Review choices for your labor and childbirth

In addition to attending childbirth classes in your final months of pregnancy, you and your partner may want to discuss with your health care provider

Don't be afraid to ask

When making a birth plan with your health care provider, don't be embarrassed by any question. For example, you may be wondering:

What if I have to go to the bathroom during labor?

In the past, it was normal for a woman to have an enema when she went into labor, the theory being that emptying the bowel reduced the risk of infection for the mother and baby and stimulated stronger contractions. This is no longer common practice. Your bowel usually will empty without intervention during labor. Occasionally, a small amount of stool is expelled during birth. This is perfectly normal and nothing to worry about.

Some women will be able to get up and urinate every few hours. Your health care provider will probably encourage you to do so because a full bladder may slow down the baby's descent. However, it may be difficult to sense a full bladder when you're having contractions, especially if you've had an epidural. Or you may not want to move, out of fear that doing so will worsen the contractions. Your health care team may provide you with a bedpan or intermittently empty your bladder with a catheter.

Will my pubic hair be shaved?

Not likely. Shaving a pregnant woman's pubic hair also used to be standard practice, to prepare a clean site for delivery. Now it's known that hair doesn't contribute to infection, so shaving is rarely, if ever, done.

Will I have to bare myself in front of a lot of strangers?

During labor, the health care team caring for you will perform periodic vaginal exams to check how you're progressing. During actual delivery, you're joined by your health care provider, labor coach and, typically, at least one nurse. A pediatrician also may be present to examine the baby right after birth. Who else you have in the labor room or birthing room is largely up to you. Medical professionals who help deliver babies see births almost every day, so they're used to the messy but awesome experience of birth. Some university hospital staffs may any questions you have about labor and childbirth. You can review any procedures, such as a Caesarean birth, that may become necessary.

Talk openly with your health care provider about how you want to deliver your baby. You can get ready by making some of these decisions now.

Discuss with your health care provider your preferences for pain relief. Even if you prefer to deliver without pain relief, you may want to learn about the main types of anesthetics used in childbirth. Regional anesthesia — which numbs the body from the waist down — is used most often today. An epidural is a form of regional anesthesia. It supplies a constant level of anesthetic through a flexible tube placed in your lower back. (See "Decision Guide: Understanding your pain relief choices" on page 325.)

ask if medical students can observe labors and deliveries, including, perhaps, your own. Remember that medical students, who also are professionals, may be able to lend a hand or extra support during your child's birth, so consider their presence an advantage.

What if I make loud noises during labor?

Labor is a physical act that requires your participation. Just as when you exert yourself at home while doing chores or exercising, you may make straining or grunting noises during the workout of labor. Don't worry about making noise during labor and delivery. It's perfectly normal, and medical professionals who help deliver babies won't be shocked in the least.

Does labor hurt the baby?

Although babies don't have a far distance to travel from the uterus to the outside world, the route can be challenging. During the hardest phases of labor and delivery, your baby is squeezed and pushed down the narrow vaginal canal. Your baby must also corkscrew through the bony passageway of the mother's pelvis. During intense labor, the baby's heartbeat slows down intermittently in response to the stress of the journey. But this is expected and not serious.

Your partner may wonder:

What if something happens to my partner during labor and delivery?

Most men don't admit they have a fear that their partner might die during delivery. But that fear can be a big one, voiced or unvoiced. Maternal death is extremely rare these days. If you have anxieties about your partner's well-being during labor and delivery, talk about them ahead of time with her or her health care provider. It can be a relief to hear from a medical expert the reassurances that labor and delivery has never been safer for women in the United States, thanks to the quality of medical care available.

Labor is work, and it isn't the time to learn and make decisions about the procedures that your health care provider has recommended. So review with your health care provider beforehand his or her preferences and usual practices. For example, what are his or her views on pain relief? When would medication be used to accelerate labor? Is he or she comfortable with birthing positions other than the traditional one of lying on the back? Under what circumstances would a cut to enlarge the vaginal opening (episiotomy) be performed?

In addition, find out what steps you should take once you're in labor. When should you notify your health care provider? Should you go directly to the hospital or call the health care provider's office first? Are there any other steps your health care provider wants you to take?

From discussions during your prenatal visits, you and your health care provider can form a written or oral birth plan — a guide to how you wish to deliver your baby. But remember: Any birth plan may need to change depending on the course your labor and delivery takes, so be realistic. And being realistic means being flexible. Think of your birth plan as a guide — not a mandate.

Most women giving birth for the first time don't have an accurate perception of what it will be like, and they may think that they're going to be more in control than they actually will be. In addition, not every labor goes according to plan, because no labor is like any other. Sometimes, problems occur that no one expected. That's when the health care team needs to respond promptly. If that happens, remember that you chose your health care provider because you trusted him or her. Control what you can — but be ready to let go of what you can't control.

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