I understand that being pregnant for the first time is a new and scary experience. I understand that you are a motivated, educated woman who takes charge of your personal and professional lives. I respect that. I relate to that. And I understand that in the face of something that is new and unknown, an experience to which you may have been looking forward for many years, you have ideas of how you want things to be. You probably single handedly planned your wedding down to the last detail, paying for most of it yourself, and it all went off without a hitch. Maybe you got pregnant right away, or maybe you struggled through some months or years when you thought it might not happen for you -- but then it did, and now, here you are, getting ready to deliver your precious infant and take him/her home to a nursery outfitted with shiny new furniture, filled with carefully laundered layettes and the whitest of white new organic cloth diapers.
Throughout your pregnancy you have avoided caffeine (despite the fact that I told you it is safe to drink two 8 ounce cups of coffee each day). You have not taken Tylenol for your headaches, although I recommended that you do so. You have taken birthing classes that have focused on the risks of medicated labor and childbirth. You have downloaded and filled in a 4 page birth plan. You have planned your delivery.
You don't want an IV.
You don't want antibiotics even though you have been found to carry group B strep.
You don't want fetal monitoring.
You want your partner to deliver your baby.
You don't want an episiotomy, a vacuum extraction, or a forceps assisted delivery.
You don't want the cord clamped until it stops pulsing.
You don't want a c-section.
You don't want your baby to have erythromycin eye drops or a vitamin K shot.
You don't want your infant to have hepatitis B vaccination.
You want to breastfeed exclusively.
You probably also didn't want nausea and vomiting during your first trimester, heartburn, back pain, constipation, hemorrhoids. But you got all of those things, and you made it through just fine.
Do you know what I want? I want my 2-year-old to wear mittens when it's cold outside. Before I had children, I was absolutely sure that I would not allow my 2-year old to make a decision about mittens for himself. And now, I can pin my toddler to the floor and force mittens on him while he screams, and the second I let go of him, the mittens come off. I have no control. And that's parenthood for you.
Go ahead and give up your ideals about parenthood now. You don't get to control the labor and delivery process any more that you can control whether or not your baby will wear mittens when he is 2.
You need an IV if you are in labor. If you start to hemorrhage, I can give you medicine to stop your bleeding. I can give you blood to save your life. My anesthesia colleagues can put you to sleep if you have an IV so that I can do a procedure to stop your bleeding. If you don't have an IV, my ability to help you is limited.
Do you really want to rush your septic infant to the hospital at a few days of life for blood cultures, catheters, lumbar punctures? (I have done this with my newborn, twice, not related to group B strep, but trust me, it is terrifying and you don't want to do this.) Treat your group B strep. You have entrusted your care to me and I feel this is an important part of keeping your baby safe. I have studied and trained for over 12 years to come to this conclusion. Just take the ampicillin.
I have reviewed the literature on cord clamping. There may be some benefit in letting the cord pulse for 2 minutes after delivery. Longer than that, there is not benefit and there may be some harm. Look at the sources of your information before you make this demand. Trust me over the random baby blog you found online.
If your baby is in distress, I may recommend a c-section or an assisted vaginal delivery. I do this to protect your baby, to give you a healthy child, not to ruin your birth experience. I have a child with cerebral palsy. You will be happier if yours does not. In fact, be grateful if yours does not.
If your baby is breech, or if you are in labor for 3 days and your cervix has been dilated to 9 centimeters and your baby is facing forward and not budging, I will also recommend a c-section. I will not recommend a c-section unless I think you really need one. I am not just trying to ruin your plan -- I am actually offering to protect your health and your baby's health.
Don't even get me started on vaccinations. Just talk to your pediatrician. I just can't go there.
I am one of the biggest breastfeeding advocates you will meet. I have devoted part of my career to helping women breastfeed. If your baby loses too much weight after delivery, if he is lethargic and not able to take in enough nutrition at the breast, if your milk doesn't come in for 6 days, I may recommend that you supplement with formula. Your baby cannot learn to breastfeed if she is too weak to latch or to feed for long enough. Your baby needs nutrition to grow, to be healthy, to live. If she cannot get enough from you, she is going to have to get it somewhere else. I will try to help you with your breastfeeding difficulties, but sometimes you have to give formula, at least for a little while.
If you go into your labor and delivery with an open mind, and if your only goal is to have a safe delivery for you both, you will probably not be disappointed. Don't worry about whether or not you want an epidural now. It's a safe treatment for pain in labor, and it's available if you need it. If you don't want one, no one is going to make you have one. Get your IV, just in case. We rush women to the OR for unexpected and emergency c-sections every single day around here. Just get your IV, and maybe you won't need it, but if there's an emergency and you do need it, you are going to be very glad you have it.
Having a c-section is major surgery, It sucks. I've had 2. I didn't like them. I recovered just fine from them though, and I am no less a mother because I missed out on the unmedicated birth.
Your delivery is just one instant in the parenting of your child. For most mothers and babies, it is also the most perilous instant in their lives, which is why we have hospital births, and trained, medical birth attendants. But delivery lasts for a second, and it's over, and then you move on to the rest of parenting. And please believe me when I tell you that you will have no more control over your children later in life than you will have over the labor and delivery process. Think of labor as preparation for motherhood, and just give up control. Your baby may not wear mittens either, and there's not a damn thing you're going to be able to do about it.
Amen sister. I had to have a c-section, and it wasn't what I wanted, but it was what Calvin needed to enter the world healthy and happy.
ReplyDeleteThank you, thank you - can you hand it out? I've worked with dozens of babies who in all likelihood would have been fine, if their mothers would have focused on their baby's needs instead of the freakin birth plan. My doc was equally focused on a "good birth experience" I am thankful that she went home & I had a c-section as my son had both an actual knot in his cord, as well as it wrapped several times around his neck (mr gymnast) but he also has an actual penny sized hole in his skull that would have had more complications with a vaginal delivery. Thank goodness for the doctors who focus on the baby, like you! And I also loved your letter to preschool parents - I run a Childcare center & preschool, & we've had kids with g-tubes, and the stupid comments AFTER we've provided general info to the kids continue to amaze me.
ReplyDeleteThis exactly the way I faced my first (and second) pregnency: no plan except to let things go like they come. I had to get c-section for my first big baby boy: after 36 hours of labor and 2 hours trying to make him come the right way, it was obvious that it will not be possible. And I never felt like I was less a mother or a women because of that.
ReplyDeleteYes, woman deliver babies for ages naturally, bye how many babies (and mothers) didn't survive birth? Taking advantage of medicine progresses doesn't mean being a lees good mother.
Thanks for your post!
I congratulate you on being a mother, and gather that you must be a physician by some of your comments. Most women who feel the need for a birth plan, do so because they are afraid of not being a participant in the decision making around their care once they arrive at the hospital. Sadly, all too often they have good reason to be concerned. Routine IVs, electronic monitoring and episiotomies, despite all the evidence against is the norm in some institutions. Unprecedented cesarean birth rates, far beyond countries that have a lower perinatal morbidity and mortality are still increasing. Delayed cord clamping for 2-3 mins, despite the evidence supporting it, is not widely practiced. Erythromycin eye ointment is given to babies before a baby has even had a chance to latch. Weights, Vit K injections and arm banding take precedent over mother and baby skin to skin. Formula is given to healthy babies day 1 and 2 with no medical indication but because 'your milk isn't in yet and you just need to get a good nights rest' ill advice. I could go on. So please don't patronize women who are just doing their best to be heard - she is not trying to antagonize the staff. There are no guarantees in birth, parenting, or life for that matter - she probably already understands that. Next time, consider approaching a woman who comes in with a birth plan with compassion. Listen to her fears, her hopes. Reassure her that you understand; that you will give her the information she needs to make a wise decision for herself and her baby. Build trust. Then, when her birth is not going according to 'plan' you will work together to find the best interventions. And she will thank you for being there for her.
ReplyDeleteIn the many years since I first wrote this, I have read a number of hateful responses so I stopped reading them. I just happened to read this response for the first time in years. This whole post was inspired by a laboring mother who carried GBS but refused antibiotic prophylaxis for her child. This infection, if not prevented during labor, can lead to overwhelming sepsis and death in a newborn. My point of view, in that situation, is that it was more important for that mother to be right, stand her ground, and exercise her authority than it was to protect her child. The women who inspire and make these decisions, like forgoing GBS antibiotics or declining Vitamin K, can't possibly know what is at stake. I believe they are probably trying to make the right decisions for their children, but based on very bad, very wrong information. My patients come to me with their birth plans frequently, and I spend a great deal of time going through their plans with them. For many of them, when I am able to explain why I recommend IV access during labor, they understand and scratch it off the plan. But I cannot understand why someone would make a choice that would risk the health and the life of her baby. I don't think these women are just trying to antagonize the staff, and I do not patronize women who are trying to be heard. In fact, it is my greatest hope that real and open conversation can solve this problem. But in this journal about my son in which I reflect upon his birth injury - one that I was unable to prevent but would do ANYTHING to be able to change - I also reflect on the many parents who make poor decisions that put at risk the health and the lives of their unborn and newborn babies. Having known many more women with children with preventable birth injuries, I can speak for them and myself when I say we will spend our lives haunted by "what-ifs" and "if onlys."
DeleteWell said!
ReplyDeleteyou must be a nurse...I am and I say these things all the time. Add to it "I know you want a home birth" but so many things can go wrong
ReplyDeleteYou make me laugh an cry all at the same time !!! So perfectly said, I would like to ask all my labor patients to read this post. At this point in my career as a parent I really don't care if my children ever wear a coat. My mom told me "if they get cold enough they will ask for it" some of the best advice ever. Thank you for not only saying outloud but putting in writing what so many of us are thinking ! You are awesome !
ReplyDeleteThis is a WONDERFUL post, and I think all first-time (and 2nd and 3rd time) moms should read it.
ReplyDeleteYou have covered all the hot topics of what everyone is talking about including in their "birth plan," and realistically discussed them. Thank you!
I asked my OB, "So what's this about a birth plan? Am I supposed to make one?" She told me no way, just TALK to me. So I did.
She knew that I wanted to deny any medications (re: epidural) as long as possible, but I obviously trusted her and would do whatever she said. I didn't have an IV in because I did a LOT of walking the halls (labored for 24 hours after my water broke), but I did have the needle inserted and just hanging out so they could pop that IV in quickly if needed.
Turns out, I needed every medication under the sun. And a C-section. Completely not what I had planned on (loosely hoped for is a better term), but I know that it was all necessary.
It is a wonderful thing to be educated about what could possibly be needed/denied, but you also have to trust that your doctor only wants what is best for you & baby.
Thanks so much for posting this!