Though I blogged a bit ago about the AMA (American Medical Association), which many of you  vehemently disagreed with, there is another AMA, I’d like to talk about today—Advanced Maternal Age.  Despite the fact that women are having children later in life, Advanced Maternal Age is still defined in the obstetrical world as anyone over 35 years old.  Women are waiting until they are older to have children for a myriad of reasons: educational or career goals, to be more financially secure, to wait for better economical times to have another baby, or even yet…to find a spouse.   While our lives are changing with the times, so is science.  This begs the question:  Can we now hit snooze on our biological clocks? 

Mainstream media brought this issue of being “reproductively challenged” to light with its physical realities and the emotional repercussions in the ever-popular series Sex and The City.  The disappointment Charlotte went through when unable to conceive and then her multiple rounds of  unsuccessful invitro-feritiliztion (IVF), leading her to her decision to adopt.  Carrie having a pregnancy “scare” and wondering if she would ever be ready to be mother. If not at 38 years old, then when?   Miranda’s accidental pregnancy led her to rethink her life and make the decision that this must be “her baby” because despite her “lazy ovary” since she had conceived against the odds.   All of these scenarios were a battle of woman versus the clock and the women did not have the upper-hand.

I worked for awhile at an IVF clinic where I saw all sorts of stories (many with more plot twists than any TV show).   While it stands to reason that many of the patients were women that were AMA (though almost as often the “problem” was the man’s). There was growing patient population at the clinic for a specific reason: women wanted to freeze their eggs to buy more time from the biological clock, not because they were currently trying to have children.  The quality of a woman’s eggs decreases dramatically after a certain age (related to specific hormone levels).  Freezing eggs while they are still a high quality increases the chance of successful IVF down the road should they later decide to have children.  Many of the women were in their mid to late 30’s who still were single, but did not want to reduce their future childbearing capabilities.  Some were married women who for whatever reason could not have a child at this point in their lives, but knew they wanted more children.

Do you see this as a positive thing that women now have more childbearing options?  Or is putting all your eggs in one petri-dish going too far?

We have had many a good debate on where to deliver your baby, who to assist with the delivery, and what to include on your birth plan.  While not to minimize the importance of these topics, I want to address the ONLY question you need answer when you are in your 3^rd trimester of pregnancy: is my baby moving normally?

While most prenatal providers will discuss the importance of this during your office visits, I cannot reiterate enough that moving babies are happy babies (from an obstetrical sense).  I just recently had a patient come the hospital that was not far from her due date.  She had not felt the baby move since the day before.  When I went to find the baby’s heart rate on the monitor, it was not there.  There is nothing more heartbreaking.

Though there is a laundry-list of questions we will ask you when you call the hospital for an advice-call, the most important will be: Is your baby moving normally?    What does this mean?   Each doctor, midwife, or facility will give you what they want as their “prescribed” number of movements in a specific time frame.  A commonly used protocol is 10 movements in 2 hours.  What is more important is if the baby is moving normally for what you are accustomed to.

If you are uncertain of whether or not you have felt your baby move because you have been busy or preoccupied, you should lie on your left-side in a quiet room with your hands on your belly.  You should be paying attention to feeling the baby move.  Do not watch TV or engage in other distracting activities.

If you do not feel your baby move, or are certain you have not felt the baby move, you need to contact your provider or go to your hospital immediately.  Please discuss with your doctor, or midwife at your next appointment what guidelines they would like you to use for assessing normal fetal movement.

Remember, although sometimes it may seem like an important question—What color are we going to paint the baby’s room?  The most important question is always—Is my baby moving normally?

What concerns did you have most during your pregnancy?

A lot of your probably saw the movie “Knocked Up” where Katherine Heigl’s character, Alison, is screaming for “her doctor” in between panting through the contractions.  Her boyfriend, Ben, goes to great lengths to try to reach her doctor who is out of town the evening she goes into labor and of course, all sorts of comical tragedies ensue trying to find someone who can deliver the baby in a pinch.  The movie was quite funny and probably those you heard laughing the loudest in the theater were someone who worked in labor and delivery (or perhaps someone recently knocked up).

 Before I worked in labor and delivery, I always thought I would want a private-practice doctor or midwife, in other words, “my doctor” to deliver my baby.  These were what I perceived to be the advantages. He or she would:

·         Know my medical and previous birth history more thoroughly

·         Have heard my Birth Wishes

·         Have a comfort level with me and my family from prenatal visits

These things seem to be an obvious advantage, right?  What I did not know were the disadvantages to having “my doctor” (or midwife) versus some of the benefits of delivering at a facility that uses staff, or “in-house” providers. These doctors or midwives deliver whoever comes in, regardless of who they saw in their prenatal visits.  How could this possibly be better, you ask?  The first time I had a “personal doctor” tell me “I have a dentist appointment, try to keep her from pushing,” I realized that I would want an in-house provider.  Let me tell you:

·         A provider who is at the hospital regardless of having “their patients” in labor has no agenda

·         You are less likely to “rushed” or “pushed” (no pun intended) into things you do not want

·         There is no “golf-game” to get to; they are there for a set amount of time whether you deliver or not

·         I believe you are more likely get the delivery you desire under these conditions than with a doctor who is missing office appointments to come deliver your baby

I know it is disturbing that these should have to be considerations at all when deciding on a facility or provider, but the reality is that these things do affect the management of your labor and your delivery experience.

Does anyone feel their doctor or midwife’s agenda affected their delivery?

There have been a lot of comments regarding statistics I have referred to and also a lot of inferences about the interventions that take place during hospital births.  This got me thinking: How can I let readers know it is not as bad as they think? Well, I acquired some data of my own and it is about as recent as it gets—June 2008 statistics.  These are numbers from a local hospital that did almost 250 births in June. Percentage of deliveries:

·         Without an any anesthesia :  51% (Yes, over half!)

·         With an epidural: 36%

·         Inductions: 17%

·         Augmentations (use of pitocin after admitted for labor): 34%

·         Assisted vaginal deliveries (i.e. vacuum or forceps): 8%

·         C-sections: 33%  (includes elective repeats)

* You cannot have an elective FIRST c-section at this facility. There is the option of an elective REPEAT c-section.  This has been the policy at the 13 different facilities where I have worked (East Coast, Midwest and West Coast). This is contrary to the Hollywood myth that anyone can have a c-section whenever they want.

Though others may argue, I find these to be reasonable numbers.  This is from a hospital where midwives are not used , which I believe means it leans overall towards a more interventionist approach.  Not bad stats nevertheless, especially since it is a high-risk facility.  

 Are these numbers you would have expected?

When I work with first-time moms in postpartum, sometimes they find themselves on the verge of pulling out their hair when they have what we call a “vigorously” crying baby who cannot be soothed by anything.  Moms are frustrated and perplexed; the baby is fed, changed, held, has been sung to, and still he cries….no,make that screams….non-stop.

What is a physically exhausted, emotionally drained, sleep-deprived mom to do?   This is where my advice, both literally and figuratively is: Step Away From The Screaming Baby.   At the hospital this might mean asking your husband or nurse to watch the baby, or at home may mean putting the baby in the crib and closing the door.  This does not make you a bad mother.  On the contrary, it makes you a good mother.  You cannot be a good mother if you are about to have a meltdown.

Now, when I say this is also figurative advice, what I mean by this is that this not only applies to the idea of your baby literally screaming.  When my head is reeling with all the things I need to do, or when I am feeling like a failure and am overwhelmed with all the “screaming” and noise that life can sometimes project, I often tell myself: “Step Away From the Screaming Baby.”  Whether this is an issue at work, a fight with a significant other, excessive traffic when you are late, a screw up with your bank account—yet again, or burning the dinner you spent all day making.  Walk away for a minute.  Take a deep breath.  Think about what is happening.  A step back definitely allows you to take two steps forward when you head back to the task at hand.  You will probably find that the baby has settled down when you return.

What do you do when you need to step away when your baby won’t stop crying? What other things in life seem to be screaming at you and what do you do to step away to keep from being overwhelmed?