Your Delivery Options

A Birth Plan

A birth plan is a guide for how you would like your labor and delivery to go. The word “guide” is key. Since you can never know exactly how the process will go, you need to accept the possibility of changes once labor is underway. What is most important about a birth plan is that it encourages you to consider your options, discuss them with your partner and healthcare provider, and make your preferences known to your health care team. Many of the options that you may consider are described in this article.

Where to Have Your Baby

The three main options for where to have your baby are a hospital, a birthing center, and at home. Most hospitals offer special accommodations for moms. These may include a birthing room, which allows a woman to be in the same room before, during, and after her delivery. There are also private rooms with space for family members to sleep. Tour your hospital’s maternity ward to see what services are offered.

Birthing centers are designed to provide a more home-like setting, but with the technology of a hospital within reach. Such centers may be attached to a hospital or be separate entities. A birthing center is appropriate for a healthy woman with a healthy (“low-risk”) pregnancy. Some people believe the home is the most comfortable and natural place to give birth. However, because birth can be unpredictable, at-home births are not recommended by most physicians. If you decide to have a home birth, you should have an experienced attendant and a plan for reaching medical care quickly if the need arises, and you should be aware that it is not always possible to reach the hospital in time to avert problems related to attempted home births.

Who Will Assist in Your Baby’s Birth

An obstetrician/gynecologist (ob/gyn) is often the natural choice to deliver your baby. If you have a high-risk pregnancy, your doctor may refer you to a perinatologist. This is an obstetrician who specializes in high-risk pregnancies. In some areas, family practitioners receive special training in obstetrics and may also deliver babies. This is especially true in rural areas or where there are few ob/gyns. A certified nurse-midwife is trained to take care of healthy women who are expected to have an uncomplicated labor and delivery. Midwives work closely with a physician who is available for consultation or to step in if complications arise.

Indications for a Cesarean Section

]]>Cesarean section]]> (c-section) is the delivery of a baby via surgery, rather than ]]>vaginally]]> . The physician makes incisions in the abdominal wall and uterus in order to remove the baby. A c-section is done if the health of the mother or baby would be endangered by a vaginal delivery. Some c-sections are planned, but many occur on an urgent or emergency basis.

In most cases, a c-section is a need, not an option. Talk to you doctor about your risk for a c-section. Conditions that call for a c-section include the following:

• Cephalopelvic disproportion (CPD)—the baby’s head is too big to fit through the mother’s pelvis.
• Fetal distress—the baby is not receiving enough oxygen.
• Abnormal position of the baby—the baby should be delivered head first with the chin tucked under. If the shoulder, bottom, legs, or extended head is in position to come out first, a c-section may be necessary. When the bottom comes first, it is called ]]>breech]]> .
• Prolapsed cord—the umbilical cord is in the birth canal ahead of the baby. The cord may be compressed and cut off the baby’s oxygen supply.
• Abruptio placentae—the placenta separates from the uterine wall before birth. This can cause the mom and baby to hemorrhage, which can cut off the baby’s oxygen supply.
• ]]>Placenta previa]]> —the placenta partially or completely covers the cervix. In some cases, this can cause the placenta to deliver before the baby, which cuts off the baby’s oxygen supply.

Cesarean Delivery

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When considering the possibility of a c-section, remember the number of people allowed in the operating room is usually restricted to one. Consider who you want to be there with you when the baby is born.

If you had a c-section in a previous pregnancy, you may still have the option of a vaginal birth. Discuss the risks and benefits to having a vaginal delivery after a c-section with your doctor, and express your preference.

Putting It All Together

Although no one can predict exactly how your delivery will go, you can educate yourself and be prepared for most situations. Read as much as you can, talk with your doctor and your partner, and take the time to outline your preferences before labor starts. At the same time, remember that this is a natural process, and as much as you can prepare, you also have to prepared for last minute changes.