Planning for Delivery

Knowing your options and stating your preferences ahead of time will help work toward the best outcome.

Labor and delivery follow predictable patterns, but the process can take unpredictable paths. So being well informed and making decisions in advance can help labor and delivery progress more smoothly.

You may have heard friends speak of writing birth preferences or a birth plan with the aid of their obstetricians, family practitioners, midwives, birth coaches or doulas (trained labor assistants). The purpose of these guidelines or intentions is to inform the birthing team of your wishes, as you have made decisions thoughtfully beforehand based on information gathered through consultations and reading.

Sources for a birth plan template that you fill in stating your birth preferences include the Internet and, possibly, some hospitals/birthing centers. If the site where you will deliver doesn’t provide a template, you can use the following guidelines to discuss options with the provider who will deliver your baby. Write your intentions in an outline or essay format to give to your provider in advance. Pack copies to take with you to the hospital/birthing center to share with those who will support and care for you during your labor and delivery. Communication is of utmost importance to achieve the kind of experience you desire.

WHAT TO INCLUDE IN A BIRTH PLAN

A birth plan should be simple — no longer than a page — covering labor, delivery and just after delivery.

LABOR Visit the site where you will deliver. Hospitals and birthing centers offer tours and answer questions regarding their standard protocol for obstetrics care. You might wish to labor and deliver in the same room; you may want to labor in subdued lighting with soothing music. If you would like certain family members or friends present, inquire about the site’s policies.

Decide who will be with you during labor and delivery. You might be interested in having a doula, who will provide emotional, physical and informational support before, during and after delivery (see www.dona.org for more information). Women who had doulas had significantly less epidural use and were more likely to rate their birth experience as positive, according to a study cited in Obstetrics & Gynecology (1999:93; 422-426).

Discuss decisions regarding induction of labor and pain medications with your healthcare provider. If needed, oxytocin (for example, Pitocin) is used to induce labor when delivery is desirable and labor has not started on its own. It may also be used to stimulate labor when contractions are weak or ineffectual. Some women opt for natural pain relievers, such as warm compresses, massage and breathing techniques, while others prefer intravenous (a needle placed in a vein in your hand or arm) pain relief, or an epidural that blocks pain but does not sedate. Epidurals will confine you to bed, which limits your laboring positions.

If you opt for an epidural, intravenous fluid is standard procedure to keep you hydrated. You may wish to labor without pain medications but have the option of an epidural if the discomfort is making you lose control, detracting from your participation in the experience.

Talk with your provider about external and internal electronic fetal monitoring. Monitoring may be continuous or intermittent. If those taking care of you during labor think the fetus is uncomfortable, monitoring may be standard protocol where you give birth. Your plan should remain flexible so that everyone can make the best decisions for the safety and health of you and your baby.

DELIVERY Would you like a mirror positioned so you can watch the birth? Would you like your partner to cut the umbilical cord? If you are having a cesarean, do you want an epidural and the screen lowered so you can view the delivery?

Discuss your thoughts on episiotomy (an incision made in the perineum to avoid tears while pushing), and decide beforehand with your practitioner. Do you wish to bank the fetal cord blood for future stem cell use?

FOLLOWING DELIVERY Do you wish to hold your baby and breastfeed immediately after birth? How do you feel about the use of a pacifier or bottles, if you are nursing? Do you wish to have a boy circumcised? Do you want your baby to room with you following the birth?

WHEN TO CALL YOUR DOCTOR

As you plan for labor and delivery, you should be alerted to signs of possible problems to inform your provider about immediately. Call your practitioner if you have any vaginal bleeding or discharge of fluids, abdominal pains, severe headache, dizziness or visual disturbance, swelling of your hands or face, fever or persistent nausea or vomiting.

Obstetrics care providers want to honor your birth preferences, but you should know that plans cannot always be followed when you or your fetus needs urgent medical assistance for an unforeseen problem.

PARTNERS IN BIRTH

Remember that your birth plan cannot forecast how labor will unfold. You must have trust in your delivery team and remain flexible to ensure that proper measures can be taken, when necessary, to ensure a healthy birth.

You are in a partnership with the delivery team. Mutual respect and cooperation will guarantee the best outcome, which each mother and her healthcare professionals want for her newborn.

Packing and Preparation

In order to ensure that you have everything you’ll need for comfort during labor and delivery — socks to keep your feet warm, lip balm to moisten dry lips and soothing music or tapes for relaxation — pack your suitcase in advance.

• Hair clips or bands will keep your hair out of the way.
• Photos, magazines and favorite books will help pass the time.
• You may wish to pack devices to aid massage.
• Take gowns, a bathrobe, slippers and toiletries for the hospital/birthing center, and a loose-fitting outfit to wear home. If you are nursing, pack nursing bras and gowns. Bring clothes and blankets for the baby’s trip home.
• Make sure the baby’s car seat is properly installed; state laws require that babies be transported in an approved infant car seat.
• Bring telephone numbers and a cell phone or calling card so you can share the good news.
• Make arrangements for older children, pets and any other regular obligations.
• Stock some frozen dinners ahead of time so you can focus primarily on caring for your new baby and not cooking meals when you return home.
• Make plans for transportation to the facility where you will give birth. Know the parking procedures and which entrance to use if you arrive after hours.

Adair R. Heyl, Ph.D., is an assistant professor, and Peter S. Heyl, M.D., is an associate professor, at the Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk.