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Notes From Ivanna

June 2009 - Posts

  • Belly Art Contest Announcement!

    We're hosting a belly art contest for all expectant moms! Enter for a chance to win a Babies R Us Gift Card at http://empoweredmommies.com/photos/belly_art/default.aspx

  • 4 Most Common Labor/Delivery Scenarios and Questions to Ask Your Obgyn

    After hearing stories from fellow moms, doing research and in my own personal experience, I've come to realize that expectant moms need to demand that there is an honest and open discussion of all reasonable alternatives with pros and cons for common scenarios that tend to come up as we prepare for labor and delivery. We can no longer accept: “the baby is too big, we need to induce, do a c-section” etc. The ultimate decision regarding care should rest with both the mom and doctor in an equal partnership.

    Assuming you have no pre-existing medical conditions or issues (such as diabetes, preeclampsia, placenta previa, etc) here are some common scenarios you may encounter as you prepare to give birth and below are some important questions you should feel empowered to ask your doctor so that no matter what ends up happening (even if it wasn’t part of your plan) you’ll feel that you understood all your options and made the best decision for you and your baby.

    Scenario 1: You are “overdue” getting close to 41 weeks. Your doctor advises that you must induce or your baby will be “too big” and could be harmed.

    • What’s the absolute latest date I can avoid induction?
    • What are the realistic risks if I wait versus risks of induction?
    • Couldn’t my due date be off by 2 weeks?
    • Are there natural ways to encourage the onset of labor (diet, exercise, etc)?

    Scenario 2:  You’re told that your baby is breech. Your obgyn tells you the baby must be delivered via cesarean due to the high mortality risk

    • Can you attempt an external cephalic version (ECV) to try to correct any sort of mal-presentation (be it breech, transverse, etc) before considering the scheduling of a C-Section prior to due date?
    • What’s the absolute last date I can wait to see if baby corrects itself in its presentation?
    • What are risks of C-section?

    Scenario 3:  You’ve had a previous C-section and would like to try for a VBAC.

    • Do you support VBACs and does the hospital?
    • If not, why not?
    • Risks of VBAC versus surgery?

    Scenario 4:  You are told you have narrow hips and vaginal delivery may not be doable.


    • Why do you perform pelvimetry? (many obgyns don’t since there is more to the the pelvis than the apparent visual aspects of size and shape)
    • Can you describe the 4 Ps of labor assessment given the size of my pelvis?
    • I'd like to still attempt a vaginal delivery and then determine if c-section may be necessary. What would you look for in that situation?

     FURTHER READING

    http://www.parents.com/pregnancy/labor-delivery/basics/the-truth-about-due-dates/
    http://www.lamaze.org/AskHenci/tabid/363/forumid/12/postid/31528/view/topic/Default.aspx
    http://www.lamaze.org/Research/WhenResearchisFlawed/VBACLieberman/tabid/176/Default.aspx
    http://parenting.ivillage.com/pregnancy/plabor/0,,midwife_4648,00.html

  • The Myth of the EDD: Why Your Due Date May Not Be When You Think

    My first child was 2 weeks "early", my second was supposedly 1 day "overdue" and my third was nearly a week and a half "overdue" to the point that I would have been induced had I not gone into labor that weekend (my inducement would have occurred that following Monday for fear of baby getting too big, umbilical cord wrapping, etc). So prior to that cut off date, I politely insisted to my doctor that unless there was a medical need or signs that my baby was under duress, I did not want to be induced and preferred to go into labor naturally. And in hindsight, I am glad I did because my baby did arrive safely on her own time. But future moms out there, especially first time moms...rest assured that the estimated due date (EDD) is not necessarily when you think. It is an estimate at best based on length of cycle and first day of last period. The wrench is the calculation is usually the length of cycle that can range from 28-35+ days for some women. So in reality, there is possibly a window of nearly 7 days or more by which your due date can be off. Below is a wonderful article regarding this very subject that makes many expectant moms antsy. http://www.associatedcontent.com/article/1047180/the_lie_of_the_edd_why_your_due_date.html?cat=25

    So if you're approaching your due date, take a deep breath, talk with your doctor/midwife and understand all your options before you rush into anything! :)

     

  • Three Babies, Three Very Different Labor/Deliveries

    After giving birth to my third child this past April, I am now convinced just how different each pregnancy is especially each onset of labor.

    My daughter arrived in her strong spirited way more than 2 weeks before her due date and a day before her baby shower. She made a grand entrance after nearly 20 hours of laboring at home and at the hospital. It was truly exhausting, but I am very happy I decided to labor in the comfort of my home for as long as I could. We only headed to the hospital once the contractions started kicking into high gear.

    It was a Friday morning and I sensed something different as I showered. I had a doctor's appointment that same morning and I remember him saying that my water had not broken yet but that perhaps he would see me later on that day. I went home and continued with some minor discomfort until the afternoon when active labor began. I still remember my sisters and mom taking notes of the timing of my contractions on a small whiteboard on my fridge while my husband comforted me. "So, you think I should cancel the baby shower?" I naively asked in between contractions. My mom smiled with wisdom as if anticipating what would come and how I wasn't yet aware of what lay ahead.

    Once we got to the hospital, the contractions continued and I decided to have an epidural in order to get some sleep before the final push. While I welcomed the pain relief, the epidural itself numbed me to the point that I couldn't feel the urge to push naturally. I received directed pushing instructions from my nurse and doctor which helped, but I still felt restricted. In the end after about 45 minutes of pushing, my little girl emerged. I had to have an episiotomy to hasten her head's emergence. But I always wondered if I had been able to feel the urge to push, could that have been avoided.

    My son on the other hand, was gentle and soft and honestly I did not feel I was in active labor until a few hours before pushing time when my water broke. We had decided to head out to the hospital in the wee hours of the morning (a day after his official due date) because I had been bleeding a little bit and having soft contractions. So to be on the safe side, we opted to be in the hospital this time for most of the laboring. I remember sitting on my hospital bed watching movies to pass the time and being told by the nurse reading my fetal monitor that I was having a "good" contractions. I couldn't believe it! These contractions were a piece of cake in comparison to the discomfort I had felt with my first baby.

    About 12 hours later, he arrived. His labor was beautiful and I managed to get through it without an epidural. I felt the urge to push naturally and that made the pushing phase faster and easier. It felt so amazing to feel everything to the very core! Quite the fait accompli :) And even though it was painful at the very end, I swear it was not as bad I thought it would be. In my head I had made it worse than it really was. I think fear of pain keeps many of us from even trying to reduce unnecessary interventions during labor and delivery. But after going through this experience my confidence and trust in my body surged. It felt so good! Your body does know how to deal with the pain because it is pain with a purpose: a wonderful thing, really!

    As if that experience hadn't been a complete 360 from my first baby, this third child threw me for a complete loop. About a week overdue, I was starting to consider the option of getting induced but I had asked my doctor for the latest, latest date to do this because I wanted to avoid inducement if possible. So what started as a Friday date night with my husband ended in the labor/delivery room in a matter of hours!

    While my parents watched our other kids for the evening, we had finished having dinner. I joked with the waiter that I wanted the spiciest dish they had for obvious reasons and he nervously smiled  as he placed my order. "Really?, it could happen right now?" he said. You could tell he was young and not a dad yet. Poor thing...

    We then headed over to the theater to catch the last showing of Duplicity. (I don't care what critics say, I think the movie was entertaining and personally thought Julia Roberts looked great in a more mature role). By the time we got out of the movie it was around midnight.

    Sensing something "different", call it woman's intuition or what have you, I settled into bed while my mind raced. I closed my eyes and about 2 hours  later, I knew it was happening. "This is it, sweetie". "I think we're having this baby tonight". And then Boom! It hit me like a ton of bricks. I went from feeling almost nothing to experiencing hard labor contractions that were barely 2-3 minutes apart. No recoup or downtime in between!

    I then realized that this would be an entirely different experience. No time to labor at home for hours like I had done with my first child and definitely no gentle and calm onset of labor while I watched movies like I had experienced with my son. No Nooo.... this little girl's arrival was going to be intense. Sensing this, I told my husband that it would be best to head to be hospital right away.

    As we entered the hospital's triage area, I was greeted by the very nice nurses there. I was checked out and confirmed that I was already 5-6 cm dilated and this little girl was ready to make her appearance real soon.

    In a moment of serendipity, I recognized one of the nurses. She had been the same one to help me deliver my first child. I am not good with names necessarily, but I am with faces and this was definitely her. She had been wonderful back then and I mentioned it to her and she smiled. This sweet surprise helped me overcome the fact that my Obgyn was traveling out of town this weekend. The Ying-Yang of life I guess….

    By the time I was checked in and in my labor room it was close to 4am. My contractions had not eased up and I swear this was perhaps the most painful of all my deliveries. Like with my second, I had committed to a natural birth and now there was no looking back.

    Before I knew it, I felt the intense pressure to push. I remember the nurse saying "hold it for a bit, the doctor (my obgyn's partner on call) is on his way. "No, you don't understand! I can't stop…this baby is coming out NOW!". And so it happened, her head and shoulders were out by the time the doctor made his way in. Everything else happened in a flash. To think 6 hours ago I had been enjoying some late night popcorn at the movies and now there I had become the mother of 3!!

    Moral of my stories? Each baby is different, but the confidence, rush and exhiliration I felt trusting my body and its abilities is uncomparable to anything else I have ever experienced. I've been forever changed.

     

     

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