The Wildest Ride

I'm going to attempt to shine a little light in a long dark hole, and hope that maybe someone, anyone, will see the light at the end of this 40 week tunnel.  For those fortunate enough to get pregnant "the normal way"(in other words, not with a box of injections and weeks of ultrasounds) ,you woke up, felt a little nauseated, tapped your boobs and thought, "hmm, when was my last period". Your mouth goes dry, you get sweaty and go to the cabinet, pull out a pregnancy test and: two lines.  Uh oh.

Welcome aboard, sister.  Mommyhood awaits, with all of the dirty diapers, crying, teething and spit up you can stand. But you've got about 36 weeks ahead, and things are fixin' to change. Big time. You have a tenant in the baby house and this will change your emotions, your weight, your skin, your body shape, your ability to see your toes, your relationship with your parents, in laws, and your baby daddy.  With your head spinning, you sit down on the toilet, and try to assimilate what has just happened.  And promptly call your OB.

There will never be another time in your life that will feel so completely out of control, and be such a defining moment in your life as the day you deliver your little baby.  I know that it is scary as hell, it hurts so very much and you don't even know what to expect exactly.  So you do what everyone does, get on the internet and read up.  I certainly applaud you taking a interest in your labor education, but it seems lately, that either there is a bunch of absolute garbage out there, or a bunch of very angry mothers or both contributing to your educational pursuits.  So, in desperation of some sort of control, moms think that if they can control the delivery, it will somehow alleviate the anxiety of it all. So, patients walk in with Birth Plans. I'm all for planning ahead, and I often tell patients to give me any specific requests that we can discuss like two adults.  But I'm talking about Birth Plans, the 8 page birth plans.

I hear folks tell me that they've read all about "birth trauma", "birth rape", and unnecessary c-sections and so, they are going to bring me a list of do's and don'ts that I get to follow during their labor. Allow me to inform you all of something that seems to be missing in all of your internet education: baby trauma.  The most stressful thing you can do to your baby while pregnant, is birth your baby.  That's why, supposedly, you asked for my help.  Your baby has a special type of hemoglobin that holds oxygen so tight, that at an oxygen saturation of 60% your baby can actually be okay, for a while.  You and I, however, get pretty grey at that level.  The reason for this special type of hemoglobin (called hemoglobin-F) is because when your uterus contracts, up to 1 liter of blood is squeezed out of your uterus, and away from your baby.  Couple that with a cord around the neck, or feet, or sometimes both, and the baby's heart rate can do some interesting things to compensate.

You, who spent more than 100 dollars on a baby monitor so you can watch it from your iphone, are informing me that I am not to monitor your baby during contractions? Because you want to walk around. Because you want to feel some level of comfort. This isn't about you.

You don't want an IV with Pitocin in it. Well, I guess you'll need to carve your pituitary gland out of your head, then.  Your pituitary gland already makes it.  Would you rather be in a dysfunctional labor pattern for 18 or 20 hours or a regular one that gets your baby out as soon as possible?  No one advocates nuking your pitocin receptors half to death, just get your pattern regular, because labor is stressful on the baby (for the reasons mentioned above). You don't want an IV because it hurts? How on earth am I supposed to give you pain medication? What do you expect me to do if you hemorrhage after your delivery?  I can't put it in then, you've already clamped down in an effort to maintain your blood pressure and I can't find a vein.

You don't want an episiotomy. That's fine, I'd rather not do one. But, if it looks like you are going to need one, or your baby is in distress, I shouldn't have to beg you for it. You don't want an epidural. I couldn't care less. Just don't kick me. I don't care what you say in the delivery room, sister. What happens in labor stays in labor.

And finally, you sure as hell don't want a c-section. You know something? I don't want to do one on you. Or on anyone else. But, I also don't want your to baby die either. Or be so oxygen deprived that they have a lifetime of hardship because of your birth plan. They either fit, or they don't. And if they don't somethings gotta give: your pelvis or their skull (or shoulders).  I can promise you that any delivery I can leave without sewing anything makes my day!

Your baby's delivery isn't about you. It is the first time in your life that you will be totally selfless, giving your lifeblood, your energy, your strength and your all into another human being. Your ability to deliver vaginally with minimal intervention, or c-section with admission to the ICU does NOT equal in any way your ability to mother this child. So, please, please, let me help you and your baby off of this wild ride uninjured.

Allow me to introduce to you my birth plan for you: I need only 3 things. I need IV access for emergencies, I need the ability to monitor your little one during this transition, and most of all, I need your trust. When things go awry, and they sometimes do, I need to have the ability to keep your baby safe, and you safe as well.

Lately, I have seen way too many disasters that could have been averted by better communication between mother and doctor.  Let's stop this madness and commit to safe deliveries and healthy babies regardless of how they are birthed.