1. Choose Your Birth Location and Provider(s)
Choosing WHERE you want to give birth and WHO you want to support your birth may be one of the most important factors in your birth experience. There is no one best place or best provider to support your birth, but it should be a provider that aligns with your birth philosophy.
If you are really wanting a home birth experience, don’t choose the hospital with the highest c-section rate; choose home birth, or if that is not an option for you, choose a hospital that is fairly supportive of physiologic birth. If you are a more high-risk patient, choosing a hospital with a high-level NICU may be a great option so that if your baby needs additional support after birth, you can stay co-located.
But, how do you know what hospital or birth location is the best for you? Some helpful people to ask may be local birth doulas.
Ask their opinion on different options available to you in your local area, or maybe only a short drive away from your local area!
The benefit of asking a birth doula is that we tend to be in an observatory role supporting birth, so we are able to notice trends between births we support in a hospital environment.
Now, we all carry bias based on our experiences, so it could be helpful to ask several doulas their opinions to get a better gauge on where you may want to give birth.
Another way to tell if a provider or clinic is a great match for you is to gauge how you feel during your prenatal appointments.
Do you feel that your provider is taking the time to answer your questions or to guide you through this process? Do you feel rushed, or that your concerns are dismissed?
Pay attention to how you feel during your appointments, and how well your questions are received by your provider. This could be a sneak peek into how you can expect your concerns to be addressed during your birth.
You want to be able to trust your providers to guide you through this likely new experience for your family. If you are hesitant or feel that you are not being cared for, it may make it challenging to trust their recommendations or advice during your pregnancy and birth experience.
This is why it is important you choose a provider that you can trust to have our best interest in mind and support our birth in the way you want to be supported.
2. Questions to Ask Your Provider
Another helpful way to plan for birth is to ask your provider questions! But, what questions do you even ask?? We may expect our provider to walk us through every aspect of pregnancy and birth before the big day, but sometimes they just don’t have the time in each appointment!
This is where taking a childbirth education course could be helpful for you to understand what your options are during birth, and you can then ask your provider more questions on the options you need more information on. Read the questions below to get an idea of the types of questions you can ask your provider.
We want to feel confident in the decisions that we make throughout our pregnancy and birth. If we do not feel confident, then we likely need more information. Confident doesn’t always mean we like the decision, such as I feel confident that choosing an induction is the best course of action for my baby and me, since I am developing this complication, but I didn’t want an induction. But, if we feel uneasy about a decision, we may just need to ask more questions so that we feel more comfortable with making a decision!
Some questions to ask:
Can you explain to me what I could expect at my prenatal appointments and tests that may be recommended throughout my pregnancy?
Can you explain the current visitor policy for my labor? Who can I bring to my birth, and are they able to leave or do they need to stay in my room with me the entire time?
I’ve read/learned about [this intervention], but I have questions on how it is used in your practice.
When do you recommend someone receive [this intervention]?
In what circumstances could I expect the provider to recommend [this intervention]?
How often do you find that patients need [this intervention]?
Are there things I can do to reduce my need for [this intervention]?
How could I expect my care to change if I receive [this intervention]? Examples could include increasing monitoring, restriction in movement, need for IV fluids, restrictions in labor comforts such as no shower if the monitoring is not wireless or portable.
What are the risks versus benefits of [this intervention]? Why are the benefits worth the risks?
Are there other options available instead of [this intervention], and if so, why do you or don’t you recommend that be the first course of action?
Can you walk me through situations in which you would recommend an induction of labor, and what I could expect if I had to be induced?
Can you walk me through what I could expect if I needed a cesarean delivery during my birth?
In what situations do you recommend a c-section?
What are the common practices done to help avoid a c-section? What could I expect my provider or nurse to do to help me have a vaginal birth before needing a c-section?
If I am developing a complication, such as a fever, or a decline in my or my baby’s health, during my labor that seems to be heading towards a c-section, what circumstances would prompt you to encourage my family and me to make a decision sooner rather than later? (this could be in situations where you are developing a fever, and your baby’s heart rate is not looking great, but no one is in danger yet.)
Is anesthesia assigned to the floor or the hospital? How quickly could I receive pain medication if I needed an emergency c-section?
How often do you have true emergencies?
These are just some of the questions you can ask, but you can see that exploring what you feel unsure about with your pregnancy and birth are great starting points to prompt conversation with your provider.
You will likely not be able to ask ALL of these questions in a single appointment, so it could be worth planning to ask a few at each appointment. Bringing a list of questions and concerns can help you navigate the conversation without completely relying on your provider to facilitate the education.
3. Deciding Your Birth Preferences/Philosophy
We are all unique individuals with different priorities as a family, so each of our birth preferences may be different, and that is okay! It could be worth imagining what you believe is your ideal birth. After exploring your ideal birth in its physical sense (such as what physically happens in your birth), imagine how you would feel in that scenario. Then, holding on to the feeling you are seeking, how can you create that feeling in different scenarios.
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Example: My ideal birth is to give birth at home surrounded by my family, with a provider that completely trusts my ability to give birth but is ready to respond in case of emergency. After describing that story to myself, I can then explore how I think I would feel in that situation, which is likely more what I am trying to achieve. I would feel surrounded by love, heard and respected by my provider, I would feel supported by my chosen birth team, and I would feel comfortable in my environment. How can I now achieve those same feelings should my birth story be different?
I can focus on ensuring I have my chosen birth team, or as close to the team as I wanted, since that seems associated with feeling supported by my team. I would ensure that I am choosing a birth location that allows me to have the support I desire, such as my partner and a doula. If a birth location has a history of restrictions on birth support team members, or is currently restricting visitors, I may want to choose another location.
If it is important for me to be heard and respected by my provider, I would want to ensure that I choose a provider that will be doing that for me, or a birth location where the team of providers listen to their patients and nurses are known for advocating for their patients. I can gauge this at my prenatal appointments on how well I am heard by my provider, and ask others their experiences with the staff in a birth location.
If it important that I feel comfortable in my environment, I can focus on what I would want to have access to in a facility that would make me feel more comfortable. This could include ensuring there is a shower and tub, and that they have wireless or portable monitors so that I can maintain access to that tub/shower. Bringing items from home that make me feel comfortable, such as wearing my own clothes and slippers, having my own pillow and blanket, and focusing on setting the environment in my room.
In each of those examples, you can see that I didn’t discuss what actually happens during my birth. I elaborate on how I can find certain feelings that are important to my experience. This may help you better navigate the unknown of birth!
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4. Understand Your “No”
As you learn more about birth options, you may decide that there are birth options that you absolutely do not want. This will vary from person to person, but it is important to establish your boundaries in a realistic manner. If you absolutely do not want a certain intervention, you will also need to understand the alternative in refusing an intervention. If you feel unsure about an intervention, then it may be worth exploring it more with your provider.
A common one that I will see in birth plans and in conversation with my clients are pushing interventions. Many of my clients will say: I do not want an episiotomy, or the use of forceps or a vacuum during pushing. It’s totally fine to say this is your no, but if there was a situation in which you or your baby needed the intervention, the alternative may be a cesarean delivery. For some of my clients, when they understand that, they may have further conversation with their provider on WHY those interventions may be recommended, the risk versus benefit, and how it may be more beneficial than the alternative. And for some of my clients, they still do not want the intervention, and would prefer the alternative should the situation demand it.
5. Rank Birth Options Based on the Scenario
There are so many paths that birth can take that may be out of our control, but we can still maintain the decision-making authority regardless of the path. It can be helpful to explore the different paths that birth may take, and rank order your preferences in each scenario. If this happens, then I would like to try this. If that doesn’t work, then I would like to explore this option next. And so on.
Possible Birth Paths:
Spontaneous Vaginal Birth
Induction of Labor
Cesarean Birth
Scheduled or planned
Unplanned (during labor)
Emergency (pre-labor or during labor)
And within each of these paths, there are numerous scenarios that could occur, such as spontaneous labor that requires intervention, or maybe you choose to get an epidural after planning to go unmedicated. Looking at each path, think of some possible scenarios, and then explore which birth options you would like to have available to you, and in what order, to help you navigate each situation.
Example:
Spontaneous Labor: Unmedicated Birth. Would like to limit interventions
But, water breaks before labor has begun and I have no contractions. If my fluid is clear and odorless, I would like to labor at home to see if I can bring on the onset of labor by breast pumping. If I still have no contractions after a certain number of hours, I will go to labor and delivery. If at any point my fluids color or smell changes, I will head into labor and delivery regardless of time frame. At labor and delivery, I would like my cervix to be evaluated to determine which labor induction method would be most optimal to begin my induction.
You can see from the example that I had a path I would have liked to start with, but circumstances in my birth adjusted the initial plan. I laid out my preferences of “if this then that” so that my partner and I had a clear understanding of what we would like to do in that situation. This would not necessarily be written out all on a birth plan to hand to your triage nurse, but would be worth discussing with your provider ahead of time and also with your partner, doula, and any other support team members, so that everyone is on the same page on your preferences.
Hope these tips help you plan for your birth! Learn more about birth planning in our childbirth education courses, or grab our free Birth Planning Guide for help in planning your birth