Hospital

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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So many women decide even before getting pregnant that they want an epidural.  Most reasons are because they do not want to feel pain.  I totally understand this as I am that woman who asked for an epidural before labor even started, lol.  I am a total wimp when it comes to pain.  

Many women will try to go as long as possible without an epidural, but remember that once you are tightening up, or out of control, your body can not dilate any longer.  This is when you need to get the epidural, so you can relax.  

Almost every labor patient that I have had or heard about has the same perception about epidurals.   “I will get an epidural, then feel nothing during labor and delivery.”  Wrong!  An epidural helps to take the pain away from contractions, but many still feel pressure and discomfort as you near the finish line.  This is a good thing!  You want to know when it is time to push and feel to push correctly.  

Do not worry though, they will make sure you are comfortable, and the epidural is working once you get it.   Most people can sleep for a while during labor and some wake up ready to push.  At the same time, do not try to be superwoman.  If you are in pain, tell your nurse because maybe your bladder needs emptied, your epidural pump turned up or you are ready to deliver.  

Ways to keep yourself comfortable with an epidural are to continue to rotate positions in bed as it helps to keep the epidural even and you will have a button to push if you need a little bit more medication.  Epidurals also work by gravity, so if you are sitting up in bed, lay back so that the medication can spread as it is supposed to.  You always want to be able to move your legs if you cannot the epidural will need to be turned down.  

Do not fear labor and delivery because of the pain.  There are many pain management things that can be done to help your pain, including positioning, medications, essential oils, and relaxation techniques.  Once it is over you will forget all the discomfort as you hold your baby in your arms.  

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2020 has come with many changes to the norm and this includes childbirth.  Support people not being able to be present at appointments, ultrasounds and at times the actual birth has sent everyone scrambling for a new normal.  

Childbirth does not have to be scary, but this virus is making it just that for many people.  

Every hospital is handling this virus differently, this is what is normal for my hospital and what you can do to help ease your mind.  One support person is allowed with the laboring mother if they are symptom free.   There is no changing of your support person the entire stay.  Every day they must be asked questions again and go through another temperature check.   

Masks are given upon entering the hospital and they are always to be worn in the hospital except when your nurse leaves your room.  Yes, this includes wearing it in your room if any staff are present.  We understand that this is difficult especially when it comes to pushing time.  We do not want to wear the mask anymore than you do but for everyone’s safety we need to comply.  At any time that you need a break, please tell your nurse and we will step out of the room so that you can catch your breath and regroup.

I personally have always been a “hands on” nurse and enjoy being at the bedside getting to know my patient and doing my best to grant them the labor and delivery that they desire.   During this time, I have had to try to stay out of the room more than normal so that my laboring mother can take her mask off and enjoy this special time.  I hate this but I want a healthy mom and a healthy baby in the end.  

People are still allowed to walk the halls if their mask is covering the nose and mouth.  Depending on the time of day you deliver, either your doctor/midwife or a partner will deliver your baby.  

Many people are scared going into hospitals and this is not what we want.  We are doing the best we can to keep everyone safe.  We are still the same amazing, caring, educated nurses we always have been!

Many parents are finding they are enjoying the peace of not having constant visitors and enjoying those special moments with just them.  I have seen more Facetiming and video calling than ever before to allow other people to be “present” during this special time.  Another option is using aromatherapy to calm your nerves and help you with this added stress.  

Remain confident in your body and what you want from your labor & delivery.  There might be a virus going on, but nothing changes the joy you will have when you meet your baby!

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