Third Times the Charm…

If you’ve been following my journey, or happen to be scrolling through my blog archives, you’ll know this is the third time I’ve tried to get The Bump, Birth, Baby Network off the ground.

The first hiatus I took due to pregnancy, maternity leave, and then beginning work full-time instead of part-time.
My second hiatus came abruptly due to unexpected job loss, family obligations, and some unresolved birth trauma. I went from thinking the birth field was going to be my life, to spending 14 months thinking I would never be able to speak about it again.

Well here I am. Trying one last time (I say that now but who knows what the future holds). Starting off slowly. Holding realistic expectations.

I knew there was a reason I didn’t want to let my domain name expire 😉

The plan currently is:

  • Begin offering childbirth education classes again
  • Re-establish connections in the birth community
  • Launch my teen parent outreach program
  • Starting in fall 2019 offer doula and photography services again

Wish me luck!

Midwife 2020

I am very excited to announce my new plans for the future.

I have registered for college and plan to become a certified-nurse midwife!

If all goes according to plan I should be entering my final year of schooling in 2020 (hence the name of this post and the new name for the blog).

Bump, Birth, Baby is not gone forever, I plan to change the focus of the blog to documenting my studies, interesting things I learn, and it will be a place where I can vent about the stresses of school. When I return back to “Bump, Birth, Baby”, it will be as a CNM and I will focus on building my new network of referrals I can send clients to.

Going to school was something I thought I’d never do. For a moment I regretted not going straight out of high school, but then I realized there is NO WAY I would have EVER gone for nursing let alone midwifery. It is going to be a long journey but as one of my co-workers says to me frequently in regards to schooling, “7 years is going to pass anyway and at the end of it you can be doing what you’re doing now or have a new career”. Truly though, I know I am not getting that late of a start. I should be a CNM the same year I turn 30.

Your support on the journey means to world to me. I cannot do this alone and I appreciate all the people rooting me on and giving me the tools to succeed.

Stay tuned for more updates, a fundraising campaign, and lots of new knowledge about bumps, births, and babies.

A short and to the point article about the rallies being held tomorrow!

 Even if you can’t  join in tomorrow, this website is one you must check out if you have even the slightest interest in child-birth rights for women.


The Largest Women’s Rights Movement in Decades

A monumental uprising is on the horizon. Thousands of men, women and children will gather on September 3rd. The rallies are being hosted in over 100 major cities, coast to coast, for Improving Birth’s “National Rally for Change on Labor Day”. Thanks to the intricate nature of social media, has been able to organize a massive movement to bring awareness to the lack of evidence-based maternity care in the US. With supporters like talk show host Ricki Lake, super model Christy Turlington tweeting about the event, and sponsors such as “InternationalCesareanAwarenessNetwork” and the “AmericanAssociationofBirthCenters,” this is sure to be an impactful event.

Much of scientific evidence takes an average of 20 to 30 years to become standard practice in our maternity care system; this is an unacceptable time table especially when talking about the well being of mothers and babies. Until we get it right, we are needlessly subjecting mothers and babies to major abdominal surgery, the long term side effects that go along with that and the unnecessary risk of death for both.

“Despite the dire situation, this is not a protest,” says Dawn Thompson, founder of ImprovingBirth. “It is a public awareness campaign to bring attention to the outdated practices that have been proven time and again to not be what is best for mothers and babies.”

Ina May Gaskin, Midwife and Right Livelihood Award winner, says “We need medical practice standards at both the federal and the state level that would address C-sections performed without medical justification and assure more mother-friendly births and fewer medical interventions during labor.” This is just one of the six steps Gaskin believes to be essential in obtaining better maternal healthcare.

Improving Birth was founded with the vision of encouraging hospital administrators to review their birth-specific policies and procedures. We ask that they implement incentive programs for doctors and nurses to get up-to-date information and education about the most current care practices.  The U.S. outspends every country in the world for maternity care, and yet we rank #49 for maternal mortality rates.  In fact, Amnesty International reports that “women in the US face a greater risk of maternal death than nearly all European countries, as well as Canada and several countries in Asia and the Middle East.”

We Can Do Better.

For more information about the National Rally for change, visit .


Healthy Pregnancy Prep Poll

Please check out my latest poll on Facebook regarding my Healthy Pregnancy Class!

I would truly appreciate everyone’s feedback about what YOU would be interested in learning if you were to attend a healthy pregnancy seminar.

 I am hoping to host my first class in mid-September at Lonestar Baby and Kids in Frisco.

I have another meeting with the manager on Monday and hope to have good news…wish me luck!

Thank you for your support!

10 Tips for Natural Childbirth…from an OB!

It is so hard to find OBGYNs who are not only supportive of natural birth, but will also help you achieve your goals. I’ve heard too many stories of “my doctor said I can have a natural birth IF I go into labor by my due date, labor on back, and am checked into the hospital for less than 24 hours. Otherwise he/she will intervene”. So when I saw this article circulating around Facebook I had to share!

The Pregnancy Companion’s Top Ten Tips for Natural Childbirth

10. Be  Healthy Before You Get Pregnant

The journey of natural birth begins well before the first contractions. Actually it starts before the pregnancy test fades to pink. For a healthy baby and natural birth, the best first step is a healthy mom. Obesity is one of the biggest risk factors for gestational diabetes and pre-eclampsia.  Both of these conditions often require induction (see #1) which can decrease your chances of successful natural childbirth and increase your risk of cesarean section.   Chronic medical conditions such as asthma, hypertension, hypothyroidism and diabetes can also causes pregnancy complications. Having them under optimal control before conception is key. 

9. Know Why You Are Choosing Natural Childbirth

Do not choose natural childbirth because your mom did it, your husband thinks you should or all the girls in your MOPS group are doing it. You choose it because in your heart of hearts you know that natural childbirth is important to you.  You must truly believe that its the best thing for you and your baby.

This is your birth, your delivery, your decision.  It’s your vagina that’s getting a cantaloupe squeezed through it.  It has to be your conviction.

8. Have a Strategy

Natural childbirth will likely be one of the most challenging things you ever do in your life. You need to be prepared. Whether it’s Lamaze, Bradley or hypnobirthing, know what your plan is for when things get bad. After you formulate a plan check to see what items your hospital has available (i.e. showers / birthing tub) and what you need to bring (i.e. Yoga ball). Practice the different birthing positions. Keep a list of your pain management strategies.

7. Have a Good Coach

When you are in transition and you are experiencing pain on a level that you have never felt before, you may not remember all those birthing strategies you practiced. That’s why you need a coach.  Some husbands are great at this, others not so much. If your husband may not be the best birth coach, hiring a Doula (a professional birthing coach) may be a good option.

6. Have a Really Quick Labor and Come to the Hospital  When You are 7 cm

Or at least labor at home as long as possible. Discuss with your provider how soon you need to come to the hospital. This will be dependent on how dilated you are, how many babies you have had and how far you live from the hospital.

Having a quick labor is also helpful, but sadly I don’t have the magic recipe for that or else we’d be selling a lot more books.

5. Be Determined

I have a lot of patients who tell me, “Well I want to try to go natural, but leave the option open for epidural if it gets really bad.”  These women, with the rare exception, end up with epidural. Labor is stinking hard and it does get bad. Of the women who say epidural is not an option, about 50% of them make it natural.

Realize this is going to be hard and stick to your guns.

4. Don’t Listen to the Haters

If natural childbirth is important to you then it doesn’t really matter if anyone else thinks you can do it, it only matters if YOU think you can do it.  I have patients ask me all the time if I think they will make it natural.  I always say, that anything is possible.

I have been proved wrong many times by patients who succeeded in natural childbirth despite the odds. Patients I thought would cave – like the unprepared teenager who had to be induced, but was just stubborn enough to stick to her guns and make it natural. There have also been patients who I swore would make it, like the 30 something with a 10 page birthplan and the Bradley book memorized, who got her epidural at 1 cm.

3. Don’t Get Fat

When you gain weight in pregnancy you gain it EVERYWHERE, including your pelvis. The fat takes up space in the birth canal that the baby desperately needs to squeeze through.  All those extra calories can lead to a big baby, making it even harder for the baby to come out. Additionally, packing on the pounds increases your risk of pre-eclamplsia and gestational diabetes, both of which increase the need for induction and cesarean section.

A normal BMI patient should gain between 25 – 30 pounds during pregnancy with the majority of that being after 20 weeks.

It’s all about moderation:  Give into to your crazy pregnancy cravings twice a week not twice a day.

2. Keep Walking

Gravity is your friend. Stay mobile in labor as long as possible, let gravity help urge the baby further down into the birth canal. When walking hurts too much, rock on a yoga ball or stand and sway your hips back and forth.  Stay out of the bed as long as possible.

1. Avoid Induction

Natural childbirth is hard. With the rare exception, its one of the hardest things you’ll every do. Natural childbirth with pitocin is even harder. It can be done, but it makes the already crushing contractions even more abrupt and intense. Some medical conditions do necessitate induction, but if you can avoid it, that  is your best option.

I must now give a disclaimer: I have never personally experienced natural childbirth.  If you want me to be totally honest, I have never actually had a vaginal delivery. But I’ve delivered over a thousand babies, so I have observed many natural labors.  These are the strategies that I’ve observed leading to the most successful natural births.

read the whole article and check out Dr Rupe and Jessica’s Blog here –>

Evidence Based Birth

I just began following a blog called Evidence Based Birth written by Rebecca L. Dekker, PhD, RN, APRN.

Her latest post about what a hospitals maternity care SHOULD be like really struck a chord with me. I absolutly  love the way she has broken down the meaning behind “patient centered” care.

 I have a feeling I’ll be sharing more of her research in the future!

“According to the Institute of Medicine, patient-centered care takes into consideration patients’ personal preferences, cultural traditions, values, families, and lifestyles. Patient-centered care empowers patients to be responsible for their self-care. It reduces the use of healthcare interventions that are unwanted, inappropriate, or not needed.

Another definition has been offered by Donald Berwick, the President of the Institute for Healthcare Improvement:

Patient centered-care includes transparency, individualization, recognition, respect, dignity, and choice in all matters– no exceptions– related to one’s person, circumstances, and relationships in health care. In other words, it is care that is wanted and needed provided at a time when it is wanted and needed.

I would argue that because the majority of pregnant women are not sick, they are not patients. Technically we should be talking about “woman-centered” care or “family-centered” maternity care. But for the purposes of simplicity, I will be using the medical term “patient-centered.” “

check out her full article and the rest of her site here!

“What to reject when you’re expecting”

I loved the title of the article from Consumer Reports I had to share it!

The following is their list of the top 10 most over used procedures you should research before consenting to. I love that such a mainstream company is backing these practices.

To find out more details on each procedure listed check out the article here

1. A C-section with a low-risk first birth

2. An automatic second C-section

3. An elective early delivery

4. Inducing labor without a medical reason

5. Ultrasounds after 24 weeks

6. Continuous electronic fetal monitoring

7. Early epidurals

8. Routinely rupturing the amniotic membranes

9. Routine episiotomies

10. Sending your newborn to the nursery

The article continues and lists the 10 things you should do while pregnant

1. Set your due date. This is the only one I disagree with. Babies are not cakes and do not have a set time they are guaranteed to arrive. Save yourself the stress and set a “due time period” of 2-3 weeks when your baby could arrive.

2. Make a plan—and have a backup.

3. Consider a midwife.

4. Reduce the risks of an early delivery.

5. Ask if a breech baby can be turned.

6. Stay at home during early labor.

7. Be patient.

8. Get labor support.

9. Listen to yourself.

10. Touch your newborn.

I don’t think I could have made a better list myself. These are topics I discuss every week in my birth classes and think more families need to know about their options and choices during pregnancy, labor, and birth! Thank you Consumer Reports for such a wonderful article!

How To Love Your Labour – Review

After a brief hiatus (my husband and I finally got to have a wedding ceremony for family to attend and got a mini honeymoon!!!) I’m back to blogging!

One of my fellow momma bloggers and natural child birth advocates, Tracy Rose of Natural Childbirth World, had just published an e-book “How to LOVE Your Labour”. I had the honor of reading her amazing story and she has asked I write a review…here it is 🙂

How to Love Your Labor is inspiring and encouraging to say the least. With the perfect balance of medical facts and personal stories, Tracy Rose gives a great over view of the joys of natural child birth. I could relate so easily to the fears and thoughts she had as an expecting mother and am sure other moms will be able to connect as well. She introduces many topics couples need to research including risks of cesareans and epidurals. Everything in this book is presented in way that is reassuring to those who doubt they can have the birth they want. She gives great insight into being flexible, listening to your body, and the importance of a supportive birth team. Whether you’re a first time mom or you’ve had a previous birth that did not go well, How to Love Your Labor can definitely help calm some of your anxieties. As a birth instructor myself, I will definitely be recommending this book to all of my moms who have a fear of labor or birth.

“Ultimately it is less important which particular branded course you do, what is really important is that you educate and empower yourself with great knowledge so that you can make a decision that is best for you and your baby.” Tracy Rose

Tracy is truly an inspiration and I know you will love reading about her personal triumph and struggles. If you would like to purchase a copy of How to LOVE Your Labour you can visit her website or if you’d like to


please like us on Facebook and answer the question posted 4/23/11 “What preparations have you done (did you do) leading up to your birth?” A winner will be selected May 5th!

science vs technology

This is a wonderful article from the latest issue of The Atlantic. If taking care of a 6 month old wasn’t so time consuming (I’m not complaining though cause I love her so stinkin much) I’d like to write articles this  long and in depth! It talks about the same things I have shared in the past about birth choices, education, and having a “medically uninteresting” pregnancy. Enjoy!


When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. What they don’t envision is the omnivorous, pants-wearing science geek standing before them.

Indeed, they become downright confused when I go on to explain that there was really only one reason why my mate — an academic internist — and I decided to ditch our obstetrician and move to a midwife: Our midwife could be trusted to be scientific, whereas our obstetrician could not.

Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.

But most birthing women don’t seem to know this, even if their obstetricians do. Paradoxically, these women seem to want the same thing I wanted: a safe outcome for mother and child. But no one seems to tell them what the data indicate is the best way to get there. The friend who dares to offer half a glass of wine is seen as guilty of reckless endangerment, whereas the obstetrician offering unnecessary and risky procedures is considered heroic.

When I was pregnant, in 2000, and my mate and I consulted the scientific medical literature to find out how to maximize safety for me and our child, here’s what we learned from the studies available: I should walk a lot during my pregnancy, and also walk around during my labor; doing so would decrease labor time and pain. During pregnancy, I should get regular check-ups of my weight, urine, blood pressure, and belly growth, but should avoid vaginal exams. I should not bother with a prenatal sonogram if my pregnancy continued to be low-risk, because doing so would be extremely unlikely to improve my or my baby’s health, and could well result in further tests that increased risk to us without benefit.

According to the best studies available, when it came time to birth at the end of my low-risk pregnancy, I should not have induction, nor an episiotomy, nor continuous monitoring of the baby’s heartbeat during labor, nor pain medications, and definitely not a c-section. I should give birth in the squatting position, and I should have a doula — a professional labor support person to talk to me throughout the birth. (Studies show that doulas are astonishingly effective at lowering risk, so good that one obstetrician has quipped that if doulas were a drug, it would be illegal not to give one to every pregnant woman.)

In other words, if the regular low-tech tests kept indicating I was having a medically uninteresting pregnancy, and if I wanted to scientifically maximize safety, I should give birth pretty much like my great-grandmothers would have: with the attention of a couple of experienced women mostly waiting it out, while I did the work. (They called it labor for a reason.) The only real notable difference was that my midwife would intermittently use a fetal heart monitor — just every now and then — to make sure the baby was doing okay.

My obstetrician and his practice had made clear that they were rather uncomfortable with this kind of “old-fashioned” birth. So we left, and engaged a midwife who was committed to being much more modern. And the birth I had was pretty much as I have described. Yes, it hurt, but my doula and midwife had prepared me mentally for that, assuring me that this kind of special pain did not have to result in fear or harm.

We did end up with one technological intervention: because my son had meconium in his fluid (this means he’d defecated in the womb), the midwife explained to me that right after birth, the pediatricians would be scooping him up to suck out his trachea (his windpipe). The idea was to prevent pneumonia. They did this, and three months later over breakfast my husband presented me the results of a randomized control trial that had just come out: it showed that babies in this situation who only had their mouths and not their tracheas cleaned actually had lower rates of pneumonia compared to those who got the tracheal intervention. Another intervention that turned out not to be worth it.

So why is it that, over a decade later, when the evidence still supports a low-interventionist type of pregnancy and birth management for low-risk cases, we’ve made virtually no inroads to making birth more scientific in the United States.

I put that question to a few scholars who work on this issue. One of them, Libby Bogdan-Lovis of the Center for Ethics and Humanities in the Life Sciences at Michigan State University, happens also to have been my doula. (Lucky me.) Libby noted that a big part of the problem is the way birth is conceived in America — as “dangerous, risky, and in need of control to ensure a good outcome.”

Libby pointed out that institutional strictures contribute to the problem: “Insurance companies generally cover hospital birth, not home birth, they are more inclined to compensate doctors over midwives, they compensate doctors and hospital-based midwives for doing something over doing nothing, and the health care system’s risk management approach backs those who can demonstrate that they did everything possible in terms of intervention.” All this in spite of the fact that, as Libby notes, “attempts to control birth are fraught with real medicalized risk and commonly lead to cascades of interventions.”

Raymond De Vries, a sociologist in the University of Michigan’s Center for Bioethics and Social Science in Medicine, has compared birth in the U.S. to that in the Netherlands, where he is a visiting professor at the University of Maastricht. He finds that, in the U.S., “obstetricians are the experts and the experts have come to see birth as dangerous and frightening.” De Vries suggests that the organization of maternity care in this country — “the limited choices that American women have for bringing their baby into the world, what women are not told about dangers of intervening in birth, and the misuse of science to support the new technologies of birth” — actually constitutes an ethical problem, although we typically do not recognize it as one. Medical ethicists “would rather look to the [comparatively rare] problems of in vitro fertilization and preimplantation genetic diagnosis than to the every day issues of how we organize birthhere in the U.S.; they would rather talk about preserving women’s ‘choices’ than to explore how those choices are bent by culture.”

So true. Ethicists love to talk about women’s birthing choices as if they are informed and autonomous, but I can’t count how many women have said to me that they “chose” pain medication during birth even though they were never told the risks of pain medication, never had anyone express confidence in them that they could birth without medication, and were never offered a doula to walk and talk them through the pain. What kind of “choice” is that? As Libby Bogdan-Lovis told me, “Today’s average childbearing woman thinks the notion of an unmedicated birth is the equivalent of suggesting that women should eagerly embrace torture.”

I think of all the choices I made, the one that shocked my peers most was not getting a prenatal ultrasound. But just a few years before I became pregnant, a major U.S. study — involving over 15,000 pregnancies — published in the New England Journal of Medicine showed that routine ultrasounds did not leave babies safer. That work was led by Bernard Ewigman, now chair of family medicine at the University of Chicago and NorthShore University Health System.

I recently called Dr. Ewigman and asked him why so many low-risk pregnancies now involve routine ultrasounds. He suggested that it was partly emotional — people like to “see” their babies — and partly due to the unsubstantiated belief that knowing something is necessarily going to lead to better outcomes than not knowing. But, he agreed, routine prenatal sonograms in low-risk pregnancies (that is, pregnancies in which there have been no problems) do not appear to be supported by science, if the outcome you’re seeking is reducing illness and death in mothers and children. Routine prenatal sonograms don’t seem to be dangerous, but they are also not health-giving.

Dr. Ewigman told me, “The approach you took to your pregnancy was rational and well informed. But most decision-making when it comes to medical issues involving a pregnant woman or baby are not well informed and not based on rational thinking.” He added: “We’re all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don’t exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome.”

Dr. Ewigman and I talked about how some people derive false certainty from prenatal sonograms, thinking that if the clinicians see nothing unusual, the baby will be born perfectly healthy. I explained to him that that was one reason I didn’t bother; I knew from my own research on birth anomalies how often sonograms mislead. He observed that our culture has “a real fascination with technology, and we also have a strong desire to deny death. And the technological aspects of medicine really market well to that kind of culture.” Whereas a low-interventionist approach to medical care — no matter how scientific — does not.

I’m not against taking into account, when making birthing choices, the kinds of hard-to-measure outcomes that may matter deeply to some pregnant women. I get that there are some women who don’t want a baby shower like mine, where most of the gifts consist of yellow and green baby clothes, instead of pink or blue. I get that some want to have those fuzzy pictures of the babies in their wombs. I get that some might want to abort if a sonogram were to show a major anomaly.

And I get that some women want a particular experience of birth — I mean, I really get that now that I have had a birth that left me feeling more powerful, more humble, more focused, and more devoted to my lover than I ever thought I could feel.

But I wish American women were told the truth about birth — the truth about their bodies, their abilities, and the dangers of technology. Mostly I wish all pregnant women could hear what Libby Bogdan-Lovis, my doula, told me: “Birthing a baby requires the same relinquishing of control as does sex — abandoning oneself to the overwhelming sensation and doing so in a protective and supportive environment.” If only more women knew how sexy a scientific birth can be.

By: Alice Dreger


What is a birth plan?

I spend a lot of time looking for articles to share, but find that a lot of them are very medical minded and/or one sided. I am not anti-medicine I just belive a normal healthy birth is not the place for standard medical procedures. I have finally found an article that explains the different aspects of birth plans in a way that is very similar to what we teach in Bradley® birth classes. It states a variety of options available and leaves it up to the consumer, YOU, to choose what fits your life style best.

This article focuses on choices, education, and flexibility. I love that it talks about home, hospital, and birth centers as options for birth places and stresses the importance of knowing why you want what you say you want.

Of course there is much more information on each topic that you should research than is contained in this one article but this a great place to start when trying to come up with your birth plan!

In the happy haze of early pregnancy, you’re probably already thinking of baby names and planning to shop for baby clothes. The reality of labor and birth may seem extremely far off — which makes this the perfect time to start planning for the arrival of your baby by creating a birth plan that details your wishes.

What’s a Birth Plan?

The term birth plan can actually be misleading — it’s less an exact plan than a list of preferences. In fact, the goal of a birth plan isn’t for you and your partner to determine exactly how the birth of your child will occur — because labor involves so many variables, you can’t predict exactly what will happen. A birth plan does, however, help you to realize what’s most important to you in the birth of your baby.

While completing a birth plan, you’ll be learning about, exploring, and understanding your labor and birthing options well before the birth of your child. Not only will this improve your communication with the people who’ll be helping during your delivery, it also means you won’t have to explain your preferences right at the moment when you’re least in the mood for conversation — during labor itself.

A birth plan isn’t a binding agreement — it’s just a guideline. Your doctor or health care provider may know, from having seen you throughout the pregnancy, what you do and don’t want. Also, if you go into labor when there’s an on-call doctor who you don’t know well, a well thought-out birth plan can help you communicate your goals and wishes to the people helping you with the labor and delivery.

What Questions Does a Birth Plan Answer?

A birth plan typically covers three major areas:

1. What are your wishes during a normal labor and delivery?

These range from how you want to handle pain relief to enemas and fetal monitoring. Think about the environment in which you want to have your baby, who you want to have there, and what birthing positions you plan to use.

2. How are you hoping for your baby to be treated immediately after and for the first few days after birth?

Do you want the baby’s cord to be cut by your partner? If possible, do you want your baby placed on your stomach immediately after birth? Do you want to feed the baby immediately? Will you breastfeed or bottle-feed? Where will the baby sleep — next to you or in the nursery? Hospitals have widely varying policies for the care of newborns — if you choose to have your baby in a hospital, you’ll want to know what these are and how they match what you’re looking for.

3. What do you want to happen in the case of unexpected events?

No one wants to think about something going wrong, but if it does, it’s better to have thought about your options in advance. Since some women need cesarean sections (C-sections), your birth plan should probably cover your wishes in the event that your labor takes an unexpected turn. You might also want to think about other possible complications, such as premature birth.

Factors to Consider

Before you make decisions about each of your birthing options, you’ll want to talk with your health care provider and tour the hospital or birthing center where you plan to have your baby.

You may find that your obstetrician, nurse-midwife, or the facility where they admit patients already has birth-plan forms that you can fill out. If this is the case, you can use the form as a guideline for asking questions about how women in their care are routinely treated. If their responses are not what you’re hoping for, you might want to look for a health provider or facility that better matches your goals.

And it’s important to be flexible — if you know one aspect of your birthing plan won’t be met, be sure to weigh that aspect against your other wishes. If your options are limited because of insurance, cost, or geography, focus on one or two areas that are really important to you. In the areas where your thinking doesn’t agree with that of your doctor or nurse-midwife, ask why he or she usually does things a certain way and listen to the answers before you make up your mind. There may be important reasons why a doctor believes some birth options are better than others.

Finally, you should find out if there are things about your pregnancy that might prevent certain choices. For example, if your pregnancy is considered high risk because of your age, health, or problems during previous pregnancies, your health care provider may advise against some of your birthing wishes. You’ll want to discuss, and consider, this information when thinking about your options.

What Are Your Birthing Options?

In creating your plan, you’re likely to have choices in the following areas:

Where to have the baby. Most women still give birth in the hospital. However, most are no longer confined to a cold, sterile maternity ward. Find out if your hospital practices family-centered care. This usually means the patient rooms will have a door, furnishings, a private bathroom, and enough space to accommodate a family, including the baby’s crib and supplies.

Additionally, many hospitals now offer birthing rooms that allow a woman to stay in the same bed for labor, delivery, and sometimes, postpartum care (care after the birth). These rooms are fully equipped for uncomplicated deliveries. They’re often attractive and have gentle lighting.

But some women believe that the most comfortable environment is their own home. Advocates of home birth believe that labor and delivery can and should occur at home, but they also stress that a certified nurse-midwife or doctor should attend the birth. An important thing to remember about home birth is that if something goes wrong, you don’t have the amenities and technology of a hospital. It can take a while to get to the hospital, and during a complicated birth those minutes can be invaluable.

For women with low-risk pregnancies who want something in between the hospital and home, birthing centers are a good option. These provide a more homey, relaxed environment with some of the medical amenities of a hospital. Some birthing centers are associated with hospitals and can transfer patients if necessary.

Who will assist at the birth. Most women choose an obstetrician (OB/GYN), a specialist who’s trained to handle pregnancies (including those with complications), labor, and delivery. If your pregnancy is considered high risk, you may be referred to an obstetrician who subspecializes in maternal-fetal medicine. These doctors have specialized training to care for pregnant women with medical conditions or complications, as well as their fetuses.

Another medical choice is a family practitioner who has had training and has maintained expertise in managing non-high-risk pregnancies and deliveries. In some areas of the United States, especially rural areas where obstetricians are less available, family practitioners handle most of the deliveries. As your family doctor, a family practitioner can continue to treat both you and your baby after birth.

And doctors aren’t the only health care providers a pregnant woman can choose to deliver her baby. You might decide that you want your delivery to be performed by a certified nurse-midwife, a health professional who’s medically trained and licensed to handle low-risk births and whose philosophy emphasizes educating expectant parents about the natural aspects of childbirth.

Increasing numbers of women are choosing to have a doula, or birth assistant, present in addition to the medical personnel. This is someone who’s trained in childbirth and is there to provide support to the mother. The doula can meet with the mother before the birth and can help communicate her wishes to the medical staff, should it be necessary.

Your birth plan can also indicate who else you’d like to have with you before, during, and immediately after the birth. In a routine birth, this may be your partner, your other children, a friend, or other family member. You can also make it clear at what points you want no one to be there but your partner.

Atmosphere during labor and delivery. Many hospitals and birthing centers now allow women to make some choices about the atmosphere in which they give birth. Do you want music and low lighting? How about the freedom to walk around during labor? Is a hot tub something you’d like access to? If possible, would you like to eat or drink during labor? You might be able to request things that may make you the most comfortable — from what clothes you’ll wear to whether you’ll have a VCR or DVD player in your room.

Procedures during labor. Hospitals used to perform the same procedures on all women in labor, but many now show increased flexibility in how they handle their patients. Some examples include:

  • enemas.Used to clean out the bowels, enemas used to be routinely administered when women were admitted. Now, you may choose to give yourself an enema or to skip it entirely.
  • induction of labor.At times, labor may need to be induced or sped up for medical reasons. But sometimes, practitioners will give women the option of getting some help to move things along, or giving labor a little more time to progress on its own.  
  • shaving the pubic area. Once routine, shaving is no longer done unless a woman requests it.

Other procedures that you can include in your birth plan are requests about fetal monitoring, extra birthing equipment you’d like in the room, and how often you have internal exams during labor.

Pain management. This is important for most women and is certainly something you have a lot of control over. It’s also something you’ll want to discuss carefully with your health care provider. Some women change their minds about pain relief during labor only to discover that they’re too far along in their labor to use certain methods, such as an epidural. You’ll also want to be aware of the alternative forms of pain relief, including massage, relaxation, breathing, and hot tubs. Know your options and make your wishes known to your health provider.

Position during delivery. You can try a variety of positions during labor, including the classic semi-recline with the feet in stirrups that you’ve seen in the movies. Other choices include lying on your side, squatting, standing, or simply using whatever stance feels right at the time.

Episiotomies. When necessary, doctors perform episiotomies (when the perineum — the area of skin between the vagina and the anus — is partially cut to ease the delivery). You may have one if you risk tearing or in the case of a medical emergency, but if there is an option, you can discuss your preference with your provider.

Assisted birth. If the baby becomes stuck in the birth canal, an assisted birth (i.e., using forceps or vacuum extraction) may be necessary.

Cesarean section (C-section). You might not want to think about this, but if you have to have a cesarean, you’ll need to consider a few things. Do you want your partner to be present, if possible? If you have a choice, would you like to be conscious or unconscious? What about viewing the birth — do you want to see the baby coming out?

Post-birth. Decisions to be made about the time immediately after birth include:

  • Would your partner like to cut the umbilical cord?
  • Does your partner want to hold the baby when the baby emerges?
  • Do you want immediate contact with the baby, or would you like the baby to be cleaned off first?
  • How would you like to handle the delivery of the placenta? Would you like to keep the placenta?
  • Do you want to feed the baby right away?

Communicating Your Wishes

Birth plans are relatively new inventions, and your doctor or nurse-midwife may not be completely comfortable with them. For this reason, make sure you communicate clearly that you intend to create a birth plan.

Give your health care provider your reasons for doing so — not because you don’t trust him or her, but to help ensure cooperation and to cover the possibilities if something should go wrong. If your caregiver seems offended or is resistant to the idea of a birth plan, you might want to reconsider whether this is the right caregiver for you.

Also, think about the language of your plan. You can use many online resources to create one or you can make one yourself. Here are some tips:

  • Make your birth plan read like a list of requests or best-case scenarios, not like a set of demands. Phrases such as “I would prefer” and “if medically necessary” will help your health care provider and caregivers know that you understand that they might have to alter the plan.
  • Think about the other personnel who’ll be using it — hospital staffers might feel more comfortable if you call it your “birth preferences” rather than your “birth plan,” which could seem as though you’re trying to tell them how to do their jobs.
  • Try to be positive (“we hope to”) as opposed to negative (“under no circumstances”).

Once you’ve made your birth plan, schedule a time to go over it with your doctor or nurse-midwife. Find out and discuss where you agree or disagree. During your pregnancy, review the birth plan with your partner periodically to make sure that it’s still in line with both of your wishes.

Strive to keep the plan as simple as possible — preferably less than two pages — and list them in order of importance. Focusing on your priorities will help ensure that the most important of your wishes are met.

You may also want to make several copies of the plan: one for you, one for your chart, one for your doctor or nurse-midwife, and one for your birthing coach or partner. And bringing a few extra copies in your labor bag is a good idea, especially if your doctor ends up not being on call when your baby is born.

Although you might not be able to control everything that happens to you during your baby’s birth, you can play a role in the decisions that are made about your body and your baby. A well thought-out birth plan can help you to do that.