The details of your delivery will contribute to how you feel about your baby, your body, and your life as a new mother. For instance, choosing the location where you will give birth is an important decision. You want to feel completely comfortable and at ease in this place. Additionally, from creating a birth plan to attending childbirth classes, there are numerous things you can do to make your delivery run smoothly. Taking care of these essentials well in advance will save you stress later on.
When visiting potential birth settings, be sure to ask lots of questions and take note of as many details as possible. If you learn a location has routine restrictions on laboring women and high intervention rates, this is probably indicative of the care you'll receive there. Ask about policies and practices that are important to you. Some of these topics may include:
Intermittent fetal monitoring
Freedom of movement in labor
Ability to eat and drink in labor
Tools available in labor (birth ball, tub, etc.)
Visitation policies (particularly for siblings)
Breastfeeding rate and support
Instead of a hospital or birth center, many women choose to give birth at home. Home birth is an option for low-risk women with qualified practitioners, doctors, or midwives. Today, many families are choosing home birth to have more control over their environment.
Home birth is a safe practice for well-screened pregnant women with qualified practitioners. Birth outcomes are as good, if not better, in similar populations giving birth in hospitals. Most home births use few if any interventions. Be sure to talk to your midwife or doctor about her training in home birth and what situations she can safely handle at home.
Birth centers offer a homelike environment for delivery, but you have a bit more support than you would at home. Doctors, midwives, or a combination may assist you. The emphasis in birth centers is on the low-risk woman who desires fewer interventions. Typically your stay at a center after birth is not very long, though it depends on your birth, the birth center's policies, and other factors.
The majority of women choose to give birth in hospitals, as they are available for all women. Though many assume hospitals are the birth location best equipped to handle any kind of complication, this depends entirely on your individual situation. Some are not prepared to handle high-risk births or premature babies. Additionally, your desires are less likely to be heard in a large hospital with lots of patients. Be sure to clearly define, with your practitioner as well as with your hospital facility, what you want out of your birth experience. A birth plan can help you with this task.
A birth plan is exactly what it sounds like: a basic plan, usually in the form of a document, created to help you, your husband, and your practitioner clarify your desires for the birth. A birth plan is not a written contract between you and the doctor or midwife, nor is it a contract between you and the hospital or birth center. And a birth plan does not guarantee you will have the type of birth that you desire.
Why would I want a birth plan?A birth plan helps you define your birth philosophy and allows you to convey this information to nurses and other support staff who have not been present during your prenatal visits. It's a sort of cheat sheet to catch up latecomers so they can provide you with a positive, safe experience.
What a birth plan does is allow you and everyone supporting you to have a set of guidelines for how you'd like to approach your labor, birth, and postpartum experience. It particularly applies to your labor and birth and the initial day or two after birth. You should keep your birth plan short and simple. It should never be longer than the front of one page; you can use bulleted points for simplicity. It is also advisable that you break the plan into sections for ease of use. You may choose headings like “Labor,” “Birth,” “Postpartum/Baby Care,” and possibly “Emergencies/Cesarean.” This gives your care providers succinct information to reference throughout your birth experience.
Sometimes the hardest part of figuring out what you want from your birth experience is knowing what questions to ask. The Coalition for Improving Maternity Services (CIMS) has a set of ten great questions to get you thinking. Visit http://motherfriendly.org/resources/10Qfor this and other helpful information.
There is a lot to cover in a birth plan, but it needs to be short and organized. You can reference Appendix B (page 279) for many great resources for birth plans, but here are some basic examples of issues to cover in your plan:
Fetal monitoring (how much and what type)
Freedom of movement
Dealing with pain (movement, massage, relaxation, medications)
Hydration (IV or not?)
Interventions (breaking your water, speeding up labor, etc.)
Episiotomy (prevention techniques, etc.)
Positioning (standing, kneeling, squatting, etc.)
Nonseparation of mother and baby
Baby care (Do you want this done in your room?)
Emergencies (Do you want someone with you in the OR?)
Birth plans should be discussed in advance with your practitioners—including the pediatrician—because they will be ultimately responsible for the care your baby receives at birth and during the postpartum period. Birth plans are usually signed by your doctor or midwife, any of their partners, and your pediatrician. Be sure to keep the signed original and give each practitioner a copy. It's also wise to take several copies of your birth plan with you when you give birth.
Childbirth classes educate you and your husband about pregnancy, birth, the postpartum period, breastfeeding, and much more. What is taught in each class will depend on the educator, the theme of the class, and the location. Be sure to ask the instructor what she plans to cover in the series of classes.
Take a class that covers everything, even details you don't think you'll need to know. For example, it is important that everyone understand the basics of cesarean surgery. While you may not think you will need a cesarean, once in labor it sometimes turns out to be the best birth method for women. It is equally important to learn techniques to help get you through labor without medication. That way, if you can't have medication or you prefer not to have it, you'll have the skills to help yourself during labor.
In choosing a childbirth class, it is important to remember that you get what you pay for. Just because a class is cheap, it does not mean you will get what you need out of the class. Be especially leery of free classes. Often these are overcrowded and run by people with their own agendas to push.
In addition to general childbirth classes, there are also specialty classes available. You might want to take an infant safety class or a vaginal birth after cesarean (VBAC) class. There are also classes on multiple births and breastfeeding. Specialty classes allow you to focus on a specific aspect that is important to you. Choose a class that has a great philosophy and an educator you like, and be sure it fits comfortably into your schedule.
There are many ways for childbirth educators to be trained. Most are certified by an organization like Lamaze International, the International Childbirth Education Association (ICEA), or the American Academy of Husband Coached Childbirth (AAHCC, Bradley). Be sure to ask your educator about her certification. Some insurance companies will reimburse your class fees because of the many benefits you get from class, but only if your educator is certified by a recognized organization.
Lamaze International has established the Lamaze Institute for Normal Birth, which focuses on six care practices that promote normal birth. These practices are based on evidence-based medicine, meaning that each is highly researched and in line with the safest medical guidelines available to date. You can access them online at http://normalbirth.lamaze.org/institute.