Delivery

Dr. Spock's Baby and Child Care : 8th Edition
by Benjamin Spock, M.D.

(Page 2 of 3)

What kind of delivery do you want? Parenting is about choices, and one of the first you will be asked to make is the kind of childbirth you'd prefer. In the old days, there wasn't a lot of choice. Mind-numbing anesthesia was common; you might get to see your baby for a few minutes when you awoke. Breast-feeding was out of the question for any self-respecting mother. And because doctors were so worried about the transmission of infection, the baby would spend the next week in the nursery, carefully ministered to by well-scrubbed nurses in antiseptic white gowns and hats while the mother lay flat on her back and recovered.

We've come a long way since those days, and now the choices are many. Natural childbirth or an epidural? Support during labor by a husband or partner, by a trained professional (a doula), or by a family member and a doula? Children in the delivery room? Lying down or squatting? Home or hospital? Doctor or midwife? Rooming in or having the newborn spend more time in the hospital nursery? Visiting nurse or lactation consultant at home or both?

No one approach suits every woman, and no method is clearly superior for the baby. As you make your choices, it's wise to consider what you want — your ideal delivery — while remaining flexible in case of unforeseen events. Childbirth is safer now than ever before, but it is still unpredictable. Plan to ask a lot of questions and do some more reading. Dr. Spock's Pregnancy Guide, by the obstetrician Marjorie Greenfield (Pocket Books, 2003), is a good source of reliable information that covers all the most important issues and is easy to read.

Doulas. "Doula" is a Greek word that means "woman's helper." Doulas are women who are trained to provide continuous support to women in labor. Some doulas also help out after the baby is born. During labor and delivery the doula guides the mother in positioning, movements, and other activities that can reduce discomfort and provides back rubs and other comforting physical contact. Perhaps most importantly, a doula who has been through many deliveries is often able to reassure a laboring woman when things really are okay, even though the woman may be feeling panicky or overwhelmed. It helps that doulas provide continuous support, staying alongside the laboring woman from start to finish.

A doula can be good for the mother and the father. It's the rare father who can soothe a laboring woman's pain and anxiety as well as a trained doula, especially when the father is anxious himself. By taking over these tasks, the doula frees up the father to be with his partner in a loving way, rather than as a coach. Most fathers feel supported by the doula, not replaced.

There has now been a good deal of research on the effects of doulas, and the results are powerful. In many studies, doulas reduce the need for cesarean sections and epidural spinal anesthesia. (Epidural anesthesia, although often a godsend, does have some risks: For example, it increases the risk that the baby may run a fever and therefore need to be given antibiotics for a couple of days after delivery.) You can get more information about doulas from Doulas of North America at www.dona.org.

Emotional responses to labor and delivery. Every woman responds differently to the stresses of labor and delivery. Some take pride in receiving no medications at all. Others are certain from the start that an epidural is for them. For some women, labor is a painful experience to be endured and, they hope, forgotten; others consider it a profoundly moving experience, a rite of passage. Some will push with each contraction for endless hours; others will become discouraged and wish for the doctor to pull out the baby with forceps or do a cesarean. Some exhausted women scream at their well-meaning husbands to get out of the delivery room and never come back. Some new mothers feel immediate love and affection for their infant; others, after hearing that their infant is fine, simply want to sleep for a little while. And most turn out to be wonderful, loving parents.

If your labor and delivery experience is not what you expected, it's normal to feel bad, even guilty. If you go in hoping for a natural birth and end up with a cesarean, it's natural that you might feel that somehow you were to blame (you weren't) or that your baby will be permanently harmed by the experience (almost never the case). Many parents fear that if they are apart from their baby for the first hours or days bonding will be permanently undermined. That also is not true. Bonding — the process of baby and parent falling in love with each other — develops over months, not hours.

Classic Spock

Parenthood is an ideal guilt-generating business, and labor often delivers the first volley. I think this situation has come about in part because of the fantasy that everything has to be perfect for the child to do well. Of course nothing could be further from the truth. First off, the "perfect" parent has yet to see the light of day. Secondly, there is no need to be "perfect" or to follow any one script. The process of human development is powerful. There is plenty of room for variation and even for making mistakes. Infants are incredibly resilient. As long as the infant is healthy, the type of childbirth is unlikely to have long-term consequences, unless there is so much guilt attached to the memory that it has a negative effect on parental self-confidence or starts the process with a strong but misguided sense of guilt. So my advice is to have your baby however seems right for you and your family. Then don't worry if what happens doesn't follow the script. Being a parent is tough enough without creating problems where there really aren't any.

Choosing Your Baby's Doctor

Pediatrician, family doctor, or nurse practitioner? While you are pregnant, you can think about finding a physician or nurse practitioner for your baby if you don't already have one. Who should it be and how can you tell if the person will work out? You may already see a family doctor who is used to caring for babies, in which case the choice is simple. But if you deliver your baby with the help of an obstetrician, you'll need to find a doctor or nurse practitioner for your baby.

What qualities are you looking for? Some parents get along best with a doctor who is casual and laid back. Others parents want to be given directions down to the last detail. You might have more confidence in an older, more seasoned professional, or you might prefer one who is younger and more recently trained.

A nurse practitioner is a registered nurse who has received additional training and usually a master's degree so that he or she can function like a doctor in many ways. Nurse practitioners always work with doctor backup; how much the doctor is actually involved varies from practice to practice. Doctors often have more experience managing complex sickness; nurse practitioners may have more time scheduled for checkups and usually provide excellent preventive care. I wouldn't hesitate to use a nurse practitioner if he or she comes highly recommended.

A good first step in finding the right professional is to talk with other parents. Obstetricians and midwives often can give good recommendations, too.

The getting-to-know-you visit. If this is your first baby or you are moving to a new area, I'd strongly recommend that you schedule a visit to the doctor or nurse practitioner a few weeks before your due date. There is nothing like actually meeting someone to know if he or she has the type of personality that will make you feel comfortable enough to talk about whatever is on your mind. You can learn a great deal from such a prebirth visit and come away confident that your child's medical care is all set.

When you arrive for the visit, pay attention to the office staff and the office itself. Are the people pleasant and courteous? Are there things for children to do in the waiting room? Are there picture books? Does the space appear child-friendly?

There are a number of practical questions that the staff may be able to answer: How many physicians and nurse practitioners are there in the practice? How are phone calls handled? What happens if your baby becomes ill after office hours? What if you have an emergency during the day? What health insurance does the practice accept? What are its fees? Which hospital does it use? How much time is allotted for well-child checkups? (Fifteen minutes is about average nowadays, twenty to thirty is generous.)

A key issue is continuity of care. Will your child have one specific doctor or nurse practitioner, or do patients in the practice see whichever doctor happens to be available? Seeing whoever is available may involve less waiting, but many parents prefer for their child to have one identified professional who is "their" doctor. That way, the health professional gets to know you and your child well, and mutual trust can develop. Medical care for children requires a team effort — with the parent and the professional being the key team members. A parent may find it harder to feel that team spirit with a whole office of doctors.

When you talk with the doctor, choose a couple of issues to discuss that are important to you, such as the doctor's views on breast-feeding, allowing you to be present if your child needs to have a painful procedure, and how he or she handles issues that are not strictly medical, such as the question of cosleeping or toilet training. Pay attention to how you feel during the interview. If you feel comfortable, listened-to, and unrushed, you've probably found the right professional for you and your child; if not, you may want to visit some other practices.

Prenatal breast-feeding consultation. If you are unsure whether to breast-feed or bottle-feed, it's helpful to discuss the issue with the doctor or nurse practitioner you've chosen for your baby, or line up a prenatal consultation with a lactation consultant. You may want to attend breast-feeding classes offered by many large practices or hospitals. Knowing more will help you feel comfortable with your decision. If you decide to breast-feed, a prenatal consultation can help you anticipate any problems and deal with them ahead of time (see page 242 for more on breast-feeding).

Planning the Homecoming

Arranging for extra help in the beginning. If you can figure out a way to get someone to help you the first few weeks you are taking care of your baby, by all means do so. Having a supportive father around full time during the first couple of weeks can be particularly helpful. Trying to do everything yourself can exhaust and depress you, and this can start you and the baby off on the wrong foot. Most expectant parents feel a little scared at the prospect of taking sole charge of a helpless baby for the first time. If you have this feeling, it doesn't mean that you won't be able to do a good job or that you have to have a nurse to show you how. But if you feel really panicky, you will probably learn more comfortably with an agreeable relative by your side. The baby's father may not be a great support person, or he may be feeling too anxious or overwhelmed himself.

Your mother may be the ideal helper if you get along with her easily. If you feel she is bossy and still treats you like a child, it's probably better if she doesn't stay when she visits. You want to feel that the baby is your own and that you are doing a good job. It will help to have a person who has taken care of babies before, but it's most important of all to have someone you enjoy having around.

You might consider hiring a housekeeper or doula for a few weeks. Doulas are professionals who support women during labor (see page 24). More and more doulas offer their services in the weeks after birth as well. If your finances are limited, you may still be able to afford someone to come in once or twice a week to do the laundry, help you catch up on the housework, and watch the baby for a few hours while you take a rest or go out. It makes sense to keep your helper around for as long as you need the help (and can afford it).

Nurse home visits. Many hospitals and health plans offer nurse home visits one or two days after you take your baby home, particularly if the hospital stay has been short (less than a couple of days). Nurse visits are often very reassuring. They can be important, too, because some medical problems, such as jaundice, may not be apparent before the baby goes home. A visiting nurse can also be very helpful in dealing with breast-feeding problems or helping to arrange the services of a lactation consultant (see page 249).

Callers and visitors. The birth of a baby is an occasion that brings relatives and friends flocking. This is gratifying to the parents and fills them with pride. However, too much of it may be exhausting. How much is too much? It's different in different cases. Most mothers tire easily the first few weeks at home. They have just felt the effects of intense hormonal changes. Their usual sleep pattern has been disrupted. Perhaps more important still are the emotional shifts that are called for, especially with the first baby.

Visitors are pure pleasure to some people — relaxing, distracting, rejuvenating. To most of us, however, only a few old friends have such a good effect. Other visitors, to a greater or lesser degree, make us tense, even when we enjoy seeing them, and leave us fatigued, especially if we aren't feeling well. So you might want to limit visitors at the start, see how it goes, then increase the number very gradually if you find you have plenty of strength left over.

Most visitors get all excited when they see babies. They want to hold them, joggle them, tickle them, jounce them, waggle their heads at them, and keep up a blue streak of baby talk. Some babies can take a lot of this treatment, some can't take any. Most are in between. Pay attention to how your baby responds, and set a limit on handling if you think your baby may be feeling stressed or tired out by the attention. Relatives and friends who care about you and your baby won't be offended. Young children in particular often carry around viruses in their noses and on their hands that can make newborns ill. So it makes sense to keep young cousins and other relatives at a safe distance for the first three to four months; if they do touch your baby, make sure they wash their hands well first.

Preparing your home. If your home was built before 1980, there's a good chance that it contains lead paint. While it makes sense to remove any loose paint chips and perhaps paint over exposed, weathered patches, it isn't safe to try to remove the paint yourself using a heat gun or sander; the fine lead dust and vapors can raise your own lead level, which might affect your baby. Professional lead removal is safer, though expensive. For more on lead, see page 764.

If you are using well water, it's important to have it tested for bacteria and nitrates before the baby arrives. Nitrate salts in well water can cause blueness of the baby's lips and skin. Write or call your county or state health department. Well water won't have fluoride added, so you'll need to discuss fluoride supplements with your doctor.

Helping Siblings Cope

What to say while you're pregnant. It is good for a child to know ahead of time that he is going to have a baby brother or sister if he is old enough to understand such an idea at all (around a year and a half). That way he can get used to the idea gradually. Of course, you have to gear your explanations to your child's developmental level, and no amount of explanation can really prepare him for the experience of having a live demanding baby in the house. Your job is just to begin the dialogue about having a new brother or sister, where the baby will sleep, what the sibling's role will be in his care and to provide constant reassurance that you love him as much as ever. Don't overdo your enthusiasm or expect him to be enthusiastic about the baby. A good time to begin these discussions is once your body shape begins to change and you are past the very earliest stages of pregnancy when the risk of a miscarriage is highest.

The arrival of the baby should change an older child's life as little as possible, especially if he has been the only child. Emphasize the concrete things that will stay the same: "You'll still have your same favorite toys; we'll still go to the same park to play; we'll still have our special treats, we'll still have our special time together."

Make changes ahead of time. If your older child isn't weaned yet, it will be easier for her if you do it a few months before you deliver, not when she is feeling displaced by the new baby. If her room is to be given over to the baby, move her to her new room several months before, so that she feels that she is graduating because she is a big girl, not because the baby is pushing her out of her place. The same applies to advancing to a big bed. If she is to go to preschool, she should start a couple of months before the baby arrives, if possible. Nothing sets a child's mind against preschool so much as the feeling that she is being banished to it by an interloper. But if she is already well established in preschool, she has a social life outside the home, which will tend to lessen her feelings of rivalry at home.

During and after delivery. Some parents hope to strengthen family togetherness by including the older sibling in the delivery itself. But watching one's mother go through labor can be very upsetting for a young child, who might think that something awful is happening. Even older children can be disturbed by the stressful effort and the blood that are part of even the smoothest deliveries. From the mother's point of view, labor is tough enough by itself without having to worry about how a child is handling it. Other children can feel included by being nearby but not actually in the delivery room.

After the delivery, when everyone is nice and calm, is a good time to show the baby to an older sibling. He can be encouraged to touch the baby, talk to her, and help out in some simple task, like getting a diaper. He should have the feeling that he is an integral part of this family unit and that his presence is welcomed. He should visit as much as he wants but not be forced to if he doesn't.

Bringing the baby home. It's usually a hectic moment when the mother comes home after giving birth. She is tired and preoccupied. The father scurries about, being helpful. If the older child is there, he stands around feeling left out, thinking warily, "So this is the new baby."

It may be better for the older child to be away on an excursion, if this can be arranged. An hour later, when the baby and the luggage are in their place and the mother is at last relaxing on the bed, is time enough for the child to come in. His mother can hug him and talk to him and give him her undivided attention. Since children appreciate concrete rewards, it's nice to bring a present home for the sibling. A baby doll of his own or a wonderful new toy help him not feel abandoned. You don't have to keep asking him, "So how do you like your new sister?" Let him bring up the subject of the baby when he is ready to, and don't be surprised if his comments are unenthusiastic or even hostile.

Actually, most older siblings handle the first days of a new baby pretty well. It often takes several weeks before they realize that the competition is there to stay. And it will be months before the baby is old enough to start grabbing their toys and bugging them. The section on siblings (page 529) has more on how you can help help siblings get along.

Copyright © 1945, 1946, 1957, 1968, 1976, 1985, 1992 by Benjamin Spock, M.D.
Copyright renewed © 1973, 1974, 1985, 1996 by Benjamin Spock, M.D.
Revised and updated material copyright © 1998, 2004 by The Benjamin Spock Trust

About the Author

Benjamin Spock, M.D., practiced pediatrics in New York City from 1933 to 1947. He then became a medical teacher and researcher at the Mayo Clinic, the University of Pittsburgh, and Case Western Reserve University in Cleveland. The author of eleven books, he was a political activist for causes that vitally affect children: disarmament, day care, schooling, housing, and medical care for all. He had two sons, a stepdaughter, and four grandchildren. Dr. Spock, who died March 15, 1998, at age ninety-four, was married to Mary Morgan. Dr. Spock's Baby and Child Care has been translated into thirty-nine languages and has sold fifty million copies worldwide since its first publication in 1946.