During Rachel Wagner’s first pregnancy, the Federal Hill resident and elementary school teacher was lacking a network of new moms in the area to lean on.

“I didn’t have a group of pregnant friends to ask questions, so I was just Googling things,” she recalls. “I had all of these questions—about delivery, what it will be like to have a human come out of me.”

Three months after her daughter was born, while on an extended leave from teaching, Wagner saw an ad for a free fitness class for moms at the park down the street. Offered by Fit4Mom Baltimore City, a local franchise of a nationwide prenatal and postnatal fitness program, the eight-week course introduced Wagner to physical and mental wellness for new moms—and to the community she had been missing.

“I met my first mom friend who had kids the same age,” she recalls. “Going through that with a group of women was very powerful, and they are still some of my best friends to this day.”

The experience was so powerful, in fact, that in the eight years since, Wagner has become an advocate of the importance of finding a network of women as support throughout every stage of motherhood.

“Once you’ve gone through it, you just become willing to help everyone,” says Wagner, who purchased the Fit4Mom Baltimore City franchise in 2015. One of five franchises in Maryland, Fit4Mom Baltimore City offers six programs, from the prenatal-focused Fit4Baby to Stroller Strides, designed for moms with their kids in tow. “It’s comforting to hear from someone who has already been through it. And us moms are very much trying not to keep any surprises from the pregnant mommas.”

The Baltimore area is home to a wealth of resources for growing families, from top healthcare providers to support for parent and baby before, during, and after birth.

WHAT TO EXPECT: BY TRIMESTER
You’re pregnant. Congratulations! Now what?

Schedule your first doctor’s appointment for week seven or eight of pregnancy, says Dr. Shillena Peters, an obstetrician at the Baltimore Washington Medical Center and a Baltimore Top Doctor. You can start taking prenatal supplements right away, ideally one with iron included, and should stop smoking or drinking alcohol.

“Find a doctor you trust and feel comfortable with,” she says. “This is your pregnancy, you should feel like you enjoy the doctor and get something out of each visit.”

Expecting families should think about the care and delivery experience they envision to decide on the healthcare team they prefer to work with for the delivery (see our sidebar on providers for more info).

At the first appointment, the provider will conduct a sonogram to establish the pregnancy and estimate the anticipated due date. “You get to hear the heartbeat, and it gives them that reassurance that, ‘Yes, I am pregnant,’” Peters says. Additionally, the provider will typically order a blood test, confirm up-to-date vaccinations, and recommend genetic testing to identify any abnormalities.

Peters uses the first appointment to give women an overview of what to expect during the pregnancy, from the frequency of doctors’ visits—every four weeks until about week 26, then every two weeks, and then weekly from week 36 until delivery—to changes in diet.

She recommends writing down any questions you have in between appointments and bringing them with you. That way, Peters says, “when you come to the visit, we can have a discussion about
what is concerning you and you feel like you’re being heard.”

In the first trimester, from weeks one through 12, fatigue and nausea is very normal, Peters says, but tends to resolve itself by weeks 16 to 18. “Hard candy, ginger ale, nausea bands—these are all strategies to help cope with the symptoms until they improve,” Peters says.

Traditionally, finding out the baby’s sex is part of the anatomy sonogram at 18-20 weeks, but some providers, including those through Kaiser Permanente, offer genetic testing at 11-12 weeks that includes finding out the sex of the baby. “Patients love that they are able to find out earlier,” Peters says.

The first trimester is also when parents should begin researching and selecting a pediatrician, Peters adds, since they will need to bring the newborn to its first appointment just days after birth.

The anatomy sonogram is a big milestone in the second trimester, which takes place from weeks 13-26, Peters says. “They get to see the baby in full form with a detailed sonogram and have confirmation of the sex, but also can see the heart, brain, and all the different structures,” she says.

As the baby grows, moms should adjust their caloric intake, too, consuming an additional 300-450 calories daily in the second and third trimesters.

By the third trimester, from weeks 27-40, providers finalize plans for the delivery, including options for pain management or bringing in outside support like a doula, who provides physical relief, emotional support, and mental preparation for the birth journey.

Planning for the birth should be a collaborative process, Peters says, and she encourages patients to have a plan but stay flexible, especially when it comes to decisions like whether to get an epidural, a pain management procedure where a local anesthetic is injected into the space around the spinal nerves in the lower back.

“I tell patients to go in with an open mind—you’ve never been pregnant before or delivered before,” Peters says of pain management. “The anesthesiologists are there, you can ask questions, and they will go over risks and benefits of the epidural, and the decision is up to [the patient] to decide if they want to or not. We support them in terms of whatever they decide.”

Most importantly, Peters emphasizes women should see their doctors as part of their team, and not hesitate to reach out to them with questions or concerns. “We want our patients to trust us because the goal is to have a healthy mom, healthy baby, and safe pregnancy.”

GEARING UP FOR BABY
Where should new parents begin preparing for their baby’s arrival in a $30 billion baby products industry, where new innovations and brands target growing families each year?

“At a boutique like Wee Chic, everyone is an expert,” says owner Bridget Quinn Stickline, who opened the Green Spring Station store 14 years ago. “Not only are they parents themselves, but they are immersed in the product category. They can help to distill options for your needs and dispel myths for first-time parents.”

The diaper pail? “Nobody uses it,” she says of the trash cans designed to lock in diaper odors. It’s one of many products moms are told they need, but often find they don’t use. Another culprit: the wipe warmer. “We never see a second-time mom buying any of them.”

While parents may opt to register for bigger purchases like the car seat or consumables like diapers and wipes at chain stores, it’s worth it to go to a local boutique for clothing, Stickline says, which stocks higher-quality products and has expert staff to help guide new parents.

“Cottons are not made the same,” she says. “You’re going to be washing it very frequently, and the more you wash it, the more it breaks down.” Look for comfortable fabrics that hold up well, especially for the everyday basics.

“Often, we think about it backwards and spend on fun going-out outfits and scrimp on the onesie, but the onesie is going to be washed six times in a week,” she points out. “If the fabric isn’t high quality, it’s going to get pilly, uncomfortable, and scratchy on your baby’s skin.”

While higher-quality fabrics are more expensive, they have a longer lifespan, too, allowing parents to consign or save the pieces to use again for a second baby.

One of the most frequent questions Stickline gets from shoppers is about sizing. “There’s a lot of mental math involved,” she says with a laugh, pointing out that parents should account for seasons and climate as well as the baby’s growth when purchasing clothing. That’s where an experienced sales associate comes in handy.

Parents should expect to get primarily 3-6 month and 6-9 month sizes as gifts, but should stock up on a few newborn (up to 8 pounds) and 0-3 month footies and onesies so they are prepared to come home from the hospital and for the first few weeks.

“They don’t warn you before they grow,” Stickline says. “You go to put that onesie on and it’s like, wait a minute, what happened? It’s nice to have the footie pajamas ready to hop into for the next size range.”

Apparel brands have innovated new closures in recent years, Stickline says, like magnetic closures and two-way zippers that open at the neck and the foot. “It makes dressing and undressing much easier when you have lots of other things you need to manage.”

While online registries and retailers like Amazon offer convenience, shopping in person ensures you’ll get what you expect. “When you do this kind of shopping, having an expert in front of you is really valuable,” she says, cautioning against showrooming, where consumers look at products in a brick-and-mortar but then purchase them from large online retailers. “Spend the extra money, then if something goes wrong you can go back and they can help you.”

Over 14 years, Strickline and her staff support their customers as their families grow. “We meet people pregnant, then they come back with their baby and toddler,” she says. “We get to know them
like family.”

AFTER DELIVERY: THE “FOURTH TRIMESTER”
After the American College of Obstetricians and Gynecologists called for redefining postpartum care in 2018, an increasing number of practitioners are placing increased emphasis on preparing expectant mothers for the time between birth and 12 weeks postpartum, also known as the “fourth trimester.”

“It can be a tumultuous time and it’s an important time to put focus on,” says Eliza C. Gould, a certified nurse midwife (CNM) with Women’s Health Associates, a practice with two physicians and 10 midwives practicing out of St. Joseph’s Medical Center.

“You have just delivered the happy hormone factory called the placenta. There is quite a fluctuation of hormones. Especially for first-time moms, adjusting to a new way of being can be challenging.”

Add to that the physical recovery from delivery, sleep deprivation, and mental and emotional struggles ranging from trouble breastfeeding to postpartum mood swings or depression. “I really encourage communication, both with your partner and with your providers,” Gould says, noting that her practice often brings new moms back for a follow-up appointment two weeks postpartum, although common practice in the industry has been to wait six weeks.

At Indigo Physiotherapy, many of founder Dr. Samantha “Sam” DuFlo’s patients come to her practice during the fourth trimester. DuFlo is a doctor of physical therapy and certified Pelvic Rehabilitation Practitioner. The pelvic floor physical therapy practice advocates for whole-body health and caring for women’s bodies so they can feel good during and after delivery.

“We prep so much for labor and birth,” DuFlo says. “But you’re pregnant for around 40 weeks, you might be in labor for eight hours, and then you have a baby, so really preparing your body and your mind for that transition postpartum is integral—not just preparing for labor.”

While several weeks of pelvic floor physiotherapy is standard postpartum care for women in countries like France, New Zealand, and Ireland, “Our culture has really normalized so much of this as something women just have to deal with—like leaking when you sneeze, having pain, scar tissue, or the ‘mommy tummy’ postpartum,” DuFlo says. “There’s a fine line here—we want body neutrality and acceptance of our body, but also, while those things are very common, they’re all things that can be treated.”

As one of only seven countries that doesn’t mandate any paid maternity leave—the Family Medical Leave Act just requires 12 weeks unpaid leave—there can be cultural pressure to “bounce back” and return to work and other normal activity as soon as possible, DuFlo says.

“If you have surgery, it can take you perhaps a year to recover,” DuFlo says. But, comparatively, most women are cleared to return to normal activity six weeks postpartum. “We’re not always looking at these huge physiological changes that have happened in their abdominals, their hip muscles, their glutes,” she adds. “Getting people back to a physical autonomy where they feel really good in their body and they can do what they want to do, is really important to us at Indigo.”

Our daughter is set to arrive this month and I’m slowly realizing that we are, for real, about to have two kids under two. We’re about as prepared as we can be, and now it’s just a waiting game. I’ve been thinking a lot about the Lou’s birth and trying to remember what we needed, what we forgot, and what our friends brought us that made all the difference.

If you’ve got someone in your life who is expecting, I’ve compiled a list of suggested items to bring over when you meet their progeny. Be mindful that the first few weeks of parenthood are an exhausting, wonderful, confusing fever dream, so keep your visit short and don’t give anything if you’re expecting a thank-you note.

(And if I’m your friend who is expecting and you’re coming to visit us, please bring watermelon popsicles and stay for a while because I will be hopped up on painkillers and in need of a constant rotation of people to talk at.)

Seltzer water:
Before breastfeeding, I didn’t know it was possible to be thirsty while chugging water. When you are someone else’s sole source of nutrients, it feels like someone coated your insides with Scotchguard and you’ll never be sated again. Histrionics aside, when friends showed up with my favorite flavor of La Croix or a few big glass bottles of mineral water, I poured a glass over ice and lemon and felt more like a grown-up human and less like a bathtub drain. Showing up with some “not tap” water is an inexpensive and extremely useful way to make a new mom consider renaming her baby after you.

Food!
During Towson University’s spring 2008 semester, I had the good fortune to fall into platonic love with my best friend Lauren. The relationship paid off in spades when she turned her passion for cooking into a career, thus enabling me to brag about the joys of having a chef close to my heart. After I had Lou, she showed up unannounced with bags of groceries and spent an entire day cooking, packaging the food in Tupperware, cleaning my kitchen, keeping me company, and just generally making me feel happy that I transferred schools and met this culinary fairy godmother.

You can give a similar gift to your new mom friend without all the hard work. Get a few people together to spring for a week of food from Gundalow Gourmet (they’ll tailor the menu to her needs and drop the meals off in pre-portioned Tupperware—it’s amazing). You could also consider a Whole Foods or Uber Eats gift card, or simply call ahead and ask what she’s craving.

Booze!
I really surprised myself and my community by not wanting to drink alcohol until Lou was five or six weeks old. When my typical desire for wine returned, I was grateful to have a few bottles from friends already chilling in the fridge. My husband had popped a few bottles over the course of the first month—it’s not easy for dad’s either—and it was nice for him to have a little stockpile without needing to leave the house. Bring something you know both parents like, and feel good knowing your contribution will be enjoyed at the exact right moment they require some adult time.

Flowers:
This one doesn’t really need an entire paragraph, right? Bring something beautiful for her to look at that doesn’t poop at 3 a.m. or require the use of nipple shields. Bonus points if you toss the flowers in a simple glass vase. Super bonus points if you get up early and create a bouquet from Local Color Flowers’ Saturday morning studio hours.

Diapers, etc.:
This one is for family and close friends. Call the new mama and say, “I am standing in Target/Giant/CVS and I need you to tell me exactly what you need.” It can be really hard to suddenly accept help from every well-meaning person in your life, and telling her that you’re already at the store—and she just needs to say the words—takes away a lot of pressure and guilt.

Hand-me-downs:
It’s difficult to know exactly what your baby will need until you’ve gotten home and realized you really didn’t need that bottle warmer, but could very much benefit from a Rock’n’Play. If you’re a mom of slightly older kids and still have infant supplies in good shape, shoot your friend a text and ask if there’s anything she opted not to buy that you could drop off. We were foolish enough to think that we didn’t need a bassinet—I think we assumed Lou would sleep in his nursery even though I couldn’t stand up unassisted the first two weeks. So friend generously lent us hers. She saved us money and time, and gave us the added gift of getting to swap early parenting stories with someone who knew what we were going through.

If more kids are in your future, make sure to indicate you’d like it back. If not, it’s okay to tell your friend that it’s hers to pass on to the next mom, or to donate when she’s finished with it.

Something for the other kid:
You can opt to bring a small present for the newly displaced child instead of continuing the gift parade for the mom and baby. Crayons and a roll of brown paper (we recently taped brown paper to the entire surface of our coffee table and Lou has never been happier and we’ve never had more free time), dolls, sticker books, or Magna-Tiles are all good gifts for younger kids. For older kids, a $20 Amazon gift card gives them the freedom to pick something themselves and requires the attention of a parent to help make the purchase (which is what they really want anyway). Anything to make that transition to newfound sibling-hood all the easier.

To my beautiful boy:

Your world is about to be rocked. In less than two months, your sister will arrive and your only child status will vanish, and I won’t pretend it will be easy. You will have spent 22 months as the absolute center of our universe, and starting sometime in mid-September you will spend the rest of your life sharing that space. 

I don’t know how much you comprehend what is about to happen. Thanks to the Spanish your incredible nanny has taught you, one of your first words was “hermana.” Most mornings you pull my shirt up and offer hermana a kiss. Some mornings you offer her a spoonful of your yogurt and the ease with which you are willing to share makes heart feel like it has wings. Occasionally (and always in public), you’ll walk over to me and pull my dress up so everyone else can see your sister. Because my bump is enormous and I don’t always see you coming, I’d say about a quarter of the city has seen my underwear now, so thank you for that.

Your attention to my bump makes me think you have some idea of what’s to come, but you’re so little that we can’t really explain it. And even if you were older, I wouldn’t know how to tell you the million small ways things are about to change. Because a lot of our friends don’t have kids yet, you’re used to having the undivided attention of almost every adult you meet. I don’t think you’ve ever been denied a story when you grab book and back into the lap of whoever is sitting closest to you. 

We spent so many hours pouring over your 100 First Trucks picture book that while you can’t say your own name, you correctly identify and pronounce police cars, bulldozers, and tractors. Every week (and entirely unsolicited), you present your nails to be clipped like a well-trained poodle, and once the task is complete to your satisfaction you choose a temporary tattoo as a reward for your manicure. (Don’t worry—they’re made from vegetable-based dye and rarely feature naked ladies.) At night your dada gives you long, bubbly baths and then all three of us read books together, and, while you fall asleep in your crib, I rub your cheeks and hair and tell you all about the day we just had.

This fairytale, my friend, is about to change.

It took nearly two years to conceive you—and another 41 weeks after that to meet you—so, when you finally arrived, we were ready. You had been our shared, constant thought for so long that your arrival felt like we’d picked up a dear friend from the airport. (The world’s most painful, horrifying airport, but you can appreciate the metaphor.) Your sister, however, was standing impatiently in the wings, tapping her tiny toe, waiting for us to be ready for her. It still took some help from science, but her conception took exactly one month and my pregnancy has flown by. Because we were expecting another battle with fertility, I’m not sure your dad or I fully believe our luck yet, but here we are just a few weeks from meeting our baby girl.

I want to tell you that I’m so sorry that we’re shaking things up. We’ve got a good thing going, us three, and now some chick who is in the process of ruining my belly button is about to burst onto the scene. I’m sorry for the growing pains we’re all going to feel adjusting to being a family of four, and I’m sorry that you didn’t get a say in this decision. 

But, my love, I also want to tell you you’re welcome. I think once the shock wears off and we’re in a groove, you’re going to be so happy. You will have someone to talk to in the back seat of the car; someone to read your Spot books to; someone to roll your eyes with when you figure out how embarrassing your dad and mom are. You and your sister will challenge each other, fight each other, make each other laugh, and love each other and you’ll both be better people for it. I’m so excited and proud to watch you become a big brother, and I hope very much that you treat your sister with at least as much dignity and respect as you treat our cats.

I love you more than I’ll ever know how to show, Mama

(And Dada. I’m assuming he feels similarly.)

Greetings from me and the tiny human I’m currently growing in my uterus! Rob, Lou, and I are very excited to welcome a lady baby to our family in September. We don’t know a lot about her yet except that she’s healthy, looks exactly like her brother in her sonogram, and might be part hummingbird because I can’t stop eating sugar. 

I expected this pregnancy to be easier since I’ve done this before, and have been very surprised to learn that being two years older and having a toddler aren’t two factors that lead to a calm, enjoyable pregnancy. If you live in my house or work in close proximity to me, you’re well aware of my near-constant whining. If you don’t number among these unfortunate people, here’s a look at how different my experiences have been, for better or worse. 

I am tired all the time.
When I am pregnant, I don’t sleep. I spend my days in a yawn-filled fog, trudge through my evenings, get an ice cream-related second wind right after Lou’s bedtime, sleep for a few hours, and then find myself awake from 1-5 a.m. Rinse, repeat.

This was frustrating during my first pregnancy, but I wasn’t working a full 9-5 then, nor did I have a toddler, so I was able to rest or nap some mornings. This round, I am accountable as an employee all day and a mama all of the time—and I’m pretty damn tired. I’ve taken to sleeping on the couch a lot because the stress of waking up Rob and Lou compounded with my eventual desire to stare at something on Netflix has led me there.

In the mornings, I wake up to Rob and Lou making breakfast, which is lovely, but I secretly resent their cheerfulness from my nest on the couch. The only saving grace of this new sleep situation is that I am in repose at exactly at Lou-height, so each morning I’m greeting with a new offering. Last week I received an open mouth kiss, a dinosaur toy, and “MAMA!” screamed an inch from my face. This week he stepped things up and brought an open bag of coffee beans and held it near my nose to smell, which was so dear that I had tears in my eyes and felt momentarily grateful that months of insomnia had led to this moment. I might have Stockholm Syndrome.

Deflated interest from strangers.
During both pregnancies, the question most asked was, “Awwww, is this your first?” When it was my first pregnancy, I would blush in the glow of impending motherhood and unknowingly give the people what they wanted: a brand new mama. Now when people ask (after I get over being flattered that they think I could possibly look rested enough to not currently have a toddler at home), I tell them it’s my second and the conversation ends and I feel like I’ve let them down. Are subsequent babies less exciting? I mean I’m pretty excited about it. 

There is less stuff to buy.
We sat down to make a list of what we need for this kid, and it turns out we already have most of it. We’re buying a bassinet because not having one during my C-Section recovery was brutal; we’re looking into whether or not a double stroller is a sound investment for our city kids; we need to fill in a few gaps in her wardrobe of Lou hand-me-downs—and that’s kind of it. A far cry from the frenzied shopping spree we went on after months of research during my first pregnancy.  

I’m a little worried about having so little to do or buy in the final weeks of my pregnancy when nesting kicks in, but once this kid is out and snuggled up in her brother’s arsenal of long-ago paid for infant-ware, I think I’ll be okay.

I have more anxiety about the birth.
Lou’s birth was not pleasant. I was induced a week after my due date, labored for well over 30 hours, and ended up with a C-Section. His heart rate was decelerating after contractions, which meant I needed an oxygen mask the entire time leading up to the surgery. And, after breaking my water some time in the middle of the night, we discovered Lou had been floating in meconium (Google it if you’re unaware), which added a lot more stress to the situation. 

This time, unless I go into labor on my own, my doctors are planning for a scheduled C-Section, which is terrifying me. I agree that it’s probably the best course of action given what went down the first time, but it’s giving me anxiety to kind of know already that I’ll be having major surgery—while awake—some time in September. I very much liked the not-knowing of Lou’s birth. We made each decision as the situation unfolded and I didn’t have time to panic—we just made a call with the doctors and then did that thing.

Having long-lead information about the impending birth is not very suitable for my personality. A very badass friend of mine is finishing the nurse anesthetist program at Georgetown and every time I see her I ruin her precious free time with questions about work. I ask for specific, step-by-step details on epidurals and spinals. With absolutely no medical knowledge backing me up whatsoever, I throw out doomsday scenarios and she patiently explains why what I just asked is impossible. I have even suggested she swing by while I’m getting my spinal just to talk me through it (and keep an eye on the doctor), which is beyond crazy.

Despite my unrelenting whining, I constantly forget I’m pregnant.

Multiple times a day, I’ll be in a meeting or in my sofa nest and think, “Oh no, one of my organs is twitching.” And it doesn’t always occur to me right away that the “twitch” is the miracle of life forming just behind my belly button. Or I’ll find myself totally winded after storming up a hill on my walk home from work and wonder why I’m gasping for air. Or I’ll wake up flat on my back and not be sure why I feel panicked and nauseous until I remember a human is crushing an artery in my body and I need to roll over immediately. Or I’ll get dressed in the morning and genuinely wonder when I put on so much weight.  

I’m going to assume this unbelievable aloofness is related to my lack of sleep. But if you see me perusing crop tops at Forever 21 at the Gallery some time this summer, please gently lead me out of the store while explaining the physics of baby bumps.

Kate Ansari was 14 weeks pregnant with her first child when she was diagnosed with thyroid cancer. Following her son Mclaren’s birth—and her own surgery, hormone replacement therapy, and six-month recovery period—she eventually quit her job as a FOX 45 morning show executive producer to become a full-time mom and try to lead a more natural lifestyle.

She soon recognized the need for completely natural products for young children and expectant or new mothers that were free of parabens, dyes, artificial fragrances, and preservatives. She enlisted the help of her sister Emily Derr, and, after some trial and error, Dear Baby Products was born in March of 2014.

The sisters sold a small roster of items at local farmers’ markets in Howard County, as well as online. They saw an immediate response. In particular, the farmers’ markets served as a great outlet to get to know their market directly. While scanning message boards on websites like whattoexpect.com, Ansari also noticed that many pregnant women were looking for a variety of products that weren’t available in a pregnancy-safe form.

“There are all of these do’s and don’ts with pregnancy, so we wanted to create [a product-line] where you can buy anything from our store and feel good about using it,” Ansari explains.

They also realized that the need for Dear Baby Products is not exclusive to babies and pregnant women.

“Really, the ingredients we use are perfectly fine for anybody and a lot of things can double as an adult product,” says Ansari.

For example, the company’s diaper rash treatment, also known as “bottom paste,” is great for eczema, and the baby powder moonlights as a dry shampoo.

As the demand grew, so did their busy schedules. Both sisters are getting their MBAs online—Ansari at Carnegie Mellon and Derr at University of North Carolina at Chapel Hill. Ansari, who is in remission, now has two young children and Derr has a full-time job in finance.

Juggling their careers, schoolwork, and family can be a bit challenging, especially since all their products are handmade in Ansari’s Fulton kitchen. But Ansari’s and Derr’s hard work is paying off, with Dear Baby now being sold at Whole Foods, on Etsy, and in boutiques all over the country.

And the sisters are prepared to grow and are confident about their future. “When life gives you lemons—you don’t have to settle for lemonade. You make lotion and launch a business.”

My husband Rob and I tend to do things all at once. We thought our affinity for semi-controlled chaos hit its peak three years ago when, in the course of ten months, we got engaged, planned a wedding, sold our house, bought a new one, moved, had the first floor renovated from a condemned former pharmacy into a living space, and then got married. I’m choosing to look at it as poetic that three years later, in the exact same January to October timeline, we’ve put massive home-improvement projects on our plate while preparing for a baby and dealing with my pregnancy. At 32 weeks, we had our roof repaired and re-tarred, and now, at 36 weeks, we’re building a new bedroom on our third floor so we can clear out the guest room for the nursery.

And while these upgrades are needed and it’s an exciting time, I’m sort of stuck—I’m experiencing the late third-trimester urge to nest, but my nest is currently a construction staging zone. After freaking out and then wallowing in our lack of preparedness, I decided to redirect my energy. And that is why my soon-to-be family of three will have the most kick-ass hospital bags any maternity ward has ever seen.

I’ve spent hours researching and cross-referencing blogs and baby sites, and then hours more online and in shops around town. I’ve imagined many different birth scenarios and used these to evaluate the usefulness of each packed item. In making this list, I’ve also realized that I am in total denial about what is going to happen to me in the hospital, so I hope that if you’re reading this and you’ve given birth, you’ll be kind to my Pollyanna packing attitude. My fear of giving birth has buried itself deep within and given rise to uncharacteristic optimism, so parts of this list read more like I’m prepping for a long layover in an airport, and not like I’m going to be cursing up a storm in a Catholic hospital.

For Me

Bag: Everlane

Robe/gown: Please know that I’m aware of the insanity in packing both a robe and the “birthing gown” I ordered off Etsy in a moment of sleepless vanity. Both purchases were cheap and made with the understanding that we may only know one another for the hours spent in Mercy’s maternity ward, but there is something very satisfying to my demented mind that I will have the option of a mid-labor costume change.

Slippers: Again, a cheap Target purchase, but this $7 investment means I’ll have warm toes and a layer of protection between me and floors that have most definitely seen some stuff my feet don’t need to know about.

Nursing bra: My nursing bras will pull double duty on the big day. I found a super comfortable sports bra/nursing bra hybrid, and one will be worn during labor and one will be worn post labor. Mine were purchased off Amazon, but I’ve seen great variations at Bare Necessities and, of course, Target.

Misc: Chapstick, sugar-free mints, Trader Joes electrolyte water, and purple Gatorade are apparently the only comforts I will be allowed during this process, so I have stocked up.

For Rob

Bag: From local company Treason Toting Co.

Overnight stuff: Toothbrushes, toothpaste, hair ties, shampoo/conditioner/face wash, make up (I mean, reach for the stars, right?), deodorant, and lotion. There’s no shame in wanting your familiar smells.

Lint roller: We are filthy humans who are outnumbered by cats in our home and I refuse to be distracted by a cat hair on my spouse or me while I’m bringing life into this world. I just will not have it.

Pillows: I bought two pillows for $4 each at target, and covered them with the oldest, rattiest pillow cases I could find. This way, Rob will have something comfortable to take a nap on until my disdain for being alone takes over and I wake him up to hang out with me/share his pillow.

Snacks: Rob will be delighted to find some snacks in his bag, but he will be cautioned to eat them out of sight and to brush his teeth with his (also lovingly packed) toothbrush before returning to me, as I am an unfriendly, godless heathen when I’m hungry. Somewhere deep down, I will find a way to be happy that Rob has pretzel chips, Kinderhook cookies, and trail mix to keep his energy up.

Misc: Deck of cards, laptop, Kindle, phone chargers, and camera. The only thing worse than being around me when I’m hungry is being around me when I have no activities.

For the Baby

Bag: Nat and Matt from Trohv

Going-home outfit: A tiny hat and a warm going home outfit, which will be simple, footed pajamas. (Unless the paparazzi get wind of our departure, in which case I’ll pack something from the North West for the Upwardly Mobile Infant collection.)

Mittens: So he can keep his little paws warm and not scratch his face

Swaddling blanket: Because I hear you should always have one around as they are endlessly useful

Properly installed car seat: It’s the law and I’d like the hospital to let us take our baby home with us.

The day I found out I was, for sure, pregnant, I took the doctor’s call from the ladies room at the Four Seasons spa. My husband and I had booked a codependent couple’s massage, which was followed by some independent hot tub soaking and sauna-ing. We weren’t big spa people, but it was a Valentine’s Day/winter sucks/let’s take a personal day indulgence, and, had it not ended in me panicking about what a horrible mother I already was for exposing my three week old cell cluster to five minutes in a 90-degree pool, it would have been very relaxing.

I spooked myself enough to swear off spa treatments, but then some kind people gave me a gift card for a prenatal massage as a thank you present, and my interest was reignited.

Because this is my first pregnancy and I’m nervous about almost everything, I wanted to find out more about the safety, benefits, and red flags of spa-ing. And because I now write this blog, I had the perfect, non-crazy-sounding excuse to ask some experts to sit down with me and explain a few things. Two lovely women at Hampden’s Charm City Skin, Shannon and Camille, took some time to walk me through the prenatal waxing and massage experience.

First up is waxing. I have shied away from booking an appointment because, frankly, having my hair ripped out with hot wax while also uncomfortably pregnant sounded terrible, but I’ve since changed my tune. Shannon, an esthetician, admits waxing will be slightly more painful due to increased blood volume and sensitivity, but letting a professional handle your hair removal is the safer option. The bigger the bump gets, the harder it becomes to shave. Women are at a higher risk of slipping (I almost bit it in the shower trying to reach my ankle recently) and of cutting themselves. And if the pain is keeping you from tidying things up below the belt, consider a modified wax. There’s no shame in putting a hold on the Brazilian and opting for the bikini for now.

Shannon also stressed the importance of both sanity and sanitation when considering spa treatments during pregnancy. Women tend to see these treatments strictly as an indulgence, but making the time to take care of yourself and your appearance can have a great effect on mood and outlook. She also advises relying on common sense and feeling comfortable speaking up if you have concerns. If you see the esthetician “double dip” the stick, then you should leave. And this doesn’t just apply to pregnant women. Incubating a human shouldn’t be the only reason you feel comfortable advocating for yourself if you see something fishy.

Armed with a degree in Wax Safety 101, I headed upstairs for a prenatal massage with Camille. I feel I should disclose that my chat with her took place after my 70-minute massage, so there’s a chance that she didn’t actually say any of the things I’m about to share. I was a loose, gooey, vaguely human form, capable only of taking sips of lemon water and realizing I’d made my voice match the low lighting. (I believe this liquidity is the standard to which all people should hold their post-massage experience.)

According to my notes, which I appear to have scrawled with my left hand while blindfolded, Camille’s expertise is assisting women through pregnancy, childbirth, and post partum. She’s not only a massage therapist—she’s also a doula who can massage you while you’re in labor. (I recall being blown away by this. In fact, I wrote, “How can this be real?”) Her prenatal massage advice mirrored that of Shannon’s: Use common sense, speak up if you’re uncomfortable with anything, and treat the experience less as an indulgence and more as an investment in sanity.

What interested me most was her post-natal advice. Women spend their pregnancies gearing up for the big event, and, once the baby arrives, they tend to forget about themselves. Obviously, the eight-pound human you just birthed needs as much attention and love as you can give, but moms need to remember to take care of themselves, too. Massage can have incredible benefits for post-partum women. It can help with pain management, reduce swelling, encourage milk production, promote better sleeping patterns, and, obviously, provide overall relaxation. Plus, I have to imagine that getting out of the house for an hour does wonders for your sanity. It won’t be easy, but mamas have to keep their head above water somehow.

Pregnancy spa experiences can be expensive, but are worth consideration as you’re budgeting. My rationalization—other than the benefits for the baby and me—is that I’m re-energizing Baltimore’s economy. The money we used to spend at bars and restaurants has been burning a hole in our savings account, and it’s time we released it back into the wild. And if that means I have to lie in a bed of pillows while someone forces me to relax, so be it.

When I discovered I was pregnant, I assumed that my body would suffer, but certainly not my mind. Not this brain, that averages a book a week and can solve an easy crossword puzzle, and has never lost to my husband in Scattergories. (He doesn’t think that’s worth bragging about, either.) But then, there I was, three months pregnant, blinking at baristas when I couldn’t remember “decaf iced Americano, please” and dreading deadlines because whatever part of me used to write with ease had rededicated itself to the creation of life.

Finding out that the brain starts to jam up even before the kid is out was . . . alarming. And responsible, in part, for why it took me so long to figure out how to navigate being a pregnant lady in this city. My millenial sensibilities assumed some fecund hipster enclave would spot my bump at a coffee shop and welcome me into their group. They’d know all the best studios for pregnancy yoga and have a shared Google doc with thoughts on doulas vs.midwives, Lamaze vs. All the Drugs, and which organic vitamin shops carried prenatal vitamins with DHA.

If they’re out there, they never found me.

And so I had to create my own little network to figure things out. I even had to pick up the phone and call a few places. It turns out that most people love pregnant ladies, and were happy to help. This came as a surprise to me because I generally don’t like people—much less two people in one—but, fortunately, I’m the minority.

Here are a few things I’ve learned in my 21 weeks of gestation, either from asking people who know better, or from assuming I know best and then being shocked when I’m proved wrong.

Some yoga studios have pregnancy yoga, and some say they do on their sites, but actually do not. For us city gals, Charm City Yoga has it on Wednesday nights and Sunday afternoons in Midtown, and Thursdays after work in Fells Point. Classes are also offered in the Towson, Pikesville, and Severna Park studios, but I’m not sure I love my kid enough yet to fight 97 traffic to make it down there.

I learned from the gal at Whole Foods and from my mother-in-law that you want to look for vitamins with the least extra ingredients, and that DHA is a supplement not often found in traditional prenatals, so you have to take it separately. Try Rainbow Light brand from the Vitamin Shoppe in Canton, and Spectrum DHA from Whole Foods. I also learned from my own gag reflex that I was not built to swallow pills the size of June bugs, so I crush mine up and eat it with low fat Greek yogurt. Except I really eat them with ice cream.

I’ve learned that 99-percent of hospitals offer birth classes where you and your partner can go sit in horror in the name of education and self-advocacy. Given its proximity to our home and its en-suite hot tub situation, we’re going to Mercy for the blessed event, so it made sense to also take our birth classes there. If you’re planning a home birth or want a more alternative option, check out Informed Birth Choices in Catonsville. Apparently these living nightmares are super popular, so ask your doctor early on when and where you should sign up and if the instructors provide fainting couches or if you should bring your own.

These classes are also a good opportunity to meet other expectant parents. This is important, because you need pregnant friends. Non-pregnants quickly grow weary of talking stretch-mark cream and exhaustion, but pregnant people will be delighted to hear, again, about how hormonal you felt yesterday. I assumed I’d make friends at yoga, but it turns out it’s more about fishtail-braided top knots and concentrating on goddess pose and less about forming a sisterhood of traveling yoga pants. So get to know your hospital, find out what’s going to come out of you, and then make some buddies.

And finally, so far, I’ve learned that a pregnant lady without a snack is like a Real Housewives reunion episode: Someone is getting slapped. Always, always have something within arm’s reach to eat. I’ve found that apples and bananas fit nicely in my purse, and bananas get bonus points for coming in their own adorably speckled case. The day will come when you leave the house without a snack, and that will be the day you run out of gas in a field or get stuck in a meeting with your boss that won’t end. Your blood sugar levels will plummet, and you’ll shrivel up to conserve energy while relying on your memory of food to float you until your next meal.

Just pack a damn snack. It’s good practice for when that person you’re growing becomes a toddler, anyway.

Megan Isennock is a freelance writer and content producer for Shine Creative. Her baby boy is due in October.

On a far-from-tropical January day, Kristen Vanneman-Gooding sits
under a poster of a palm tree in the waiting room of her obstetrician’s
office at the Greater Baltimore Medical Center (GBMC). It is exactly a
week to the day before her scheduled cesarean section, and she is
filled with anticipation. This delivery, she suspects—and hopes—will be
entirely different from her last one.

Five years ago, a pregnant
Vanneman-Gooding came for a routine visit to this very office.
Vanneman-Gooding had stopped in for a checkup of her as-yet-unborn
identical twin boys—conceived through in-vitro fertilization—from Dr.
Claire Weitz, head of GBMC’s Division of Maternal and Fetal Medicine.

The
pregnancy was a troubled one from the start. At 18 weeks, an
ultrasound had shown that the twins were together in an amniotic sac
without a dividing membrane, a condition that is often fatal for one or
both fetuses. “Claire said there was a 50-50 chance that either one or
both would not make it,” says Vanneman-Gooding.

But in the weeks
to come, she and her husband, Ira Gooding, breathed a sigh of relief
when a follow-up ultrasound showed that there were, in fact, two sacs.
Several
weeks later, there was more cause for concern: The twins were
suffering from a “growth discordance,” in which one fetus was
significantly larger than the other. So—as is standard for most twin
pregnancies—Weitz put Vanneman-Gooding under “house arrest” to ensure a
healthy delivery for both fetuses. (“I watched a lot of L.A. Law
reruns,” she recalls.)

Months later, during another ultrasound,
there was more worrisome news: the black-and-white images showed that
one of the fetuses was sluggish. Asked to return the next day to verify
the findings, Vanneman-Gooding did; when the results were the same,
Vanneman-Gooding remembers Dr. Weitz saying, “We’re going to take them
today.”

“We didn’t even have a camera,” Vanneman-Gooding says. “It
was a whirlwind—it was just a matter of fifteen minutes between being
in Claire’s office on the fourth floor, walking down the hall, and
being in the operating room for the C-section.”

Today, those
twins—Duncan and Finnigan, both born the same size—are healthy, happy
preschoolers. And although she suffered a miscarriage several months
before her current pregnancy, Vanneman-Gooding—an assistant teacher at
Lutherville’s Havenwood Preschool Center and part-time office manager
at State Farm Insurance—is relieved that this pregnancy has been so
simple.

“I’ve been able to enjoy this pregnancy more than I did with
the boys,” says Vanneman-Gooding—who herself was born at GBMC 32 years
ago. “I’m so much more relaxed, and knowing what to expect at delivery
time is a load off my mind—I’m not nervous about the surgery. I’m more
concerned about what to pack in my hospital bag.”

It’s hard to believe that as recently as 1930, delivering a child was
the single most dangerous event in a woman’s life: One out of 150
pregnancies ended in the death of the mother (most births occurred at
home).

In the 21st century, standardization of practice—from the
presence of fetal heart monitors (100 percent of the time at GBMC) to
advances in anesthesiology (used by about 85 percent of maternity
patients at GBMC) to the prevalence of pitocin (a synthetic hormone
used to speed up labor) and intravenous fluids—has made giving birth
very safe. In 2003, there were 12.1 deaths per 100,000 live births in
the U.S.; that’s about the same mortality rate as that of women with
lung cancer.

“In terms of the safety of the mother, this is probably
the best it has ever been,” says anesthesiologist Jonathan Hamburger, a
partner of Physician’s Anesthesia Associates, whose group provides all
anesthesia services to GBMC. The constant screening of
Vanneman-Gooding’s first pregnancy is just one example of how
improvements help both mothers and infants.

More babies are
delivered at GBMC than any other hospital in Central Maryland: some
4,500 newborns begin their lives at the hospital each year. (In 2006,
Johns Hopkins Hospital and University of Maryland Medical Center
delivered 3,290 babies combined.)
In the past five years alone,
GBMC has delivered more than 22,200 bundles of joy. The hospital has
been the delivery destination of people from all walks of life in the
region, including former First Lady Kendel Ehrlich. Some satisfied
customers even commute from other states—Kensy Boulware, wife of former
Ravens linebacker Peter Boulware, traveled from Tallahassee, Florida
to deliver the couple’s third child at GBMC last fall.

Ever since
its founding in September of 1965, GBMC (which merged with The Hospital
for The Women of Maryland in Baltimore City and The Presbyterian Eye,
Ear and Throat Charity Hospital) has been known for its outstanding
obstetrical department. In recent years, GBMC has become known around
town as “The Baby Hospital” or “The Baby Factory” for good reason.
Despite the fact that there are numerous other prestigious area
hospitals delivering plenty of babies, GBMC—in the wooded, tony suburbs
of Baltimore—has become a leader for women’s healthcare.

The
physical plant of the 106-acre hospital campus perches atop a swell of
land off of Charles Street; the tranquil campus is often called “The
Hilton on the Hill.” And if the hospital as a whole is the Hilton, the
second floor primarily dedicated to maternal and newborn services, is
the concierge level. In the obstetrics lobby and admitting area, a
hospital volunteer tickles the ivories on a Yamaha piano to soothe the
nerves of anxious family members. The 17 state-of-the-art labor,
delivery, and recovery rooms, known as LDRs, are currently under
renovation—they’ll be redone in a tasteful green and beige palette, and
will feature bamboo flooring.

They’re also thoroughly modern rooms.
There will be wireless internet service (some mothers have been known
to log on to their e-mail servers or check their BlackBerries while
dilating); handy desks to set up and recharge cell phones, laptops, and
other gadgets; and plasma HDTVs. The 48-bed postpartum unit, with
private rooms and a dedicated 11-bed high-risk obstetrics unit, is
adorned in soft soothing colors and floral fabrics.

Since 2000, GBMC
has invested approximately $9.9 million in labor and delivery room
renovations, neo-natal intensive care units, and state-of-the-art
equipment. Cracks Dr. Weitz, who has two grown children: “When I took
the first tour, I said, ‘Gee, it’s almost enough to make me have
another baby.’ I’ve been to other hospitals, and this is about as good
as it gets.”

And the amenities don’t stop there. The Lactation
Station retail store is the only one of its kind on a hospital campus
in Baltimore, and sells everything from fashionable nursing shirts to
breast pumps and nursing pillows. Lactation experts have also set up a
breastfeeding information “Warm Line,” open seven days a week from 6
a.m. to 10 p.m. The Warm Line is headed up by lactation consultant
Marla Newmark, who nursed 12 of her own children (she has 11 surviving
kids).

Additional maternity services through GBMC Boutique include
an on-staff aesthetician who visits the maternity ward to provide
things like hair cuts, manicures, pedicures, and facials; parent
education classes; and doula (or birthing coach) services.

The
official acceptance of doulas—women who provide emotional and physical
support to expectant mothers—by a staid, suburban hospital like GBMC was
a big step for both sides.

“GBMC is known as a traditional
hospital,” says Lanny Dowell, doula coordinator. “It has been
interesting to introduce an age-old concept to new and modern medicine.
A lot of doulas were worried about how the staff at GBMC was going to
take it. Did they think we were going to be dressed in old field garb
and doing voodoo?”

Far from it. “We are known as the Ann Taylor and
Talbot’s doulas,” says Dowell, looking very much the part in a pair of
classic winter-white trousers, black mules, and tasteful top. “We are
trying to merge the two images. We are not this cloaky person in labor
and delivery with heavy incense. Our goal has been to soften and change
the idea of the doula.” The list of doula services—from acupressure to
massage—sounds more like a luxe spa’s offerings than tasks handled by a
birthing coach. GBMC doulas also offer postpartum services, from meal
preparation to infant care to light housekeeping—and even carpooling
older kids to school, should the need arise.

In short, sums up
Victor Khouzami, Chairman of the Department of Obstetrics, “At GBMC,
there is a dedication to obstetrics at every level. This is a maternity
hospital within a general hospital.”

Says Susan Bowen, Clinical
Director of Labor and Delivery, “I joke with Dr. Khouzami that we
should secede from the Union and build our own hospital.”
In some
ways, that’s what’s happened: GBMC’s decision to pour resources into
becoming a major obstetrics center has paid off. Year after year, GBMC
has racked up awards, including a coveted ranking in U.S. News &
World Report’s “America’s Best Hospitals” in 1997 and 2001 for
gynecology, “Best Maternity Hospital” by the readers of Maryland Family
Magazine every year from 2002 through 2006, number one in Obstetrics in
the Central Maryland Region by Maryland Hospital Association every year
between 1995 and 2002, and one of the top 10 maternity hospitals in
the U.S. by Child Magazine (1995). GBMC also has many other claims to
fame, including the first birthing rooms in the state (1978), the first
peri-natal center in Baltimore County (1985), the establishment of the
first Lactation Department in the Baltimore area (1989), and the first
robot-assisted gynecologic surgery at a community hospital in the
mid-Atlantic (2006).

All those awards are not exactly what Ira Gooding is thinking about
as he sits on a blue plastic chair in the hallway outside Delivery Room
1 on the second floor of GBMC.

It’s one week after Kristen
Vanneman-Gooding’s visit to Weitz’s office, and Ira Gooding is dressed
head to toe in disposable navy blue scrubs, and clutches a camera.

“I’m
more relaxed this time,” says Gooding, an Open Courseware Coordinator
at the Johns Hopkins School of Public Health, “but I want to get in
there and for everything to go well.”

Minutes later, Ira is perched
on a leather stool within a foot of his wife’s head and several feet
away from where his daughter is about to be born. At 66 degrees, the
inside of the operating room feels as cold as the January day outside
(it’s kept cool to prevent germs and bacteria from flourishing).
Vanneman-Gooding is draped in warming blankets, and wears a surgical
cap that brings out the blue in her eyes. Weitz; her first assisting
physician, Dr. Margaret Cyzeski; and a scrub technician congregate
around Vanneman-Gooding’s midsection.

The anesthesiologist, Dr.
Stanislav Malov, tends to the monitors near her head. A circulating
nurse and neo-natal intensive care unit team are on standby.
The
540-watt prism halogen surgical lights flood the room, intensifying the
green of the doctors’ gowns, the silver steel storage cabinets, and
the ruby red blood that blossoms on Vanneman-Gooding’s skin as Weitz
makes her first incision through the skin with a number-10 scalpel.

Obstetrical devices have come a long way, both scientifically and
culturally. In the 17th century, when obstetrical forceps were invented
by Peter Chamberlen, the innovative instrument was such a closely
guarded secret that it was used only when a laboring woman was
blindfolded.

Other primitive practices in the 1940’s through 60’s
included putting women in a “twilight sleep” through a potent cocktail
of morphine and a powerful amnesia-inducing drug called scopolamine.
Freed of their inhibitions—but not their pain—thrashing women were
often strapped to gurneys to keep from hurting themselves. “It was such
a powerful amnesiac, some patients would wake up the next day and not
even know if they had a boy or a girl,” says Hamburger.
“Patients
would run down the hallway stark naked,” recalls Khouzami, who joined
the GBMC staff in 1981 as head of the Division of Maternal Female
Medicine.

Modern obstetrics was still in its infancy (so to speak)
when GBMC opened its doors in September 1965. In the 60’s and 70’s,
recalls Khouzami, “We had labor rooms, delivery rooms, and recovery
rooms. The woman delivered in the labor room with no family or support
services, and she pushed the baby out for hours, and then the baby was
taken to the nursery, and [the mother] was taken to the recovery room
where maybe someone would visit. It was very, very [impersonal].”

“The
husband dropped you off at the door of the labor room,” recalls Bonnie
Lauryssens, a retired nurse practitioner who worked labor and delivery
at GBMC from early 1966 through 2005. “Ashtrays were all in the labor
rooms, doctors would walk in smoking, and women smoked while they
labored. You had to pull bars up the bed because the anesthesia made
them thrash and try to climb out of bed. It all seemed so normal—this
was what we knew.”

Women had no say in the birthing process either.
“There was [a] paternalistic attitude,” recalls Khouzami. “The attitude
was ‘You do it because I know what’s best for you.'”

By the
mid-70’s, as more Americans began to question the status quo on much
conventional wisdom, “Families started to demand to share and have
greater participation in the delivery,” remembers Khouzami. “They said,
‘Don’t shut us out,'” and GBMC was the first hospital in Maryland to
respond to these needs. “We opened the first birthing rooms in the
state of Maryland in 1978, and we included fathers in the process.”

By
the early 80’s, birthing centers—where women delivered through the
help of a midwife and in the absence of a doctor—had sprung up around
Baltimore. GBMC added them and tried to provide families with both the
warm, nurturing feeling they would get in a birthing center and the
technology and backup staff found in a hospital setting. “That’s how we
started changing our thinking to, ‘pregnancy as a natural process,'”
says Khouzami, “and we shouldn’t be intrusive, but we should be there,
should an emergency arise.”

Another trend in the mid-70’s was a
shortened length of stay for mother and child. “It got to the point
where the woman had a baby, took a shower, and went home,” says
Khouzami. “The length of stay kept dwindling.” By the 1990’s, the
average length of stay was 1.7 days.

“There was pressure put on me,”
Khouzami says, “because we thought we were going to go down to 12
hours [from admission to release]. I said ‘Over my dead body. It’s
going to swing back.'”

It did, in 1995: Maryland was one of the
first states to mandate a 48-hour length of stay before the practice
became a federal law under President Clinton.
And then there was the
liberal open-door policy for visiting family members in the LDR. “We
went from having no one in the room in the 70’s, to having to put a
limitation on how many people could get into the room,” says Khouzami.
“By the 90’s, it started to get crowded—I remember one delivery in
which there were twelve people in the room.”

Recalls Lauryssens,
“There were mothers-in-law, fathers-in-law, brothers, sisters,
sisters-in-law, and friends. It got to be a joke that pretty soon they
were going to let the family dog in.” (Now the policy is five visitors
for a traditional delivery, two for a C-section.)

A drape hung near her chest prevents Vanneman-Gooding from seeing the
C-section occur. On the other side of the drape, Weitz is the model of
calm and confidence, and she cuts side to side along the turgid
abdomen, then cuts through the fascia covering the abdominal muscles,
through the peritoneum en route to the thick, muscular uterus. Using
numerous white gauze pads, the team of three stanches the deluge of
blood that pools and pours from Vanneman-Gooding’s body.

Even
though it is possible for Ira to avert his eyes, he watches as Weitz
pulls and probes inside the deep exposed cavity in his wife’s abdomen
and then, using a suction device, eases the crown of the baby’s head out
of the womb.
“Ira, get your camera ready,” calls out the
circulating nurse—and then, baby Wren arrives, about 12 minutes after
the first incision.

“It’s a girl,” says Weitz. “I thought you told me it was a boy—I was all set to say, ‘Three boys, you’re screwed.'”

The
baby is weighed (7 pounds, 6.2 ounces) and evaluated (an APGAR score
of 9—nearly perfect). APGAR—an acronym for activity, pulse, grimace,
appearance, respiration—is a 10-point scale used to provide an
immediate, if rough, status report of a newborn’s health.

While
that’s going on, Weitz cuts and ties Vanneman-Gooding’s fallopian tubes
(a procedure Kristen and Ira had decided to undergo after their third
child), before closing the C-section incision with sutures.

The
circulating nurse methodically counts the instruments—the bladder
blade, the retractors, the sutures, the scissors, the scalpel, the
clamps—three times to ensure that nothing gets left behind in the
patient’s body. Ira snaps a digital photo of their new daughter, and
hands the camera to his wife, which lets her study her beautiful baby
girl for the first time.

On January 22, 2007, Wren Dorothianne
Gooding is logged in the hospital’s official record book at 10:57 a.m.
She’s the 278th baby to be born at GBMC this year; Kristen will return
home four days later.

Anesthesiologist Malov offers a little comic
relief. “How soon before there are no more [natural] deliveries?” he
asks, only half joking. “In the next century, babies will probably be
genetically engineered, and there will just be this zipper across
here,” he says, pointing to his abdomen.

Malov’s quip is not entirely in jest. Cesarean section on demand has
become de rigueuramong professional women in modern, industrialized
nations like Japan where, according to Khouzami, the C-section rate is
90 percent. In the U.S., nearly 25 percent of births today are by
cesarean (in 1970, it was only 5 percent).

C-sections offer benefits
(greater control over time of delivery and the removal of some risks
from the childbirth process) with a bit of risk (it is surgery, after
all, and long-term effects may include more postpartum pain and
infertility issues).
“We knew this was coming to the American
workplace sooner or later,” says Khouzami. “We knew the day would come
when women would start asking for it. We are simply coming to a time
when women are saying, ‘This is how I want to deliver,’ but the East
Coast is very slow to change. We’ve had maybe a handful of C-sections
on demand in which women have said, ‘I don’t want to labor. Get me a
date.’ But the trend is not here yet.”

Dr. Weitz seconds the notion.
“There will be an increasing demand for elective primary C-sections,”
says Weitz, who jokes that for some women, natural childbirth means
delivering without makeup. “We are the old prudes,” she says, “the last
to jump on the bandwagon. We are taking it cautiously, but I do
foresee a tremendous increase in patient requests for elective
C-sections. When you really look at it, women can get nose jobs, breast
implants, tummy tucks. Why does society say that we must make them
deliver vaginally? It’s your body and your decision. We respect the
woman’s autonomy.”

To date, the C-section rate at GBMC is about 22
percent—higher than the national average, but misleadingly high because
of GBMC’s high-risk patient population. These include mothers with
multiple births (many of whom medically must deliver through
C-section), older mothers, and repeat patients (at higher risk), and
the fact that the local Catholic hospitals will not perform tubal
ligations (often done in conjunction with C-sections), so many
expectant women choose GBMC to have their C-sections so they can also
get their tubes tied.

So are we professionalizing childbirth—turning
it from an arcane, vague, mysterious process into a regulated,
structured, guesswork-free procedure? 

Susan Bowen, clinical director of
labor and delivery, believes we’re well on our way. “I joke that one
day we are going to get our hours down to nine to five, Monday through
Friday,” she says. “I think the sad part of it is that our whole lives
are planned from the minute we step out of bed in the morning until the
minute we get back in bed at night. And this should be a wonderful
experience for a woman. I worked nights for nine years, and the thing I
enjoyed most was that natural labor that came through the door and you
could be so supportive and really help the woman and her family.”

However
women deliver these days, what’s clear is that they are having a much
greater say in the process. “We try to do what the woman wants us to
do,” says Bowen, “as long as it’s okay with the doctor and within the
policy of the hospital.”
“Years ago, if someone told me they wanted
to breastfeed for two days,” says lactation consultant Marla Newmark,
“I would tell them ‘It’s not worth the work.’ Today, if they tell me
they want to breastfeed for two days, I give them the same amount of
attention as if they planned to do it for a year. We are out to please
the consumer. What the patient wants is what we do.”

Something else has changed too: the patient and the doctor now look a
lot more alike. The influx of women entering obstetrics has caused
sweeping changes in a formerly male-dominated field. At GBMC, there are
57 OB-GYNs: Nearly half are women. “We used to have the token female,”
says Khouzami laughing. “Now we have the token male.” Susan Bowen
agrees. “Women have made a big difference in the field because they have
experienced labor. This is not a disease—it’s a natural process so we
have a lot of influence when it comes to how we want to give birth.
Women are more assertive. You don’t have the little housewife who comes
toddling through the door saying, ‘I’m here. Take me.’ It’s not that
anymore. We have a lot of career women who know what they want, we have a
very educated client base—everyone’s doing research on the internet,
the women take classes, they want what’s best for their baby.”

Claire
Weitz was the only female resident in obstetrics when she did her
training at Johns Hopkins Medical School in the mid-70’s. “When we would
show up [to put on scrubs for the OR], the locker rooms would say,
‘Doctors’ or ‘Nurses.’ I would go into the ‘Doctors’ room, and it would
be the men’s room. We are the majority now. Women have brought a new
perspective. Things become a little more personalized [for the patients]
because they’re often dealing with someone who has experienced
pregnancy—been there, done that, and gotten the T-shirt—but it doesn’t
mean that the men are unsympathetic to pregnant women. Some of the
kindest, most sympathetic men I’ve ever known have been obstetricians,
and that’s a loss for the field because men are not being encouraged to
go into it anymore.”

“When technology first came in, nurses felt
put out,” says Bonnie Lauryssens. “They let technology take care of
their patients—they would go in a room, look at numbers, and write them
down on a chart. Now, it has evolved. The nurses are even more into
the deliveries and are incredibly encouraging. Half the nurses probably
have hemorrhoids from pushing with the patients.”

Khouzami couldn’t
agree more. “I remember as a student, I had a teacher from Virginia
who was a real gentleman,” says Khouzami. “He was part philosopher,
part obstetrician, and he said that a delivery should be ‘by art, not
by force.’ It’s art, not science. Yes, some part of OB is science, but
if you make it purely science, you take all the emotion out of it. You
have to have a solid foundation in science, you have to have
technology, but it has to be tempered by humanity.
“Obstetrics is
more humane than ever. The technology is better than ever. As we move
ahead, we have found this wonderful balance.”