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HEALTH Having Your Baby

With more options than ever, childbirth has become the ultimate consumer act. But how much do you know about what you’re buying?
By Catherine Newton |

DAWN HALLMAN IS ON A ROLL. DURING the 10 p.m. break of her childbirth class, one of the women, seven months pregnant and with the dark circles that come from endless nights of restless sleep, has just casually remarked that her doctor told her, “you’re insane if you don’t have an epidural.”

Epidurals are next on tonight’s agenda- “Birth Plan Options”-and like a preacher ready to set her congregation on fire, the director of Dallas Association for Parent Education (DAPE) is a study in contained energy. The five couples in attendance settle themselves onto cushions and folding floor chairs, slowly and awkwardly, and fix their attention on Hallman, whose long, straight brown hair swings from side to side as she pivots to the dry-erase board behind her and launches into a lecture that is part history, part science and part inspiration.

The historical precedents for the anesthetic procedure that numbs the body from neck to knees don’t, however, ignite the future parents’ interest. Eyes wander to the ragged posters, overcrowded bulletin boards and biology-class charts that earmark this room as the life center of a nonprofit organization. Then Hallman spins back to the group and reels off a list of reasons why she believes epidurals are not the magic bullet women might want to take away the pain and make labor perfect.

“You have to have an IV, you have to have a monitor, you can’t move around, you’ll often end up with an episiotomy and forceps delivery and you feel powerless. And if you get an epidural early on, the chance of having a c-section goes up. If you’re dilated to just two centimeters, you have a 50 percent chance of having a c-section.” Brows furrow at the statistics. “The national average for cesareans is somewhere between 22 and 24 percent, In Texas, it’s 27 percent.” Finally Hallman concludes, “There’s nothing wrong with a c-section-unless it’s unnecessary.”

A pretty blonde woman sitting near the front looks like she’s going to shoot the messenger: ” Before taking this class it was cut and dry.” Her words sound like an accusation. “Now we have all these facts. Now we’re overwhelmed. Now we don’t know what to do.”

Having babies in the late ’90s can indeed be overwhelming. In Dallas, childbirth choices are dazzling and dizzying. Even if you had a baby five years ago, if you’re expecting today, you should expect some changes in procedures, processes and philosophies. Thanks to the hard work of health professionals, childbirth educators and scientists, as well as to the increasing demands of women, having a baby today is a rite of passage over which you, the parent, can exercise a larger degree of control than ever before. Having a baby has become, in fact, the supreme consumer purchase.

The problem is most of us aren’t savvy health care consumers. When my second child was bom, two years ago, I did what most good North Dallas mothers do. I spent more time trying to decide which sport-utility vehicle would be better for our growing family than I did thinking about the mechanics of birthing. The details of that seemed best left to the professionals.

What I failed to realize is that medicine is as much an art as it is a science. Every birth experience is as different as the woman who has it. Statistics and data may be objective, but there’s latitude in interpretations. When you gather information, in other words, you need to consider the source. Because while every professional in the baby business wants you and your baby to be happy and healthy, each may have a different opinion on the best way to get there. And no one, except you, has that goal as his or her sole priority.

Progress, problems and puzzles: Welcome to the current stage of labor in our city.

LDR, Anyone?

IT SEEMS ODD TO CALL A SURGICAL TABLE “lovely,” but this one is. Everything in this Labor/Delivery/Recovery room, one of 12 here at Medical City, is lovely: dark woods, rich blue fabrics with rose accents, a comfortable-looking couch and rocking chair. Janice Bell, director of women’s services, looks more like a Realtor than a hospital administrator with her grass-green summer dress and fresh make-up. She opens up a cabinet and shows me a state-of-the-art audio/visual system ( “You can bring CDs to play during delivery, or a VCR tape”), then crosses the room where she opens a tall cabinet and pulls down a bed and warmer for newborns.

The room is, of course, much more than cosmetic, and Bell and her co-tour guide, Diane Stephens, the hospital’s manager of labor and delivery, are quick to point that out. The bed cabinet also contains every bit of resuscitative equipment a doctor might need in case a birth suddenly becomes high-risk. Next to the bed is a computer where nurses can instantly document vital stats. The fetal monitor tracing comes up on the computer screen here, as well as at the nurses’ central station. An elaborate lighting system folds down from a celling panel at the touch of a finger. “The lighting and the bed are most important,” Bell notes. “Physicians need to feel comfortable here, too.”

LDR rooms are approximately three times the si2e of traditional hospital labor rooms. As their name suggests, they combine the facilities and services that patients used to get in three different areas through three different sets of staff. Women no longer need to be moved, with all their IVs, tubes and possessions, from room to room via stretcher. Labor coaches (husbands, friends) are welcome and can relax, along with other family members, on roomy pull-out couches.

While LDRs have been used in other dries around the country for more than a decade, they’re still relative newborns in Dallas. In January 1989, a story in Dallas Child described LDRs as cutting-edge “alternatives.” Today, Medical City boasts 12 spanking new LDRs on the seventh floor of the hospital’s north tower. Methodist Hospital has nine, St. Paul has 15, Presbyterian has 10 with blueprints for more in the next couple years, Parkland has eight, and Baylor will have 8 LDRs completed by this October and 14 more LDRs to be completed by the end of next year.

Understanding the LDR transformation is important not only because it’s what you’ll probably experience if you have a non-high-risk delivery in Dallas this year, but also because it serves as a microcosm of some larger changes that are going on in the health care industry, all of which are having a similarly profound effect on your childbirth choices. To understand what these changes are, just ask “Why LDRs? ” and listen to the various responses:

“Women are screaming loud enough and are being heard,” explains Trish Cave, a certified nurse-midwife in Richardson.

“It’s market-driven,” says Miriam Sibley, director of women’s services at Parkland. “LDRs provide better quality, provide patient satisfaction, and are cost effective.”

“They were developed as patient satisfiers,” says Presbyterian Hos-pital’s administrative director of women’s services Marcy Doderer, who spends a lot of time worrying about the bottom Une, ” but from an operations perspective, they also provide efficiencies. There’s not so much moving, cleaning. Before you had three separate rooms, three separate staffs.”

The LDR phenomenon thus illustrates perfectly a dichotomy in American health care that all prospective parents should know about. As Business Week noted this past February, two market forces are affecting today’s hospitals: Managed care, the article explains, “has compelled hospitals to cut staff, shorten inpatient stays and shift treatment to ambulatory settings, Yet competition has also forced them to find new ways to cater to the needs of the patients, especially those who have discretion over where they go for treatment. “

In the case of LDRs, what’s cost-effective seems to match what patients know they want. A mutual coincidence of wants and needs, as any Econ 101 student might say.

Unfortunately, as in most health care issues today, it’s seldom that simple. The advent of managed care, for one thing, is changing the old ground rules. Dallas Ob-Gyn Jeffrey M, Thurston, author of Death of Companion, believes that managed care programs destroy the doctor-patient relationship by taking medical decisions out of the hands of doctors and patients and putting power in the hands of the bottom-line bean counters. According to Thurston, doctors’ time, energy and emotions are being drained by the demands of HMOs, PPOs, co-pays, pre-certification and so on. He bemoans the fact that insurance companies, which represent vast numbers of Americans through managed health care plans, have increasing power to mandate policies that influence medical decisions. If doctors or hospitals don’t meet the policies, they risk being dropped from the carrier and losing their business-the patients. The problem is that the policies focus primarily on cost efficiency rather than the best interests of the individual patient.

All of this is sad, and maddening, but what do these health care market concerns have to do with you as you make room for baby?


Just as they made a 24-hour stay a reality for most mothers who delivered vaginally, by pre-certifying for only a one-day hospital stay, HMOs and PPOs are increasingly forming policies that may restrict your childbirth choices. They’re mandating rates for c-sec-tions. They’re mandating rates for VBACs (vaginal birth after cesarean). Your doctor and hospital and you have less control over your health care decisions. And in some cases, in fact, your decision-making power may already be gone.

Just Testing

IT’S 1993. I’M FOUR MONTHS PREGNANT AND my doctor’s calling me, which I take immediately as a bad sign. And sure enough, he’s calling about some test results on something called the AFP3 or Triple-Marker Test. I didn’t have this test done the first time I was pregnant, just three years before, because it wasn’t around then. The test tells mothers their fetus’ risk for certain chromosomal errors, primarily Down Syndrome, and mine has just come back with results that say abnormal. Suddenly, my stomach hurts.

My doctor is citing statistics and telling me that I may want to have an amniocentesis, which is more accurate in its findings. Unfortunately, it also involves inserting a long needle into my burgeoning womb to extract amniotic fluid, which increases the risk of miscarriage.

Before I can get too scared, though, my doctor reminds me why I trust him. “Listen, Catherine,” he says. “This test doesn’t tell if your kid is normal or abnormal. The reason it says abnormal is because your risk is more than a standard deviation outside of the average for your age group. If your risk is one in 650 for Down Syndrome in general by age, and this test shows your risk is one in 310, it says abnormal. But it still means there’s a 309 out of 310 chance that your kid is normal.”

I forgo the amnio, opt instead for a high-level sonogram that is perhaps less accurate but involves little or no risk, and am reasonably confident that I had the right information to make the best choice for me.

As technology gallops along, testing has become increasingly sophisticated, giving prospective parents more decisions to make, starting with the decision to undergo certain tests in the first place. Those who go the testing route will find that more information about the health of the mother and the developing fetus is available than ever before- blood tests, a hepatitis screen, an HIV test, a rubella antibody and a urine culture screening. Most doctors will also perform a vaginal ultrasound in the first trimester to screen for neural tube defects and fetal anomalies. Then there’s an oral glucose screen at 25 to 30 weeks and a vaginal culture at 28 weeks. Additional testing may include AFP3s, repeat ultrasounds or amniocenteses, especially if you are over 35 or for other medical reasons your pregnancy is considered high-risk. {One encouraging trend for older moms is the decreasing tendency to label all women over 35 as high-risk patients. This has happened simply because more and more data and statistics have been gathered that show that a woman of 35 or 40 is not really at high risk for anything, as long as you control for preexisting disease.)

Some tests are optional. Some are mandated by law. Some may be covered by your insurance policies, while others, like the first trimester ultrasound, may not be.

And some may involve dangers, and may call for some risk/benefit analysis. Take, for example, a hot topic in the obstetrics world: the choroidplexus cyst, an anomaly of the fetal brain that doctors have only recently discovered thanks to technological advances in ultrasound equipment. There’s no question that it exists. But what it means, clinically, is uncertain because information on associated risks is still being gathered. One doctor at Harvard found that the cyst was associated with Down Syndrome-with a correlation as high as one in 100. If that’s all you knew, and you knew your baby had a cyst, you might decide to have an amniocentesis to be more certain about the Down Syndrome risk. But take a quick jaunt through the cyber records of Medline, an America Online service that features abstracts from current medical journals, and you’ll find a range of published, academic opinions about the risk of the cyst versus the risk of the amnio and a range of opinions about the best course of action if your sonogram reveals a cyst.

So what do you do? Don’t believe everything you read, but read as much as you can. And ask for expert opinions-not just advice from your best friend.

Information, Please

THE NOON TOUR AT THE BIRTH AND WOMEN’S Center on Swiss Avenue has been delayed for about 20 minutes, giving me and the expectant couple on the comfy couch plenty of time to sip herbal iced tea and flip through the packets of information we’ve been handed. There’s a list of La Lèche volunteers, a business card advertising doula services, a pamphlet from a massage therapy center and some official-looking consent and disclosure forms, one of which explains that this is not a hospital, and blood and anesthesia are not administered here.

Chérie Boettcher, one of the two certified nurse-midwives who practice at the center, steps across the room’s large hooked rug, and the tour begins. The two-story, 100-year-old house looks indeed more like a bed and breakfast than a medical facility. There are two birthing rooms-large, comfortable spaces stuffed with antiques. The bathrooms are ultramodern, though, and one features a Jacuzzi tub. “It’s up to you where you want to have your baby,” explains Boettcher. “You don’t have to get in the bed.”

Back in the family room, Boettcher explains the center’s policies in more detail. All the mothers go through Bradley classes, a prepared-childbirth course that emphasizes natural delivery-i.e., no drugs. The expectant mother next to me nods and adds her opinion of the classes: “You become an informed consumer. “

But what I don’t hear here is that the Bradley method is somewhat controversial.Just a week before, in the Richard-son offices of Health Central, certified nurse-midwife Trish Cave told me that this is “the only class that possibly goes against the medical community. I know nurses who roll their eyes and say, ’I’ve got a Bradley patient!’ It makes it harder for the nurses because the patients will want to get out of bed and be walking during labor.”

Dawn Hallman of DAPE also had something to say about Bradley classes: “Their curriculum is controlled more from a national basis. They adhere to one philosophy.”

Hallman issues warnings about any childbirth classes that have to answer to any organization, be it national or local, a hospital or a nonprofit agency. “Does the educator have an agenda? You have to ask: Who controls her curriculum and who pays her bills?” she explains, “If there’s an anesthesiologist [on a hospital staff] who says an instructor can’t explain risks, then the teacher at a hospital class can’t say it. And if a class has an agenda, it will tend to be watered down.”

While hospital administrators say that their classes give a wide variety of information and options, others within the traditional medical community acknowledge that teachers don’t have carte blanche to disseminate stats and figures. “They absolutely are restricted,” says Presbyterian’s Dr. Thurston.

So how do you know if you’re getting the information you need?

Hallman suggests attending classes that answer only to the public. Thurston suggests getting online with Medline. And above all, he says, ask questions. And start, he says, with your doctor or health care specialist. If you’ve spent the time up front establishing a bond of trust, you’ll get the information you need to help you decide what’s right for you.

Labor’s Love Lost

ASK ALMOST ANY HOSPITAL ADMINISTRATOR, any doctor, any labor nurse in Dallas, and they all will tell you that they work hard to give “the client” what she wants during the labor and delivery process. But here’s the dilemma, according to other experts: If you don’t know the options, if you don’t have the information you need, if you’re asked your opinion only at the 11th hour when you ’ re in labor and you can’t think straight, can you even know what you really want?

Dawn Hallman says no.

She tells her childbirth class that every mother should devise a birth plan, an option checklist.

As she talks, I try to remember if I ever had a birth plan. Sure, my husband and I attended our hospital’s get-you-ready classes that were required in 1990 before a spouse could set foot in the operating room. We learned about all kinds of different ways to breathe. I guess my plan then was to keep breathing. I didn’t think much beyond that. And as far as I can remember, no one suggested that I should. Our first baby was bom after a fairly brief but painful labor, and arrived into this world in the surgically sterile environment of the OR. Thanks to a steady supply of Demerol, I remember it with the same happy haze that I recall Friday nights in the pool room at my husband’s fraternity.

Hallman passes out a sheet of paper that lists birth options and begins to go over some information, stressing that each woman needs to decide what’s best for her. I’ve had two babies and suddenly I feel like Gone With the Wind’s Prissy: I don’t know nuthin’ ’bout birthin’ babies. And while most of the options seem to be matters of convenience and com -fort-shaving, enemas, showers and video cameras-some are more significant. Do you need continuous monitoring? An episioto-my? An IV? What are the risks of VBACs (vaginal birth after cesarean) vs. c-sections? Are there any drawbacks to epidurals? Should you have your baby sleep in the room with you or send him or her to the nursery?

Clinical studies have been done on all these subjects with objective results, Nevertheless, whoever you talk to will probably give you a subjective answer about what he or she thinks is the best plan. And each will probably feel strongly about his or her opinion.

For example, one director of women’s services at a large Dallas hospital tells me that she believes babies should stay in the room with their mothers because studies have shown that more time with mom means fewer medical computations for the infant. She then says that most doctors at her hospital probably tell mothers to put the babies in the nursery at night because they want the mothers to rest. Mother’s rest is important and so is the baby’s health. Both ideas have merit, but what’s right for you? You can’t decide unless you know both arguments.

Another more serious area of controversy comes with epidurals. Some studies have shown that early epidurals, given before the cervix dilates to approximately 5 centimeters, have led to as much as a fourfold increase in c-section risk, as well as higher forceps rates and longer second stages of labor.

Some health care professionals believe there is a correlation between epidurals and c-sections. “We get stuck try-ing to do what the woman wants,” says Deb Maitre, nurse manager at Presbyterian Hospital, where as many as 85 percent of about-to-be mothers choose to have epidurals, “We probably do set women up for c-sections more than we need to through epidurals.”

Presbyterian s Thurston adds that it’s most important to look at what kind of medication you’re getting in your epidural. “An epidural is not an epidural is not an epidural,” he says. “’I would argue that prior to 1990 there’s no question that epidurals were given in a way, particularly if they were given too early, that led to a higher c-section rate. ” But newer drugs, fast-acting narcotics, he says, have better success rates than the “caine” drugs that were used before.

Of course, not every epidural is given via the latest technology, Thurston admits that nationwide it’s “probably still true” that high epidural use is leading to high c-section rates.

And to make matters more complicated, another doctor at another large North Dallas hospital, who asked not to be identified, added another note of caution: You might want to be careful, he says, about who administers your epidural. Years ago, obstetricians did their own epidurals-and many still do because it’s a profitable part of their practice. But the ones who still do might not be certified To use the newer, probably safer technology that most anesthesiologists use today.

Goodnight Nurse, Hello Nurse-Midwife

SUSAN BAXLEY, DIRECTOR OF METHODIST Hospital’s perinatal education program, points to a diploma-like certificate thumb-tacked to the wall above the stacks of paper on her desk. “That’s the class I was telling you about.” All of Methodist’s L&D nurses are currently taking or have just completed this class, an ASPO/Lamaze Labor Support Training Program that involves 17,4 contact hours and focuses on helping women cope with labor pains through physical support, such as relaxation techniques, different positions and massage.

“We hope having this class will reduce the c-section rate and the epidural rate because women will need less medication,” explains Baxley.

Physical support is increasingly being seen as more than just a perk lor laboring women. In a recent Parenting magazine, a neonatolo-gist at the University of California at Berkeley noted that massage can actually alter the sensation of pain by helping the mother s body secrete both oxytocin, which makes the uterus contract, and endorphins, which reduce pain. The story also says that massage may help women avoid forceps, c-sections, epidurals and the use of Pitocin (a drug used to speed up the labor process).

Methodist is the first of Dallas’ major hospitals to institutionalize a program of physical support for laboring women. But their program is part of a larger national trend that shows women seeking that additional layer of support through nurse-midwives, doulas and health care professionals who make it a part of their practice.

” People are seeking health care that’s alternative because they’ve been burned,” explains Brenda Woods, a certified nurse-midwife at Health Central in Richardson. Woods and her partner, Trish Cave, are part of a collab-orative practice that includes 10 physicians. The midwives, both former labor and delivery nurses who wanted to expand the level of care they could give their patients, handle only low-risk patients; if a patient becomes high-risk, one of the doctors in the practice takes over. All the babies are delivered in the LDR rooms at Baylor/Richardson.

Certified nurse-midwives-who have nursing degrees as well as additional midwife training and who, by Texas law, must work in a collaborative practice with a physician- have been practicing in the United States since 1929. The first nurse-midwives in Dallas hospitals showed up in 1989, though, when Parkland Hospital simply didn’t have enough staff members to catch the record number of babies that were being born each day. And so the hospital founded its own school of midwifery. Today there are 20 nurse-mid wives at Parkland, as well as a private practice at Baylor, the two nurse-mid-wives at the Birth and Women’s Center, and the two at Health Central.

While a nurse-midwife isn’t for everyone-especially women with problems such as diabetes that could cause complications during the pregnancy and delivery-many women who have used them rave about the birth experience. Susan Meny and Katherine Stewart, both of North Dallas, were disappointed in the low level of control they felt they had over the births of their first children in hospitals. “I didn’t like being confined to bed with a fetal monitor attached to me, ” says Stewart. “With a midwife I walked almost to the end.” Both women told me they would consider having another child solely for the experience.

Some Dallas women, who prefer the treatment of an obstetrician but also want the physical support a traditional labor nurse may not provide, are beginning to turn to doulas. A doula (the word comes from an ancient Greek word meaning “woman with woman”) cannot make medical decisions or recommendations, but can assist with a range of needs. This can mean anything from babysitting a mother’s other children during the labor process to providing massages. Alice Morrow, head of women’s and children’s services at Baylor University Medical Center, says she would “love to see more doulas. They have the advantage of knowing the women before they’re in labor and they work with them through labor techniques.” She notes that a hospital’s labor nurses work on shifts and often cannot stay through the whole process. This can leave the mother with a “little bit of a disconnected” feeling.

Whether you opt for a nurse-midwife, doula and/or a traditional labor nurse, it’s important to have a clear understanding of how vital their role can be in the labor process. “If you haven’t had a baby before, you don’t realize how much your nurse does,” says one Dallas father of two. “That’s who stays with you. Your doctor often just comes in to catch the baby.”

Mom, I’m Home!

CALL IT BAD NEWS/GOOD NEWS. THE BAD news is that managed care has made a 24-hour hospital stay policy almost universal. After 24 hours in the hospital, barring some disaster, mom and new babe must vacate or start paying full price. The good news is a plethora of cost-effective educational classes and services have sprung up to offset some of the problems caused by the new policy.

“The biggest change in childbirth in the last five years,” says Susie Hubbard, nurse manager at Methodist Hospital, “is the amount of education available.” You’ll find hot lines, warm lines, classes on breast feeding and bottle feeding. Before or after baby comes, you can practice everything from diapering to CPR. You can join a support group for older moms, moms with multiples or families who’ve had children in neonatal intensive care units. Baylor and Medical City also offer the Newborn Channel in all postpartum rooms, a station that runs 24 hours a day and covers about 20 topics.

Methodist now offers a postpartum follow-up call two to three days after delivery, and several hospitals, including Methodist and Presbyterian, are prepared to offer postpartum home visits either through agencies they’ve contracted with or their own home health companies.

Joining the hospitals is a cottage industry of postpartum care services. Some doulas specialize in home care after the hospital, taking the traditional role of extended family members by making dinners, bathing the baby and helping mothers get some rest. Increasingly popular with the well-monied set are home nursing services, such as one called Bubbles! Created Just For You!, which offers services ranging from a baby bath and gift for $75 to a ghree-visit program offering education and training in child care for $250.

Finally, if you’re more inclined to go online than dwell on bloodlines, you’ve got friends on the Net.

It’s a Woman Thing

IN 1993, WHEN I WAS READY TO DELIVER MY second child, I expanded my birth plan from simply breathing. I wanted what most of my friends had had: an LDR and an epidural.

Two weeks before I was due, I went to my doctor for a routine visit. Because he’s in a large practice and you have to meet all the doctors in case your doctor’s not on call when nature calls, I met with one of bis partners. She took one look at me, said my baby looked too small, and sent me to the perinatologist in the next building for a sonogram. He said I was fine but needed a stress test. When it was over, he sent me back to the doctor. Without an explanation.

She told me my water was low, and that if this were earlier on in the pregnancy, she would prescribe complete bed rest. Then she gave me a choice: Did I want to go home, stay in bed all weekend, and then come back on Monday to induce labor, or did I want to induce today?

Let’s get it over with, I said, because I was simply sick of being pregnant. She said something like this: I guess if you have to choose between the risks of premature lungs at birth or strangulation by an umbilical cord due to low water, that’s a good choice,

Uh…well…uh…I called my husband from a pay phone and headed down to delivery, where they hooked me up to a monitor and started an IV with Pitocin. My real doctor came in at some point and said exactly this: “This is bullshit.”

Then he told me that my water could be up or down at any given point and that there was no reason to induce labor right then. At every point during the day, decisions had been made that, while within the guidelines set by the American College of Ob-Gyn, were the most conservative decisions possible. If he had seen me that day, he would have sent me home. “But you’ve started now. You might as well continue,” he said.

Then he left for a weekend at his lake house.

I moved into the LDR room when the contractions began and soon I felt the familiar vise-like grip on my back. An anesthesiologist came in and set me up with an epidural.

For the next eight hours, I lay in bed, throwing up intermittently.

Finally, the nurses said they needed to speed up the Pitocin. They told my husband it was a good time to get something to eat and he headed for the vending machines.

I felt awful, and said what I really needed was more anesthetic. They said they’d have to do the Pitocin first and then wait a while. They asked me to turn over so they could do something with the IV. I couldn’t because I was in too much pain. Not yet, I remember saying. Not yet. Just wait.

Suddenly one nurse said she couldn’t get a fetal heartbeat. I think they started to prepare for an emergency. Someone pulled back the sheet.

Lying at the foot of the bed, blue and not breathing, was my baby girl, Hadley.

We screamed. I thought: She’s dead.

Someone handed Hadley to me, and someone else ran to call the doctor. Two minutes later, my husband came back with two bags of Doritos and some Diet Cokes. You missed it, I said.

Hadley was fine and under the warmer. But what went wrong? For years, I’ve blamed a labor nurse whose name I can’t remember.

But I’ve got to take some of the blame. I agreed to many, many decisions that day, and I can’t remember asking even one question.

Why? Because, like most of us, I looked no further than my friends for advice, and all of us are part of what every health care professional I asked described as a community that is “very conservative,” “very traditional”-even “very backward,” according to one very traditional doctor at one very conservative hospital, who called the Dallas medical community itself “the most inbred medical community on the planet-ever.”

But there are signs that the pattern may be shifting, and Dallas women may be beginning to find the power of choice that women in other parts of the country have already discovered. As Presbyterian’s marketing director pointed out, “In families, women tend to drive the health care decisions. Most families make their initial connection with a hospital when a woman has her baby. It’s the start of a huge product line.”

Marketing forces are right for women to make their choices heard. And with increasingly powerful managed care companies looming on the horizon, we may lose our options if we don’t start getting involved in decisions now. And, after all, this is about more than marketing.

If medicine is an art, childbirth experiences are nothing less than the masterworks of the medium. And for Dallas women, the time is right for each of us, now, to become the master of our own canvas.

For Further Info:

● Dallas Association for Parent Education, 777 S. Central Expwy., Bldg. 1, Ste. 1-T, Richardson: 699-0420; DAPE warmline, non-medical support and suggestions for parents: 699-7742

● Bubbles! Created Just For You!, Gwen Foster, R.N., B.S.N.: 614-5071

● Birth and Women’s Center, 3100 Swiss Ave.: 821-8190

● Doulas of North America, Dawn Hallman, representative: 699-0420

● Health Central nurse-midwives, Richardson: 363-7882

● Renaissance Women’s Health Associates (nurse-midwife at Baylor): 823-6500

● Internet support group for expectant moms: send a message with the words “subscribeMONTH” (the month being the one in which your baby is due) to [email protected]

● America Online parenting page (everything from health info to support groups): Keyword: Families

● America Online medical database: Keyword: MedLine

Birth Order

A Checklist for Your Pregnancy, Labor and Delivery

1. Find a good doctor whom I trust, who knows he or she works for me.

2. Decide on childbirth education; take classes, gather resources such as books and magazines that discuss pros and cons of new trends, talk to friends and family, establish connections online.

3. Decide on fetal monitor; do I want one throughout labor?

4. Decide on medication; do I want an epidural? When should I have it? What other procedures or kinds of medication are available?

5. Learn about c-sections and the kinds of birth emergencies that require one; decide on the non-emergency circumstances, if any, under which I’d consider one.

6. What do I expect my labor coach to know and do?

7. What about a nurse-midwife or doula to help with the labor?

8. Will the baby sleep in with me the first night or go to the nursery?

9. Does my insurance require I stay in the hospital no longer than 24 hours? What are the exceptions, H any, to this policy? What can I do beforehand to prepare myself to go home with my baby after that length of time?

10. What sorts of postpartum services are available? Which will be best for me and my family? How can I find out more about this?

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