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What To Know When She's Expecting

by Harold Bays MD, and Mike Nilsson

What to know

Copyright 1997


Now that we are in our second printing, we are pleased that most of our most avid readers and supporters have been women. Because, unless read with the most superficial and defensive mind-set, most open-minded women have found "What to Know" a humorous, educational tool that encourages the man to be more active in the whole pregnancy situation by improving his knowledge, and by acknowledging his perspective, in a format that he might actually read.

But this support from women comes as no surprise. Because the content of this book was derived, not only from the personal experiences of the authors, but from many meetings with women, who gave us their best "men and pregnancy" stories. So, while not all aspects of this book may apply to all couples, it does reflect the realities of many pregnancies - as documented by women.

The point is, most women genuinely care about what the man is experiencing during an event in which all attention is usually directed only towards the woman. The irony has been that, at the same time that men are being encouraged to play a more active role in the whole pregnancy situation, many of their issues (such as those raised in this book) are too often dismissed, or flat out ignored. Therefore, for those women who really do care about what the man might actually be experiencing during this mutual event, then, as we see it, they have one of three options: (1) just ask him about his feelings - and we all know how fruitful that conversation might be, (2) read books discussing how men are suppose to feel - probably written by women, or (3) read this book.

Because, this book is not just humor, it is not just stereotyped rhetoric, but in many realities, it is simply the truth.

Chapter 14: What to know during the whole labor and delivery situation

QUESTION: We attended a class on pain relief, but I'm still not clear on the epidural. Should she get an epidural? When should she ask for an epidural? What is an epidural?

ANSWER: Inside the bones of the back is the spinal cord, which carries nerves such as her pain fibers. The epidural region is next to the spinal cord. Epidural anesthesia is when numbing medicine is administered between the backbones, into the epidural region, around the spinal cord.

It numbs the nerves.

Once she receives the epidural anesthesia, she will be mostly numb from the waist down, and be able to experience the birth of her child, free of pain.

That's the theory, anyway.

However, she might be a little leery in view of all the stories about how her friend's epidural "wore off" or "fell out." Stephen King could not have described anything more frightening.

But even though epidural anesthesia is the "drug" of choice for most women, many experts (including some of the more militant women's groups) warn that epidural anesthesia has many potentially serious short, and long term side effects.

But, because you are a man, you may not be particularly persuaded. But the facts suggest (as opposed to what you might otherwise expect from such groups) that these potential concerns are quite real.

So, hopefully, she has already thought about it, and decided whether or not she wanted to take such a risk, long before she got to the hospital.

Partially due to the potential risks of the epidural, plenty of women still prefer natural child birth, i.e., without drugs. And if these women have a room down the hall from you, you'll know it by the terrified moans and shrieks careening down the hallway.

And you thought your hangnail was painful.

Even the most committed woman desiring "natural childbirth," may eventually choose a different path once the baby's head has pried her cervix open about six centimeters. She may suddenly find that the person she most wants in the delivery room is no longer her doctor, her mother, or even you.

Suddenly, the anesthesiologist may become the most important person in her life.

This is natural. It also seems normal.

Which brings us to the "tip of the day."

The following piece of advice will finally make you seem sensitive to her, and brilliant to her family and friends. And best of all, the advice is both practical and logical.

And the advice is this:

If, after weighing all the risks and benefits, she has decided she definitely chooses drugs during labor, ask the nurse and/or anesthesiologist to start the epidural at the first hint of pain and/or the earliest it is thought to be safe.

Many practical concerns support this recommendation.

First of all, if she has decided that she definitely wants the epidural anesthesia at some point, then why wait? What is the benefit?

Secondly, if labor has truly started, and the pain has started, it ain' t going to get better. It will only get worse. Again, no need to wait.

Finally, seizing the earliest opportunity to start the epidural avoids potential long delays later. For example, suppose the friendly anesthesiologist visits the room and asks if she wants to have the epidural started (which involves placing an access port in the back region.). Suppose she wants to act brave and declines because she is only experiencing moderate pain right now. The anesthesiologist then leaves to care for fifteen other women who just hit the hospital ready to deliver. (Believe it, it can happen. It does happen.) Now it may be hours before the anesthesiologist may be able to return, regardless of how much pain she has. These are hours of suffering that did not have to happen. And guess who will be expected to take responsibility for her pain?

But now suppose you were smart enough to read this book. So instead, she took your advice, and requested the epidural sooner rather than later. And when the pain worsened, all someone had to do was simply turn up the drip.

No other assembly required.

And the rest of the whole delivery experience is just a walk on the beach - all because of your brilliant advice.

You have just become a credit to your gender.

QUESTION: Is there any limit to the amount of people in the birthing suite while she is in labor?

ANSWER: That would be up to individual hospital policy, but the best advice would be to limit the number to the barest minimum. There are only so many players that should be involved with this particular game.

The two of you should mutually decide, in advance, who gets to be in the room itself, and who really would be much more comfortable in the waiting room.

Because it is not unheard of for a woman in labor to have a steady flow of visitors in and out of the birthing suite for hours on end. And while she may not be in a great deal of pain in the beginning, she may not be feeling much like "entertaining" extended family members while wearing a gown that ties in the back.

Oh, she may be smiling and kissy huggy while everyone's parading by her stirrup-studded delivery gurney, giving her chocolate, and asking "how are you feeling" for crying out loud. But deep inside she's seething and wishing you'd get all of these people the hell out of here - now!

So assign a family member as your liaison to the rest of your family and close friends. Ask this person to be a buffer between you and them, conveying information, progress reports, etcetera. (A prior employment as a bar bouncer is the type of person you are looking for). Put this person in charge of making necessary phone calls and acting as a "gofer" in the event that you need anything outside of the hospital.

It might be advisable to pay this person an hourly salary.

An alternative, practical way to handle this is to have your doctors and nurses serve as "bad guy" if you want them too, and shoo certain individuals out of the room.

Just be sure that they don't shoo you out too, especially if the only other place left to go is with the rest of the family, and away from the football game on the birthing suite television.

QUESTION: I don't want to be there during the delivery. I don't think she even wants me there. I think it might make me sick. How do I get out of this?

ANSWER: Not long ago, delivery at most hospitals was witnessed only by doctors and nurses, with an occasional grandmother there occasionally for moral support. Panicky dads were left in the waiting room, walled-in like veal in a fattening crate.

My, how times have changed.

Now dads are expected to be there for every second of it. And regardless of how you feel about it, you are suppose to be there pal, and you can't weasel out of it. Remember the lesson from Chapter 12:

Your level of caring is defined by how willing you are to endure experiences out of your element. And the more painful the experience, the greater your demonstration of caring.

And don't be fooled by her statement that:

"You don't have to be there if you don't want to be."

We have all certainly heard that line enough to know it is never to be taken seriously.

QUESTION: Would it be improper if I left during her labor to get a breather, or a cup of coffee?

ANSWER: Most likely not, but you may want to ask first. Don't just say, "Okay, I'll be back shortly," and scamper out of there.

Yes, everyone will need a break. And there may be some down time when you could disappear for twenty minutes or so. Bring a pager or cell phone if you have one, or stay close enough to her room that someone can retrieve you if needed.

Because if you miss the event . . .

If she absolutely refuses to let you leave, just give in. Someone else can bring you coffee. Stay with her, because she probably really needs you.

And don't be fooled by her statement that:

"You don't have to stay here if you don't want to."

As noted before, we have all certainly heard that line enough to know it is never to be taken seriously. And it's not going to be worth the time or energy to find out if she really means it or not.

So do what she says now. And keep a list. That way, you can remind her about it later whenever you get tagged that ill-deserved "insensitive" label again.

Pay backs are hell!

QUESTION: Now that I am stuck during the whole delivery situation, what am I up against?

ANSWER: Delivery is a montage of blood, mucus, and screams of agony . . . you know . . . the kinds of things you would expect from such an ageless miracle.

So you need to be prepared. Some fathers perceive this experience with wonder and excitement, and want to participate as much as possible.

Others just pass out.

If you get sick, that's O.K. It happens a lot. Let's face it, as great a wonderment as it may be, the birth of a child is one of the most gruesome biological processes imaginable. So if you find yourself the least bit lightheaded, don't stand up. And if you know you're turning pale, and the nurse asks you how you are doing, tell her the truth. Failure to admit that you've got a problem will only make things worse.

For example, admitting that you are a little queasy, and staying in your seat instead of standing to fully view the whole delivery situation will soon be forgotten. However, if you faint and fall face first into a hemorrhaging womb . . .

It will be remembered.

QUESTION: We have been told that active labor may last for hours. During that time, it doesn't seem like much else is going on except for shrieks of pain that make it difficult to hear the televised college football game of the week. When the nurse comes in the room and turns down the volume, is it O.K. if I turn it back up when she leaves?

ANSWER: Hey, it's your prerogative, Mr. Cro-Magnon. However, remember that most nurses are still women. And as unfair as it may seem, they may be more inclined to be concerned with your partner's active labor, than whether or not you get to see the end of the Alabama/Auburn game.

QUESTION: I've seen a million TV shows where the woman is having a baby, and the father is yelling at the woman to breathe a certain way. She then takes deep breaths, and whooshes it out through her mouth and nose. Suddenly, she seems to have a substantial relief of pain.

They didn't go over this in our prenatal classes. Why?

ANSWER: Certain breathing techniques are said to alleviate pain during child birth.

"Hee Hee! Hoo Hoo!"

One can only imagine that this was the response immediately after someone suggested that deep breathing could relieve the pain during childbirth.

"Hee Hee! Hoo Hoo!"

So, while it is true that women who deliver using natural childbirth methods, without pain-relieving medicine, do a lot of breathing . . .

They also do a lot of screaming.

This is natural. This is normal.

QUESTION: I've seen a million TV shows where the woman is having a baby, and yelling at the man, cursing the man, slapping the man, and screaming that the pain experienced during the whole delivery situation is solely, and completely, the man's fault. But I don't think this is anything I have to worry about because she never curses, and is basically a rational person. So, in my case, when she is at the peak of pain, and sweat is dripping from every pore of her body, will I really have to be prepared about foul language?

Will I really have to worry about bodily injury?


Be prepared for some very colorful language, and perhaps some words you've never heard before.

And you'd better wear a cup.

QUESTION: The doctors and nurses just asked us if it was O.K. if a medical student watched the delivery. She asks me what I think. I just don't know. What do I say?

ANSWER: This is a decision that should be left totally up to her. Soon she will have countless strangers examining, poking, surveying, and generally reviewing the most intimate, private parts of her physical self. So on the one hand, one more person won't have much practical impact on the most undignified situation that anyone could be put through. On the other hand, one more person may be just one more person too many.

So if she is the least uncomfortable about it, just say no.

Medical science will survive.

QUESTION: What is the umbilical cord, and will I get to cut it? And what is that placenta thing anyway?

ANSWER: The uterus (otherwise known as the womb) is an organ in the pelvic region of the woman that looks like a balloon with really fat walls. At the bottom is the round opening ("cervical os" or cervical opening). During regular menstruation (before pregnancy), the first weeks are dedicated toward building up the inside wall of the uterus. The last week is dedicated toward tearing it down. The tearing down of the inside wall of the uterus (with the monthly debris coming out of the uterus, through the cervical opening, and out the vagina) is the dreaded bleeding that we have all heard so much about.

At the top of the uterus are two ducts (fallopian tubes) that come from the ovaries (that contain the eggs). Once a month, if the ovaries cooperate, the egg is released from one of the ovaries, goes through the fallopian duct/tube, and is delivered into the inside cavity of the uterus. If at the same time, millions of your sperm just happened to have been swimming by, by route of the cervical opening, and also entered into the cavity of the uterus, then one of them may penetrate and fertilize the egg. If this fertilization occurs, then the egg may stick ("implant") on the inside wall of the uterus and grow. As this process continues, the structure that remains attached to the uterus becomes thick and round and is known as the placenta. The tube from the placenta to the fetus is known as the umbilical cord.

The whole point of all of this is to allow stuff in her blood (like nutrients) to go to the uterus, where the placenta decides which of the stuff continues on to the fetus. If the placenta thinks it's O.K., then the stuff goes on through the placenta, through the umbilical cord, onto the fetus through the connection at the fetus' navel.

This is the way it works during the whole pregnancy situation.

However, at delivery the baby won't be fed through its navel ("belly button") anymore. So the umbilical cord and placenta aren't needed, and have to go.

That is why, immediately after birth, the umbilical cord is "clamped," thereby stopping the flow of blood. After it is clamped, it is usually cut.

But who gets to cut it?

Individual hospitals differ in their policies concerning this practice. Some may not consider it worth the risk to put a sharp object in a new father's hand. So while it has been said that it is good luck for the father to do this, if you screw it up, or if you pass out, then perhaps it wasn't so lucky.

So if you don't get to cut the cord, don't worry. You'll have plenty of other stuff to occupy your interest.

After the whole umbilical cord cutting situation, the placenta is still hanging in there like a useless relative, and has got to go. Because it is still attached to the umbilical cord, it is likely that you will see the doctor slightly pulling on the cord, while massaging the abdomen in order to deliver the placenta. But, as much as everyone would like to speed the process up, it is unlikely that your doctor will become so impatient that he or she starts yanking on the cord to jerk it off the inside lining of the uterus.

So relax.

Remember. The delivery of all the stuff left over after the delivery ("afterbirth") is a natural process. Unless a problem arises, the whole afterbirth situation should be allowed to happen naturally.

QUESTION: How soon after the baby is born will I get to hold it?

Many factors will go into determining this. In the case of a normal delivery, the baby will be taken directly to a scale, weighed and cleaned and then handed directly to the parents. You'll be holding your bambino in a matter of minutes.

If complications arise (involving mother, baby, or both) this entire situation could be completely different. Don't worry too much if they take mother or baby away. Just ask a doctor or nurse to be straight with you and tell you exactly what's going on. They will most likely tell you. Try to be prepared for any eventuality, as difficult as that might sound. Remember that the hospital staff is taking every step to make sure that the health and safety of all persons involved in the delivery are maintained.

QUESTION: I've heard about babies looking slimy and shriveled-up when they are born. Is that true?

ANSWER: Yes. Your baby has been living for the last nine months inside of a womb, which is a self-contained unit where food, waste materials, and all other matters of nastiness are sloshing around. Suddenly, the baby is forced out this little cubby, and it's just natural to assume that the little cherub will emerge with some of this goo still covering its skin.

Don't worry. It washes off.

And when the nurses hand you your baby, it will likely be a rosy-red little skin-bundle with bug-eyes and a mewling little mouth.

It will also be the most perfect thing you've ever seen - goo and all.

And it will be even more perfect if it's handed to you in a towel.

QUESTION: We want to video tape the delivery. I plan to take the home video camera, and crouch behind the doctor to get a great close up as the matted, hairy head of our newborn is pushing through my wife's bloody vagina.

Some of my friends have expressed little enthusiasm toward receiving copies of this video.

Others think this is just weird.

Is this weird?


This is entirely too weird.

Look, if you just have to video tape the whole morbid delivery situation, and you want it to be suitable for others, then at least consider avoiding action shots of her pelvic region. Nothing will be lost if you, and your video camera, stay at the head of the bed as the intact baby is first revealed by the doctor raising the child above the sheets of privacy.

And in this way, you don't have to worry about video rating systems, or V-chips.