Pregnancy and birth are a really standard part of life. Yet the right pregnancy and birth for each of us is not so standard. In fact, there are a lot of decisions you can make to ensure this experience is the right one for you. Just don’t wait until you are in the middle of labor and your doctor is asking you about circumcision to make these decisions.
Below I have done my best to outline some of the most common pregnancy, birthing, and newborn decisions you can make. I will be telling you my personal stance on each of them before diving into detail so that I can be as transparent about the information I share with you as possible. I am trying to write without bias, but it’s nearly impossible to have no bias at all, so hopefully by telling you where I stand, you can take some of my opinions in stride and make a decision that is right for you (you’re the one having this baby after all, not me!).
Pregnancy Decisions
The decisions you make during pregnancy can alter the way you feel about your pregnancy. I fully believe that the more involved in the decision making process you are, the better you will feel about your overall pregnancy. As such, being proactive around what type of prenatal care you get and making your own educated decisions around exercise and nutrition are great ways to feel empowered in your pregnancy.
Prenatal Care
The two most common types of pregnancy care are either with your OBG-YN or your Primary Care Provider if appropriate and they are willing to see you. Another wonderful option though, and one that I highly recommend, is a midwife. You want to decide early on which of these providers you want to receive care with so that they can be with you through your pregnancy journey.
You will also want your care to be with someone who shares your values. You don’t want to be planning to breastfeed and find out you have a doctor who doesn’t support that process. Or on the flip side, if you know for sure you want to formula feed, some midwives will only work with you if you agree to breastfeeding. So take time to intentionally select this individual.
I do know from personal experience that sometimes, even if you want to give birth with a midwife, circumstances may cause you to switch to a doctor or hospital at the last minute. It is important to know that whomever you are working with has connections in a hospital if so needed. So make sure whomever you are working with can transfer you into a hospital both for emergency and non-emergency needs.
At your appointments, you will have to decide which tests to get and make other pregnancy care decisions. You will also have a chance to ask questions and kind of geek out about your pregnancy, so make sure the provider you end up with is someone you can enjoy and feel comfortable talking to. You don’t want to be in the middle of a yeast infection and not feeling comfortable telling your provider that something odd is going on down there.
Occasionally, ultrasounds are required because there is a concern about the health of your baby. However, most of them are not, and you are able to opt into which ultrasounds you do or do not want. You can read more about the most common ultrasounds you may be offered here. I had two non-essential ultrasounds with both of my kids. They aren’t the most important medical care to receive, but I found it to be really fun to see their little heart beat and their lanky and odd limbs, even if I can’t read a sonogram to save my life.
Some individuals believe that the technology behind ultrasounds is still too unstudied and may expose your unborn child to an unnatural and unnecessary risk. If you are feeling uncomfortable with the ultrasound process, there is nothing wrong with taking a moment to decide if you really want one, and if you do not, to let you care provider know that you would like to opt out.
I do, however, believe that some ultrasounds are vital and can actually save your baby’s life. In the 3rd trimester of my second pregnancy, my little one was still measuring very small, and we finally decided to go to get a late ultrasound just to see what was going on. Turned out that my baby was struggling and had it not been for the various ultrasounds (3 in the 72 hours leading up to the decision to have an early birth and a C-section) guiding me and my care provider’s decisions, I don’t know that my baby would have made it to term. So as much as I want to say make the decision exclusively around what works well for you, if your provider suggests it for medical reasons, I really would listen.
Eating
There are a lot of guidelines for every woman around how much weight she should gain during pregnancy. You need to decide what is right for you in this pregnancy, especially depending on how your pregnancy sickness is going. Honestly, my approach was pretty much just eating what I could manage to keep down and trying to hold down my prenatal vitamins for as long as possible. That may not sound like the most glorious or well educated approach ever, but when you’re staring at a toilet bowl for 4+ months straight, you get less educated.
As I’ve mentioned a few times, I had pretty miserable pregnancy sickness with both of my kids, including losing 25 pounds with my second kid and not getting back to pre-pregnancy weight until the week before they were born. As such, I think blindly prescribing an appropriate amount of weight gain to any woman is inappropriate and probably unrealistic. At the same time, the whole ‘eating for two’ nonsense also has to go.
You need to find and make the right eating decisions for you. Decide what sort of exercise you think you can maintain while pregnant, as well as what sort of journey you are interested in partaking in to work off the weight after birth. Don’t think you can eat an extra 2,000 calories a day and then lose all the weight you gained in just a few months. You want to aim for healthy, while avoiding hangry. Only you will know what that balance is though.
Birthing Decisions
The physical process of giving birth is loaded with opinions. As I have mentioned, I’m going to do my best to share with you what my opinions are so that you can see where I may hold a bias. My first birth was at home, and my second was a borderline emergency C-section in a hospital. Two vastly different experiences, and I will admit to being a pretty big fan of the home birth route. Still, you need to think about these types of questions so that you can make the decision that is right for you, your pregnancy, your comfort level, and everyone’s safety.
Home Vs. Hospital
One of the first big decisions you want to make may be home vs hospital. Now a lot of the notes below may help you make your decision. If you want a “natural” birth without medication, a low chance of C-section, no episiotomies, and a lot of control over your birthing environment, home may be the best choice for you. I know with my first, I had my little one, got snuggled into bed, my midwife cleaned up the house and helped me establish breastfeeding, and I didn’t even have to travel home. With my second birth in a hospital, I remember being woken up and nearly crying because I just wanted to sleep (also, I didn’t have my baby with me because they were in the NICU).
Your home birth with a midwife offers a lot of control and not a lot of interventions. You get to decide how you move, in what position you give birth, and what you eat. Every step of the journey really does feel controlled by you. You feel every contraction, every moment, and often, the very first person to hold your baby, is you. There is no exchanging that experience in my opinion. However, many states have a lot of weird and obnoxious laws around homebirth, including outright making midwives illegal. And I know there are other stupid rules, like you have 24 hours to give birth from the time your water breaks or you are supposed to go to a hospital. Things like that lie very much outside of your control, and that can feel frustrating to many women.
On the flip side of the coin, a hospital offers individuals a significant amount of security. Please note at no point did I ever feel unsafe with my home birth, but I also know that birth can suddenly go wrong. Being in a hospital already can help you feel more prepared for that ‘just in case’ moment. It gives you more options, such as internal and external fetal monitoring, pain medication, and if an emergency arises, no travel is necessary. The rate of unnecessary procedures at a hospital is higher though, including a higher rate of C-sections, inductions, and episiotomies. If these aren’t part of your ideal birth plan, you may want to look at alternatives before settling on a hospital.
"Natural"
I put natural in quotations because in my mind, there isn’t really anything about birth that isn’t natural. The term natural here though means without pain medication and with as little intervention as possible. This type of birth can occur at home or in a hospital. It means vaginally and without any medication, including Pitocin (to bring on labor) or an epidural (to ease the feeling of contractions, though you certainly still have contractions).
I believe that giving birth is one of the most beautiful, empowering experiences a woman can go through. I hear so many women say they are afraid of the pain, but I find that it isn’t as excruciating as we are taught to believe it will be. I think most women can go through the physical pain of labor and will be just fine.
Regardless of what you decide, you will be the one delivering your baby. Not the doctor, not your midwife, but you. Take away whatever empowerment you desire from that statement. Because no one can bring this exact life into the world except for you.
Movement
This may not be a choice for you depending on other interventions that you may or may not choose to partake in. I know I found walking between contractions to be really relieving and relaxing. I also think being able to switch positions, and to find whatever birthing position is right for you can be really beneficial. Movement can support the labor process and offer you some comfort.
Some hospitals will not allow you to move. Additionally, if you get an epidural, or even some types of fetal monitoring, you won’t be able to move. So if moving around during labor is important to you, you will have to seriously consider a birth with a different type of pain relief than the standard one offered.
Fetal Monitoring
Fetal monitoring is exactly what it sounds like: monitoring of the fetus. This device goes around your stomach and monitors the baby’s heart rate. This is useful in the event that you are having complications. I know with my second pregnancy, we were able to determine that the stress of labor would have likely been too difficult for Sprinkle and thus a C-section was the safest route. We were able to determine this through fetal monitoring.
On the flip side, with Monster, I had next to no fetal monitoring, except for my midwives occasionally listening with their stethoscopes. And Monster was just fine. My point here is that this one really depends on your circumstances. We knew Sprinkle might not be strong enough for labor, whereas we had no reason to think Monster wouldn’t breeze through without problem.
Some limitations of fetal monitoring are that they can be a little finicky. So you might be required to stay sitting and even requested to sit still (not a strength of mine). Some hospitals do offer traveling monitors that allow you to walk around though. It sort of depends on the technology where you are.
C-Section
This is a hard one for me to answer because I don’t want to mislead women. I very strongly believe that if you need a C-section, for either the safety of you or your baby, you need to get one. However, I also believe that hospitals are too quick to move to C-sections and I definitely am against scheduling a C-section or getting one for the convenience of it.
A C-section is major abdominal surgery where they cut open your abdomen and remove your baby. You should be completely numb for this process and thus really won’t feel much except a weird tugging. Then they stitch you back up and send you on your way. But again, this was major abdominal surgery. I have heard a lot of women say that recovering from a C-section is a longer and more painful process than recovering from vaginal birth.
But again, if it is for medical reasons, where you or your little one might be in danger, I think it’s really important to rely on modern technology where appropriate. I just think we over rely. Regardless of my opinion though, you can schedule a C-section and know exactly what to expect. There is a certain predictability to the process, since it is standardized and high medical.
Induction
Inducing is the process of starting your labor through the use of medication or other means with the intent of having a vaginal birth. Usually the drug used in the hospital is Pitocin. I was prescribed the Midwives Brew for my first birth (DO NOT do this unless prescribed to you by a medical professional. It CAN cause serious complications and should never be used just because you are tired of being pregnant). Thus this was a form of induction because it induced my labor. Without it, I likely would have had to give birth in a hospital. I had a super-fast, super fabulous labor as well, and I think part of that was due to being induced.
Again, there are always two sides to a coin. I have heard that Pitocin brings labor on too fast and too strong, resulting in really intense and painful labor. Sometimes this rapid labor puts baby in fetal distress and leads to an emergency and now you have to have a C-section. BUT it can also offer you the chance to labor naturally in the event that your labor is stalling.
Sweeping of the Membranes
This process is supposed to help break your water and jump start labor. Again, it’s essentially another way to prompt labor. My personal opinion is that a lot of times things like inducing or sweeping membranes are just ways to force baby onto our clock. But your little bundle of joy is going to arrive when they are ready. Why rush it?
Episiotomy
I don’t know if I can offer a neutral stance on this one because I’m pretty against it. The concept of an episiotomy is all about convenience and ease for the doctor in my opinion. The idea that you need to be cut to make yourself wider sounds simply wrong to me. The idea is to make a clean cut that is easy to sew up instead of a more jagged rip if you tear on accident. Except have you ever been to a fabric store and watched them cut a little snip in fabric which then makes it super easy to tear? Yeah… now imagine that happening to your vagina. Hard fucking pass here.
Ok, trying to stay neutral. As always, there are instances where an episiotomy may be medically necessary and life saving for your baby…. That’s all I’ve got. I would literally sue a doctor if they gave me one without my express permission though.
Who can be in the room
This is a really, really important question to think about with you and your partner before you are in the midst of labor. You really don’t want to be discussing if your mother-in-law is welcome in the room while you are mid contraction. This is really personal for everyone. I know some women who would have the entire neighborhood in the room and not care, and I know other women who barely even want their partner there. I know my mom always said “the only people who should be in the room when you give birth are the people who were there when you made the baby”. I personally wanted my bestie there, and then I had two amazing, supportive people I could lean on when needed. Think about who and what you are comfortable with now. And don’t let anyone bully you into partaking if you don’t want them to.
Do note, with a C-section, you are much more limited in who can be present. You are often only allowed to have one person in the room with you at that time. So you better be sure you know who it will be beforehand.
One way to help ensure your birthing plan and desires are followed, or at least supported, is through a birth doula. The birth doula advocates for you and helps ask questions through the process so you don’t have to feel like everything is on you. It’s also useful for the crowd control, where she can help guide people out of the room and even take care of your partner so you don’t have to. If you are looking for a Birth Doula in the Denver/Boulder area, check out what I offer here.
Immediately After Birth
After birth there are a few options you have around how to have your baby cared for. These options will, as always, be significantly affected by your hospital’s policies, so they may not even be options depending on your birthing location.
Delayed Cord Clamping
Delaying cord clamping can give your placenta time to return blood and other nutrients back to the baby that may have been pushed out in the process of birth. This is a weirdly, highly debated topic on the benefits of delayed cord clamping. Some people are super for it, and others adamantly express that there is no evidence supporting the benefits of it. The way I figure, there also isn’t evidence against this process. So why not give it a shot?
Skin to Skin
This is putting your peanut right on your bare skin at birth. Their physical skin on your physical skin to connect, bond, and offer them a loving first touch. Sometimes this isn’t possible if you have a medical emergency, but I will say for myself, it is the most amazing, beautiful, wonderful first meeting of your little one that I can imagine. Skin to skin can also help a baby with their natural reflexes and support breastfeeding.
Nursing
Breastfed vs. formula fed is a huge debate, and not one I want to get into here. However, if you do want to nurse, doing so shortly after birth can be the difference between success and not. This can be supported by skin to skin practice.
Postpartum
So you’ve gone through pregnancy, labor, and birth. Now we are settling into the post-partum period. If you gave birth in a hospital you will likely be there for a few more days. If you gave birth at home… well… enjoy your bed ^_^. No matter where you gave birth, there are still decisions to be made around the care for your little one.
Rooming In
If you gave birth in a hospital, some hospitals offer you the choice to room in with your baby. I really love this option, since they have been with you for months and the idea of separating from you now, so soon after birth, actually breaks my heart (part of this may be because my separation was medically necessary and Sprinkle was in the hospital for another month. So maybe some trauma on my part there).
Rooming in can help support bonding, attachment, and breast feeding. Plus, for extra new parents, it sort of gives you a trial run at parenting while you still have the support of hospital staff if you need it. I know some families opt not to room in in order to better facilitate recovery for mom and to catch a few more nights of sleep.
Circumcision
This is the process of removing the foreskin of the penis on infants. Many individuals do this for cosmetic reasons, though some do it for religious reasons. I’m not going to address the religion, because I’ve got nothing on that. However, cosmetically speaking, do note that it is an unnecessary procedure. There are many who say that it makes cleaning the penis easier, which is true. However, I have also heard from grown men that their uncircumcised penis is more sensitive and thus sex is great for them. I know, I know, you don’t want to think about your baby growing up to be a man already, but it’s a thing eventually.
Continued Nursing
If you want to nurse, continue to do so regularly at this point. Your milk will come in around 3-5 days postpartum, but until then, colostrum is all your baby needs at this time. Really take time to establish nursing, and if your hospital or midwife offer lactation support, take it.
Vaccinations
Oof, this one is probably the most controversial decision in this whole long as hell blog. But here it is: I write this in the middle of the Covid 19 pandemic, which is a world without ONE vaccination. Vaccinations are scientifically and medically sound and can be lifesaving. I’m not going to convert any anti-vaxers here, but you may want to make sure you and your partner are on the same page about this before you are getting your first one.
Did you know there is a doula for postpartum? This amazing woman will come in and help you with child care, education, sibling acceptance, cooking, cleaning, the works! She can make sure that your transition into parenthood is smooth and supported. I myself am a Birth Doula (pricing and packages found here) and I support lactation, sleep training, and offer tons of education. I think every family should have a postpartum doula.
So that’s it! Well, that’s not it. I’m sure I’ve missed a ton of things, but I feel like this blog is already getting long and there are limitless considerations. Still, I hope this blog was helpful for you and you are starting to feel like you may have some ideas for your own birthing plan.
