The Birthing “Understanding”

Can I skip the IV?

Pregnancy is a condition where you can be completely normal one moment and have a bleeding emergency the next. Although this is unlikely, the IV can be lifesaving, allowing your doctor to administer drugs, fluids, and, if needed, emergency transfusion. If you're afraid you might get some medicine through the IV, a compromise is a heparin lock, in which the IV tubing remains in your vein but is capped, ready to use in an emergency. (Not having at least a heparin lock is dangerous. (It's not easy to try to find a vein for an IV when someone is undergoing cardiovascular collapse. Been there, done that, hated it.) Short of using an IV for mere hydration if needed, the rest of your labor can proceed naturally with a heparin lock. It is not attached to any other tubing, so you're not flitting any tubes about every time you move your arms. You can walk about without that flagpole they hang the bags on.

I'd like to avoid a C-section unless it's absolutely necessary.

Wouldn't we all? Think about what you're saying here. Of course you shouldn't have a C-section unless it's necessary. Absolutely. A good deal of the literature your doctor reads deals with ways to avoid C-section and when they must be done. Also, there's a thing called peer review. If your doctor is doing unnecessary C-sections, she will soon be called before a disciplinary committee at her hospital to explain her actions.

The indications for C-section are:

1. Fetal distress in which a C-section would be a more timely delivery than a vaginal delivery. Vaginal bleeding that is a danger to you or your baby, as in placental abruption.
2. Failure to progress in labor, such that successful delivery probably won't occur, presenting a danger to an unborn baby. There are criteria for "failure to progress" as well.
3. Malpresentation of your baby, as in breech or transverse lie, risking severe trauma to your baby should vaginal delivery be attempted or forced.
4. Infection, in which C-section would be more timely than awaiting a vaginal delivery. Of course, operating through an infection poses slightly more risk to the mother, so the timeliness of both types of delivery should be weighed along with the severity of the consequences for each scenario.
5. Previous C-section, if you were to refuse VBAC (Vaginal Birth After Cesarian), which is your right.
6. Maternal Choice C-section, which is also your right as a woman. This should not be considered an unnecessary C-section.

Who can I have in my room? Family? My children? A Doula? Another birthing assistant?

This is an illustration of how there need not be a conflict between a natural approach to childbirth and modern obstetrics. Having a birthing assistant (midwife, doula, or others) should be very helpful as long as the obstetrical decisions (interventions) are called by the obstetrician according to a birthing understanding. No obstetrician should have a problem with a birthing assistant that helps you through your labor. But there would be a big problem if there were an argument between your doctor and birthing assistant, either overtly or via mind games. By this time, you trust your doctor. So should your birthing assistant. This understanding should be crystal clear before going to the hospital. Birthing assistants are very valuable partners in the team when they assist in the natural progression of things. If intervention is indicated, a smart birthing assistant will take a back seat in the decision making. She can still be very helpful no matter how the delivery goes.

What about others? Family? It's common and even recommended for the father to be there for you, of course. Often your mother may find herself there, either by your request or her meddling. Keep in mind that this is a very personal thing between your husband and you. Having a child is your love brought to fruition. Cheerleaders, your posse, and persons who might pass out may take away from this moment. Evaluate this life experience before you go into it, set the rules for visitors, and both of you stick to it. If you're afraid to hurt someone's feelings, ask the nurse or doctor to be the bad guy in asking that they leave. They love all that authority stuff.

As far as having children in the delivery room, I think this is a bad idea. I'm not talking about your 22-year-old daughter who has already had a baby herself. I'm talking about your 8-year old or your 10-year old. There's a big difference between the stick figures she may see in the pages of her grammar school health book and the graphic true life brouhaha she will witness here. The forces of labor and delivery are such that even I'm amazed at how it transpires successfully, much less a wide-eyed, astounded little girl. It's not that she couldn't handle getting grossed out. Her boy classmates and what they catch in the schoolyard provide plenty enough of that. My point is that this should not be your young daughter's first hands-on introduction to sex, in this case the end result. Additionally, even with the best of breathing techniques learned in prenatal classes, there will be the grimaces, huffing and puffing, and generally visible unpleasantness on the face of someone she loves and will worry over. A mix of fear and polluting her sexual being with such a distortion of the anatomy right in front of her may not be good for her. And that's if everything goes well.

Can my husband cut the cord or assist in the delivery?

When comedian Bobcat Goldthwait was asked if he wanted to cut the cord during his wife's delivery, he asked, "Isn't there someone here more qualified?"

In my opinion, anything that doesn't interfere with your health or your baby's health should be your decision. The cord's job is over. If your husband wants to whack the cord, great. I've even had a native Indian cut a segment of the cord and pray over it in a corner of the room. None of this will impact your safety or your baby's health. If this sole criterium is met, then you should be able to do anything you want. Assisting in delivery is another matter. I myself would have no problem with your husband gowning up and gloving so that he can put his hands over mine to feel my pulling on your baby to assist delivery. The problem, however, would rest with the hospital. This would pose a legal liability although I trust how much pulling is going on, I'm the one doing it. But in such a situation the hospital is responsible for allowing Dad and me to be practicing medicine together, so unfortunately this can't be done. Dad can cut the cord, you can breast feed immediately, but leave the rest of the thrills for raising your baby. That's the important part.

Can we take video or pictures?

This wouldn't bother me, but some hospitals have a policy against video in that it's a medium too prone to misinterpretation should something go wrong. Again, they have a responsibility to avoiding unnecessary legal liability. Take for instance a friend of mine, an excellent obstetrician who attended a delivery that was going well. The atmosphere was jovial, and both parents looked forward to every ensuing minute. It was a celebratory atmosphere, and there was some light joking going on. The infant went on to have an infection in the nursery, became very ill, but eventually did well. The parents sued the doctor, and their lawyer spent no less than twenty minutes in the deposition grilling the doctor on how he wasn't taking the delivery seriously, based on the light banter on the videotape. In medicine, when things go well, they go great; when they go badly, they can go very badly. The retrospectroscope in the hands of a lawyer can add more blame than is justified, as in the case of my friend. He felt he was being sued for having a personality. Ironically, this is probably what attracted this patient to him in the first place.

In any event, video doesn't interfere with your health or your baby's health, so it's OK with me. But the hospital may have its own rules, so if this is important to you, ask the nurses during your prenatal visit there. Also, I'm just the obstetrician. There may be an anesthesiologist involved who has veto power over video. These are all things that should be settled beforehand. Still pictures are probably fine with everyone.

There's yet another consideration. Is the graphic video of your delivery going to be something you're going to watch over and over? Are you going to show your in-laws and neighbors? In today's world where video cameras are almost disposable, it's tempting to record your life in every detail, from the entire wedding ceremony which no one will want to watch in its entirety to every dance recital in the years to come. The expecting couple has a tendency to dissociate themselves from the delivery, as if the blood and mucus and swelling of your labia are not really you. "That's some other person and not lil ol' me." And sure enough, you'll probably be restored close to normal again by the time anyone sees the video. But it really is you. And it's your external genitalia flapping around for all to see. And it's personal. What I recommend, if there's video, is to tape the goings on of faces only, strategic shots of the newborn that miss the NC-17 poses, and following the baby to the nurse's evaluation and back to you thereafter. If you want a memory, this is the one you want — not one Sam Peckinpah would shoot.

Can I breastfeed immediately? May the baby stay with me and not be whisked away?

Once again, as long as it doesn't interfere with your baby's health, this should be the preference. In fact, breastfeeding immediately after delivery is a good thing, triggering the reflex that helps contract your uterus, decreasing the bleeding that accompanies the immediate postpartum period. Also, you baby's been through a rough time ... There's nothing more beautiful and unifying. Let Dad take the pictures because you two have much more important things to do.

But what if immediate breastfeeding were to interfere with your baby's well-being? I'm talking about distress at the hands of a low blood sugar or poor ability to tolerate the sudden change in temperature from the 98.6 to room temperature. Sometimes a baby can crash, which is completely reversible and harmless if the cause is recognized and addressed. But a baby that is sputtering needs to be stabilized before occluding the mouth and nose with your breast. This is just common sense. Generally, if the delivery nurse knows you want to breastfeed right away, she will make that happen unless there really is a problem.

Will you tell me what medicines I'm getting before I get them?

Of course. Unless there's an emergency which prevents a civilized discussion of what's going on, you should have a relationship with your doctor in which explanations are part of the process of giving any medicines.

And then there's my question for you:

If a true emergency arises, do you trust me to do anything -- I mean anything to save your life or your baby's well-being?

The Right Answer: Of course.

Then we have a deal!