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Your Birthing Experience: Understanding&Embracing Best Practices in Birthing Care

Online Health Chat with Rebecca Starck, MD

September 10, 2012

Introduction

Cleveland_Clinic_Host: As an expectant mom, you want the very best for your child from the moment he or she is born. Birthing hospitals across the country, including Cleveland Clinic’s birthing hospitals, are taking special steps to create the best possible environment for newborns and their families.

For More Information

Cleveland Clinic offers obstetrical and birthing services coordinated through the Cleveland Clinic Birthing Center at Fairview, Hillcrest, Lakewood and Medina hospitals. To learn more, visit our regional hospital websites:

Women and babies benefit from world-class medical expertise in a family-focused environment. Cleveland Clinic offers three tiers of obstetrical services:

  • For low-risk obstetrical services, midwives are available.
  • For low-and medium-risk obstetrical services, obstetrics/gynecology (Ob/Gyn) physicians are available.
  • For management of high-risk pregnancies, maternal-fetal medicine specialists, medical geneticists and neonatologists are available.

Cleveland Clinic’s birthing hospitals are committed to providing the highest level of birthing care for you and your growing family. Lakewood, Hillcrest and Fairview hospitals recently received Baby Friendly Designation from Baby-Friendly Hospital Initiative USA. The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. Medina Hospital is in the process of obtaining Baby Friendly designation.

On Your Health

Expecting a baby? That’s fabulous news! Cleveland Clinic’s birthing hospitals are excited to offer you our free weekly parenting eNewsletter, Parenting Connection. Based on the latest research, Parenting Connection offers a step-by-step guide through pregnancy, labor and delivery, and then through your child’s third year of life. And as advocates for exclusive breastfeeding, we are pleased to also offer an exclusive eNewsletter for breastfeeding mothers.

Sign up with your local Cleveland Clinic birthing hospital at clevelandclinic.org/parentingconnection

MyChart®: Your Personal Health Connection, is a secure, online health management tool that connects Cleveland Clinic patients with their personalized health information. All you need is access to a computer. For more information about MyChart®, call toll-free at 866.915.3383 or send an email to: mychartsupport@ccf.org

A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult®  website. To request a remote second opinion, visit eclevelandclinic.org/myConsult


For Appointments

To schedule an appointment with Rebecca Starck, M.D., or any of our Cleveland Clinic obstetricians and gynecologists (Ob/Gyn), please call 800.553.5056 or visit clevelandclinic.org/obgyn.

To make an appointment with any of the specialists in our Women’s Health Institute at Cleveland Clinic, please call 216.444.6601 or call toll-free at 800.223.2273, ext. 46601. You can also visit us online at clevelandclinic.org/obgyn


About the Speakers

Rebecca Starck, MD, is Department Chair of Regional Obstetrics and Gynecology at Cleveland Clinic. She is board certified in obstetrics and gynecology, and her specialty interests include comprehensive obstetrical and gynecologic care, adolescent care, pregnancy care, menopause management and alternatives to hysterectomy. Dr. Starck is a fellow of the American College of Obstetricians and Gynecologists

Dr. Starck is a graduate of University of Michigan Medical School in Ann Arbor, Mich., and completed her residency in Obstetrics and Gynecology at William Beaumont Hospital in Royal Oak, Mich.


Let’s Chat About Your Birthing Experience: Understanding and Embracing Best Practices in Birthing Care

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic Obstetrician and Gynecologist Rebecca Starck, MD. We are thrilled to have her here today for this chat, "Your Birthing Experience: Understanding and Embracing Best Practices in Birthing Care."


Hospital SelectionPinky123: I am trying to decide between two hospitals where to deliver my baby, since my doctor is affiliated with two different ones. What specific things do you think are most important to look for when choosing a hospital for delivery of your baby? Do you recommend having a written birth plan (and if so, what should be included)?
Dr__Starck: When choosing a hospital to deliver your baby, I would suggest you see them both and ask your provider which one they prefer. The next question would be whether there is in-house anesthesia 24 hours per day, seven days per week, and whether there is in-house pediatrics. There are unforeseen complications at times and on-site specialists may help you make your decision. You can also check the cesarean section rates for the hospitals of question.

Jacqui: I'm currently 26 weeks pregnant and plan to deliver at Hillcrest Hospital. We live in Wadsworth, so my husband was hoping to stay with me and the baby at the hospital. Are there accommodations at Hillcrest Hospital for my husband to stay with us?
Dr__Starck: I can assure you that the staff will do everything possible to accommodate your needs to keep you and your husband together for your postpartum stay.


Birthing Methods and Birth Plans

smart_me: I've only recently found out that I am pregnant. I am just starting to look into different birthing methods. Can you go over some of the methods and advantages and disadvantages?
Dr__Starck: First, congratulations on your newly discovered conception! It's fun to think about all the options ahead of you for labor and delivery. I previously answered a question regarding this, and suggested first and foremost that you try to allow as much of the natural process to take place as possible. Learn what you can about pain management (with or without medication), which can include hypnotherapy, massage, etc. You can look into water birth or the option of an epidural. A birth plan is nice, but, remember, we are all looking to have the same outcome—a happy, healthy baby and mom! Whichever route you chose, keep an open mind!

club_med: If you were pressed, what birthing method do you recommend as the best?
Dr__Starck: I'm not sure what you mean by birthing method. However, my first recommendation is to let labor start on its own. Try to avoid induction unless it is medically necessary. Some women prefer to be at home or in a shower during their labor. Once you have checked into the hospital, if the baby is checked out and OK and you are doing fine, you may be able to still walk around or get into the shower at the hospital. We have pain medication available if needed, either through an intravenous route or epidural route. Both can be effective depending on the circumstances. I would only recommend a cesarean section if indicated by your labor course, or perhaps any unforeseen concerns with the baby's tolerance to labor. We generally try to avoid an episiotomy, vacuum- or forceps-assisted delivery. However, many skilled obstetricians can safely deliver a baby with some help. My motto is, "Mother Nature has been doing this a lot longer than me.” So, let labor start on its own if at all possible and you will do great.

peruvianmom: I discussed with my OB (obstetrician) that I wouldn't want students or other interns in my room when I am in labor or delivering. She mentioned that sometimes they still come over. Is there a way to ask that students or interns not be allowed? Do I have to do that in advance?
Dr__Starck: It is important to educate students and interns at all stages of their career development. However, you absolutely have a choice as to whether or not you will allow a student at the time of your labor and delivery. You can inform the nurse when you arrive, or your OB provider. Your wishes will be supported either way. Best wishes to you!!

peruvianmom: How often will I have nurses coming over to check on me and the baby?
Dr__Starck: That depends on your needs! The nursing staff will initially assess how you are doing and periodically check on you every hour or so. If you are doing well and would like less attention, please feel free to ask.

peruvianmom: I am 37 weeks pregnant, and getting very anxious about my labor experience. I am opting for a medicated free birth experience, but I am keeping an open mind for the whole process. I would like to know that if something happens to me, would my husband be able to do the skin-to-skin bonding with our baby?
Dr__Starck: Always keep an open mind! If you have never experienced labor before, we want you to remember that our goals are the same as yours—a healthy baby and a healthy mom. And, yes, generally if you are not able to provide skin-to-skin contact, your husband likely will be able to do so.

peruvianmom: Also, I would like to know about the cord blood bank. My OB (obstetrician) mentioned that it depends on the time when I deliver for that to happen. Is this true, or would I be able to schedule this ahead of time? I am not going for the private bank.
Dr__Starck: There are many private cord blood banking companies and you can contact them ahead of time to get a kit to bring to the hospital. The public cord blood banking is also an option most days and nights, and someone will discuss that with you when you arrive at the hospital.

Cleveland_Clinic_Host: There is a Cleveland Cord Bank that is public. You may find out more information on their website. There was also a chat a couple of weeks ago discussing cord blood banking. It will be posted online this week at clevelandclinic.org/webchat

cheese_and_crackers: I am being induced in two weeks. My doctor said that I should have an epidural with the induction. I don't want one. What are your thoughts?
Dr__Starck: Please ask questions. Inductions should only be recommended if medically indicated. The labor you experience at the time of an induction can be more painful. However, many women are able to achieve natural childbirth even if they do need an induction. I would suggest you wait and see how you feel. An epidural is not essential.

mariap: I prefer a natural delivery, and would like to deliver in the position of my choice. Can I request that of my physician, or do I have to deliver lying down with my legs up? How do I know if the baby is in danger, or if the physician just wants to get the delivery over with?
Dr__Starck: There are many positions that a mom can be in for the delivery of her child. Your provider may want to monitor the baby through the birth process, but this can often be achieved while you are squatting or standing. If there is concern about the size of the baby or the position of the baby, you may need to change your position, but you should feel free to let your wishes be known. Good luck to you!

curious: What are your thoughts on scheduled c-sections (cesarean)? My first baby was an unexpected c-section at 41 weeks. I was so uncomfortable at the end of the pregnancy. If I am going to have another c-section anyways, I'd rather schedule it around 37 or 38 weeks, so I am not so big and uncomfortable!
Dr__Starck: I would not recommend an elective schedule cesarean section before 39 completed weeks. While I realize that the last few weeks of pregnancy can be uncomfortable, it is an important time for newborn brain and lung development. You may want to consider a trial of labor depending on the circumstances around your first cesarean. Your provider can discuss with you the advantages and disadvantages of a trial of labor. Hang in there for those few extra weeks, it's best for your baby!

jenna: What is your opinion on have siblings being present at the birth?
Dr__Starck: That would depend on the age and maturity of the sibling. Some are very nervous if they see their mom in pain or if there is a lot of bleeding. I have had some siblings present though, and it was a beautiful experience for all! I would suggest you discuss this with your provider, and consider bringing the sibling in for a prenatal appointment ahead of time. You can also peruse the childbirth education classes for a sibling class.


Kangaroo Care (Skin-to-Skin Contact)

momma_2_B: I've been reading a lot about skin-to-skin contact and kangaroo care. I was really excited about this special bonding time, but then found out I would be having a c-section (due to some health issues). I am so bummed! Is there anyway I can still do kangaroo care?
Dr__Starck: Kangaroo care is wonderful, and the good news is that even if you are not able to provide that in the first 30 minutes, your support person can do skin-to-skin contact. Many spouses have found this to be a wonderful experience and it helps with their ability to bond with the baby as well. You can certainly have the opportunity to provide skin to skin contact in a short time after birth. This contact has been shown to help the baby transition into the ‘world outside of the womb’ by helping maintain temperature regulation, heart rate stability and respiratory stability. So, the good news is that you or your partner can still provide kangaroo care!


Rooming In

tired_mom: I am 32 weeks pregnant, and already a mom to a 2-year-old girl. I've started preparing for my stay in the hospital. I've been hearing from my friends and even from my OB (obstetrician) that my hospital wants all babies to stay in the room with parents at all times! I imagine I'll be exhausted and this will be a good time to catch up on my sleep before going home to a newborn and a toddler! What's the deal?

Dr__Starck: First, congratulations on your pregnancy! I am sure that you are getting excited to bring home a new baby. I am not sure whether you breastfed your first baby. However, if you did, that's great! We encourage all moms to breastfeed— and in order to establish the best ‘rhythm’ between mom and baby, studies have shown that ‘rooming in’ is a great way to achieve that bond. Having said that, we also recognize that labor is exhausting and we want you to get rest. Rooming in can help establish good sleep patterns between mom and baby as well. So, that's the deal with rooming in. It is certainly your choice to have the baby in your room through your entire hospital stay, but please realize that the staff is there for you and your baby regardless. We want you to express your wishes and enjoy your hospital stay, but mostly enjoy your time with your new baby.

junebugs_mom: Can you explain to me the benefits of keeping your newborn with you 24 hours,7 days per week? It seems exhausting to me!
Dr__Starck: In fact, keeping the baby with you ‘24/7’ has been shown to help the baby establish a better sleep cycle, which in the long run will provide better long-term sleep patterns. Having said that, you need to recover from your delivery— and if that means getting help from the nursing staff, by all means, we are family friendly and will provide all the support you need.


Baby Friendly Designation

maren_k: I keep hearing this buzz word ‘baby friendly’ at my childbirth education classes, but I have no idea what it means. Shouldn't all hospitals be baby friendly?
Dr__Starck: Yes, all hospitals should be baby friendly! In fact, ‘Baby-Friendly USA’ is the national authority for the Baby Friendly Hospital Initiative in the United States. The Baby-Friendly Hospital Initiative is a global program sponsored by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to encourage and recognize hospitals and birthing centers that offer an optimal level of care for infant feeding. There are several features of this initiative that have proven to help moms achieve and maintain breastfeeding for the baby’s first six to 12 months. All Cleveland Clinic hospitals are currently on the road to attaining ‘Baby Friendly’ designation.


Breastfeeding

amy: I am planning on breastfeeding, and have been reading a lot about it. I see that six months exclusive breastfeeding or longer is recommended. I told my mom this (who did not breastfeed) and she said that is way too long to go without giving my baby actual food. What do you recommend?
Dr__Starck: The American Academy of Pediatrics and the CDC (Centers for Disease Control) certainly advocate at least six months of breastfeeding! Many women are able to exclusively breastfeed for up to a year or more. The nutritional needs of a newborn infant are complete from breast milk alone. In fact, the solids that are given in addition to breast milk are given in an effort to develop certain tastes and textures, but offer minimal nutritional value. Your baby will be getting those solids in addition to breast milk, so go for it! I'm certain that your mom will be supportive, and it will be amazing to both of you how your baby develops simply by the nutrition that you provide.

rch518: Due to lots of pressure from some family members, I did not breastfeed my first child. However, I really would like to try with my second baby due next month! What can I do to start off on a successful path?
Dr__Starck: Exactly what you are doing. ask lots of questions! There are breastfeeding support groups and lactation consultants that can meet with you now. We encourage you to provide skin-to-skin contact right after delivery of the baby, and keep the baby with you in the postpartum room. The staff will help you establish that bond and those first few days can be the best first step in providing a great breastfeeding routine. I encourage my patients to talk to as many people as possible to get support in their efforts. Many realize in doing so, that there is no right or wrong way to breastfeed. It's trial and error, and you just do what works! You really can do it. You just have to believe, and get the support you need from those around you. Don't forget, it's best for the baby.

peruvianmom: Is there a possibility that I won't be able to produce any breast milk? I want to breastfeed so badly, but I am scared I won't have any to feed my baby.
Dr__Starck: You need to trust yourself and your body. Don't worry about things too early. Most women are able to produce breast milk, and breastfeed successfully.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Cleveland Clinic Obstetrician/Gynecologist Rebecca Starck, MD is now over. Thank you, Dr. Starck, for taking the time to answer our questions today about Your Birthing Experience: Understanding and Embracing Best Practices in Birthing Care.
Dr__Starck: Labor and delivery is a special time for all involved. Enjoy your experience and enjoy your newborn!


Contact Information

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