Making Delivery Decisions

What should my birth plan include?
Many women find that a thoughtful conversation with their healthcare provider and their partner or support person before labor can lead to a more empowered birth experience.

Hospitals may present an optional, formal birth plan during the third trimester. Even if you have not yet formalized your preferences, they can still be recorded for doctors, midwives and nurses to use when the big day arrives. Labor points to consider include:
• Whom you would like as support people, along with their roles. For example, who should be present for the birth, keeping in mind that some hospitals limit the number of people in the labor room, and whether your partner should cut the cord if it’s deemed safe to do so.
• Pain control or epidural wishes, which may change as labor progresses.
• Hospital environment choices such as music, lighting and temperature.
• Activities during labor, including pushing/delivery positions.
• Desire for immediate skin-to-skin bonding with your baby, and your infant feeding preferences.
• Delayed cord clamping and/or cord blood collection.
• Requesting or declining circumcision for male infants.

Keep in mind that births do not always go as planned; and, should a high-risk scenario or complication arise, you may be asked to reconsider some of your preferences in order to preserve safety. It’s important to stay flexible and keep the lines of communication open with your nurses and providers.

Your written birth plan should be clear, concise and understood by your partner. The primary goal during delivery is always your safety and your baby’s safety. Therefore, the essential purpose of a birth plan is to open a conversation with your team of caregivers about how to accomplish a safe delivery while simultaneously accommodating your wishes for increased comfort and satisfaction.

What are the stages of labor, and how will I know when labor begins?
As the big day draws near, there can be a lot of confusion and anxiety about whether you are in true labor.

In terms of timing, the labor process can be very unpredictable, so keep in mind that your due date is approximate. Only five percent of babies are born on the due date, so keep any work or travel plans flexible.

Many women experience increasing Braxton-Hicks contractions in the third trimester. These contractions are characterized by overall tightening and a sense of pressure or discomfort, which resolve in seconds to minutes. However, these contractions are not truly painful. If you press your belly allover it will feel firm and you may feel uncomfortable, but this does not necessarily indicate labor.

Especially with first-time moms, true labor can be insidious onset. However, real labor is unmistakeable. By definition, labor requires painful contractions and cervical dilation.

True labor has three stages. The first stage, characterized by the change from zero to ten centimeters, starts out slowly, with mild-to-moderate discomfort (latent or early labor) before becoming very intense (active labor). The second stage is from ten centimeters until delivery of the baby. The third stage is the delivery of the placenta, typically within 30 minutes. For a first-time mom, the average duration of labor is about 20 hours.

True contractions are very painful, and you cannot talk through them. You need to focus, change your breathing or positioning, and do what you can to cope until they are relieved. If you can talk, smile, laugh or do anything of that nature, you are not experiencing a real contraction. Many providers use the 5-1-1 rule: Contractions should be five minutes apart (from the start of one until the start of the next one, not the rest time in between), lasting a minute each, for at least one hour.

Generally, your water breaks later in labor, but approximately ten percent of women break their water first — usually indicated by a large gush or clear fluid — before going into labor or being induced. When in doubt, call your provider, who can help you to triage if it sounds like real labor or will let you know if it’s best to stay home.

Should I bank my baby’s cord blood?
Cord blood — a rich source of stem cells that can potentially be used to treat many blood disorders, including leukemia, lymphoma and many other medical conditions and diseases being aggressively researched — can be drained from your baby’s umbilical cord shortly after birth.

The options include private cord blood banking (through various commercial companies), which generally involves an upfront cost for processing and then an annual or lifetime storage fee, or cord blood donation, which is free to the patient and either goes toward a public storage bank or toward research.

There’s no risk to the newborn, as the cord blood is collected after the umbilical cord is disconnected from your little one. At this point there are proven potential uses should your child become ill, and even more experimental or theoretical uses being researched. However, couples may find the cost or uncertainty of rare conditions a downside.

In general, just as with so many aspects of childbearing, cord blood banking is a personal decision with no right or wrong answer. Getting input from your provider and your planned pediatrician may help you make a decision.

What do I pack for the hospital?
Generally, when packing for the hospital, you want to be prepared and comfortable, but also keep in mind that everything you bring in must be carried out (along with your new family member!), so sometimes less is more.

The hospital will provide disposable underwear and pads, toiletries, a breast pump, and infant basics such as diapers and wipes, baby soap and washcloths, and clothing and blankets.

But some items from your home will certainly make your stay more comfortable, including your favorite toiletries, pajamas, lounge clothes, lightweight robe, nursing bras or tanks, easy on/off shoes or sandals, and a couple of infant outfits and blankets for photos, going home or other special moments.

You will need an infant car seat. In most hospitals, the nurses will actually check whether the car seat is a good fit for your infant before you are discharged. You’ll also want to bring your phone (and a charger with your name on it), a small camera, your wallet with photo ID, insurance cards and, perhaps, a computer. There is no need to bring medications, as they can be ordered through the hospital pharmacy.

In many hospitals the food service has limited hours, so consider packing some high-energy snacks such as trail mix, granola bars or anything else to help keep you going, especially if you deliver in the middle of the night.

Also keep in mind that there is a fair amount of downtime, so if you need something essential and don’t live too far away, your partner or other family member can bring it to you.

Take advantage of your short time in the hospital and the support within to help you get comfortable with your little one!

Margaret K. Chory, MD, is a general ob/gyn practicing in Pittsburgh, PA.

Have a question for our experts on pregnancy, birth and parenting? Email em@cwpg.com.