Just got off of the phone with DH- he's at work this evening, so the kids have been running wild! He is not going this weekend. He would have been 3.5 hours away in the middle of nowhere, and reception is so-so, as in he has it at his brother's house, but if he goes to the lake down the road with the kids, he has not reception.

I basically was evil. I pulled up world-wide stats on pre-e and sent him the info via text, then reiterated the maternal deaths d/t pre-e, and told him he wasn't going. He agreed without a fight. I also told him that if he wanted to spend time with his parents, that was fine, but his brothers could take the time to drive them to our apartment, since they have never done so.

So, he is still the great guy I married Maybe he doesn't need to sleep on the floor tonight

On another note, I am SO glad I decided to do part-time this year and next, instead of chug ahead with M2. I am not sure how this would work over the next few weeks otherwise. It was hard to make the decision, but obviously given the events of this weekend, was a much better decision than I realized.

Thanks for the support everyone! I am sure this little one will be fine... after all, she was already estimated to be 7-8 pounds last week, so good sized. As long as her lung development is on track, she should be more or less okay at this point- just want her to 'cook' a little longer!

So good to hear, SW. You know we will all be worrying about you over here over the next few weeks. This little girl better not give her mommy any more trouble!



To answer some of your questions-
APGARs can be done with the baby on you. It is very common for women to request what you are proposing; I'd be quite surprised if they gave you a hard time about it.

Nurses are nice people for the most part; I wouldn't worry about them ruining your 3rd your rotation (they can't grade you anyway). *OTOH* if there are residents at your hospital....OB residents can make 3rd year life pretty miserable if they want to, and word travels fast about difficult patients! I wouldn't go into this planning on having a tantrum.

Stitches without an epidural are very very painful, but I still would choose a natural childbirth again.

asunshine - true true. Point well taken. I tried to amend my "intensity" later on in the string, but I suppose a nicer way of putting it is that skin-to-skin with my baby is very important. I've heard horror stories from my girl friends who had babies where their babies were snatched from them and whisked away for these things, so I suppose my intensity about this subject came as a fear of that happening to me.

But yes, you are right - and I am aware - I need to watch myself around the residents. They aren't involved with my doctor, though, so I shouldn't see any of them at all.

However, all the same, I am definitely going to have my husband help advocate for my wishes during the birth.

Would you mind sharing your perspective on natural vs. epidural? I've heard this from many people, and then again, I have other friends who liked their epidural experience. I'm somewhat terrified of the whole thing, so I'm really not sure how to manage. I don't have time to attend classes etc. for natural, but could I still manage it without that? Maybe just by doing some reading about breathing?

One more question - I thought it was a reasonable expectation to nurse right after the baby is born, but I had a friend tell me it may be a few weeks until my milk comes in. How could this be when that would mean my baby would need formula instead of milk during that time? Is she just wrong, and should I expect my breasts to produce milk immediately upon the birth? How does all this work?

Hi southernmd,

I really liked Ina May's Guide to Childbirth, which is written by a midwife who works on a collective somewhere out in the boonies. Needless to say these are home births unattended by physicians, and I'm not advocating that to you, but I found the book really comforting as I planned for a natural delivery.

My reasons for a natural delivery were varied. For one, my mother delivered naturally, and she always told me that she really appreciated the fact that she could feel my head coming through and new just how to grab it with her muscles and push. That influenced me a lot. I had also heard that babies tend to be more alert when the delivery proceeds without an epidural. I don't know how much truth there is behind that, but I didn't want to take any chances of the epidural influencing my baby's first moments in the world. Finally, I admit I had this sort of feeling like "I am a woman, women have been doing this for all of humanity, so I can too, and screw modern medicine and it's pain relief. Except I'm delivering at the hospital!" LOL.

A couple things I'll point out. One, a lot depends on your OB. I delivered with the lowest intervention midwifery group in town, and I loved them. They promoted natural birth and their policy was not to offer pain relief. If you requested it, they wouldn't deny you, but they tried to help you through without. I don't remember how far along you are in your pregnancy and I realize you seem to like your OB, but midwives stay with you throughout your entire hospital experience, rather than running from patient to patient (though some OBs might as well, I just don't know), and their support helps quite a bit, especially if you're considering natural childbirth.

Another thing about planning a natural childbirth: up to a point, you can always say "screw this, I need an epidural". It wouldn't make you any less of a woman. In fact, if I had been in the hospital I might have done just that, though in retrospect I'm really glad I didn't. (I didn't get to the hospital until 10 minutes before DD was born!). You can have an agreement with your OB that you will try a natural birth, but that if you seem to be having trouble he will let you know before you get to the point where it's too late to have an epidural.

Anyway, as you can probably tell I'm a proponent of natural childbirth. I really don't like the way many OBs push epidurals on women without a second thought. That being said, I do not think poorly of women who request epidurals and I know many women who were very happy to have had them. And as I said, had I been in the hospital I very well might have caved I'm not sure if that helps at all, but those are my thoughts on the topic. As far as not having time for a childbirth class, my husband and I took a class with a doula. She also offered private classes in your home on the weekend. Pricey, but maybe an option you want to look into?

Oh, and as for "kangaroo care", that's standard in many places now but you should check both with your hospital and your OB. My DD was placed on my belly right after she popped out, before the cord was even cut, and I wouldn't have traded that moment for anything in the world

Eek, sorry about the super long post!

You are producing colostrum immediately upon birth, and that is what the baby will get for a few days, until the milk becomes more like milk ("comes in").

@ npb: 'I really don't like the way many OBs push epidurals on women without a second thought.'

Just a quick note of reply to this statement. I am an ob/gyn and myself and my colleagues do not 'push' anything for patients. If a woman wants a natural childbirth and has no complications with her pregnancy or labor then obstetricians are very respectful of that wish. However, what most commonly occurs is that the vast majority of patients who "don't even want to be asked" about labor analgesia end up screaming for an epidural as soon as labor really gets going. I am very tired of hearing about how ob/gyns 'push' for things like epidurals, pitocin, c-sections--for normal, spontaneously laboring patients in active labor, when in reality the opposite is in fact true. As obstetricians, our job is to empower women in all aspects of their lives including of course the process of labor. Now, if someone had medical co-morbidities that require labor induction, that is an entirely different subject. Labor induction agents such as a pitocin increase the intensity and frequency of contractions and are much more painful than those generated in spontaneous labor and most women have a difficult time managing pain without some kind of analgesia. If a woman is in this situation and requests an epidural, of course I will support her decision; she should not be made to feel like she somehow 'failed' the labor process if she needs analgesia.

reluctantmd, no offense intended. That's the problem with making generalizations, which I shouldn't have done. In my limited experience, the OBs I have encountered have been far quicker to suggest or offer an epidural than have the midwives I've worked with. My sample size is small. I've also spent more time with midwives, and this is the perspective I have heard from them, which of course is inherently biased.

My understanding is that, when it comes to uncomplicated pregnancies and deliveries, OBs have higher rates of "interventions" than do midwives. This is why I chose to work with midwives for my own delivery, and I will continue to do so. Additionally, they seem to have more time available to spend with their patients during L&D, which is again based on a limited sample size and is, I suspect, a product of the system and not the individuals. I am sure there are many OBs out there that I would work great with as a patient, and many midwives with whom I wouldn't mesh well. I mean no disrespect to the profession - those are just my personal views It's great of you to contribute perspective from an alternate viewpoint.

Thank you guys so much for all the information! It is really helpful!

I do LOVE my doctor - he really is wonderful, and I actually trust the entire practice of doctors a whole lot, and I am very comfortable with any of them delivering. I probably won't switch or change anything.

In fact, reluctantmd - he sounds like he has your ideals of patient management.

I would love to hire/see a doula, but to be completely honest - since my husband lost my job and we are living only on my military stipend from HPSP - money is tighter than anything I've ever lived under in my entire life. We can't even afford a meal out at a restaurant right now, so I doubt we could afford to hire a doula. However, my bff at med school will be right there with me, and she is a third-year on her clerkship, but her sister is a doula and highly learned in natural childbirthing and is passing on tips for her to help me deal with my birth in the best way. Hopefully this will be helpful.

You guys are making me lean towards natural birth since I am in the uncomplicated category of pregnancy right now and likely would not need induction.

I'm going to start reading about all my options...I really don't want a catheter anyway! LOL

Southern- I went for natural childbirth with our first- my mom was 98 lbs when she got pregnant with me, all three of us were 10 pound babies and she delivered every one of us vaginally with no medications. Yes, she is superwoman.

So my assumption was I would be able to as well, which obviously, did not happen (I forgot to account for DH's head and broad shoulders...lol). But from my experience, I have two thoughts:

1. If I could have been up and walking around (or burned my back off in the shower) for the entire labor, I would have handled the pain much better. It wasn't an option for me, as I had pre-e with our first and ultimately had to be induced with pit. But they started off breaking my water b/c I was contracting on my own, and those were the easy hours of labor (the ones before pit).

2. Once I had pitocin, and it kicked in, I worked through it for several hours, but it killed me. Once I knew I needed a c/s and it would take a while to get everything set, I demanded my epidural. And once I had that epidural placed, I wondered why women do this to themselves. Why do we 'need' to go through this pain? So. much. better. with the epidural.

Totally contradictory I know, but just my experience. And after having an unplanned (in reality and mentally as well) c/s and two subsequent c/s, I would take the c/s recovery any day of the week over labor. So, yes, I am full of contradictions.

My OBs were wonderful by the way- I am also extremely picky about who we see. The OB for my first three was totally on board with my plan for a natural birth, but let me know that I could change my mind at any point, and set it up so if I chose to have an epidural, that was fine with him without 50 phone calls and 20 extra minutes when I made the decision. I also didn't feel as though I had 'failed' despite getting an epidural and ultimately having a c/s, and a part of that is due to the way my OB presented things and the openness he had to the various options.