Really Cool Delivery

I had a lot of positive feedback from my last post on “my birth plan.” A few months ago I had a delivery that really made an impression on me and I wrote it down, so that I could remember the details.  It illustrates the style, I wish was more prevalent in obstetrics today.  This is the birth story, as I wrote it down.

“I had a really neat delivery this AM for a super sweet couple.  It was the mom’s 3rd baby and she  was laboring on her side.  (I have delivered all of her babies.)  When it came time to push, I left her on her side as she was quite comfortable in this position.  Baby was occiput posterior, so it took some work for her to push it out.  Dad was sitting on a chair next to the bed on the side mom was facing doing very encouraging, support person stuff.  I was sitting on the bed, behind the mother.  There were no interfering drapes or sheets.  Because of mom’s position, as the baby was coming into view, the father was as close to her perineum as I was, so he got to see his child’s birth in detail, rather than peaking from up above.  The really cool thing was that since the baby was OP, as it was born, it had its eyes wide open and was looking right at his father, so his father was the first person he saw instead of me.  Then this baby took a big breath and began audibly crying while the head was still the only part delivered, which added another unusual twist to the delivery.

It felt so right to me,  because with me behind mom and dad being so close and involved, I felt like I was not even integral to this delivery, It was just something, very personal, that this family was doing together.  Then the icing on the cake was that instantaneous eye to eye contact between father and son as the head emerged.  I so wish I had it on video.”

When one feels all of the pressures with this kind of job, it is this kind of experience that reminds one as to why you keep doing it.

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My Birth Plan

I have been delivering babies now for 25 years.  Birth plans have been around for that whole time, but they are certainly presented by couples to their doctors more frequently today than they used to be.  The increase in birth plan development is a consequence of couples trying to influence what happens in a hospital where one frequently becomes swept along by events out of their control.

I certainly do not mind being presented with a birth plan and using it to review a couple’s expectations and preferences.  However, in my opinion, it is far more important that one find an accoucheur (birth attendant) whose default style is in line with your birth plan, than trying to get someone to change their style to match your preferences.  In light of this I decided to write down my birth plan from the perspective of the professional who is being entrusted with caring for an expectant couple.  Here are my goals and preferences:

  1. Give the couple the type of birth that THEY want to experience.  While most overt birth plans are produced from those who are looking for a natural birth experience.  Not everyone is looking for this.  I have some moms who want no medications at all and I have some who want an epidural placed in the parking lot.  Whatever the preferences, I will do my best to accomodate them.
  2. Explain all interventions and get the mother’s permission, before doing them.  One of the biggest complaints I hear about unpleasant birth experiences is that things were done to them without them knowing what was happening.  While it is easy for a doctor to go into automatic mode, I do my best to not let that happen.
  3. Alleviate fear.  One of my frequent statements about pregnancy is that it is the permanent state of paranoia.  Couples are often plagued by the “what ifs”  and modern obstetrics often adds to this with the constant pursuit of worst case scenarios.  While it is certainly true that bad events can occur during pregnancy, thankfully this is the exception and not the rule.  My job is to be alert for  problems without turning every visit into a worry generating experience and to reassure moms when there is no reason to worry.
  4. Avoid Inductions.  I hate inductions.  Sometimes, inductions cannot be avoided, but even then I still hate them and really try not to do them.  No one knows what actually triggers labor, but one thing I do know is that forcing a uterus not yet ready to labor to labor is asking for trouble.
  5. Encourage mothers to stay out of bed and in motion.  The best way to reduce discomfort and to move labor along is to stay out of bed and move about and frequently change position.  One can also use birthing balls, whirlpool tubs, showers, hypnobabies.  Doulas are welcomed as part of the birthing team and a great help in keeping the labor moving along in a productive manner.
  6. Prefer no epidural.  If women want to have an epidural, they may, but my preference is no epidural as this allows for the most physiologic beneficial labor possible.
  7. Keep the stirrups stowed.  When someone is ready to have their baby, the nurse’s automatically reach for the stirrups.  I tell them to put them away.  In my opinion, the stirrups serve no useful purpose and they impede a mother’s ability to find the most comfortable position in which to give birth.  I deliver women in whatever position they are most comfortable and have delivered ladies on their side, hands and knees, leaning over bed, standing, squatting, whatever works.
  8. No episiotomy.  I avoid episiotimies.  (Hint:  when a doctor says they only cut an episiotomy when it is needed, they probably cut episiotomies on most of their deliveries)
  9. Put baby on mother’s chest as soon as baby is born.  The baby goes from me to the mom, not the nurse.
  10. Delay cord clamping.  I cannot say, that this is something that I fully understand, but it is frequently requested so I have incorporated it into my routine.
  11. View Cesarean section as a negative outcome.  Again sometimes cesarean sections are unavoidable, but I never view them as equivalent to vaginal birth for delivering a baby.  Whenever, I have a pregnancy ending with a cesarean section I review the various aspects of the pregnancy and labor to see if I could have done something different to have ended with a vaginal birth instead of a cesarean section.
  12. Maintain a relaxed environment.  Sometimes things can get pretty tense in the birthing suite, but it is my job as the team leader to keep things relaxed and low key.  I have no use for all of the drapes and masks.  I do  not even wear scrub suits (though my wife wishes I would).  This is how I got my nickname “Dr. Polo Shirt.”  I work at calling everyone involved in the birth by their name and try to treat them the way I would want to be treated.  
  13. Care for the baby I deliver.  I really like it when I get to take care of the baby that I have delivered.  This is one of the services that is unique to family physicians who do obstetrics. Keeping the pediatric care with the same doctor who one has gotten to know throughout the pregnancy provides a level of comfort not available with most other care providers.