Updates from Rebekah Clay

Have you ever gone to the dentist to have a procedure done, only to find out you can't get numb?  What about the numbing wears off before they get done?  Ever woke up from surgery while they were still operating? Have you ever hard a hard time controlling pain with medication?  You might be one of the lucky ones, or should I say unlucky.

There are a handful of people that metabolize pain medication quicker than the average person.  If any of the questions that were mentioned above have happened to you, then you are one of these people.  Once the dentist or doctor knows this about you, they can affectively treat you.  Unfortunately, this is a trial process.  You get treated like the average person until they find out otherwise.  So I am sure you are asking what does this have to do with getting an epidural.  Much!

Just like at the dentist, you will metabolize the medication used to keep you comfortable during labor.  This same thing will happen with an epidural, spinal or under general anesthesia.  Knowing this ahead of time will save you time and pain during labor.  With an epidural, you should be comfortable within 10-20 minutes.  If your provider does not know you metabolize medication quickly then you will continue to have break thru pain and they will have to adjust your epidural level.  It is frustrating when you want relief and your not getting it.  You would not want to have a caesarean and start feeling surgery before they were done or wake up during the surgery if they put you under general anesthesia.   Let the anesthesia provider know that you have a hard time getting numb at the dentist and they can adjust accordingly with the amount and type of medication they give you from the beginning.  Be sure to let your nurse know as well so she can remind anesthesia if you are not able to speak or think clearly during this time. 

If you don't have this problem at the dentist, please don't tell them you do.  (I know some of you were thinking this because you are scared and want to feel nothing😉)  If they dose you as if you do, then you will be too numb and not be able to push properly which can lead to other problems.     

Getting the epidural allows your body to relax and make the changes necessary to birth your baby (you can still do this without an epidural😉), maybe even get some sleep before the big performance.  Epidurals are not for everyone.  If you are not handling pain well then the labor process will slow and make for a frustrating time for you as you are still feeling the contractions painfully.  In this case, get the epidural!  If you can focus enough and relax during labor then you should do it without the epidural.  This is not to say that you will not feel anything with the epidural, cause believe me, pressure is REAL!  As your baby makes it's way into the birth canal you will feel rectal pressure and the urge to push.  This is a good thing!  It's time to meet your baby!

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When you are selecting a prenatal care provider, the first thing you need to do is decide who you want to deliver your baby.  The options are an OBGYN, family doctor, or a certified midwife.

 A midwife is good for uncomplicated pregnancies, women under 35 years of age, those that want a home delivery or birth center, first time mothers or those that have had successful vaginal deliveries before.  Family doctors can see any of the above, but they only deliver in hospitals and they cannot see women that need a cesarean section or have had one before.  An OBGYN can see all types of women, perform cesareans if needed, refer to maternal fetal medicine for high-risk pregnancies but only deliver in hospitals.  

Secondly, you need to talk to family, friends and neighbors and see who they recommend.  Find out why they liked that person and see if it fits your birth plan and personality.  Once you have some possibilities, contact your insurance, and make sure that the doctor and the hospital is covered unless you are paying out of pocket.  

Thirdly, with the providers that have made the cut so far, do some research.  Look online, watch videos, and see if they practice the way you want.   Look for things like: Do you only see your doctor? NP? How long until I can be seen?  Is there someone who covers them in the office while they are at deliveries?

Next since you have narrowed your list down, it is time to have a consult with them.  This is your time to ask questions, a chance to get to see who they really are.  Does their personality fit with yours?  Are you comfortable around them?  Ask who covers on-call, since many providers have multiple people in their practice.  Will you get to meet them prior to delivery?

Fifth and final, decide on the best fit for you and your baby.  Remember though, if you do not mesh well with a provider you can switch, just try to do it earlier rather than later.  Do not be afraid to switch!  This is your delivery, and you want to be comfortable during the pregnancy as well as “go time”.  

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Delayed cord clamping is all the rave right now. I can tell you that about 99% of the deliveries I attend, they are requesting this.  Do you know why delayed cord clamping is being requested?  I personally think most people are asking for it because “Dr. Google” tells them they should, lol.  But in all honesty, I think most people have no idea why it is good and what the cons are to doing it.  So, here are the reasons that I know of to support and discourage delayed cord clamping. 

Delayed cord clamping IS an option during a cesarean. The best option is to ask your provider to delay cord clamping for as long as possible and to “milk the cord”.  Do not be afraid to ask, remember this is your birth, they are just guests to the party.  

 

There are two drawbacks that I am aware of to delayed cord clamping at delivery.  The first is that with an increase of red blood cells, we see jaundice levels go up.   Jaundice is the yellowing of the skin and eyes that many babies get.  If this level gets high enough it can cause brain damage.  The way to combat high levels is with phototherapy treatment.  This means we are seeing more babies going home on bili-blankets or having to stay longer in the hospital for the phototherapy.  

 

The second drawback is that there is a reduction in the volume of umbilical cord blood available for harvesting stem cells.  This only would apply if you are choosing to save the cord for stem cell donation or personal use.  

 

I personally think a happy medium is the way to go.  Delaying clamping for 30-60 seconds still gives the benefits without getting the entire 60% of red blood cells, leading to higher jaundice levels.  Reasons to forgo delayed cord clamping would be if baby needs to be resuscitated away from mother or maternal distress.  

 

These are the current recommendations for how long to delay the cord.

*ACOG and AAP recommends 30-60 seconds*

*WHO recommends at least 1 minute*

*The Royal College of Obstetricians and Gynecologists recommends at least 2 minutes* 

*The American College of Nurse–Midwives recommends 2–5 minutes*

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What does a doula do anyway?   They know about birth but so does my labor nurse.  They only are used for natural births, and since I want an epidural, I do not need one.   Doula’s help with positioning and charge me for it, I do not need that extra expense with a baby on the way, especially since the hospital has nurses for free.   I have heard and believed these things for years so I wanted to make sure others knew when they should not use a doula.  

There is NO evidence that having continuous support in labor has any negative outcomes NONE!

Please hear my heart... this must be said, heard and repeated....

DOULAS DO NOT EXPECT YOU TO HAVE A NATURAL OR UNMEDICATED BIRTH!

 

Doulas want you to be informed, know the ins and out of birth, your options and to be completely supported throughout your pregnancy, birth, and postpartum period. You, your baby, and your pregnancy are unique. It is not supposed to look like anything but what you need it to.

 

Doulas support ALL Births....Will they support your birth?

 

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Many women think that breastfeeding is easy.  All you do it put the baby up to your breast and the baby starts sucking…right?  Well not exactly.

Breastfeeding is a learning process for both mom and baby.  Baby start sucking while in the womb, so they know how to suck (usually) but need some help in flaring their lips and not sucking on their tongues.  Most mothers have not had someone sucking on their nipples for extended periods of time, so the learning comes from getting used to that and positioning baby for comfort and maximum stimulation of the breasts.   

Breastfeeding has discomfort in the beginning for sure, but well worth sticking with it.  After the first couple of weeks, the pain subsides, and it is nothing but pure enjoyment.  I believe, the bond that takes place while nursing your baby can not be replicated.  There is just something special knowing that you are the only one your child wants when he or she is hungry, and your body is providing his or her complete nutrition.

   

No matter if it is your first or your fifth, the first 2-3 weeks is the hardest for breastfeeding.   I personally went through crazy pain, bleeding, cracked, infected nipples, engorged breasts making it impossible for my baby to latch, thrush, mastitis and needing a shield while nursing.  But I would do it all again for the pure joy that came after the first couple weeks.  

Find someone that will support you on this journey and give advice when needed.  There are many lactation consultants, doulas, midwives, nurses, and doctors that are willing to help if your desire is to continue breastfeeding.  I encourage you to seek them out when you need the extra help.  

Even with my fifth baby, I was meeting with my lactation consultant, crying in her office, begging for help as an L&D nurse.  It is ok to need help, many mothers do.  This does not mean you are a failure, it means you are a mama that strives to do what is best for your baby, even if that means sacrificing your comfort for a short time.  

I had a woman that helped me with breastfeeding my first and I know I would not have continued if it was not for her help.  I want to pass this help on to you! I am available to answer questions or just talk about what your concerns are.  My website gives you 15 minutes to chat with me about anything pregnancy, birth or postpartum related at no charge!  I want to see you succeed just as much as you do!  Do not give up, it will get better.  I promise!  

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