother will also come to share her experience and answer any real life questions.

Cost: $20 per couple, partners strongly encouraged to attend. Pre-registration is required, please email beautifulbirths2003@yahoo.com to register.

Class will last approximately two hours. Come learn about the benefits of breastfeeding, find support, ask questions– all for  less than the price of one can of infant formula.

To keep current on events, please “like” my FB page

All Rights Reserved, 2011, Kimberly Sebeck, Knoxville Doula

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Dying in Childbirth

Be open to transformation.

Be open to transformation.

Many women fear dying in childbirth. Their family, spouses, partners, and friends may carry this fear for them, too. In fact, if you ask most women why they choose to go to the hospital to birth their baby, they will say, “In case something goes wrong…. you know…”, delicately skirting their fear of dying in childbirth.

Most people in my generation grew up with the theory that hospitals are a safer place to give birth. We heard stories from our parents, grandparents, and news media addressing the subject of women dying in childbirth. We heard how cesarean sections (surgical birth), forceps, medication all saved babies and mother’s lives.  In fact, there are some situations where medical intervention was necessary and potentially saved a life. Many did not — but gave the illusion of safety.

However, what if women were to consciously, pro-actively,  and fully acknowledge there is a part of them that will die in childbirth? Life cycles generally involve a death, or transformation in order to reach the next phase of the cycle. At conception, a sperm and egg form into what will become a baby. When we plant a seed, it grows into a plant. In the seasons, leaves die and fall to the ground, winter comes, and eventually, spring marches forth with new life. Many religions consider  baptism to be a “dying” to a former way of life.

Becoming a mother through pregnancy and childbirth does involve the death of some things. Your body changes in ways it never has before. Breasts become capable of nourishing a baby.  Organs are transformed and shifted around in the body for the new growing life.  Bonding begins before ever lying eyes on your baby.  Major emotional, hormonal, and physical changes occur.

This involves, in a sense, a dying to who you were before pregnancy and birth. A woman’s focus will be riveted towards her pregnancy and baby. The focus shifts from herself, or her work, spouse, etc., to the little person who will now hold her heart.

It is easy to transmute this fear of dying to your former life and ways into a fear of physical death through birth. Most of us have grown up in a society where good parenting is emphasized and we fear that if we acknowledge there will be changes to our personality and focus, that somehow it demonstrates a lessened or sour desire for children. We may fear we are a bad parent if there is any question, doubt, fear, anxiety about bringing a life into the world and then caring for it. Being a good parent and loving our baby does not have to eschew all acknowledgment of the changes that will take place. It can be as simple as juggling diaper bags, nursing, and a car seat in order to run an errand vs. hopping in the car by yourself. It can be as serious as caring for a child with disabilities.  Acknowledging these changes and the emotions that are attached to the changes can ultimately help a woman to have a more peaceful and tranquil pregnancy and birth.

Fear of the unknown. Honor the feelings by journaling, talking to family and friends, a counselor, educating yourself,  meditating, praying — they will not be as scary or consuming when you are familiar and ready for your emotions, even if it is fear.

Happy birthing.

All Rights reserved, Kimberly Sebeck, Knoxville Doula 2010

http://www.knoxvilledoula.com

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Pregnant? Thinking about a Doula or Childbirth Class?

I know no less than 20 pregnant women who are due in November and December of this year — each week I receive several inquiries as to using my labor/birth or postpartum doula services, as well as taking  prepared childbirth classes from me.  If you fall into the category of expecting a baby sometime this year and are considering hiring a doula, taking a class, having a breastfeeding consultation, or any of the other parenting services I offer, please contact me for a free consultation.

I commit to only 2-3 childbirth doula clients a month, in order to provide the best care and service.  Once I am booked for the month, I am full.

My consultation is free, we can meet at your home or mine, or a local public area, such as a coffee/sandwich shop.  If you are not sure of the benefits of having a doula, this is a great time to learn and ask questions, as well as start becoming familiar with one another. I can give you a schedule of upcoming classes, or schedule a private class for you and your partner. If you are a first time parent, or new to the area, I can provide you with many local resources, such as a birth setting that fits your desire, newborn photographers, cloth diapering shops, and more.

I serve the greater Knoxville area, and under certain circumstances, travel as far as Chattanooga, Johnson City, and other outlying areas.

Ten years of experience and helping hundreds of families has made me love what I do even more! Let’s talk!

You can reach me at beautifulbirths2003@yahoo.com or (865) 705-7734.

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Upcoming ICAN of Knoxville Events

The May meeting for ICAN of Knoxville is featuring Franya Peterson, D.C. Her topic will be:

Using Chiropractic to Optimize your Pregnancy and Birth Outcome.
May 5th, from 6-7 pm

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June’s meeting is movie night! Join us on June 2nd to watch “Pregnant in America” 6-7 pm

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We will not have a July meeting as it falls during the 4th of July holiday period. Should you need personalized support or information, please email me at ICANKnoxville@yahoo.com

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August 4th — Tips for Physical Recovery after Cesarean Birth.

Had or having a Cesarean Birth? Come learn tips for physical recovery from and following a C-section.

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September 1st — Placenta Encapsulation and General Support Meeting

Join us as Holly Stewart, Placenta Encapsulation Specialist discusses the placenta and ways to benefit from encapsulating it.

Following Holly’s short discussion, there will be time for general support — come ask questions, tell your story, and generally feel supported in a safe, caring environment.

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All meetings are held on the first Wednesday of the month at the Earth Fare in Turkey Creek, Knoxville, TN. Meetings are from 6pm to7 pm. Babes in arms are welcomes, however, childcare for older children is not provided. Cost is FREE for all meetings, however donations in any amount are gratefully appreciated and accepted and go towards our local chapter as well as ICAN’s national organization. ICAN is a 501c non-profit, ALL volunteer organization.

Are you interested in volunteering? Ask me how! It can be as simple as posting one of our fliers at your doctor’s office, daycare, or local mom’s group.

Why subscribe to ICAN? Becoming a subscriber not only gives you access to monthly support group meetings online,  webinars with special guest speakers, a discount to the ICAN online bookstore, etc,  it ensures you are helping other women receive the information and support they need.