Well, yes I am.  According to a lovely post by my “friend” Kathy.  You might be a birth junkie, if…

Go read the whole list.  SO funny.

Here are the ones that I could say, YES I do this. 

• if you blog about birth (more than just your own birth for historical purposes) or if your birth story is at least two pages long  Both of these are true for me!
• if you can say “vagina” in a sentence without blushing  OF COURSE!
• if when you’re discussing something related to birth, you receive those polite but puzzled looks… right before your conversation partner moves away YES
• if you have birth-related artwork somewhere in your house (includes placenta pictures and belly casts, etc.)  Belly Cast in my Closet
• if you currently have or ever did have a placenta in your freezer No, but I have a bag of breastmilk, that I will probably never let thaw. 
• if you have ever consumed placenta No, but if I have another, I will encapsulate mine. 
• if you have a model of a pelvis, uterus, or some other female organ  I got a Pelvis Model for my 36^th Birthday. 
• if you always keep honey sticks on hand  In my doula bag at all times!
• if you’ve ever gone to the bookstore and hidden “What to Expect When You’re Expecting” (or some other similar non birth-junkie book) and replaced it with some pro natural-birth book  Yes, and left my cards in some books too!
• if other women get tired of telling you their birth stories before you get tired of hearing them  YES!
• if you have a library (or would love to acquire one) of birth-related books and videos  Of course, I love having a valid excuse to buy birth books.
• if you have 10 or more birth-related videos saved to your account on YouTube  YES
• if you appear on any YouTube (any internet) video talking about birth, in labor, or giving birth (picture montages count)   YES
• if at least half of the blogs you regularly read are birth-related  There are other kinds?
• if someone tells you she “had to have” a particular intervention and you can come up with several alternatives that were never mentioned to her (bonus points if she doesn’t get mad or defensive)   Yes
• if you refuse to play the “my birth was worse than your birth” game   YES, but I do like to say, your next birth can be better and this is how. 
• if you feel like you know your fellow online birth junkies (even though you’ve never actually met them) better than you know some of your flesh-and-blood friends   This is so true!  I know it would be so fun to hang out together. 
• if ten or more of your Facebook friends (or other equivalent) are people you’ve never actually met but know them through birth-related functions (blogs, email lists, etc.)   There are SO many I don’t “know” but we are “friends”.
• if you’ve ever gone to a birth conference   I LOVED the Trust Birth Conference
• if someone tells you her baby is breech and you give her names (bonus points if you know phone numbers) of chiropractors skilled in the Webster technique or people who can perform moxibustion   AND where to get the Turn Your Breech Baby Hypnosis CD
• if you know what counterpressure is and how to apply it (bonus points if you’ve done it)  BONUS POINTS!
• if you know what a rebozo is (bonus points if you’ve used one)  I know what one is and it has been used on me.
• if you encourage your children, especially young children, to watch birth videos OH YEAH, get them while they are young!
• if you can get hoarse from watching TV birth shows (like A Baby Story), because you’re yelling through the screen at the woman or her care providers I DO yell a lot, they do the craziest things, it makes me SO mad!

I am SO a Birth Junkie!

I found a grat article singing praises for having a doula support you during your birth.  A Doula – The MUST HAVE for Expecting Parents.    I agree!

I am a little biased of course.  I had a doula for my last birth and loved it.  My husband loved it.  He asked why we didn’t have one for all our births! 

I am also a doula.  I think that for most moms planning a natural childbirth in a hospital setting really SHOULD have a doula.  There are so many L&D nurses who have NEVER SEEN a natural childbirth.  They don’t know how to support you, they are busy taking care of other patients, paperwork, etc to really give you the support a mom needs.  Most Dads don’t have a lot of birth experience, so they feel more confident with a doula in the room too. 

If a mom is having a homebirth a doula is a great thing to have too, but not as necessary.

If a mom is having a hospital birth and is planning on getting an epidural, a doula is still a great member to add to your birth team.  A doula can help you navigate all the choices you will have.  A doula can help you be in positions that will help your birth to progress.  A doula can help you stay focused and calm until you get your epidural. 

For any dad who wonders if you need a doula.  All I know is the one time I supported a single mom by myself.  I so wished we had another doula.  It is hard to be the only one giving all the support to a birthing mom.  Pretty exhausting.  When there are 2 of you, a lot of the pressure is off and it is more fun!

Monday July 27th 9pm EDT

Are you keeping your fingers crossed and hoping for the best? Well, take charge and find out ways you can increase your chances of having an easier and safer birth. First-timers and experienced mothers both can benefit from this class.

This 2-hour online session will help you learn:

• Different kinds of care providers you can use, and the pros and cons of each
• How to empower yourself to make educated choices during your pregnancy and during labor
• What factors contribute to your chances of having an unnecessary or preventable cesarean
• What is the “downward spiral of intervention”
• Why avoiding an unnecessary cesarean is safest for you and your baby
• When cesareans are truly necessary

Get more information and Sign up here.

This could also be called the potential interesting situations that arise when you are a Childbirth Educator.

I recently changed my screen saver to shuffle through pictures in My Pictures Folder. I didn’t think much of it. Until today.

Yesterday I got all jazzed up and made a Power Point Presentation for Class 3, Choices in Childbirth. I go over the pros and cons of IVs vs Heplocks vs neither, Continuous Fetal Monitoring vs Intermittent Monitoring, AROM (Artificial Rupture of Membranes – Breaking the water), pushing in Lithotomy Position (no pros there!) and tons of other choices.

So I made this new folder in My Pictures labeled Class 3 and have all these interesting pictures in there. Here are some.

So today I am doing the dishes and glance over at my computer and see these images coming up.   Intermingled with Easter Egg Hunt pictures of my boys. 

I couldn’t help but start laughing.

Not surprisingly T. wasn’t very satisfied with this conversation.  She didn’t feel heard or respected.  Rather she felt that she had been lectured to.  She wanted to have a genuine conversation with him about some important topics regarding her birth.  He felt like she was questioning his authority and just wanted her to trust him.

This stressed T. out as she is in her third trimester and it had been hard to find an OB who would accept a late transfer.  She had called a whole list of OBs and he was the first who was willing to take her, so she felt stuck.  She knew she didn’t want her old OB, and this new OB was at a better hospital.    

She asked me, “Does it really matter who my OB is?  Aren’t they just there to catch?” Well often during the birth they do show up just to catch, but it IS important for a number of reasons. 

1.  Induction Happy OB – If you have an induction happy OB, you are on the path to an intervention filled birth before you may even get close to your birthing time.  Some OBs like to induce all their moms at 38-39 weeks, some 40 weeks.  Seeing as on AVERAGE a first time mom won’t birth her baby until after 41 weeks, that is a lot of moms getting induced before their bodies and babies are ready.  There are a lot of issues and questions regarding inductions.  

Also it is important to ask NOW to any OB (even if you are 10 weeks pregnant) does your OB use Cytotec/Misoprotrol/Miso, to ripen the cervix.  If the answer is yes, that is a huge red flag.  A letter from the makers of the drug issued a letter years ago advising not to use it to induce saying:

Serious adverse events reported following off-label use of Cytotec in pregnant women include maternal or fetal death; uterine hyperstimulation, rupture or perforation requiring uterine surgical repair, hysterectomy or salpingo-oophorectomy, amniotic fluid embolism, severe vaginal bleeding, retained placenta, shock, fetal bradycardia and pelvic pain.

The problem is MANY care providers still use cytotec.  I have had 2 Hypnobabies students who were told they needed to be induced that day and then found out the hospital/careproviders only had cytotec to help ripen the cervix.  No other option was available.  This is NOT something I would want to find out if I was being pressured to induce that day.  

So ask this NOW!  If they usually use cytotec, are there other options available if you refuse (for instance cervidil or a foley bulb?)  There was one OB who made a comment, “Oh, you must have been reading scary things on the internet.”  Is it foolish for a mom to do research?  Should she just submit to using a drug KNOWN to cause death in moms and babies.  She may not have a choice unless she asks early in her pregnancy, to be sure there are other options available. 

2.  Scared of Big Baby OB – This could lead to pressure to induce or have a cesarean.  It is impossible to know how big a baby is before he is born.  A big baby doesn’t need to be a big problem.   Some OBs like to play the big baby card, just to convince a mom to induce or have a cesarean, because it is easier for them! 

3.  Cesarean Happy OB – There really ARE OBs out there, who will come up with a reason to perform a cesarean, so they can go home for dinner.  I would say most are NOT like this.  But if you never ask your OB their cesarean rate, how would you have any idea?  What if they don’t know their statistics or vaguely respond.  Well that would be a red flag for me.  Low intervention OBs will be proud of their statistics and want to share them!  Ask them specific questions about their cesarean guidelines.  (It is also important to find out the cesarean rate of the hospital you are at, that can make a big difference too) 

4.  Informed Consent –  Why use scare tactics when talking to moms?  You need an IV or we won’t be able to find a vein in case you hemorrhage.  Don’t eat a cheeseburger on the way to the hospital, you may die!   If she has questions, answer them, don’t lecture her and make her feel bad for asking.  Why not have a normal conversation explaining the pros and cons and let the mom decide.   Isn’t that what informed consent is?   

T’s OB said “ if he’s going to be our doctor, then we have to trust him; lots of people are giving lots of advice that have never been in his shoes and don’t have his liability.”

ALL patients have the RIGHT to informed consent.  I don’t understand why OB’s think they are above giving moms informed consent.  If a mom can’t even have a simple conversation on equal levels, gathering information from their OB about pros and cons of different interventions before their birth, then how are they supposed to “trust them” to provide informed consent during their birthing time? 

5.  Birthing Time/Pitocin Happy OB – Did you know some OBs put every mom on pitocin.  Even if she comes in and is having consistent and strong birthing waves, automatically she gets put on pitocin.  Why?  Who the heck knows?  It makes no sense.  Maybe because they have a routine and they like to have something to do?  So on the pitocin goes.  Ask your OB, What percentage of your patients get pitocin?  In what circumstances do you usually use pitocin? 

6.  Actually Catching the Baby - Even if the OB isn’t really involved before the birth and is just there for catching, they can have a huge effect!   Here is a story which demonstrates the difference an OBs attitude towards birth can have on a birth.   

Also what about episiotomy’s?  This is a huge thing to think about.  Some OB’s really think all first time moms need an episiotomy.  If your OB thinks that what are the odds of you getting an episiotomy?  I would say 99% chance.  This is another area where asking ahead of time is important.  If they are real vague and say, “Let me decide if it is necessary.”  I would really press for their statistics or at least ask, “When do you feel it is necessary?”    

So yes, it does really matter who your OB is, even though they may only be there to catch the baby. 

So what can T do?

She had called so many OB’s on her list and he was the first that was even willing to take her.  Could she find anyone else who would be willing?   What if they were no better than this OB was?  She was stressed out and really just wanted to be done with this process and have an OB.

Find out what happens in the next installment.

So when I met with T. the other day, she told me about her meeting with the OB. The most outrageous comment he made was   “Just make sure you don’t eat a cheeseburger on the way to the hospital.  The number one cause of death during birth is aspiration!”

Ok, that one just left me flabbergasted.  He had been warning her to be careful about where she is getting her information from.  Even though I am not an Ivy League trained OB, I knew right away that what he said is wrong! It isn’t common sense for one thing and also I know a lot about childbirth and that just isn’t true!

I also saw it as a challenge.  I love to research things.  My friends call me when they want something researched.  They know I will send them a nice Excel Spreadsheet with gathered information for them, to help them in their decision making process.  So to have him warn her about me, like I just made these questions up for fun and there was no reasoning behind them, was offensive.  But then to top it off with a comment like that, which was completely NOT Evidence Based.  I had to research it.  I guess to prove him wrong.  You can decide who is right.

So while this is Enjoy Birth and I typically try to focus on happy birth topics, here is what I learned about the causes of maternal deaths.

First the enjoyable news, maternal death is very rare in developed countries.  Since you have the internet and are reading this, I figure you are in a developed country. So luckily this isn’t something you need to really worry about.  But in case you are now scared to eat a cheeseburger on the way to the hospital, let me reassure you…

The World Health Organization who has statistics from all over the world doesn’t have aspiration listed anywhere as a cause of maternal death.  Maybe they don’t have cheeseburgers in Africa?

So I continued on and searched high and low for USA statistics.  Surprisingly this is not widely advertised topic, so not easy to find information on.  There were some scholarly papers, which I don’t have access to.  But I did find this article Maternal Mortality during Hospital Admission for Delivery, which is about 10 years old.  But it is all I found, so it will have to do.

The only reference I found that could be aspiration related was here…

An anesthesia-related complication was one of the pregnancy-related diagnoses associated with maternal mortality among African-American women. Death caused by anesthesia-related complications, specifically problems associated with the airway, is the sixth leading cause of pregnancy-related mortality (13,34). Nagaya et al. (35) concluded from a two-year review of maternal death certificates and chart review in Japan that inadequate anesthesia services were associated with maternal mortality. Continued efforts to review and analyze anesthesia-related maternal deaths are warranted to formulate preventative measures for future care.

But apparently it didn’t make the list for Caucasian women:

The most common pregnancy-related diagnoses associated with mortality in Caucasian women included preeclampsia/eclampsia (15.9%), postpartum hemorrhage/obstetric shock (13.6%), blood clot embolism (9.1%), cardiac arrest/cerebral anoxia (9.1%), and cerebrovascular event (9.1%).

There were limitations to the study and they said this regarding this topic

the UHDDS did not include the type of anesthesia (regional versus general versus IV sedation) for labor and delivery, making it difficult to determine the incidence of anesthesia-related complications based on anesthesia technique (16).

So, while aspiration is a very, very, very small risk***

for Jane Doe, it could happen

If she needs an emergency cesarean

with general anesthesia

and if her anesthesiologist doesn’t intubate well

and she vomits

she may aspirate some vomit

which could cause complications

one of them potentially being death.

It is certainly NOT the number one reason for maternal morbidity. In fact it is very LOW on the list.

***** I am not a number person, I really have to think when I do this.  So please let me know if I am wrong.  I woke up early in the morning and thought, what if someone reads this and then gets confused and thinks they have a 6% chance of dying from eating a cheeseburger?  That would be bad!

So I had to wake up and do the math.  This is how much I love to research, I get up early to do math, which I don’t like.  So about 10 in 100,000 moms die due to childbirth in the US.  (I found stats ranging from 9.3 to 11, but to make the math easier, I chose 10.)  Which is the same as 100 in 1 million moms.  So the only statistic I found that could be aspiration related said 6%.  SO -

6 in 1 million moms, who die due to birth related causes, could be due to aspiration.

Which equals 0.000006% chance of dying from aspiration.  Which numerically speaking is a very, very, very small risk.

So this brings us to the question – How serious is this Death by Cheeseburger threat?  Or better yet, “Is it safe to eat and drink during your birthing time?”

Well, I say it is probably worth the risk if you are hungry and low risk.  (If you are scheduled for a cesarean, then don’t eat, a planned cesarean is not low risk!)  If you are planning on a natural childbirth and all is well and you are hungry, then swing through In and Out and get a Double-Double with some Fries on the way to the hospital.    You’ll have some yummy protein and energy to continue your birth! 

Articles for your enjoyment. In a study of 78,000 mothers who ate and drank during labor, not one had any problems with aspiration. Even more recently in England they recently did a study that showed there is No risk from eating during labor.

Another great blog post on this topic over at The Unnecesearan.

Don’t eat a cheeseburger? Where’s the Research?!

I have a doula client who when I met her was looking to change care providers.  So I offered her this list of questions to ask.  (I normally don’t concern myself too much with care providers, because most moms are reluctant to change, so unless mom isn’t happy, they are not open to changing)  But since this mom was in process of changing, I thought she might as well make sure she picked a care provider that was actually supportive of what she may want! 

My comments on her discussion are italicized.

T’s take on her discussion with the OB

Clearly he has thought about these things for a long time and has said them to more than just me. But I definitely think he got defensive. He stood there with one hand on one hip and the other waving around.

Basically it comes down to – He said if he’s going to be our doctor, then we have to trust him; lots of people are giving lots of advice that have never been in his shoes and don’t have his liability.

Really, is this what we are supposed to do, just trust all doctors?  They know best?  Or can we talk to them about things and gather information from them, so we can make the best decision for us? 

He basically said consider the source. What are their qualifications? Do they profit off their advice? & What’s their liability? He proudly counted these off to me on his fingers.

I agree with this, he definitely is coming from a different place.  Rather than being concerned that a patient has they type of birth she wants, his number one concern is liability.  In today’s litigious society, I don’t blame him. 

It went on for a lot longer than that. And I tried to interrupt saying that I believe he’s the expert and that’s why I’m asking him these questions, but got a “Can I finish?”

During his lecture, regarding the qualifications of those other people giving advice to pregnant women – he talked about how he’s delivered more than 5,000 babies and how went to an Ivy League school. “They haven’t been in my shoes.” “Why do you think Dr. H. trusted me with all of her deliveries, why do you think Dr. S. trusted me with hers?” (2 doctors I know)

OOOO, OOOO I actually did go to an Ivy League School too!  But I guess it doesn’t count since my degree was in Education.  But I am a professional Childbirth Educator, educated at an Ivy League School.  But I have delivered NO babies and thankfully I have never been in his shoes.  I love that I don’t have to worry about the medical aspect of birth, rather focus on the emotional, educational and supportive aspect. 

He said “If you hire that doula she will make more at your delivery than I will.”

Holy Cow!  If this is true that is really sad.  Any idea how much most OB’s make per birth? 

He said if I want to have as natural a labor as possible I should stay at home as long as possible. Because once I get to the hospital then the nurses must follow AORN requirements (when I wrote that acronym down, he’s like, “you don’t have to take notes on that.”).

Ok, my L&D nurse followers.  What the heck are AORN requirements and how would they affect birth? 

When I asked what his philosophy was on episiotomies (cutting me) He said “If needed.” I said what if I don’t want one. He said, “Why don’t you let me make that call.” He also said, “If I cut you, I have to sew you up, I don’t want to make more work for myself now do I.”

Does he…? Dun dun duuun.

 Wouldn’t it be better to explain the times when an episiotomy is a good choice.  What about saying your episiotomy rate for first time moms.  That would be more helpful.

Some other answers (some from him, some from his nurse practitioner) -

- He said an IV is very important because you can’t get one in once (if) the mom has started to hemorrhage because the veins collapse (yikes). I said what if I want to be in the shower in my room, he said, well, a helplock.

Why must OBs  try to scare moms into doing what they want?

- When it comes to monitoring, he felt that was very important. If I plan to be in the shower then he said I guess it’ll have to be the intermittent one (so I don’t have to be confined to the bed). But I’ll have to work it out with the nurses.

It really isn’t up to the nurses.  The nurses seem to say it is up to the OB, or hospital policy.  No one seems to want to take ownership of this!   Nurses do have an effect on this.  I have had OBs say intermittent is fine, but some nurses are not comfortable with this and they really try to keep it on continuously.  So indeed nurses count, but if an OB requires it than for sure the nurse will want it on.  If an OB is ok with intermittent, then mom has more of a chance of actually getting it. 

- Philosophy on going beyond 40 weeks – his nurse said he’s fine until 41 weeks then he gets very nervous.

His nurse said his goal was to allow all women to tryfor a vaginal delivery. He had said his goal was to make sure you want to come back for your second child “there are 50 other OBs nearby that you could go to.”

He said he had to induce a mom this morning who’s got a 10 pound baby.   He thinks he should c-section her, but she wants a vaginal birth, so he’s letting her try for a while.

Oh, this one really gets my goat.  I have an issue with Big Baby Bull.  I wonder if this mom got her vaginal birth after “trying for awhile”   I really hope she did.    I also wonder how big her baby really ended up being. 

He said don’t eat a cheeseburger before coming to the hospital, because aspiration is the number one cause of death during labor. Then he knocked on the cabinets (because they’re presumably wood).

Ahh, this is worthy of its own post.  Death by Cheeseburger

How did T. feel about this conversation? 

How would you feel?  Would this be the ideal OB for you? 

 T’s feelings coming in the next post.

Honestly, I am not really into movie stars.  But I do notice and get excited if they have “normal births” 

I know a lot of women DO care about famous people and if they see they can have vaginal births, than maybe it will inspire them to.  Silly I know. 

Anyway, I was excited to see that Molly had her twins “naturally“.  Horray for her and her babies!  Congratulations and thanks for being an example to birthing moms.  Especially ones expecting multiples.  So many are told twins = automatic cesarean. 

Here is a great link if you are expecting twins or more!

A lot of moms choose their care providers from friend recommendations, PCP recommendation or just randomly picking one out of the insurance choices.  This is dangerous.  Take time to really research this choice, because it can have a HUGE impact on your birth.

Their impact on your birth often starts before your birth even begins!  Starting with if they routinely do late term ultrasounds.  This is often just a way to say, “Your baby looks BIG!”  Which leads to, “You need an induction/cesarean.”   If your care provider likes to induce most of his patients and you don’t know this, then you will likely believe their “scare tactics” when they give them.  It is better off to find a care provider that doesn’t usually do this.

How can you know… ASK!  Ask your care provider questions (list below) and also ask local doulas and Childbirth Educators for recommendations/opinions. They are a great resource, please use it!

The earlier you ask your care provider these questions, the sooner you will know if they are a good fit.  If you don’t like the answers then SWITCH!  Or if you don’t like the way they answer the questions, then SWITCH!  But remember, it is never to late to switch.  I have had doula clients switch at 37 weeks, but I know moms who have switched later.  Don’t think, I will just wait until my “next birth.”

BASIC QUESTIONS

• Do they require an IV or is a heplock ok? (IV restricts your movement because you are connected to a bag and pole and may overload your body with fluids.  A heplock means they put the part in your arm, but it isn’t connected to a bag.  This allows them to feel better, because a vein is open in case of an emergency.)

• What kind of monitoring do they require? (Continuous Fetal Monitoring has greatly contributed to our rising c-section rate while not improving infant outcomes or reducing rates of cerebral palsy. Intermittent Fetal Monitoring when they monitor 15-20 minutes out of the hours, is a much better choice.  This is also what ACOG recommends)

• Does your hospital have telemetric monitoring? This allows moms to be monitored while walking the halls and in the tub.   

EPISIOTOMY QUESTIONS

• What is your episiotomy rate for first time moms?

• What do you do during birth to help prevent tearing?

INDUCTION QUESTIONS

• What is your induction rate?

• What is your  philosophy on going past 40 weeks? (If they typically schedule  inductions at 40 weeks (or before) that is a red flag. They should be fine going to 42 weeks as long as you and baby are fine.  Let them know you are willing to do NST to reassure them of this.)

• What medications do you use to induce? (If Cytotec, Misoprostrol or Miso)  Do you have other cervical ripening agents available, if I refuse Cytotec?   What about using a foley bulb if another cervical agent isn’t available.

• Do you routinely do late term ultrasounds?  Why?  (These late term ultrasounds typically lead to the whole Big Baby Scare)

• What is their philosophy on “big babies?” (ACOG Practice Bulletin No. 22 which appeared in the November 2000 issue of Obstetrics and Gynecology found no value in inducing for “big baby” since it simply doubles the CS rate and does not prevent shoulder dystocia or reduce newborn morbidity. Nor do they support cesarean section for “big babies.

CESAREAN QUESTIONS

• What is their CS rate? (If it’s greater than the World Health Organization’s recommendation of 10-15%, this is a huge red flag.  This is often connected to their induction rates, OBs who induce most of their moms are going to typically have more cesareans, maybe because of “pit to distress” syndrome.)
• Do they perform an automatic CS if waters have been broken for more than 24 hours, even if there is no evidence of infection and mom and baby are fine? (If they say yes, huge red flag. Find another provider.)
• Do they have a time-limit on how long your labor can be before they c-section you? (There should be no limit as long as baby and you are fine.)

• If I do need a cesarean –
  • do you do double suturing?
  • Is the baby with me in the recovery area or does he/she have to go to the NICU…if so for how long?

Please also visit Nursing Birth’s Top 7 ways to protect yourself from unneccesary and harmful interventions. For other great tips!  (Choose your Care Provider Wisely is number 1)

Also thanks to VBAC Facts, who has a GREAT list of questions for VBAC moms to ask their care providers.  I got the ACOG link from here and some of the cesarean questions.  If you are a VBAC mom, use her list!  Much more comprehensive for you.

I had a cesarean with my first baby and the hardest part was being separated from the baby afterwards.  I was in recovery alone (with a nurse) and my hubby was with the baby in the nursery.  This was the worst part of my cesarean.

Many hospitals have this routine.  Mom goes to recovery and baby goes to nursery for 2 hours and then you are reunited.  That is a LONG time and pretty traumatic for mom and baby.

Some hospitals allow mom and baby to recover together (as long as baby is healthy)  At Saddleback I love the fact that after a cesarean the mom AND baby go back to the mom’s room TOGETHER for recovery.  So mom and baby are not separated.  This is so helpful for the mom, dad and baby.  Much nicer for everyone.

In this country where on average 30% of moms (though my class statistics are 7.5-11% cesarean rate… yay for Independent Childbirth Classes!)  are ending up with cesareans, even if you are not planning on having one, this is an important question to ask!  If you have different hospitals to choose from, find out the policies and choose the one you like best.  You can call the hospitals to ask these questions.  You can call your local Childbirth Educators or Doulas, they typically have wonderful insights into what goes on at the hospitals!