Tuesday, March 17, 2015

Who will be present during labor and delivery?

Who will be there?

Well, that really depends on you, mom.  Who do you want to be there? This is not the time to do something for someone because they want it- this is ALL about your comfort level.  Basically consider this- who wouldn't you mind seeing yourself butt naked and completely exposing your lady parts too? That changes the mood a little now.

For me, I only wanted my husband there. Him, my trusted OB, and the random medical staff in the hospital.  No offense to my family or close friends, but I really did not feel like I'd be able to concentrate very well if I was trying to push a baby out and worry if the family member or friend were seeing too much of me in a way they never had before.

Let's go through all of the roles who may be involved:

I had an OB/GYN doctor for my first delivery.  They are a medical doctor who has gone through medical school and a residency program specializing in women's health, including obstetrics and surgery for cesareans.  For my second delivery and current pregnancy, I am seeing a family practice doctor.  I chose a family practice doctor because they would be able to see me for prenatal care, women's health issues, and other illnesses, like the flu.  They would also be able to do pediatric care as well, so my new baby will see the same provider as me.  I like having a family practice doctor for this very reason.  They are also more likely to be present at your delivery instead of being in an office where there is a group of doctors where any one of them may be on-call the day you go into labor.  This varies between offices, of course, but I choose my providers carefully for this reason.  The only issue with a family practice doctor is that they are likely not trained in surgery (though some are), so if you need an unplanned c-section, you'll go with someone you may have never met.

There are two kinds of midwives, certified nurse midwife (CNM) and certified midwife (CM).  A CNM is a registered nurse who has completed a graduate-level degree in nurse midwifery.  They are basically nurse practitioners who have specific obstetric education and can diagnose, prescribe medications, and treat you as any other primary care provider.  A CM is a medical professional who did not previously have a nursing education.  They are still required to have a bachelors degree prior to beginning their program and are trained extensively, but because they are relatively new, CMs are not legally allowed to practice in many states.  They are gaining more rights as practitioners though, so soon, they may be just as available as a CNM. A CNM can deliver both at the hospital, birth center, and at home and a CM will mostly only be allowed for home births and some birth centers.

You would think I would have opted for a CNM to support my fellow nurses, but circumstances have just always brought me to seeing a physician.  There are many, many CNMs/CMs who are just as competent at delivering a baby though :)

I had no idea what a doula (DUAL-luh) was until my second pregnancy.  I had told my chiropractor that I was planning to have an medication-free labor and delivery and she said, "well, you're going to have a doula, right?" A doooo-what? I researched them for awhile before coming across a lovely lady who I ended up having present at my delivery.  So, a doula in my definition is like a hired friend/support person- they can be your partner or they can enhance the support your partner gives you.  They are certified and trained to assist families in having safe and focused labors- I don't think I personally would want one if I was planning on having an epidural, but for a unmedicated labor and birth, they can help you stay focused and provide the support you may need.  My doula took on a few roles- she helped apply counter-pressure to my low back when I needed my husband by my side provide the cues I needed to stay in hypnosis, she took pictures for us, she helped me cheer me on when I needed more support, and she was just so wonderful to have as an extra support person who had "been there, done that" many times already.  She was a birth doula but there doulas trained as postpartum doulas and can be of great assistance for things such as breastfeeding education, infant care, and support for mom in the weeks following delivery- a person who will regularly check in on you to make sure your needs are being met.  Doulas can cost anywhere from $200-$800 (or possibly more!), so having a little disposable income is helpful.  
http://www.dona.org/mothers/ for more information on doulas.

Birth/Midwife Assistant
There is a newer role called a birth assistant or midwife assistant- they are not as common, but more training programs are popping up here and there.  Their role is to assist with the delivery- one step up from a doula, so they have a little more medical training in regards to actual baby delivery. 
Registered Nurse (RN)
For the sake of not having to go into what kinds of licensed nurses there are, I am just going to cover the nurse role as an RN.  Depending on your facility, you will likely have a Labor and Delivery (L&D) nurse and a Mother/Baby nurse.  I have only had good experiences with the nurses that cared for me (except for that one nurse who I swear had no clue what she was doing when trying to show me how to nurse my son...) and am always grateful for the help.  What does the nurse do in either of these roles? So much more than you can see.  First of all, they monitor your health and the baby's- you will be connected to monitors to measure vital signs like blood pressure and heart rate as well as a tocometer, which is often shortened to "toco" (think taco, but with a TOE sound) and monitors contractions and fetal heart tones/tracings (FHT).  Depending on hospital protocol, you may be allowed to be disconnected from all of these things to be able to move around more freely.  With my daughter's birth, my hospital had wireless toco monitors so that they could have continual monitoring without interfering with me too much.  I'll admit, I shook off the pulse oximeter (measures your O2 levels- it's the clip that goes over your finger and lights it up like ET [phone hooome]) and any other cord my nurse attached to me when she came in to chart my vital signs. Nothing more distracting than being tangled in a cord! Your nurse will also be the one who places an IV, does cervical checks to check labor progression when the provider is not present, and basically watches your every move even if you don't see them.  They are the middleman when communicating with you and your provider- both parties heavily rely on the nurse to be effective communicators.  Nurses complete most of the patient charting- this charting goes on your medical record so that insurance (and heaven forbid, lawsuits) can see it and it also holds the nurse accountable for all interventions and patient care. No pressure.

Patient Care Assistant (PCA) or Certified Nurse Aide (CNA)
A PCA and CNA are the same, it just depends on what the hospital calls them- I will just call them CNA in this post. Nurses rely on CNAs to assist in patient care- without them, nothing can be fully done.  A CNA will be responsible for different things depending on the patient- they can monitor vital signs, assist you to and from bed, answer your call light, and communicate with your nurse if the nurse is with another patient.

Lactation Consultant
The booby nurse.  Not always a nurse, but usually.  They specialize in breastfeeding assistance and can be a godsend if you are having breastfeeding troubles.  They will evaluate your baby's ability to nurse and will give you helpful advice and hook you up with different things like a nipple shield and breast pump supplies.

Social Worker
Sometimes a social worker will come in just to make sure your needs will be met when you go home.  They can help with any legal paperwork too like completing social security paperwork and obtaining a birth certificate.  If I recall correctly, bring a checkbook because both these things cost $$.

This is the dracula of the hospital.  Just kidding(ish).  They are trained medical professionals who draw your blood for lab testing.  You will likely encounter one at least twice, if not more, during your stay.

I probably don't need to include this, but anyway, a janitor will come into your room at some point to clean.

If you want happier staff, bring a treat in during your stay :) I brought a sealed container of cookies from Trader Joes both times- not sure if all nurses are like me and some of my old coworkers, but I rarely trusted homemade treats from patients haha!

Support Person
This can be anyone- your go-to helping hand.  Some women want their significant other, some may just want mom.  Maybe your person is your BFF.  Having someone personal present at the birth is comforting and I highly recommend it.  No matter what method you deliver by, having someone you trust present to share the experience with is great.  I cannot imagine not having my husband there with me! Limit your visitors to those who will only uplift you, not test your patience or break your concentration. As I mentioned in the beginning, consider what your support person will see you doing- moaning, deep breathing, yelling, etc. and possibly dressed in your birthday suit only.

As suggested by my friend, Michelle, she also had present at her birth of her second child:

Birth Photographer
This is a great idea if you want some truly beautiful keepsakes from your experience. A birth photographer can capture the joy of meeting your new baby in a picture. The nice thing is that you have someone who will be able to take a picture of you and your support person and any others involved, instead of having your support person take on the photographer role too.  Cost depends on the area and demand. I did not have a professional photographer at either of my births, but I did consider it! With my son, I didn't take nearly as many pictures as I wanted to and while I got a lot of pictures with my daughter, having some professional pictures would have been nice.

My friend's husband is deaf so she actually had an interpreter present during her son's birth! What a great idea.  Consider hiring/having an interpreter present for either you or your support person if you are birthing somewhere that does not speak your native/primary language.  There is a lot less confusion and potential miscommunications.  Most hospitals in the US are legally required to have an interpreter present for you, the patient, if English is not your primary language, FYI.  Of course, keep in mind that an interpreter may really just be a "language line," which is a phone connected to an interpreter somewhere else.

Hoping you feel enlightened and more prepared about the people you may encounter during your own labor and delivery! I will add in more if I can think of any more roles.

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