Are you having a C-section?

The though of having a C-section can be very scary, but not if you are WELL PREPARED! If your first C-section was an emergent C-section after a failed trial of labor, your planned section will be a much different and hopefully MORE PLEASANT experience.

We use SPINALS for C-sections.

What is an SPINAL? It is ONE SHOT (!!)  into your back and the local anesthetic is injected directly into the subdural space. To get a spinal, you're in sitting position and your back is cleaned. The numbing medication feels like getting the flu shot at your doctors office. The spinal med is injected and within 5 seconds, your legs get warm, tingly and numb. You won't be able to move your legs for couple of hours.

The risk vs benefits of a spinal are SOOO LOW. The risks involved are the same as with Epidural (see previous post). The drop in blood pressure is more dramatic with spinal because onset is so much faster. With the drop in blood pressure, you may experience nausea and vomiting but it is easily treated. The risk of a high spinal, where your diaphragm and respiratory muscles are weakened, is also higher with spinal than epidural. As long as you have supplemental oxygen and your pulse oximeter is reading normal, you are fine!!

LASTLY, I always advise my friends to watch one C-section video on youtube. Once you have your spinal and you are comfortable, the operating room team will allow dad to come inside (must wear disposable scrubs, hat and mask!) to sit next to you.
If you go into the operating room knowing what to see and expect, you will be less nervous. Don't worry, you will not allowed to look over the "blue drapes" to watch the actual C-section!

GOOD LUCK!

Should I get an epidural?

YES!!! Absolutely!! Rest as much as possible, while you can!

I spent the day on L&D, and thought this would be the perfect entry!! ALL my patients were jumping off the wall anxious today, so in the hopes of alleviating others' fear, here is my post on epidurals.

What is an EPIDURAL? Epidural is used for laboring patients. The skin on your back is numbed up with local anesthetic (feels like a flu shot) & the epidural needle is placed (don't worry- you don't see it). When your anesthesia a provider (M.D. or CRNA) finds the right (epidural) space, a small, thin, super flexible catheter is placed and the needle is taken out. You will receive continuous epidural meds through the catheter until the baby is born and then the cather is taken out.You will be numb from your bellybutton down but will be able to move your legs. Strength in the legs will be decreased, so you will not be able to walk around. Takes about 10 minutes for the effects to fully set. You might have heard of a "walking epidural", but for liability issues, no L&D will allow you to walk around with an epidural. You may be TOO COMFORTABLE so that you may not feel the need to push when you are fully dilated. Your anesthia provider (M.D. or CRNA) can decrease the dose so you are able to FEEL the contractions more.
If you need to get a C-section after a trial of labor, a much stronger med is given through the epidural cather and it can be used for the Section.

When can I get an epidural? ASAP! Sooner the better (from the point of the anesthesiologist). Especially if your ob is starting Pitocin. The recommendation used to be 1-2L of IV fluids before epidural or spinal, so the nurse will put in an IV and give you fluids before calling the anesthesiology. Now its recommended to "co-load" instead of "pre-load".

It's OK to be nervous! My birth plan was: HAVE A HEALTHY BABY & GET AN EPIDURAL.
 I place epidurals for laboring patients ALL THE TIME. BUT when it was my turn to be the patient, I was still a LITTLE nervous. JUST a LITTLE.

NO, an epidural: 

• DOES NOT harm the baby
• DOES NOT slow the progression of labor
• DOES NOT cause nerve damage
• DOES NOT cause back pain

Risks involved:

• bleeding (but not any higher than with IV placement)
• infection (but not any higher than with IV placement)
• headache
• incomplete relief

Waiting for my epidural

Emilia, less than 12 hours old! 

The right time to become a doctor mom

In doctor life, you are always waiting for the right time to....

The Right time to:

- get married

- buy a house

- have a BABY!

There really is NO right time for a baby. You find yourself justifying why you're NOT doing something... no money, crazy work hours, too young, want to graduate first, want to finish residency/fellowship first, want to secure a great job first, want to buy a house, want to travel, and the list goes ON and ON and ON!

In retrospect, med school was probably the MOST IDEAL time to have a baby in regards to having time. When I think back, I had so much free time.  I only had class or rotations for part of the day so much of the day was free to do things like nurse, pump, sleep, eat (& of course, study!). Even a full day of school is less hours than a full day of working in private practice.
I was so young in medical school.  I might have had the TIME for a baby, but I did not have the emotional intelligence to have one back then. We were pretty immature back then! 

I got married my last year of medical school and had my son during my last year of residency. My husband and I always went back and forth on when to have children. We didn't want to be older parents, but we also had so many things we wanted to do before we had children (travel the world!). We thought it would be ideal to have our first child after I finished my training (to be financially responsible), but plans changed. Now that I look back, having a baby during residency was the BEST EVER!! My attendings were able to give me breaks to pump throughout the day. There were enough of us moms in the department that there was also a designated pump call room! I was guaranteed a morning break, lunch and afternoon break. I loved the other residents in my class and we were there for each other through our baby struggles.  Almost all the girls in my graduating class had babies in their last year! I was also mostly done with overnight calls so I was home most nights and weekends!! The only bad part is that there is no paid maternity leave. You can take as much as you need, but to be board certified in your specialty, you are required to have "x" amount of weeks of training. This means if you take off 12 weeks for maternity, you will be graduating 12 weeks later than the rest of the physicians in your class. I wanted to graduate on time- my program had a policy where if you worked holidays, you got one extra vacation day.... so I worked all the holidays to get 2 extra weeks of vacation my last year.  I rolled over a vacation week from the year before and was able to get a total of 7 weeks of vacation which I used as my maternity leave.

Private practice is the toughest place to have a baby! Yes, you're making a lot more money than as a trainee, but a busy practice makes it tough to find proper pump breaks & a place to pump, shortage of physicians makes it tough to take a prolonged maternity leave (unless you are lucky), paid maternity leave is unheard of (some practices may offer partial pay). You don't have an attending advocating for you, so you are fighting to get out of the radiation cases, laser cases, ortho cases, etc.while pregnant and fighting to get pump breaks later.  In private practice, you are also ON CALL ALL THE TIME! In terms of childcare, this means you need to find someone/someplace that will also be ON CALL FOR YOU and your child in case you got stuck at the hospital and couldn't come home on time for your child. I was able to get 12 weeks off through FMLA- which was WAY better than the 7 weeks I got the first time.

You'll never really be prepared for pumping at work, sleepless nights, the messiness, piles of laundry, & endless diapers changes. JUST DO IT! It will change your life, but it will be the most joyous change in the world. Pregnancy& labor DOES get physically tougher the older you are, so DON'T WAIT! AND GET AN EPIDURAL!!!!

The complete list of ESSENTIAL BABY ITEMS

for my preggo ladies.... THE ONLY THINGS YOU WILL NEED FOR YOUR BABY!!

1. Stroller

2. CRIB/BASSINET/PACK N PLAY ($100-$200)

Arms reach Cosleeper-  It was key during those early months when she was up every 2-3 hours. I could sleep next to her and I knew all her needs before she even cried.

She outgrew it at 4 months and we moved her into a Pack 'n Play by our bed.

3. Baby carrier (Ergo, bjorn, k'tan, moby wrap, hip carrier)- Love the Ergo (see previous post). Henry LIVED in this for the first year. 

4. BATHTUB 
Any baby tub will do! I don't have one that I feel strongly about. Sorry! This is the one we have. Works well for us!

5. CHANGING TABLE- $
You will be changing your newborn approx 10 times a day!! Save your back and instead of bending over all day long, have an area dedicated to changing- No need to get a fancy changing table. I just secured a changing pad to the top of my dresser with no slip cover, and put an organizer next to it stocked with diapers, wipes, lotions/creams ready to go! Also get several changing pad covers because you WILL have poo explosions!!!

6 BOUNCE CHAIR/ SWING

Fisher price has a very popular series- the "My Little Snug-a-" series. We used the snugabunny bouncer and swing with both kids. 

7. DIAPERS- Believe it or not, we cloth diapered with Henry! I LOVED it. Super SIMPLE and never had any diaper rashes! I would cloth diaper again with Emilia if our apartment had Washer/Dryer.

8. DR BROWN BOTTLES- Henry never really took to bottles. Emilia is more receptive to it. Girl Loves to EAT!! These decrease the amount of air the babies swallow when they drink milk. More parts to clean, but it's not that bad. I'd rather clean more parts than have to burp a baby for like an hour. BURPING AN INFANT IS THE WORST. 

9. KIMONO STYLE ONESIES- It is a PAIN to put a baby's head through the opening of a tshirt/jumpsuit. One more thing you DON'T want to worry about is irritating the umbilical stump. Most onesies have buttons or zippers down the front & you have to pull it on over the baby's head. The  kimono onesie go on like a jacket, AND they don't irritate the umbilical stump.

Love the disney onesies. ALL of them have 2 sets of snaps at the bottom so they can grow with the baby. 

10. BREAST PUMP & ACCESSORIES- Keep a spare set at work in case you forget to bring them one day.

11. MY BRESTFRIEND NURSING PILLOW