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April is Cesarean Awareness Month

Many bloggers have written incredible posts about the shocking cesarean rate, VBAC support, and resources for healing.

I’m not going to try to repeat what they have already so eloquently written.

I want to talk about the idea of family-centered cesarean birth.

I don’t attend many cesareans.  The ones I’ve attended lately are so vastly different from the ones 5 or 6 years ago.  Those involved babies sent to nurseries while mom was in recovery–sometimes alone.  Waiting family members snapped pictures of this new life while mom caught only a quick glimpse in the operating room.

Now, I witness something astoundingly different.  It is much more common to witness births in the operating room involving skin-to-skin contact, sometimes delayed cord clamping, moms with arms unstrapped, and recovery together as a family.  Baby is often held skin-to-skin with dad when not on mom’s chest.  Doulas are more frequently allowed to accompany the family for the cesarean.

Recently, one of my couples experienced a cesarean birth.  After pushing for hours in every position imaginable, their posterior baby (with a 15 inch head, mind you!) was born by cesarean.  Their medical team gave us all the time we needed to try every trick I knew.  The couple was disappointed but they remained empowered throughout their birth experience.

They won’t be showing up for the 18 month cry.

I want to share a few of the pictures from their cesarean birth.  The obstetrician called in to perform the cesarean was Dr. Danielle Harris.  She immediately agreed to their wishes for delayed cord clamping and skin-to-skin.  The family physician who had supported them through the birth was Dr. Keith Stafford.  You know him on this blog as Dr. Polo Shirt.

Dr. Harris hands baby to Dr. Stafford who places him directly onto mom’s chest.  He doesn’t dry the baby first or take a detour to the warmer first.

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Dad steps in to help mom hold their son.  Mom’s arm is free to touch her baby.

Here’s hoping that more babies who must be born by cesarean will experience a gentle welcome like this one.

Huge thanks to my clients for permitting me to share a little of their birth experience.

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Extraordinary Nurses

Many families worry about which nurse they will get during their birth.  The nurse is a wildcard.  We can pick our midwife or doctor.  We can pick our doula, our birth photographer, our childbirth educator.  We can pick our hospital.  We don’t get a choice in our nurse(s).

I’m so happy that nearly all the nurses I’ve worked with in the last few years have been amazing.  Occasionally, one nurse really stands out and shapes the birth in extraordinary ways.  Like Beth two years ago.

This time, I’m bragging on Mona.  I adore Mona at Greer Hospital.  She’s been a rockstar for many of my clients.  Mona played a big role in this birth.   And she caught the baby before Dr. Polo Shirt could arrive at this birth.

So I knew I could relax when I saw Mona walk into the birthing room.

monaWhat made her support so extraordinary at this birth?

  • She kept interactions with the mama at an absolute minimum.  Mama stayed in the tub and the door to the bathroom remained closed 99% of the time.
  • She used a handheld doppler for quick listens to the baby’s heartrate while mom was in the tub.  She also used a handheld monitor while mom was pushing.  My client didn’t have anything strapped around her belly.
  • She ran interference when the doctor preferred that the mom get out of the tub sooner rather than later.
  • She stalled when another nurse prompted that the mom needed a hep-lock.  The mama never did get that hep-lock.
  • She applied hot compresses on mom’s perineum when baby was crowning.
  • She patiently and quietly guided this first-time mom and then called the doctor in a few minutes before the baby was born.
  • After the birth, she didn’t fuss with the baby or try to talk to the mother.  She stepped back.  After an hour, she still didn’t fuss with the baby or suggest taking her.  In fact, when I left, mama was breastfeeding her baby and blissfully devouring her own lunch tray.

I love this nurse.  She is a strong and quiet presence.  If you give birth at Greer Memorial and Mona walks into the room, relax.  You’re in very good hands.

(Also, I hope she doesn’t kill me for blogging about her!)

A first time mom “Peace-d” her baby out

I was honored to witness this birth.  The words that came out of this mom’s mouth during the most intense part of her birthing time were “yes, thank-you, peace, love.”  It was beautiful to watch.  Here, she shares her story and offers excellent tips for expectant families.  I love her “in case I ask for an epidural” plan.  I also appreciate how she describes the Hypnobabies Special Safe Place tool. –Julie

“Child,” said the Voice, “I am telling you your story, not hers. I tell no one any story but his own.”

The Chronicles of Narnia, The Horse and His Boy

When you get pregnant, people assume you want to hear their birth stories. And I suppose that you do want to hear them, until they get to the part about 30 hours of labor, 15 stitches or how they were cursing out their husband to get the drugs. Personally, I could have done without hearing some birth stories I was told. I guess people just want you to hear what you may be “up against.” I am thankful to have grown up with a mother who likes to remind me that she gave birth four times naturally. And I guess hearing that enough somewhere down the line had an effect on me. I think at some point long ago, I began really believing that God made my body capable of giving birth without intervention. I believe birth is natural and though it may hurt, the reward is worth doing it all over again and again. Having those beliefs engrained in me was vital, and it’s never too late for others to start believing the same thing.

So here, I want people to read my story and see that while giving birth is natural, at the same time, you don’t have to do yoga, be a member of La Leche League or have your baby in a pool in your living room in order for it to be considered natural. (And just as a side note, all of those things are great…I may even try a couple, but they aren’t crucial when it comes to giving birth naturally.) A woman who desires to give birth naturally can do so in a hospital and have a wonderful experience, provided she is prepared and surrounded by a caring support team of people who fully understand her desires for her birth.

And I am blessed to have been one of those women…

My birthing time began somewhat uneventfully. There was no gush of water that soaked my pants in the mall and sent people into hysterics like in the movies. Actually, it was just some leaking, and at the time, I didn’t know what it was exactly. So of course, I googled it. I read about tears in the amniotic sac that can heal themselves, how some women leak cervical fluid and how fastidious hygiene can keep you safe from infection and from going to the hospital where you may be admitted. And after reading way too much and spending entirely too much time concerned about it, my doula put my fears to rest. She wasn’t worried, which meant I didn’t need to be. And that’s kind of how it is with her. I was trying to describe her to someone the other day, and I think I put it best when I said, “She’s like the definition of peace embodied in a person.” Talking to her, you realize she knows what she’s talking about because you also realize that if she didn’t know, she’d be the first to tell you. I could go on and on about her, but having her with me is another story that I can tell another time.

Fluid continued to leak out of me for a couple of days. It was Thursday when it started, four days before I had predicted having her. Yes, I had my own date separate from that of the doctor’s “due” date. My guess date was May 28th, Memorial Day. For months and months I had been telling myself that was when Emma Jean was going to come. I didn’t really have a reason for that date, I just felt like she would come at the end of May and Memorial Day seemed like a good day to be born on…especially if you’re a future Olympian.  🙂

Anyway, it was early Sunday morning (12:00am) when I started to feel some pains in my lower abdomen. I wasn’t really sure what they were, but I felt like something was getting started. I tried to sleep and told myself rest is important, but there was no use. At 1:00am I was writing down my pressure waves (contractions), how long they were lasting and how often they were coming. By 2:00am I woke up my husband and told him to come to another room with me. I told him he could lie down and sleep but that I just wanted him near me because I thought I might be beginning my birthing time (labor). I don’t think he really thought it was happening, and I can’t blame him because how can you really tell? How was I supposed to be sure? So during the next couple of hours I was moving around, sitting on my birthing ball, pacing, swaying, talking to myself (“Relax, breathe, pray” and “Peace”) and just kind of staying within myself. Charlie was making sure I drank water, reading me Psalms and getting in touch with our doula.

Here’s the part where everyone wants to know, “Ok, seriously, how bad did it hurt?” And much to people’s dismay, it’s really hard for me to describe. I think because I was using hypnosis, my entire birthing time was dream-like. People who read this will probably think, you mean, nightmarish? And no, I mean dream-like. I mean that my thinking brain had shut down and because I had a place to go to, a place I had visualized many times, a state I had practiced being in, I went there and I decided I would stay there until all of this was over. So the pains were not in the forefront of my mind. I felt them, I expected them but they didn’t consume me. I was able to relax into them instead of running away from them and it made all of the difference. I will say the most vivid pains I remember during this time happened when I tried to lie down. My husband suggested I try to rest since I’d been up for several hours, and although this would have been a good thing for me, every time I stopped moving and tried to lie down, it took me out of my zone and the pain was much more present. So instead, I moved around, talked to myself and listened for 4 or 5 hours. I think I listened to my Easy Birthing Guide (from my Hypnobabies CD library) 6 or 7 times through. Charlie just put it on repeat, and I think hearing those birthing prompts, the positive reinforcement and just hearing it over and over, really helped me stay within myself, in the zone. I honestly don’t remember what was on the track at all but having that playing repeatedly gave me something to concentrate on, which in turn relaxed my body and comforted me. Needless to say, I pretty much paced, swayed, etc…my way through my birthing time until my doula said she thought it was time to head to the hospital.

And then came the ride to the hospital. Here, I can answer the pain question better. It was terrible. I had to sit upright with my knees touching the dash (we installed the car seat behind the passenger, not smart, put it in the middle) as we drove for 25 minutes to the hospital. I couldn’t move, all I could do was breathe and moan as we hit every single light on Wade Hampton. It was terrible. It was the most present and non-dreamlike state I was in during my entire birthing time, and it is the reason that next time, Lord willing, I won’t be getting in a car at all. But I told myself the whole ride this wouldn’t last forever and that we would make it there…and we did.

Upon arriving at the hospital, I remember walking from the car through the lobby, to the elevator and into labor and delivery. I took my time on that walk knowing that where I was going was a different environment than my home had been. My home had been dark, comfortable, relaxing and this place was bright, unfamiliar and different. So as I walked in and up, for about 5 minutes, I got my breathing, relaxation and everything else I had at home back on queue knowing that I needed to be in the same state in order for this to continue progressing. I trusted that my doula and my husband would take care of answering questions, filling out papers and finding our room. And that’s what they did, except for the filling out of papers. We miraculously avoided that altogether during this time; for whatever reason, the nursing staff felt like the papers could wait until later…turns out they can. [Mona was her nurse.  Mona is AMAZING!]

I walked into the room and got up on the bed, for those of you reading who know yoga moves, in a child’s pose. I will never know why I did that, I just trusted my body to know what it was supposed to do. And that’s just what happened. My butt was in the air, my face was resting on pillows and my arms were outstretched. Also, in the very far reaching corner of my mind, I prepared myself for getting an IV, something I knew was policy considering me being positive for Group B Strep. But God knew the desire of my heart and totally answered my prayer: no IV. For whatever reason, the nurse didn’t push the issue. The nurse checked me, I never heard the results [she was fully dilated] and not long after, the doctor checked me. He said and I will never forget it, “Norie, if you want to have this baby now, you can,” in a familiar non-chalant manner. In my head I kind of laughed to myself, ya, Dr. Stafford, I would! However, that didn’t necessarily mean I knew how to. But then my body once again took over and big pressure waves started coming. My doula said to me, “Norie, let your peace build with those waves and then when it can’t build anymore, breathe all your peace down.” And for whatever reason, that made complete sense to me. I visualized big waves building up, up, up, and when they couldn’t get any bigger, I visualized my peace coming on top of them and smashing them down. I know it sounds weird, it sounds weird to me now, but at the time, it made perfect sense. So as the waves built, I peace-ed my baby out. And I will say that during this stage, I was definitely more aware of pain in a sense. I remember as Emma Jean’s head was coming, feeling a burning sensation, different than anything up until this point. But at the same time, what is pain when you know that on the other side is life? I mean, yes, I felt pain but I knew that I was having a baby so it wasn’t something I cared about. All I cared about was breathing Emma Jean out and into this world where I could finally hold her in my arms. Somewhere during this stage my doula jumped up on the bed and grabbed both of my hands and as I breathed peace, I squeezed her and was able to let my peace go down further. Also, toward the very end, I remember feeling Emma Jean coming out and my doula leaned in and reminded me of my “aah-aah-aahs” that helped me slowly, gradually and not forcefully breathe Emma Jean out. I’m glad I let out those aahs because I feel like they were a part of the reason I didn’t tear. And as I let my peace crash down one more time, my body trembling, heart racing, brow sweating, I felt a huge release and Emma Jean emerged. I was overwhelmed. She was passed underneath me, so when I opened my eyes after the last push, there she was, my baby girl. I picked her up carefully, rolled over and held her close.

Charlie helped dab her off, and I can’t remember much else. I couldn’t take my eyes off of her. I didn’t want to. I do remember the doctor asking me for one more little push and there was my placenta, which I now realize why no one ever tells you about the afterbirth, because who really cares about that when you’re holding a new life?

And so there it is, my first birth story. I am so thankful to serve a God who allowed for me to have such a wonderful first birth covered in so much grace and mercy.

Here are a few things that I believe made a huge difference for my birth. I don’t think these are necessities for all women. However, I do believe in preparation and I believe God sees our preparation and may choose to honor it, so I think it’s best to be prepared:

  1. Pray (from day one of finding out your pregnant all the way through your birthing time, there cannot be enough prayer)
  2. Have a plan (I used Hypnobabies, but not because it was my first choice. In fact, I didn’t even know what is was really when we got into it, I just knew that I needed a way of going about birth whether that was Lamaze, the Bradley Method or whatever.)
  3. Create a birth plan (this is something that you hand to your doctor weeks before your birthing time and something you definitely give the nurses at the hospital when you arrive. It’s just an outline of the things that you desire out of your birth, things that you do have a say in. Honestly, I think the birth plan helped me more than anyone just to be confident with the decisions that we were making.)
  4. Be in as good of shape as you can be (when I found out I was pregnant, I was already in pretty good shape. And I made a commitment to try and stay in the best shape I could all the way until my birthing time. I definitely could have done a better job with this, especially during my last trimester, and I think that the longer you can stay active the more it will help you during birth. I don’t think that anyone is ever too far behind because walking is low impact but can strengthen your legs, which you will want to be strong. Also just doing squats and lunges can make a huge difference as well. And though I am not a good example of this, swimming is probably the best for you and baby, even if that just means getting a kickboard and kicking for 45 minutes. Not only will it strengthen your legs, improve cardio, it also helps baby get into a better position for your birthing time.)
  5. Drink Red Raspberry Leaf Tea (I’m not normally a tea drinker, but a dear friend of mine gave me some of this tea and told me that it would help tone my uterus on top of a bunch of other great things. So I thought why not? And I pounded the stuff back for the few weeks before my guess date, and I just believe it helped me. If at the very least, it made me believe that I did have a toned uterus and could give birth naturally, and to me, that was worth it. But I believe that it actually did do the trick and postpartum has made a huge difference in cramping, etc…If you don’t mind the taste, why not? It can only help.)
  6. Write Things Down (I wrote down a list of things that I wanted to do early in my birthing time, like take a walk, bake something, etc…of course I began my birthing time at 1am so many of those things I didn’t get to do but they were there in case I had been able to do them. I also wrote down a ton of Psalms on notecards for my husband to read to me during my birthing time. Writing them down beforehand was great because I felt comforted as I read each of them then and once more comforted when Charlie read them to me later. The other thing I wrote down were things I would say to myself in case I asked for an epidural. I knew I didn’t want an epidural, so I wrote down all the reasons why. Then I cut each one out and put it in an envelope entitled, “In case I ask for an epidural.” We never opened it, but it was there in case I had needed to be reminded of, “Norie, you can do this. You’ve wanted to do this your whole life. Billions of other women have already done it.” Or “God made your body able to do this, just trust in Him.” And so on and so forth. I think it was wise to have that envelope because even though I could say to myself, I’m not going to ask for drugs over and over beforehand, you never know what you are going to do in the moment. And I knew the only person who would be able to keep me from doing it, would be me, so I knew I had to write those out myself.)
  7. Tour the Hospital (the day we were supposed to tour the hospital is the day we had Emma Jean. In our defense, we had tried to tour earlier that week but they were too busy for us. But I think that it could only have helped because it lets you know the environment you will be stepping into as you arrive from a very different environment [most likely your home]. It’s important to know where you are going in order for it to be a smooth transfer that does not alter where you are mentally.)
  8. Do your kegels! Kegels are an exercise that work your pelvic floor muscles, also known as your Kegel muscles. The best part is, you can do them anywhere, anytime and no one will even know you are doing them. Just google Kegel exercises to find lots of information about them and how to do them.
  9.  Have a support system (For me, this consisted of my husband, my doula and a physician that I knew, 100%, understood my desires for birth and was going to do everything he could to make those happen. For others, they may choose family members or midwife. But whoever you choose to have with you during your birthing time, it’s essential that they understand your desires for your birthing time and are willing to do whatever it takes to make those come true.)
  10. Visualize what you want: good things! (It is super easy for me to sit and think about how things can go wrong in any situation. For my birthing time, it wasn’t any different. If I let myself start worrying about having a c-section or Emma Jean turning the wrong way, all of the sudden I was visualizing it happening with crazy detail. So I really had to take time to practice visualizing good things happening. I visualized giving birth in different positions, I visualized breathing/relaxing into pain, and ultimately I visualized things going well. This visualization practice was part of Hypnobabies, but I will say that whether I had done Hypnobabies or not, I would have used visualization to reinforce having a wonderful birthing time. I’ve been an athlete my whole life and used visualization many times in order to practice being successful. And when I look at my birthing time from an athletic perspective, it just makes sense that I would practice positive visualization. After all, I would never practice visualizing striking out so why would I visualize something bad happening during my birthing time? I think it’s often easier for us to expect things to go badly, that way, we won’t be surprised or letdown if they do. But it’s like my doula said, “What if everything goes great? What if everything is wonderful?” So don’t dwell on the negative “What if(s)…” but instead choose to see your birthing time happen in a wonderful way even before it ever does!)

Poses

The saying, in the birth world, goes: If you have two births due two weeks apart, they will go at the same time. If you have two births due on the same day, you’re golden.

I had three births that spanned a month with two weeks between each one. They all birthed in a five day span. And they all began with rupture of membranes. There must have been something in the atmosphere last weekend!  I thought someone was pranking me when two first time moms called on the same day to tell me their water broke.

I’m dying to blog about these amazing births but our birth community is so small, I don’t want to violate anyone’s privacy.

But I can brag on Dr. Polo Shirt and I have permission to share these two pictures. Seriously, how many hospital care providers would strike this pose and wait patiently and hands-off? I offered him the knee pads I keep in my birth bag.


(Check out another great birth position Dr. Polo Shirt attended here.)

This first time mom birthed in an extended child’s pose–very low to the ground.  A first, I think, for me to witness.  With an 8+ lb baby over an intact perineum, I might add.  Also, no needles, no monitors around her waist, no forms to sign.  She walked into the room, went into child’s pose, and had her baby.  Hurray!

Negotiating Laborland

She could take me down with her pinky finger.

Her body was strong.  Her mind was sharp.  She carried a gun.

Thankfully not during her labor.

Her motto was “To serve and protect.”

When I walked into her home, shaking off the adrenaline from my speedy drive, I found her deep in her labor dance.  She was leaning over her bed and swaying her hips.

Things had moved rapidly since I’d visited her that morning.  That morning we had laughed about her spacey contractions and she prepared to go shopping.

It was 4pm.

The first words she said, “I’m not strong like you.  I can’t do it.”

“Crazy talk.  You are MUCH stronger than I am.  And you ARE doing  it.”

Her husband, who also carried a gun, was mastering the fine art of the double-hip squeeze.  I caught his eye and sent him telepathic messages:  she is close.

And she was.  I arrived during mom’s transition stage; when her body was releasing adrenaline to prepare for pushing.

And there was a problem.  This beautiful police officer, in that strong police officer voice that I’ve spent a lifetime respecting says, “I want an epidural.  I am not leaving this room.  I’m absolutely not getting in the car.  I can’t.”

I look to her husband but he is suddenly very involved in double hip-squeezing.

I’m on my own.  My usual pep talk with murmurs of encouragement fly out the window.  This woman is practical.  I give it to her straight.

  • A) I’ll call a midwife and we’ll have the baby right here.
  • B)  I’ll call an ambulance.
  • C)  We will walk to the hospital you did not want to use (1 mile away)
  • D)  We walk downstairs, get in the car, and drive to your hospital and your doctor.  (45 minutes away)

Negotiations begin.

I know we don’t have time for negotiations.  I channel my inner police officer.

I send Dad to load and cool the car.  He also fortifies himself with a Red Bull.

When Dad returns, I give him “the look” and I run to transfer my things to their car.  This birth will be my first time driving the getaway car!  Usually I follow in my car but this one is too dicey.

Somehow Dad gets her into the car and we’re off.

I’m driving two police officers to the hospital.  And one is pushing!

Holy cow, what a ride.  Mom is on her knees with her faced smushed up to the window.  Dad is still rocking the double-hip squeeze.  I’m handing back a chux pad in anticipation of her water breaking.

We were still a good 25 minutes from the hospital when the pushing sounds began.

Then I hit stupid Wade Hampton Rd.

When I pull up to the hospital doors, I jump out, grab mom, and bolt.  I hear knocking and look back to find Dad stuck in the backseat which can only be opened from the outside!  I rush back and let him out.

We get upstairs, there is flurry, there is some chaos.  Mom is a VBAC so there is extra flurry and extra chaos.  I catch the eye of a nurse I know and mouth “which room?” while Dad deals with check-in.  She points and I go.  As soon as we walk in, Mom’s water breaks.  I strip her clothes and toss on a gown.

She crawls into the bed on her knees.  Baby crowns.  I hear one of the nurses say to another, “I’ve never done one in this position.”  Too late.

The nurse receives the baby, mom flips overs and takes baby.  No one clamps the cord until the OB arrives 10 minutes later.  I guess the OB has to have something to do, right?  She doesn’t even get to suture since Mom’s perineum is perfectly intact.

Baby was born 15 minutes after we pulled in.

This woman’s first birth:  a 40 week induction + cesarean + NICU.

Second birth:  a quick birth without assistance.

I think that women can be just completely surprised by the change in them from giving birth—you have something powerful in you—that fierce thing comes up—and I think babies need moms to have that fierceness—you feel like you can do anything and that’s the feeling we want moms to have.” –Ina May Gaskin, midwife

Icing on the cake

I got an email from Dr. Polo Shirt. It was too beautiful not to share. Why don’t we have more Dr. Polo Shirts? He gets it.

“I had a really neat delivery this AM of a really sweet couple. Mom’s 3rd baby and was laboring on her side. (I have delivered all of her babies.) When it came time to push, she stayed on her side. Baby was OP [occiput posterior–facing toward the ceiling], so it took some work for her to push it out. Dad was sitting on a chair next to bed on the side mom was facing doing very supportive, support person stuff. I was sitting on the bed, behind the mother. Because of mom’s position, as the baby was coming into view the father was as close to her perineum as I was, so he got to see his child’s birth in detail, rather than peak from up above. The really cool thing was that since the baby was OP, as it was born, it had its eyes wide open and was looking right at his father, so his father was the first person he saw instead of me. Then this baby took a big breath and began audibly crying while the head was still the only part delivered. I do not remember ever seeing that before.

It felt so right to me, because with me behind mom and dad being so close and involved, I felt like I was not even integral to this delivery, It was just something that this family was doing together. Then the icing on the cake was that instantaneous eye to eye contact between father and son as the head emerged. I so wish I had it on video.”

Most of the time, birth doesn’t need any help. A good care provider knows when to step away and let it happen. Let the couple experience their amazing moment. 

Let’s not rush in to save the day when it doesn’t need saving.

Heard in L&D

“Pitocin is natural.  It is the same thing that is in your body to make the baby come out.  It even helps your milk come in!  All my babies have pitocin.”

Yes, spoken by an OB.  I think she even threw in a “girl,” or two into the conversation.  As in, “Girl, you’ve done the natural thing long enough.  Get the epidural!  I did!”

This same friendly OB also ruptured membranes without consent or warning.  Usually I am able to intercept a move like that so mom can give consent first, but I completely missed this one.  It happened so quickly.

When the mom did get an epidural (at 8cm, AROM) after “bad cop” OB suggested it could be another “five hours of excruciating torture,” pitocin was automatically administered and cranked.  The mom was progressing normally.  But “good cop” OB wanted to get home.  I heard her say this.  So Pit was cranked.  Not a gradual increase.  And I watched baby’s heartrate which had been varying in the 130’s-150’s immediately begin dipping to the 100’s during the fast-peaking pit contractions. 

But the pit worked quickly and soon a precious babe joined the world.

I’m thankful mom had a beautiful baby with few complications.  I wish the OBs had been more supportive, encouraging, and patient.  I wish there had been more informed consent.  The mom is happy which is the most important thing and lets me know I did my job.  It is her birth; not mine. 

What can expectant moms take from this?  Talk to the doulas in your community.  Even if you don’t plan to hire one.  Doulas know the inside scoop.  We witness what happens in L&D.  All OBs/midwives are not the same!  I show pictures.  Pictures of different styles in the birth room.  A picture speaks a thousand words.  Does the doctor wear what looks like a radiation suit; so covered you can’t even recognize her?  Does he hand the baby to the nurse instead of the mom?  My observations are just one part of the story but they are things I have witnessed.  Honestly, how else is a family to know what birth looks like in different environments, with different care providers?  I know one mom who wanted to switch to a more natural-birth friendly hospital but one doctor was booked for her date and the other group has a policy about taking patients after a certain date.  I was really saddened that she was unable to birth at the hospital she wanted. 

So, meet with a doula.  Early in pregnancy.  When there is time to interview other providers.