Birthing Options

During your prenatal visits, talk with your health professional about your labor and delivery options. As you identify your preferences, you may want to write them down as a birth plan. A birth plan is not so much a "plan" as it is an ideal picture of what you would like to happen. Since no labor and delivery can be predicted or planned in advance, be flexible. As you consider how you'd handle possible complications, give yourself permission to change your mind at any time. And be prepared for your childbirth to be different than you planned.

A birth plan isn't a contract for your health professional to follow—if an emergency situation arises, he or she has a responsibility to ensure both your safety and your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When you are writing your birth plan, first consider the location of your delivery, who will deliver your baby, and whether you want continuous labor support from a designated health professional or a doula, a friend, or family members. If you haven't already, this is also a good time to decide whether you'll attend a childbirth education class, starting in your 6th or 7th month of pregnancy. After you've set the stage, think through your preferences for comfort measures, pain relief, and medical procedures and fetal monitoring, as well as how you'd like to handle your first hours with your newborn.

Comfort Measures

There are many ways to reduce the stresses of labor and delivery. Consider:

Continuous labor support from early labor until after childbirth, which has a proven, positive effect on childbirth. Women who have continuous one-on-one support (for example, from a mother's support person, or doula; nurse; midwife; or childbirth educator) are more likely to give birth without pain medication and are less likely to describe their birthing experience negatively. Although there is not a proven direct connection between continuous support and less labor pain, having a support person does help you feel more control and less fear, which are strong elements of mental pain control.
Walking during labor, including whether you prefer continuous electronic fetal heart monitoring or occasional monitoring. Most women prefer the freedom to walk and move around, but a high-risk delivery would require constant monitoring.
Nonmedication pain management ("natural" childbirth), such as continuous labor support, focused breathing, distraction, massage, and imagery, which can reduce pain and help you feel a sense of control during labor.
Early laboring in water, which helps with pain, stress, and sometimes slow, difficult labor (dystocia). Giving birth in water needs more study to show how safe or risky it is for mother and baby.
Issues about eating and drinking during labor. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted because the stomach digests food more slowly during labor. An empty stomach is also best in the rare event that you may need general anesthesia.
Playing music during labor.
Acupuncture and hypnosis, which are low-risk ways of managing pain that work for some women.

Birthing Positions

Birthing positions for pushing include sitting, squatting, reclining, leaning on a ball, or using a birthing chair, stool, or bed. See illustrations of various birthing positions:

Walking
Leaning
Sitting
Squatting
Kneeling
Kneeling on all fours
Downward from knees
Side-lying

Medical Procedures for Labor and Delivery

While fetal heart monitoring is a standard practice during labor, other procedures are used as needed.

Labor induction and augmentation includes a simple "sweeping of the membranes" just inside of the cervix, rupturing the amniotic sac, using medication to soften (ripen) the cervix, and using medication to stimulate contractions. This is not always, but can be, a medically necessary decision—such as when a mother is about 2 weeks past her due date or when the mother or her baby has a condition that requires immediate delivery.
Antibiotics if you tested positive for group B strep during your pregnancy.
Electronic fetal heart monitoring may be either continuous for a high-risk delivery or periodic to check for signs that the baby might be in distress.
Episiotomy widens the perineum with an incision. This is sometimes used to deliver the baby's head more quickly, when there are signs of distress. (Perineal massage and controlled pushing can also prevent or reduce tearing.)
Forceps delivery or vacuum extraction is used to assist a vaginal delivery, such as when labor is stalled at the pushing stage or when the baby shows signs of distress at the pushing stage and needs to be delivered quickly.
The need for a cesarean birth during a labor in progress is primarily based on the baby's and mother's conditions. (For more information, see the topic Cesarean Section.)

If you have had a cesarean delivery before, you may have a choice between a vaginal trial of labor and a planned cesarean birth. For more information, see the topic Vaginal Birth After Cesarean (VBAC).