Important Decisions

You will make many important decisions during pregnancy. Please see the topics below to find out more about such issues as how to find a pregnancy care provider, childbirth preparation methods, male circumcision and cord blood banking.

Choosing a Provider

Finding a health care provider for your pregnancy is probably one of the most important choices you’ll make early on. All of Golden Gate’s doctors are board certified Ob/Gyns.

Ob/Gyns are doctors who specialize in women’s health care. These practitioners complete four years of specialized training in obstetrics and gynecology after completing medical school. An Ob/Gyn must pass written and oral examinations to show that he or she has obtained the knowledge and skills required for the medical and surgical care of women. A certified Ob/Gyn can then become a Fellow of the American Congress of Obstetricians and Gynecologists, a group that helps doctors stay up-to-date on the latest medical advances.

  • We are a group practice, so we work together to take care of our patients.
  • You can have appointments with just your doctor during your pregnancy, or you can rotate to meet all of our doctors.
  • We only deliver at California Pacific Medical Center, California Campus.
  • After hours, Ob/Gyn nurse practioners are available to answer emergency calls and questions. They can give medical advice and fill some prescriptions. They will instruct you when you need to come to the hospital, and will contact the doctor on call when necessary.
  • All of our doctors rotate in the after-hours call schedule.
  • Your doctor will make every effort to deliver your baby during regular hours. If he or she is not available, one of our partners will be with you.
  • Our philosophies on pain management during labor, fetal monitoring, operative vaginal delivery and cesarean birth are all consistent. Your doctor will be happy to answer specific questions at any of your visits.
  • We encourage your partner to be with you during your labor and delivery, and are supportive if you would like additional family members or friends to attend your birth.

It’s important to us that you are comfortable with your pregnancy care provider. If you have concerns, make sure you bring them up.

Childbirth Preparation Methods

Childbirth preparation is a means of coping with pain and reducing the discomfort associated with labor and delivery. Childbirth preparation classes teach these various techniques. The most common methods of preparation — Lamaze, Bradley and Read — are based on the theory that much of the pain of childbirth is caused by fear and tension. Although specific techniques vary, childbirth methods seek to relieve discomfort through education, support, relaxation, paced breathing and touch. Here is a brief overview:

  • Lamaze: The Lamaze method of childbirth was invented in the 1950s by French obstetrician Dr. Fernand Lamaze. This method is based on the idea that a woman’s inner wisdom guides her through childbirth. Lamaze childbirth education helps women gain confidence in their bodies and learn to make informed decisions about pregnancy, birth, breastfeeding and parenting. To learn more about this method, visit Lamaze International.
  • Bradley: The Bradley method views childbirth as a natural process and is based on the belief that a healthy pregnancy and birth can be achieved through education, preparation and support from a childbirth coach. This method involves the active participation of the mother and her coach during the labor process and teaches a variety of relaxation techniques. Find more information about the Bradley method here.
  • Read: One of the first methods to introduce the concept of prepared childbirth, the Read method seeks to eliminate fear and anxiety by educating mothers and coaches about labor and delivery. The Read method is explained in the book Childbirth Without Fear, written by its founder, Dr. Grantly Dick-Read.
  • Hypnobirthing: This method teaches relaxation and self-hypnosis techniques. The instructors have gone through extensive training. The goal is to teach women how to harness the body’s natural painkilling chemicals — endorphins — to achieve a natural and fear-free childbirth. Information about this method is available online.

With all of the choices available, you’re likely to find something that appeals to you and your individual beliefs.

Cord Blood Banking

Cord blood is blood from the baby that is left in the umbilical cord and placenta after birth. It contains cells called hematopoietic (blood-forming) stem cells. Stem cells can be used to treat some diseases — including disorders of the blood, immune system and metabolism — and offset the effects of cancer treatment on the immune system. Other uses are being studied. It’s now possible to collect some of this cord blood after birth and store it in case your baby or a family member needs it in the future. Before you make a decision about banking your baby’s cord blood, it’s important to get all of the facts.

Currently, only a few diseases can be treated with the stem cells from cord blood. The chance that cord blood stem cells will be needed to treat your child or a relative is very low — about 1 in 2,700. However, research is being done to find new uses.

There are limitations to how your baby’s stem cells can be used. If a baby is born with a genetic disease, the stem cells from the cord blood cannot be used for treatment because they will have the same genes that caused the disorder.

Cord blood is kept in one of two types of banks: public or private. Public cord blood banks operate like blood banks. Cord blood is collected for use by anyone who needs it. The stem cells in the donated cord blood can be used by any person who matches. There is no fee for storing cord blood in a public bank. Donors must be screened before birth. This screening entails a detailed medical history of the mother, father and their families. Many people do not pass the screening required for a public bank. A limited number of hospitals participate in the public cord blood banking option. To find out more about public banks, check out the National Marrow Donor Program.

The other storage choice is a private bank, which charges an annual fee. Private banks store cord blood for “directed donation.” The blood is stored for use by only your baby or relatives.

Whether to donate or store cord blood is up to you. You have three choices:

  1. Donate the cord blood to a public bank.
  2. Store the cord blood in a private bank.
  3. Do not donate or store cord blood.

If you decide to donate or store cord blood, you will need to choose a cord blood bank. Here are some questions to ask yourself when choosing a bank:

  • What will happen to the cord blood if a private bank goes out of business?
  • Can you afford the yearly fee for a private bank?
  • What are your options if results of the screening tests show you cannot donate to a public bank?

You must let your health care provider know far in advance of your due date (preferably two months) if you want to collect and store your baby’s cord blood. If you have chosen a private bank, you will need to arrange for the collection equipment to be sent to your health care provider. Health care providers usually charge a fee for collecting cord blood. This fee is not usually covered by insurance. Many cord blood companies pay doctors an additional amount for the collection as well.

Keep in mind that even if you have planned to donate or store cord blood, it may not be possible to collect the blood after delivery. For example, if the baby is born prematurely, there may not be enough cord blood for this purpose. If you have an infection, the cord blood may not be usable.

Male Circumcision

Circumcision means cutting away the foreskin, a layer of skin that covers the tip of the penis. An anesthetic will be used to lessen the pain. Circumcision usually is done soon after birth and before the baby leaves the hospital.

For some parents, circumcision is a religious ritual. It also can be a matter of family tradition or personal hygiene. Studies show that there are some medical benefits to circumcision, including a slightly decreased risk of urinary tract infections during the first year of life; a lower risk of getting cancer of the penis (although this cancer is very rare to begin with); a slightly lower risk of getting a sexually transmitted disease, including human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS); and a lower risk of infection of the foreskin.

However, these medical reasons are not sufficient to recommend circumcision for all infant boys, and the American Academy of Pediatrics believes the decision should be left to the parents. If you want your son circumcised, tell your health care provider ahead of time. Also, check with your insurance provider because the procedure may not be covered.

Children in the Delivery Room

Some families invite their older children into the delivery room to witness their sibling’s birth. Only you can know if this is right for you or your child. If you would like to make your baby’s birth a family affair, let us know so we can guide you ahead of time.

If your other children are going to be in the room, each needs to have his or her own adult support person. Even if your child isn’t with you during delivery, he or she can meet the new brother or sister shortly after birth.

Pain Relief During Labor

You may want to start thinking about whether you would like pain relief during labor and delivery. You don’t have to decide now, but it’s a good idea to know your options. Even if you do make a decision now, you may change your mind once you’re in labor.

Each woman’s labor is unique. The amount of pain a woman feels during labor may differ from that felt by another woman. Pain depends on many factors, such as the size and position of the baby, the strength of contractions, and how you handle pain.

Some women take classes to learn breathing and relaxation techniques to help cope with pain during childbirth. Others may find it helpful to use these techniques along with pain medications.

There are two types of pain-relieving drugs — analgesics and anesthetics. Analgesics lessen the pain, while anesthetics block all pain and sensation. Some forms of anesthesia, such as general anesthesia, cause you to lose consciousness. General anesthesia usually is not used for vaginal births. Other forms, such as regional anesthesia, remove all feeling of pain from parts of the body while you stay conscious. Several forms of regional anesthesia are used during childbirth:

  • Epidural Block: Epidural blocks cause loss of some feeling in the lower part of a woman’s body, yet she remains awake and alert. An epidural block may be given soon after contractions start or later as labor progresses. It is given through a thin tube inserted in the lower back.
  • Spinal Block: A spinal block — like an epidural block — is done with an injection in the lower back. It provides good relief from pain and starts working fast, but it lasts only an hour or two. It usually is used for cesarean delivery and only rarely in late labor or for a vaginal delivery.
  • Combined Epidural-Spinal Block: A combined spinal–epidural block has the benefits of both types of pain relief. The spinal part helps provide pain relief right away. Drugs given through the epidural provide pain relief throughout labor.

There are advantages and disadvantages for each form of anesthesia. An anesthesiologist will work with your health care team to help you choose the best method.

Child Care

If you are planning to return to work after having the baby, finding good child care will be a top priority for you and your partner. Give yourself some time to figure out which option is best for your family. You may want to arrange child care during the final weeks before the baby arrives. Ask around for child care recommendations.

There are three basic child care options: care in your home, care in a caregiver’s home, or care in a child care center. If you want to hire someone to care for your baby in your home (such as a nanny or au pair), contact agencies that focus on child care placements. This type of care can be very costly. To cut costs, some parents share a caregiver with another family. The caregiver in these “share-care” setups is paid to watch two babies in one family’s home.

A less-costly option is having a relative or a licensed provider care for your baby in their home. In most cases, these caregivers watch more than one child. Child care centers are another option. This type of setting may take care of many groups of children of all different ages. Some accept babies as young as six weeks, and some do not take infants until they are out of diapers, so be sure to ask questions while you’re doing your research.