Total Health Radio

The Truth About Childbirth

Podcast published: May 7, 2014



New mom in hospital holdig baby and dad is taking selfie of happy family

Childbirth. It’s an amazing thing. And for those of us who have yet to go through it, it’s more than a little mysterious. What should the birth plan include? What are the options for managing pain? What can you expect during delivery? And what happens during childbirth that even your good friends haven’t shared with you? This episode of Total Health Radio attempts to demystify the final weeks of pregnancy as well as labor and delivery. It’s a frank conversation about what you can expect – and what might surprise you – as you welcome your bundle of joy into the world.

About the Guest
Amanda Calhoun, MD, is an obstetrics and gynecology doctor for Kaiser Permanente in Northern California.  You can follow Dr. Calhoun on Twitter: @kppregnancydoc

Episode Host
Farra Levin communicates for a living at Kaiser Permanente, and she loves talking about health topics and issues. Her passion comes through in her interviews – along with her humor and straight-talking attitude.  Read more about Farra.

Learn More
Looking for more information about childbirth – the basics as well as those things people have a tough time talking about? Check out these online resources:


Transcript

FARRA: Hi everyone, this is Farra Levin, host of this episode of Total Health Radio.  We’re calling it, “The Truth About Childbirth.”  Regular listeners of Total Health Radio will probably notice the tone of this show may be different than others. It’s a frank conversation about the realities of childbirth. We talk candidly about the changes a woman’s body goes through, and how to stay healthy during this special and sometimes hectic time. Our Kaiser Permanente experts shared with us the questions their patients ask the most — and the questions patients are sometimes too embarrassed to ask. Some of what you hear may make you blush, but we hope that the information in this interview will help you, or the expectant mother in your life, prepare for what comes after the baby bump. Enjoy the show.

FARRA: All right, so this is it, ladies.  You’ve made it through expanding waistlines and bust lines for that matter and hopefully the morning sickness is gone, but I’m sure that the heartburn is raging on.  But congratulations! Because you’re nearing the end of your pregnancy.  But before you replace that baby bump with an actual baby, let’s talk about the things you need to know in your final weeks.  Joining us to talk about the end of pregnancy and your impending childbirth is our very own pregnancy guru, Dr. Amanda Calhoun, an OB-GYN with Kaiser Permanente in Northern California.  Welcome!

DR. CALHOUN:  Thanks for having me.

FARRA:  So the last month.

DR. CALHOUN:  Finally!

FARRA:  I know, right?  I think for women it’s probably like how long can I be pregnant.  And then all of the sudden it sort of picks up quickly.

DR. CALHOUN:  And the anxiety starts kicking in.

FARRA:  So let’s talk about that.  The last month – what are the things that you really hear from women in terms of concerns or changes?

DR. CALHOUN:  Well, the first thing I hear is that they’re incredibly uncomfortable.  And having lived through that experience it’s definitely true.  There are lots of what I call the “petty indignities” of pregnancy that really start kicking in.  So, it’s the wobbling when you walk.  It’s the low back pain.  It’s the difficulty sleeping.  It’s the heartburn. Inability to have a full meal.  These sorts of things really start picking up.  And then for first time moms — just not really knowing what labor is gonna be like can be really anxiety provoking.

FARRA:  I notice on Twitter that you were talking about something that a lot of women probably don’t think about. You had mentioned not shaving or waxing after a certain time in your pregnancy.  What’s the deal with that?  Why?

DR. CALHOUN:  So actually, it’s somewhat of a little known fact, but if you don’t shave and wax in those last few weeks it can actually really help prevent infection.  What happens is that you get little micro tears even with waxing around your bikini line.  And that will be the sight of a C-section.  So given that a quarter to a third of women end up with a C-section, we really don’t want them to have this and increase their infection risk.

FARRA:  You mentioned it was the bikini line.  So just to be clear we’re not talking upper lip.  We’re not talking legs.  Woman can still shave their legs and feel – if they can reach them, they can still shave their legs.

DR. CALHOUN:  Well, actually that’s something I always recommend is do shave your legs!  Do get a pedicure!  And have somebody else do it, because you’re not gonna do a good job.  And, that might be the last waxing or pedicure that you get for quite some time once you’re tied up with your baby.

FARRA:  Let’s talk about each of the different styles of delivery.  And then maybe even what are some of the pain management options for each of those styles.  So, let’s start with vaginal delivery – just the –

DR. CALHOUN:  Straight forward vaginal delivery.  Now, and that is what most of our patients want.  And it’s what most of our patients have.  And there are countless ways to manage your pain or discomfort with a vaginal delivery.  One of the things we’ve tried to do is to reframe it as coping, because pain is a relative concept for each person.  So having a happy face scale from one to 10 doesn’t mean very much except for that individual.  And it’s not about the amount of pain that you have.  It’s about the degree to which you are coping with it.  So the first thing we’ve done is to try to think about it differently.  Then in terms of coping with pain with vaginal deliveries, there are supportive measures such as massage, shower, walking – all sorts of things that help the body be a little bit more flexible in managing the pain.  Then there’s IV pain medication – things that are in sort of the morphine family or Fentinale, which are short acting, but they will go away before the baby’s born.  We don’t like to give that right before the baby comes.  But it does a nice job of taking off the edge.  And then there are epidurals.  The great thing about the epidural is that it doesn’t go to the baby at all.  IV medications will go to the baby, but then they wear off.  The epidural doesn’t go to the baby at all and an epidural can get you to have essentially no pain sensation.  But if it’s done well, you can still have the pressure.

FARRA:  So let’s talk about the C-section. For women who have never been through it, tell us, essentially, what it is.

DR. CALHOUN:  Now, we essentially never recommend a C-section off the bat unless someone has twins in some cases, or the baby’s breech, because it’s a much riskier procedure.  It’s a major adnominal surgery.  There’s increase risk of hemorrhage, increase risk of infection, increase risk of blood clots. Even though it’s something we do everyday, and it’s relatively safe, it is definitely not as safe for mom as a vaginal birth.

FARRA:  You mentioned sort of all the risks around it.  For women who have never been through it, tell us essentially what it is.

DR. CALHOUN:  So a C-section is a major abdominal surgery wherein once the woman is good and numb we’re gonna make an incision along the bikini line usually about 12 centimeters in length.  And we go through the various layers.  Of important note, we do not in general cut muscle.  We usually separate the muscle.  And then deliver the baby and then sew up the different layers of the uterus, the fascia, all the way up to the skin.

FARRA:  And women can be awake for that?

DR. CALHOUN:  Yes.  And that’s the thing that is very different from lots of other kinds of surgery.  We do it under – except for rare emergencies – under spinal or epidural anesthetic, which is a regional anesthetic that makes you numb from your about breast level down, so that you can still engage with your baby and what they experience.

FARRA:  And the recovery after that?

DR. CALHOUN:  So the immediate recovery, in terms of getting on your feet and shuffling around your room, happens pretty quickly.  It’s by the next day.  But in terms of really getting back to your full normal self, it’s more on the order of six to eight weeks.

FARRA:  And does having a C-section impact your ability to breast feed at all?

DR. CALHOUN:  It’s mixed.  There’s nothing intrinsic about it that decreases the ability to breastfeed.  Sometimes the milk is a little bit more delayed in coming in because there aren’t as many hormonal triggers.  This is particularly true with scheduled C-sections as opposed to C-sections in labor.  In labor all those triggers have been happening for hours and hours and hours whereas a scheduled C-section, you’re walking in.  You’re hair is done.  Your pedicure is gorgeous.  You lay on the table.  You have your C-section, and you’re done.  So it’s a very different sort of experience.

FARRA:  And the pain management for that will always be sort of the epidural spinal block?

DR. CALHOUN:  Yes, for a C-section. Unless it’s an absolute emergency.

FARRA:  So VBAC – and for people who don’t know, it is Vaginal Birth After Cesarean.

DR. CALHOUN:  Very good.

FARRA:  So, you’ve had a C-section with your first baby.  And now you’re gonna have your second, and you want to try.  Maybe you wanted to try it first time and it didn’t work out.  So you want to try it this time.  What should you talk to your talk to your doctor about, and what should you be mindful of?

DR. CALHOUN:  So the most important thing with VBAC is that you’re in a medical center where you’ll be safe.  And what I mean in terms of being safe – that you have immediate access to an OB/MD and to OB anesthesia, because when bad things happen, even though it’s incredibly rare, you need to be able to respond right away.  The other thing too is to have a supportive environment and a supportive community, because it’s a very different experience.

FARRA:  What are some of the complications around a VBAC?  What should women know about making that conscious decision to try to go vaginal this time versus a C-section?

DR. CALHOUN:  Well, Farra I want to spin the question a little bit differently because what people don’t think about is, “What are the risks of a repeat C-section?” Because they always obsess about “what are the risks of this crazy VBAC thing I’m doing?” and they think only about immediate risks.  The bigger risks with C-section are your long-term risks.  So immediately, C-sections have increase risk of infection, increase risk of bleeding, increased risk of blood clots in your legs.  And then of course, the recovery time is much longer.  And if you’re having your second baby, which inherently you are in this situation, to be back on your feet to take care of your toddler or preschooler is incredibly valuable.  So there are a lot of benefits of having a vaginal birth.  Now, the big thing that people are scared of with VBAC is uterine rupture.  So that’s when the scar tissue – the place in the uterus where the old scar is – ruptures and causes catastrophic bleeding. It’s for that reason that when someone is VBACing, we always want them to be on the fetal heart rate monitor, so that if we see any signs of that starting to happen, we can respond before there’s a catastrophe.  Now, the risk of that is somewhere on the order of one in 500.  So it’s quite, quite, quite rare.  But because it is a dramatic and potentially disastrous outcome, that’s why people are sometimes quite nervous about it.

FARRA:  Is there a time frame?  So if you had a kid two years ago, are you more likely to have a successful VBAC versus if you had a kid seven years ago?  Does it matter?

DR. CALHOUN:  No.  It does not matter in terms of your success rate.  The rupture rate however, is a little bit higher for people who’ve had their C-section recently.  So in general, if it’s under 18 months, we’re a little more hesitant about VBAC because that rupture rate is a little higher.  Now, you speak of success rates.  There are things that can increase or decrease your risk for success.  And the main one is why did you have that C-section in the first place.  So if you had the C-section because you have twins and the first twin was upside down, well, that doesn’t mean anything about how you would be in labor. Or if you have a breech baby, even if it’s just one, that says nothing about how you would be in labor.  So those folks have no increased risk for a repeat C-section in labor, or to say it conversely they have just as good of a vaginal birth chance of success as someone who hasn’t had a prior C-section.  Now, when it comes to someone who dilated 10 centimeters, they pushed for three hours, and still the baby didn’t come out – now those folks we’re more concerned about, because that tells us that at that time there was something about the baby relative to the mom’s pelvis that didn’t allow the baby to come out.  So in those situations, the chance of success is less.  But it’s still around 40, 50 percent so it’s still, in my opinion, worth a try.

FARRA:  We asked people what were some of their biggest fears or concerns, and these are some of the ones that we heard the most.  A lot of women are scared.  And they ask this question of their friends.  Do a lot of women poop during labor?

DR. CALHOUN:  Yes, they do. Partially because labor happens when it happens.  It doesn’t say, “Oh, have you gone poo yet?  And that’s when I should break my bag of water and go into labor?”  So it may just be where you are in life at that moment.  Also, folks know that in the 50s and 60s women used to get an enema on arrival to the labor and delivery unit.

FARRA:  Really?

DR. CALHOUN:  Yes.  So, I think that’s why people are worried about it.  And they’re kind of scared that their partner is gonna see them do this thing that usually doesn’t have an audience.  But, when you are pushing, if you poop that means you’re doing it right.  So we really encourage patients to poop.  If they are having a hard time pushing, that is the focus.  That is the same muscle that you use to try and open up and push your baby out.  So if you’re pooping that means that you’re doing it right.

FARRA:  Perfect.  Okay, so you should feel free, women, to poop.  And that means success.

DR. CALHOUN:  Correct.

FARRA:  Poop during labor.  Okay, there was concern about tearing.  And I know a lot of people have heard of episiotomies.  So let’s talk about, do you let people naturally tear?  Is that where people go now? Or are people still doing episiotomies?  And I guess we should say, what is an episiotomy?

DR. CALHOUN:  An episiotomy is a small cut that’s made in the perineum to make increased space for delivery.  Now, that is one of the things for which there is good data.  And when people have an episiotomy, they’re more likely to have extensive tears than they are when they tear naturally.  So nothing is best.  But if you are going to tear, tearing naturally is much better than tearing along the lines of an episiotomy.

FARRA:  We haven’t talked about birth plans.

DR. CALHOUN:  I think it’s great to have a birth plan, because it’s good to have an objective.  It’s good to say, “If everything goes just the way I want it to go, this is my vision.”  But it’s the folks who are really wedded to their birth plans who tend to have some of the least happy experiences because the babies don’t follow the manual.  The births don’t always go just the way you want them to go, so there has to be a degree of flexibility.  Also people feel bad about themselves sometimes when they feel like they haven’t been able to stick with their birth plan.  And I think that’s a very negative experience for families when this is an incredibly special thing that’s happening.  So I definitely encourage my patients to make a birth plan, but also to keep it in perspective that our number one goal is healthy baby, healthy momma, and that whatever it takes to get there we will walk with you on this journey.  And our number one priority is your safety.  But right after that it’s making it the best birth experience possible.

FARRA:  And it’s preparation, right, because your kids after that will never do what you want them to do either.

DR. CALHOUN:  That is correct.  It’s your first lesson in parenting!

FARRA:  All right.  Well, I think that wraps it up.  So hopefully ladies as you’re getting ready to push or deliver your little bundles this helpful information.  Thanks so much for joining us.

DR. CALHOUN:  Thanks for having me.

 

This show is for educational purposes only. If you have specific health concerns, you are encouraged to address those with your personal doctor. And as always, if you’re having a health emergency, please call 9-1-1 or go to the nearest emergency department.