The idea of childbirth can be scary, especially for first-time mothers. But learning about your options and knowing your preferences can help you feel more confident going into the process.

Long gone are the days when a woman in labor went to sleep and woke up with a baby in her arms. Today women have much more information and are active participants in the birth process. From where to have your baby to how to manage the pain, there are many decisions you can make about your baby’s birth. But you must be flexible, as births are unpredictable and things will not always go as you plan. Take time during your pregnancy to learn about your options and discuss with your doctor what is best for you and your baby.

A Birth Plan

A birth plan is a guide for how you would like your labor and delivery to go. The word “guide” is key. Since you can never know exactly how the process will go, you need to accept the possibility of changes once labor is underway. What is most important about a birth plan is that it encourages you to consider your options, discuss them with your partner and doctor, and make your preferences known to your health care team. Many of the options that you may consider are described in this article.

Where to Have Your Baby

The 3 main options for where to have your baby are a hospital, a birthing center, and at home. Most hospitals offer special accommodations. These may include a birthing room, which allows a woman to be in the same room before, during, and after her delivery. There are also private rooms with space for family members to sleep. Tour your hospital’s maternity ward to see what services are offered.

Birthing centers are designed to provide a more home-like setting. These centers may be attached to a hospital or be separate entities located close to the hospital. A birthing center is appropriate for a healthy woman with a low-risk pregnancy.

Home delivery is another option for low-risk pregnancies. Some women believe home is the most comfortable and natural place to give birth. However, at-home births are not recommended by most doctors because birth can be unpredictable. While this is true, studies of over 500,000 low-risk women who gave birth at home or at the hospital found that there were no differences in infant illness or death. This suggests that there is no advantage to delivering in a hospital for pregnancies at low risk for complications.

If you decide on this option, you should have an experienced, licensed midwife and a plan for quickly obtaining medical care if the need arises. You should also be aware that it is not always possible to reach the hospital in time to avert problems related to attempted home births.

Who Will Assist in Your Baby’s Birth

An obstetrician/gynecologist (ob/gyn) is often the choice to deliver your baby. If you have a high-risk pregnancy, your doctor may refer you to a perinatologist. This is an obstetrician who specializes in high-risk pregnancies. In some areas, family practitioners receive special training in obstetrics and may also deliver babies. This is especially true in rural areas or where there are few ob/gyns. A certified nurse-midwife is trained to take care of healthy women who are expected to have an uncomplicated labor and delivery. Midwives work closely with a physician who is available for consultation or to assume care if complications arise.

Pain Control Options

You will need to determine how you will manage pain during your delivery.

Medication options include spinal and epidural anesthesia. In epidural anesthesia, pain medication that numb nerves are given through a catheter placed in the epidural space around the spinal cord. In spinal anesthesia, the medications are injected into the spinal fluid. In most women, these medications almost completely relieve labor pain, but do not numb the entire body.

Other types of pain medications can be given orally, through an IV catheter or through an injection into the muscle. These may affect the baby and should be used carefully.

Other ways of managing pain without medication include: undergoing hypnosis, doing yoga, walking, having a massage, changing positions, taking a bath or shower, and engaging in other distractions.

Indications for a Cesarean Section

Cesarean section (C-section) is the delivery of a baby via surgery, rather than vaginally . The physician makes incisions in the abdominal wall and uterus in order to remove the baby. A C-section is done if the health of the mother or baby would be endangered by a vaginal delivery. Some C-sections are planned, but many occur on an urgent or emergent basis.

In most cases, a C-section is a need, not an option. Talk to you doctor about your risk for a C-section. Conditions that call for a C-section include the following:

  • Cephalopelvic disproportion (CPD)—the baby’s head is too big to fit through the mother’s pelvis.
  • Fetal distress—the baby is not receiving enough oxygen.
  • Abnormal position of the baby—the baby should be delivered head first with the chin tucked under. If the shoulder, bottom, legs, or extended head is in position to come out first, a C-section may be necessary. When the bottom comes first, it is called breech .
  • Prolapsed cord—the umbilical cord is in the birth canal ahead of the baby. The cord may be compressed and cut off the baby’s oxygen supply.
  • Abruptio placentae —the placenta separates from the uterine wall before birth. This can cause the mother to hemorrhage, which can cut off the baby’s oxygen supply.
  • Placenta previa —the placenta partially or completely covers the cervix. In some cases, this can cause the placenta to deliver before the baby, which cuts off the baby’s oxygen supply. It can also cause life-threatening hemorrhage in the mother.
Cesarean Delivery
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When considering the possibility of a C-section, remember the number of people allowed in the operating room is usually restricted to one. Consider who you want to be there with you when the baby is born.

If you had a C-section in a previous pregnancy, you may still have the option of a vaginal birth. Discuss the risks and benefits to having a vaginal delivery after a C-section with your doctor, and express your preference.

Putting It All Together

Although no one can predict exactly how your delivery will go, you can educate yourself and be prepared for most situations. Read as much as you can, talk with your doctor and your partner, and take the time to outline your preferences before labor starts. At the same time, remember that this is a natural process, and as much as you can prepare, you also have to be prepared for last minute changes.

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