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Birth: the Adventure

So this was all over my facebook this week

Parents Magazine has created a Choose Your Own Adventure for labor and delivery. Which could be great because envisioning different scenarios can be really helpful. But let's take a looksee, shall we?

I'm only going to give a few highlights because I don't want to do a complete spoiler.

"You're 37.5 weeks pregnant and while making breakfast one morning you feel something that comes on gradually and reminds you of a mild menstrual cramp. Just like a menstrual cramp it fades away. You....

A. Wonder if it might be a contraction then decide its probably not-it's just wishful thinking. You still have two weeks to go. Hello Braxton-Hicks! You continue making breakfast and getting ready for work.

B. Think oh my god it's a contraction! Its almost time, it's getting close, it must be the Baby! You go lie down for a few minutes to see if you feel another one."

OK why are we starting our labor visualization at 37.5 weeks? I know, I know labor can start 2 weeks either side of the EDD. Due dates are just a guess anyway. BUT average gestation for a first time mom is 41 weeks 1 day and for mother having their 2nd or later child 40 weeks 3 days.

In a later scenario after arriving at the hospital dilated at 1cm and with broken waters you are given the option to wait and see what happens or to be induced immediately. Even the American Congress of Obstetricians and Gynecologists(ACOG)reccomends AGAINST an elective (non-medically indicated) induction before 39 weeks. This medscape article indicates a wait and see approach is clinically appropriate for at least the 1st 24 hours after your water have broken. (After 24 hrs the main risk is intrauterine infection. This is one reason to avoid vaginal exams if your waters have broken, avoiding vaginal exams may help reduce the risk of infection.) Most women (90%) will go into spontaneous labor within that time.

In the Parents Birth Adventure if you choose to wait then you walk the halls till midnight at which time you're 3cm and your OB is apparently ready to go home. At this point your waters have only been broken for 13hrs! But the OB says you need a cesarean because "you're just not progressing" and he thinks the baby will be "8 pounds plus."

As this article from the American Academy of Family Physicians shows, cesarean section for suspected big baby is NOT Recommended. Estimates of fetal weight are often off by up to two pounds. And 8lbs isn't actually a big baby anyway. Fetal macromsomia is defined as a baby who is over either 8lbs13oz or over 9lbs15oz.

There are a few good things in this scripted adventure though. At one point you are bouncing on a birthing ball and you seem to have freedom of movement throughout labor.

Birthing Naturally has a similar tool on their site.

What I like best about the Birthing Naturally tool is the emphasis given to reflection. After you complete your virtual labor you are asked to answer some questions about the experience.

I think the thoughtful examination of choices can make an imagined labor and delivery a much more significant help for an expectant mother.

Some other ways to prepare for the different courses your labor might take include reading birth stories both online (here's my most recent birth story) and in print and talking to your friends and family. And the most important factor determining how your labor will go is choosing carefully when you choose your care providers.

Here is the page from about choosing your care provider. The way your provider typically practices will probably be the way s/he cares for you too. So it's important to find out up front how s/he deals with situations like going "overdue", breech presentations, labor progress that falls outside the Friedman's Curve and anything else you can think of. You want to know ahead of time what his or her stance is on induction, episiotomy, etc. What is his or her cesarean rate? How do they monitor baby during labor?(continously or intermittently? doppler or fetoscope?)

In addition to your choice of provider you have a choice in where you birth your baby. Each location will have its own section and induction rates. Different hospitals or birthcenters may have different options. One may be set up for waterbirth for instance and the one down the street is not. One may restrict the number of people who can be in the room with you and amother may not?

The only way to find this information out is to ask. Ask providers when you interview. Ask them continously during your prenatal care. Ask friends and family who've used the same care provider. Ask the hospital or birth center staff. Ask childbirth educators and doulas in your area.

(more to come)

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