I had an Ob appt today. Just one where they measure you and whatnot, and everything is fine. I'm still feeling good. Tomorrow will be 23 weeks! Next visit is the glucose challenge test where I somehow have to manage to make it to campus without passing out after not eating anything for breakfast.
Good times.
They gave me the consent form for Labor and Delivery today, and reading it I can totally understand how a woman might freak out and decide to go with a homebirth. Note -- I would NEVER EVER do that, but I understand that feeling that if you run far far away from the medical establishment then nothing they say can go wrong will be able to. They make it sound horrible. Really horrible. Which, intellectually I know is for liability reasons, but I still cried when I read it.
I also noted that it kind of slips in the "clinical students may be present / assist with the delivery" which I am NOT ok with. NO NO NO. These are people I am going to graduate from medical school with, my classmates. It is NOT ok for them to see me deliver my baby, or for them to touch my vagina. Sorry, not ok at all.
I think we may have to have a talk about that one. Hopefully nobody will give me any grief about it.
Today the NP who saw me asked if I wanted to go to any childbirth classes, and I said no. I wondered a bit if that was a mistake, so I said if she felt that I should go I would.... but that I'd participated in a number of deliveries as a med student, even delivered a couple of babies myself (and placentas.... oh Jesus the placentas), and I felt like I kind of knew what to expect. She said that she didn't feel it was necessary.
Whew!
Just to give you the rundown on my impressions of delivery from my Ob/Gyn rotation, I remember the first time I saw a vaginal birth, I thought to myself, "Wow, that looks pretty awful."
Then I saw a c-section and thought, "Huh, well that is even worse."
I just figure that delivery will be a really really unpleasant 24-48 hours, and I will get through it, and it will be fine (as long as nothing on the consent form actually happens....). And life will go on, we hope. And then the *actually* hard part will begin when we bring the baby home.
Oh joy.
22 Pearls of Wisdom:
What you said about your experience on ob/gyn is *exactly* what I was feeling. Each time I saw a vaginal birth, I'd think I wanted a c-section, and vice versa. They both seemed so horrible!
I do remember one nurse who was delivering with a epidural and I remember thinking how chill she was, and that was the kind of delivery I wanted. And I got it twice. Maybe I was just lucky both times, but I thought vaginal delivery with an epidural was a breeze. And that's even with a bit of scoliosis that caused the epidural to mostly go to my left side both times. At one point during my last delivery, my nurse got a little frustrated with me and said, "You're so quiet! You need to act like you're having pain!" I did have pain, of course, but it was the kind of pain I could intermittently doze through. I certaintly never got to the point where I was screaming obscenities.
Also, I did a childbirth class my first time around. It was a complete waste of time for me. BUT my husband went too and actually learned a lot from it, I think.
And I do think it's perfectly reasonable for you to request no med students in your situation. This is why I delivered at two non-teaching hospitals.
Hi OldMDGirl - Congratulations on the pregnancy! I've been following your blog for a while now and really enjoy reading about Boo - she is so adorable and cuddly! I wanted to suggest that instead of the glucose tolerance test, you could ask for the 50 carb breakfast. My OB was fine with that since I never had any issues to indicate gestational diabetes, but I did have to ask since they brought me the glucose test paperwork first. I too was worried about not eating in the morning. Just a suggestion! Good luck :)
Fizzy -- That's a really good thought about taking my husband to childbirth class. I'll talk to him about it this weekend.
Not even sure I'm going to be able to get an epidural. If my platelets are too low (I've had mild thromocytopenia in the past year), then I might not be able to get one. Oh joy. I'm hoping they will be fine by the time I deliver.... but yeah. I wasn't too thrilled when I found that out.
Lisa -- Thanks for the advice. I'll probably just suck it up and be a hungry cranky bitch. :-)
Congrats on the pregnancy! I finally didn't forget to comment. Kids during grad school is tough, but they are so worth it! We have 2 now and they are the best decisions we have ever made. My wife had a walking epidural the first time around which stopped the labor, so she essentially had a normal childbirth. The 2nd she didn't take a chance, full epi. Best of luck with the remainder of your pregnancy!
Aw, come on. If you don't let your classmates see your vagina, how on Earth are pictures of it going to get on Facebook?
I'm glad you're going down this road before me. I know you're going to tell it like it is!
If there is a chance that you aren't going to be able to get an epidural, I strongly recommend you take a CBE class, so you and your husband can figure out how to manage labor together, and get a decent, professional birth doula to support you both. Look up the studies if you like, RCT doula/no doula and it makes a difference in length of labor and perception of pain and women have more positive attitudes about their partner's support (that last one was presented at a conference, don't know if it was ever published.)
I am an MPH, and also a CBE and was a birth doula for many years. Now that I'm a premed student, I realize how far off the natural childbirth script I really am (or how off the sanity train many of them are), but there are good, professional, non-judgemental people who can help with labor. Ooo, here's another tip - I had a client once with Factor X deficiency so no epidural AND an induction for her and she used a TENS unit (had to rent it from a rehab medicine place beforehand) with great results.
Wow that was a lot more advic than I usually give. Best wishes and feel free to ignore it all!
Larissa -- Thanks! I'll have to think about it. I can't say I'm really that into the doula idea, but it might be something to consider. I think the trick might be in finding one of those professionals who WASN'T off the sanity train, and honestly I don't have a whole lot of time (or patience) to interview a bunch of them.... I don't know. I'll think about it. What is a TENS unit?
Having delivered many babies at home, I would recommend a doula or a knowledgeable friend to join you. If you don't get an epidural - continual back pressure, cold cloths etc take hands and the nurses aren't there. It allows your husband to be present with you, not running for cloths. The doula is for your husband, you won't care who is there. : )
i'm laughing. my son is 30, but i still remember his birth in great detail.
my behind was visible to anyone who walked by my open door, and after nearly 24 hours in labor (with a pitocin drip after a non-productive and fitful night), i didn't care who had their face/fingers between my legs. trends come and go, and in the 80's, most women opted not to have an epidural. with the second birth, most signed up for one 6 months in advance.
find a good birth coach or experienced RN - mine was a little too earth mother for me, but she gave me information/facts that really helped (my partner refused to attend). one was that 3 or 4 days post-birth, my hormone levels would plummet, and i should expect a crying jag. when it happened, i handled it, and didn't freak out.
"The doula is for your husband, you won't care who is there. : )" - she is so right, and you will do fine.
the TENS unit - i sent you info. great idea.
TENS - Transcutaneous Electrical Nerve Stimulation
It is a small unit that has 4 pads attached to leads. You place the pads on your lower back/hips/butt and control the electrical signal being sent through the unit to your nerves. They are used with chronic pain suffers and other folks, in addition to women in labor who can't have epidurals.
Srsly, think about a doula - you could craft a frank email about your expectations and plans and send it as a boilerplate inquiry to several doulas, they'd probably self-select whether or not they would be good fits for you. Do we know where you live or is that anon? I did doula work for a long time and might have some professional contacts to recommend.
The "childbirth" classes we had covered a little more than what I saw on the OB rotation (and that was 7 years before I had my baby). Like what to do at home for pain, WHEN to call or come in, and other non-delivery but baby-related stuff. I also decided to go for my husband's benefit but I think I got a little bit out of it, too. Definitely they should honor your request for no students. Also, my epidural did not work except for 30 glorious minutes. I'm still not sure what I'll do this time and will likely just decide at the time.
And yes, you are sooooo right. Barring major complications, you'll get through it and THEN it gets hard.
TENS = transcuteous electric nerve stimulator. It's one of our rehab modalities that we prescribe a lot without any solid evidence that it actually works.
You know I'm a very down to earth person, but I actually think the doula idea isn't a bad one if you're delivering without an epidural. I think in that situation, it would be nice to have a supportive person in the room. If you find one who does a lot of hospital deliveries, she's probably less likely to be crazy.
Hopefully, you can get the epidural though! Those things are miracles. My husband was laughing at me on my last delivery because the first thing I said when they admitted me was, "When can I have my epidural?" I had several complications from it, and I *still* think it was fabulous.
Two thoughts (I just finished OBGYN):
-At our institution, if you don't want any medical students in the room, you can just say so when you come into triage. I'm not sure what your experience was on OB, but we were very clear on which rooms we could go into and which rooms we couldn't and we were careful to respect that.
-At our university OBGYN department we have some faculty who are CNMs, usually also formally trained as NP's, who attend their patients' deliveries. They see their own patients in clinic (in the same building as the MD faculty). Their patients are not seen by the residents/MD attendings/med students on admission, but we do triage them if needed, watch their tracings for distress and help out as directed by the CNM. CNM patients can get the same pain relief options as MD patients and can be taken to the OR if the CNM says so (and the operating MD agrees), just like MD patients. Consider that option as a sort of "third way."
-Also, interesting that you have to take your first (50gm) challenge fasting. We were taught to give it as a random, nonfasting test.
Firehose -- You know, I'll have to check the order. It's possible it was a GTT rather than a GCT, but I assumed GCT because they usually do that to screen whether you need a GTT. It could be that they just ordered the GTT....
Oh also, I know I can verbally opt out at the time of delivery (at least patients were able to do that when I did my Obgyn rotation 3 years ago, anyway), however in that case it should not be in the consent form that I am ok with them being there. Suppose I required an emergency c-section with general anesthesia and COULD NOT verbally kick the med student out at the time of my surgery.
I left no question about my expectations for those in the room - I limited the audience as much as humanly possible, barring any emergency that is detailed in the consent form. Everyone respected it.
I also crossed out anything I didn't agree with in the consent form :) - it made me feel better, at least. Ie - no research, no students.
Good luck! And I second the CBE course - not one sponsored by the hospital, though, because that will be a waste of time. Find one that will actually give your husband some useful information so you're on the same page, or a doula is a good suggestion too.
Why would a CBE class sponsored by the hospital be a waste of time? It seems like it would be the other way around...
Hospital childbirth class waste of time - I would agree if you are thinking of a non-medicated birth. Face it, it's a rarity in the hospital. A midwife will commonly do childbirth classes and focus more on natural pain relief and breast feeding. They'll cover the same things, but the hospital will tend to focus more on the bad that can happen vs the more typical things that will happen. They will also be swayed by the trends at their hospital rather than giving you information to make choices. For instance - epidurals pros and cons - cons are going to be talked down for sure. Breast feeding, episiotomies - all depending on the hospital. Now, a midwife's classes can be swayed too, but for you, it will likely be swayed in the "right" way. You already know the pros - she'll give you cons. Plus, I find most midwives know very well the benefit of hospitals and are very fair minded about when they are pros with birth. Another perk with a doula - many are lactation consultants as well and will come to your house later to help you if you need it and check in. On day 3 or 4 it's really great to have someone come to your house and give you that support. When the doctor is a patient with a kid, it's nice to be a patient, plus really the husbands don't really believe that we know anything more about it then they do :) It's nice to have someone back you up.
Just Me,
Thanks for your advice. You have completely convinced me not to take a class or get a doula.
Wooooooooooo.......
You should be able to get an epidural unless your platelets are dropping regularly and are lower than 70K. If they've been stable and are in the 50-60s, you can still get one. Pregnancy is a hypercoagulable state and there has not been a pregnant woman who wanted an epidural who didn't receive one from me because of low platelets.
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