{new #OutsideTheMomBox post} Touring The Birth Place at #Duke Regional Hospital - Part II

In this post, we continue where we left off and will tackle what happens from delivery to discharge. Part I of this post was published here.

After you have delivered your baby, you will spend only about 2 hours in your labor & delivery room. Then onto the mom & baby rooms. Before that your nurse will help you get up at some point and use the bathroom. At Duke Regional, the labor and delivery rooms are separated from the mother and baby rooms by the nursery. It's a nice quick jaunt to get from one to the other. However you'll likely be in a wheelchair. If you delivered vaginally, you may find yourself to be ravenous (I was!) and you are encouraged to eat. Your IV will be removed. If you delivered via csection, it will be a slower progression to get to foods but the goal is to get you back on a regular diet. 

This is a L&D room from the 1960's. Thanks News Tribune Attic for this photo.

Once you are in your new room, you can expect to stay there for 2 nights if you delivered vaginally or 3-4 if you delivered via csection. It is your right to leave after 24 hours but this is discouraged for many reasons, not least of which is due to helping you figure out breastfeeding. An IBCLC at Duke Regional will come after the first 24 hours because after the first 24 hours is when a feeding challenge might show up and because newborns are super sleepy in the first 24 hours so may not be as interested in feeding. These rooms are private and simple, not fancy. They don't offer much in terms of comfort for your partner i.e. there are "reclining chairs" not a sofa for them to rest on. There were be pretty regular interruptions as staff come in to check on your and baby's vitals but they will try to be mindful of your rest. The nurses will teach you how to swaddle, diaper, bath baby and also help with breastfeeding. They will likely show you the movie "The Period Of Purple Crying" and perhaps offer a copy for you to take home or...share with your nanny or other caregiver. Circumcision, if you have decided to go that route, can happen anytime but like the hearing test, baby will be removed from the room for this. The newborn screen includes a bilirubin test as well as the hearing test. Finally, the carseat will need to be brought into the hospital on the last day of your stay. You cannot leave the hospital without a carseat so my guess is this extra schlepping is simply to prove you have one.

A couple of other miscellaneous bits of information:

• If you do't have a breast pump, you can buy one at the gift shop at Duke Regional with a 35% coupon that comes in your tour packet. I advise checking which brands they stock and the price. THEN comparison shop a bit at places like Buy Buy Baby or somewhere similar to make sure you are getting the best deal.
• There are options for photography in your room, at the hospital, if you are interested in that. It's free, easy and confidential. I've blogged about wishing I had more photos of myself and Elisabeth during the first few days so I think this is just a terrific service.
• There are no set visiting hours at The Birth Place but there is a very strict security system. Your baby gets a little bracelet that, if it falls off or is removed, will alert staff to come and check on baby as well as lock down doors (although perhaps not immediately). 

As always, one of the most important bits of advice I can offer is to make sure that you have good support before, during and after childbirth. That means a birth doula, childbirth educator, postpartum doula and IBCLC. But good support i.e. a birth doula, during labor, increases your satisfaction with your birth. Greater satisfaction with the birth process (feeling heard, listened to, appreciated, understood, comforted) helps decrease the chances of a postpartum mood disorder. 

What have I missed? If there is something you wish I had included here, please leave me a comment below and let me know. Thanks for reading.

To epidural or not to epidural?

When we see a woman in labor in television and in film, she is always in the second stage of labor, or what we normally think of as the pushing stage. [Side note to those unfamiliar: this is the shorter of the two stages but often the more suited to made-for-tv movies, hence it's popularity as The Depiction of what a woman in labor really looks like.] And no doubt this image of a woman working hard, seemingly in horrible pain, to birth her baby has contributed to the fear of childbirth that we have today.  That fear may be one reason why pregnant women can be so keen on getting an epidural.  Ah, an epidural....numbness from the waist down so you can't feel those dreaded contractions. Doesn't that sound fabulous? Maybe. Let's explore a few of the facts about epidurals:

1. Yes, epidurals can numb the laboring woman from the waist down and that can be a huge relief when you are tired and in pain. But what is less commonly known is that epidurals actually lengthen the pushing stage of labor...and by even more than what was originally thought. And a study published last month finds that epidurals are actually associated with a longer labor than had even previously been thought of and as if that wasn't enough, they may also lead to unnecessary interventions by doctors who worry that labor is going on too long.
2. Aside from longer labors, epidurals also prohibit the laboring woman from moving.  That in and of itself is problematic because we know that one of the best things a woman can do in labor is to move and change position. There are a plethora of reasons why it's important for a laboring woman to move but what might not be as obvious is that movement gives a feeling of control to a laboring woman.  It can feel very disempowering and even scary for a survivor of intimate partner violence or sexual assault to not be able to move on her own, and of course this applies to non-survivors too.
3. Epidurals numb the laboring woman, completely. Which means that a woman in labor don't feel the pain of contraction. Again, that can be a blessing but it should be understand that it can also add another wrinkle to your labor.  If you can't feel contractions then how will you know when to push? Yes, your partner or another support person can look at the monitor and see when you are contracting.  They can then urge you to ours at that point but ideally, you want to be following your body's urges to push (spontaneous pushing) as opposed to coached or directed pushing.  This is a great video on the benefits of spontaneous pushing, if that is not familiar.
4. Epidurals will numb the pain but not the pressure. That's an important distinction.  You will be feeling a lot of pressure in your perineum that won't go away until you actually birth your baby. That can be confusing for some first time moms because it basically feels as if you are trying to deliver a baby out of your rectum instead of vaginally! An epidural will not take the pressure away; it will only take the temporary pain of contractions away.
5. Epidurals aren't immediate.  From the time that you ask for one and the time that you are actually in position, an hour may have elapsed. An hour is what expecting parents (and me!) were told on our tour of The Birth Place at Duke Regional Hospital.  More information from that tour is here.  

Epidurals can be a wonderful coping tool for a laboring woman who is too tired and feels the need to recharge a bit from her long labor. But, like everything else, the pros and cons should be appropriately weighed before making a decision as to whether or not to have one. As with so many things in life, it's always better to be better informed in advance, during a childbirth education program for example, as opposed to having to make a decision in the moment.

Moms, did you have an epidural?  Or if you are pregnant, are you considering an epidural?  Leave a comment below.  Thank you for reading.

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