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Preparing for Delivery: Having a plan, but keeping it flexible

©MFMER

Your trip to the hospital, like a trip to go camping, will benefit from advanced planning. Myra J. Wick, M.D., Ph.D., Mayo Clinic obstetrician, gynecologist and medical geneticist, joins Co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D. to help you think of everything you’ll need, before you need it, including:

*          A birth plan

*          A “go bag”

*          How you want doctors to help control your pain

*          Who you want in the room (obstetrician, doula, midwife)

*          Delayed cord clamping

*          Pre-planned C section, if you want it

Listen: Preparing for Delivery: Having a plan, but keeping it flexible

 

Read the transcript:

Dr. Angela Mattke:

Welcome to the “Mayo Clinic Moms” podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke, and I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor, also at Mayo Clinic, and is also pregnant.

On this episode, we’re talking about preparing for delivery. Should you have a birth plan? Do birth plans even matter? Because we all know babies and delivery are going to go how it’s going to go–and maybe we don’t have as much control of it as we actually think we do. And what do obstetricians really think of birth plans? How should you control pain? Also–how do you choose who’s going to deliver your baby? Do you consider an obstetrician, a midwife or a doula to be present during that delivery?

And what about delayed cord clamping? Have you heard about that? If you haven’t, you should. What about a pre-planned C-section? What should you pack in your go bag? We have a lot to cover in this episode, so I think we should just dive right in. We’re joined again by our special guest, Dr. Myra Wick, who is an obstetrician-gynecologist and a medical geneticist at Mayo Clinic. She has some serious street credibility, everyone, because she is the medical editor of Mayo Clinic Guide to a Healthy Pregnancy. Dr. Wick, thank you again for joining us.

Dr. Myra Wick:

Thank you for having me. It’s a pleasure.

Dr. Angela Mattke:

I’m really interested to hear what you think about birth plans. We’ll get to that in a little bit, but let’s start by talking about where you should deliver — hospitals, birthing centers, there are lots of different options. I myself chose a hospital because during my pediatric residency, I learned that obstetrics and delivery is probably 90% routine, sort of boring, and then 10% is sheer terror when everything goes wrong that can go wrong. And I decided that I wanted to be in a hospital where there were neonatologists, neonatal nurse practitioners, respiratory therapists, skilled nursing staff, obstetricians and anesthesiologists, and everyone present who needed to be present if something was going wrong with my baby, because I wanted to make sure that my baby had the best chance of having a smooth delivery and doing well. Thankfully, I chose a hospital and neither of my deliveries went according to plan and it was sheer terror for everyone involved in the room. Nipunie, have you decided where you are going to be delivering?

Dr. Nipunie Rajapakse:

Yeah Angie. For the same reasons that you outlined, we’re definitely planning to deliver in a hospital. I think we want to be somewhere that we know that all the backup is there if it’s needed; hopefully, it won’t be needed. But I think for peace of mind, that’s what we’ve decided as well.

Dr. Angela Mattke:

Yeah. Dr. Wick, I think there’s some confusion about what the difference is between an obstetrician, a midwife, and a doula. Can you help us understand that a little bit?

Dr. Myra Wick:

Sure. I’m just going to interject my own story. We also chose to have our children in a hospital and you never do really know what’s going to happen. With our third child – after two vaginal deliveries – with our third child, no anesthesia on board. I was going to do it all natural, and there was an abruption, and I ended up with the crash C-section. I think it was probably scarier for my husband, who was watching everything. But anyway, you never know, even after, two relatively routine deliveries, you don’t know what’s going to happen with the next one or with the first or second. So back to your question — an obstetrician gynecologist is a medical doctor. We have to go to medical school for four years.

We have four years of residency training. We can perform lots of procedures, like C-sections, operative vaginal deliveries. For midwives—well, there are slightly different flavors of midwives. Most of those associated with a hospital are certified nurse midwives. And they also have medical training. Many of them are nurses or have a Bachelor’s in nursing, and then they do graduate training in midwifery. They’re also medically trained. They aren’t able to do procedures, so they wouldn’t be able to do a C-section. They wouldn’t do an operative vaginal delivery like forceps or vacuum. They tend to be a little bit more hands-off in general, as far as cutting episiotomies. We don’t do that routinely either, but they’re a little more holistic than you might have with an obstetrician. A doula is not medically trained. They’re more of a support person. For some of them, they are support people before delivery, some are during delivery, and there are even doulas for after you go home, so a support person for taking care of the baby at home. Many of them have some minimal training, but they don’t have any specific medical training.

Dr. Angela Mattke:

Well, do you have any rule of thumb for making these choices? There are a lot of options out there. I think people hear a lot of information from friends, family, social media, internet, Instagram. I mean, you probably obviously have some bias in this area. I know that we probably all have some bias because we are trained as medical doctors as well, but what are your thoughts?

Dr. Myra Wick:

Right. Yeah. Oh, and I also don’t want to leave out our family medicine friends and colleagues.

Dr. Angela Mattke:

Yes, absolutely.

Dr. Myra Wick:

We have several in our practice that deliver babies. They are in labor and delivery with their patients. I think it really depends primarily on whether or not you’re a high-risk patient. Patients who have medical complications, you know, which can be anything from severe autoimmune disease, even to gestational diabetes that requires insulin. Those are pregnancies that are going to be taken care of by an obstetrician, usually. Low-risk pregnancies are going to be taken care of oftentimes by midwives, if that’s what you choose. The family medicine doctors are great for continuity. If your children are seeing a family medicine doctor, and you’re seeing that doctor, and he or she is also providing obstetrical services and you’re a lower-risk pregnancy, those are great people. I know my colleagues here at Mayo Rochester will come and sit in labor and delivery while their patient is laboring. And they’re very attentive. I think that’s probably one of the wonderful advantages of going with a family medicine doctor.

Dr. Angela Mattke:

Yeah, absolutely. I did a rural rotation in medical school where a lot of the family med doctors did all of the prenatal care; they did the deliveries, and then they got to see the baby for the rest of their lives. And it was just such a beautiful moment to meet your patient at birth, you know? I’m really glad you brought up the family medicine providers who do obstetrical care as well.

I mentioned birth plans, and I have a lot of thoughts on birth plans. I personally didn’t have one because my experience in residency taught me that it seemed like everyone who had really, really detailed birth plans, like, “I was going to have certain essential oils, and then I was going to walk, and then I was going to do this, and I was going to do that. And there were going to be no interventions, and there were going to be no pain meds.” Those were the ones that always went wrong. And granted, as a pediatrician and a pediatric resident, we were only called to deliveries where there were concerns for the baby. They wanted us to be present to be able to offer the baby any type of assistance after birth with breathing or other things. I felt like–okay, if I’m going to do that and have all these expectations, I’m guaranteed that something’s going to go wrong because I feel like in medicine, there’s this rule of thumb. If you’re in medicine, everything’s going to go wrong for you–so you expect that.

I didn’t have a birth plan. I told my sister, she couldn’t have a birth plan. The only birth plan is “healthy mom, healthy baby.” And that’s what I told my midwives; that’s who I went with. Nipunie, do you have a birth plan? What are your thoughts on this? Then I really want to hear what Dr. Wick’s thoughts are on birth plans, and if she sees the same pattern that I saw in residency.

Dr. Nipunie Rajapakse:

Yeah. I have gone from both extremes when it comes to birth plans in many ways. I think my natural tendency is, “Yes, I want to write out a plan. I want to be able to plan exactly how this is going to go,” but for the same reasons that you just said, I know that you can write down as much as you want, but what’s going to happen is going to happen. I don’t have a birth plan. I haven’t written one yet. And then when I think of birth plans, I guess I think about maybe not the most important stuff that you may want to have in there. I’m interested to hear Dr. Wick’s perspective on that because when I imagine a birth plan–and maybe it’s the portrayal that we see on TV or in movies–but I’m thinking about people specifying what music they want playing as the baby’s being born or what the lighting is going to be like in the room. And those things don’t really matter to me.

As you said, “healthy mom, healthy baby,” I think is the outcome that I want afterwards. But I also want to make sure that we’ve thought through some of the different decisions that we’re going to have to make in advance, because I can imagine trying to make those decisions when you’re in pain or actively in labor is not easy. I do want to feel like I have prepared adequately. I’m interested to hear Dr. Wick’s perspective. What do you think about birth plans? Should we write them down and what aspects of the delivery do you think are worth thinking about in advance or having included in your birth plan?

Dr. Myra Wick:

Yeah, well, first of all, I do echo Angie’s thoughts where it seems like the most detailed, well-laid-out birth plans oftentimes don’t go as planned. But I think it’s important to go through and think about it. We, in our practice have a little booklet that we hand out to patients. It just asks if you’ve thought about different things that you might not have thought about. Are there different kinds of anesthesia? And, who do I want in the room when the baby is there? And what do I want after the baby is delivered? And you mentioned cord clamping. I think all those things are important to think about, and be flexible. If everything doesn’t go according to plan, if you end up with needing to have a cesarean for whatever reason, that’s okay. It might not have been what you had planned for, but things can change really quickly in labor and delivery. Having said that, I think it is important to think through the decisions and it’s good to think through those things ahead of time, rather than right at the time when you need to make a decision.

Dr. Angela Mattke:

I’m glad you brought that up because it’s not just about the music and stuff like that. But those are–and I don’t mean to, pooh-pooh birth plans because I had one too, right? I wanted to know about my pain, how it was going to be controlled. And my other things were, where did I want the baby after birth? Did I want them on me if it was possible? I’m glad you mentioned those really important aspects.

Dr. Myra Wick:

And even things like cutting the cord in a vaginal delivery, we’ll often let the dad cut the cord, and some dads are like, “No, I’m not doing that!”.

Dr. Angela Mattke:

It’s a lot different than what they think it’s going to be.

Dr. Myra Wick:

Yeah. So even what seems like a relatively small decision, it’s good to think about those ahead of time.

Dr. Angela Mattke:

You mentioned delayed cord clamping. Let’s come back to talk about that because I don’t necessarily know if that’s something a lot of people are aware of. As a pediatrician I have looked at the research about this and developmental outcomes and overall outcomes with infants, both that are term and healthy and preterm and healthy. Can you talk a little bit about benefits of delayed cord clamping? But also recognizing there are times where we can’t do delayed cord clamping because the health and of the safety of the baby are going to be at risk.

Dr. Myra Wick:

Yeah, I think, and you correct me if I’m wrong, but I think the initial studies came out of preterm babies where they saw a lot of benefit to delayed cord clamping, and there had been some controversy about, “Should we do this in a term healthy baby?”. And the American College of Obstetrics and Gynecologists now is saying, “Yes, we should delay cord clamping for 30 to 60 seconds after the baby’s delivered because it helps to increase the hemoglobin and the iron levels, and that may help developmental outcomes.” We are routinely trying to do that in both our vaginal deliveries and our C-sections. So yeah, we are doing that beyond a minute. Sometimes lot of patients say I want to delay cord clamping until the placenta starts to loosen. And there’s really not a huge benefit in doing much delay beyond a minute.

The highest volume is really being transferred to the baby in that first minute. But like you mentioned, Angie, there are times when we might not be able to do that. For example, if the baby had a fetal heart rate tracing that was concerning and we want to get the baby to our pediatrics colleagues right away, or if we’re worried about meconium aspiration, or we’re worried that the mom’s bleeding a lot. We think that there’s something going on with the placenta; there’s a postpartum hemorrhage, and we need to manage that in part of labor, that third stage of labor, then we might hand off the baby a little bit more quickly than if everything’s going pretty smoothly.

Dr. Angela Mattke:

Nipunie, have you started to think about your pain management? What are the options or what do you want that to ideally look like during delivery?

Dr. Nipunie Rajapakse:

Yeah, so this goes back to why I haven’t really put together a birth plan yet. During our pregnancy, we found out pretty early on that there were a couple things that make it a bit difficult to know right now, whether I might end up needing a C-section or whether we’ll be going to try for a vaginal delivery. One thing that was noticed was that I had a low-lying placenta, so the placenta is low and right near the cervix, which is where the baby would come out from. Obviously, that can result in some complications during delivery. I was also noted, actually, on our very first ultrasound, to have quite a large fibroid, which is a benign mass in my uterus that is putting some pressure or displacing the cervix a bit as well.

The combination of those two things, we’ve been following along the course of the pregnancy with ultrasounds to help decide whether a planned C-section might be the way to go, or whether the risk is low enough that we can attempt to deliver the baby vaginally. We’re still waiting for final decisions on that based on how things go over the next few weeks. And so, in terms of pain control, then, I’ve   thought about both scenarios and possibilities. I know one of the main pain control strategies that is offered is an epidural. Angie, did you have one for your deliveries?

Dr. Angela Mattke:

Oh, for sure. Yes. I basically got the epidural probably before I was supposed to get the epidural, but I will say I worked in labor with both my babies. And I worked almost full days in labor with both of them and went home. The first one I delivered about 12 hours after going home, and the second one I delivered only four hours after going home. Basically, I got home, kept calling my husband and saying, “Where are you? I need my epidural. Let’s get to the hospital.”

I don’t know, but I guess my experience in watching a lot of these deliveries, it seemed like the delivery was more controlled, and this is probably my anecdotal experience. It seemed like the delivery was more controlled with an epidural and everyone seemed to be calmer, even though most deliveries are a little bit chaos, and I think people need to be prepared for that. I just wanted to have a little bit calmer experience. I thought if there’s anything that can make me less likely to tear, then I will definitely have an epidural — and they were blissful. So yes.

Dr. Nipunie Rajapakse:

Great. Maybe, Dr. Wick, can you explain a bit about what an epidural is? And if there are any downsides to getting one? Because that was something I was interested in learning a bit more about.

Dr. Myra Wick:

Yeah. An epidural is medication that’s put around the spinal column and helps us give you numbness to the – not complete numbness, but quite a bit of numbness to below the waist, so you get a lot of relief and comfort. Our anesthesia colleagues are great at trying to get the epidural or the spinal just right so that when it comes time to push, you’re able to have enough sensation to push. And for a lot of women, it can be a game changer. Angie, I think you’re right, there seems to be more of a level of calm, you know, especially if there has to be an intervention, like a vacuum delivery or forceps. And moms are typically calmer because they’re not in so much pain, and there might not be screaming and yelling, and sometimes they’re able to listen better too, if there’s something going on, and we need to deliver quickly. If the mom’s in a lot of pain and screaming, sometimes she can’t focus on what the team is asking her to do. So yeah, I’m biased.

Dr. Angela Mattke:

Yeah, I’m biased too because like I said, both of my kids’ deliveries — they were really naughty, and we had bad heart rates and Category II tracings and all kinds of stuff where we had to get them out very, very quickly or we were going to be going to an alpha section. I just remember, how you said, I needed to focus on directions. With my second child, it was, “push, breathe, and then push again. You can’t stop pushing; you’re just going to push straight. We’re not waiting for contractions.” I don’t think I could have done that without my epidural. But I’m biased, and everyone is going to make the right choice for them. That was the right choice for me. I’m very happy I did it.

Dr. Myra Wick:

There are other options. Some people like to get up and move around and be on a ball or in a rocking chair. Massage–sometimes massage is a great thing for people. Getting in the shower with my second delivery, I was in the shower for probably over an hour, and it was a huge relief to just sit in there and feel the water. In our labor and delivery unit, we have a couple of laboring tubs or bigger tubs where moms can sit in the tub, and that can be a huge relief. We have nitrous oxide that patients can use, too. Lots of different options. Our midwifery team will use water bubbles they’ll put underneath the skin, just under the skin injection. And sometimes, they call them water papules. That gives people relief, too.

INTERMISSION

Dr. Angela Mattke:

Are you thinking about getting pregnant, or maybe you’re a current mom-to-be, or you’re like myself and you’re in the midst of raising kids, and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press wherever books are sold, or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Nipunie Rajapakse:

I’ve heard that there’s a bit of time sensitivity. I’ve heard of people being too late to get an epidural. What does that refer to, and what are the things that you look for to decide that it’s too late?

Dr. Myra Wick:

Yeah, oftentimes it’s not too late unless somebody is pushing actively, and you’re seeing the baby is really moving with the pushes. It’s probably too late, then; just push the baby and get it out and be done. But you know, even for a patient who’s at nine centimeters, if it’s a first-time mom, oftentimes there’s still adequate time for anesthesia to get in and get the epidural placed or a spinal placed. Sometimes people worry about getting the epidural too early. I think if somebody is in labor and delivery, and the plan is for delivery, and they’re super uncomfortable, then it’s fine to go ahead. Even if they’re not very dilated, there’s not really a cutoff either way; it really is situational. And each situation’s a little bit different.

Dr. Angela Mattke:

There used to be – at least when I was in training – concerns that getting an epidural would increase your likelihood of needing a cesarean section or prolonging your labor. Has there been any research? I mean, in the past 10, 12 years since I’ve last been a resident that can shed some more light on this?

Dr. Myra Wick:

Yeah. It doesn’t increase C-section rate. It can make the labor a little bit longer, especially if the epidural is really dense, meaning that you don’t have a lot of feeling in your legs or in your bottom area. When it comes time to push, your pushing initially might not be doing a whole lot, just because you can’t feel; you don’t have that sensation. The labor could be a little bit longer. But other than that, there aren’t any concerns.

Dr. Nipunie Rajapakse:

Have there been any studies that have shown any increased risk for the babies related to different methods of pain control?

Dr. Myra Wick:

No. Well, let me go back. With an epidural, there aren’t really any risks to the baby. We tend to avoid IV narcotic pain medications, especially in the second stage of labor where moms are pushing because we know that those medications cross the placenta, and sometimes the babies can be a little bit sleepy. If the mom has had a lot of narcotic pain medications, and — Angie, I’m sure you’ve probably had some experiences dealing with that situation, taking care of those babies…

Dr. Angela Mattke:

Babies that don’t want to breathe, that doesn’t go well. We like it when they breathe after they’re born!

Dr. Myra Wick:

Yeah, we do, too.

Dr. Angela Mattke:

You mentioned some of the complimentary things to medicine that the midwifery team does, like with water bubbles. Are there any other complimentary alternative medicines that can be really beneficial during labor? I know I’d mentioned essential oils earlier. Is that helpful? There are probably so many things I haven’t even heard of.

Dr. Myra Wick:

Yeah. Some people like the essential oils or scents in the room. Massage is a really a nice way for some people to go. Bouncing on a birthing ball can be really helpful. Sometimes just taking different positions, squatting or moving around the room. Those are ways that people deal with pain. A couple times we’ve had patients use HypnoBirthing. I don’t know a lot about that, but we’ve had some people get through labor with HypnoBirthing, and they are listening to tapes. I certainly don’t have expertise and have not done a lot of reading. But that’s an option that I’ve seen some patients use.

Dr. Angela Mattke:

Well, these are really good medical details to how Nipunie can think about how she’s going to approach pain control during her labor. But I want to shift gears and maybe talk about a little bit more practical advice. What should Nipunie have packed in her go bag? All of a sudden, sometimes we think about labor being super quick and having to get to the hospital. Most of the time with your first baby, it’s not like that. But still having something packed is probably a good idea because you don’t want to end up not having the things you need when you get to the hospital. What do you recommend?

Dr. Myra Wick:

Yeah, a lot of things we actually have in the hospital, so, we have lovely mesh underwear–

Dr. Angela Mattke:

Ooh! Lovely!

Dr. Nipunie Rajapakse:

Excellent!

Dr. Myra Wick:

–that you might want to consider. Birthing and postpartum is messy. There are fluids coming from everywhere. You’ve got bleeding; you might have milk leaking. You might be sweating a lot, so don’t bring your best, fanciest stuff. There are nursing gowns. You can wear those. I would suggest a bathrobe or something for moving around out in the hall if you’re walking around. And, of course, we’ve had less of that with COVID. We aren’t encouraging a lot of walking around the halls. Slippers — hospital floors are not super clean, so some slippers or flip flops or, you know, something to get your feet into and out of quickly. We have the basics of things like toothpaste and those kinds of things, but if there are special things–if you want makeup or special shampoo, bring your own toiletries, if you will. Sometimes women find that comforting too, to have the things that they have at home in their bathroom. You might want to bring a nursing bra and also the shields for your nursing bra. Those are things that you might want to bring along. As far as for the baby, really all you need is that going-home outfit because while the baby’s in the hospital, the hospital usually will have onesies, they’ll swaddle the baby, and there are diapers and there’s formula and donor breast milk. All those things are available. Breast pumps are available in the hospital. And obviously you have to have a car seat. You can’t leave without the baby’s car seat.

Dr. Angela Mattke:

Yeah. We’re in Minnesota and that is a state law–that we have to see the car seat before the baby can leave the hospital, and different states are going to be different, but obviously think about getting a car seat because you’re going to have to get your baby home some way, unless maybe you’re lucky enough to live within walking distance and you’re feeling up to it after delivery; but remember, you might not feel up to walking home after delivery. So, definitely.

Dr. Myra Wick:

Oh, I think another thing: food and snacks. Depending upon the hospital that you’re at, the cafeteria might not be open all night. We used to let delivery people–before COVID–into the hospitals. People would come in with pizzas and whatever, and we’re not doing that now. I think it’s more important to make sure you’ve got some snacks. Usually, the labor and delivery and postpartum area will have some basics, like soup and oatmeal and that kind of thing, but it’s okay to bring your own snacks, too.

Dr. Angela Mattke:

Especially if it’s something you haven’t been able to have during pregnancy, and you’ve been craving it the whole time–treat yourself. Plan ahead. Have that, or have somebody bring it to you. Get your sushi after delivery.

Dr. Nipunie Rajapakse:

Did you have a special post-delivery meal, Angie?

Dr. Angela Mattke:

No, I didn’t. Everyone talked about how hungry they were, and I just wasn’t hungry. I had no appetite, and I think it was just from not sleeping for 72 hours; that probably was the reason why I wasn’t ready to eat. But, you know, I would add one thing. If you’re planning on nursing or breastfeeding, if you have purchased a breastfeeding pillow or support sort of thing before? Ours was maybe a Boppy or something like that. Oh, no. I think mine was “My Brest Friend” or something. I think that’s a game changer, because trying to nurse with the hospital pillows is really, really hard, and you need octopus arms to be able to hold the baby in the right position.

Anything you can do to support that, because they just flail all over and pull their heads off like 95 times while you’re trying to get them to latch. Anything you can do to support that, I think, would be really helpful. I packed some clothes because that made me feel more like a human being after I gave birth — to put on some clothes instead of a hospital gown because I’m always freezing, and hospitals are really, really cold. So I felt warmer.

Dr. Nipunie Rajapakse:

There are some great pregnancy apps out there. I’ve been looking through, and now they’re starting to suggest the list of things to pack. And one of the things they were saying was don’t forget to pack stuff for your partner or whoever’s going be with you as well, because they will also need to stay comfortable.

Dr. Angela Mattke:

Yeah. I didn’t do that. I was already giving birth. I figured he can do that. The guys have to think of something. But I will add, my husband almost missed the birth of our first child because we had no one to take care of our dog. I sent him home to let the dog out. For your fur babies and if you have real babies at home, too, think about who’s going to be taking care of them when you’re laboring and so your partner doesn’t miss the delivery of your child like mine almost did.

Dr. Myra Wick:

Yeah. That’s a great point. A lot of our patients already have fur babies, so they’re going to need care while you’re in the hospital.

Dr. Angela Mattke:

Well thanks Dr. Wick for joining us today. I think this was a great discussion. And you’ll be joining us for more episodes of our pregnancy podcast. In episode six, Dr. Wick is going to join us again, and we are going to go beyond delivery preparation and get into the nitty gritty details that no one tells you about–with topics including vaginal delivery, tearing, episiotomies, and also, I think most important, what your partner should not do if they don’t want to get their head ripped off during delivery. We’re also going to go over questions, including what happens when a vaginal delivery isn’t going well and maybe a C-section is on your horizon — and is a C-section really a big deal? I think sometimes there’s that idea that it’s just going to be easy-peezy, and you’re going to walk out, and it’s no big deal.

And then also most importantly, when I put on my pediatrician hat, I want you to think about what type of screening tests you should be thinking about for your newborn after delivery, as we strongly recommend all of those. Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode, and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and  a pediatrician in the Division of Community Pediatrics and Adolescent Medicine at Mayo Clinic Children’s Center in Rochester, Minnesota.

Nipunie Rajapakse, M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

Myra J. Wick, M.D., Ph.D.

Dr. Wick, medical editor of Mayo Clinic Guide to a Healthy Pregnancy, 2nd Edition, is a specialist in the Department of Obstetrics and Gynecology and the Department of Clinical Genomics. She is also an associate professor at the Mayo Clinic College of Medicine and Science — and a mother of four children. Dr. Wick has particular medical expertise and interest in prenatal genetics and diagnosis.

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