Birth is a natural process, and pregnancy is not a pathological medical condition. My ideal way to deliver babies is the “Home Birth in the Hospital” method, which is low intervention with high safety, combining all the best benefits of both worlds.
Being in the hospital has the benefit of having immediate access to medical intervention in case you need it, without having to first be transferred from home or a Birth Center, which can lead to the loss of precious minutes. My philosophy of low or no intervention management, however, allows your labor to be natural. And, if you desire, it can be completely unmedicated and allowed to progress at its own pace.
Over the years, I have come to realize what a rift exists between the medical establishment and the care of women in their pregnancies.
So many women come to me with the fear that I will not hear them or will take away their right to medical decision-making.
From the very beginning, I want to assure all my patients that we make all our decisions together. I share with you what I know and how I think I can be of service to you. Then, you share with me what your needs are, and together, we come to a decision on what is the best approach to your pregnancy.
Under ideal circumstances, you will barely need me. I am just there to steer our ship into a safe haven, and most of the time, the ship is on the right course and doesn't require me to so much as touch the rudder.
The 10 questions below are, by far, the most frequent questions I get asked, and often with an anxious glance. Therefore, I have decided to answer them here. Of course, I will also be happy to revisit them with you during any of your visits.
1. What is your C-section rate?
Over the years, I have kept track of my C-section rate so I could answer this question, and while the rate varies from year to year, it is generally anywhere between 15% and 17%. It is important to me that you understand that, just like all of your other medical care decisions, it is one we usually make together. If I suggest that you need a C-section, it means that we have tried and exhausted most other options.
Not all C-section decisions are the same, however. There are a few emergency situations that require immediate intervention and cannot be delayed, for the sake of the safety of you and/or your baby. We would still have a discussion before proceeding, but there would not be time for a very long one. Two examples of en emergency C-section would be: placental abruption and umbilical cord prolapse.
With patience, most people will deliver vaginally. And patience is something I have when it comes to obstetrics. I will give you the time you need as long as your baby is doing well and there are no signs of fetal or maternal distress. Many patients, when given the time, have had beautiful vaginal deliveries after a long protracted labor.
2. Do I have to get Pitocin?
The short answer is no. Pitocin is only for those patients that truly need labor augmentation, for various reasons, which we would first discuss together. I do not routinely use Pitocin, and no one is obligated to take Pitocin, even when it is indicated.
3. Do I have to stay in bed throughout my labor?
It is useful and intuitive to ambulate and move during labor, especially in the early stages. Being admitted to the hospital, however, does not mean that you are now confined to the bed with an IV running. There are certain scenarios where we might prefer you be in the hospital bed, so we can better monitor you and your baby. One example is if the fetal heart rate should drop. But, if you and your baby are doing well, I highly encourage physical activity throughout labor. You can move around until you are ready to have the baby if that feels right to you.
4. Do I have to push while lying on my back?
Pushing can be done in many positions, the most common ones being on your back, side-lie, squatting, and on elbows and knees. If you have an epidural, however, your choices are limited by the fact that you have no strength in your legs so that we cannot safely have you on your knees or squatting anymore. But side-lie pushing is still an option even with an epidural, and often, we switch it up during the pushing stage and will do a few pushes in different positions until we find the one that works best for you. And just for your information, I don’t use stirrups. Stirrups take away your ability to actively participate in your delivery, and I need you to participate!
5. Do I have to wear a hospital gown?
The idea of wearing a baggy hospital gown with openings in all the wrong places may not sound attractive, but come delivery day, fashion statements will not be front and center in your thinking. We need access to your belly, and when you are laboring (especially during the later stages), we need access to the vagina—so underwear is not an option. That being said, there are special gowns that you can purchase online for the occasion that look a lot cuter than the hospital gowns and accommodate all access needs. They may, however, be somewhat pricey, and you should know ahead of time that whatever you are wearing would likely get quite soiled with things like amniotic fluid, blood, and even poop.
6. Can I eat during labor?
Yes, you may eat during labor. It is your physician who gives your nurse instructions to feed you/not feed you, place an IV/not, start/not start IV fluids, etc. We do have to follow certain hospital policies, though, such as how long you can walk around without a monitor before having to check your baby or only allowing you to eat “clear liquids” if you are receiving Pitocin. These policies may vary from one hospital to another but tend to be rather reasonable. Another thing you should probably know before eating a large pizza from Domino’s is the fact that, as your labor becomes more active, you may start vomiting. Some people vomit incessantly during labor, while others don’t vomit at all, but eating large amounts of food (especially greasy, heavy food) may cause you to do so. This is why I recommend only small, light snacks that are high in energy.
7. Do you do routine episiotomies?
No, I do not perform routine episiotomies. I cannot repeat this enough. Episiotomies are for certain situations where the baby needs immediate delivery and cesarean section is not feasible. Fortunately, such scenarios are very rare.
8. Do I need continuous fetal monitoring?
No, if you are healthy and your baby appears to be doing well, your baby can be monitored “intermittently.” The hospital has a policy that tells the nurses exactly how long you need to be on the monitor and how long you are allowed off the monitor, but your physician is the one who orders “intermittent” vs. “continuous” monitoring. If the baby’s heart rate indicates that everything is well, we can continue intermittent monitoring. When you are pushing, however, the baby’s heart rate always needs to be monitored a little more closely.
9. When do I go to the hospital?
This is largely dependent on your individual pregnancy and preferences. If you desire an unmedicated birth and your pregnancy has been normal, you can labor at home for as long as you feel comfortable doing so. I prefer checking in with you from time to time, and I usually will ask you questions like “Are you leaking fluid?, Are you having any bleeding?, Is your baby moving in between contractions?, How frequent are your contractions?”. On the other hand, if you plan on having an epidural, going to the hospital when contractions are regular and painful is recommended. The reasons is that the anesthesiologist will usually require lab work and some preparation (extra hydration with IV fluids) prior to placing an epidural, and this can take some time.
10. What happens after I get to the hospital?
When you come to Labor and Delivery with labor pains, the nurse will have you change and give her a urine sample in triage. Then, she will place the fetal monitors on your belly to check in with the baby. If I am around, I will come and check to see if you are dilated, but often times, the nurse will examine you and relay the information to me. We then decide what will be the next step: walking around, returning home, or moving to a labor room. If we decide that you stay, they will draw some blood and leave “heplock” (a kind of IV catheter) in your arm so they don’t have to stick you again if we need to give you IV fluids later.