Ep. 20 - LiveWell Talk On...Top Questions from Expecting Parents
Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital
Guest: Shari King, RN, Birth Care Nurse, St. Luke's Birth Care Center
Dr. Arnold: This is LiveWell Talk On…Preparing for Labor, Top Questions from Expecting Parents. I'm Dr. Dustin Arnold, Chief Medical Officer at UnityPoint Health - St. Luke's Hospital. The last few weeks of pregnancy are always the longest. I have no personal experience in that but, I'm told, but they can also be the busiest while expecting parents anxiously await for their new arrival. They may work on the nursery, classic nesting, determine the top baby names, but how can parents best be prepared for labor and delivery? It can be a scary situation for someone when they deliver for the first time. For some individuals it might be the first time they spent the night in the hospital. So, meeting with me today is Shari King a Labor and Delivery nurse from UnityPoint Health - St. Luke's Hospital Birth Care Center. She's going to answer some of the top questions she hears from expecting parents and share her best tips for the least stressful delivery. Welcome.
Shari King: Thank you.
Dr. Arnold: What is the most common question you get?
Shari King: How am I going to get through this? How is my pain can be controlled? Who's going to be able to be with me, who's going to teach me how to take care of my baby when I go home?
Dr. Arnold: I know my two daughters are in high school. It seemed like everybody had an opinion on how we should do stuff with the first one. And they were all different.
Shari King: Yes.
Dr. Arnold: So how does a young parent, expecting their first child sift through that? What's your recommendations?
Shari King: I think a lot of parents, boy, Dr. Google is out there, so a lot of them do internet searching and things like that. They talk to other family members and friends. What I recommend they do is come to prenatal classes, go to Lamaze classes, talk with doulas to find out about: What is the process of birth? How am I going to get through it? What are my choices? What are some of the things I need to be thinking about?
Dr. Arnold: Let’s back up a second there. What is Lamaze?
Shari King: Lamaze is a method of birth that is kind of controlling the environment, controlling their pain within themselves, using breathing techniques, using lighting. Having a birth plan, doing things the way they want to have things done. What is their outlook for their birth? What do they want that to look like? Some people are wanting to go natural, some people think they don't like pain at all. So, they're going to want an epidural as soon as they come in. So, finding out about all those methods, all of those things that they can do to try to make the birth what they want it to be. So, Lamaze the helps them with that.
Dr. Arnold: And you mentioned the term doula. Can you explain that one for me?
Shari King: A doula is someone that the couple will hire to be with them during the labor process. Sometimes they meet with them a couple times before they go into labor to find out what their preferences are, how she can help them do it. I don't know of any male doulas. I think there's only female doulas out there, so it's kind of a birth partner along with their husband, their support person, whoever their family members are going to be with them at the time of birth. So, it's someone that is there for her specifically one-on-one to help her with breathing, relaxation, suggestions of things to get to get through her birth plan.
Dr. Arnold: You know, you mentioned there’s no male doulas. I remember my first delivery as a medical student and the mom obviously was in labor and the husband who was to this side of the bed and he smiled at her and she just like, you know, she was right in the middle there. She was like, “What the hell are you smiling at?” You know? And I was like, “Oh my gosh!” I want to go back to where they don't… they don't sit down in the waiting room and wait and cigars anymore do they?
Shari King: They do not. No. I've been doing this 39 years. And when I first started, the dads had to go with the dads or support person had to go to a class before they were even allowed to stay in the room with them. So, boy, have times has changed. Now they come in knowing virtually nothing about it. Some of them have not been the classes, some of them haven't prepared at all. They have no idea what to expect and they're thrown in this thing and some of them are okay with it and some are from like, I don't want to see anything put me where I don't have to see anything. I am here, not against my will, but I'm here, you know, as a support to her. But I don't do blood or I don't do, you know, pain things.
Dr. Arnold: That's understandable. How about in the age of social media and we get some requests for a video or photographic recording of the delivery and the labor process as my daughter's older you realize that we probably have boxes of videos that we never look at anymore. So, you don’t want to hear this, I'm like, well, they're new parents, you know, because if it’s their sixth child, they'd be like, yeah, whatever, I'm not going to record that. But what is the policy on that?
Shari King: Our policy right now is no videotaping during the birth. It tends to distract the staff that's working with the mom. It kind of distracts the support person too, they're worried about, am I getting a good shot? Am I getting a bad shot? And she needs your help. She doesn't need you to be taking pictures. And most of the time, like you said, you had a dad say what? You know, the mom say, “What are you smiling about?” They tend to go through transition. Which isn't a happy time for them usually. So, she needs that support and that can distract from them. So, we don't allow videotaping of the births. We encourage them to bring their cameras and their phones in to take pictures. And usually at the time right after birth is when they start that process. And most of the time it's the staff that have to say, if you want pictures now, it'd be a great time to get that out because they're so caught up in the moment. They forget.
Dr. Arnold: That is the policy on this side of the street, on the adult side of the street for adult medicine, no video taping because you're absolutely right, staff start to act rather than perform their roles. And it can be difficult for some people being on camera. Do you get inquiries about people that want to have their baby at home with a midwife? I know that we don't have this. Now I'm going to try to say this word without laughing because I, for whatever reason, I was laughing. I said it's midwifery. I don't know why it's not midwifery, but I know we don't have midwives, here at St. Luke’s, but, do you get a lot of requests for this? Does that come up?
Shari King: We do. Sometimes during our tours that's one of the things that the families will ask. What do you do? Do you have midwives here at St. Luke's and actually in Cedar Rapids there are not midwives that come to the hospital. So, we don't. The midwives is a home delivery, having done this 39 years, I've seen a lot that can go very wrong very quickly. And even in normal pregnancy uncomplicated young mom, no health risks and something can happen. So, I discourage that, for home deliveries because I just, I've seen what can happen and an ambulance ride three minutes away from the hospital, it can be too late, for mom or baby.
Dr. Arnold: Yeah, that's so true. Anesthesia and Obstetrics are two of the specialties where it's monotony or catastrophe. And that's why highly trained physicians are in those specialties because it's pretty day-to-day routine until it's not. And then you have two patients, not just one.
Shari King: And I've always said in OB, and in labor, you have two patients that you take care of. One that you can't see, you can't touch, you can’t ask questions to, it can't answer you back. All you have is how she's acting. And if you have a monitor on ‘em, how her tracings are looking, that's how you have to assess that second patient. Things can go wrong in that second patient that you have to act on. Just based on what you see.
Dr. Arnold: Absolutely. And as you know from your experience, and mine, from my experience that sometimes the numbers and the tracings and the EKGs lag a little bit behind the actual clinical situation. The clinical situation develops a little earlier than it starts to with the ability to measure it so that you have to be. So, it's more than just having someone boil some water and tear some rags, like, you know, kind of with movies.
Shari King: And hold babies
Dr. Arnold: And hold babies.
Shari King: Yeah, it’s a lot more than that.
Dr. Arnold: I imagine this at home births and the anti-vaccination movement, this kind of rejection of mainstream science, if you will, which is another whole podcast. We could do, Do you get a lot of those questions that are kind of almost cult-like in a way? That come up?
Shari King: We do most of the people that are refuse- Oh, I guess I shouldn't say most of the people, some of people are refusing those things, have just read it somewhere, that it's bad. They've read an article or they've heard something about in vaccinations that's harmful. And once we talk with them about the benefits of vaccination and medication and things like that, that sometimes people need, they'll come around. They'll say, “I have no idea, I had no idea that there was this much more to it.” So, they come in with the idea maybe because they've heard it somewhere, nut, “I don't want to do that.” But once they hear the benefits of the things, you know, some of them will and some of them won't. And St. Luke's pediatricians, at least for the babies and the vaccinations, most of them will, again, educate the parents and try to just make sure that they're making an informed decision.
Dr. Arnold: What percentage of women present, pregnant women present and they haven't had that prenatal care, that establishment of an obstetrician or family practice doctor. What percentage do you think?
Shari King: You know, the pendulum over the years has swung back and forth a couple of times. Right now, we're in a pretty good percentage that I would say probably 60%, maybe, have got classes or some education somewhere about birth, the birth process and labor and newborns and things like that. It's been much lower than that at times. But I'd say probably on average 60% do have some education when they come in, at least in this area. I think that could vary a little bit regionally.
Dr. Arnold: Along those lines of pre-planning for pre-delivery, pre-labor, let's call it pre-labor, I think that's actually a medical term though. I don't know for the listeners. Yeah, I do not know. I virtually know nothing about obstetrics. So, this is all new to me as well, even though I have two children. But, should they establish a pediatrician ahead of time?
Shari King: It's a good idea to look into the clinics. And we do encourage that when we give our tours. We say, have you got a pediatrician picked out yet? Some of them take their tours very early in the pregnancy. They might've just found out, they're so excited and they just want to start planning right away. And those are really really fun tours to do. If they wait until later and we've got somebody maybe due in a couple of weeks and we're asking them on their tour have you thought about your pediatrician yet? And they say, no, it's like, okay, we need to think about that because it's important for your child's health to have follow-up care, along the continuum of their life. So, we do talk about that with them and encouraging what some offices call prenatal visits, for them. So, we want them to ask questions of the person that they might have take care of their child. What are your office hours and what's your answering service and who's going call me back in the middle of the night and do you have holiday hours and weekend hours? So, we just give them some questions that they can ask to try and find the right fit for them, for their child.
Dr. Arnold: But if they should not have that chosen ahead of time, we do have resources to provide them at the time.
Shari King: Yep, absolutely. A UnityPoint pediatrician would see their baby while it’s in the hospital and then probably would do the follow-up afterwards until they found somebody that they were comfortable with.
Dr. Arnold: How many people know what they're having, boy or girl ahead of time. What do you think?
Shari King: Again, the pendulum has swung back right now, they're kind of going back to not finding out. I would say it's still very heavy that they find out what it is. There's all the gender reveal parties that people have and things. So, I would say it's still a majority, maybe 65-70% that know what they're having, but the numbers are getting higher, that come in that don't know. Those are fun deliveries.
Dr. Arnold: Now how many have the baby named picked out ahead of time?
Shari King: Most of them have a list, and mom and dad usually don't agree on the list. So, when the baby comes out, somebody wins. So, they pick from there. But most of them have a list.
Dr. Arnold: Do they? Yeah. I can't remember what-my wife always gets her way anyway, so it really didn't matter, but I don't remember. So, you've been a labor and delivery nurse for 39 years. How many labor have you been in on?
Shari King: You know, I get asked that question and I wish I would have kept track, but thousands, thousands probably. Yeah.
Dr. Arnold: Have you ever been in on the labor of someone that you were in on their delivery?
Shari King: Yes. That, that is now happening.
Dr. Arnold: Second generation.
Shari King: Yes, that’s happening. Yeah, I have been. And those are fun. They'll say, “you know what? I think you were my mom's nurse. I think your name is in my baby book.” And it's like, Oh my gosh, how can that be? But how exciting. And then when I see the mom and we kind of reminisce a little bit about how it was.
Dr. Arnold: That is fun and it really is truly, healthcare in general, medicine. It just is a rewarding profession, you know, I'm excited everyday to come in.
Shari King: Yeah, me too.
Dr. Arnold: So, one last question. Why did you become a birth care nurse?
Shari King: When I was in nursing school, once I did my OB rotation, I knew that was it. I thought, I don't even have to finish the rest of school. Let me just do this. This is what I wanna do. I don't need to take the rest of this stuff. This is what I want to do. So, then when I got out, the passion was still there. And I pursued that right away and I just got into it and I just love it. The miracle of birth, the amazing process of birth and labor and the new little baby that comes out and that being part of the family unit for their rest of their lives. Like that, that girl that came in that I had been her mom's nurse, you just can't beat it. Like there can't be a better place in the hospital.
Dr. Arnold: I think it was like my second delivery. I was a medical student and I had a brand new pair of Air Jordans, you know, this is like 1992. And most of the amniotic fluid went down one of them and just soaked it. And I said, no, not for me. This is, this is not for me. I'm not going to do this. No way. No matter the miracle. Well, that's a neat miracle, not for me.
Shari King: I think you love it or you don't.
Dr. Arnold: You know, that's interesting you say that because, at least here at St. Luke's, you have decades of experience across the street, centuries, centuries. You have nurses that once they get in labor delivery, they're there forever. Yeah, I'll confidently say centuries of experience probably right now. Today.
Shari King: Yeah. Well there were the other day a doctor was in talking with the patient and I was in the room and there were two other nurses in the room, when we were talking and he said, “Oh, you have got a great tenured team here today.” He said, “What is this like?” And I think between the three of us, there were 105 years of experience.
Dr. Arnold: It doesn't surprise me at all.
Shari King: Yeah. We have a lot of us that have been here.
Dr. Arnold: I think in general, St. Luke's has been fortunate over the years to retain a lot of frontline nurses with decades of experience, particularly in Labor and Delivery or Intensive Care Unit or ER, OR. Which as a physician, it's a lot of fun.
Shari King: When I moved here, we moved here from Illinois in 1996 and I’d been a nurse for 15 years in Illinois. And when I came into the unit, which was still over in this main building on sixth floor, I knew that's where I wanted to work. It just felt like, “Yep, this is it. This is the type of nursing I wanna do.”
Dr. Arnold: I was born at St. Luke's and my first office when I started the Hospitalist program, the adult Hospitals program, was the same wing that I was born on. So, I always said, if I die, they'd say “He never went anywhere.” This is great information, Shari, thanks for coming by. I really enjoy this. I enjoy talking about topics that, I'm not familiar with. For more information or to schedule a tour of St. Luke's Birth Care Center, visit unitypoint.org/baby, if you have a topic you'd like to suggest for Talk On podcast, shoot us an email at firstname.lastname@example.org. We encourage you to tell your family, friends, and neighbors, strangers about our podcast. Until next time, be well.