NodeWomen Pregnancy Guide
  1. Generally speaking OB/GYN’s are not great at anything other than very specific tasks that insurance requires — and just relying on your OB/GYN for information and planning for the birth is going to leave you at best uninformed. If you have a high-risk pregnancy or if you are just more comfortable with an M.D., there’s nothing wrong with them, but know that you will have to be that annoying patient who reads on their own and asks a million questions.
  2. Overall, OB/GYNs are very unlikely to be *proactive*
  3. Midwives (which unfortunately you may have to pay for out of pocket — look for midwives who are in a practice with at least one OB/GYN as those are more likely to get insurance coverage) will be much more hands on, and are particularly great at pre-natal care, assessing size and ease of birth in particular (through touch as well as ultrasound), closely checking placement and helping along if needed, helping with birth planning etc. Midwives who are used to working in a hospital setting are generally going to have greater leverage and better communication skills the OB/GYNs during the birth than those who don’t. They are also more likely to stay with you (or at least in the hospital) throughout your labor. Most OB/GYNs leave the labor to nurses and show up for the delivery; midwives check in more frequently and will stick around if you’re in distress. Also, many midwives work in teams and you will meet all of them over the course of your prenatal care, so you know whomever is on call when you go into labor; many OB/GYNs will exclusively see prenatal patients but then when you go into labor you get whichever doctor in the practice in on call, who may be a stranger to you. Good Midwives and Doulas book up 6+ months in advance. If you need to use an OB/GYN and are interested in decreasing the likelihood of an unknown practitioner on delivery day, solos and small practices still exist, but they may require research to find and are less likely to accept insurance.
  4. Midwives also vary greatly in how they are regulated and how they practice from state to state. The best midwives should be CNMs (certified nurse midwife), which means they have the full range of nursing training with significant additional training in prenatal care and birth.
  5. Have a birth plan. It’s not because you expect the birth to go to plan, it’s to have made decisions in advance when you weren’t going through all the challenges of birth. Make it more like a decision tree, with preferred outcomes and procedures, acceptable outcomes and procedures, and absolute limits. Attach a copy of your advance directive and medical power of attorney, put a copy in your file at your medical provider’s office, in the file when you pre-register at the hospital, and bring copies to have in your room and give to all the nurses, doctors, midwives, and other providers you may see.
  6. Make sure you have updated copies of an advance directive and medical power of attorney, that the person(s) named as your medical decision makers are on call, and that you have discussed with them in advance what to do if something goes wrong. Childbirth is a medical event and you should be prepared as you would with any other surgery or procedure. If possible, take care of this early on, so you don’t need to focus on these possibilities as you prepare to deliver. Ultimately, birth is a natural process that we’re lucky to be able to medicalize when it’s necessary.
  7. Opt out of episiotomies, ointment/drops in the babies eyes and delay the Hep B vaccine unless you know you have someone in your immediate social circle with Hep B (the rest of the world doesn’t start innoculations until 8 weeks at the earliest). Basically opt in for the Vitamin K shot (which can prevent death due to a rare but catastrophic bleeding disorder and has a long history of use without adverse effect) and opt out of everything else and have that all written down in as many places as possible — both in your birth plan and discussed in advance with your caretaker and make sure they write in your chart.
  8. Doulas (also out of pocket) — are particularly good for a first birth as an advocate who is going to help speak for you and what you wanted in your birth plan. It’s an unfortunate reality in the US that our medical system has a tolerance for little or no deviation from a course of treatment that is often determined by risk mitigation for the institution, which doesn’t mean it’s right for the parent(s). No matter how educated you and/or your partner are, you may face a situation where you are not in the right frame of mind to advocate for yourself.
  9. Epidurals — for your first birth you’re probably not going to be able to truly gauge the pain until you get there — but bear in mind there is a limited amount of time once you are in labor to have one, certainly by the time you’re pushing it’s too late. Epidurals are super challenging for people with low blood pressure, because it tanks your blood pressure further. If your labor is not progressing (very common in first labors, especially for Type A/professional women who may have trouble relaxing and letting our bodies do the job) an epidural can help move things along — and those who have them haven’t reported excess tearing or difficulty to breastfeed, but they did have the epidurals fairly late in the process. However, getting an epidural tends to lead to other interventions so if you are trying to have a fully unmedicated and non-interventional birth, wait if you can. Self-hypnosis and acupuncture are two tools that can help release fear and assist with chilling out a bit. That said, no way is better than another, so long as you and child separate successfully.
  10. Gross surprise to better know in advance, bearing down feels somewhat like pooing and that may well happen, particularly with an epi.
  11. Interventions — best to know once you’re into the first of any you do basically lose control over any decisions there after. It’s important to know not only what the philosophy is of your OB/GYN but also the hospital/birthing center and the other OB/GYNs there.
  12. A major thing that midwives do that OB/GYN’s view as bordering on witch craft is measuring pelvis and skull size — and that’s a really critical skill you want to have at your disposal, especially if you’re under 5’4”. That may lead to a conversation about a scheduled c-section, those take some planning but as you’ll see below, it beats an emergency c-section.
  13. C-sections. The US has almost gone full circle, from pushing way too many women into c-sections to making it actually quite hard to get insurance approval for an elective c-section. There’s a bit of a misunderstanding around recovery time — the recovery time from a vaginal birth is faster than a c-section, but the recovering time from a long and arduous labor plus an emergency c-section is much more significant than both. Thus if you’re in any risk category, it’s better to have a very clear and open discussion with both a midwife and your OB/GYN. Early. So that if you’re going for an elected c-section you can get to work on the insurance approval. There’s also some controversy over pelvic/shoe size — but basically a US shoe size 5 or smaller puts you in a 2X more likely category to end up having to have a c-section.
  14. Post — natal, human babies in the 3–6 month age range are particularly difficult because basically they need an extra trimester or two but there isn’t space. Hence the focus around swaddling, white noise, closeness to mother etc all basically aiming to mimic the womb. Happiest Baby on the Block is a great book on the “fourth trimester” and don’t be ashamed if you have a particularly fussy baby and you have trouble bonding/feeling positive for a while. Keep watch for signs of post-partum depression in yourself as well.
  15. If you choose to breastfeed, lactation consultants can be really helpful, and there are organizations like La Leche that provide free phone consultations.
  16. Co-sleeping — we have a consensus view that co-sleeping or at minimum rooming together with the baby was basically the only to get through the first few months of late night feeds (assuming you don’t take sleeping meds, drank, or had sleeping disorders, which are the major risk factors for rolling on the baby). But you can now get bassinets or co-sleeping tools that are designed to sit right next to the bed and/or pillows to stop your legs rolling. Arm’s Reach cosleeper cribs and similar offer something close to co-sleeping without the rollover/suffocation risk; in-bed solutions like Dock-a-Tot are safer than fully co-sleeping without them.
  17. Home births can be wonderful. Particularly in a city with good ER/Ambulance access and for a second birth, if something goes wrong you’d probably get into the OR faster from home than you would from the maternity ward or a birthing center. Also simulating a “birth” a second time around at home after a particularly traumatic birth can be a powerful way to start healing.
  18. Ignore the last umpteen years years of films and doctors wanting things to be more convenient for them. Giving birth lying on your back is an awful idea and can do a tremendous amount of damage to your back and hip muscles. Standing, squatting, birthing chair all much better ideas.
  19. As in much of life, it pays off to prepare for the worst but expect the best. Things in hospitals are particularly funky with Covid19, checks get missed, so be on your guard and ask lots of questions.
  20. Take care of you first. Then you can take care of others.

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