Ask an OB: "You can't grow a baby too big . . ."

"Ask an OB" is a weekly series with Dr. Maude "Molly" Gurein, MC, FACOG.  If you have a question you'd like to ask her, please share it with us here. 

What do you think of the statement, "You can't grow a baby too big for your body to birth."  Can you also talk about the importance of Gestational Diabetes screening?  What danger is there in skipping that test?  Is there a weight gain at which a pregnant woman would be suspected for Gestational Diabetes?  For example if she has gained 60-90lbs and is craving sugar toward the end of her pregnancy, would that be a warning sign? - Lansing Mom

“You can’t grow a baby too big for your body to birth” is a completely false statement.  The latest worldwide statistics on maternal mortality show that 8% of pregnancy related deaths in women are due to “obstructed labor” – in other words, baby actually WAS too big and mom DIED trying to deliver it. So let’s not spend any time debating the validity of this statement – it’s nuts.
 
The thing I really hate about this statement is that it implies that if you have a C section for this reason, you just didn’t try hard enough. If only you had been stronger, tougher, more deserving – a better person – you would have been able to do it. You’re a quitter, a wimp, a weakling, not deserving of respect. And the opposite is familiar as well isn’t it? Somehow those lucky women who blast 10 pound babies out in 3 hours with 1 push are proud and self-satisfied, revered and rarified. Let’s just accept the fact that some women have big pelvises and others don’t, and that babies vary in size and shape. Usually mother nature puts the right sized baby in the pelvis – 90% of the time babies fit in moms over 5’1” tall. In moms under 5’1” 80% of babies fit! Make sure your contractions are strong enough and be patient – if your pelvis is big enough the baby will come. If not, you will have a well deserved and life saving cesarean section – personally, I think you deserve MORE credit for that delivery than the 3 hour, 1 push delivery!

Diabetes is related to this question of bigger babies. Gestational diabetes mellitus is increasing in frequency, mostly due to increasing obesity rates in moms, now occurring in about 7% of all pregnancies. Even in moms of normal weight, GDM is present about 5% of the time. So the chances are small that you will be affected – 95% of the time you will be fine. Why do we care in that case? Well, we care because if you do have uncontrolled GDM it can greatly increase the chance for complications in you or in your baby.  Look at this data from a 1998 study of about 800 women, which remained significant after controlling for maternal age, race, parity, body mass index, pregnancy weight gain, and gestational age at delivery.
 

	Uncontrolled GDM	Controlled GDM	No GDM
Baby over 8.5#	44%	9%	5%
Shoulder dystocia	19%	3%	3%
Birth trauma	25%	0.3%	0%

(Am J Obstet Gynecol 1998;178:1321-32)

Note that you won’t give yourself diabetes by gaining too much weight, but that pre-pregnancy obesity IS related to developing GDM. “Sugar craving” is unrelated to GDM as far as I can tell. Bottom line: even though your risk of having GDM is small, if you do have it and don’t control it, the chance for problems is quite high. In the interest of as many vaginal deliveries as possible, let’s control GDM so we can reduce babies that are too big to fit out vaginally and safely.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here. 

Ask an OB: "Birth isn't a disease, it's a normal bodily function"

"Ask an OB" is a weekly series with Dr. Maude "Molly" Gurein, MC, FACOG.  If you have a question you'd like to ask her, please share it with us here. 

Can you address the NCB claim that, "Birth isn't a disease process, and therefore doesn't need medical intervention"?   ~ Michigan mom

This is an interesting statement because it contains an assumption that I don't believe to be correct.  The assumption is that we decide to medically intervene base on whether or not something is a "disease process".  This is actually not true - we decide to intervene if we believe we can reduce pain, suffering, death, or disability.  

Tripping in the forest and breaking your leg isn't a "disease process" - it's a side effect of living life.  Lack of sanitary sewers is not a disease process, but it kills a lot of people.  Getting cancer because you are old and your immune system is weak is also a natural process.  Is obesity a disease process?  How about smoking?  We use "medical intervention" in all these conditions because we believe we can reduce pain, suffering, disability, or death.

Pregnancy related morbidity and mortality were staggering before the modern era, and continue to be a source of concern today. 

"In 1915, the maternal mortality rate was 607.9 deaths per 100,000 live births for the birth registration area.  In 2003, the maternal mortality rate was 12.1 deaths per 100,000 live births in the United States.  Despite the tremendous overall improvement, maternal mortality continues to be a significant public health issue and commands an enormous amount of attention."  [CDC, Maternal Mortality and Related Concepts, 2007]

Based on the facts, I believe pregnancy qualifies as a condition that can cause pain, suffering, disability, or death, and therefore qualifies as a condition that benefits from "medical intervention".  Check out these graphs to see if "medical intervention" has been a good thing for maternal mortality in the US since 1915 or for a perinatal mortality in the state of MI since 1970:

Going back to the 1950's, after antibiotics and general anesthesia, but before risk-based prenatal  care and intervention, fetal monitoring, and timely cesareans,  and you will find a maternal mortality rate 7 times higher than today & a perinatal mortality rate 8 times higher than today.  Yes, your cesarean rate is also 8 times higher.  You pick...

Ask an OB: Group B Strep, What the Research Says

Today's post is a special edition of Ask an OB, which is typically a weekly series.  Dr. Maude "Molly" Guerin, MC, FACOG, had some insightful thoughts to share  on the Group B Strep conversation. 

Is screening all women for Group B Strep just another example of doctors looking for problems that are not really there? I want to keep things as simple as possible for my birth and this seems optional to me. - On the fence mom 

Again, this is an excellent example of making an informed choice. Get the data from a reliable source, and decide for yourself what you want to do.

Here are the FACTS:

            • 20% of women carry Group B Strep as a normal part of their healthy vaginal   

              bacteria. It doesn’t hurt them and it is supposed to be there.

            • 1 to 2 out of every 100 babies born vaginally to women who carry Group B Strep 

              will develop sepsis, a severe infection from GBS, usually meningitis or pneumonia.

            • 20 - 50% of babies that get septic from GBS will die

            • Starting in the mid-1990s research showed that getting IV antibiotics during labor 

              reduced the risk of sepsis from 1 – 2 per 100 babies to 1 in 1000 babies. (Morbidity  

              and Mortality Weekly Report www.cdc.gov/mmwr. Recommendations and Reports,
              November 19, 2010 / Vol. 59 / No. RR-10)

Graph: Incidence of Early and Late Onset Group B Strep Disease


Research into using antiseptic vaginal douche (chlorhexidine) rather than IV antibiotics was initially promising because it appeared to reduce babies being born with GBS on their skin. Unfortunately the chance for sepsis did NOT go down with this intervention (Vaginal chlorhexidine during labour to prevent early-onset neonatal group B streptococcal infection Brenda C Stade^1,*, Vibhuti S Shah², Arne Ohlsson² Editorial Group: Cochrane Pregnancy and Childbirth Group Published Online: 23 APR 2008).

So, let’s start with 1000 healthy pregnant ladies who deliver vaginally and are not screened for GBS. Statistically, 200 of them will carry GBS. Then 4 of those 200 babies will get septic. Then 1 or 2 of those babies will die. Alternatively you could be screened, and if positive for GBS get a heparin lock placed for an every 4 hour dose of antibiotic while in labor. Know the facts from a reliable source and make your choice.

Ask an OB: Delayed Cord Clamping

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here. 

What are your thoughts on delayed cord clamping?

The main issue for cord clamping is iron stores in the newborn. Blood flows from the placenta into the baby for up to 2 – 3 minutes after birth, and then ceases. Clamping the cord early (less than 30 seconds) deprives the baby of this extra blood. This extra blood can be thought of as an “iron transfusion” for the baby, which lasts about 3 months. Because breast fed babies are more prone to iron deficiency, this may be mother nature’s way of protecting the baby from anemia (Timing of umbilical cord clamping: effect on iron endowment of the newborn and later iron status Volume 69, Issue Supplement s1, pages S30–S36, November 2011.) 

In the US today where most babies take a vitamin and iron supplement, the benefit of delayed cord clamping (2 – 3 minutes) is probably not as important as it was in times past.

Ask an OB: Does Mother Nature really know best?

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here. 

Why do doctors get nervous and want to induce women when they are overdue? Doesn’t Mother Nature know when the best time is? -- Skeptical Mom

Most of the time, she does. My three boys were 14, 12, and 10 days overdue – I had no non-stress tests, no ultrasounds, no discussion of induction, even though my blood pressure was high – and everyone lived!  My how times have changed in the last 30 years. The problem is that stillbirth does become more common as pregnancy advances, dramatically after 42 weeks – it’s 17 times higher after 42 weeks than it is at your due date. That being said, the chances are good that your baby will be fine even at 42 weeks – look at these numbers:

Completed Weeks	Stillbirth/10,000 births
37	2.4
38	3.6
39	4.0
40	2.6
41	9.4
>42	34.7

Obstetrics & Gynecology, VOL. 103, NO. 1, JANUARY 2004

So in today’s world, we like to get people delivered before 42 weeks. Usually once you pass your due date we are checking the amniotic fluid by doing a quick ultrasound once a week – this helps us know the placenta is still working well. Also doing a non-stress test by putting you on the monitor for 20 minutes twice a week helps us know the baby is doing well. These tests are not perfect, and our data on them is always being updated, but currently they are the standard of care and recommended by the American College of Obstetrics and Gynecology.

Here is a meta-analysis of studies on the management of post-dates pregnancy by the highly respected Cochrane Group:

Selection criteria

Randomised and quasi-randomised trials of interventions involving the intention to induce labour at a specified gestational age.

Main results

Twenty-six trials of variable quality were included. There were four trials of routine early pregnancy ultrasound, two of nipple stimulation, nineteen of routine versus selective induction of labour and one of antenatal fetal monitoring. Routine early pregnancy ultrasound reduced the incidence of post-term pregnancy (odds ratio 0.68, 95% confidence interval 0.57 to 0.82). Breast and nipple stimulation at term did not affect the incidence of post-term pregnancy (odds ratio 0.52, 95% confidence interval 0.28 to 0.96). Routine induction of labour reduced perinatal mortality (odds ratio 0.20, 95% confidence interval 0.06 to 0.70). This benefit is due to the effect of induction of labour after 41 weeks. Routine induction of labour had no effect on caesarean section.

In other words, induction of labor after 41 weeks reduced the chances of the baby dying by 80%. And since we never know if your baby is going to be one of the 9966 out of 10,000 who is fine, or be one of the 34 that is not – we want to get you delivered.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here. 

Ask an OB: Crystal ball

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here. 

How can you make sure you are on the same page, specifically regarding risk, with your midwife/OB? For example, is it appropriate to say, "I would like to do my best to birth this child naturally but if you can tell that the baby may not make it, or I am to blow out my body, that is where I draw the line." How do you draw lines with them? Is this a conversation you should initiate during prenatal classes? Should you say, "I am all for candles and bathtubs, but ultimately I am here for the outcome (i.e., healthy mother and baby) and am willing to sacrifice the process (i.e., uninterrupted birth) to get there. I need you to help me identify when our health is at risk." - Okemos Mom

 

I badly need a crystal ball. When they invent them, I get it first! If I could peer into it and see a 30 hour labor, 4 hours of pushing, a C section, a stay in the Neonatal Intensive Care Unit for the baby and a blood transfusion for you . . . I would do a C section before labor and skip all that! If I could see a baby that comes out and doesn’t breathe, has Apgars of 1 and 4 . . .  I would labor you in the hospital, on continuous monitoring, and do a C section if things looked bad. And you would gladly forgo the “candles and bathtubs,” I’m sure!  If I was worried a VBAC would rupture your uterus with a trial of labor, but could use my crystal ball to see a 3 hour labor, 2 pushes and a happy baby and mom, we wouldn’t even talk about all the bad things that can happen! Unfortunately we don’t have that crystal ball. Therefore you DO NEED to have that conversation with your partner before you decide where to have your baby. Then you need to be explicit with your provider. Here are some examples of ways that you can set clear expectations:

• “We are committed to a natural labor and delivery at almost all costs. We accept some increased risk for low Apgar scores, neonatal seizures, and a long labor – in hopes of reducing our risk of a C section. Unless you have clear incontrovertible evidence that my baby or I WILL have irreversible damage, I want to continue with no intervention and accept the outcome.”

• “We sincerely hope for a low tech, ‘hands-off’ labor and an unassisted vaginal delivery. Please stand by and let us know if you see warning signs of trouble for mom or baby…we would like to discuss options for intervention in that situation, and have a time line for decisions.”

• “We want as close to a 100% guarantee as you can give us that our baby will be under absolutely no stress during labor and delivery. If things aren’t going perfectly we want a C section immediately.” 

Writing your feelings down is always good, too. I would much rather see an essay on your risk tolerance and the strength of your desire for no intervention than the list of “do’s and don’ts” that make up most birth plans. So my advice is yes – please talk talk talk to your provider about risk and how you want to handle certain situations. If your provider has her/his own agenda about these things, you need to know that up front and decide if you can live with that. 

Finally, I find the last sentence of your question critical. “I need you to help me identify when our health is at risk.” Honestly, this is not your job, it is our job. Your job is to be strong, to be thoughtful, to climb the big mountain that is labor. Our job is to be nearby spotting you. When you veer off the safe path, we notice, we shepherd you back. Sometimes we yank you back! “Hey your baby is in trouble – get into the O.R. RIGHT NOW!!”  You shouldn’t have to worry about identifying when your health is at risk, you have a huge job to do just getting through this (it’s called “labor” for a reason!). If you are second guessing your provider and don’t trust that they will be able to “identify when your health is at risk”, you are in the wrong place for care.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.

Ask an OB: Holy leg pain, Batman!

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here. 

I experienced terrible, shooting pain down both of my legs during my labor. It was much worse than the pain of contractions. I had never heard of this before and it caught me totally off guard. Is this normal? Is there anything I can do to avoid leg pain in future labors? - Michigan Mom

Hard to say without more details on the shooting pain…. did it intensify with contractions or was it constant? Did it disappear at delivery or did it persist? Did it radiate up into your uterus, your lower back, or down into your calves? The nerves that carry pain sensations from the thighs and the uterus overlap, especially in later labor, and it sounds like your pain got worse as labor progressed. If it was constant (intensity between contractions just as severe as during contractions), then I suspect the baby was lying on some nerves. If the pain intensified during contractions and faded back a tiny bit between contractions, I suspect this was part of contraction (uterine) pain. 

 “Labor” is serious work and it really hurts. Is there a single woman out there who felt her FIRST labor was not as bad as she thought it would be? Personally I thought it was the most intense physical feeling I’d ever experienced. Eventually rewarding and exhilarating, but WAY more painful than I imagined. The good news is that subsequent labors are so easy you want to burst out laughing when it’s done. So don’t let a (first) painful labor stand in the way of another baby. I invariably tell first-time moms, “you never have to deliver your first baby again, the rest of your labors are your reward for the hard work you did today.”

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here. 

Ask an OB: Red Flags

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here.

What signs should midwives be looking for in labor that signal the mother and/or baby need additional help? It seem that other birth attendants (like dads!) would also like to know these signs and help look out for them. -- Lansing area family 

“Needing additional help” falls in to four categories:
1) Baby not tolerating labor
2) Mom exhausted/too painful to continue without medication
3) Labor not progressing as it should, especially if membranes are ruptured
4) Mom's status is concerning  

1.) Baby not tolerating labor
To know this you have to listen to the baby’s heartbeat FREQUENTLY. American College of Obstetrics and Gynecology recommends listening before, during, and after a contraction every 15 minutes in active labor, and every 5 minutes during pushing (which will be almost every push most likely).  Adhering to this standard will find most cases of severe fetal compromise. Subtle, earlier changes that are marked by loss of “variability” without changes in the “rate” of the baby’s heart will not be picked up by this method.   
You can read this article for details. 

2) Mom exhausted/too painful to continue without medication

3) Labor not progressing as it should, especially if membranes are rupture
In a “normal” labor, first-time moms will progress about a centimeter an hour during the “active phase” between 4 and 10 cm. The “latent phase”, from 0 to 4 cm can take a lon ger time, up to 24 or even 48 hours. Pushing can take up to 2 hours and be considered normal.  So anything outside this time frame (24 hrs latent phase, 6 hrs active phase, and 2 hrs pushing phase) should be cause for concern. Previous vaginal delivery shortens all these numbers dramatically! Pushing more than 1 hour would be abnormal in someone with a previous vaginal delivery. Many many women will not fit this time frame and be perfectly fine, and we do NOT put women on a timetable in labor! But an alert accoucheur will prick up her ears when these thresholds are crossed and begin to discuss the situation, try to figure out why (baby too big? Labor poor quality? Baby in unusual position?), have Plan B in mind, and do the simple things that can help (hydrate, position change etc). As time goes by and no progress is made, despite best efforts, transfer is a good idea. Frequently pain relief, rest, and augmentation to make contractions better will result in a vaginal delivery. 

4) Mom’s status concerning 
Fever, high pulse rate, excessive pain, high blood pressure, severe headache, blurred
vision can be signs of preeclampsia or infection. Transfer is mandatory if these are suspected. 

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here. 

Ask an OB: Prolonged Labor

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here.

What problems are related to prolonged labor? Is it noble to push for 10 hours or is it risky? -- Long labor mom

Before we get to the particulars of this question, understand that I am assuming that your baby is being adequately monitored and is in perfect shape. The key to understanding this issue is to answer another question: why is labor prolonged? In medical school we simplify prolonged labor it’s the baby, the pelvis, or the contractions. Some of these problems are solvable and some aren’t – we can’t make your baby 6 pounds instead of 9, and we can’t make your pelvis bigger! We can encourage your baby to turn if it’s posterior (position change and patience), and we can make your contractions stronger and more frequent (patience, hydration, nipple stimulation, or the dreaded pitocin!).

So the first thing to do is to know when your labor is longer than average (24 hours in latent phase, 0 to 4 cm; 6 hours in active phase, 4 cm to 10 cm; and 2 hours pushing in a first delivery, 1 hour in any subsequent delivery). Next, try to figure out why your labor is longer. 

• Is it the push? How frequent are your contractions? Every 2 – 4 minutes in active and pushing phase is normal. How strong are your contractions? Experienced birth attendants can feel the uterus during a contraction and judge this. 

• Is it the passenger? What position is the baby in? Again, an experienced provider can often tell how the baby’s head is lying in the pelvis – face up, face down, or in between. How big is the baby? We are notoriously terrible at guessing! I’ve seen ultrasound off by 2 pounds and I’ve personally been off by 3 pounds – pretty bad! But about 80% of the time, experienced providers and ultrasound are accurate to within 1 pound. If you’ve already had a baby you are actually just as good (if not better) than ultrasound or your provider, so use your expert judgment.

• Is it the passage? Experienced providers can feel the pelvic bones (pubic bone, sidewalls, tailbone) and make a reasonable assessment of “small medium or large” pelvis.

All these factors need to be carefully pondered in order to do the right thing for a “prolonged” labor. For instance: here are 2 scenarios with first-time Mom stuck at 7 cm for 3 hours:

Mama One : Observations: Estimated weight 7 pounds. Pelvis feels average. Baby may be posterior (harder to deliver). Contractions have spaced out from every 2 to every 6 minutes over the past 5 hours and have gone from strong to moderate to palpation. Assessment: needs better contractions, and this will also hopefully help baby rotate into a better position. Chance for successful vaginal delivery: high 

Mama Two: Observations: Estimated weight 8#. Pelvis feels borderline. Baby feels in a good position. Contractions are every 2 minutes and strong. Mom went from 2 cm to 7 cm in 4 hours. Assessment: baby having trouble fitting through pelvis despite good labor and good position. Chance for successful vaginal delivery: probably less than 10 - 20%.

I would be more patient with Mama One than I would be with Mama Two. If you are Mama Two where your pelvis is just too small, persisting in labor is all risk and no benefit because your baby isn’t going to fit no matter how long you labor! The longer your baby rams against the pelvic floor, the higher your risk for infection, hemorrhage, lacerations and damage to the uterus during your inevitable c section. 

So, to answer your original question (finally!) : if you are having 4 contractions an hour, you can push 10 hours. If you are having 20 contractions an hour it is just plain dumb to push 10 hours. And risky. Notice that WHERE you deliver and WHO does your delivery are not on the list of things we consider when we are trying to decide what’s best for you. If those things are on the list – beware.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here. 

Ask an OB: Fetal heart rate

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here.

What is a normal range for fetal heart rate during labor? What kind of variability would be cause for concern? - East Lansing Mom

Normal baseline fetal heart rate is usually 120 – 150 beats per minutes. Some babies run a bit lower at 110 – 120, or a bit higher at 150 – 160, but I would be watchful at these rates for 2 reasons. First, higher baselines can be a sign of infection or stress. Second, lower rates can actually be mom not baby. You’d be surprised how often mom’s heart rate is 100 – 120, and it can be hard to tell who is who. If baby’s heart rate was supposedly normal up to a minute before delivery and then the baby is born without a heartbeat, you can be sure they were listening to mom not baby and were falsely reassured. Even an internal scalp electrode will trace mom not baby if baby has no heart rate. So it can be quite tricky. At the hospital if we are uncertain, we put you on the fetal monitor and put a little soft plastic cap over your index finger. Then we can see mom’s heart rate right on the fetal heart rate tracing and make sure they are both there and fine.

The other issue with heart rate is that you have to listen before, during, and after a contraction. The rate may be normal before, then abnormal during or after a contraction. The heart rate that drops following a contraction can be subtle – even just 10 beats per minute difference – and be quite ominous. Deeper dips during a contraction may not be as concerning, depending on the depth of the dip and how fast it recovers. Another factor that can help us tell your baby is wonderful is not the RATE of the heart, but what we call the VARIABILITY. Variability is not apparent with spot checks of the heart rate, and explains why babies who do not get continuous monitoring have a higher chance of bad Apgars (even though most of them are great with no monitoring at all!). Babies that have good oxygen levels and normal brains have quite a bit of variation in beat-to-beat heart rate. When you trace this out on the monitor, you see a squiggly line, not a straight one, with ups and downs. This baby is happy!

Happy baby: Top line is heart rate, bottom line is contractions. 

This baby (chart below) is in serious trouble. No squiggle, and subtle dips following contractions. Oxygen levels and acid levels are not normal at this point. Got to get this baby out ASAP! 

Baby in trouble: Top line is heart rate, bottom line is contractions

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.

Ask an OB: What does that mean?

"Ask an OB" is a weekly series with Dr. Maude "Molly" Guerin, MC, FACOG. If you have a question for her, please share it with us here. 

I've heard people talk about pushing against a "cervical lip" during labor. What does this mean? Why does it happen? Are there any risks involved? - East Lansing Mom

“Cervical lip” refers to the nub of cervix that is left when the cervix is almost fully dilated. When the cervix is fully dilated it disappears and all you can feel is the baby’s head, with no little “cuff” of cervix around it. When the cervix is ALMOST fully dilated you can feel a little edge of cervix, usually right under the pubic bone, that puffs up because of the pressure of the baby coming down. Eventually this lip usually disappears, and then you can push. If the pelvis is too small this little “lip” never does go back around the head – so you never get fully dilated. If you start pushing before the lip is gone (in other words before you are fully dilated) one of 3 things will happen: 1) you will tear the cervix, deliver, but maybe have a weak cervix next time leading to premature delivery. 2) the lip will not go back, will swell up, and you will never deliver vaginally 3) the lip will go back over the head and all will be well. Pushing against a lip for a short time might be OK to see if it goes back easily, but if it doesn’t do that, you need a hospital.

What is "caput" and what does it indicate for a laboring mother/baby? - East Lansing Mom

Caput refers to the swelling that occurs on the top of the baby’s head in response to coming through the pelvis. The pelvic sidewalls form a tight “chute” and the baby helps fit through by “molding” the skull bones to make the head literally more pointy. The leading portion of the scalp gets swollen from all the pressure, and gives baby the “cone head” so characteristic of first labors (and completely normal). With subsequent labors, the baby spends very little time deep in the pelvis – some second babies come shooting out in one push!- so the swelling and molding are much less. When more and more caput forms, we worry that the baby is stuck – the bones can’t fit, but the contractions keep trying to force the baby through.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.

Ask an OB: Hospital worries

Thank you for your questions! Dr. Molly will answer them as they come in and we'll post a couple to share here on the blog every Monday. Here are two to start us off . . . 

What are three common misconceptions that the NCB (Natural Child Birth) culture promotes about hospitals that you would like to dispel? - Mom of three

1. “You will be strapped into bed flat on your back the whole time you are there”. 

Actually . . . .we don’t want you flat on your back! Please walk, go in the shower, crouch on your haunches, rock on all 4s, roll on our birthing ball, etc.

2.  “The chance for a c section is 40 – 50%”.

Actually . . .  the chance for a c section in a mom who is term, low-risk, and in spontaneous labor is about 15 – 20%. Most of these are done because either the baby won’t fit, or the baby’s heart rate doesn’t tolerate the strong contractions in late labor.

3. “Your baby will be taken away from you and given meds, formula, pacifiers, sugar water and vaccines you don’t want it to have”.

Actually . . .your baby will be plopped right up on your chest at birth, left there till you want him weighed, allowed to nurse as soon as she wants to, room in 24 hours a day, and go home whenever you are both ready to go.

What is the No. 1 fear that women come to the hospital with that they really DON'T need to worry about? -Mom of three

For some reason some women worry they will be a bystander to their labor and delivery – that all decisions will be made without their knowledge or consent, that nurses and doctors have an agenda that they don’t share, and that what the parents want will be disregarded. This is absolutely not true! Please talk with your provider about your hopes and dreams for your labor and delivery – it is our strongest desire to make you happy. If there is a mismatch between what you want and what we think is safe – we WILL discuss this in as much detail as you need.

You can read more about Dr. Maude "Molly" Guerin, MD, FACOG, right here.

Ask an OB: Meet Molly

We are excited to kick off a series of posts here on the blog called, Ask an OB. Our resident OB, Maude "Molly" Guerin, MD, FACOG, will field questions you have related to pregnancy, labor and hospital birth.  Wondering what it means to be post date? Worried about the so-called "cascade of interventions?" Curious about cord clamping philosophies? If you have a question for Molly, please share it with us here.

Before we get started with questions, let's meet Molly . . . 

"I made a big loop that started in Ann Arbor for undergrad, wound through Florida, Maine, New Hampshire, and then back to Michigan in 1989, with med school (1978), OBGYN residency (1982), marriage (1977), and three boys (1981, 1983, 1987) along the way. After my family, my biggest love is my work. I still love coming to work every day, because of the transformative power of the three “blood events” for women. Being a small part of the “becoming” (…a woman… a mother…a wise old lady) for my patients is a privilege I am grateful for every day. Birth is the most dramatic of the three transformations: the most physically challenging, and the most dangerous, the most rewarding. My job as an obstetrician (from obstare “to stand by”) is to be present, vigilant, and ready to intervene when necessary. Creating a strong bond of trust between parents and provider is a critical goal of prenatal care, so that, when necessary, interventions are done with understanding and consensus. Just because things usually go well doesn’t mean they always go well - my job is to anticipate, be prepared, and do what it takes to get a healthy mom and baby as often as is humanly possible."