Tuesday, June 29, 2004

getting born

sometimes i read something that aggrivates the heck out of me. i'm slapping julie with a trackback so she can see it later, because what really tworked my tweeter appeared on her blog.

there's a comment on the tracked entry from an obsetrician offering advice about choosing an obstetrician. and while i'm a man, and while i've never had kids, i did have to be the intelligent thoughtful counterpoint to my wife's pained pregnancy-induced retardation, at times making decisions that she simply wasn't coherent enough to make. here's what i've learned:

  • not all obstetricians are the same, but at the same time, finding one who takes your insurance is of paramount importance.

  • most ob's deliver at one or two hospitals very close to their offices. when a woman is in labor and it's time to attend to her, it's time, and the ob can't afford a 30 minute car trip to get to the office. in our case, the ob's office had a back door that opened directly onto the hospital's labor-and-delivery unit.

  • pre-delivery tours offered by hospitals are a good thing, if, for no other reason, than it will give you the opportunity to see the operating room before you're wheeled in for your emergency c-section. sue had a full-blown panic attack in the or -- while open -- because she was so frightened by the sterility of the environment.

  • while your doctor's advice is something you should never blatently ignore, we sometimes know our bodies better than our doctors. if you think something is wrong, do not hesitate to be a bitch and make an ass of yourself to your doctor or your doctor's staff to make sure your concern is resolved to your satisfaction, whether it's blood levels or blood pressure or the idea that maybe you saw two heartbeats on the last visit to the wand monkey. at the same time, if you think your doctor tells you something that's full of crap, be an adult and do some research, or if you're too retarded, have your smarter partner do it for you.

  • there are lots of options other than hospitals for having children. some are great, some are not so great. contrary to what's been said on julie's blog, most of these people are well-educated, competent professionals who are professionally trained and licensed, and who have assisted in hundreds or thousands of births. options such as having your child at home, in a birthing center, or in some other friendly environment are worth considering if your pregnancy has been healthy and is somehow desirable for you. obviously, when choosing a birth assistant, you want one who will know when to quit -- that is, know when to move you to a hospital if that becomes necessary. on the other hand, this is your body and your baby, and all decisions should ultimately be yours. your phyisican or other birth assistant should be your partner and advisor, not your commander.

  • if you want anesthetics, you should have them. if you do not want anesthetics, you should not be forced to have them unless you're having a c-section. if you're doing a hospital birth, your hospital will have competent anesthisologists (doctors who are trained and specialize in pain relief) available 24x7. part of your hospital's accreditation procedures include evaluation of its response to your pain and in helping you relieve your pain. if you're not having a hospital birth, your birth assistant will be able to help you learn ways to relieve, if not completely eliminate, your pain.

  • choosing a male or female obsetrician is a matter of personal preference, and having a vagina does not automatically make a doctor better. the phyisicans who cared for my wife were men, and are uniformly excellent in terms of their skills and decision-making ability. if their bedside manner leaves something to be desired, that is a condition that isn't unique to male physicians.

  • age of your physician isn't some magical elixer either. i've met bored and tired doctors who burned out at 40; i know a few who still love doing their thing at 80. find a doctor or birth assistant who loves doing his or her thing, and don't be tied to an age.

  • always remember that it is your body and your baby. your doctor is your advisor, your helper, and your assistant. he or she is not your commander. if you are unhappy with the care you're receiving or the direction your care is taking, you have the right to ask for what you want. we fell into the trap of simply doing what our doctor told us and wound up having a c-section for our second pregnancy. at 34 weeks and in active labor that magnisium couldn't stop, we wound up with a c-section because we didn't forcefully enough ask for a vaginal birth even though our physician said the choice didn't make any difference to him (one standard position, one breech at the time of scan, but we'll never know now if he'd have rotated or not).

  • a c-section, while common, is major abdominal surgery. a vaginal birth, while no walk in the park either (what would you call a process where you push an object the size of a watermelon out a hole the size of a grape?), has a shorter recovery time and is preferred. you may consider refusing a c-section if you don't understand exactly why your doctor is recommending one. you have right to ask for a second opinion from another doctor, too.

  • if you're looking at a doula, midwife, or other non-doctor professional to assist with childbirth, you may wish to discuss it with your phyisican, and many non-doctor professionals may insist that you be evaluated by a doctor before labor, so that there is a baseline record of your medical history in case you need emergency medical intervention. if your physician is adamantly opposed to your being treated by a licensed professional who isn't a doctor, you may want to find another doctor who's more open-minded. some obstetrical clinics even have nurse-midwife practitioners on-staff. (ours has three.)

  • you or your non-retarded half may wind up having to play referee between two or more different doctors. this happened to us. the two doctors (main doc and night doc) covering sue had different treatment philosophies, and they didn't communicate well. this caused us confusion because each had a different plan on how to treat her, and it became obvious after a day or two that they weren't coordinating their plans with one another. it may be their responsibility to coordinate your medical care, but it's your body and they may not do their jobs appropriately. when in doubt, take notes, ask questions, be an asshole if you need to. this is a major life event that can kill you if it's fucked up; you deserve to not be taken lightly. your doctor may do this 20 times a week; you may only do this once in your life, and you deserve to be treated that way.

having a baby is a very private, personal process. it's something that each family -- mom and dad -- must decide how to do for themselves. whether they opt for traditional western medicine and medical intervention, or they choose the home-water-birth route with a doula or midwife, it's a decision each person on the team needs to feel comfortable with.

for your amusement i'll also offer some experience-based suggestions on both pre- and post-delivery thoughts specifically about your baby, not so much about your delivery.

  • if you're a first-time parent, your hospital will offer parenting classes that will teach you things you need to know, like what to do when your child chokes on something, how to change a diaper, how to treat diaper rash, when to call a pediatrician and when to take your child to the emergency room or call for transport. take these classes. the financial investment is minimal, and the peace of mind you'll get from having a little familiarity with how to deal with the day-to-day baby-raising stuff will help immensely. (especially if you're a guy, knowing how to change your daughter's diaper is very important. i did not know how and needed to learn.)

  • pick a peditrician early. the time to start is in the second trimester. many peditricians offer a "meet new parents" appointment where you can interview your doctor(s), see and become familiar with their offices, and learn how they handle such matters as after-hours calls, and what their guidelines are on when to call them, when they'll want to see your newborn after birth, and other such things. you may want to choose a doctor with privleges at the hospital you'll be delivering at. you may want to interview several physicans.

  • breastfeeding is a personal decision made in consultation with your husband and your child's physician. sue tried and was pretty much unable the first time, and chose not to the second time. i had my own opinions but of course they weren't my tits we were talking about. still, there are issues to consider. i'd be wary of any physician who is so certain of the way that he's unable to consider the parent's point of view on the care of their child. my own doctor made it very clear to us that he'd support whatever choice we made, whether we went breast, bottle, or combination. again, your doctor should be your advisor and ally, not your commander.

  • some pediatricians have rules (that sometimes can be bent) about whether or not they'll accept new patients. my pediatrician will not accept a new patient unless the patient is a newborn. if you move to town with your family of 5, the youngest being age 7, you'll need to find a different doctor. this is his way of limiting the size of his practice.

  • why think about this early? choosing a doctor for your baby is just as important as choosing one for yourself. if you don't have one chosen when you arrive at the hospital for delivery, one will be assigned to you automatically and you may not like him. it's important to start early because your pregnancy may end prematurely and you may not have the time you planned to choose a doctor. this happened to us: we'd planned on choosing a doctor for our first baby during her 9th month. but she developed preeclampsya and never got to her 9th month. she was induced at 36 weeks, and our baby spent 10 days in the hospital. the second time, she went into labor at 33 weeks, and we were unable to stop it. (the twins went home with mom that time.) we got lucky in that the doctor we were assigned turned out to be fantastic, and we're thrilled with his attitude and service. but we could just has easily have gotten a monster.

as always, it's your body and and your baby. you are ultimately responsible for the choices you make, or do not make. you deserve to have your choices respected to the greatest extent possible given your medical condition.

good luck and lots of love to each and every one of you, ladies.

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