"Life is always a rich and steady time when you are waiting for something to happen or to hatch.” ~E.B. White
Complete Prenatal Care & Delivery by the Most Personalized Obstetric Team in Westchester
What makes "mcgroaryandmalley" unique?
What distinguishes our team is more than our small size of two physicians balancing all our patient's prenatal care and delivery.It is also our commitment to the highest standards of medical care, personal devotion to our patients.
While our team may grow in the coming years, it will be with the understanding that we, your physicians, and you, the patients get the best, most consistent care, from a small team that knows you, who you feel comfortable with.
Dennis and I care for and nurture all of our pregnant patients from first pregnancy test (sometimes earlier,even), to supporting your breastfeeding, and enjoying your baby stories as your family grows. You will not find a similar group in the region, with the warmth, personal attention and committment to you during your pregnancy that we represent. One of the two of us will deliver your baby, and you will be completely comfortable with our team before you need to be.
We literally plan our family vacationsaround our patient's due dates, and are never both out of town at the same time. One of us will always be there for you. We like to think that we practice medicine this way because it is the way we hope to be treated by our own physicians.
Our offices:
We mainly work out of two offices: Katonah and Yorktown Heights.
Dr. McGroary also has a satellite office in Carmel. They are all connected by electronic medical records, so we can give informed care from all locations.
You can visit us in any office; we have hours every day, including every Saturday morning and evening hours on Tuesdays.
Our patients deliver either at: Northern Westchester Hospital in Mt Kisco (nwhc.net), or Putnam Hospital Center in Carmel, New York (health-quest.org). Each are well-supported with obstetric anesthesia and neonatology, private rooms, on-call lactation support and a state-of-the-art, neonatal ICU.
Frequency of visits:
We usually follow your first visit with another in two weeks to check on your transition to pregnancy, reassure you through morning sickness, and show you the baby on sonogram if you like. After this, starting in your first trimester, you will have monthly visits until 24-26 weeks, then every 2 weeks until 36 weeks and weekly until your due date at 40 weeks. This may be adjusted if you are carrying twins or triplets, or having a complication during pregnancy, such as high blood pressure or gestational diabetes, that requires more frequent visits.
The only drawback to all these visits as you near delivery, is that we all become attached. Your delivery and parenthood suddenly require that you spend much time with your new physician, the pediatrician, and we are all left a little bereft. Please remember to visit and send us baby pictures to help with the process.
Routine prenatal visits:
Uterine growth and heart rate are measured, and often, an ultrasound is done to take a look at our growing star. Just as importantly, we will prepare you for the changes coming in the next few weeks.
Calling the office:
During the day: one of our experienced obstetric nurses, Laurie or Kathy, will triage your calls. Depending on your situation, she will consult with us and get right back to you, ask you to come in, or have one of us call you back.
If you are worried, or feel it is an emergency, please let the nurse or receptionist know. If you call after hours, our regular office number is answered by a physician’s answering service; they will connect you directly to one of us.
Confidentiality issues:
We will ask you early on for the best number to reach you, what information you feel comfortable being left on your answering machine, etc. We will have you sign a form for your chart to clarify who we can speak to with results, etc... in your absence. To best ensure your privacy, please be sure to leave us an updated daytime phone number, including your cell phone.
Prenatal Vitamins:
We recommend a standard prenatal multivitamin with iron and folate as fine for most pregnant women. Early folate supplementation has been shown to decrease neural tube defects (spina bifida, hydrocephalus...), and should continue through the first trimester. Let us know if you have any dietary restrictions: such as being lactose intolerant or a vegan, so that we can consider other needs…
Obstetric Record:
At one of your first prenatal visits, you will sit with our Obstetrics Coordinator, Laurie, who will help you complete a questionnaire, detailing your social, medical, and family history, starting your Obstetric record with us.
What To Expect As You Get Closer to Delivery
Birth "planning":
To help you prepare for this visit, see our section on "birth preferences", you can print it out, give it some thought and discuss with your partner, so that you have had a chance to think about some of the choices. We all conceed that much of this day is beyond our control, we follow the process as naturally as possible, to give you the best chance for a vaginal delivery. What we can influence, such as room lighting, music, those present for your delivery, etc..., we want to be completely your choice, and will review options again over the course of the day.
Your Delivery:
We all share the same goal: to have the delivery that satisfies you as a mom, and is safest for you and your child. It is generally healthier and safer for both mother and baby to deliver vaginally.
Patience is a virtue when waiting for your little one after a long labor. Be reassured that there will be no time limit to allow the baby to navigate your pelvis, as long as we see progress and you are both tolerating the process.
You will be encouraged to walk when able, and to rest when able, to maintain your strength for this amazing marathon. We will support you every step of the way. In the event that a cesarean section is necessary to preserve the well-being of of mom or baby, we will consistently try to consider your needs, respect your wishes at every step to ensure a dignified, beautiful experience.
As experienced physicians, we will sometimes remind our patients of our one most important goal: to deliver a healthy baby to a healthy mother. All other goals are important, but secondary to this one. As one of our most thoughtful postpartum nurses, Lisa, put it recently: "You may not end up with the delivery you had hoped for, but what really matters is that you end up with the healthy baby you have always wanted."
Natural Childbirth: Alternatives to Pain Medication
You can always change your mind and ask for an epidural, but if labor is going quickly and smoothly, this may be something you'd like to try during your birthing experience.
- Ways to enhance your chance of a natural delivery (if all is going smoothly throughout your pregnancy) include: staying home (where you have control over your mobility, diet, etc.) until you are in active labor, walking for as long as you’re able, taking a warm shower, soaking in a warm Jacuzzi, oil massage, hot or cold packs and changing position as you need to.
- When you're in labor, you will likely not want to be in bed the entire time, experiencing painful cramps without a chance to work through them physically. We will encourage you to try different positions to see what you find most comfortable, including: rocking in the rocking chair, balancing on your birthing ball, standing, leaning on your partner, and walking through the halls.
- If you’d like soft music, bring your favorite CDs, (there is a CD player in every labor room), or loaded ipod (Dennis and I have an ipod docking station for our patients on L&D.)
- Aromatherapy can also be soothing. Especially a combination of lavender , oil of citrus and others are especially recommended for relaxation in labor. (We have these with us in our labor kit, and will offer it to you.)
- Alternative Medicine: NWH offers free alternative care practitioners to help with your labor pain. Some of their techniques include Reiki healing, pressure points, massage and their own aromatherapy.
- Early in labor, light eating is fine, food you would choose if you had a stomach flu, such as chicken soup, oatmeal, graham crackers, non-acidic fruits and hard candy. Every woman's appetite in labor is unique, and encourage you to pack a bag with some comfort foods in the event you don't like the hospital's offerings.
Medication options
Narcotics. If you decide that you’d like pain relief, a gentle narcotic (stadol through the iv) can be used in early labor. We generally avoid narcotics withing 1-2 hours of delivery because the sedating effect crosses the placenta and can depress the newborn.
Epidural. An epidural can be placed at any point, if desired, by an experienced anesthesiologist. The medicine in the epidural does not cross the placenta, and will not affect the baby.
It works by blocking the pain fibers innervating your uterus and perineum, while allowing you to continue labor more comfortably. Your level of consciousness is not affected, so your head is still "in the game" with us.
Unfortunately, once the epidural is in place, your mobility is limited. Your legs won’t be able to support your walking, and you will then need to be in bed or in a rocking chair and continuously monitored in this setting. This is generally not as big a problem as first-time moms worry about.
By the time many women are prepared for epidural anesthesia, if they decide on that route, they have often been awake for 12-18 hours and are prepared to rest. Some women who receive an epidural after a long, painful labor, are pain-free enough to relax, fall asleep, and wake up fully dilated: ready to start pushing.
Pushing in Labor: The best maternal position and way to deliver your baby has yet to be determined. Rather than start pushing when your cervix is fully dilated to 10 cm, if the fetal heart rate is reassuring, in the absence of infection, we generally allow passive descent of the baby until you feel the urge to push. This patience pays off by not draining your resources, when you are in the final leg of your "marathon".
Benefits suggested for an upright rather than lying down position include using gravity to help baby’s descent, decreasing compression of major blood vessels (mom’s), stronger and more efficient contractions, improved alignment of the fetus for passage through the pelvis, and increasing your pelvic opening.
For women in an upright position, outcomes are similar whether kneeling or sitting, we ask our patient to push in the position she finds most comfortable.
We and your nurse, and your doula if , will encourage you while you push. Let us know if you prefer enthusiastic cheerleading or gentle guidance. We will coach you to bear down and push according to your own needs (responding to the pain of contractions and the pressure from the fetal head.)
When you feel your contractions, you will instinctively bear down when you feel the need, in control of your body, with the support of your partner. We will have a mirror available if you'd like to see which pushing efforts show progress, or simply to watch the baby's head crown.
Episiotomy
(Yikes!) We do not practice routine episiotomy; systematic reviews have consistently shown no benefit; cutting a routine episiotomy is more likely to increase the risk of perineal tears and blood loss than carefully controlling the delivery of the baby's head.
In the delivery room,perineal massage with warm olive oil and gentle stretching as you push, helps us minimize tearing. In the rare circumstance that we would need to cut an episiotomy to help deliver a very large infant, if a shoulder dystocia is anticipated, or if the baby is in distress, we would discuss the situation with you and do so only with your permission.
Controlled pushing, maternal panting while the baby’s head is crowning, support of the perineum and delivery between contractions has been shown to decrease the likelihood of perineal tears. We will do everything possible to minimize likelihood of vaginal tears, to speed healing after delivery.
What if you need a Cesarean Section?
Although surgery is not the goal, it becomes a reality for about 25-30% of first-time moms, fewer if you've delivered vaginally in the past. In the event things look like they are headed that way (breech or transverse lie pre-labor that don't respond to external version), fetal distress in labor, arrest of labor... we want to assure you to that we will make every effort to make the experience as peaceful and beautiful as the delivery you've always wanted.
If baby is fine, we will encourage early breastfeeding, and skin-to-skin contact. We will minimize extraneous personnel during your delivery to keep the experience as sweet and personal as you would like, while maintaining the highest level of care possible.
The anesthesiologist is often relegated the job of photographer as new dad, mom and baby meet for the first time. Baby will be kept with you, as long as he/she is well, for as long as you like, until you are moved to your postpartum room (1.5 hours later, generally.)
Despite common myths, c/s will not interfere with your ability to breast feed, nor bond with your new baby. Our entire staff if dedicated to reducing your worries surrounding loss of autonomy around the possible abdominal delivery.
While not the goal, if a cesarean section is agreed by all (you, your husband and your physician) to be the right route of delivery for your baby, it will still be a special experience. As we agreed throughout your pregnancy, the most important end result of our experience, is a healthy mom and healthy baby, driven home by a healthy new dad.
"Babies are always more trouble than you thought - and more wonderful." ~Charles Osgood
