Advice about talking to my OB? (kinda long) — The Bump
Natural Birth

Advice about talking to my OB? (kinda long)

I have my a/s Thursday (I'll be 21 weeks), and I plan on talking a little more in-depth with my OB about natural birth. We touched on it at my last appointment, but I had more questions about what I needed to be doing now (in terms of nutrition, exercise, etc.), so it kind of got glossed over, and that was two months ago (I had no insurance and had to cancel my last appointment, but now I'm covered and good to go!). For the record, I live in a small town in East Texas, there are no midwives or doulas or any other support for natural birth within an hour of where I live, so DH and I are kind of alone in this, and my mother is being extremely supportive (so much so I'm changing my mind about not having her in the room with us, just to have the extra support. She's also really good at talking with medical staff and getting them to agree with her, as I've seen from her staying by my grandmother's side several times). From our previous talks, my OB has never witnessed a completely natural birth, but seems interested in helping me achieve one, if somewhat skeptical. His c/s rate is low for this area (only around 10% for ftm's), and we've already talked about extending his induction deadline to 42 weeks (his practice's policy is 41 weeks, but he's willing to go to 42 as long as I consent to additional scans to ensure baby's health and practice natural induction methods), even though I can tell it makes him uncomfortable. I have already written a rough draft of my birth plan and have been doing a LOT of research (I'm a nursing student anyway, I've just kind of added this into my studies), but I'm worried if I go into that much detail with him on this appointment, we won't get very far. 

So I guess that's a long paragraph to ask: What topics do I need to make completely sure I cover  at this appointment? Is now a good time to bring my birth plan, or should I wait until I'm happy with the finished product (it's a bit too long right now)?

If I don't like his answers, there's not much I can do, really, except prepare for a fight come January, or try to convince him otherwise. There are 3 other OB's in town, but they're all extremely knife-happy (we're talking c/s rates upwards of 50%, even for first timers) and jack***es (I've been to all 3 before this OB moved to town, and hated them, even when I was a teenager just seeking b/c).

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Re: Advice about talking to my OB? (kinda long)

  • I would ask mostly about hospital policies since that is what will matter the most for you.  Routine IV, pitocin, continuous monitoring, etc. 

    He's never seen a natural birth before?  I said that there were OBs out there who hadn't seen natural births before awhile back and got laughed at.  :)  Guess it can happen. 

    Mama to Lucy (7/06), Lexi (5/09), and Max (11/11) M/C 12/17/10
  • I agree with PP; talk about hospital policies and your OB's usual methods, to see how much control/freedom you'll have while in labor. Doing your research is a great idea because it will help you make informed decisions about what's best for you and your family and you won't get sucked into the scare tactics used by hospital staff.

    I'd look for a Bradley class in town, if you can't find one you can do a home-study with the book.  (Husband Coached Childbirth comes highly recommended by my MW).  it will teach relaxation techniques, what to expect (physically and emotionally) during labor, and it will help your husband be the best support he can be for you.  Write up your birth plan, and go over it in DETAIL with DH because he will be the one who has to argue with nurses and be your advocate while you're in labor.  If you want your mom there too, that's great!  If you decide to study the Bradley method they also have resources for "assistant" coaches, or your back-up support besides DH.

    Good luck with everything, and keep us updated on what your doc says! 

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  • Wow, I'm surprised that he's never seen a natural birth! It's so great to hear how supportive he is of your wishes though and how much he's willing to work with you. 

    I agree with pp in understanding the hospital procedures.  My question/concern would be what are the policies/philosophies of the other doctors in his practice? Surely there is no guarantee that he will be the one delivering your baby, so I'd want to make sure that his backup doctors are on board with your plan as well. 

    Also, I'd recommend staying home as long as possible when you go into labor . . .

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  • DH has actually helped me write my plan (he's good at remembering things I've talked about but forget later!) and he'll be there with me on Thursday as well. He is wonderfully supportive, and I think he's more excited about me having a natural birth than I am! I've already read Natural Hospital Birth, and Bradley is next on my list. There aren't any classes in town, but I do plan on practicing the methods myself (I already have a yoga routine, so relaxation and breathing are some things I'm very familiar with). I think the only class the hospital offers is a Lamaze class, but a friend of mine who went through it about four months ago said they just assume everyone taking the class is going to receive an epidural!

    Thank all of you for your advice, I will definitely ask about his and the hospital's policies. There's only one other doctor in his practice, but all 4 OB's in town rotate at the hospital. He's already admitted to me the others won't be as accepting, and that's why he's worried about me not wanting any sort of induction (counter-intuitive, isn't it?). I think I'll concentrate on that and my plans to labor at home as long as possible when we talk, and I'll save my detailed birth plan for next month's visit.

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  • One of the doulas here in town will tell you "no" every time you ask her if she thinks it's time to go to the hospital. When the mom says, "I kinda feel like I need to poop," she's like, "ok! Time to head in!" lol. She keeps you at home so you basically push at the hospital and that's it. If you aren't there hanging out, they can't do things to you or push interventions on you.
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  • First I would make sure dr knows exactly what you mean by "natural birth".  For many, than means no pain meds.  To me it means no pain meds and no interventions.  If you haven't talked to the dr about what you expect from your natural birth and you haven't toured or taken the hospital class I don't think you're at the point to present a birth plan.  Most of us put way too much in a birth plan; they should never be more than one page long.  Many things may be a moot point and waste of ink if you write you don't want something the dr or hospital doesn't do anyway.  See for sure if the hospital has a class.  We have a smallish rural hospital and they offer 2 prenatal classes.  If the class is lamaze-ish and assumes everyone wants an epi it's the perfect time to speak up and say hey, what about the rest of us!

    He's skeptical yes because he's never seen one but also because you're a first time mom.  Before he knew I wasn't doing the stuck in bed epidural thing my dr told me that first timers often push 2 hours and I literally laughed at him because I don't plan on being at the hospital much more than 2 hours before baby's born!  (the biggest tip for natural birth in a hospital is to go in as late as possible)  But drs tend to think we don't know what we're getting ourselves into and will probably change our minds since we've never done it before. 

    And they're right sometimes.  Some women say they want natural labor, until they're in it.  They aren't prepared for the intensity and longevity required and/or don't have support persons backing them up.  So go grandma for standing up for your daughter!  You might need her in the event you get one of the other jackass drs =) on call; it happens in the hospital.  My mom would be begging the dr to give me a csection asap if the slightest thing went off kilter....needless to say she will not be in the room!  You need to be prepared for yourself; don't simply think because doc is on board that he will be there to push you through it.  That's your DH's and mom's job along with your own perserverance.  If you're learning Bradley that's a great step.  You don't have to fight, just be informed and stand up for yourself.  Do your birth plan.  Make your wishes known.  Tell everyone you want to know about any medication or even the smallest procedure before it's given/done.  Say no if you really disagree with a change in plans (but remember, hardly any birth goes 100% to plan and emergencies do actually happen).  There's a book called Natural Hospital Birth that outlines the most common interventions and how to deal with them when presented to you. 

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  • Go to this page http://www.choicesinchildbirth.org/ there is a guide on what to ask your obgyn and I think it is very useful, also, if you have any questions on a decision you are considering for your delivery, there is information on that too.  
  • His c section rate is very low. And he's letting you go to 42 weeks. That's huge. You cannot control everything or plan everything, neither can your OB. I would just ask him if baby is tolerating labor well and so are you-meaning no high blood pressure and things of that nature, is he comfortable with leaving you alone and letting things progress in their own time with no intervention? That's it. I am almost positive his answer is yes. A 10% c section rate is unheard of for almost every OB.
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