Friday, March 21, 2014

birth series ::: Choose your doctor wisely

Part 2: Choose your doctor wisely

One of the best ways you can ensure to have a natural birth is by finding a doctor who is on board with you having a natural birth. Unfortunately, this is harder than one might think. There are many doctors who will mislead you or even flat-out lie about how supportive they are of having an unmedicated birth. That’s why you have to do your research and find one of the many good doctors out there.

*Pitocin/epidural side note that I should have explained earlier: For those of you who don't know what pitocin {aka pit} is, it's basically synthetic oxytocin. Oxytocin is the natural hormone that starts contractions. While your body is capable of handling the contractions your body naturally produces, it often struggles to handle contractions brought on by pitocin. Because those contractions are synthetically produced, they're often stronger and last longer than 'natural' contractions. Doctors frequently use pitocin to get labor started. Because {pit} contractions are pretty rough, an epidural is administered. Sometimes the epidural reverses the effects of the pitocin {slows contractions down}, more pitocin is given. More anesthesia. Baby {or mom} have severe negative reactions to this "cocktail" {dropped heart rates, low oxygen supply}, so a c-section becomes necessary. This might be one of the main reasons I lobby for unmedicated births.

Before selecting an OB to deliver your babe:
find out what your doctor’s c-section rate is {can call their office-hospitals}
- find out what the hospital’s c-section rate is
- talk to friends – try to find someone who’s had a natural birth {intentionally} and try to get that doctor
- might be a good idea to find a doula before finding a doctor, that way you can find out which doctors they've worked with, which ones they'd recommend, and which ones to stay away from.
- Consider trying to find a Family Doctor to deliver your babe instead of an OB. An OB is a specialist. Giving birth is not a sickness, and a family doctor is a great option for a low-risk birth {which most are}. Some areas even have midwives who deliver in hospitals! What a great option for someone who wants to be in a hospital setting! {My doctor with Ragan was a family doctor, and I could tell that her care for my overall health was much greater than with my other dr}. Family doctors also do not perform c-sections, so you know that they're going to do what they can for you to have your baby vaginally.

Ask questions - lots of them: 
By asking doctors good questions, you will usually be able to tell whether your doctor would actually be on board with an unmedicated birth. At my first appointment with my OB with Simon – I expressed that I was interested in natural birth, and she seemed to be on board and supportive. However, I would talk about it each time and ask different questions, and after each visit – I was more and more sure that she wasn't really on board. The two most telling things are how long past your due date your doctor will let you go without induction and the second is what position your doctor is comfortable with you pushing in. Some doctors only do c-sections {emergency or not}, maybe stay away from those {questions to ask will follow}.

Something that I realize now and wish I’d realized earlier with Simon’s doctor, is that you hire a doctor. You hire them to provide a service for you. That being said, just as you hire a dr, you have the right to fire them. If you’re moving along in your pregnancy and realize that your dr has their own agenda, switch. I know that’s easier said than done, but you will be so thankful you did. Looking back now, I wish I’d gone with my gut and switched drs when I was pregnant with Simon - even late in the pregnancy. I wish I'd gotten over my fear of hurting her feelings and done what was best for me and my babe. I'm fairly sure that her feelings wouldn't have been hurt. Since I had a dr I completely trusted with Ragan, I cannot tell you the difference it made just to know that my doctor had my best interest in mind, not her own.

I know way too many people who have been pushed into having a c-section by their doctor {and some nurses are just as guilty}. Women go in wanting a vaginal birth and because they’re ‘failing to progress,’ don't understand negative effects of pit/epidural, or don't understand the 'system' - they end up with a c-section.  {The term ‘failing to progress’ has to do with a mama’s body not following the standard, textbook timeline for labor. Just as everyone’s pregnancy is different, so is the timeline of how a woman’s body will experience labor.} Maybe some women don't get pushed straight into having a c-section, but a series of medical inductions and poor choices lead to no other choice but to have a c-section.

Remember the stat in the intro to this series: only 2% of births are high risk {in need of a c-section} births. But even though such a tiny fraction of births are dangerous, our national c-section rate is 33% and in some areas over 50%! 

Possible bad intentions for a doctor to push for a c-section:
They make more money {NPR article}  
Surgery is way more exciting than just catching a baby - an OBGYN is a trained surgeon
A c-section is over quickly – No need to ‘wait’ for a mama’s body to do the work
If your doctor isn't the one who delivers your baby, they don’t get paid for it {in some practices}
- Control – they choose the time so that their nights or weekends aren't interrupted with your birth {many c-sections occur around 5-6pm and 10pm and also on Fridays-before the weekend}
- Fear – some doctors {and nurses} graduate from med-school never having witnessed an unmedicated birth. Some may be afraid to allow the body to do what its designed to do if they’ve never witnessed it. Plus, women can do some crazy things when they’re giving birth {think Madea gone wild}.

Here’s a list of questions you can ask your doctor. As always, trust your instincts. If you don’t think your doctor would be on board for an unmedicated birth – then switch {hopefully you’re in an area where you have some options}.

A great question would be to see if your dr has worked with doulas before - and an even BETTER question would be to see if they have a list of doulas. If your dr. has a list - then YES! Stay with them - because that means they've worked with enough doulas to know which ones they have a good relationship with. If they seem like they frown upon the idea – switch! That is not a good sign. {Even my dr who was 110% on board with natural birth recommended I get a doula – because y’all, there are some pushy nurses out there and a doula can help you stand your ground until the dr. comes}.

Birthing Positions:
What positions are they comfortable with you pushing in - on your back is the WORST position to be in. You could give the example of maybe you'd want to squat, or be on your hands and knees, or a really good position is on your side --- the side is a great position because you can rest during contractions. When you're on your back- -  the baby has to go over your pelvis to be born - not the case with these other positions. Drs love it when women are on their backs because it's easiest for THEM! I pushed for 3 hours with Simon because my dr made me get on my back --- I pushed for about 15 minutes with Ragan when I was on my side. Now - I do know people who pushed longer on their side - but it's much better for mom and baby to NOT be on your back. 

The more I talked to my OB, the more I realized that she wasn’t ok with me pushing in any position other than on my back. She kept saying that if I’m on my back, she’s in the best position to help me; while I knew very well that the worst position for ME and my babe is on my back. If she were really interested in helping me, she would have allowed me to push in whatever position felt most natural {side, squatting, hands/knees, sit/squat, one leg up}.


At what point does the dr start talking induction? Are they ok with you going 42 weeks without ANY interventions? Could they perform a non-stress test? (these tests are designed to make sure baby is doing alright around 41 weeks...problem is, if baby is having a sleep stage during the test, you will not do well and will likely have an emergency induction right then and there. happens ALL the time!) -Bethany Robbins

If you're healthy and baby is healthy - there is no reason why your doctor shouldn't let you go 2 weeks past due date - the key is to avoid medical intervention to start induction.- There are good reasons to induce early – however – unless there’s a pressing issue, there’s really no reason to induce earlier than 2 weeks past the due date. Many doctors will say that they won’t allow you to go a week over your due date, when maybe your baby isn’t ready then {remember all those mixing/sending of messages}. Also, when doctors induce – they have more ‘control’ over your birth.

Also remember that a due date is more of an estimation. Everyone's pregnancies are different. Some babies are "ready" at 37 weeks, some might even need longer than 42 weeks! Will share some tips on how to "get that baby out" naturally before your doctor starts talking induction in my last post.

Baby's size:
Ask them what they consider to be a big baby. Some doctors will want to do a c-section {without even allowing you to try to have your baby on your own} if they think your baby is too big. Rarely does your body 'make' a baby that your body can't also birth.

The value in having a doctor you trust is that you know that they have your best interest in mind. If you know that they're naturally minded and that they view induction, interference, and c-sections as necessary only to save either your or the baby's life, then you can trust that when they recommend something - it's not for their benefit or convenience. Remember that there is a 98% chance that you can do this. Naturally.


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