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The Best Birth Plan: Doctor approved with the safety of Mom and Baby in mind

Birth plans are IN. Every app, every mommy website, every natural birth instructional anything contains mention of and often a template for a birth plan. In this post I will answer the following questions:

  1. What is a birth plan?
  2. What are some common misconceptions between doctor and patient?
  3. What are things that you, the mother, can do to increase chances for a vaginal delivery?
  4. What factors are unpredictable, so that you won’t be shocked if you encounter them?
  5. What items SHOULD be on EVERY PARENT’S birth plan?

Wait, you’ve haven’t heard of a birth plan? jonas-kakaroto-458503-unsplash

Well, a birth plan is essentially a written guide crafted by the mother that lists her requests for her labor management and delivery. Sometimes it contains lists of medications that are requested and ones to avoid. Sometimes it contains requests for who will participate in the labor and delivery- Attending physician versus midwife versus resident versus medical student etc. Sometimes it contains statements like this:

I do not want a C-section.

Why do people create birth plans?

The answer is simply two words: Vaginal Delivery. A birth plan is like a recipe for the best Thanksgiving dinner delivery. Most people want their baby to come out of their vagina as healthy as possible. At the end of the day, they want an uneventful vaginal delivery. If you get the ingredients just right, that baked macaroni and cheese delivery will be amazing. Right?

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It is a delicate line to walk as a physician.

BIRTH PLAN FOR MY PERFECT DELIVERY

No induction.

No pain medication.

No IV fluids.

No Pitocin.

No breaking the bag of water.

No C-section. No C-section. No C-section.

GLOWING VAGINAL DELIVERY

These are common components of birth plans, large and small. It is technology’s fault that vaginal deliveries don’t always happen. It is because we doctors want to rush ladies through the labor process and have a baby before our own dinner time. If we doctors would let labor happen on its own, with minimal intervention, there would be less C-sections. Right? Wrong. I have no incentive to rush your labor. I am not motivated during your labor by any other goal than to get you and baby through labor and delivery unscathed.

I want to tackle a few facts.

  • 99% of OB/GYNs want you to have a vaginal delivery as much as you do.
  • There are things you can do to increase your chances for having a vaginal delivery, and I will share those.
  • There are factors that are out of both the doctor’s and patients control that can lead to a c-section, birth plan or no birth plan. I will give some examples.

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Picture this: You need to get from one end of the country to the other. You have never traveled outside in the elements before. You can’t drive and the only map you have is one drawn by a friend or acquaintance who once traveled a long distance on foot in the past. The only difference is that they started from a different place and had a different destination than you. Some had luggage, some didn’t. Some exercised, some didn’t. Some traveled in the summer. Some traveled in the winter. Some traveled over mountains. Some over flat land. Some traveled 2 miles, and some traveled 20 miles.

Oh and one friend had a brand new prosthetic leg when she made the trek.

In my analogy, the distance represents the labor course. I’ve cared for women who were in labor for 5 hours and women who were in labor for 5 days. The luggage represents not only the woman’s weight, which can matter in labor, but also the size and shape of her pelvis. How easy or hard is it for this baby to make it through the pelvis? The season and weather can represent the baby’s well being, which is very unpredictable, variable and can change in an instant without warning. The prosthetic leg represents the different circumstances that make us each unique. Maybe this woman has fibroids. Another woman has had surgery on her cervix. Another has severe back pain resulting from a slipped disc. They are all different, and because of this, the labor course is unlikely to be the same.

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Where do I, the OB/GYN, fit into the mix of this analogy? Well, rather than being guided by a person or people who have traveled a hand full of times over limited terrain and have drawn you a picture, consider me an in-person hiking guide who has made thousands of trips over variable terrain in every season in every storm. Who do you want as your guide?

Technology is not the enemy.

In places and countries where interventions are not available, there may be less C-sections, but there are more complications. In the United States, one of the biggest risks for a woman in labor is hemorrhage or excessive blood loss. A working IV is essential to be able to give fluids during labor for baby’s safety, but also to slow the effects and allow intervention during hemorrhage. While a person is bleeding excessively, this is the WORST time to try to start an IV (the veins practically disappear) or to find out that an IV that does not have fluid flowing through it is not working or had clotted shut. In my hospital, you can still walk and be mobile with an IV. It is like a labor seatbelt.

Likewise, monitoring the baby’s heart beat ensures that you and baby are getting through labor safely. Some desire to not have their babies monitored because they don’t want interventions as a result of monitoring. Keep in mind, if the baby looks healthy and safe, interventions aren’t necessary. If the baby looks like they aren’t getting enough oxygen based on the heart rate, this may lead to intervention, but you would want that intervention. In that moment, the safety of you and baby is more important than the route you take on you cross-country trek.

If you are in a car accident, that is not the time to put on the seat belt. It is the time to use it. Allow the IV.

Pregnant trimester

Some things that a woman can do to increase her chance of having a vaginal delivery are to exercise before and during the pregnancy, to try to be at a healthy, non-obese body weight at the beginning of the pregnancy, to keep diabetes and high blood pressure under good control if present, and to deliver before 2 weeks past the due date. These are just a few examples.

Some factors that are relatively out of the mother and doctor’s control are the baby’s ability to tolerate labor, the size and shape of a woman’s pelvis, the size of the baby (sometimes it is just genetic) and the baby’s position. I am actually writing a post about some factors that may increase breech or head up positioning at term (the due date) and some ways to encourage normal positioning. Stay tuned for that.

Labor, unlike many other aspects of life, is very difficult to control.

Most people can walk a short distance. A few blocks or even a mile or two on foot on a mild spring day could literally be a walk in the park. But what if your destination is a little farther. What if you unexpectedly have two suitcases, you are wearing high heels, and your grandma who gets short of breath when she walks is with you? In a blizzard? How are you going to get to your destination in one piece with all of your stuff and your grandma? That’s what your guide is for.

So what SHOULD you put on your birth plan? At my hospital most of these items are automatic, but just in case, here are some suggestions for a term (not premature) pregnancy:

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  1. What kind of pain management am I interested in, if any.
  2. I would like any labor interventions discussed with me for understanding and clarity.
  3. I would like skin-to-skin with myself and baby if the baby is breathing well. Dry the baby first to maintain body temperature but then chest-to-chest contact with mom is important.
  4. I would like delayed cord clamping for at least 30 seconds if there is no meconium and baby is breathing well.
  5. I would like BLANK PERSON to cut the cord.
  6. I would like to breastfeed if possible. It is the healthiest thing for baby if I am able. I understand that occasionally supplementation is necessary depending on the amount of baby’s weight loss and/or blood sugar measurements.
  7. Do I want music playing? Who is bringing the play list.

While these are not the only items that can go on a birth plan, notice that these few suggestions do not include labor management. You have to trust that your doctor is making appropriate decisions with and for you and your baby’s safety. If you aren’t clear about the reasons things are happening during the management of your labor, ask for explanations from the nurse and/or doctor.

Informed consent and shared decision making…

… means that we – the doctor and the patient – discuss the management, including, risks, benefits and alternatives of the various options and together come to a mutually agreed upon decision. This will continue to foster trust and allow the labor process to take place with low risk for complications and with clear expectations.

My birth plan as your doctor: To get you and baby through your delivery as safely as possible, with as little intervention as is necessary, but as SAFELY AS POSSIBLE. Try this:

The OB/GYN Serenity Prayer

In pregnancy, grant me the SERENITY to accept the things I cannot change,

The KNOWLEDGE and MOTIVATION to change the things that can increase my chances for having my dream delivery,

The PEACE and UNDERSTANDING that my healthcare providers have the best interests of myself and my baby at heart,

And the WISDOM to know the DIFFERENCE between what can be changed and what cannot while understanding all associated risks, benefits and alternatives.

What do you think?

I made this little video one day in my car…

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You Should Never Get These Three Cancers: Here’s how to protect yourself.

If you have had the chance to pick up my book, It Smells Just Like Popcorn, that breaks down medical things in plain speak (THANK YOU!), you may have come across the section about Cancer:

Here is a excerpt about WHAT CANCER IS…

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Cancer is not an alien beast that finds its way into your body. Cancer, generally speaking, is caused by rogue cells of your own body. Our whole body is composed of cells, tiny building blocks with specific functions that work together. When a few cells decide to do their own thing, it is like a mutiny. I recently watched Guardians of the Galaxy 2. *Spoiler alert*. When Yondu’s crew was overthrown by Taserface, they killed all of the loyal crew mates by tossing them off of the ship into the vacuum of space.

Taserface was like a cancer, turning the formerly good crewmates against Yondu.

If we keep with the cancer analogy, what would have then happened is the newly corrupted crew members would have started multiplying and forming new corrupt crew members like that agent in the black suit with the earpiece in the Matrix. Eventually those crew members would multiply beyond capacity, use up all of the resources, food and water on the ship, and everyone would die.

The way that chemotherapy works is that it targets the cells that replicate quickly.

Cells that rapidly divide and multiply use certain building blocks that chemotherapy and radiation can target and attack. Hair follicles have rapidly dividing cells, which is why people lose their hair during chemotherapy.

There is also a component of cancer that results from a deficiency in eliminating malfunctioning cells. Let me try that again. When cells don’t function well, there are proteins that are supposed to cause those cells to die. It’s like a gardener who pulls up weeds and prunes rogue branches on bushes. If the gardener isn’t working well, parasitic weeds can overgrow and overtake the whole garden. Good luck to your delicate herb garden when big chunky weeds go unchecked.

The weed analogy gives the visual, but just to reiterate, the cancer cells are not foreign. They are cells that were at one point functioning normally in your body who just decided for one reason or another to malfunction.

Okay, now that that we’ve gotten through that, (did you read it? Go back and read it. It’s interesting, I promise) we can get into the cancers that you should never get if you follow my instructions.

 

via GIPHY

 

I’m not claiming to be able to stop cells from randomly and spontaneously going crazy. I am claiming that you can catch those rowdy, rabble rousing, troublemaking cells before they become cancer AND you can not PROVOKE certain cells to wile out! (To wile out means go crazy for those who don’t know.)

Cervical Cancer

Cervical cancer is like a freight train that you can see coming from miles away. But here is the catch: Instead of being able to see that freight train through the barrel of a telescope or binoculers, I can see it through the barrel of a speculum with a Pap test.

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Yep, I use a speculum and a swab to take samples of cells from the cervix. Those cells ring train crossing bells in the pathology lab that tells me to tell you that cancer is coming. Those bells allow me to tell you what is happening on your cervix WELL before you get cervical cancer.

Is that the only way?

The short answer is YES.

YOU can almost never see, feel, smell, taste or know about cervical cancer before it happens. It is a microscopic change that happens almost universally as a result of HPV exposure. Even with the HPV vaccine, a woman can still contract this virus. The vaccine helps reduce exposure though, don’t get me wrong. Even condoms don’t eliminate exposure to this virus. EVEN if you are abstinent and never, ever, EVA had sex, there is a small percentage of cervical cancer that occurs spontaneously. It occurs slowly, though. Very, very slowly.  Go see your gynecologist and get your Pap test and you will, almost certainly NOT get cervical cancer.

Colon Cancer

It is National Colon Cancer Awareness Month. I am going to send this to topic over to my better half, Dr. Ed McDonald of The Doc’s Kitchen, as this is his specialty. I will say this small piece, though: Colon cancer is a lot like cervical. Those cells start changing slowly and can often be caught well before they become cancer if you get your colon cancer screening- your colonoscopy. That screening should start at 50 years old for many, at 45 years old for African Americans, and for you, 10 years younger than your closest relative was if they developed colon cancer. Take it away, babe.

 

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It’s a stool. Get it? He’s a Gastroentereologist…

 

Lung Cancer

Sure there are circumstances, like asbestos exposure, or exhaust or other environmental and work exposures that can increase lung cancer risk, but you all know what I plan to cover here: SMOKING.

Yes, those little monsters are like whoever that was that Roberta Flack sang about: Killing you softly, only there is no song. It has been the goal of the TRUTH campaign for years to reveal the dangers of cigarettes, and cigarette use has gone down. Horray!

Don’t worry, doc. I just use a Vape Pen.

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Well, my friends, congratulations on not inhaling the carcinogens (cancer causing ingredients) of traditional cigarettes. Unfortunately e-cigarettes have a whole host of carcinogens of their own- formaldehyde being a big one. The jury is still out when it comes to how and what components of e-cigarettes may affect your health, but we know that in addition to cancer-causing formaldehyde, the lung disease Bronchiolitis Obliterans, or popcorn lung is caused by diacetyl, an ingredient in some vape liquids.

The chemical can cause a dry cough that won’t go away. It also causes shortness of breath, wheezing, headaches, fever, aches, and other health problems. The vapors also can irritate your eyes, skin, nose, and throat. Here is the reference.

We may not have the full story until 10-15 years from now. This is especially scary since teen vape use is spreading like wildfire (no pun intended).  If you are a user of a Vape pen or any other electronic nicotine delivery system, at least check out this website by the FDA to make sure that yours meets safety regulations, that you aren’t charging it improperly and that the liquids you are using are reporting the ingredients properly.

In conclusion…

Any cancer can sneak up on you, but the ones above sneak about as well as my toddler, who runs like an elephant and yells “Moommmyyyyyy!” all of the way down the hall. Don’t be surprised by a cancer that you can possibly avoid or prevent.

 

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Okay, this is creeping me out.  But think of it like a cancer you want to avoid and RUN, to your doctor (and away from smoke).

 

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Bringing Your Teen To The Gynecologist: When to do it and what to expect

One question I often am asked is “Doc, when should I start bringing in my teenaged daughter?” The mother continues,

She is fifteen. I’m SURE that she isn’t sexually active but she can be quite a pill during her period.

My answer: Yes. Bring her in. There is no age cut off for most gynecologists (the youngest patient I have seen was 10), and the visit covers a myriad of topics (sexually active or not) and questions.

A big benefit to bringing girls in early is they have a trusted resource besides Google and their friends.

Let’s review what to expect during a gyn visit for a teenager.

  • First she will get triaged by the nurses, this includes a blood pressure and weight check, and a general review of any medical concerns or issues she may have.
  • Although every doctor is a little different, the guidelines do NOT recommend a pelvic exam unless the patient wants an STD test, has pelvic pain/ discharge, or has another complaint that requires an exam.
  • Most of the visit is a counseling visit when they come to see me. We discuss any concerns they may have, questions about myths they have heard online or from friends.
  • We review the recommendations for vaccines (Gardasil, meningitis, flu when applicable).
  • Sometimes during our chat, it becomes clear there may be a menstrual issue that we can address to help improve quality of life.

emmanuel-bior-563567-unsplashSpeaking of menstrual issues, did you know girls are still missing school because of bad periods??? In some households, pads/ tampons become too costly. It pains me when I hear what some of these girls suffer through. Parents, an easy way for you to gauge if your daughter’s cycle is too heavy is if she is bleeding through her clothes and sheets at night. That means her flow is TOO heavy.

What can we do about it?

Well, one option to decrease the amount of blood loss is to start birth control. No, birth control does NOT increase sexual activity. Nor does it give a girl the green light to have sex. There is virtually no correlation between using birth control and sexual activity. A young girl’s quality of life can dramatically improve because of either the pill, or the depo provera shot or really any form of birth control. It does NOT affect future fertility either. Check out my previous article about this very subject for more information.

sharon-mccutcheon-580064-unsplashAny teenage girl that seems to be struggling with her menstrual cycles should definitely come in to be seen.

All teenagers should see their gynecologist at least once a year if they are sexually active, and every 12-18 months if not.

It can help tremendously to diminish the nerves and anxiety surrounding the gynecologist. It also helps foster a trusting relationship between the teen and he doctor so if she needs something and is too embarrassed to ask her parents, she has someone to turn to. We want your these young women to be as safe and healthy as they can be, just like you.

When in doubt, bring them in!

 

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Too cool for school. Wait, stay in school, lol

 

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Deodorant: To stink or not to stink. Five things you should know about deodorant as a woman.

Deodorant is a regular use item, or at least it should be (in my opinion.)

If you are natural, that’s great, but natural smell is often synonymous with straight up funk! So we learn as we approach puberty, or maybe even before, that every shower should be accompanied by a deodorant or antiperspirant of some sort. If not, you can pretty much count on sitting alone in the lunch room after PE.

In recent years there has been a concern with the use of aluminum containing antiperspirants when it comes to breast cancer risk. In fact, as I type in aluminum deodorant in my search engine, one of the first thinks that comes up is “aluminum deodorant risk.”

Dr. Google Strikes Again

But, the question has value and the results are interesting. The first thing I want share is that there is a difference between deodorant and antiperspirant. Sidebar: I am actually going to include five points in this post, unlike the vague five of my last post. It was still a great post though…

  1. Antiperspirants contain ingredients like aluminum salts that block the sweat ducts and prevent perspiration. Deodorants absorb wetness and neutralize odors. If you choose a deodorant over an antiperspirant, you should be prepared to “pit out” in stressful situations because you WILL sweat.

If you prefer an antiperspirant I would like to share some concerns about aluminum antiperspirant use that have been challenged.

What concerns have been disproven:

2. Aluminum does not cause breast cancer. The initial concerns were not founded or replicated in research on the subject.

3. Aluminum does not cause Alzheimer’s disease. The research in that space was also not reproduced in enough data to demonstrate a correlation between aluminum and Alzheimer’s.

4. Aluminum salts in antiperspirants are not absorbed into the skin or blood stream to any significant degree. These salts form a chemical reaction with water in the duct and block the actual sweat duct where applied. For those who think that we humans should sweat, feel free to sweat in other areas of your body. Under the arms where odor is likely to form? I’ll pass.

But there are concerns with any commercial skin care product that you should look out for.

Parabens have some estrogenic qualities, though not conclusively linked to breast cancer. I try to avoid skin products containing parabens for myself and especially for my children. Few antiperspirants contain parabens but it is worth checking the label, especially in adolescents.

5. Natural deodorants exist as well. The Environmental Working Group is an organization that has closely scrutinized thousands of products and rated them based on ingredients and manufacturing practices. They have a whole section on deodorants here. 

Since becoming a mother of three, I find that what I put on my skin and under my arm pits gets a higher level of scrutiny. There is nothing like motherhood to level up a baseline level of paranoia. (No shade to the ladies without kids. You have the right to be just as paranoid as I am.) I appreciate the results of this investigation giving me license to be de-funkdafied (#dabrat) in peace. I don’t want to put my kids or my co-workers at risk of a nasal offense if I don’t have to.

My sons still have aluminum and paraben free deodorant. Somethings may never change.