Archive for the ‘childbirth’ Category

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Wednesday, March 9th, 2011

Having our baby

Once the special moment comes for you to go to the hospital to deliver your baby, there’s so much that goes on that it just may not be the best time to remember questions you wanted to ask your obstetrician. I’ve been there four times – so, as they say, been there done that! I’ve also had a number of cases that made me stop and think – “I wonder if some of the issues that my clients encountered could have been avoided if they had asked some questions before they wound-up in labor in hospital?” As you can well imagine, that is perhaps not the best time for a Q and A session.

This past weekend, I posted somewhat of a survey on our Facebook Page and Twitter asking our friends, fans and followers what questions they wished they had asked their obstetricians before they arrived at the hospital. I also have a number of moms, who work in our law office; so I put the question to them as well. The responses received provided some interesting food for thought, which I thought I might share with those about to have their baby.

Who will be delivering my baby?

This was one of the most frequent questions making the list. A number of women complained that they wish they had known that their primary obstetrician was not going to be the delivering doctor. Turns out that physician was being covered the day/night these moms delivered. While they may have met all the members of the practice (if it was a group practice), they were not particularly happy when their primary obstetrician wasn’t there for the delivery. The problem is compounded when their primary obstetrician was off and being covered by someone they had never met before. Suggestion: find out as best you can what the chances are that there will be coverage by someone you’ve never met before you arrive at the hospital. You may want to make an appointment to meet that potential covering physician if this is a concern.

When will I see my obstetrician at the hospital?

One of the cases we are handling somewhat arose from a situation that raises this as an issue. You get to the hospital, you’re admitted, you’re placed in bed, monitor attached – you’re good to go. But – where’s your doctor? Does he/she even know you’re there? When is your obstetrician coming to see you? Several of the women who responded said this was a real concern and wished they had discussed this with their doctor before they sat in bed waiting and waiting for their doctor to arrive. They also wondered – if there was no direct phone call before going to the hospital, just how could they be sure their doctor was notified that they had arrived. In one instance, one obstetrician claimed she didn’t know the patient was even in hospital for more than 4 hours! This woman had to undergo an emergency C-Section when the doctor allegedly figured out she was there. Suggestion: confirm with the hospital staff after you arrive that your doctor has been notified that you have arrived and ask when you might expect for your doctor to arrive and examine you.

Who will be doing the circumcision of my baby boy?

A number of parents indicated that while they had discussed whether their newborn son would have a circumcision, it hadn’t crossed their minds to ask – “Who will be doing the procedure?” If this is an important consideration, and you would like an answer not only as to “who” but “what experience” they have, think about covering this with your obstetrician beforehand. While some physicians are very good at performing this procedure, others are not so good. There have been a number of infant penile injuries that we have happened in the hands of – well let’s say – less than skilled physicians.

What will happen if for some reason I require general anesthesia but I’ve recently had a meal?

One of the common orders for a patient who will undergo general anesthesia is that they be NPO (nothing by mouth – liberal translation) for hours prior to surgery. While you may have planned to have an epidural or natural childbirth, some conditions involving you and/or your baby (non-reassuring fetal heart tracing, placental abruption, etc) can occur that may change the “plan” and require that you undergo a different form of anesthetic management. Suggestion: if such a situation should arise, you will be seen by an anesthesiologist first. Perhaps you will have a discussion about possible alternatives for anesthetic management, but I can virtually assure you, that will not be the best time to have a coherent, meaningful discussion. Some have suggested, based on their experience, that asking for and having a meeting with anesthesia personnel before going to the hospital for delivery is time well spent. You can usually have such appointments made through your obstetrician’s office and have a meaningful discussion of the various alternatives, risks and complications at that time.

How long will the effects of my epidural anesthetic last after delivery?

It’s been pointed out to me that while some hospitals have discontinued the practice of providing pain relief (analgesia) post-partum by use of PCA (patient controlled analgesia) pumps, some hospitals still continue that practice. Regardless of what the hospital’s practice may be, there is usually a very consistent practice/protocol for when a woman who has had an epidural should be discharged from a recovery room/area. This is when she is able to bend her knees, move her hips and flex her feet in both directions. Suggestion: ask your obstetrician what his/her practice is for providing you pain management/relief after you deliver your baby. Will you have an epidural running to provide that relief? When should you expect to get return of your ability to use and feel your legs? Don’t guess – you could suffer what is known as a prolonged block, where the anesthetic, for various reasons, is taking too long to wear-off and affecting your neurological functioning. If your obstetrician doesn’t know, then consider talking to specialist in such pain relief techniques – the anesthesiologist at the hospital where you will be delivering your baby. While you’re there, you may also want to discuss what the risks, benefits and complications of epidural, spinal and general anesthesia are so that you are aware of these issues in advance.

What suggestions do you have?

This is only a partial list of a number of suggestions made by our readers and staff. What suggestions do you have? If you have already been through childbirth, are these matters or issues you wish you had discussed before you went to the hospital? If you are about to have your first child, are these issues, concerns or questions you might share? We – and our readers – would really like to hear from you. There is no substitute for experience – or so they say.

Image by corbisimages.com


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The daily struggle of raising a disabled child

Thursday, February 24th, 2011

Parents must cope with daily concerns of special needs children

Like many parents, I am blessed to have healthy children.  I take it for granted that my kids are smart, active, well-adjusted.  I don’t even have to think about their health other than the occasional cold or earache or sprained ankle. Others are not so fortunate.

This past weekend I was reading in Maryland Family Magazine an article about a local college professor who wrote a book about raising a son with severe autism.  After writing the book, he assumed that a major publisher would have interest. He ended up being turned down by some agents who told him that without a happy ending or a cure, there was no way they could market the story. Apparently, the public wants stories about disability to have a Hollywood ending. (A publisher finally did come along that agreed to publish the book).

This, in turn, made me think of a good friend of mine (I’ll call her Jane), who has a disabled son (autism spectrum) in addition to three normal children. I hesitate to use the words normal and disabled for two reasons:  1) we live in a politically correct world where deciding what label to apply to anything means stepping into a social minefield; and 2) on the spectrum of mental or physical ability, it can be difficult to say what exactly is normal versus abnormal. I never want to suggest that children with limitations are abnormal. Some parents even bristle at the term “disabled.” Others use the more cumbersome term “neurotypical” rather than the term “normal.” You can see that it can be hard to discuss the topic of disability when we don’t even have terms we can all agree on.

Jane and I often discuss our kids and parenting. She has been very candid with me in describing how incredibly hard it is to raise a disabled child. She believes that no one really wants to hear the negative side of raising a child with special needs. Like the publishing agents that the professor encountered, some people only want to hear about the inspirational side of the story. Truth is, there is not always a happy ending or miracle cure when raising a disabled child, be it autism or cerebral palsy or paraplegia. These are life-long disabilities. There are happy moments, of course, as well as accomplishments both major and minor, but for parents raising a disabled child, it is a daily struggle to make sure that the child gets the medical care and therapy and attention that he or she needs. Parents undertake this monumental and thankless task not because they hope for some Hollywood ending, but because they love their child and they do what they need to do, even if they never knew they had such strength and determination in them.

It’s not all negative, of course. Jane tells me all the time how much she loves her son and how he has taught her so much about herself and about life. She says she cannot imagine who she would be without her son. At the same time, however, she also feels a lot of pain and loss and regret about what she and her family have had to sacrifice in order to care for her disabled son. The daily struggle can truly be overwhelming at times. Jane believes that parents often feel unable to express these feelings for fear of being branded a less-than-stellar parent. As she told me, “There isn’t a safe place to express one’s own doubts about being able to effectively take care of another person who requires so much care. It’s daunting, hard and stressful and for some reason it’s not completely OK to admit that.”  Jane is careful about the sentiments she expresses in public versus those she tells to her friends:

There is the aspect of autism that you are allowed to talk about versus not allowed. I’m allowed to admit it’s hard, but I can’t really say how hard or I’m too negative. I’m just supposed to say it has changed my perspective and I’m blessed.  It has changed my perspective but I’m not blessed. Shut up about being blessed.

While disabilities are all different and every parent’s story is unique, there is a common thread that runs through them all – raising a disabled child takes its toll on the parents and the family as well as the child. The challenges can be enormous. Some of the more common challenges include:

  • Financial:  Finding ways to afford medical care, therapy, services;  working with insurance companies and various state agencies;
  • Educational:  Struggling with teachers and school administrators to make sure that your child is getting an appropriate education and Individualized Education Program or IEP.
  • Medical:  Finding doctors who are willing to take the time to listen to your concerns and diagnose your child; getting referrals to specialists; sorting through the myriad hoops of insurance; finding therapies that work for your child;
  • Social:  The loss of normal everyday activities like going out to dinner, taking trips, seeing friends; not having anywhere to turn to talk about what they are going through.
  • Marital:  A couple often experiences difficulty because of all the other stresses that are created by having a disabled child, as well as the substantial time investment that is required.
  • Family: Other children in the family can be affected because mom and dad have to devote so much time to the disabled child and because the family’s usual routine and activities are disrupted; money can often be tight.
  • Psychological: Many mothers experience feelings of guilt, wondering if it was something they did during pregnancy that caused their child to have this disability.
  • Legal: Figuring out what rights you and your disabled child have, what services you are entitled to.

I can’t say enough about those parents who take on these challenges on a daily basis.  It is difficult to even imagine the level of devotion and commitment that is required.  I welcome all parents to share their stories — the good and the bad — so that the rest of us can try to better understand the reality of raising a disabled child.  In future blogs I will talk about some of these challenges in more detail and where parents can turn for assistance.

Image from metroparent.com