labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Sunday, September 30, 2007

The Lonely Soldier

I am so discouraged by the beliefs of some of my fellow midwifery students. Many of them do not believe in homebirths, VBAC’s, non-nurse midwives (such as CM’s or CPM’s), or other non-interventional childbirth. They think all births should occur in a hospital with sophisticated monitoring equipment and capabilities. What in the world are they doing in midwifery then?

One of the discussions in class led to the topic of litigation. The things coming out of some of their mouths were just repetitious dogma of ACOG and malpractice insurers. Some were saying how risky VBAC’s are, others saying so many things can go wrong at home. There were some actually accusing CM’s and CPM’s of not having a scope of practice and over stepping their boundaries by practicing medicine. Huh?

I posed the question of perception. Has the risk of uterine rupture increased with VBAC recently? No. Well, let me answer that with yes. It will increase when women who are VBAC-ing are given misoprostil. Here’s a thought: don’t give women misoprostil. Don’t mess with their labor. Again, what has changed that suddenly makes VBAC’s the devil’s labor?

The "things can go wrong at home" argument just doesn’t fly with me for reasons to not homebirth. Sure, put a high risk mother (for instance a woman with preeclampsia) in her home to labor and birth and you are asking for trouble. Put a low risk, healthy mom in her home to labor and birth and most of the time you will see a wonderful event. On the flip side, put a low risk woman in a hospital to labor and birth and watch the intervention rate sky rocket and her chance for a c-section at 30% (or higher depending on the hospital).

The other thing that bothered me was the misunderstanding of what non-nurse midwives are capable of. They are trained, skilled labor attendants. They are taught to watch for signs of possible trouble, and know their limitations (sound familiar? So do CNM’s!) and when to refer. I had no idea that there was such animosity towards what is commonly called “lay” midwives. And for the record, I don’t like the term “lay”. It doesn’t give the general public the right perception of who they are and the training and certification they have received. It makes them sound like they are a group of hippie women with armpit hair and hemp necklaces who decided to birth some babies out in a field.

Yet one more thing to make me feel like the lonely soldier fighting the seemingly impossible battle. How can things change when your colleagues don’t believe in real midwifery care?

Wednesday, September 26, 2007

P.O. vs B.O, It Still Stinks

I think it is time to repost one of the all time biggest hits from Life & Times. Hope you find a chuckle in it the second time around.

P.O. vs. B.O.

Sometimes there are women who must have a poor sense of smell or even maybe even a lack of olfactory nerves that comes into the labor unit. And she always seems to have a posse of others with the same problem.
What do you mean, you ask? I'm talking P.O. people. Think B.O. just substitute that B. And I must say I would highly prefer the B.O.
Now I usually try to remind myself that these women are in labor. Maybe they felt like they didn't have enough time to take a shower. Or maybe it began on the drive over to the hospital. I really try to cut them some slack, but it's really hard to do when the person came in for an induction and had plenty of time to shower before coming in because she wasn't in labor. And it is really hard to do when you are assisting in an exam where you end up having to revive the person going into the battlefield, if you know what I mean.
Now, nurses and doctors don't sit around the desk talking about your private parts. We see so many of them that if you walked in with a vagina on your forehead we wouldn't blink. But when we have to resort to shallow breathing and Haz-Mat suits while in the room or keeping a bottle of Febreeze handy it gets us talking.
First we make the pronouncement that yes, Virginia, there is an odor. And no, Virginia, it isn't pretty. And so we contemplate as a group, "Does she realize she stinks?" and "Does anyone else that is with her know she stinks?" If the answer is yes to the second question, then I want to know why didn't they kindly inform the woman of the stench so that she could do something about it? And then we wonder, is it infection? So depending on the doctor they may decide to do a culture but I must say it always comes back as a really bad case of stink puss. I've had one case where the stink was so bad that the baby came out smelling foul, and it persisted even after a bath. Who wants to snuggle a baby who smells like a 10 day old dead salmon?
And it also put us in a predicament. Do we want to say something? Absolutely! But how do you delicately approach such a topic with someone you just met? First off, I offer the shower or jacuzzi as a way to help with labor. This will provide a two fold bonus for all involved. It will help the woman feel better and keep the people caring for her from singeing their nose hairs. If she doesn't do this, then I start hosing her down. When I am changing the wet pads underneath her in bed, for instance, I use that little peri bottle to wash her off a bit. It doesn't work perfectly, but at least keeps the amniotic fluid and bloody show from joining in the potpourri. And when all is said and done, I push the shower. And let me tell you, for as many women who beg for a shower even before they have got out of bed for the first time after the birth there are as many who don't want anything to do with it at all. Maybe they like their stink. Perhaps it's a way for them to make a mark of where they have traveled.
Likely no one will ever tell you that you have stinky crotchitis. So do yourself a favor and take a shower if at all possible prior to coming to the hospital. Use soap. And dry well after. Put cotton underwear on. These simple steps go a long way.

Wednesday, September 19, 2007

Midwife Glasses

Today I attended my first birth as a student nurse midwife. And let me tell you how weird it is trying to stay out of the "labor nurse" mindset. As I worked with my preceptor, I found myself drifting off to the things I would be doing if I was the labor nurse. I kept wanting to silence alarms and document nursing things in the computer. I wanted to make sure all of my busy work was out of the way (filling out baby bands in advance, having an organized room, things of this nature). And then I would think...oh, wait, I don't have to worry about that! It didn't help that the real labor nurse kept trying to compare notes, asking how my hospital did things and what not.

And then came time to start birthing a baby. At this point (after 7 hours of trying not to be the labor nurse) I had managed to put my nurse midwife "glasses" on, and boy oh boy! The things I don't pay attention to! As the mom was pushing, there was this quasi-wrinkly tissue hanging out on the anterior aspect of her vagina. The first thing that came to my mind was that she had a cystocele (her bladder bulging into the vagina), but turns out it was good old fashioned vaginal rugae (vaginal folds). Huh... go figure. After all these years being an OB nurse and I never realized this before. I knew of vaginal rugae, but have never seen them kind of hanging there, being pushed forward by a baby's head.

I also got a really good look at "skidmarks". Now, many of the women I have care for have had skidmarks after a birth but I had never actually seen them in such detail. And for those of you scratching your head, thinking of poop stains in the underwear, think again. Skidmarks are used to describe tiny little abrasions that do not require suturing. It's like skinning your knee. Except on and around the perineum.

Oh, the places I will go!

Tuesday, September 18, 2007

Back To School Sale: Student Midwife Special

I'm trying to get back into the swing of things here for school. Classes started and I am swamped. I took an extra course this semester because I didn't want to be bogged down when I had a larger number of clinical hours to complete later on.

And speaking of clinical, I am happy to report that this current clinical rotation seems to be nothing like my prior clinical experience last spring. For those of you who were reading me on Life & Times last spring, you will remember my frequent whining and complaining. I had a preceptor from hell, who believed that it was not her job to teach. I was not allowed much patient contact, could not document in the patient records, and generally wanted to gouge my eyes out every slow minute that passed in that office. So I am just elated that my current preceptor, a very experienced nurse midwife, is quite the opposite. She takes the time to explain every thing she does, and was astute enough to notice how difficult it is for me to just observe. She assured me that I would be doing everything before long. Bonus points to this midwife!

However, my preceptor woes are far from over. I have yet to find anyone willing to take me as a student in January 2008. I also received a voice mail message from a midwife who had verbally agreed to take me in March 2008. The tone didn't sound good, sounded like she might be backing out. She was not available to call back until later this week, so I sit here pondering my clinical fate.

I'm also just as good as always with my procrastination skills, too. I should be entering my clinical data for school instead of blogging.

Sunday, September 16, 2007

What A Pain

Labor = Pain.

Most people would agree with that statement. There are some who have had the Labor = Ecstatic version, but seeing that is far and few between I’ll keep to the first notion.

Now, I am sure that most women realize that they will experience pain when they go into labor. I’ve discussed that some seem to be quite surprised that they have to experience pain, but I won’t go into that again. So, assuming that every woman who is due to give birth at some point in their life will have a first hand account with labor pain, I figured that it might be helpful to understand a few things about that pain.

What does labor pain come from? Well, duh, Labor Nurse, it comes from the contracting uterus and a large baby exiting your nether regions. Yup, you are right. But, it is more than that.

  • Dilation and effacement of the cervix. The opening and thinning of the cervix while a baby’s head is rammed up against it can be unpleasant.
  • Pressure of the baby within the pelvis. Imagine placing an 8 pound bowling ball in your rectum and holding it there while it is intermittently squeezed resulting in an increase in that sensation.
  • Pressure from the contracting uterus against surrounding organs. The uterus isn’t floating in its own orbit; it is smooshed against your other organs (like your bladder and intestines) and causes them to hurt, too.
  • The increase of lactic acid within the uterine muscle. Actually, the uterus is just one big muscle, and when it is exercised, so to speak, for hours and hours it will make lactic acid. It’s pretty much the same thing as an over worked bicep or quadriceps muscle if you exercise it too much.
  • And of course, the most obvious: stretching of the perineal and vaginal tissue with a descending baby. This pain has frequently been referred to as the infamous Ring Of Fire.

Another factor contributing to labor pain is your personal and cultural beliefs and experiences surrounding pain. Think back to a time in your life when you had some serious pain. How did you react to that? Did you find anything that helped you cope with it? How did that change your view of any future anticipated pain? I’ve personally found that women who have had bad experiences with pain in their past that they were unable to cope with for whatever reason have a really hard time when labor kicked in. On the other hand, women who approached previous pain with a mindset that they can deal with it one way or another have an easier time getting through contractions. I’m not saying that if you merely winced when your arm got chopped off that you can whistle through contractions; what I mean is that those who have been able to successfully tackle and mentally cope with whatever pain they’ve experienced seem to be able to accept and get through labor without losing their minds. And when I say “tackle and mentally cope”, this means that the person found something to help them. What that something was can vary considerably, and it actually doesn’t really matter. It was that they found something that was important.

Women who have a hard time coping through labor can actually make their pain worse by merely being afraid of it. Pain is heightened by fear and tension. And this turns into a self feeding cycle. You have pain, you tense up, you become afraid of what your feeling, which further increases tension, which increases the level of pain experienced…. you get the idea.

There are a few other things I think are important to address regarding pain. Since most give birth in a hospital, there are some annoying things that have to be done. First is that nurses must document pain levels. This is a standard in any area of nursing set forth by our hospital’s lovely accrediting body (JCAHO). So we have to ask what your pain level is on a scale of 1-10. If we are solely looking at how this works for documentation purposes, providing a number helps anyone looking at the chart see the progression and/or relief of pain. But it’s very annoying to ask a woman who is clearly experiencing a lot of pain, “What number would you give this pain?” Like she cares to answer. I think I’d probably answer something like, “Who the fuck cares? It hurts!” but unfortunately we need that damn number.

The other thing is that many people get caught up in what the monitor is telling us. I can’t tell you how frustrating it is to see family members staring at the monitor during a contraction and hear them say, “But honey, that one only registered a 35 on the monitor!” when she is moaning and writhing in pain. Unless the woman has an internal uterine contraction monitoring device, that monitor isn’t telling anyone shit about the pain level. Only the woman can tell us that. So stop looking at the monitor (I wish we didn’t have to use them… it would solve so many problems).

Lastly, think about the traditional definition of pain. Pain is typically defined as suffering caused by injury or illness. Labor does not signify injury or illness. It’s a normal, natural physiological process. But our society seems to forget this and equates this normal pain with pathological pain that must be treated and fixed. And so many times women jump into the whole pain, tension, fear cycle because their mind is telling them that their pain is abnormal and something must be wrong. But there isn't.

Wednesday, September 12, 2007

Ok, So Maybe You Do Like Me!

I was just reviewing some stats and saw that I was ranked in the top 25 nurse blogs by the Nursing Online Education Database. Pretty cool.

Apparently Not Everyone Likes Me

I was reminded last night of an interaction I had with a former patient. It left me feeling that I lacked something, or perhaps that I was viewed as part of something was unpleasant.

I had won sports tickets through my hospital and brought along my Dad. Before the event we were given a hearty buffet brunch. There was much fanfare for those of us lucky enough to get into the events tent and the food was good. My dad and I made our heaping plates and sat at a table to eat. My hospital had also sent along a representative. This representative was a former patient.

I cared for this woman during her office appointments. I felt that I had gotten to know her well during her prenatal visits, which was something I hoped to do with all of my patients. However, this woman was a big wig of some department within the hospital and therefore made the office staff nervous. I never felt her presence as overbearing or stiff, and remember thinking that she seemed rather young and relaxed to hold such a position. I didn’t get a chance to see her during her postpartum follow up visit and never saw her again until that day at the game.

When she approached the table she was friendly and warm. My face was towards the plate (not uncommon for those of my genetics) when she approached so I don’t think she saw that I was one of the lucky ticket winners. When I did look up and say hello, I could see the look of recognition in her face. And it didn’t look good.

She tried to pretend she had no idea who I was. She introduced herself to me and my father. I said, “Yes, we’ve met when you were pregnant with you daughter.” I smiled to convey my relaxed demeanor when seeing my patients outside of the office.

“Oh,” she replied stiffly. She was suddenly very uncomfortable and seemed to be a bit upset by my mentioning her pregnancy. There was no one else at the table but my father and I, so I didn’t believe that it was because I mentioned I knew her when she was pregnant. I didn’t mention that I cared for her, so I certainly wasn’t announcing anything involved with her care or violating the precious HIPAA laws.

Normally I would have asked how her baby was doing, what milestones they reached, but her body language said it all. She did not want to talk about anything relating to my connection to her.

I think that some would say that I was taking this all a bit too personally, but I found her response quite odd. Most patients I have cared for that I run into in the outside world seem quite happy to see a caregiver associated with a cherished event in their life. Did something happen during her birth that I was unaware of? Did she feel that we failed her? What was it about me that conjured up bad feelings?

She soon left after our quick conversation. I watched as she purposely avoided the area I sat. And I still wonder what was it that was so bad?

Thursday, September 6, 2007

Birth as an American Rite of Passage

Birth as an American Rite of Passage, Second Edition, by Robbie E. Davis-Floyd has been hyped as feminist propaganda and an eye opening must read for childbearing women. This book was first published in 1992 with the second edition following in 2004. Outside of the preface to the new edition, the book was not changed or updated. This is much to its downfall.

Davis-Floyd is an anthropologist whose life work surrounds human childbirth. She views our current system of childbirth as technology driven, under a technocratic and paternalistic model. She analyzes the need for societies and groups to have rites of passage, birth being one of these rites. She examines the history of childbirth through conceptual frameworks that changed through generations. The underlying theme in most of these frameworks is that women’s bodies are flawed. During the industrial revolution and scientific awakening, mankind began to view the body as machine. The ultimate machine is the male machine, and the female machine is the flawed or continuously faulty body. It is under this belief that drives current trends and medical approaches to childbirth.

Davis-Floyd interviewed many women during and after their pregnancies. She analyzed these interviews for underlying themes in how women view childbirth under the current medical paradigm. Surprisingly, the majority of the women wanted or at least accepted the medical approach to birth. Drat!

However, the question must be asked: is this because we are products of our culture? Are we as a society bred to believe that birth in a hospital with all the latest gadgets and procedures (of which many have no scientific evidence basis) is the best and only way? I’d say yes. How often do we hear the dogma of the medical approach to birth because it is inheritantly dangerous? Why are we ignoring the evidence that many of the dangers are technologically grounded?

Outside of this discussion, the author includes her interpretation of the medical and hospital procedures performed during childbirth starting from the wheelchair into the labor room. Because this book was originally published in 1992 many of the procedures discussed are out dated. It is still interesting to read why such things (enemas, shaves, ritual separation of mother and baby) occurred.

Because some out dated procedures remain in the book, many discredit this work as foolish drivel. I agree that the author should have updated her references and ritual analysis of hospital childbirth procedures. There certainly is enough evidence out there to continue to support her theories and analysis.

This book will not tell moms-to-be “what to expect”, but it may help in making informed choices. If you are looking for a book chock full of birth stories with benign messages, look elsewhere. There are birth stories in this book, which I found interesting, but will likely leave The Baby Story crowd unfulfilled.

Wednesday, September 5, 2007

Demands, Demands

For those who have read me back in the good ol’ days (aka Life & Times), you know one of my biggest pet peeves are those who must have an epidural yesterday. You know, labor and birth are as old as dirt so I can’t imagine any woman these days who didn’t know going into this that labor was going to hurt. Hello, people! What were you expecting?

I recently was asked (or rather, demanded) when was “my epidural was getting here?” Huh? I didn’t realize it was on order. And by the way, when you say “your epidural” you must mean the human being that was highly trained commonly known as the anesthesiologist to place said catheter? Um, ya, she will come give it to you when I can safely prepare your wussy ass for this intervention.

Ok, so I didn’t really say that. What I really said was something like this: I need to do several things to get you prepared for the epidural. First I have to start an IV and run a liter of fluid into you. However, I can only run that liter of fluid over 20-30 minutes, at the most, because too much fluid too fast can cause problems. We also have to get the results of your blood count, because an anesthesiologist will not place an epidural catheter until they know what your platelet levels are. Your labs were ordered stat so I hope to get the results in 30 minutes. I’m doing my best to move things along so you can get an epidural.

Needless to say, irony has a funny way of working itself into these sorts of situations. Well before anything was ready, this woman became fully dilated. She fought and argued that there was no way she was pushing without an epidural. “I can not do this without one!” is what she yelled. The doctor said something like, “Well, you have no choice.”

Now, had the attending been someone else, say one of the docs who isn’t so forthright, she would have got the epidural. I have seen some who fight their body’s own natural urge to bear down so that they can get an epidural. In the time it takes to prep them, get the epidural in, and then for the time it takes to work, they could have had a baby, breastfed, and taken a nap already.

But hey, to each his own, so they say. Unfortunately for her, this woman did not get what she wanted but she did have a baby 10 minutes later, and spoke nothing of the epidural after.

p.s. before you all get your noses pushed out of joint over “wussy ass”, keep in mind that this was being asked by a woman who came in in early labor and was still able to talk and breathe easily through contractions. We originally thought she was going to be one of the women that would be sent home after having confirmed false labor.

Tuesday, September 4, 2007

Student Contact

So it’s back to school time, which means for me that I go back to being a student and a nursing instructor. My plate this coming fall will be very full. I am taking three courses and teaching a maternity clinical rotation to nursing students. Frankly, I think I would prefer to spend my time reading and knitting, but I won’t get paid or be able to graduate doing those things.

This coming semester I have given up my clinical skills lab instructing. I have worked in the skills lab for several semesters teaching new nursing students how to take pulses, blood pressures, and good body mechanics. I have taught the more senior students how to place Foley catheters and hang IV medications safely. But nothing is more amusing than teaching students who are, shall we say…. stimulated, with the skill at hand.

When a new skill is taught and practiced, students use each other as their “patients”. I was working in a practice lab, so my job is more or less just observing and supervising, and many times correcting, the students while they practice. A group of students were practicing auscultation of lung and bowel sounds, the first skill that requires them to touch skin that normally lays under clothing. You can see that some students feel uncomfortable lifting the shirt (even if it’s the back) of a fellow classmate to properly listen to their lungs. And some have no problems with it.

This particular group consisted of three young, perky 20 year old girls and one 20-something guy. When it was the male student’s turn, he was very careful with what he was doing with his hands and how he touched his classmates. The girls didn’t mind at all that their fellow male classmate could see them with their shirts half off and abdomens exposed.

The problem came up when it was the male student’s turn to be the “patient”. He took his sweet time laying down on the bed, and then moved in some strange ways that caught everyone’s attention. He was trying to hide his erection.

There was this awkward moment of stillness as we all registered what we were looking at, and there was a hesitation on the part of the girls to begin listening to his bowel sounds. The guy laid their trying to discreetly cover his groin while staring straight up at the ceiling. I told them they were all doing a good job and left the area.

I pulled a colleague aside and laughed my ass off at that poor guy. The next skill they were moving on to was body mechanics and proper transfer techniques. This requires a lot of full physical contact, and I wonder how he handled that. He never came into the practice labs for that skill.

Saturday, September 1, 2007

A Revisit of Helpful Hints

It was requested that I repost some of the things that I mentioned on Life & Times that you may find useful when preparing for a new baby. I also have the list of what to bring and not bring to the hospital somewhere, so when I find it I will post that next.

I have added more thoughts to the original post in blue.

Labor Nurse's Hints From Heloise, or Useful Shit

I have been asked here on the blog as well as at work and in my childbirth classes what a new mom should buy, read, and avoid. I list what comes to mind, but remember that this is just personal recommendations, not professional. You know, blah blah blah, don't be upset with me if you follow something and don't like it.

1. Good God, get that car seat out of the box. Do this before you are 36-37 weeks. Trust me, trying to figure out one of these contraptions on the day of discharge is no picnic, and your nurse might not be able to help you legally. People who are working within a professional role who are not car seat safety certified can not touch the car seat, and especially can not place the car seat or its base in the car for you. So read the damn manual and figure out how it works. If you are anticipating an early delivery, don't be surprised when the nurses tell you the standard car seat you have is not appropriate. Many hospitals are now testing babies that are less than 37 weeks gestation or less than 5 1/2 pounds (about 2500 grams) in car seats. The purpose of the car seat testing on babies in these categories is to make sure they do not stop breathing or drop their heart rate while in a car seat. In the rare case of a baby who "fails" the car seat test, a special flat lying seat will be required.

2. Do not place anything into the car seat that didn't come with the car seat. Believe it or not, this is a sensitive topic for some parents because they can't imagine placing a baby in the seat without one of those plush head supports or some sort of dangling entertainment from the handle. Keep in mind that if you were to get into an accident and the car seat failed, and you decide to take action against the manufacturer, and there was something attached to the seat that it didn't come with then you are out of luck. Besides, the reclined position will keep the baby's head from rolling forward (doesn't matter that their head is to the side, they can still breath and clearly its not bothering them if they are sleeping) AND those little toys could turn into a weapon in an accident. They can come loose and whip across the cabin of the car, hurting anyone present. I can't stress enough that I am not trying to be mean and make your baby uncomfortable or insinuate that you are a bad parent for buying or using car seat accessories. This one set off a few readers the first time around. It's just the recommendations of car seat manufacturers and the American Academy of Pediatrics (although don't quote me on that one, I'll have to double check that) and as a nurse I must inform parents of these safety recommendations. It is completely your choice whether or not to follow it. At my hospital, nurses have to document how the baby left the unit. For example I would have to write in the baby's chart: "Infant discharged with parents in car seat following recommended guidelines" OR "Infant discharged with parents in car seat with after market added head support. Informed parents of car seat safety guidelines, parents both verbalized understanding and stated they prefer to keep after market accessories in car seat." We even have to get the parents' signatures on this documentation (in both scenarios) to ensure that there is full understanding. Of course, when I have to document scenario #2, parents think we are writing something against them, certifying them as official bad parents. Unfortunately, in our lovely litigious society, if that family was to get in a car wreck on their way home and something terrible happened to their baby because of an after market accessory we have proof that they were aware of the guidelines and therefore the hospital is not liable.

3. Once you follow #1 & 2, go to your local fire or police department for an official car seat safety inspection. Most people, even those who read the manual, do not install the base of the car seat properly.

4. Be wary of the gimmicks. First time parents are usually the most vulnerable to this... certainly all good parents must have the Pee Pee Teepee's for their little boys, or the ultra soft and sensitive silk with woven gold fiber crib sheets. When you shop at the baby stores, look very carefully at the layout of the store. Notice that all the essential baby items (diapers, cribs, car seats, strollers) are all at different corners. This ensures that all parents coming in to shop must walk through countless aisles and sections of the nonessential but must have to look like a good parent sections. I've recently noticed that even Target has re-done their baby section and placed essential items in the back while all the cutesy non-essential stuff is placed up front.

5. Stock up on diapers. In all sizes. Don't bother with buying the newborn size. Most babies these days can go right into a size 1 diaper, and all those newborn size diapers are a waste of your money.

6. Speaking of diapers, consider having a diaper baby shower as opposed to the traditional shower where people buy useless cutesy items that you are likely never to use, or baby will never wear because its impractical, too small, or too big for the season its meant to be worn. People can bring just diapers and some can even become quite creative with it.

7. Although, probably not a good idea to plan your own baby shower (you look very greedy), but you can always drop hints.

8. Newborns do not need special lotions or other skin care products. As a matter of fact, newborns should not have anything put on their skin because it is so sensitive. Just wash the vital parts once a day (face, hands, diaper) and a tub bath just every 2-3 days.

9. Most baby needs are simple. Food, comfort, warmth. Which brings me back to #4.

10. Avoid What to Expect When You Are Expecting like the plague. Who cares that its a number one best seller for years. Its loaded with anxiety provoking sentiments like, "That twinge you feel near your groin is likely just growing pains, but it could be uterine detachment or uterine rupture and your fetus is now outside the womb tangled up in your intestines. Call your physician." One of the things that Dr. Wagner writes in his recent book Born in the USA struck me as a great piece of practical advice for pregnant mom's looking for books: if the book has the mantra "Trust your doctor" put it back; if the book has the mantra "Trust your body" then it's a keeper.

11. DO NOT, hear me, DO NOT buy a home fetal doppler. It's a waste of your money. The ones in stores almost never work. All you will hear is static and possibly the playings of alien transmissions. The dopplers in your doctors office are $600 - $800 or more dollars, which is why they work so well. Go ahead and buy the professional one if you have the money, but if you don't mind spending big bucks for something you'll use only a few times contact Tom Cruise and see if you can buy his ultrasound machine.

12. 3-D ultrasound is not better than the ultrasound your doctor or midwife has you get around 18 weeks. The ultrasound "centers" that do these 3-D ultrasounds for the hell of it are making a huge profit off you just so you get a few glimpses of your baby. What most people don't realize is that ultrasound is used for medical reasons, not just so you can find out the sex of your baby. Places that perform ultrasound for non-medical reasons are crossing the fine line of ethical "treatment".

13. Attend a non-hospital based childbirth program. You should know why.

14. Hire a doula, or ask a female friend or relative that you trust to be with you for continuous labor support. Ya, I know, Dad is going to be there, but he's likely to be scared to shit and not really know what to do. Women trained to give labor support, or even those who have gone through it seem to do a better job.

15. Get yourself a very comfortable, supportive bra without wires. Sports bras are great for those who are going to bottle feed. When you become engorged you are going to want lots of comfortable support. (And ice... ice those puppies several times a day until the engorgement is gone.) For the breastfeeding mom's, get a comfortable nursing bra without wires. Trust me, you won't want to wear that little Victoria's Secret push up.