The idea of childbirth can be scary, especially if it is the first-time. But learning about your options can help you feel more confident going into the process.

A Birth Plan

The birth process is a little different for everyone. It is impossible to plan each exact step or procedure because changes in the process are common. Instead, a birth plan is a guide for how you would like your labor and delivery to go. What is most important about a birth plan is that it encourages you to consider your options. The plan will also help you communicate your choices to your partner and care team. Many of the choices 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 a birthing room. This allows you to be in the same room before, during, and after 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 offices located close to the hospital. A birthing center is fit for those with a low-risk pregnancy.

Home delivery is another option for low-risk pregnancies. Some feel that home is the most comfortable and natural place to give birth. There are studies that show there is no greater risk of infant illness or death in home births for pregnancies at low risk for complications. In fact, some mothers may need less anesthesia than those in hospital setting. An experienced, licensed midwife should be present for homebirths. There should also be a plan for quick medical care if the need arises.

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—a catheter delivers pain medication to a space space around the spinal cord. The medicine numbs lower body. The catheter allows medicine to be increased or decreased throughout labor.
• In spinal anesthesia—medicine is injected into the spinal fluid. It can almost completely relieve labor pain, but does not numb the entire body.

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

Natural types of pain management include:

• Hypnosis
• Yoga or walking
• Massage or changing positions
• Taking a bath or shower
• Distractions

Indications for a Cesarean Section

Cesarean section (C-section) is the delivery of a baby through surgery. The doctor makes incisions in the belly wall and uterus in order to remove the baby. A C-section is done if vaginal delivery would endanger the health of the mother or baby. Some C-sections are planned, but many occur on an urgent or emergency basis. Your care team will talk to you about risks and benefits of C-section if the need arises.

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 getting 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 needed. 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 pressed and cut off the baby’s oxygen supply.
• Abruptio placentae —the placenta separates from the uterine wall before birth. This can cause severe bleeding.
• 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 bleeding.

Cesarean Delivery © Nucleus Medical Media, Inc.

Putting It All Together

No one can predict exactly how your delivery will go. You can educate yourself and be prepared for most situations. Read while you are pregnant. Talk with your doctor and your partner, and take the time to outline your preferences. Having this knowledge may help you feel more confident and secure about decisions during labor and delivery.