What are our birth preferences?
What are birth preferences?
Your birth preferences are what the mom-to-be would like to have happen during and immediately after childbirth. Labor and delivery involve a lot of variables, however, and it’s helpful to discuss your preferences in case things don’t go as planned.
Discussing birth preferences with each other will make it easier for you to speak to your healthcare providers about this topic. A good healthcare provider will not only support your birth preferences but also be a trusted partner in helping you make informed decisions that prioritize the health and well-being of both you and your baby - even if things don’t go as planned.
Starting the discussion
You can start talking about birth preferences at any point. But give yourselves enough time to do any research you want, think things through, and make decisions. Keep in mind that your preferences might change as you learn more, so it's a good idea to check in with each other now and then.
Your decisions about birth preferences, your healthcare provider, and where to give birth are related - and I’d recommend discussing them as such. For additional information, check out our articles on these topics here and here, respectively.
Primary decision points for a vaginal birth
A vaginal birth can be spontaneous or induced. Spontaneous labor is when labor begins on its own and without the use of labor-inducing drugs or other interventions. Induced labor, or labor induction, is when your healthcare provider initiates labor using drugs or other techniques.
Inducing labor is a medical decision between you and your healthcare provider. You may schedule a labor induction when there is a risk to the health of the mother or baby or when the pregnancy has gone past the due date.
Pain management
There are different ways to manage pain during labor and delivery, including non-medical methods and medical interventions.
Non-medical methods
Controlled breathing exercises, such as slow, deep breaths or patterned breathing, can help you stay focused and relaxed during contractions.
Massage can alleviate muscle tension and promote relaxation, whether performed by your partner, doula, or yourself.
Hypnobirthing is meant to ease the pain and anxiety associated with childbirth by using hypnosis, deep breathing, visualization, meditation and other techniques.
Other methods include movement, heat or cold packs, position changes, hydrotherapy (laboring in water), and visualization or meditation.
Depending on your preferences and labor progress, these techniques can be used alone or in combination with medical interventions.
You can also use tools such as birthing balls, combs, or even a small handheld device that sends mild electrical impulses to pads on your back to block pain signals (transcutaneous electrical nerve stimulation - TENS).
Medical interventions
Epidurals provide effective pain relief through a catheter placed in the lower back. While an epidural can help you remain more comfortable during labor, it may limit your mobility and increase the likelihood of further interventions.
Nitrous oxide, or laughing gas, is another option that can be self-administered for mild to moderate pain relief without affecting mobility.
Birthing positions & movement
Having the freedom to move and explore various positions can allow you to work with your body to find the most comfortable and effective ways to navigate the birthing process.
Upright positions, including standing, walking, or sitting on a birthing ball, allow gravity to assist in guiding the baby through the birth canal. This could lead to shorter labor durations and reduced pain levels. Moreover, these positions can give you greater control over your body and the birthing process.
Alternating positions throughout labor, such as walking followed by periods of rest, can help manage pain and encourage the baby to move into an optimal position for delivery. Certain positions, like hands and knees, squatting, or lying on one's side, can help to open the pelvis and alleviate pressure on the back, which you may find beneficial during labor.
Internal exams
Cervical exams are a common practice used to assess the progress of labor, but you have the right to make informed decisions about whether or not to undergo these exams.
You may appreciate the information they provide about the progression of labor, or you may find them uncomfortable or invasive. You can also ask your healthcare provider to use alternative methods for assessing labor progress, such as external palpation or monitoring contractions.
Fetal monitoring
This allows your medical team to assess your baby's well-being during labor and delivery. There are two main types of fetal monitoring: intermittent auscultation and continuous electronic fetal monitoring.
Intermittent auscultation involves periodically listening to your baby's heartbeat using a handheld device, such as a Doppler or fetoscope and is typically recommended for low-risk pregnancies. Continuous electronic fetal monitoring, on the other hand, involves strapping two sensors to your abdomen to track your baby's heart rate and your contractions continuously.
This method is often used for high-risk pregnancies or if complications arise during labor. It's essential to weigh each method's benefits and potential drawbacks and consider your individual needs and preferences.
Ambience
Dim lighting, calming music, and personal touches can help create a more relaxing environment during labor.
Food
Eating during labor is a topic that has been debated among healthcare professionals for years. Traditionally, women were advised to avoid eating or drinking during labor due to concerns about aspiration (inhaling food or liquid into the lungs) if general anesthesia became necessary.
However, recent research suggests that consuming light food during labor may be beneficial. Studies have shown that eating during labor can provide energy, prevent dehydration, and improve overall comfort. Light snacks such as clear liquids, popsicles, or easily digestible foods like toast or crackers are often recommended.
Primary decision points for a planned C-section
A cesarean section, or C-section, is a surgical procedure in which the baby is delivered through incisions made in the mother's abdomen and uterus. You may schedule a planned C-section in advance due to certain factors, such as the baby's position or maternal health concerns.
Slow delivery
A slow delivery aims to mimic some of the processes that occur during a vaginal birth, allowing your baby to emerge from the incision slowly and giving them time to adjust to the world outside the womb. By opting for a slow delivery, you may be able to facilitate early skin-to-skin contact, delayed cord clamping, and a gentler transition for your baby.
Clear or lowered drape
A clear drape will allow you to witness the moment your baby enters the world, while a lowered drape provides a partial view of the birth. This option can create a more intimate and emotionally connected experience for both of you, as you'll be able to see your baby immediately after delivery.
As with a vagina delivery, discuss what kind of ambiance would help you feel most comfortable.
Primary decision points after birth
After your baby is born, the focus shifts to bonding and recovery. The Golden Hour refers to important practices that help stabilize both mother and baby right after birth. Key aspects include delayed cord clamping, at least an hour of skin-to-skin contact, conducting newborn assessments on the mother’s abdomen, postponing non-urgent tasks like bathing the baby for 60 minutes, and starting breastfeeding early. These practices help regulate the baby’s temperature, reduce stress for both the mother and baby, and strengthen their bond. They are also linked to higher rates and longer durations of breastfeeding.
Skin-to-skin contact
The baby is placed directly on your chest, helps regulate the baby's temperature, breathing, and heart rate while promoting bonding.
If you have a C-section, you can ask your healthcare providers to put the ECG electrodes where no contact will be possible with the new baby (at the back of the shoulders, for example).
Delayed cord clamping
You wait to clamp and cut the umbilical cord for some time after birth, typically 30 seconds to 3 minutes, instead of doing so immediately.
Delaying cord clamping allows more blood to transfer from the placenta to your baby, providing numerous benefits.
Research has shown that delayed cord clamping can increase your baby's iron stores, reducing the risk of iron deficiency anemia in the first year of life. It may also improve developmental outcomes and lower the risk of complications in preterm infants.
While healthcare providers often cut the umbilical cord, some couples choose to have the partner or support person do the honors.
Placenta delivery
After your baby is born, the placenta, which has nourished and supported your baby throughout the pregnancy, will also need to be delivered.
This process, known as the third stage of labor, typically occurs within 30 minutes after your baby's birth. Your healthcare provider will discuss your options, including active or physiological management of the third stage.
Active management involves medical intervention to help the uterus contract and the controlled traction of the umbilical cord to help deliver the placenta. Physiological management, however, allows the placenta to deliver naturally without intervention.
If you have a C-section, your doctor may use cord traction to gently pull on the umbilical cord after the uterus has contracted and the placenta has separated from the uterine wall. This technique is often used as part of an actively managed third stage of labor. Alternatively, the doctor might manually remove the placenta from the uterus if it doesn't come out on its own.
Feeding
Most babies start to show signs of wanting to feed soon after birth, and you'll need to decide whether to breastfeed or bottle-feed your baby after birth. Breastfeeding can be challenging initially, but lactation consultants and support groups can provide guidance and encouragement. For further information, check out our article on this topic.
Lactation consultant
Most hospitals and birthing centers have lactation consultants and nurses trained in providing feeding support. You can receive personalized guidance on proper latching techniques, comfortable positioning, and strategies for maintaining your milk supply by scheduling a consultation with them before you go home with your little one.
Newborn screenings & care
There are a few standard newborn screenings and care practices intended to keep your baby healthy and avoid problems. Screenings vary state by state in the US but often include heart, hearing, and jaundice screenings. Jaundice is a common newborn condition and can be treated with light therapy.
In addition, a small blood sample is taken from the newborn's heel within 48 hours of birth and tested for a variety of conditions.
Care practices include:
- A vitamin K shot to help their blood clot properly and prevents a serious bleeding issue.
- Antibiotic eye ointment to guard their eyes against infections that might happen during delivery.
- Hepatitis B vaccine to protect against hepatitis B, a liver disease.
Going home
The timing for going home after childbirth can vary based on the type of birth and individual circumstances. Most women who have a vaginal birth stay in the hospital for about 24 to 48 hours after delivery. This allows time for monitoring both mother and baby to ensure that there are no immediate complications.
Women who have a C-section generally stay in the hospital for about 2 to 4 days. This longer stay is due to the nature of the surgery and the need for more intensive recovery.
Some hospitals offer early discharge programs where, with proper support and if both mother and baby are healthy, you might be able to leave the hospital within 24 hours of a vaginal birth or within 48 hours of a C-section. This often requires a comprehensive discharge plan and follow-up care.
Discussing support options
Having your partner in the room can be physically and emotionally helpful. They can provide comfort measures such as massage, offer words of encouragement, or simply be a calming presence.
Your partner can also advocate for your wishes and help communicate with your healthcare team. By working together as a team and understanding each other's needs, you can create a supportive and empowering environment for welcoming your baby into the world.
Consider loved ones or a doula if you feel you’d benefit from additional support. For more information, check out our article on birthing doulas.
Understanding different scenarios
Labor and delivery involve a lot of variables, and things may not go as planned. Being informed about different possibilities can help you feel more prepared and empowered and think through your preferences in these situations.
You may also hit information overload, so discuss how much information works best for you. Topics you may want to consider learning more and asking your healthcare provider about are ways to initiate or augment labor, episiotomy, assisted delivery options, and emergency cesarean sections (C-sections).
Initiating or augmenting labor
If there’s a concern about your health or the baby’s or you’re two weeks past your due date, your healthcare provider may recommend initiating labor. They may recommend augmenting labor if labor is stalled or progressing very slowly.
One common approach is the use of Pitocin, a synthetic form of the hormone oxytocin. Pitocin is administered intravenously and works by stimulating uterine contractions.
Other techniques for inducing labor include the artificial rupture of membranes (AROM), also known as "breaking the water," which can stimulate the release of prostaglandins and encourage contractions.
Prostaglandin gels or suppositories, such as misoprostol, can also be applied to the cervix to promote ripening and dilation.
Episiotomy
An episiotomy is a surgical incision made in the perineum (the area between the vagina and anus) during childbirth to enlarge the vaginal opening and facilitate the baby's delivery.
While episiotomies were once routinely performed, current medical guidelines recommend their use only when necessary, such as in cases of fetal distress or when the baby is in an abnormal position. Research has shown that routine episiotomies do not prevent perineal tears and may even increase the risk of more severe lacerations.
Assisted delivery options
When labor is not progressing as expected, or the baby's safety is a concern, healthcare providers may recommend assisted delivery methods such as forceps or vacuum extraction.
Forceps are a pair of curved, spoon-shaped instruments carefully placed around the baby's head to guide it through the birth canal. Vacuum extraction involves using a soft cup attached to a vacuum pump, which is placed on the baby's head to help guide it out.
Both methods are generally safe when performed by a skilled practitioner, and they can help avoid the need for an emergency C-section.
Emergency C-sections
These are performed when unexpected complications arise during labor, such as if the baby is in distress or labor is progressing too slowly or stalling. While C-sections are generally safe, they carry a higher risk of complications compared to vaginal deliveries and require a longer recovery period for the mother.
Talking to your healthcare provider
Your healthcare provider, whether a doctor or midwife, will be your partner in ensuring a safe and positive birth experience. By asking questions and sharing your concerns, you can work together to make informed decisions about your birth preferences, helping you feel safe and comfortable during labor and delivery.
Communicating your preferences
Birth plan
You can create a birth plan to capture these decisions, making it easier to communicate them with your entire healthcare team - some of whom you may not have had the chance to discuss your preferences with beforehand - during labor and delivery.
Healthcare power of attorney & advance healthcare directives
A healthcare power of attorney lets you choose someone you trust to make medical decisions for you if you can't communicate during pregnancy or childbirth. Hospitals or birth centers will typically ask you to complete a form for this.
Advance healthcare directives, including a living will, let you specify your preferences for medical treatment in different situations. These documents help ensure your wishes are followed and ease the burden on your partner and family if problems occur.
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