How Childbirth Works

Making a Birth Plan

To know what you want, you need to know what your options are.
To know what you want, you need to know what your options are.
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­Other than buying up supplies, staying healthy and going to the doctor regularly, there's not much for a pregnant woman to do but wait until the big day rolls around, right? Wrong. There are many decisions to be made and options to consider. That's why pregnant women often write a birth plan, a wish list for their ideal birth. There's no way to know ahead of time what might be medically necessary, but a birth plan is a way for her to express her preferences.

These preferences begin with the atmosphere in which she labors and delivers. Perhaps she'd rather have only necessary personnel in the room (no medical students or residents, for example), or she'd like the freedom to eat and drink while in early labor. Some doctors stress the importance of only having clear fluids or ice chips due to the possibility of anesthesia or surgery, but others have relaxed these rules. A woman in labor can also choose not to have her heart rate monitored and say no to an internal fetal monitor (which involves screwing an electrode directly into the fetus's scalp) unless doctors are concerned about the fetus's heart rate.

Most pregnant women feel strongly about pain relief during the childbirth process. Some would prefer to avoid medication, while others don't see anything wrong with taking drugs to help ease the pain. In a birth plan, women can indicate when they would like to be offered medication (as soon as possible or not until they ask for it) and what kind: an IV narcotic such as Stadol or an epidural. Some women also prefer nonmedical pain relief options, such as massages or warm showers or baths.

It's important for a woman to express her desire to deliver without intervention (including induction, forceps, vacuums or Cesarean) if that's what she prefers. There's also the issue of the episiotomy. This is when a doctor makes an incision in the perineum, the area between the vagina and the anus, to allow for a wider vaginal opening and a smoother delivery. After delivery, the perineum is stitched closed. Some women would prefer to have the tissue tear by itself (which sometimes happens) or try massages or warm compresses to try to stretch the area before resorting to an episiotomy. Critics claim that doctors are too quick to cut this sensitive area. It usually takes several weeks to heal following one, and some women have lasting pain during sexual intercourse afterwards.

Once the baby actually arrives, there are still many options. Perhaps the mother would prefer to have her partner cut the cord and have the baby laid on her chest immediately. Some don't care about who cuts the cord and would rather have the baby after he or she is cleaned and weighed. The mother can also refuse or delay some routine tests and treatments, or request that the baby stay in her room instead of being in the nursery. Some mothers who are breastfeeding prefer that their baby not be given bottles or pacifiers to avoid confusion, too.

But before we get to all of this in more detail, let's start with two very important decisions: who will deliver the baby, and where it will take place.