Baby catching up: 31 weeks and the hospital tour.

[rivka]

I'm 31 weeks pregnant. My due date is nine weeks away.

I feel as though I've grown noticeably in the last week. My belly now starts with a hard ridge about two inches below my sternum, which is high enough that leaning forward in a chair leaves me gasping for breath. Tying my shoes has become an adventure.

It's much easier to tell how the baby is lying these days. Right now she's head-down with her feet wedged up under my right breast and her hands near my left hip. She consistently seems to hang out on the right side of my body. She's kicking a lot, which usually isn't painful (unless she gets her aim just right) but is certainly strong enough to arrest my attention.

My cold is awful, but pregnancy still feels pretty darn good. I don't mind the fatigue and the decreased mobility at all - I'm perceiving them as parts of a normal process, so they don't worry or frustrate me. Yet. Honestly? I thought pregnancy would be much worse than this - much more uncomfortable and, given my orthopedic history, possibly disabling. So I feel incredibly lucky to be almost at eight months and still doing well.

Since my last long baby post, we toured the hospital where we're going to deliver and had our fourth childbirth class. (I'll talk about the class in my next post.)

The hospital is a private community hospital affiliated with the University of Maryland (where I work) and run by the Sisters of Mercy, an order of Catholic nuns. It's a five-minute drive from our house - just across the street from the alt.polycon hotel, for those of you who were there. They've positioned themselves in the community as specialists in women's health, so they have a 5-star obstetrical service - including a Level IIIB NICU, which we will not need but which is the second-most-advanced level of neonatal care that there is.

The tour started with admissions procedures - where to park, which entrance to use at which hours, how to check in and get to labor and delivery, all presented in extreme detail. Key thing to remember: anyone visiting the L&D floor or the mother-baby unit must have a photo ID. (saoba, do you have one even though you don't drive?)

We visited an L&D room, which was surprisingly large and decorated in a late-80s motel style. There was plenty of room for several people to move around, and plenty of room to labor outside of bed. All the scary medical equipment was packed away in cupboards. The room had a birthing tub, which I had envisioned as being in the middle of the floor but turned out to be in the bathroom. That seems awkward - and crowded, if you're planning to have a water birth and have the midwife and doula and father all hanging out by the tub. Apparently only two of the L&D rooms have tubs, but they save them for midwife patients and it's usually not a problem to get access. They have birth balls and mirrors, but if you want music you need to bring a player from home.

Good things: every time the L&D nurse mentioned care providers, it was always "your doctor or midwife." (Obviously, midwife care is a big part of the service, which is not typical for a U.S. hospital.) She cautioned us to make sure we bring a robe and slippers, because "your doctor or midwife will probably want you up and walking the halls." (Many U.S. hospitals still encourage women to labor in bed.) They have a patient kitchen, including a fridge and microwave, and we're encouraged to bring snacks from home. (Many U.S. hospitals forbid women to eat or drink during labor, in case general anesthesia is needed for an emergency C-section.) They have sandwiches and so forth on hand 24 hours, in case you deliver after the hospital kitchen is closed. (My mother said she once delivered at 5pm, missed dinner, and wasn't given anything but Jell-O until sometime the following morning.)

You stay in L&D for about 2-3 hours after you deliver, while they make sure you're not going to bleed to death, and then they move you down to the mother-baby unit. The mother-baby unit has all private rooms, with a standard hospital bed and a recliner that converts to a cot. (UK readers: not a crib for the baby, but a narrow bed for the father.) Their standard arrangement is 24-hour rooming-in, although you're allowed to drop your baby off at the nursery for a few hours if you want to shower or get some uninterrupted sleep. When you first arrive on the unit they take the baby to the nursery for an exam and testing, but parents are allowed to go along if they like.

For an uncomplicated vaginal delivery, the standard hospital stay is 48 hours after delivery. Uncomplicated C-sections get a 3-4 day stay. The nurses are all very hyped on postpartum education, and encouraged us to see the hospital stay as a time to learn about baby care and get supervised experience with things like baths and cord care. Professional lactation consultants make rounds twice a day, and in the interim many of the nurses are trained in breastfeeding support. They don't give breastfed babies formula, sugar water, or pacifiers.

They have ridiculously elaborate security precautions. Immediately after the birth, the baby is tagged with an alarm bracelet and anklet. Mom and Dad get matching bracelets to show who belongs to the baby, and can't access the nursery without having their bracelets scanned and matched. Visitors have to leave a photo ID at the desk, and can only come up three at a time. If the baby is removed from the mother-baby unit, or even comes too close to an open elevator, an alarm sounds and security personnel descend immediately. Have they ever had someone attempt to steal a baby? No, but they say that you can't be too careful.

In general, I was very pleased. Our midwives had already said good things about Mercy, so I knew it wouldn't be awful there, but I am pleased to know how many of the things we would have requested are already standard practice there.

Comments

[minnehaha.livejournal.com]

I'll bet the "bring your own player" is because so many women spend all this time picking out the music they want to labor and give birth by, but then end up requesting that it be turned off when they are actually in the experience. The hospital knows this.

Not sure where your "many US hospitals" info comes from. I was certainly encouraged to be up and walking when I gave birth at a small-town hospital in rual Minnesota in the 1970's.

The old standard of a week or two in bed in the hospital (discredited even when I was having my babies) was in part to give the new mom lessons in baby care. All the post-delivery nurses I ever dealt with were very good at their jobs, everything from sitz baths to getting started nursing.

With my first one, it helped that I was the only patient in Maternity for 2 days after giving birth. I stayed three days, then, I think.

K.

[rivka.livejournal.com]

Not sure where your "many US hospitals" info comes from. I was certainly encouraged to be up and walking when I gave birth at a small-town hospital in rual Minnesota in the 1970's.

Since then, continuous electronic fetal monitoring has become the standard of care in many places. You can't move around very easily when you're wearing a fetal monitor. Hospitals with high epidural rates also tend to be organized around the assumption that mothers - even those without epidurals - will be staying in bed.

[riarambles.livejournal.com]

FWIW, from what I have seen, the hospital I work at (as an interpreter, so I only see a very specific subset of laboring mothers: those that speak Spanish and are in labor when I am on call) seems to keep all women on the fetal monitor the entire time they are in labor.

[rivka.livejournal.com]

I'm not surprised, but that's a Bad Thing for two reasons:

(1) It keeps women in bed, which can slow down labor and make contractions more painful.

(2) Continual use of a fetal monitor sometimes leads to a baby being identified as "in distress" when in fact nothing is really wrong - it's just a momentary blip in the heart rate. So sometimes the fetal monitor leads to unnecessary C-sections.

[riarambles.livejournal.com]

I'm actually aware of those two problems, which is why I was having my doubts about delivering there (if I were pregnant in some imaginary future). However, I was talking with a midwife today while I was there, and she said that they often do not require constant fetal monitoring, and that the few deliveries I've been there for have probably been high risk for one reason or another. So. I feel better about it now.

[kcobweb.livejournal.com]

The Electric Baby has shifted I think, but I don't have a good handle on what parts are where. She's turned into the proverbial octopus, with limbs everywhere.

Our hospital has birthing suites, where you labor, deliver and stay in the same room, with baby the whole time (they will take her away briefly for tests at some point). They do look exactly like a hotel room, albeit one with medical equipment tucked into the corners.

When we talked to our doctor at my last appointment about delivery, she was adamant that we will be able to call all the shots as far as what we want/don't want. She said "It's *your* birth experience." Have I mentioned that I adore my doctor?

[rivka.livejournal.com]

Are you putting together a birth plan? I'd love to compare notes.

[beckyzoole.livejournal.com]

Sounds great! I am surprised that they encourage eating during labor; I suppose if a woman does need an emergency C-section they just use NG tubes and so forth as they would with any other emergency surgery.

Those elaborate security precautions are all too common now. Two friends of mine had babies last year, and both hospitals had similar security set-ups.

Baby in nine weeks -- so exciting!

[ailbhe]

Most emergency c-sections don't need a general anaesthetic, which is the main reason they give for not allowing people to eat. So although emergency c-sections are quite common, it's very very rare for whether or not the patient has eaten recently to be a problem. That's how I understand it, anyway.

[wiredferret.livejournal.com]

Although I will say that there are non-general anesthetic reasons you might /regret/ eating.

[rivka.livejournal.com]

So I hear. I'm thinking of planning to stick to clear liquids.

[ailbhe]

FWIW, by the time I threw up, I hadn't been able to eat anything for several hours anyway. The hospital fed me melon, because it's light enough to be easy and food-y enough to keep pregnant women from eating the midwives. We brought cereal bars, and I had a lot of those and tea. I tried to eat a yoghurt and couldn't, tried to eat a sandwich and couldn't. If your body *generally* knows what's good to eat, the way mine did, it will probably guide you right during labour. My digestive problems were due almost entirely to IBS and what I felt like eating in labour turned out to be *exactly* the right things.

I'm beginning to feel like most of the "advice" I give people is "trust your instincts and fight for them if necessary".

[saoba.livejournal.com]

I do in fact have photo ID. The security doesn't sound too oppressive in practice, though getting it all explained in a chunk like that must have been a bit weird.

The hospital sounds terrific. I love the default of full time rooming in.

Personally, I did so much walking with my third labor I should have been given a track suit instead of a hospital gown.

As for bringing your own sound system, that's not too unusual. My daughter sent her husband back to the house when it turned out part way through her labor that she had a very strong need for a particular artist that neither of them had expected. The nurses seemed to think that was pretty normal, they just checked her progress and told him to obey the traffic laws.

[telerib.livejournal.com]

Sisters of Mercy! They were responsible for my education from grades K-12. (OK, not every teacher was a nun - heck, most weren't - but they ran the grammar school and high school I attended.) I always thought they were good women.

Glad the hospital meets with your approval!

[ailbhe]

Isn't having your baby with you all the time standard practice in the US? It is here.

Cord care and dealing with a baby girl's first bloody nappy and so on is all a lot easier with someone to hold your hand for it so you can check "Is this the same as what you said was 'normal"?"

It sounds lovely. I hope you have enough visitors that rooming alone is ok - you might even appreciate the quiet! I'm glad you're pleased with it.

[janetmiles.livejournal.com]

dealing with a baby girl's first bloody nappy

Um, what? (Keeping in mind that I have never been interested in having children, so I've never run across this bit of arcane-to-me information.) (And that "um" is not meant as an attack, it's meant as a buffer noise before the question, so it doesn't come out sounding like I'm shrieking at you or something.)

[rivka.livejournal.com]

Creepily enough, the massive onslaught of female hormones babies are exposed to during birth produces certain... effects. Both boys and girls can have swollen breasts at birth, and girls often have a few drops of "menstrual" blood. Freakish, and scary if you're not expecting it, but normal.

Sorry for the TMI.

[janetmiles.livejournal.com]

Huh. I guess I was more or less correct in my hypothesizing, but since it seemed so very odd, I didn't want to verbalize it lest I look like an idiot.

Thanks for the explanation.

[ailbhe]

It *is* odd, and even when you see it, there's a real urge to double-check that it's normal with someone who has seen lots of baby girls. We were quite ok with the subsequent ones; just the first one made us want to check.

[papersky.livejournal.com]

I was under the impression that the starving you thing was instead of giving you an enema, rather than for fear of needing to do an emergency c-section -- but what if they do need to do an emergency c-section? Because if they can't do an epidural, you would need a general. Or acupuncture... I know someone who had an emergency c-section under acupuncture (in Hong Kong), but apparently if you want to have it done in Britain (goodness knows about the US) it's prohibitively expensive and the doctors hate it.

[rivka.livejournal.com]

what if they do need to do an emergency c-section? Because if they can't do an epidural, you would need a general.

One of the illuminating things I learned in class this week is that spinal anesthesia is different enough from epidural anesthesia that it might be possible for me to have a spinal. Apparently, it's a much less tricky procedure that relies much less on everything being placed exactly where they expect. Spinal anesthesia is also immediate, so it can be used for an emergency C-section. So I'm hoping, but trying not to get too excited until I actually talk to an anesthesiologist at the hospital where I'm delivering.

Even for an emergency C-section under general anesthesia, though, these days they pretty much routinely intubate anesthetized patients. If you've been intubated, your stomach contents are highly unlikely to cause a problem. The "nothing by mouth" rule is a holdover from the days before intubation was standard practice.

I'm thinking that I'll probably compromise, and stick to clear liquids during labor. (Less likely to result in vomiting, too, as wiredferret discreetly alludes to.) But I don't want to be entirely without calories - labor is hard work.

[almeda.livejournal.com]

That spinal thing sounds somewhat like the regional nerve blocks a bright boy is trying to talk the US armed forces into accepting as the new standard in dealing with amputations and massive trauma on the battlefield (instead of the current regime of general + morphine later, which hasn't changed since the invention of general anaesthesia).

Details in the current issue of Wired, if you're interested (and it is a VERY interesting article).

[ailbhe]

Digestion doesn't work fast enough, given the normal duration of in-hospital labour, for nil-by-mouth to have the same effect as an enema. Acupuncture sounds great, but I'd be too scared to try it.

[starstraf.livejournal.com]

they may not have had a baby stolen, but some hosptials have, and you try telling a psycho-hormone-pregnant woman "Oh don't worry about that it never happens"

Sounds like a great place - and may we read many more pre-delivery posts (My way of wishing you full term baby)