experience the creature comforts of home during a stressful and painful time, it is common to consider the availability of emergency medicine for you and your child to be the final trump card when making the decision of where to deliver your child.

                What exactly happens during a hospital birth?  Depending on your particular situation, a hospital birth could go in a number of different directions.  Generally, the first thing that will happen Most expectant parents will choose to give birth in a hospital.  Although many mothers would rather when you start labor is that you will call your obstetrician.  He or she will ask you to time your contractions, and let you know when to meet them at the hospital, ideally when your contractions are spaced out by a certain amount of time.  If you have a planned cesarean section or planned induction, you will schedule the date and time with your obstetrician beforehand.

                When you arrive at the hospital, you will be required to fill out paperwork, unless you have pre-registered.  This paperwork will go over your insurance information and your medical history.  You will get an identification bracelet and be moved into your room.  Depending on your particular hospital, this may be the actual delivery room, or you may be moved to a different room for your delivery.  The delivery nurse will discuss your concerns with you, and will review your birthing plan, if you have prepared one.

                Depending on your preferences and the stage of your labor, you will be given the option of wearing the hospital gown, being hooked up to monitors continuously, given an IV, and offered an epidural or some other form of pain relief.  Your doctor will come to check on you. 

                Once your contractions are coming at a rapid pace, and you are fully dilated, your doctor will instruct you when to push, how to breathe, and any other relevant direction you may need.  After the baby is born, he or she will be cleaned up, weighed, and, again, depending on your wishes, given to you or put in the nursery.  Your baby may also be in the nursery overnight, or with you in your room. 

                If the birth goes normally, and it is vaginal, you will stay in the hospital for about two days after the baby is born.  If you have had a cesarean section, four days is normal.  If there are no complications with the baby, you can take the baby home with you when you leave.  

                There are several benefits to a water birth.  It is believed that, for the baby, the transition from the uterus to warm water is easier than the transition from the uterus to open air.  Water births also heavily aid in relaxation for the mother.  The warm water can help to lower blood pressure, and helps to relax the muscles, which helps to ease pain and can eliminate the need for anesthesia.  The buoyancy of the water helps to lighten the body weight, which will help you with repositioning during labor.  The water also helps the perineum become more elastic so the chances of tearing or needing an episiotomy are lessened. 

                As with every option there are drawbacks in addition to benefits.  There have been a few studies about the effects of water birth on the babies and the mothers, but not many risks have been found with high enough occurrence to determine whether the water births themselves or improper monitoring were responsible, namely the potential for the baby to aspirate water.  Proponents of water births state that the baby will not breathe under water so the risk of aspiration is negligible, but this statement does not appear to be based on any sort of research, instead based on anecdotal evidence.  Also, there is a chance that without careful attention, the umbilical cord can become snapped in the water.  Lastly, the water will make it difficult to tell how much blood the mother is losing, thus risking an unrecognized hemorrhage. 

                If you should decide that water birth is something you’d like to explore, check around your area to see what facilities have birthing pools available.  Many hospitals include birthing pools in their birthing suites.  If there are no facilities with pools available, or if you are having a home birth, birthing pools are available to rent for about $300 if you check online

As a new parent, while you wait for your child to arrive, your thoughts are probably preoccupied with daydreams of playing with Baby, nightmares about affording Baby, and careful research about how early is too early to start teaching Baby how to speak Latin/learn violin/play football.  The little things are overlooked, things that do not even occur to a new parent until you are standing there, with Baby, ready to go home, and you realize you have no idea what to DO with Baby. 

                Luckily, you are neither the first nor the last person in the world to have a baby.  There will always be a number of other parents willing to tell you what you need to know.  But first things first: What are the basic things that you need?

ü  The baby needs a place to sleep: for as long as babies have been born, parents have been able to provide them with a safe place to sleep.  You don’t necessarily need a crib, but the current recommendation is to give your baby a separate sleeping place to avoid accidentally rolling over on him or her.  If you are using a crib, make sure that it meets the ever-changing safety guidelines.  Other options are a bassinettes or cradles.  Some people believe that co-sleeping is the most beneficial, but do this cautiously, especially if you drink or have sleep problems like apnea or need to take sleeping aids.

ü  The baby needs to eat: If you will be breastfeeding your child, you may think you are all set; it will be very difficult to leave the hospital without the baby’s food.  However, some baby’s have problems breastfeeding, and some mothers choose not to or are unable to, so don’t make your decision without your baby’s input.  You may need a breast pump, bottles, or formula. 

ü  The baby needs to stay warm: Stock up on sleep sacks, onesies, hats, receiving blankets, socks and a heavy winter coat or snowsuit for those winter babies.  Also consider mittens so your baby doesn’t scratch his or her face.

ü  You will need a lot of diapers and a place to put them: stock up on newborn sizes and the next size up, since babies grow so fast.  Consider getting a covered pail for the diapers, regardless of if you are going disposable or reusable.  If you have pets, this will keep them from sneaking them out and examining the dirty diapers on your living room couch. 

ü  You will need a way to transport the baby:  You will need an infant-sized car seat for the baby in order to leave the hospital.  If you do not have a car seat, make arrangements to borrow one so that it can be installed in the driver’s car before your trip home.  Even if you don’t drive, you will want to invest in a car seat so that your baby can ride safely with you when you are in a taxi or getting a ride from a friend or family member.  Once you are home, consider additional ways to transport you baby.  You  may need a stroller, or you may want to try a baby sling.

If you have chosen to give birth to your child at a hospital, you are probably wondering what you should bring with you when it is time.   A lot of new parents will pack a “go-bag” or an overnight bag for their hospital stay.  Pack this bag well in advance of your due date – you don’t want to be caught off guard, especially if you do not have someone you can have run home for you.

Supplies to bring:

ü  Toiletries

• o   Bring things that you would ordinarily take on an overnight trip, like your toothbrush, comb or brush, something to tie your hair back, glasses and/or contact lens case and solution, deodorant, and any makeup you want to have.  Also, if you are choosy about your hygiene products, you may want to bring your own shampoo, soap, lotion, towel, and sanitary pads.  If you are concerned about nausea, you may want to bring some mouthwash. 
• o   The hospital will provide what a hotel would provide: shampoo, soap, towels, and possibly some lotion.  They will provide sanitary pads for the duration of your stay. 

ü  Clothing

• o   Bring clothes wear after delivery, such as loose pajamas, a robe, socks, and slippers.  Keep in mind that if you will be nursing, you will want clothes that give easy access to your breasts.  Also bring something loose to wear home from the hospital, and loose fitting underwear.  If you prefer to wear your own clothes during your actual delivery, make sure it is something loose with short sleeves.  If you are doing a water birth, you should consider whether you will be comfortable nude, or if you will want to wear a shirt, sports bra, or swimsuit top (your birthing partner should bring water birth clothes as well). 
• o   The hospital will provide a gown and socks to use during labor.

ü  Paperwork

• o   Remember identification, insurance information, a birth plan (if you’ve made one), a list of people to call to and announce your baby’s arrival (or emergency contacts, if you have gone in alone), and pre-registration forms

ü  Other

• o   Snacks, money for cafeteria or vending machines, a pillow from home, books or magazines, music, massage oil, other entertainment for the long labors, and the supplies for bringing Baby home!   
• o   Consider if you want to bring other tools (check to see if your hospital provides them), like a birthing ball or a clock or watch with a second hand for timing contractions.
• o   If you will be bringing your other children to the hospital, they will need to be entertained.
  • §   Many hospitals have televisions in the room, and many hospitals now have wifi for wireless devices.  Beyond that, you may be on your own.
• o   Don’t forget the camera!

Once you have your baby, your baby will need to have a regular doctor to visit.  When doing your research into choosing a doctor for your child, think about the type of doctor you want, the type of care you want, and the availability of the doctor.

                There are two main types of doctors that your baby can see:  Pediatricians specialize in child care.  Family practitioners specialize in treating an entire family, regardless of age.  If you see a family practitioner, it may be the most convenient to start your child seeing that same doctor.  If you want a doctor who has specific expertise on children’s issues, it may be a better idea to see a pediatrician.

                What type of care do you want your child to receive?  Do you want a standard medical experience for your child, where the main reasons for visitations are immunizations, check-ups, and illness?  Or, would you prefer more of a holistic approach, practicing more preventative and natural approaches to growing and healing?  If you prefer a traditional doctor, you should have no trouble finding a one.  If it is important for your child to be treated more naturally, and you have concerns about the effects of traditional medicine, you will have to dig deeper for a family practice physician or pediatrician who practices holistic medicine.  Check with midwives in the area to see if they provide care (be sure to check their licensing) or know of doctors who use this approach.

                Another important consideration is the availability of the doctor.  When researching potential doctors, you should inquire about their availability.  How are after-hours called treated?  Is this doctor in a clinic where another doctor will be on hand if yours goes on vacation?  Will your doctor make house calls in an emergency?  Will you be able to see the doctor with short notice, or will you need to wait weeks before getting an appointment? 

                Remember to do your homework.  If you do a quick Google search, there are a number of utilities available on the internet where you can check out a doctor’s “report card” or read reviews of the doctor’s performance from other patients.  Keep in mind that people generally see the doctor when they are ill, so don’t base your entire decision on patient reviews.  Check out the Federation of State Medical Boards to look into any disciplinary actions involving your potential doctor. 

                Lastly, and most importantly, always remember that doctors work for you.  If you do not feel that your doctor is providing the attention or care that your child needs and deserves, you should look for a new one.   

For gestational diabetes to occur, you have to be pregnant.  Risk factors for gestational diabetes include whether anyone else in your family has developed it (your chances are greater if you have family members who have experienced this), being overweight prior to pregnancy, being over twenty-five during pregnancy, or have high blood pressure.  These factors are easily determined by simple observation or quick testing.  Some more in-depth risk factors include whether you currently have, or have had in the past an unexplained miscarriage, too much amniotic fluid, or sugar in your urine.  These factors require more extensive testing.

When Gestational Diabetes occurs, all the extra glucose in your blood is transferred through the placenta to your baby.  This means that your baby’s insulin levels increase to try to convert the glucose to energy.  Since it doesn’t need all that energy, the extra energy is stored as fat.  A baby affected by gestational diabetes will often be larger than other babies, and will be born at risk for obesity and development of diabetes themselves.  Because of the baby’s size, you run a higher risk of requiring a c-section, and a higher risk of stillbirth.

Gestational Diabetes is normally treated by having you stick to a strict regimen of healthy foods and exercise.  You will have to control the amount of sugar and carbohydrates you eat, and keep your calorie and food intake stable from day to day.  You may be asked to count the calories you eat to determine if you are eating too much.  If your new eating habits along with exercise do not help the glucose levels decrease, you may be put on a dosage of insulin.  Your doctor will also want to do a lot of fetal monitoring to ensure that the baby is developing normally, and is not stressed out.

Gestational diabetes often goes away after childbirth.  The reduction in the pregnancy hormones allows your insulin to work normally, converting your glucose into energy.  However, once you have developed gestational diabetes, your chances of developing diabetes in your lifetime increases, particularly if you are overweight or obese.  Carefully monitor your diet and exercise to reduce this risk.

What is FMLA?     

Family and Medical Leave Act is a United States law that requires companies with more than fifty employees to grant leave for employees who have worked at least 1,250 hours in twelve months.  The leave is up to twelve weeks for, among other things, the birth and care of a child or the placement of an adopted or foster child.  If you and your child’s father are married and both work for the same company, the twelve weeks is split between the two of you.  If you are not married, you are each entitled to twelve weeks.

You are required to provide a thirty-day notice to use FMLA leave. FMLA is unpaid, but your job is protected (meaning that they expect that you will come back).  You do not have to take all twelve weeks at once, depending on company policy. Your health insurance will be maintained, but you will be responsible for paying your premiums while on leave.

If you believe that your company is in violation of these requirements, you can file a complaint with the U.S. Department of Labor’s Wage and Hour Division using their websiteor calling at 1-866-487-9243.

What is the Pregnancy Discrimination Act?    

This act is a 1978 amendment to Title VII of the Civil Rights Act of 1964 that prohibits discrimination on the basis of pregnancy, childbirth, or related conditions.  It states that “women affected by pregnancy, childbirth, or related medical conditions shall be treated the same for all employment-related purposes, including receipt of benefits under fringe benefit programs, as other persons not so affected but similar in their ability or inability to work”

            If you are unable to perform your job, your employer is required to treat you the same as any other employee who is temporarily disabled, such as temporary leave or leave without pay, according to company policy. 

What is the maternity and paternity leave policy for your company?    

Each company is different regarding their leave policy.  Some companies (and states) will allow additional leave beyond what the FMLA requires.  If you have accrued paid leave, you can use some of that for maternity leave.  Check with your company’s Human Resources representative, or in your employee handbook.

Do you want to go back to work?    

You do not need to make your final decision until after your leave is exhausted, but it will help to be able to inform your boss whether you plan on returning to work.  If you do not plan to return to work under any circumstances, and you plan on using your accrued paid leave prior to resigning, ensure that your company does not have a policy in which you need to pay back certain vacation time taken before a certain date.

Do you want to suggest a plan for how your work will get done while you’re on leave?    

This is highly recommended if you will be returning to work.  Not only will it help with the workload that is waiting for you when you return, but it will show your boss that you respect the company’s time and clientele.  Your boss will make the final determination about how your work will get done, but depending on how far removed your boss is from your process, it will be helpful to suggest coworkers who understand your duties and can assist with the workload.

What is the company policy on part-time, flex-time, or working from home?    

Check with your human resources department about whether alternative work schedules are allowed.  If they are, bring them up in the conversation with your boss.  Ask if he or she will consider a reduced work schedule or a flexible schedule. 

Once you have done your homework, schedule a meeting with your boss and let him or her know exactly what your plan is.  Head into the meeting with your notes, and be prepared to ask questions about company policies, and to answer questions about your plan.  Your boss’ main concerns will be how your work will get done while you’re gone, and if you plan to return.  If you have tentative answers for at least those two issues, the meeting should go smoothly.

The Lamaze Technique, though, is much more than a recommended breathing pattern.  It is an approach that acknowledges that childbirth has been going on forever, and that a woman’s “inner wisdom guides them through birth.”  The intent of Lamaze is to break a woman from thinking that she has to give birth in certain way or at a certain place, and reminds women of the important and natural aspects of child birth.

The Lamaze childbirth supports six Healthy Birth Practices:

1. 1.       Let labor begin on its own – do not induce labor unless it is medically necessary.  For example, if your water has broken but you are still not in labor; if you are more than 42 weeks along; if your blood pressure is high; or if you have an infection, those would be medically necessary reasons to induce labor.  Lamaze does not support induction for convenience.

1. 2.       Change positions throughout labor – moving around during labor helps to lesson pain, and leads to shorter labors. 

1. 3.       Bring a loved one or doula for support – a support person is important because labor can be scary, and being scared can cause more pain.  It is helpful to have a knowledgeable person around during the labor process.

1. 4.       Avoid medically unnecessary interventions – An epidural is a common pain-relief method during labor.  However, epidurals come with their own set of complications, such as a drop in blood pressure, need for IV fluids, and the baby taking longer to turn.

1. 5.       Avoid giving birth on your back and follow your body’s urges to push – Research shows that directed pushing (i.e. pushing when your doctor tells you) instead of spontaneous pushing (i.e. pushing when your body tells you) may result in more harm to your pelvic floor muscles or perineum, and may also lead to a longer labor.  Also, giving birth while in positions that use gravity, like squatting, allow your birth canal to completely open as opposed to lying on your back.

1. 6.       Keep mother and baby together – Instead of moving the baby to a nursery and a mother to a hospital room, it is better for bonding and successful breastfeeding to keep them together.

A good Lamaze class will spend a lot of time discussing how to keep labor simple and safe while building up a mother’s confidence.   Lamaze classes will also go over the familiar controlled breathing, aimed toward relaxation and reduction in pain perception, but the teachers respect that there is no “correct” way to breathe during labor.  The importance of breathing is to find your rhythm and to focus.

When to avoid sex      Although most women will have no problems with sex during pregnancy, it is recommended that you abstain from sexual intercourse during pregnancy if any of the following are true:

• ·         You have an incompetent cervix
• ·         Your doctor has recommended against sex
• ·         You have had pre-term labor in the past
• ·         Sex causes you pain
• ·         You have placenta previa (low placenta)
• ·         You have vaginal bleeding
• ·         You (or your partner) have a herpes outbreak
• ·         You are in labor

When to embrace sex     If none of the above conditions are true, then go ahead and have all the sex you like.  There are generally no risks to sex during pregnancy.  Some women find that the elevations of hormone levels make sex more pleasurable during pregnancy.  Some studies have shown that orgasm is easier to achieve during pregnancy because of the increased blood volume.

You will eventually have to consider the positions you choose during intercourse.  For example, you shouldn’t lie on your back after week 16 because your fetus and uterus weigh enough at that point to push down on the aorta, which is important to blood flow for you and your baby.  Other positions may become impossible or impossibly uncomfortable as your belly gets bigger.  Talk to your partner and make sure you are both comfortable.

Keep your partner in mind     As a pregnant woman, you may be focused on your own sexual appetite (or lack thereof); keep an open line of communication about sex with your partner.  Your partner may be completely open to any and all sexual experiences (i.e. they will take what they can get), but they may also start to grow self-conscious.  If you feel like your partner never initiates sex, so therefore must not want it, try to think of times which your partner DID initiate sex and you had to tell them that you weren’t in the mood because you couldn’t stop staring at your swollen feet and felt completely unsexy.  Your partner could simply not want to bother you, or feels like you would only be open to sex to be doing them a favor.  That is why communication is the MOST important part of sex during pregnancy.  Make sure you are on the same page, and if you aren’t, talk about how to get there.

Midwives believe that technology is largely unnecessary for childbirth and care.  They prefer to avoid technology in a labor setting, and instead will serve as a nurturing caregiver that supports you during your childbirth.  Midwives will employ natural methods for pain, such as positioning, massage, and focused breathing.

There are also several different options for doctors when it comes to pregnancy and childbirth.  If you see a family practice physician, ask if they practice obstetrics and deliver children.  If they don’t, they can refer you to an obstetrician or an obstetrician/gynecologist or OB/GYN. 

Doctors believe that the technology available at a hospital is beneficial for childbirth and care.  They have the resources to quickly perform medical procedures such as cesareans, episiotomies, and epidurals.  They can offer medicinal intervention for pain.

Obstetricians will probably not be as personal as midwives, and midwives will probably not be able to quickly attend to birthing complications.

If you have a high risk pregnancy, it is a good idea to consider giving birth in a hospital setting.  You can choose to work with an obstetrician or you can find a nursing midwife who is licensed to practice in a hospital.  If your pregnancy is routine with no complications, you can choose to give birth outside a hospital under the guidance of a midwife, or in a hospital under the guidance of an obstetrician.

When making your final decision, think about how you want your childbirth to go:  would you be most comfortable in your home or a birthing center, with no painkillers, surrounded by supportive and nurturing people; or would you be most comfortable in a hospital setting, close to the painkillers, with the most advanced technology ready to monitor and fix any problem that may arise?  Only you can answer that question.  Take some time to talk to friends and family about their experiences, and call a few midwives and a few doctors and ask them questions.  The spectrum of treatment not as this-or-that as you might think – you may find a nurse-midwife that practices in a hospital, or a obstetrician that prefers holistic approaches when possible.  Research is the only want to find out.

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categories: midwives and doctors.  Both of these options have benefits and drawbacks to carefully consider.  Generally speaking, they do the same thing, placing differing emphasis on technology.