by Nate Dallas
I’m sure that when everything goes smoothly, home birth is beautiful. However, bad things can happen, and those things scare me to death. Complications are more common with first-time deliveries. There may be problems with Mom, with the baby, and even with Dad. Sometimes, one of the parties needs to go to the OR, ICU, or NICU. Sometimes they need to get on a helicopter and speed to another facility for emergency attention. There may be the need for some cutting, some suction, or some IV drugs to get that baby that is suffering trauma out faster. You don’t get a trophy for doing it at home. If something goes wrong at home, you will likely blame yourself for that decision and never get over it. My personal recommendation is to plan on delivering at the hospital because it’s the safest place to be if things go awry. I know that the hospital has a lot of unwanted diseases and germs within its walls, but hopefully that is all on a different floor or in a different building and has been properly addressed. You can do the research yourself and make some informed decisions. I am not passing judgment on home birth parents. I just want you to consider all the options and make a decision on what’s best for your family. Plan and hope for the best, but be prepared for the worst.
So now you know that I like to deliver at the hospital. We do use a midwife there. Why? Because our midwife is awesome. Her care and bedside manner are superior to the docs in the practice. She is very capable, and my wife loves her.
The other item after the where is the how. There are many locations, positions, and methods to discuss with your doctor or midwife. But beyond these is a more important question. That is whether or not to use medicine. Specifically, I mean induction meds and epidurals. Pitocin™ is the most common IV drug used to speed up labor. It’s a synthetic form of oxytocin, which is a hormone that causes labor. Slowly introducing this drug with IV fluids causes more frequent and stronger contractions and speeds dilation. There is a lot of pressure to do this by many doctors and hospitals. Many clinics prefer this method because it makes scheduling easier and more predictable for them. They want to make a schedule ahead of time and have everyone on it and ready to go. Scheduling inductions means that the on-call doc may not have to be bothered to get out of bed and come to the hospital at 3 a.m. It also means that the hospital can stack more people onto the schedule, making more money. They can also generate a few more services and fees to add to your bill. You may think it’s a good idea too so that you can plan your schedule. The problem is that your wife isn’t getting her teeth cleaned, she’s having a baby! It’s a huge process with nine months’ worth of natural, chain reactions that lead up to one giant crescendo. There are about 10,000 events in the child development sequence that need to be in place before labor and delivery begin. It’s an amazingly complex process. Some healthy women naturally deliver babies at 38 weeks. Others will routinely go two or three weeks past their due dates before going into labor. Timing is a large part of it. Inducing labor does increase the chances of needing a C-section and can increase the risk of other complications, both during delivery and after. Sometimes, the situation is started prematurely, and things progress at the wrong pace. For this reason, my wife and I do not do planned inductions unless medically necessary. If your wife is a small person or it’s her first time delivering, the medical staff may not want her to go past her due date and may recommend inducing labor before that day. If there are early problems with the baby or Mom, the doctor may decide that an induction is necessary. There are certainly special circumstances that would make inducing labor the best decision. Do it out of necessity, not convenience. Again, there are tons of articles to check out on this topic. Do some informed research on it so that you can make the healthiest decision. Always discuss these things with your doctors.
So, you heard it correctly; I am not a fan of scheduled inductions for mere convenience. I think a woman should go into labor naturally as long as everything else is going well and the baby is safe. That is unless she is well beyond her due date or begins to have complications. Modern medicine is well equipped to take care of premature babies. Sometimes it is a very smart idea to get them out early when there is evident trouble inside. Please don’t plan to induce a week early because you want to make it to a birthday party the week after. Everything else can take a back seat to this event. Nothing is more important.
The other question on the drug topic is whether or not to get an epidural. This is a procedure that is usually administered by an anesthesiologist or nurse anesthetist. A test dose of the potent medicine will be delivered at a specific nerve location in her back. The fluid goes into the epidural space around her spine. The goal of an epidural is to provide analgesia, or pain relief, rather than anesthesia, which leads to total lack of feeling. Sometimes you get both, and everything below the waist gets numb. But if completed with ideal results, the Mrs. will be able to move her legs but not feel pain in the lower half of her body, most notably in the pelvis area where the monster pain is going to be unleashed. A test dose is given to confirm the location and monitor for any potential allergy or other adverse reaction. Once the test is successful, a small tube, or catheter, is inserted that will deliver medicine consistently to the spot. The delivery of medication is usually controlled by some form of an electronic pump. The benefit here is obvious: no pain!
You know as well as I do that many women want to go all-natural and give birth without any relief from an epidural. Again, I don’t want to sound condescending, and I will let you all work this out on your own. I don’t have a dog in your fight on this, and what I am going to say may surprise you. However, I must ask those people who insist on doing it drugless, “Are you freaking crazy?” There is no trophy for this. You don’t get inducted into the Mother’s Hall of Fame for screaming in pain, biting pillows, and eventually pulling it off after spewing expletives and insulting everyone in the Labor & Delivery wing. Are you surprised at my tone? We do eat a strictly all-natural diet at my house, but we also appreciate the advances of modern medicine. Maybe we could be considered hypocrites, but if we have an infection, we might take some antibiotics. If we have a headache, we may take a Tylenol™ or an ibuprofen. If we are having a baby, you bet your wallet that we get an epidural!
I know that some people are naturalists, hippies, or whatever else you want to call it, and if that’s your wife and she wants to tough it out, go for it. If you are doing it just for bragging rights, but not for some deep maternal connection or health reasons, you may want to think about it again. There is one vital issue to understand that gets a lot of people in trouble. A lot of women will say that they want to skip the meds, and these same people will adamantly change their position when they hit about 9 centimeters in the delivery room, just before it’s time to start pushing. The caveat here is that there is a point where you cannot change your mind. The specialist cannot insert the catheter on a woman during active contractions. Your bride may not be able even to sit up by the time she waves the white flag. In this case, she will be denied the help, and there is no choice but to suffer along and finish without it. Many, many women change their mind at 5 centimeters, and many more try to go back on the decision at 8, 9, or 10. The pain can be inconceivable and unbearable. It is unlike anything she has ever felt, and the initial decision was unfortunately based on her previous pain experiences. Her prior pain scale is relative. Her previous 10 may actually only be a 5.75 on the newfound, childbirth-enlightened pain scale. So if you are going for it, just know that it’s going to be tough. Some women say, “I want to try it,” assuming that the back-out plan is an option. A half-committed approach to test the situation is a bad idea. In the words of Yoda the Jedi, “Do or do not, there is no try.” If she wants to tough it out so that she can tell the child that she did so one day, so be it. However, appreciate that a horrible experience could affect your chances of doing this whole baby thing again in the future. Hopefully, the natural, post-delivery hormones that induce amnesia for mothers will do their job. Nonetheless, if there are legitimate health reasons for abstaining from drugs,
I understand. I’m just being honest on this because I think many people won’t.
I have never seen a woman give birth naturally, so I cannot speak first-hand. But several of my buddies and their wives say that they hope to never experience it again. The first baby is almost always the hardest to deliver and takes the longest to come through the birth canal. If she is thinking about childbirth without any anesthesia, it may be beneficial to try to convince her to consider doing that on baby number two or three, and maybe play it safe and painless on the first. Don’t have a fight about it, but at least discuss the pros and cons. It’s her decision in the end. Do not, I repeat, do not pressure her to go all natural so you can brag about it. This is her decision. Just remember, if she does go all natural, don’t take it personal when she tells you what she thinks of you and your mother in the heat of battle.
The final element that must be worked out is what types of film and pictures you want during the delivery process. You need to talk about it way ahead of time so that you have what you need, and you can add it to your checklist. We always elected to film the delivery and to position the camera, so it shows Mommy’s point-of-view. This camera angle serves two functions: she can remember it the way it happened and reflect on what she saw on that remarkable day, and if she ever wants to share the footage, friends and family aren’t staring at her highly personal parts. If you want still pics and video, you will need an accomplice so that you don’t end up with both hands occupied, capturing poor screen shots on both fumbling devices, and not having a hand for your wife to hold. I recommend recruiting her mother or significantly close friend or family member to be in charge of one device. Oh, and just in case you were thinking of doing so, don’t pin it, post it, update it, or share it until much later with her explicit permission. Be in the moment and watch it first-hand. The rest of the world can wait.
3 MONTHS BC
Ugh! The Third Trimester
Geez, will 39 weeks ever get here? The happy trimester has expired and now the clock is ticking much louder… or is that a gong? Six months in seems like it’s been so long, but there is still a ways to go.
Every passing week gets more and more uncomfortable for the expectant mom. She has less room inside for basic necessities, like a bladder. She has to go more often, and it has to happen around the clock. It’s harder and harder for her to get comfortable. She’s working harder, getting hotter, and running out of gas earlier every day. She needs more rest, probably even more than the first trimester. It’s now difficult to lie flat or to find a good sleeping position for more than a few hours. Lots of tossing and turning is to be expected.
Many times in the third trimester, mothers will begin to have labor-like symptoms early. These typically happen toward the end of the trimester but can show up several months earlier. The early pains and rumblings may be the mild, non-labor contractions called Braxton Hicks contractions. They are very common. In contrast to a labor contraction, this type can become more comfortable with a change in position. These aren’t as painful as the real thing, but they can be concerning to Mom, especially if she has never felt any contractions before. They can even happen on a regular schedule and create some premature excitement. It’s not considered early labor unless there is continuous strengthening in the intensity of the contractions, and they are accompanied by dilation and effacement. Dilation and effacement can also start several weeks (even months) early. Sudden changes could be totally normal and not a big deal, or could be very alarming and serious. Always inform her doctor of any new developments.
Effacement is the process by which the cervix starts to prepare for delivery. Once the baby drops low enough into the pelvis, he gets closer to the cervix and causes a fascinating chain reaction. The cervix will begin to stretch and become softer, shorter, and thinner. It’s also sometimes called ripening or cervical thinning. These changes cause hormonal changes and muscle changes that cause more contractions. During a healthy pregnancy, the cervix has been closed and is covered by a protective coating, or plug, made of thick mucus. As effacement happens, the plug gets more and more loose and eventually is dislodged and passes. This passing of the plug is sometimes called a bloody show because it normally passes with some blood. It may happen in the delivery room or several hours before you arrive there. Sometimes it’s very small and never even noticed. You will hear effacement referred to as a percentage and usually follows a dilation measurement. The doctor or nurse will say, “She is 2 centimeters dilated and 40% effaced.” When she is 10 centimeters dilated and 100% effaced, it’s time to have a baby. These numbers will be checked several times in the third trimester and many times on D-day.
After the cervix begins to efface, it will also begin to open, which is called dilation. Cervical dilatation is monitored by repeatedly checking with a gloved finger to feel the width of the opening. The diameter of the opening is measured in centimeters. Zero means that the cervix is totally closed, and 10 means that it is fully dilated. Ten centimeters is about 4 inches. Her cervix must be completely dilated before starting to push. Sometimes a woman can be slightly dilated for weeks or more before the baby comes. A few centimeters open can be common late in the pregnancy, even if she is not in labor. If the dilation becomes too exaggerated, too early, the doctor may intervene. If the baby drops into the low pelvic position too early, the pressure triggers all the other sequences in the chain reaction to move faster. Sometimes, women will dilate or begin to efface weeks, or even months, early. Some women do this with every pregnancy, make it full term, and never have a problem. In some cases, though, it may be more serious, and the reactions should be slowed. Bed rest, exercises, positioning, or medication may be needed to halt the laboring process. Your OB will let you know if any changes are necessary. Just know that in the case that lowering activity is necessary, or bed rest is warranted, you will need to step up and once again, be prepared to work harder as the man of the house. Just follow directions, and lean to the side of caution. Early babies usually mean added stress, concerns, and expenses. Don’t let her overdo it. You are the protector of both of them. It’s your job.
Let’s hustle on to the rest of the prep that needs to commence during this trimester for most every case. Much like the plan for the first trimester, the strategy is simple. That is, to make her as comfortable as possible. In the first trimester, discomfort was more a result of hormonal chaos. In the last trimester, discomfort is more attributed to physically being a larger person with a more demanding load. If she wants to be in pajamas and maintain a home temperature preferable to a polar bear, that’s okay. Grant her that luxury. She’s working hard and getting zero breaks. Dress however necessary to avoid becoming a burden to her. Don’t complain about the temperature, her bathroom frequency, or her flip-flops. Let her know you are on her team. If she needs the side of the bed closest to the bathroom, give it up. If she requests sleeping in another bed altogether, cater to her the request. It may actually be a big help for you. Just make sure it was her idea.
The other thing that must happen during this final incubator phase is hospital prep. You must prepare emotionally, physically, and logistically. First, let’s talk about logistics. One thing you want to do sooner than later is to pre-register at the hospital. It’s best for the expectant mother to register weeks before she needs any services. Presenting all of the patient information and insurance details will save a few steps later when you are in a mad rush to have a baby.
It doesn’t matter if your wife is having paranoid, fake labor or about to birth a child on the ER waiting room floor, no one at the hospital will be in a rush when you arrive. The hospital staff deals with false alarms all the time. Many people come in too early and are monitored for a few hours and subsequently sent back home. Common false alarms have created a “boy who cried wolf” phenomenon. Even if you have never had a false alarm, the staff still assumes that you are having one because of how many they see every month.
The hospital’s lack of urgency is particularly present
with your first baby. They will ask, “Is this your first?” If you are not an honest person, or if you believe in conditional dishonesty, this would be the time to lie. You will be taken more seriously if they think you aren’t a rookie. OK, I can’t encourage you to fib. Maybe you can be honest and just be more creative. When they say, “Is this your first?” you can give a confident look and say, “It’s my first with her.” (ATTENTION: Be sure you discuss this comment ahead of time with your wife if you plan to use it.) Hey, cut me some slack. It’s true, and it is a great hospital triage hack. If and when your wife is in real, active labor, it starts to get really painful. Nothing will tick you off quite like a nonchalant, somewhat bitter, condescending hospital worker belittling your wife’s emergent state. Fifteen minutes of paperwork can feel like an eternity, but if you have pre-registered, you can skip some of this frustrating drama. They will need information about her insurance, referring doctor, medical history, etc. The front office will likely request quite a bit of personal data concerning you too.
Here’s the luxury hack that you never expected. When you call to pre-register, ask them about L&D room options. Most people are unaware, but some hospitals and birthing centers take room reservations just like the Ritz Carlton. There are a limited number of suites at some hospitals, and they are often first come, first served (or at least first paid, first reserved.) Our first childbirth was in a small hospital that had about 14 rooms, some of which were singles, and some were shared. They also had two additional, oversized suites. I paid extra in advance (I think it was like 200 bucks) to lock down one of these primo spots. The place was glorious. We had a mini-fridge, a microwave, a sofa, a small separate visiting area, and even a fold out bed for Dad. Jackpot! A deluxe room is likely not available everywhere, but don’t miss out because you neglected to ask.