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Pitocin (Oxytocin) Pitocin can help your labor begin or accelerate it, bringing on painful contractions. This medication can also be used after birth, as it has been shown to reduce the potential for hemorrhaging. Anesthetics Anesthetics like an epidural or spinal block can make it easier to tolerate the pain and still allow you to remain alert. These blocks will cause you to lose some feeling in your lower body and you may not be able to walk around, which can affect birthing positions.

Epidural or spinal block Anesthetics like an epidural or spinal block can make it easier to tolerate the pain and still allow you to remain alert. These blocks will cause you to lose some feeling in your lower body and you may not be able to walk around, which can affect birthing positions.   Local anesthetic A local anesthetic can numb specific areas, like the vaginal area for an episiotomy or a tear repair after you deliver. This will not help with labor pain from contractions, though.  Nitrous oxide Some pregnant women breathe in this gas prior to contractions to decrease anxiety and reduce pain.

You can decide in your birth plan if you want to use pain relief medications, and under which circumstances. Sometimes you can change your mind during the labor process, but that’s not always possible. The baby may have progressed too far to safely give some anesthetics. One consideration for receiving pain medications is if labor is induced.

Pain relief

Mobile apps can walk you through the process of creating a birth plan, and answer questions you have on pregnancy and the birthing process. Providence recommends one of these mobile apps to help you define your birth plan.

You can build a birth plan at any point during your pregnancy, but Providence obstetricians recommend you discuss it with your care team no later than the third trimester. A birth plan can be documented and shared in many ways – you can write it down, type it out or even create it using a mobile app. Regardless of the format, it’s worth considering asking your care team to add the plan to your medical record alongside other relevant health information like your medications or pre-existing medical conditions.

“[By the third trimester] you’re far enough into your pregnancy to experience and think about the reality of birth.”

Building the right birth plan

Talking through your birth plan can help your doctor understand what you want, and to get clarity on the reasons why specific preferences may not be feasible during delivery. You may want to avoid an IV during labor, for example, so you can walk around without pulling a pole with a saline bag. Your doctor may advise you that an IV is helpful for medications given emergently for contractions or blood pressure regulation. Being connected to the saline IV may not be required during labor.

Talking through the birth plan can help the doctor understand what the pregnant woman wants, and for her to understand reasons her preferences may not always work. She may want to avoid an IV during labor, for example, so she can walk around without pulling a saline bag hanging on a pole. The doctor may explain that the IV is helpful for medications given emergently for contractions or blood pressure, but they can avoid connecting it to to saline during labor.

“Ultimately the patient has the right to say she wants this or that. If I can’t meet that desire, I need to explain to her why I wouldn’t do that.”

The patient-doctor discussion

Who’s in the room? Your hospital or health system may have its own rules about who can be in the delivery room with you. Whether your support person is a partner or family member, or a doula or midwife, make sure they’re on board with your birth plan and prepared to advocate for your wishes during labor. When you share your birth plan with Providence caregivers, you can rest assured that they’ll be prepared to get your support team on board with your preferences.

Family medicine doctor: Family medicine specialists with obstetrical training can deliver babies in low-risk situations. They typically do not perform C-sections. OB-GYN: An obstetrician-gynecologist is the doctor you've selected for prenatal care, labor, and delivery. They can perform C-sections and other surgical interventions if needed. Maternal fetal medicine specialist: This obstetrician has additional training for high-risk pregnancies. Some only perform consultations, but these specialists at Providence hospitals also deliver babies.

Midwife: A midwife has medical training and can help you deliver your baby at home or in the hospital. Midwifes can be a good option for low-risk pregnancies

Doula: A doula can provide you support before, during and after labor.

Choosing a doctor and labor support team is very important. By the time you are creating a birth plan, you’ve probably already chosen or narrowed down a list of doctors for your delivery, but it’s also important to consider your options for who will help deliver the baby.

“We always allow two people, a partner and support person (to support a woman during labor). That improves outcomes and the experience.”

“Midwives take care of low-risk pregnancies. Their strength is providing a high touch and low intervention. (They achieve) good outcomes and high patient satisfaction, for low-risk patients.”

“We have a doula program at Swedish, including a group of Black doulas who support Black women in labor, to work against the disparity of birth outcomes.”

When to use a doula, midwife, or OB-GYN

Did you know? Oxytocin is often administered under two key scenarios: a) to strengthen or start contractions to help the labor process as your uterine muscle begins to get tired and b) to help reduce bleeding by making the uterus contract after the placenta is delivered.

The type of delivery can depend on both your own and your baby's condition. While you may prefer one type of delivery, your doctor or care team may recommend an alternative for your own and your baby's safety.

A safer delivery

With a plan in place, you’ll be better prepared for the various parts of labor, delivery and the post-partum process – even if your body, or the baby, have plans of their own!

A birth plan provides a roadmap. The labor and delivery team will use it to give you the best experience throughout your delivery. While Providence caregivers are committed to delivering your baby as envisioned, it’s important to keep in mind that circumstances in-the-moment may necessitate modifications to protect you and your baby's health. The plan helps you think through your ideal birth experience. Moreover, having a plan makes clear your personal preferences and makes it easier for you to share your desired journey with your labor and delivery team.

A birth plan provides a roadmap. The labor and delivery team will use it to help you get the best experience, but there may be detours taken to protect you and your baby’s health.   The plan helps you think through your ideal birth experience. Creating a birth plan allows you to share in the decision-making more easily, as it communicates your preferences to your labor and delivery team.

“A birth plan includes what will make you feel safe and confident going into labor.”

Why have a birth plan?

Finished your birth plan? Congratulations! A comprehensive birth plan is a wonderful way to prepare for the delivery experience and make sure your wishes are communicated clearly. Creating the plan and talking through the options with your labor and delivery team can enhance your birth experience and ensure it’s as close as possible to what you want. Remember, while it’s great to have a plan, finding the right team that listens and understands your desires is essential. At Providence, we approach every expectant mother with compassion and dignity. Our partnership approach helps to ensure a safe and successful birth. To learn about maternity, birthing and maternal care at Providence, visit providence.org

Finished your birth plan? Congratulations!  A comprehensive birth plan is a wonderful way to prepare for the delivery experience and make your wishes are communicated clearly. Creating the plan and talking through the options with your medical labor and delivery team can enhance your birth experience and ensure it’s as close as possible to what you want.   Remember, while it’s great to have a plan, finding the right team that listens and understands your desires is essential. Providence approaches every expectant mother with compassion and dignity to help to ensure a safe and successful birth.   To learn about maternity, birthing and maternal care at Providence, visit providence.org

Welcoming a new baby into the world is one of life’s most amazing experiences, but it can also be overwhelming. To alleviate some of the stress associated with this life-changing experience, create a comprehensive birth plan that helps ensure your delivery team honors your wishes on “the day.” At a time when pregnant women are at their most vulnerable, Providence caregivers employ a listen-first approach to help you create the right birth plan for you.

Building a birth plan helps expectant parents define their ideal labor and delivery experience

Preparing for baby’s arrival with a comprehensive birth plan

Members of the editorial and news staff of the USA TODAY Network were not involved in the creation of this content

• Who will support you during labor? • Do you want to spend the first stage of labor standing up, lying down or walking? • Do you want pain medications, and under what circumstances? • Do you want fetal monitoring to be continuous, intermittent, internal, external or only if the baby is in distress? • Are there any practices you don’t want for interventions, like the use of forceps? • Will your partner cut the cord? • Will you bank cord blood? (umbilical cord tissue is filled with stem cells. Learn more.) • Do you plan to keep the baby at your bedside 24/7? • Do you plan to circumcise your baby, and if so, will it be at the hospital? • Do you plan to feed the baby with breastmilk or formula? You might not have all the answers while you create the birth plan, but thinking about questions like these and others can lead to good discussions with your doctor. Your doctor can tell you what aspects can change depending on your labor circumstances. This means there will be fewer unknowns or surprises.

BIRTH PLAN QUESTIONS

PRO TIP: Check with your hospital, birthing center, doctor or midwife to learn about their processes and recommendations. Many of your preferences may already be standard practices, including: • Immediate skin-to-skin contact Baby to be put on mother’s chest immediately after birth • Delayed cord-clamping Medics to wait 1-5 minutes before clamping the umbilical cord

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Many hospitals have a rotating staff of labor and delivery doctors, so unless your delivery is scheduled, your regular OB-GYN may not be present. If familiarity with the person delivering your baby is a priority for you, ask your doctor about their on-call practices or request to meet the extended team prior to your due date.

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Under ideal circumstances, your delivery will go according to your plan. However, the type of delivery can depend on both your own and the baby’s condition. While you may prefer one type of delivery, the doctor and care team may recommend another type of delivery for the safety and health of the mother and baby. Below are some common scenarios to be familiar with: Spontaneous delivery: This type of delivery follows your natural body rhythm. Labor may begin when you experience contractions or your water breaks. “Presuming all is going well, going into labor on your own is ideal because the body says it’s time.” – Tanya Sorensen, M.D. at Swedish in Seattle, WA Labor induction: If you have risk factors due to your age or the gestational age, the baby's health or other risks, labor can be induced. C-section: The cesarean section is typically reserved for labor that doesn’t progress, babies in a breach position, or large babies due to gestational diabetes and a risk of shoulder dystocia. VBAC: If you previously had a C-section, but want to deliver another baby vaginally.

Delivery procedures

Providence’s C-section rate is half of the national average

Across 51 Providence hospitals, there was only 1 childbirth-related maternal death in the past two years.

PRO TIP: The point of a birth plan is to make your priorities clear and communicate your wants and needs on delivery day. Keeping your birth plan explicit is the best way to get your care team on the same page.

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– Tanya Sorensen, M.D., maternal fetal medicine specialist at Swedish in Seattle, WA

– David Lagrew, M.D., Executive Medical Director of Women's Services at Providence in Southern California

– Tanya Sorensen, M.D., maternal fetal medicine specialist at Swedish in Seattle, WA

• The Circle app • Wildflower app

Here’s a helpful list of questions your birth plan may address:

PRO TIP:

DELIVERY PROCEDURES:

process, but that’s not always possible. The baby may have progressed too far to safely give some anesthetics. One consideration for receiving pain medications is if labor is induced.

Finished your birth plan? Congratulations!

To learn about maternity, birthing and maternal care at Providence, visit providence.org

NOTE: Swedish is an affiliate of Providence serving patients in the Greater Seattle area