Pea in a Pod: Your Complete Guide to Pregnancy, Childbirth, & Beyond - Softcover

Goldberg, Linda

Softcover

ISBN 10: 0757001815 ISBN 13: 9780757001819

Publisher: Square One Publishers, 2009

Synopsis

Back in the good ol’ days, mothers-to-be visited their obstetricians once a month and gave birth under heavy sedation, while dads paced nervously in the waiting room. If you choose to be more active in the birth experience, Pea in a Pod is your perfect playbook.

After presenting an overview of birthing options and caregiver choices, Pea in a Pod

offers a detailed description of conception and fetal development, along with the physical and emotional changes to expect during pregnancy. It also provides nutritional guidelines, exercise plans, information on prenatal tests and procedures, and a wealth of hints for the expectant father and labor partner. Labor variations are

discussed along with common interventions and medications. Final chapters focus on infant care, detailing such topics as breastfeeding and childhood immunizations. The birth of a baby is a significant event in a parent’s lifetime. Pea in a Pod will help make your journey from pregnancy to parenthood both memorable and rewarding.

About this title

Excerpt. © Reprinted by permission. All rights reserved.

Pea in a Pod

YOUR COMPLETE GUIDE TO PREGNANCY, CHILDBIRTH & BEYONDBy Linda Goldberg

Square One Publishers

Copyright © 2009 Square One Publishers
All right reserved.
ISBN: 978-0-7570-0181-9

Contents

Credits......................................................viA Word About Gender..........................................viiiAcknowledgments..............................................ixIntroduction.................................................11. Birth, Your Way...........................................32. Pregnancy.................................................173. Questions and Concerns....................................334. Prenatal Care and Testing.................................475. Nutrition.................................................836. Prenatal Exercise.........................................1137. Tools for Labor...........................................1378. Labor and Birth...........................................1779. Labor Variations..........................................21710. Medications and Anesthesia...............................22911. Interventions During Labor and Birth.....................24512. Cesarean Birth...........................................26313. The Newborn..............................................28314. Baby Care and Concerns...................................30115. Breastfeeding............................................34316. Alternative Feeding Methods..............................38917. The New Parent...........................................403Glossary.....................................................437Trimester Checklists.........................................447Resources....................................................449Notes........................................................457Bibliography.................................................465About the Author.............................................471Index........................................................472

Chapter One

Birth, Your Way or Decisions, Decisions

Pregnancy is a time of heightened awareness. You become aware of changes in your body, in your way of thinking, and in your priorities. You must also become aware of the available choices that can help determine how you feel about your birth experience, your baby, and yourself as a parent. You have the right as a consumer to know the different options from which you can choose. You have the responsibility to learn as much as possible-through classes, your doctor or midwife, and independent research-to make informed, considered choices from among those options.

After presenting a brief history of childbirth in the United States, this chapter offers an overview of current trends and options that all expectant parents should consider. Topics range from choosing a caregiver to determining where to have your baby to deciding on the childbirth method that best suits your needs. Subsequent chapters offer more detailed information on these and other topics to help you make the most of this important, life-changing experience.

HISTORY OF CHILDBIRTH IN THE UNITED STATES

Over the last century, the experience of childbirth has undergone numerous changes. In the early 1900s, most births took place in the home, attended by women who were skilled in delivering babies, by midwives, and/or by family physicians. By the middle of the century, the act of giving birth had largely moved from the home to the hospital, and it was male physicians who began delivering the majority of babies. Giving birth changed from a normal, healthy, at-home occurrence to a medical event within the hospital environment. Normal, healthy childbirth was determined only after a woman had given birth without complications.

Pregnancy and birth during the 1940s and the 1950s were managed largely by physicians. Women in general were not informed about their bodies and they knew very little about the process of giving birth. They simply followed the advice of their doctors without question. In the hospital, the use of narcotics and an amnesiac drug called scopolamine was common during labor. During birth, women were given a general or spinal anesthesia, and babies were often delivered with forceps. Women no longer trusted their bodies alone to give birth, nor did they feed babies from their breasts. Formula feeding became the norm, as women placed their trust in medical experts and the scientific approach to infant feeding.

In the late 1960s, as a result of the woman's movement and several natural childbirth pioneers, women became more informed about their bodies and the process of birth. Suddenly, they began investigating the benefits and risks of the common procedures that had turned the normal event of giving birth into a technological experience. This heightened awareness resulted in the natural childbirth movement, which gave women more control over their labor and birth. For the first time, husbands were allowed in the labor and delivery rooms. Expectant mothers began questioning childbirth methods and procedures that their own mothers-just a few decades earlier-had blindly followed upon the advice of their doctors. Needless to say, many physicians saw this consumer movement as a loss of control.

Some women began choosing to have their babies at home to avoid common medical interventions. And out-of-hospital birth centers started to spring up, giving women the option to control their childbirth experience with expert midwifery care. During the 1980s, hospitals began responding to these actions with birthing suites-rooms that were designed to give the hospital a home-like appearance. Much of this was just interior decorating as the use of technology continued to increase. Fathers were routine in birthing rooms, and the choice of midwives as caregivers for labor and birth became more popular. Consumer-based childbirth classes were slowly replaced by hospital-based programs. These programs typically provided information that was specific to a particular hospital or group of physicians.

During the 1990s, a number of standard hospital procedures became less common. Routine episiotomies, for example, were on the decline, as were repeat cesarean sections. More and more women attempted vaginal births after having cesareans. Women became aware of the beneficial services provided by doulas-trained labor support persons-who assisted them in achieving the birth experience that they desired. On the other hand, epidurals became the norm. Fewer couples attended childbirth classes or they preferred shortened classes that fit into their busy schedules. Television and the Internet became primary sources for information on pregnancy and childbirth, and couples, once again, began relying on their physicians to make decisions for them without question.

Today, at the start of the twenty-first century, the approach to childbirth has become one of convenience. With everyone's busy schedules, preparation for this event has taken a back seat. Many first-time pregnant women give birth to their babies without attending either childbirth or breastfeeding classes. The number of labors that are being induced without medical indications are skyrocketing. Women are choosing to deliver their babies when it is most convenient, or when their favorite obstetrician is on call. Maternal exhaustion (a term that simply means "tired of being pregnant") is another growing reason for inducing labor at thirty-eight or thirty-nine weeks.

The Lamaze method of childbirth preparation, which first gained popularity in the 1970s, was referred to as "painless childbirth." Today's "painless childbirth" means that the woman gets an epidural as soon as medication (Pitocin) is started to induce her labor. This prevents her from experiencing any painful contractions. Cesarean deliveries are again skyrocketing, as scheduled cesarean births are becoming more frequent. Women who have had a cesarean delivery but desire giving birth vaginally with subsequent pregnancies are generally discouraged from doing so. Doctors inform them, as well as women who have already experienced a vaginal birth after cesarean (VBAC), that they no longer allow women to labor and must have another cesarean. Women who desire a VBAC often have to go to great lengths to find a caregiver who will support them in their decision. Another alarming trend involves the number of planned cesarean births for first-time mothers who are supposedly carrying "large" babies-a determination based on a sonogram report, which may be off by over a pound. Even more disturbing, just because they are preferred, cesareans are being performed upon request with no medical indications.

On the positive side, in-hospital lactation services, which assist women in the early days of breastfeeding, are becoming more common. But even so, it is not unusual for women to stop nursing within the first weeks if breastfeeding doesn't come easily. Many hospitals continue to offer formula supplementation without a medical reason.

The journey of pregnancy and childbirth is one of the most significant events in a woman's life-one in which taking an active role is vital. Healthy, normal birth should be considered the standard for care. If there is interference in the normal birth process, the flow of labor may be interrupted and result in an altered outcome. It is imperative for expectant mothers (and fathers) to become aware of all aspects of pregnancy and childbirth, and to take an active role in the many decisions involving this experience.

MAKING DECISIONS

When you announce your pregnancy, you may be surprised at the number of people who will begin to share their birth stories with you. Even after many years have passed since giving birth, most women are able to recount their personal experiences in vivid detail. Some of the stories will be positive and heartwarming; others may instill you with fear. Just keep in mind that the events surrounding your child's birth are unique memories that will last a lifetime. That is why it is so important to be aware of and involved with all of the decisions that need to be made during this special time.

Early in your pregnancy, take the time to examine your feelings about labor and birth. Talk to family and friends about their pregnancies and birth experiences. Discover what choices they've made that were positive and negative, and find out what they would change if they had to do it over again. Understand that there are certain factors over which you have no control, but the choices that you do make, including your choice of doctor or midwife and your place of delivery, will have an impact on the birth experience. Your health insurance may cover specific facilities, and they may provide a list of caregivers from which to choose. If you desire to use a caregiver or facility that is not on the list, be prepared to pay the difference to ensure the type of birth that you desire.

In addition to becoming knowledgeable about pregnancy, labor, and childbirth, you can enhance the experience by eating well, exercising, and practicing relaxation and breathing techniques. All of these factors, which are discussed in later chapters, can influence this very important event in your life.

CHOOSING YOUR CAREGIVER

Your caregiver is the person you select to provide your prenatal care and to attend your birth. It is the doctor or midwife that you hire to be your healthcare provider. This very important person can have a significant influence on the course of your labor and birth and the type of experience you have. It is important to decide which "model of care" best suits your particular needs. Taking the time to interview different caregivers will help you decide on the one that is best for you. Remember, these models of care, which are discussed beginning on page 7, are general guidelines that describe how a particular healthcare service is usually delivered. Some midwives may practice more like physicians and some physicians may have incorporated midwifery practices into their care.

Early in your pregnancy, there is sufficient time for interviewing and exploring the options. However, even in late pregnancy, women have successfully changed caregivers. If possible, include your support person (husband, father of the baby, significant other, family member, friend, or whoever plans to be with you during labor and birth) in the interviews with potential caregivers. He or she may want to be an integral part of the entire experience, including the prenatal visits. Interestingly, many women have reported that caregivers seem to spend more time with them during the initial interview and subsequent visits when their partner attends. The amount of information you receive during office visits, especially the first one, can be overwhelming. Having a second set of ears will help you remember all the instructions and details that are discussed. A partner can also assist you in remembering any questions that you need answered by your caregiver.

Communication is key. It is up to you to express your desires to potential doctors or midwives, and discover if they are willing to accommodate you. If any of their policies are unclear, be sure to have them explained. An open exchange of views establishes a good rapport and a feeling of mutual trust and security.

A conscientious, caring doctor or midwife will take the time to discuss your feelings. He or she will also promote good nutrition, and encourage you to educate yourself on pregnancy and childbirth through reading and by attending classes. During interviews, you may want to ask caregivers what percentage of their deliveries are cesarean sections, as well as the percentage of cesareans performed in the hospitals where they deliver. And find out the reasons they consider non-negotiable for performing this procedure. For example, some caregivers automatically perform cesareans for twins, a breech baby, or if a woman has had a previous cesarean. You may also want to verify the credentials of the doctors and midwives you are considering.

Many women in the United States prefer to have obstetricians (OBs) as their caregivers because of an OB's training in handling any problems that may arise, especially during labor and delivery. Midwives care for the majority of normal healthy women in most other countries; and even in the United States, the number of births attended by midwives has steadily increased over the years. In 1975-the year that certified nurse-midwives (CNMs) were noted on birth certificates for the first time-they attended the births of 19,686 infants, or 0.6 percent of all births that year. In 2002, CNM-attended births had risen to 307,527, which accounted for 7.6 percent of all births that year, or over 10 percent of all spontaneous vaginal births that year.

According to Charles Mahan, MD, OBG, dean of the University of South Florida College of Public Health and former State Health Officer for the State of Florida, "Midwives are willing to start in early labor and sit with a woman fourteen hours. I'm not willing to do that. Most of my colleagues aren't either. For low-risk women, they are better off with a midwife."

Physician Model of Care

Physicians-obstetricians, perinatologists, and family practice physicians-deliver the majority of the babies born in the United States, and most deliveries take place in a hospital setting. Obstetricians care for the majority of pregnant women. Their training focuses on diagnosing and treating high-risk pregnancies. A perinatologist is an obstetrician who has additional training and certification in the treatment of high-risk pregnancies. Most perinatologists only take care of women with high-risk pregnancies; they may care for these women during part of the pregnancy in consult with their obstetricians or family practice physicians. Both obstetricians and perinatologists diagnose and treat complications and manage diseases that affect pregnant women and their fetuses. Family practice physicians also deliver babies, although this is not a common practice. These physicians, who practice mainly in rural areas, may need to consult an obstetrician or perinatologist if the woman develops complications.

In the United States, most pregnant women choose obstetricians as their healthcare providers, even though midwifery care is an excellent alternative for healthy women, and at a lower cost. The care of most obstetricians is two-fold: focusing on the woman's physical changes and testing to rule out possible complications. They focus on the "pathologic potential of pregnancy and birth." Obstetricians perform many interventions "just in case." Women with chronic medical problems such as diabetes or high blood pressure, or who become high-risk during pregnancy greatly benefit from the expertise of an obstetrician or perinatologist. But women with normal, healthy pregnancies who choose these physicians as their providers are often managed in the same manner as women who are high-risk. This means they are likely to undergo frequent and unnecessary testing during pregnancy. Furthermore, during labor, they will probably to be confined to a bed while hooked up to a continuous electronic fetal monitor, and they may not be permitted to eat or drink. Although there is no medical reason for it, their labor may be induced and they will probably request an epidural.

Although some physicians wait for labor to start on its own, many women with no medical reason to be induced are being offered the option, even before their due date in some cases. Today, it is unusual for a pregnancy to go beyond forty-one weeks, even though this time period is still normal. At forty-two weeks, women are considered overdue and induction is recommended if they have not spontaneously gone into labor.

In hospitals, it is the nursing staff that tends to women during labor. Doctors rely on nurses to provide information on the laboring women's progress. Patients may receive occasional visits from the OB, but just for a quick check of the cervix. In many cases, the first time a woman in labor sees the doctor is during the pushing stage. And most nurses-who have multiple duties and who are assigned to more than one patient-rarely stay with a woman during her labor for any length of time. Most women who deliver in a hospital have continuous electronic fetal monitoring that can be viewed at a central nurse's station. Intravenous fluids, the use of oxytocin to induce or augment labors, and epidurals are commonplace. As a result, women are less inclined to get out of bed and move around during labor. They are limited to sucking on ice chips or ice pops and sipping clear liquids.

(Continues...)

Excerpted from Pea in a Podby Linda Goldberg Copyright © 2009 by Square One Publishers. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Edition details

• Publisher: Square One Publishers
• Publication date: 2009
• Language: English
• ISBN 10: 0757001815
• ISBN 13: 9780757001819
• Binding: Paperback
• Number of pages: 496