Pregnancy

During your prenatal visits, talk with your health professional about what you would like to happen during your labor. Consider writing up your labor and delivery preferences in a birthing plan, either in a childbirth education class or on your own. You can find various examples of birthing plans on parenting Web sites.

Because no labor or delivery can be fully anticipated or planned in advance, be flexible. Your experience after labor begins may be totally different from what you expected. If an emergency or an urgent situation arises, your plans may be changed for your own or your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When making plans for your baby's birth, 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 sixth or seventh month of pregnancy.

After you've set the stage, think through your preferences for comfort measures, pain relief, medical procedures and fetal monitoring, and how you want to handle your first hours with your newborn.

Comfort measures may include:

• Nonmedicine pain management ("natural" childbirth), such as focused breathing, distraction, massage, imagery, and continuous labor support, which can reduce pain and help you feel a sense of control during labor. Acupuncture and hypnosis are also low-risk ways to manage pain that work for some women.¹³
• Laboring in water, which helps with pain, stress, and may also help prevent slow, difficult labor.¹⁴
• 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, which helps reduce discomfort, but a high-risk delivery would require constant monitoring.
• 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. This may make you vomit or feel like vomiting. An empty stomach is also best in the rare event that you may need general anesthesia.
• Playing music during labor.
• Birthing positions during pushing, including sitting, squatting, or reclining or using a ball, whirlpool, or birthing chair, stool, or bed.

Pain medicine may include:

• Epidural anesthesia, which is an ongoing injection of pain medicine into the epidural space around the spinal cord, to partially or fully numb the lower body. A "light" epidural allows the mother to feel enough so that she can push, reducing risks of stalled labor and cesarean delivery.
• Pudendal and paracervical blocks, which are injections of pain medicine into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where the baby will come out. Paracervical has been generally replaced by epidural, which is more effective.
• Narcotics, typically Demerol, which are sometimes used to reduce anxiety and pain. Narcotics have limited pain-relief effectiveness and can have troubling side effects for mother and baby.

Should I use epidural anesthesia during childbirth?

Some pain relief medicines are not the type that you would request during labor. Rather, they are used as part of another procedure or emergency delivery. But it's a good idea to be familiar with them. They include:

• Local anesthesia, the injection of pain medicine into the skin, which numbs the area before episiotomy or before inserting an epidural.
• Spinal block, the injection of pain medicine into the spinal fluid, which rapidly and fully numbs the pelvic area for assisted births, such as for forceps or cesarean delivery. If you have a spinal block, no pushing is possible.
• General anesthesia, the use of inhaled or intravenous (IV) medicine, which renders you unconscious. It has more risks, yet takes effect much faster than epidural or spinal anesthesia. So general anesthesia is only used for some emergencies that require a rapid delivery, when an epidural catheter has not been installed in advance.

Medical procedures for aiding a safe delivery may include:

• Labor induction and augmentation, including rupturing of the membranes and medicines for softening the cervix and stimulating contractions. This can be a medically necessary decision, such as when a mother has high blood pressure or another health problem that may endanger the fetus.
• Electronic fetal heart monitoring, either continuous for a high-risk delivery, or periodic, to check for signs that the fetus might be in distress.
• Episiotomy, which widens the area between the vagina and anus (perineum) with an incision. Episiotomy is done to shorten the time until the baby is delivered. Perineal massage and controlled pushing may also prevent or reduce tearing.
• Forceps delivery or vacuum extraction to assist a vaginal delivery, such as when labor is stalled at the pushing stage or the baby has signs of distress and needs to be delivered quickly.
• Need for a cesarean birth during a labor in progress. 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).

Newborn care decisions

Newborn care decisions include:

• Whether you plan to bank your baby's umbilical cord blood after the birth for possible use as a stem cell treatment. (This requires advance planning early in your pregnancy.)
• Keeping your baby with you for at least 1 hour after birth, for bonding and introduction to breast-feeding. Some hospitals allow rooming-in, with no mother-baby separation during the entire hospital stay. (A rooming-in policy also allows you to request time alone for rest, if you need it.)
• Delaying vitamin K injection, heel prick for blood test, and eye medicine, to help calm your newborn after delivery.
• Whether and when you'd like visitors, including children in your family.
• Allowing no water or formula for a breast-fed baby, to decrease early breast-feeding problems.

Should I bank my baby's umbilical cord blood?