Have a Safe and Satisfying Birth

I wrote this checklist for our book Pregnancy, Childbirth, and the Newborn: The Complete Guide.

It’s a summary of things to do and choices to make during pregnancy to increase the likelihood of having a safe, satisfying birth and avoiding a cesarean birth and other unwanted interventions.

Take care of yourself during pregnancy so you begin labor in the best possible health. Exercise in moderation and eat well. If you’re overweight when you become pregnant, aim to gain a small or moderate amount of weight. Seek prenatal care to help you detect and manage any health problems that may arise.
Choose a birthplace that has a low rate of cesarean birth and minimal routine interventions. If your pregnancy is low-risk and you prefer minimal interventions, consider birthing at a birth center or at home. Several studies show that women having low-risk pregnancies undergo fewer interventions in an out-of-hospital setting and their birth outcomes are just as good as those of women birthing in hospitals.
Find a caregiver who has low intervention rates and encourages the use of self-help techniques in labor. If your pregnancy is low-risk, consider using a midwife◊. Midwives typically use fewer medical interventions than physicians do. If intensive medical care becomes necessary during pregnancy, a midwife will refer to an obstetrician.
Educate yourself and prepare a birth plan. Take childbirth classes that emphasize informed decision-making and self-help methods to relieve pain and aid progress. Read “The Rights of Childbearing Women,” which outlines a set of basic maternity rights for all childbearing women. Review your birth plan with your caregiver.
Hire a birth doula.*, ** The continuous labor support◊ a doula provides often leads to a shorter labor, reduced need for pain medication, increased chance of normal vaginal birth, and increased satisfaction with the birth experience.
Avoid labor induction for non-medical reasons**. If your caregiver suggests induction for a debatable medical reason (such as a suspected big baby, or less than 12 hours after your water breaks*), ask about other alternatives.
Use medical interventions only when clearly necessary, not because they’re routine. For example, avoid routine IV fluids, continuous electronic monitoring* ◊, and augmentation with Pitocin or breaking your bag of water* for overly short limits on duration of labor * ** ◊. In some situations, interventions may be the best option for you or your baby. Ask questions (about Benefits, Risks, and Alternatives) to ensure you make informed decisions. That way, when you remember the birth in the years to come, you’ll know you made the right choices.
Learn to differentiate between early labor and active labor so you can delay hospital admission until active labor*. Use labor-coping skills◊ at home to manage pain and aid progress. Eat, drink,◊ and rest as needed to keep up your energy.
Use a variety of positions*◊ and activities during active labor, such as walking, dancing, rocking in a rocking chair or on a birth ball, or taking a shower or bath.
Push in positions that aid descent,◊ unless the birth is happening fast; then use positions that slow descent. Use spontaneous pushing*◊ if you have an urge to push. Delay pushing if you don’t have an urge to push (and you and baby are doing fine).

All of these recommendations are supported by research. Many of the links will take you to evidence-based sources. I have also marked recommendations that align with recent recommendations from major organizations:

* American Congress of Obstetricians and Gynecologists (ACOG), Approaches to Limit Intervention During Labor and Birth. 2019

** ACOG, Safe Prevention of the Primary Cesarean Delivery. 2014

◊ WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience, 2018.