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Planning for the Big B-day

Pregnancy Planning for Birth Cartoon

How to plan for the birth a mom-to-be wants

It is important for a woman to take time early in her pregnancy to think about the kind of birth she wants, and then take steps to increase her chances of getting what she wants. This means creating a birth plan, becoming an active participant in her own care and using her health team as a resource, not unquestioned authority. Her birth plan should outline things like her preference or not for pain medication during labor and delivery, who she’d like in the delivery room with her and who is to be her advocate — speaking up for her when she is too dazed and tired during labor to speak up for herself.

Selecting a birth health care provider option or supporting team is a personal choice. Pregnant women should look at options and interview several birth professionals to demystify specific roles and approaches in the labor experience, as well as to gain awareness of their rate of intervention and number of assisted normal births. When interviewing potential providers, they should look for qualified birth professionals or teams that possess an intrinsic desire to give patients both what they want (and need) while using reliable professional judgment, critical thinking, and fast decision-making skills with compassion and empathy — in emergencies as well.

A mom-to-be should understand the differences in prenatal care and delivery models as well as the approaches that are available. Both midwives and obstetricians are respected birth professionals, and they share the same desired outcome — healthy mom and healthy baby. Women interested in having a water birth should know that some birth professionals are not comfortable with this way of delivery.


Obstetricians are medical doctors with special training in pregnancy and birth as well as surgical skills that enable them to take action when things get complicated or turn into an emergency. Obstetricians are highly trained to identify risks and deal with the mechanics of pregnancy and birth. You should ask them for their policy regarding medical intervention during labor and delivery. This will help you understand the doctor’s birth philosophy, as well as the options available.

During labor an obstetrician comes in and out to check on the progress. In a nutshell, the obstetrician “manages” a woman’s labor until the baby is ready to be born. In the case of a necessary cesarean, the doctor performs the medical procedure. Many women opt for this prenatal care and delivery option as a way of securing continuity of care throughout their pregnancy. Once a woman is in labor — unless her obstetrician has specifically committed to being with her during labor and delivery — the mom-to-be has no guarantee that she will be cared for by her chosen obstetrician.


Midwives are highly trained professionals with special expertise in supporting women through a healthy pregnancy and birth. They are not medical doctors but they are knowledgeable in normal births and in guiding women through pregnancy, birth and the period of time immediately after the birth. Depending on their credentials and training, a midwife in specific health care settings can deliver babies and perform necessary examinations throughout pregnancy, labor, delivery and postpartum.

Looking at childbirth more as a natural rather than medical event, midwives often work in collaboration with a doctor, and will call one in if complications arise; otherwise, they handle low-risk births from start to finish. Certified nurse midwives have graduate training in midwifery and are licensed to practice in all 50 states. Others may not have college degrees and are more likely to assist out-of-hospital births.

Midwife-assisted births have been on the rise in the past few decades. Roughly 8 percent of all American births involve midwives.


Labor and delivery nurses are skilled, multifaceted, patient-facing medical professionals. Unique among the many types of nurses, they have a praiseworthy job — to help deliver healthy babies and get moms through the process safely using their professional acumen and strong decision-making skills. Providing personalized care to moms and their newborns, they collaborate with physicians and other involved health care providers, meeting the often-changing needs of mother, newborn and family. They also provide psychosocial and emotional support when needed.


Labor-support doulas are well-trained childbirth coaches who provide continuous physical, emotional and informational support to the mother before, during and just after birth. They do not deliver babies. A doula often will labor with a woman at home, before the transition to a hospital or birth center is made. Doulas do not change shifts and usually deal with one client at a time. They provide excellent assistance and support — helping them create birth plans, speaking up for them in the delivery room when necessary, helping them during labor with back rubs, nourishment, and best pain relief positions. Often a doula will bring mom to the hospital or birth center, and give her partner ideas for how best support and encourage her.

The childbirth experience is dynamic and includes not only the mom-to-be and her family, but also a health-care team that must be compassionate, knowledgeable and collaborative on multiple levels. Effective communication and balanced patient-centered teamwork are always needed during a pregnancy, particularly during labor and delivery.

Dr. Lizellen La Follette is a board-certified obstetrician and gynecologist in private practice in Greenbrae. She also provides ob/gyn health care at California Pacific Medical Center and Sonoma Valley Hospital. Her “A Woman’s Perspective” column appears every fourth week.

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