women
THERE WILL BE more and more moments now when you say to yourself: “Wow! This is real!” No matter how much we prepare for something, choose it, and intellectually understand the parameters, reality still sets in slowly. I had a friend who was in such panic and denial that he was about to become a father that we gave him his own shower! The baby is growing inside you and you’re still adjusting to the reality. Imagine how it might be for Dad, the rest of the family, and your friends.

This month is dedicated to some important details that will set you up for support. I don’t want you to be blindsided by any of the myriad decisions you may be asked to make. Forewarned is indeed forearmed. To this end, we’ll spend the first week making sure your birth plans are fairly foolproof. Did you know, for example, if you have chosen a hospital birth that you’ll likely be spending more time with the nurses than with your OB-GYN? I have a friend who is an OB-GYN and he tells me the head of the department at his hospital misses just about every birth. He does, however, sail in the next morning with a dozen red roses and a well-rehearsed apology. Your doctor isn’t likely to behave like this one; however, you still want to be sure you’ll be surrounded by the professionals of your choosing, and that includes the nurses. Ask your obstetrician or midwife about who will provide backup care if she is unable to make it to your birth. Will another care provider in her practice fill in? Ask about meeting other medical staff who might be involved in your care.

In the following week, we zero in on how you can stay connected to others after the birth. Motherhood is a blessing and a joy. It can also be isolating and lonely. But not for you! You need to take conscious steps to stay connected. Let’s start now. Make your wishes known. After the excitement dies down, everyone goes back to their same old/same old lives. They may be so caught up in their own realities that they either forget you for the moment or assume that you will call when you need them. Don’t play the time-worn “If you really loved me, you’d know” game with anyone. Even if you come from a family of professional psychics, assume they are off duty and need to be told what you need!

Of course, no month would be complete without a little on-your-feet organizing project and this month we’re going to work on the laundry and the pantry. Have you ever noticed that moms have an unconscionable amount of laundry to do? We need that room to be in tip-top shape. And personally, I find that pantries are one of my favorite areas in any home. There’s something nurturing about an area devoted to food. I don’t want you in there after the baby is born asking, “Now I wonder if we have. . . .” I want you to know exactly what you have and where it’s located. We end the month with a look at those first weeks Baby will be home. The way you handle this critical juncture will very likely predict the way your careers as parents will be spent. Take this week to consciously communicate with your partner and create an equitable division of labor.
 
HABIT OF THE MONTH
 
Practice Self-Care

What’s that refrain all pregnant women utter ? Oh yes: “I feel like a beached whale” or “I’m as big as a house!” If you’re eating properly you might stay the size of a small whale but, still, adding twenty-five to thirty-five pounds to your frame is usually part of the process. That doesn’t mean you can’t have pretty fingers and toes. Make yourself a cup of tea and use a favorite teapot. Get the latest issue of Vogue and start dreaming about what pieces you’ll add to your wardrobe after you lose the baby weight. Why not create a Dream Board showing a stylish mom having fun with her baby and her husband? Take an aromatherapy bath while your favorite music plays. Wear a piece of jewelry you forgot you have. Read a book while you’re in the tub or dim the lights and daydream about the future. Take a nap. Call an old friend you haven’t connected with in a long time. Grab your baby journal and list five ways to care for yourself that are unique to you.

28 WEEKS PREGNANT

Finalize Your Birth Plan

This week, you can
• Create a more specific birth plan
• Talk to your care provider to make sure you’re on the same page

B Y NOW, you’ve had a chance to do some serious reading about labor and delivery. Now that you have some data about common hospital procedures and interventions, take a few minutes to go through this list of common birth-related procedures and ask yourself how you feel about each one. Remember that every goal, whether it’s getting labor started or making contractions more comfortable, has several alternative methods you can try to get there. Thinking about each option separately will help you tease out exactly what it is you do or don’t like about the idea of each medication or procedure. Knowing the choices available to you means you’ll be armed with the information you need to make the choice that’s right for you. If the need to take action arises, you can usually start with the option you are most comfortable with and then work your way down the list.

Here’s an example of why I think it’s so important to have a real handle on the different medications and procedures you’ll likely be confronted with in the delivery room. A mom I know named Heather went through her first pregnancy with only a basic understanding of the medical side of labor and delivery. She wanted a natural birth and had a general idea that she would try to avoid an induction. However, some test results close to her due date concerned her doctor, who wanted to get labor started. Heather didn’t realize that there is more than one option for getting labor going, and checked into the hospital early the next morning to start her Pitocin drip. Since Pitocin causes stronger-than-average contractions that come on much faster than a typical labor would, Heather found that the rest of her birth plan was thrown out the window as she struggled to cope.

During her next pregnancy, Heather again had troubling end-of-pregnancy lab results and her doctor wanted to induce. This time, she understood that there were a few things they could try before they skipped right to the Pitocin, and she asked her doctor if they could start with a prostaglandin gel and stripping her membranes. It worked! Her contractions started that night and by the next evening she’d had her baby . . . without pain medication. Heather never had Pitocin and her second labor was much easier to handle.

Following is a chart that will keep each of these topics separate and give you a way to define which procedures and interventions you’re just fine with, which you’d rather avoid, and which ones you want to discuss more with your care provider, both now and as they come up during labor. This chart includes the most common procedures and medications, but it’s not exhaustive, so I also left blank spaces at the end of each section for you to fill in if needed.

With your chart in hand, you’ll be prepared to talk to your doctor or midwife about your concerns without forgetting any details. You don’t have to bring up every single thing on the list. Instead, use it as a tool for determining your priorities and areas of greatest concern. Ultimately you’ll be able to use the information you’ve gleaned to have a frank discussion with your care provider about your birth plan, and make sure the two of you are on the same page. I recommend doing this in week twenty-eight of your pregnancy because you’ll be able to tell a lot by the conversation you have with your care provider—and if it doesn’t go well, there’s still time to switch practices. If your doctor or midwife is thoughtful and respectful and takes time to go over each of your concerns and come up with compromises, that’s a good sign even if she ultimately thinks some of your wishes aren’t likely to happen. If she brushes you off, condescends, or, worse, seems put out or offended that you’d state your preferences, that’s a huge red flag. You need your care provider to be on your team. If this isn’t the case for you, strongly consider finding another one. The third trimester is not too late to shop around, but you’ll want to do it quickly, as many practices won’t take on new patients who are very close to their due dates.

If you’ll be delivering in a teaching hospital, student doctors and nurses could have a large involvement in your care. Think ahead of time about how much of your care you’d like to turn over to them. For example, you may be just fine with a student taking your vitals but would prefer they didn’t perform internal exams. You may be just fine having a room full of people you barely know watching you push your baby out . . . but you may not. Speak up! It is your right to determine who will perform your care and be present at your birth.

After you’ve spoken to your doctor or midwife, it’s time for possibly the most important part of your birth plan—the hospital tour. Why is this so important? Most of the time, the nurses on duty at the hospital have much more one-on-one contact with a laboring mother than does her obstetrician, who checks in with nurses (often from home) during the bulk of labor and then comes in as Mom’s getting ready to push. What does that mean? Your nurses have a huge amount of say over the care you’ll get while in labor, and the hospital’s procedures will determine whether or not some of your wishes are do-able. For example, your OB may think it’s a great idea for you to walk around during labor, but if it’s the hospital policy that moms must be constantly tethered to a monitor, it’ll be much harder for you to make that wish a reality. Whether or not you’ll be allowed to eat and drink, walk around, have guests, or skip the routine IV is largely determined by hospital protocol.
Just as you have preferences for how you’d like your birth to go, nurses have their own opinions as well. Some have a decidedly “birth is a medical event” mindset, while others view it more as a natural process best left unmanaged. When you check into the hospital in labor, take a moment to tell the nurse about your preferences.
Certain nurses may be more willing than others to “bend” the rules, but if the labor and delivery unit is always very busy, you may find it more difficult to have things your way. That’s because straying from standard operating procedure takes more time and effort on the nurses’ parts—and if they’re already stretched thin as it is, they may not be able or willing to do the extra work. Don’t forget to ask about your postpartum care and newborn procedures as well—too many moms focus on the birth and forget about the environment they’ll be getting to know their new baby in. It’s important! Will you be allowed to room in with your baby? Is there a boardcertified lactation consultant on staff to help with breastfeeding issues? If it turns out that your baby has to spend time in the neonatal intensive care unit (NICU), will you have close, regular access to him? The NICU is a reality for many babies, even if it’s just for a brief time, so factor in how “mother friendly” it seems.
Ask questions, and if you have concerns, don’t be afraid to research other hospitals and birth centers in your area to see if there’s a better fit. Visit www.motherfriendly.org for a list of hospitals deemed “mother-friendly” by the Coalition for Improving Maternity Services.

As you look around at hospital options and talk with your doctor or midwife, you’re likely starting to see how complicated this birth plan business is. Even if your care provider is 100 percent on board with your wishes, you can’t guarantee your nurses will be. And vice versa. You also can’t predict what your body or baby will do while you’re in labor, which throws another wrench of unpredictability into the whole process. Try to relax, and if you haven’t strongly considered hiring a doula yet, now may be the time to start looking. She can help you make sense of what you’ve learned through talking with your care provider and touring the hospital, and can work with you to figure out how to get the best possible experience you can. Hiring a doula is the first big step you’ll take in setting up your support network, which we’ll be working on next week. For now, take a deep breath. Don’t worry—one way or another, this baby is going to come out!

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