By the time the second trimester kicks in, most expectant moms have studied up on childbirth and have a fairly firm idea of what they want to happen during delivery. Some hope for a natural, drug-free birth; others may welcome medication.
From pain-relief methods to delivery positions to the number of support people, the options are myriad. That's why most mothers-to-be are encouraged to write a formal birth plan-to record choices they may be in no position to articulate once delivery time rolls around.
"It's tough to convey preferences in the middle of a contraction," observes Penny Simkin, a childbirth educator in Seattle. "A birth plan gives you a voice during labor."
A birth plan is your personal wish list for what you consider to be the ultimate birthing experience. It doesn't have to be complicated process -- all you need is some time to reflect on some important questions pertaining to your birth experience.
The idea of a written document to help mothers achieve the labor they've always envisioned was introduced about 20 years ago as an outgrowth of the natural-childbirth movement. But birth plans are by no means exclusive to women who expect to deliver vaginally.
"Even someone who has scheduled a C-section has a vision of what she wants her delivery to be like," Simkin says. A birth plan lets her specify that she wants her partner by her side throughout the procedure, for example, or that her baby should be placed on her chest immediately after birth.
Writing a birth plan lets you identify the issues that concern you most, and prepares you for discussing them with your health-care provider or birth attendant.
Every labor and birth is different, each miraculous in its own way. It's a situation full of unknowns -- and the best way to approach it is to familiarize yourself with the possibilities. Start with getting familiar with this rundown of birth and labor options.
Remember that formulating a birth plan doesn't guarantee a seamless experience. No matter how you go about it, labor and childbirth call for a flexible attitude and a sense of adventure!
Hospital: Ninety-nine percent of all births occur in a hospital. For a homier setting, look for a hospital with birthing rooms. These specially equipped facilities feel more like a bedroom than a traditional delivery room, and you can stay in them from labor through recovery.
Birthing Center: Certified nurse-midwives usually provide the bulk of care at a free-standing birthing center (also known as a maternity center). These facilities tend to emphasize low-tech approaches to childbirth and are best for low-risk pregnancies. If complications arise, you may have to be transported to a hospital (each center has a relationship with a specific hospital). for a different level of care or emergency care -- if you want an epidural, for example, or if the labor is not progressing properly.
Home: A very small but growing number of couples opt to give birth at home, assisted by a qualified physician or certified nurse-midwife. This is a safe option only for women in excellent health who have had low-risk pregnancies, and optimally, who have already been through at least one complication-free childbirth. Back-up plans should be in place in case a transfer to a hospital is needed.
Note: Be sure to ask if your birthing site limits the number of people who can be in the room with you.
Birthing bed: Many birthing sites now have special beds that are designed for both labor and delivery. The back can be raised or lowered to support different laboring positions. Options (which vary from one setting to another and should be discussed with healthcare providers) may include:
Birthing chair: Some birthing sites have these special chairs or stools, designed to support a woman in a squatting or sitting position. They allow women to benefit from gravity, and see more of the birth, but may cause increased tearing of the perineum (tissue between vagina and rectum).
Umbilical cord-blood donation or banking: The blood in a baby's umbilical cord was once routinely tossed away, but now it's seen as a valuable medical asset. Cord blood is enriched with stem cells, which can be used to treat over 50 life-threatening diseases. Drawing the blood is quick and risk-free — and it's definitely painless, since it's done when the cord is no longer attached. But you do need to arrange for a collection ahead of time, because cord blood banks, where the collected material can be stored, are not available in every community.
Some parents choose to bank the cord blood privately, so that they can have access to it later; this is seen as a sort of biological insurance against possible illness in their child's future. This is a costly option, though, and the American Academy of Pediatrics encourages donating the cord blood or blood stem cells to a public cord blood bank instead. Parents should consider privately banking the blood only if a family member has a current or potential need for a stem-cell transplant. Discuss the matter with your healthcare provider. For more information on cord blood donation, contact the National Marrow Donor Program, 800-Marrow-2.
Circumcision: Circumcision is the surgical removal of the foreskin, which covers the end of the penis. The procedure is usually done in the first few days after birth. As of the late '90s, about 63 percent of baby boys in the U.S. were circumcised, but the practice is much less widespread in other parts of the world. Though medical research shows some medical benefits of circumcision, the American Academy of Pediatrics states that the benefits are not sufficient to recommend the procedure as routine for all boys.
Some parents may want their sons circumcised for religious, social, and cultural reasons. Others are concerned that circumcision desensitizes the tip of the penis, causing a decrease in sexual pleasure. Since circumcision is not essential to a boy's health, parents should choose what is best for their son by talking it through and exploring the benefits and risks.
Rooming in: Some hospitals allow parents to keep their newborn with them in their room, rather than in the hospital nursery. You can state your feelings about this before birth, but feel free to change your mind later on. Here are your options:
As you gather your ideas, be open to the unpredictable nature of labor, suggests Kathleen Slone, a certified nurse-midwife in Baltimore. You may have firm ideas about holding your baby right away, for example, but you should avoid sounding adversarial or overly demanding. Always preface each statement with "All things being normal, I'd prefer . . . "
Pam Cass, a certified doula from Warrenton, Virginia, suggests opening with a statement like "I realize that any birth may take unexpected turns. These goals reflect my idea of a model birth, and I thank you for your support in helping me achieve as many of them as possible."
Then emphasize one or two of your most important objectives, she suggests. (You might underline them or put them at the top of your list.) Focusing on the issues that mean most to you can help you feel good about your labor — no matter what happens.
"I attended a birth in which the mother needed several interventions that she had wanted to avoid," Cass says. "But because she wasn't separated from her baby after delivery — her top priority — she felt everything was great."
A good birth plan, however, should be more than a list of preferences; it should convey a sense of who you are. For instance, you might write, "I've never been in a hospital before except when my grandmother was dying, so I'm a little fearful" or "It took us nine years to get pregnant, so we want every bit of technology you've got to ensure that our baby is born healthy."
"Disclosing a little personal information can make the hospital staff more likely to rally around your plan, because they'll see you as a person, not just a patient," Simkin says. You should start thinking about what to include in your plan as early as your second trimester, though you needn't put it down on paper until the 32nd through the 36th week of pregnancy. Bring up your questions with your obstetrician or midwife, and negotiate any areas in which you might have different viewpoints, suggests Slone.
Once you've written your plan, give a copy to your doctor and schedule an appointment that will be slightly longer than usual to discuss it. Make sure the plan is part of your medical records, which are automatically sent to your birthing site.