There are a lot of routine things that we normally just do unless you’d rather do something else. That doesn’t mean you can’t refuse them. It means you just need to know why we normally do them, and why you’re making another choice.
Today’s guest is Dr. Franziska Haydanek, an ObGyn attending, former blogger, current TIktok obsessed, and mama of two young children. Find her on Tiktok @pagingdrfran for TONS of great pregnancy information!
This episode was inspired by chapter 5 of The Online Prenatal Class for Couples where we chat about routines in the hospital.
Big thanks to our sponsor The Online Prenatal Class for Couples — where you can learn about what normally happens, and get the tools you need to communicate with your healthcare team.
In this episode
Breaking your water in labor.
Continuous fetal monitoring
Pushing at complete
Other things that might interest you
Producer: Drew Erickson
Check out my other pregnancy podcasts:
[00:00:00.130] – Hilary Erickson
Hey, guys, welcome back to the Pulling Curls Podcast. Today on episode 148, we are talking about things that are routine in the hospital that you may or may not want. So let’s untangle it.
[00:00:20.850] – Hilary Erickson
Hi, I’m Hilary Erickson, the curly head behind the Pulling Curls podcast, where we untangle, pregnancy, parenting, home, and even travel. We know there’s no right answer for every family, but hopefully we can spark some ideas that will work for yours. Life’s tangled just like my hair.
[00:00:43.210] – Hilary Erickson
Okay, guys, before we get started, I think it’d be awesome if you made a routine of reviewing podcasts like mine. Thanks.
[00:00:50.250] – Hilary Erickson
Today’s guest I met on the TikTok. Just like all my favorite guests, she gives great, credible, normal, run of the road pregnancy advice, and she’s actually an OBGYN. This is the first doctor I think that I’ve had on the podcast. I’ve had PhDs, but this is the first medical doctor, at least the first OBGYN. On TikTok, you can find her at @pagingdrfran, I want to introduce today’s guest, Dr. Fran.
[00:01:17.690] – Hilary Erickson
Do you feel prepared for your delivery? In just three short hours, you can be prepared for the confident, collaborative delivery you want. You’ll know what to expect and how to talk with your health care team. And there are no boring lessons in this class. I’ll use humor, stories from my 20 years in the delivery room to engage both of you.
[00:01:34.170] – Hilary Erickson
I love how Alyssa told me that she found herself laughing at things that used to sound scary. Most of all, you guys are going to be on the same page from bump to bassinet.
[00:01:42.660] – Hilary Erickson
Join the online prenatal class for couples today. You can save 15% with coupon code UNTANGLED. You can find the link in the show notes.
[00:01:52.710] – Hilary Erickson
Hey, Dr. Fran, welcome to the Pulling Curls Podcast.
[00:01:55.230] – Dr Fran
Thank you so much for having me. So excited to be here.
[00:01:57.680] – Hilary Erickson
I think you’re my first doctor.
[00:01:59.560] – Dr Fran
Really? Well, an honor.
[00:02:01.560] – Hilary Erickson
I tried some of the ones that I worked with, and they all looked at me like I was insane and walked away. So not the first time that look.
[00:02:10.950] – Dr Fran
Well, I’m excited to be here. Thank you for having me. Yeah.
[00:02:13.900] – Hilary Erickson
So we just want to talk about kind of the routines that the hospital has and before you all get your panties in a bunch, which is really easy when you’re pregnant in some ways, a lot of people get upset that we have routines. But think about your life. If you had zero routines, you have to have kind of a plan as you walk into the room about what you’re going to get done so that things actually get done. If we did something different every single time, it would be really hard to live our lives.
[00:02:39.070] – Dr Fran
Exactly, exactly. Our routine is to help keep our patients safe.
[00:02:42.780] – Hilary Erickson
Yes. And to keep our brain safe, because I think a lot of people are like, oh, well, they always come into the hospital just before office hours. I’m like, yeah, because that’s a routine. That’s how it happens.
[00:02:54.030] – Dr Fran
[00:02:54.670] – Hilary Erickson
Of course, they’ll come in if they have to in between times. But yeah, exactly. But I want you guys to know that any of these at any point in time, you can be like, no, I’m not really up for that. And then just let us know and we can turn the bus. But the bus has a route that it goes most of the time because I have to be really honest that most patients are just like, yeah, whatever.
[00:03:13.110] – Dr Fran
[00:03:13.940] – Hilary Erickson
Those people are not on TikTok, though.
[00:03:15.790] – Dr Fran
No. And many of them are. They just don’t verbalize themselves all the time. They’re not everyone’s out there going, yes, I had a routine labor and delivery. Everything went fine. That’s kind of boring. No one wants to talk about the fact that the majority of the time everything is fairly routine and everything goes as planned.
[00:03:32.530] – Hilary Erickson
Yes. Thank goodness.
[00:03:33.690] – Dr Fran
[00:03:34.510] – Hilary Erickson
Let’s talk about the first one that everyone loses their mind over. The doctor coming in to break your water.
[00:03:39.540] – Dr Fran
Yes. So I think this is really probably one of the things that we’re going to talk about. That is the most up for discussion. Right. First of all, your OB provider, whether that be an Obstetrician or your nurse midwife, they should talk to you about this prior to it happening.
[00:03:56.220] – Dr Fran
They should explain what their thought process is, what their plan is, why they want to do it, why they think that’s important, so that you as a patient, can say, yes, that sounds good to me. Or you can express your wishes. I don’t want this to happen right now.
[00:04:09.420] – Dr Fran
You don’t really need to have to explain yourself why you don’t want it, whether that is because you want to do everything with less intervention or because you want to wait for your epidural because you think it might increase your labor pains or whatever your reason is before it even happens, it really should be a discussion.
[00:04:23.950] – Dr Fran
So if your Obstetrician or nurse midwife comes in and wants to break your water, they probably have a reason for it, right? Breaking your water can continue labor, or it can be a form of induction.
[00:04:35.790] – Dr Fran
So if you’re there for an induction, it may just help continue on getting you into a good labor pattern, or if you’re already in labor but you maybe aren’t contracting as much or your baby is still very high up and we’re just trying to see how we can help you move further along, breaking your water is a good way to help that along without the need of medications if you’re trying to avoid them.
[00:04:57.420] – Dr Fran
The other time that we think about breaking water is if we need to use internal monitors for whatever reason. We really have two types of internal monitors. We have the fetal staff electrode, which is a tiny little wire that goes on the baby’s head to get a better reading of the baby’s heart rate.
[00:05:12.710] – Dr Fran
Or we have an IUPC or an intra uterine pressure catheter, which lets us pick up your contractions not only how often they’re happening, but also how strong they are. So your provider may feel that they need to have a little bit better monitoring and to be able to place those your water has to be broken. So that is probably two reasons why they’re thinking about breaking your water.
[00:05:32.900] – Dr Fran
But like I said, I think this is the one where really there is the most autonomy because it doesn’t really have to happen for the most part. It just is something that can be used as a tool to help move labor along or monitor your baby closer.
[00:05:47.190] – Hilary Erickson
Right. If it is an emergency, even I could break the water. I mean, officially labor nurse is not supposed to, but we can use an IOPC to break the water if we need to and won’t get in too much trouble.
[00:05:56.150] – Dr Fran
Yeah. And for us, the hospital I’ve always worked in, we’ve always had residence at. So that’s the difference if you’re going to a larger academic style hospital where you have a doctor in house at all times, residents who are always there training to be full fledged Obstetricians, or if you’re working in a smaller hospital where maybe there is not always an OBGYN in the hospital where your labor nurses are very capable of doing the same thing.
[00:06:21.670] – Hilary Erickson
Yes. I meant I can break it with an FSC, not an IUPC, just because it has a pointy thing on it. So as you put it in, it would break the water.
[00:06:28.430] – Dr Fran
Yeah, exactly. And we do use that.
[00:06:29.980] – Hilary Erickson
And that would only be necessary if we were like, we can’t find the baby. We don’t know what’s going on. It just gives us the opportunity to look a little bit further. So I will say from somebody who is on the other end of the amnihook, a good number of doctors don’t ask before they break water. And so if you’re in labor, what you can do, especially if your nurse is like, I think your doctor, whatever is going to pop by before office hours, say, do you think they’re going to want to break my water?
[00:06:53.780] – Hilary Erickson
Or if they come in the room before they check your cervix, say, are you thinking about breaking my water? I think it’s just a smart thing to ask because some of them will just be like, amnihook, water broken. Never say a word about it, which isn’t okay. I’m not saying that’s okay.
[00:07:07.010] – Dr Fran
[00:07:07.380] – Hilary Erickson
But I’m just saying if your doctor seems to be a little bit more like that, you can take the reins by saying, do you think you’re going to break my water? And if so, you’re wrong.
[00:07:16.010] – Dr Fran
If you are, please don’t. If I don’t want you to, yes. And that is such a good thing for your laborer nurse to be such a verbalizer of support because you’re, a labor nurse, will probably talk to you about what your wishes are during. How do you want this labor to go? How do you want you to treat your pain throughout this day? Do you have any wishes? It doesn’t have to be a written outburst plan, right?
[00:07:36.970] – Dr Fran
You can just say like, hey, I really kind of want to wait for my water to be broken until whatever point or not at all. And that way you also have that support of your labor nurse and those nurses who know the physician better, what they may or may not do, who can also be that second layer of support is verbalizing your wishes.
[00:07:55.120] – Hilary Erickson
Yeah. Because if a patient told me I want to wait to have my water broken and I knew that they have a doctor that doesn’t ask them, I’ll say, just so you know, in case I’m not in here, in case I’m on my lunch break or whatever, if he goes to check your cervix, ask him if he’s going to break your water and then verbalize what you want done.
[00:08:10.220] – Dr Fran
Yeah. I do hope that in the grand scheme of medicine is that as someone who has recently finished training and also is very involved in training the next generation is that we get much better about consenting our patients for those kind of things. I completely know what you’re talking about is saying that there are certain people who just won’t even ask. But I think and I really hope that the field as a whole gets better about that. And I think we are I don’t.
[00:08:33.940] – Hilary Erickson
Think I’ve met a doctor under 50 who would probably not consent for water breaking. All the ones I know would be over at least 45 to 50.
[00:08:43.410] – Dr Fran
So I hope we are changing for the better.
[00:08:45.380] – Hilary Erickson
Yes. And, just, I think if you make the idea that you expect to be consented for bigger things like that, you know on TikTok, a lot of times they’re like, they need consent to put my blood pressure cuff on. And honestly, that’s just not going to happen. Like, the nurse just can’t live her life like that, essentially by you coming to the hospital.
[00:09:04.010] – Hilary Erickson
There is a consent for minor things like that, adjusting the monitors, stuff like that. But major things, you should expect to have consent given and you don’t have to say, I consent to it. “Yeah, that’s okay” like, yeah.
[00:09:18.150] – Dr Fran
[00:09:19.680] – Dr Fran
The doctor, for the most part, should kind of verbalize what the big pros and cons are, but they may just say, hey, I really think it’s important that we break your water because we need to trace your baby. Are you okay with that? Yes, I am. That is consent.
[00:09:31.920] – Dr Fran
You have put your trust in your provider to help you and try to keep you and your baby safe. So sometimes it can’t be a point of conversation. Right. Because we’re trying to help in what might be a very stressful situation, but it should always still just be like, are you okay with it?
[00:09:46.750] – Hilary Erickson
Yeah. And most people don’t want to even have more than a 30 second conversation.
[00:09:52.240] – Dr Fran
Yes, exactly. Just, Yep! Whatever you think is best.
[00:09:54.500] – Hilary Erickson
If we had a 20 minute conversation about everything, people’s eyes would glaze over. They would have no idea what’s going on. They just be like, whatever you think is best. I chose you as my doctor. I trust you. That really is the feeling for most people in the hospital.
[00:10:06.180] – Hilary Erickson
So if you have more questions, it would really be up to you to be like, okay, are you just breaking it because it’s your routine? Because a lot of doctors, it is the routine. Before they go into office hours, they go and try and break all the water.
[00:10:16.420] – Hilary Erickson
And if that was me and I was that patient, I’d probably be like, Whoa, Nelly, let’s do it at lunchtime. And they may put on, like, a little bit of a guilt trip that I’m not going to be here. I will not be able to speed your labor up until lunch or dinner or whatever. And you just like, that’s fine.
[00:10:30.590] – Dr Fran
And that’s that shared decision making.
[00:10:32.760] – Hilary Erickson
Yeah. Okay. So the next thing I thought about was continuous monitoring. So usually when you go to the hospital, you have the monitors put on you, and that would be the standard of care, especially when you show up.
[00:10:42.730] – Hilary Erickson
We want to see your contractions and your baby and all that kind of stuff. But once we have, like 20 minutes and the baby looks beautiful, you can make the choice to get up. Do you have a lot of patients who asked for not continuous monitoring?
[00:10:53.860] – Dr Fran
I cannot say that we have a lot of those. And then actually, sometimes people don’t want the monitoring because they feel tied down to the bed. And actually a lot of hospitals now have ours is called, like, a Monica, where it’s like a sticky that goes on your belly and you actually can move around and still be traced very well.
[00:11:10.630] – Dr Fran
And you can also still stand by the bed. I’ve had many women sit on labor balls or rocking next to the bed while still being monitored. So I feel sometimes there’s a perception that being monitored means that you’re flat on your back and you can’t move.
[00:11:24.240] – Dr Fran
And that’s not necessarily, hardly ever, the situation. So just to dispel that little myth, I would say I’ve had very, very few people ever not ask for continuous monitoring. And I think a lot of our patients who come to the hospital are looking to be monitored.
[00:11:39.730] – Hilary Erickson
Yeah. That is one of the main safety benefits is that monitor and nurses constantly watching it. There is always evil eyes on every bed and every single baby.
[00:11:50.390] – Dr Fran
I mean, there is hardly ever a time that there is less than two people’s eyes on a baby strip, whether that’s a nurse and the nurse sitting next to her. It’s people sitting at the nurse’s station. It’s the charge nurse. It’s the residents. If there are some, it’s the attending.
[00:12:04.360] – Dr Fran
There are so many eyes on these strips to make sure that we are keeping baby safe. Medications like Petrosin are being given at appropriate intervals. When we see a baby’s heart rate go down for that terminal decel, people across the unit are running because so many people are there to keep an eye on everyone and to keep them safe.
[00:12:25.490] – Dr Fran
So I would say, again, this could be a big discussion that you have. And I do think it is a discussion that should be had prior to coming to labor and delivery. If this is a discussion you want to have, you see your care team for 36 weeks of your pregnancy.
[00:12:39.450] – Dr Fran
I probably wouldn’t wait until the day that you show up in labor delivery to say, these are all my wishes. These are things I think you should discuss with your care team prior to the stressful hospital environment that it could be.
[00:12:50.230] – Dr Fran
[00:12:50.530] – Hilary Erickson
Because they can really tell you about the risks and the benefits or times that that’s just not going to be appropriate. Because if you’re getting induced or you have high blood pressure or some other things, they’re really going to be like, continuous monitoring is better and 100% agree.
[00:13:03.600] – Hilary Erickson
I think people feel like they have to lay in the bed, but I’m always like, let’s grab over the labor ball. Let’s use the doctor’s stool. We’ve used the Monica at my hospital, and you can’t put all your chips on the Monica because sometimes you’re just like, I don’t know where Monica is today, but she’s not working.
[00:13:20.550] – Hilary Erickson
But usually they have telemetry monitors, which means it just hangs out on an IV pole and you can walk around with it. A lot of times they have monitors that can go in the water. So if you wanted to get in the shower or the tub, you can do that. You don’t need to be just flat on your bed. But also, monitoring is such an art, like how many washcloths we use or the way we use tape.
[00:13:40.230] – Dr Fran
Yes. You guys are like magicians when it comes to getting the monitor on correctly.
[00:13:45.210] – Hilary Erickson
Yeah. And if you’re willing to help with us or tolerate our weird monitoring that we’re trying to do, a lot of times you can move lots of different ways. But the problem is when you’re like, well, I just don’t like it right there. And you’re like, well, that is literally the only spot your baby can be monitored.
[00:13:59.330] – Hilary Erickson
But I will say most hospitals, if you have an extremely low risk, you can be monitored for 20 minutes, and then you can get off the monitor for the rest of the hour, walk around, be free as a kite, and then back on the monitor for those 20 minutes. Every now and then I hear people who just do baby’s heart rate, which would be done with a Doppler. But if you’re that early, that that’s okay. I say stay home.
[00:14:20.190] – Dr Fran
Yeah, that’s also true.
[00:14:22.550] – Hilary Erickson
And one of the other keys is staying home as long as you can tolerate being at home, because it’s so much better when you can make cookies and watch your favorite TV shows in your own bed.
[00:14:31.620] – Dr Fran
[00:14:32.760] – Hilary Erickson
That’s almost as good as an epidural. Almost. Okay. One that I’ve been talking a lot on TikTok, is fundal massages. And so this is something that a hospital definitely has strict policies and routines. In, like, every 15 minutes, we’re supposed to check the level of your funding, which is your uterus, after you have your baby, just to make sure that you’re not bleeding.
[00:14:52.990] – Hilary Erickson
And we will push down just a little bit just to make sure there’s no clots or anything going on in there. And it’s a routine that’s really there to keep you safe. And if you’re making the choice to not have that one, that’s a little I’d be like, oh, come on.
[00:15:05.650] – Dr Fran
Yeah. So I see this from two sides because I hear people talk about like, oh, my doctor was mashing on my uterus, and it was so incredibly painful, which I’m sure it is.
[00:15:16.020] – Dr Fran
But the reason that your physician or nurse midwife is doing that is because you are probably bleeding. And so before going to medical interventions, we’re trying to do our less medical interventions with a fundal massage because fundal massage has shown that it can help bring back that uterine tone so that heavy bleeding that you have after delivery may stop.
[00:15:38.320] – Dr Fran
So if your obstetrical provider had their hand in your vagina was massaging your uterus, it’s probably because they were trying to either prevent heavy bleeding or to stop the bleeding that you’re having.
[00:15:48.660] – Dr Fran
So I see that side that’s mentioned. And then, like you said, with every 15 minutes, the reason it’s also done is because sometimes the uterus can the bleeding and the uterus can almost stay in the uterus, and then the uterus will expand and expand and expand. And we may not know that you’re bleeding so heavily unless we’re checking to see where the level of the fundis is.
[00:16:10.620] – Dr Fran
So I’ve definitely seen that where we caught heavy bleeding by fundal checks.
[00:16:15.880] – Hilary Erickson
[00:16:16.890] – Dr Fran
So it’s not our nurses aren’t checking for fun. It is truly. We’re trying to prevent morbidity and mortality through bleeding, which is one of our biggest causes of death. Right. So that is why we do it.
[00:16:30.060] – Dr Fran
Can you refuse? Yes, you can refuse anything in the hospital. But again, that’s I think something that your nurse or your physician will likely explain to you why they’re doing it. And that’s because we’re trying to keep you safe and alive.
[00:16:41.360] – Hilary Erickson
Yes. And your blood inside your body instead of on the floor and your blood.
[00:16:44.180] – Dr Fran
And your blood inside of your body. Exactly. I think once you’ve seen a pretty severe postpartum hemorrhage. You will appreciate that even a simple fundal massage can be truly life saving.
[00:16:55.260] – Hilary Erickson
Yes. There are trauma nurses that walk in rooms, and I just cannot believe what is pouring out of a person. It’s crazy.
[00:17:01.800] – Dr Fran
Yes. We call it audibly bleeding because the blood is hitting the floor. And I don’t say that to be vulgar. That is what it is.
[00:17:08.900] – Hilary Erickson
Yeah. So things you can do. But even though that’s our routine and honestly, I would just recommend all of you go with it. Tell your nurse this is really hurting. What can I do? I’ll do breathing with the patient. We’ll breathe in together, and then they’ll breathe out while I push. You can push on your fundas.
[00:17:25.950] – Dr Fran
That’s a good one.
[00:17:28.030] – Hilary Erickson
But I’m still going to come behind you and make sure because I know what a bleeding fundess feels like and you don’t. But you can push on it and make sure that it’s not bleeding so that I don’t have to do it as hard. So there are things you can do if it’s really bothering you, talk with your provider. What can we do? This is really bugging me.
[00:17:44.180] – Hilary Erickson
And if your uterus is firm, we probably don’t have to be as mashy as we feel. But yeah, exactly. Okay. Another one is vaginal exam. A lot of hospitals have a routine where like, every hour we check your service, which I’ve never worked at a place that’s like that.
[00:17:58.250] – Dr Fran
Do you? So where I trained, we were a little bit more regimented with our serverful exam. The place I work at now, I appreciate more because we are going more towards clinically indicated, which I think is much better. We don’t check every 4 hours if we don’t have to. If you’re not in active labor yet, nearly 4 CM. We don’t need to check you again for hours unless you’re starting to feel a lot of pressure. So I think that is definitely one of those great ones where there is a lot of room to buy your preferences if you would prefer to be a lot more hands off and be like, I really only want a check in the beginning so we have a baseline, and then if I start to feel pressure that I want to be checked, I think that is appropriate. Unless, again, there’s a medical indication, which, again, your team should discuss with you. But I think that was probably the one that we have the most wiggle room on.
[00:18:48.180] – Hilary Erickson
Yeah. And I think you just need to find out if this is like your hospital culture. They just check every hour. It might not be a written policy, but a lot of training hospitals, I know that they have residents in there checking you very frequently to make sure that your service is open. I don’t really understand it because I’ve never been in a teaching hospital.
[00:19:04.580] – Dr Fran
Yeah. And I’ve only been teaching hospitals. So I see it. Like I said, where I currently work and where I currently work as an attending. I think the way that we do is really nice because it’s a little bit more hands off and there’s not always a need to check every 2 hours. It’s different if you’re not making cervical change. Right. Because we’re trying to see what else we can do to help. We don’t want you to go 40 hours not having made any thermal change. That’s not good either, but I think it doesn’t have to be a regimen thing. And I’m coming from the perspective from a large teaching hospital. It may be different if you are at a smaller hospital where your physician is not in house and it’s coming before the office or coming during our lunch to check you again. This is just a discussion that you have and say, I just would prefer not to be checked as often as possible, and I think everyone is good with that.
[00:19:50.140] – Hilary Erickson
Yes. And then there’s the opposite side of patients who want to be checked every hour because they’re like, I want to know, I want to know. And then I’m like, Your water is broken. I don’t know that we should check your cervix again. We’re having the conversation both ways. Some people want it really frequently, and some people are like, don’t check me at all unless you absolutely have to.
[00:20:09.810] – Dr Fran
Yeah. And the same goes in the office too. I will just ask patients when I do my group restructure around 36 weeks. I will offer it. I don’t really ever recommend it, but I know some patients just want to know, like, oh, I’ve been feeling cramped. Do you think I’m dilated to check? Sure. And explain. They’re really not telling us anything, but if you’re interested, I will do it for you. I do not routinely check anyone’s perfectly in the office, ever.
[00:20:31.880] – Hilary Erickson
Even at 40 weeks.
[00:20:32.910] – Dr Fran
Even at 40 weeks, it wouldn’t change.
[00:20:34.850] – Hilary Erickson
Anything for me unless they’re getting induced, obviously, right? Yeah.
[00:20:37.880] – Dr Fran
And even then, though, if we’re scheduling an induction that day, we would check them again when they came in for their I still don’t. The only time I would again is if the patient asked me to. If the patient wanted me to strip their membranes after 39 weeks, then I do a cervical exam otherwise, and it changes nothing for me. If they’re saying I’m having a ton of pressure, I just feel like babies move down a lot. Can you tell? I will, but it’s not at all part of my routine.
[00:21:02.440] – Hilary Erickson
Isn’t that interesting? So because our doctors are not in house where I’ve worked, they definitely check your cervix before an induction because they want to know if they should send you in the morning or in the night to do your induction. Yeah.
[00:21:13.680] – Dr Fran
So it’s much different where I work because we can’t even schedule a time for you. We call you in when we have staffing availability.
[00:21:20.030] – Hilary Erickson
Yeah. And I think a lot of hospitals are that way. We may say you have a. 07:00 A.m. Induction. It’s all alive right now.
[00:21:27.750] – Dr Fran
[00:21:28.660] – Hilary Erickson
You have an induction when you have a bed and a nurse. Good luck.
[00:21:32.350] – Dr Fran
Yes, exactly. Okay.
[00:21:33.830] – Hilary Erickson
The last one I thought of was pushing it complete. I know a lot of people want to be able to labor down, and every physician seems to have their own preference of this. And I will say as a nurse, when you know that the physician doesn’t want to labor down and you think the patient could use it, that patient’s just 9 CM for a little extra longer.
[00:21:52.210] – Dr Fran
Yeah. So this is so up to provider preference that it’s hard to say what is all on the standard. I can tell you what ACOs says and what the studies say, and that is that they do not recommend laboring down. And it has not been shown to significantly decrease the amount of time that you are pushing and it has been shown to increase the rate of infection. So that’s what like a cog and what the literature says. I will say if a patient is sitting comfy at 10, still sky high and doesn’t feel anything and has a really good epidural, maybe an hour or two of just being 9 CM is beneficial. But again, this is also different. Are you a first time mum? Have you had three children before? Very different. Right. I will say on a personal basis, with my first child, I did labor down for about an hour and a half and I still pushed for two and a half hours. And then with my second baby, I got to complete and I pushed two times when I had a baby. So every situation is different. Every provider is different. Everybody’s body is different.
[00:22:54.040] – Dr Fran
Do you have another girl that is working great and you don’t feel anything or do you have that urge to push? Yeah, it’s just a situational. It’s just different for everyone. So I can tell you, they don’t say you should, they don’t say you shouldn’t. They just say it has not been shown too much like decrease your time to delivery. But it’s so different. And again, if you don’t want to labor down, you don’t have to. And if you would like to labor down because you want to wait to feel that urge, that is something that you discuss with your provider.
[00:23:22.460] – Hilary Erickson
Yeah. And I think this shows where routines maybe don’t service as well, especially close to delivery routines are kind of iffy because it’s just kind of a crapshoot baby could drop really easily, you have no idea.
[00:23:34.380] – Dr Fran
[00:23:34.820] – Hilary Erickson
So a lot of times it’s really just a lot of experience of being like, she’s so tired, she could really use a nap. The baby is still high. I think if she relaxed and got that rest, we’d push better versus this is her 12th baby, even though baby is high. I think if I put some pepper on her nose and she sneezed a couple of times, we’d probably have it.
[00:23:54.340] – Dr Fran
Exactly. So again, lots of wiggle room, a lot of opportunities to discuss with your care team if you have strong wishes one way or the other. And if you don’t and you say you tell me what you think may be the best for me because you have the experience of having done this hundreds or thousands of times versus I’ve done this zero to ten times. That’s just wherever you fall in that spectrum.
[00:24:17.120] – Hilary Erickson
Yes. And a lot of times we’ll just ask my patients, do you feel ready to push? Where are you at? Where’s your brain at? Do you want a little time to wrap your head around the fact that you’re going to be a mom? Because sometimes I think people feel rushed and the baby is going to Zoom right out and that’s not going to happen. This is not TV.
[00:24:34.040] – Hilary Erickson
Unless it’s your 10th baby, then it is TV. Yeah. So I think we’ve shown that some routines are helpful. Hopefully, you guys understand that we all have to have routines in order to get things done. But you are the driver in the routines as the patient, and you can make your choice whenever you need to. Like, if something’s not working for you, just let us know. Communication. It’s the key in marriage, it’s the key in parenting, it’s the key in labor. It’s the worst because we all communicate differently. And don’t ever be afraid that nobody’s ever like said, don’t break my water yet. I promise you, every doctor has heard that already.
[00:25:07.180] – Dr Fran
All the time.
[00:25:07.780] – Hilary Erickson
Yeah, all the time.
[00:25:08.580] – Dr Fran
So you just have to express your wishes. And I think, like we talked about the beginning is that I feel the best time to do that is not in the heat of the moment. The time is leading up to that time for me. I start talking about those specific labor wishes around 36 weeks. Once you’re in that last month of pregnancy, I really start to like, how are you feeling? Are there anything specific you want to talk about during your stay on labor delivery? So you have time to talk about it and look into your own things and talk to your friends and watch. There are so many good tick tocks out there that will talk about all different aspects of it that I think is so important. But you have to have that time to talk to your team. So you guys come up with the best plan and wishes and desires for your birthday you want to have yes.
[00:25:50.240] – Hilary Erickson
It is frustrating for a physician. So say somebody comes in and is like, no, I don’t want an IV. And then for me to call that provider and then just be like, I’ve seen her, we’ve had a relationship for 35 weeks. She never mentioned it. And now she’s saying, and he’s like I even went over it.
[00:26:06.980] – Dr Fran
Yeah. I will say the Ivy is one of those things that I think has the least wiggle room.
[00:26:11.220] – Hilary Erickson
I mean, you can refuse labor and delivery like you said.
[00:26:14.850] – Dr Fran
You sure can. You sure can refuse everything. But I think just the locked ID can be the difference between something catastrophic and something that could have been catastrophic.
[00:26:24.620] – Hilary Erickson
Yes. Like she said.
[00:26:26.130] – Dr Fran
But again, a discussion to be had.
[00:26:27.870] – Hilary Erickson
You can bleed out a lot and we can really try and make sure what she’s saying is we don’t have to be hooked up to a tube necessarily. We just need to have that porn in your arm just in case. There is so much safety in the hospital by just having that. And everyone thinks that you can just put one in like magic when it starts to be a problem. But your body does things that makes it really hard to get an IV in when you’re dying.
[00:26:50.910] – Dr Fran
Yes, exactly. I know we’re kind of like jumping back now about the IV, but there are so many big scary things that happen that can happen. Right. Obviously rare, but have happened that we need immediate IV access for. And so it doesn’t have to be hooked up to anything. You don’t have to get anything through it. But just having the minutes between getting an IV and not getting an IV could just be so catastrophic that I think that is the one that I would really have a very long conversation about if someone was concerned about it.
[00:27:17.140] – Hilary Erickson
Yeah. And I’ve even wrapped towels and taped towels around people’s arms so they don’t see it. I’ve put gauze over it. If there’s something about it that’s too much for you, let’s try and make it work.
[00:27:27.120] – Dr Fran
Yes, absolutely. Sorry to that’s a good one. That’s hard.
[00:27:31.690] – Hilary Erickson
It’s routine. And I also want you to have one in because I’m the one that’s having to try and find your vein, and all the pressure is on you’re.
[00:27:38.470] – Dr Fran
Seizing or bleeding out on the nurse.
[00:27:40.520] – Hilary Erickson
Trying to find that vein, and they’re just sweating and swearing in their head. Yeah.
[00:27:45.610] – Dr Fran
We appreciate how hard you guys work on those, but seconds can be a matter of life or death in that situation sometimes. Yeah.
[00:27:53.560] – Hilary Erickson
So take a prenatal class, learn the.
[00:27:55.500] – Dr Fran
Routine things, talk with your provider.
[00:27:57.500] – Hilary Erickson
Then once you especially know if there are specific things that you’re really hoping for, and then also be flexible because who the heck knows what your baby is going to decide to do that day? Darn it. Exactly.
[00:28:06.830] – Dr Fran
There are little troublemakers, and they are always giving up surprises.
[00:28:10.650] – Hilary Erickson
Yeah. And then they just turn into big troublemakers. All right. Thanks so much for coming on, Doctor Fran.
[00:28:18.190] – Dr Fran
Thank you so much for having me.
[00:28:20.000] – Hilary Erickson
I hope you guys enjoyed that episode. I think knowing routines is really important. In fact, I have a whole chapter about the routines of labor and delivery for a couple of reasons. Number one is I think it really helps people to know what to expect. You’re nervous enough at delivery. The fact that you have no idea what’s going on just adds to that and if you have just a basic idea of some routines that you can expect, it just makes you feel a lot more comfortable. And number two by knowing those routines like we’ve talked about today it gives you the opportunity to think in advance if everything’s fine I think that’s something I’d like to delay, like with breaking your water. So I think knowing those routines is so important and I have to say a lot of prenatal classes just glaze over it. Maybe they don’t understand that most hospitals do things fairly routine and these are the things that you can expect but I think find a class that really discusses those. Find mine. I’d love to have you guys inside. You can find it at onlinepranatalclass.com.
[00:29:13.880] – Hilary Erickson
Okay. Stay tuned for next week’s episode. It is on strep throat which is a bit of a jump from this week but did you know you can die from strep throat? But then I also have a child who has a sore throat like every week. So how do you know we’re going to talk all about that?
[00:29:28.880] – Hilary Erickson
Thanks so much for joining us on today’s episode. We know you have lots of options for your ears and we are glad that you chose us. We drop episodes weekly and until next time, we hope you have a tangle free day.