You know what they say about best laid plans. And childbirth is about the best example of something you can try to plan down to the detail, only to have things go in a completely different direction. Whether you’re a birth plan kind of woman, or not, there are some benefits to thinking through what might happen in the delivery room, because being informed means being empowered.

The topics below should be addressed with your doctor before you go to the hospital. It is important for health care providers to know your preferences regarding these important decisions. Chances are, when you meet in the hospital, you may already be in labour or otherwise unable to weigh and discuss your choices and make an informed decision. Discussing your preferences on each of these issues early in your third trimester means everyone is on the same page and can do their best to adhere to your wishes.

If you have very strong feelings about any one of the issues listed below, you may want to discuss it as early as your first appointment with an obstetrician. If, for whatever reason, either the doctor or their associated hospital have rules or preferences that contradict yours, it is best to know early on and look for another doctor who makes you feel more comfortable.

Making a birth plan? Discuss these topics.

Pain management

Whether you think you’d like to attempt a completely natural birth without any pain management, or you are certain you want as many pain meds as possible, it’s still vital to inquire about this point. Each hospital has different approaches to pain management, including the types of pain medication that are available and the stages of labour during which they can be administered. It’s important to know in advance what those rules are, so that you are prepared, especially if fear of pain is something that’s worrying you during your pregnancy.

Induction

Hospitals and doctors have varying approaches to Pitocin, the intravenous drug that speeds up labor, and other labour induction drugs, and the artificial rupture of membrane to induce labour, which is the breaking of the amniotic sac to speed up labour. While these methods can speed up a long labour, some women prefer to avoid it because of a personal preference to avoid unnecessary drugs, and because artificial rupture of the membranes carries a higher risk of infection. Either way, it’s good to know where your particular healthcare provider stands on this, so that you can decide for yourself and state your preference.

C-section circumstances

There is a lot of debate, and variation in clinical approaches, about when C-sections are preferable. Some doctors may only recommend a C-section in the most dire of circumstances, where it is absolutely necessary to save the life of mother or baby, whereas other doctors will advocate for a surgical procedure when it seems a vaginal delivery will be riskier, more complicated, or significantly more time-consuming. If you have strong feelings about avoiding a C-section, it is particularly important to voice these before labour begins, as it becomes difficult to discuss the pros and cons of a particular situation once it’s underway. One good way to gauge a doctor’s position is to ask for her C-section rates.

Intervention (suction, forceps, episiotomy)

Some complicated or extended vaginal deliveries can be speeded up by the use of suction, forceps, or an episiotomy (a procedure where the vaginal opening is surgically cut) to get the baby out faster. Again, there is significant variation among doctors on when these interventions are necessary or beneficial. While these procedures are generally considered safe, the World Health Organization and many childbirth advocates argue they are completely unnecessary and introduce more likelihood of injury to the baby. Episiotomies can lead to complications with recovery, and heightened risk of long-term injury to the mother. It’s important to ask a doctor about her episiotomy rates (and/or forceps delivery rates); that’s a good way to gauge how often she thinks they are necessary in the delivery room.

Birth partners

Check with your hospital or doctor on how many family members you can have with you in the delivery room, and how many hospital staff are required. You may be able to request less hospital staff be in the delivery room at some facilities. Also ask about visitation hours — some hospitals will allow fathers to spend the night, while other hospitals will not.

After-birth preferences

If you would like to try so-called kangaroo care, where the baby gets immediate skin-to-skin contact and tries to breastfeed immediately, ask your doctor whether hospital policy allows it. Many hospitals have policies about doing Apgar tests almost immediately, so they may mandate that the baby is taken for those tests and cleaned before you hold her. Top feeding by hospital staff before maternal breastfeeding is also a common practice. While many hospitals are relaxing these rules due to patient demand, it is important to be prepared and understand what will happen immediately after the baby is born.

And there you have it. Even the best, most straightforward births can feel a little out-of-control when you’re in the middle of it. But by discussing these six points with your health care provider early, you both have a rough birth plan that allows you to meet any normal progression or possible complication from the same page.

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