The process of labor and delivery is such an exciting experience, but it is also painful and terrifying. Having a baby is a scary experience whether this is your first or fourth baby. One thing that helps women and families through this experience is having the opportunity to plan and mentally prepare for what to expect. That’s where your birth plan comes in. 

I would like to walk you through some of the common aspects of a typical birth plan. You can find outlines at your hospital, doctor’s office, and/or online. Once you have decided on what you would like I would recommend discussing this with your provider. There are many medical conditions that may change what is safest for you and your baby. 

One thing to keep in mind when forming your birth plan is that labor is a very dynamic and potentially dangerous process and things can change all the time. Please be FLEXIBLE. Everyone caring for you has one goal – a healthy mother and baby. Things don’t always go as planned (as anyone with kids already knows), but hopefully everyone is safe on the other side. 

When you come to the Labor and Delivery unit to be evaluated for labor, the first thing that will happen is they will take you to a triage area. In this area, one of the nurses will check your cervix to see if you are dilated. 

Unless you are in advanced labor, they will likely monitor you and the baby for the next hour and recheck your cervix. If you have not changed your cervix during this time they will likely send you home, even if you are contracting. This is because you are not yet in active labor. 

Active labor can come on suddenly, so just because they send you home does not mean you might not go into labor later that same day, but for many women it will be days to weeks before active labor sets in. If you do change your cervix then you are in labor! Yay! 

 At this point, you will be moved to a labor room. 

Now let’s talk about preparation for the big day. 

Before you go to the hospital: 

• Think about if there are any comfort objects you would like to have with you during delivery (remember delivery can get messy so make sure it is not something you would worry about ruining) 

• Do you want music available? – Bring it with you and something to play it on 

• Bring at least one change of clothes to go home in. You may also want your own pajamas and slippers. 

• Toiletries- hospitals typically have some basics for you, but if you want your own stuff you will have to bring it with you 

• Pictures!- Many hospitals have photographers that will come by after delivery and offer to take pictures of your little one and YOU! So you may want to keep that in mind when packing. Try and have these things packed in a bag or easy to find for when the big day comes. You probably don’t have to bring them up when first evaluated. I’d leave them in the car until admitted. 

 In the labor room: 

• Do you want an IV? 

o This seems to be a sticking point for some people because it makes the process seem more medical than natural. It is wonderful and natural process much of the time, but unfortunately emergencies happen and we would never want a delay in taking of you or your baby because we had no way to give medicine or fluids rapidly. 

 • Do you want IV fluids? 

o This is done for multiple reasons. The first is to help keep women hydrated during labor and delivery. 

  Why can’t I just drink water? In some cases you can, however, often women experience vomiting during labor. Also, should you need an emergency c-section, typically not predictable, we would want your stomach empty to decrease your risk of aspiration of stomach contents into your lungs. 

o However, if you desire the freedom of not being hooked up to an IV pole we can potentially do things like intermittent boluses of fluids or no fluids at all if preferred. 

• Fetal monitoring: 

Labor and delivery is the most stressful time in your baby’s life. This monitoring is designed to help detect when the stress is too much. This typically entails having two belts with monitors on them around your belly. 

 o If you are in spontaneous labor (not induced) and your baby is doing well we can sometimes do intermittent monitoring and allow you more freedom of movement, monitoring the baby for 20-30 mins an hour. 

o If you are requiring any medications to help augment your labor or to induce your labor, continuous monitoring may be recommended. Some hospitals will have ambulatory monitors so that you can walk and stay on the monitor. If you think this is something you may want, ask early, as these monitors are typically limited. 

 • Pain management: 

o Do you want an epidural? – For this, medicine is placed by an anesthesiologist in your spine to alleviate the pain of labor and delivery. Typically you receive a continuous infusion of medication that is stopped after delivery. Your sensation and movement usually recovers a few hours later. 

o Do you want IV pain medication? – This allows for temporarily pain control, but it does cross the placenta and can suppress the baby’s ability to take deep breaths at delivery if given too close to delivery. So typically it has to be stopped when delivery may be close (within a couple of hours). If it is given we can usually reverse the effects on the baby quickly, but we try and avoid having to do that. 

o Do you want to deliver without medications for pain? If this is the case I would recommend attending a class or some form of preparation for how to deal with the pain. Many hospitals have labor balls, rocking chairs, showers, and tubs (more rare) that you can use to help control your pain. If you don’t even want pain medication offered let your nurse know early so she can honor your wishes. 

• Do you want medication to augment your labor? 

o Pitocin is the most common medication for this purpose. 

  Benefits – shorter time in labor, and it may help your labor progress when it otherwise would have stopped or the prolonged labor put you and your baby at risk both of which could lead to a c-section 

 Disadvantages – labor tends to be more painful with Pitocin. It can make your contractions stronger, which can sometimes put more strain your baby, but monitoring typically allows us to make adjustments for this. 

o More natural ways to augment your labor can be walking and nipple stimulation 

• Do you want your water broken? 

This typically occurs during labor anyway, but sometimes your provider may want to do this sooner. 

o Why is this done? – This can be used as a way to help your labor progress without medication. It may also be done if internal monitors for your baby become necessary. 

o Why wouldn’t I want this done? - Labor typically becomes more painful once your water is broken. Having your water broken for over 18 hours prior to delivery can increase your risk of infection. • Would you like a mirror while pushing to be able to see your progress? 

o This is typically placed at your feet to allow you to see the baby’s head as it is coming down. 

• When and who do you want to cut the cord? 

o Typically there are about 3 different times the cord can be cut- immediately, at one minute, or at 5 minutes (or when the cord stops pulsing). In general the research supports waiting about a minute. The benefits of waiting beyond this may or may not be helpful. 

 o There are times when the cord may need to be cut quickly to allow for resuscitation of the newborn. In these situations, the cord can be “milked” 2-3 times to allow similar benefits to waiting a minute. 

• Do you want skin to skin as soon as possible? 

o For this the baby is placed on your chest as quickly as possible after delivery, usually with the initial resuscitation done on your belly and then once we are sure the baby is breathing well, the baby is placed on your chest. This has been shown to have multiple benefits including a more comfortable transition for the baby, improved bonding, and decreased time to initiate breastfeeding. 

• Do you want to breast feed? 

o Ideally breastfeeding for at least 12 months is recommended. However, even small amounts of breastfeeding have been shown to be helpful. This is a time consuming and sometimes painful commitment to make as a mother but even if you can only do it for a few days or few weeks you will have given your baby a leg up. 

 o Hospitals typically have lactation consultants available to you to help learn about breastfeeding and help your baby latch correctly 

• Do you want your baby to have a pacifier? 

o Some people become concerned about nipple confusion with the use of a pacifier and breastfeeding. This does not mean you can never use a pacifier, but you may want to wait until the baby’s latch is well established. 

• Do you want your male baby circumcised? 

o I would recommend discussing this with the doctor performing the procedure, in our area this is typically the pediatrician. 

 I encourage you to talk with your provider if you have any questions about these things or the labor process in general. You can also take classes to will help you better understand labor and delivery and/or take a tour of the unit in the hospital to help you prepare for your family’s big day! 

Congratulations and good luck!