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Caitlin Whyte: Planning for delivering your baby, whether it's your first or your fifth is so much more than just day of planning. Joining us today to talk about safe labor and delivery is Dr. Courtney Morris, a Board Certified OB GYN at Franciscan Health. This is the Franciscan Health Doc Pod. I'm your host, Caitlin Whyte. So Dr. Morris, when it comes to planning a safe delivery, what can we do in the days or weeks beforehand?

Dr. Morris: So I think some of the most important things to prepare yourself for labor and delivery, if there is such a thing as being prepared to deliver a baby is gathering as much information as possible about the environment and expectations for that day. You know, as an obstetrician, we're at home on labor and delivery, but almost everyone else isn't even other people that work in the hospital don't feel comfortable on labor and delivery, just because there's a lot of monitoring’s and a lot of equipment we might use that is unique to our specialty. So I always recommend my patients that aren't familiar with our labor and delivery ward, to do a tour of labor and delivery. That's kind of difficult now with COVID-19 situation, but prior to, and hopefully after this COVID-19 pandemic, you know, touring labor and delivery, I think highly valuable. It's usually done with someone who's familiar with the instruments we might use. We'll show you the monitors we're going to put on you. They'll all show you the nursery then NICU, if your baby happens the NICU. And so I think just, you know, when you arrive in labor on your big day, just being familiar with the location and the room situation is huge. It goes a long way to your comfort for that day.

Host: Now what should expecting parents look for in a hospital or delivery setting?

Dr. Morris: So, you know, we're very proud of our awesome NICU that we have. So we all want, of course, those providers and patients want the best experience that, you know, our main concern is healthy mom and healthy baby. And so you need a labor and delivery service that does a lot of deliveries and can handle those unexpected complications that might arise. So if you know, even a full term, baby can sometimes have issues and challenges that might force that baby into the NICU. And so, as I mentioned, we're very proud of our NICU. And I think something that expected parents don't ask too much about is the NICU because they think, well, you know, I'm going to have a full term, baby, what are the chances my baby doesn't make you well, unfortunately, you know, that that could happen at any gestational age. So I think that's important, you know, talking about what the rooms look like. There's a couple different models for how labor delivery works at the hospital I work at.

We have LDRP rooms, which means labor delivery, recovery, and postpartum. So once the patient gets parked in her room, she's going to be there until she goes home potentially. So I think that's a pretty nice setup. Other hospitals do more traditional labor and delivery rooms and then, you know, would get wheeled to another room on a postpartum unit. So those are just a couple of things, you know, even just logistically to think about with the labor and delivery. Something else that is important is the available of anesthesia services. So larger hospitals like ours, we have a dedicated anesthesiologist just to our OB patients, 24 hours a day. So that enables us to perform a C-section at any minute of any day, and also allows our patients to get epidurals in a timely fashion. That certainly is not universal. There are some hospitals that are just not large enough to offer those services. And if an epidural is very important to you, then I would definitely ask about, you know, the availability of anesthesia

Host: And to follow up to that question, what should they look for in a delivery doctor?

Dr. Morris: So I think it's really important that you have great communication with your doctor, because, you know, at the end of the day, you're going to be looking at him or her for advice on, on not only just your pregnancy care, but the day of delivery. And unfortunately, things happen fairly quickly on labor and delivery. And if you don't trust your bathroom, that's going to put you in a very difficult situation. So that, that line of communication is crucial. If you don't feel comfortable talking to your doctor, even if you think they're silly questions, we get asked so many questions throughout the course of a day, a week, a month or a year. You know, if you think, Oh, that's too silly for me to ask or, Oh, I don't want to bother my doctor with that. You might not be with the right doctor. You know, I want my patients to ask me anything, even the silliest thing, because if it's bothering them, I don't want it to bother them. I want it, we got to get that air out so we can answer all those questions before going into the big day. So I just, I think communication is very crucial. Obviously, for the most part, we've all been trained the same and various levels of experience based on how many years we've been in practice. But at the end of the day, you just have to be comfortable with your doctor and trust him or her that they're going to make the right decisions for you and your baby. And if you think something isn't going the way you want, something's really bothering you. You just got to be comfortable enough to ask.

Host: So when it comes to the day of what should be at the top of the list in terms of actions, I mean, the baby is coming, where do you start?

Dr. Morris: So this goes back to the head of that. Pre-Planning so having taken a tour, all my patients who are not planning on epidurals, I still talk to them about an epidural and I strongly recommend they take, you know, some sort of class. Now with COVID-19 we're doing those virtually, but you need to know what you're getting into. And so, yeah, there was as much as you can taking some of those birthing classes, just to talk about breathing, staying in control, that's going to get you through your labor without an epidural. You've got to stay in control. You've got to have realistic expectations and you've got to practice your breathing. Those classes going into labor and delivery are crucial for that. You also need to have your bag packed, of course, with just the essentials. I usually tell my patients to bring what you would bring if you're going away for a weekend. You know, we have soap, so you're probably not going to want to use it. You're probably going to want to use your own stuff from home, have your bag packed and ready to go.

So you're not stressing about whether or not you bought your house flippers on the day of labor. I think that sometimes people don't think enough about what an epidural is going to look like. Can I get an epidural? Am I going to wait too late? You know, I would have all my questions need to be answered before you hit the door. And I always tell my patients that it's okay if they're undecided about the epidural, because they have never, for some of them have never experienced labor and don't know what to expect, but we at least need to have already had that conversation about what an epidural looks like, what it does, what it doesn't do and the timing of an epidural. So a lot of that planning can happen before you hit the door. And once you hit the door in labor, I think you need to, you know, people kind of overthink the process, which I know sounds silly, but Oh, I got to have a birth plan and, Oh, I got, no I don't want IV. And you know, the truth of the matter is as providers, we want to intervene as little as possible, even though you know, we're your doctor, we're monitoring you very, very closely.

You know, if things are going well and we're laboring, and we're not going to give you medications, you don't need, we're not going to intervene unless we feel it's necessary. So I think people tend to overthink the quote unquote birth plan and, you know, no one is trying to do an intervention, that they don't need done. And there was not an ambulance list of medicines we can use. There's only a couple of medications that we can give you. So I think that we're not going to intervene, nobody, no doctor that I know is quick to do C-sections or has that on the plan, if a patient isn't delivered by a certain time, you know. Certainly pregnancies, certainly labor can take turns that we're not expecting, but we're always ready for anything. And so I think that's hard for some patients when their labor course doesn't go the way they wanted it to. But our goal at the end of the day is healthy moms, healthy baby. And if that means a C-section, in some instances, that's going to mean a C-section, and we're only going to do that if we think it's the best course of action for mom, baby, or both.

One other thing, again, not really relevant with COVID-19, but I think it's important to set up expectations for family visiting. That can be a real source of stress to during, you know, labor. Oh, your mom's texting. So I think setting up family expectations and boundaries is very important. Bonding time, that bonding time, right after delivery and [inaudible 09:14], is so important. And it's unnerving to go into a room and have 10 family members and your great aunt's eating pizza in the corner. And it's just not what that patient anticipated her postpartum time would be. So I think it's very important to set those expectations up, you know, earlier in the pregnancy, rather than the day of labor.

Host: Those are very specific scenarios. I'm wondering if you've seen a lot of these happen.

Dr. Morris: Oh girl. Yes.

Host: Yeah.

Dr. Morris: You know, and it breaks my heart. When I walk into one of my labor room and the room is full with chatter, TV and yelling and the poor little patient is sitting in her bed, just tears, running down her eyes. It's hard because you know, that that patient is overwhelmed and just needs some quiet down in time with her baby. And so I just think setting those expectations up firmly beforehand is very important.

Host: Well, Dr. Morris, are there any tips that we haven't gone over that you really want expecting parents to hear?

Dr. Morris: The only other thing was just mention that, to think about how you're going to feed your baby. You know, if you're planning on breastfeeding, you can certainly take a class on that. It's one of those things where you can't really learn how to do it until you have a baby and your doing it, but just kind of having some thoughts or talks with your doctor about how you're going to feed your baby is breastfeeding is a good choice for you and your baby. And it's so you need to bring, you know, nursing gown or nursing top, nursing pillow, to labor and delivery that day.

Host: Well, thank you so much for joining us today, Dr. Morris, I hope we've helped some expecting parents with their delivery planning. That was Dr. Courtney Morris, a board certified OB GYN at Franciscan Health. You can find out more about labor and deliveries at franciscanhealth.org/OBGYN. I am your host, Caitlin Whyte. Thanks for listening.