Birth plan guideBirth plan options, explained

Hospitals offer the widest range of pain relief and emergency care, with surgical and newborn teams on site. People often choose one for an epidural, for a higher-risk pregnancy, or for peace of mind. Birth centers are homelike settings, usually run by midwives, for low-risk pregnancies, with a plan to transfer to a hospital if needed. People often choose one for a less medical feel, more freedom to move, and tubs or showers for comfort. A planned home birth is attended by a midwife or physician in your own space. People often choose it for privacy, familiar surroundings, and continuity with a provider they know well.

What the evidence suggests

For low-risk pregnancies, research links birth centers and planned home births with a trained attendant to fewer interventions, including cesareans. Some people who start at a birth center or at home transfer to a hospital during labor, most often because labor is slow. The American College of Obstetricians and Gynecologists (ACOG) considers hospitals and accredited birth centers the safest settings and notes a small increase in serious risks to the baby with planned home birth.

Sources: ACOG (2017) (opens in a new tab), National Birth Center Study II (Stapleton et al., 2013) (opens in a new tab)

The people in the room with you matter, whether that's a partner, a family member, a friend, or a doula.

What the evidence suggests

Continuous support in labor is one of the best-studied things in birth. In a large Cochrane review, people with continuous support were about 40 percent less likely to have a cesarean, more likely to give birth vaginally without forceps or vacuum, less likely to use pain medication, had somewhat shorter labors, and were more likely to feel good about their birth afterward. No harms were found. The benefits were largest when the support person was a doula rather than hospital staff or a partner, which is why many people bring a doula in addition to a partner.

Sources: Cochrane review (2017) (opens in a new tab), ACOG (2019) (opens in a new tab)

A sentence or two about what matters most gives your team the "why" behind your preferences. Plans change during labor. If your team knows the reason behind your choices, they can still honor it when the specifics shift. "Keeping my baby with me, however the birth goes" tells them what to protect if a cesarean happens. "Understanding what's happening before anything is done" tells them to slow down and explain, even when things move fast.

What the evidence suggests

How a birth is remembered has less to do with whether everything went to plan and more to do with feeling informed and involved in decisions along the way. Shorter plans also seem to work better. One study found that having more of your requests met was linked to greater satisfaction, while a long list of requests was linked to less. A brief, personal "why" helps your team see what matters most.

Sources: Cook & Loomis, J Perinat Educ (2012) (opens in a new tab), Mei et al., Birth (2016) (opens in a new tab)

If you've had a cesarean before, you can usually choose between planning a vaginal birth this time (VBAC) or a planned repeat cesarean. People often choose VBAC for a shorter recovery, to avoid another surgery, and because each cesarean adds risk to future pregnancies. People often choose a repeat cesarean for predictability, to avoid the chance of an unplanned cesarean partway through labor, or because a prior surgery makes VBAC riskier.

What the evidence suggests

ACOG reports that 60 to 80 percent of people who plan a VBAC go on to give birth vaginally. The main risk is that the scar on the uterus opens during labor. This is rare but serious for you and your baby, and it's least likely with the most common type of incision, a side-to-side cut low on the uterus. Whether VBAC is a good fit depends on the type of incision from your prior surgery, why the cesarean happened, your pregnancy history, and whether your hospital is set up to support a planned VBAC.

Sources: ACOG patient FAQ: VBAC (opens in a new tab), ACOG Practice Advisory (2021) (opens in a new tab)

Many hospitals are teaching hospitals, where students and residents learn by taking part in care under supervision. These are different roles. Medical, nursing, and midwifery students are still in school and mostly observe or help with basic tasks. Residents are licensed doctors finishing their training in obstetrics, and at many hospitals they're part of the core delivery team for every birth. People who welcome trainees often like the extra attention and want to help the next generation learn. People who'd rather not often want a smaller, more private room, or have had past experiences that make it important to know exactly who is touching them.

ACOG guidance says you should get the chance to agree to or decline care from trainees, and that you can say no as long as it doesn't put your safety at risk. At some teaching hospitals, though, residents are part of the team for every birth, so it's worth asking what "no students" means where you're delivering. Saying your preference ahead of time lets staff plan, and you can always change your mind on the day.

Sources: ACOG (2025) (opens in a new tab)

Birth ball

A large exercise ball for the first stage of labor. Sitting on it keeps you upright with your hips free to rock and circle, and kneeling on the floor to lean over it takes pressure off your back, which many people find easier than a bed.

Peanut ball

A peanut-shaped ball tucked between your knees while you lie on your side. It opens the pelvis while you rest, so it's useful any time you want to lie down: when you're tired, between stretches of walking, or once you have an epidural and can't get up. Switching sides every so often keeps you changing position from the bed.

Water for comfort (tub or shower)

Laboring in a warm tub, birth pool, or shower during the first stage. Many people find warm water the single most soothing thing in labor. Most hospitals have showers in labor rooms, but fewer have tubs. Giving birth in water is a separate question. Most hospitals ask you to get out for the birth itself, while some birth centers and home-birth midwives offer it.

Squat bar

A sturdy bar that attaches across a labor bed so you can pull up into a supported squat while pushing, without getting off the bed. Most hospital labor beds can take one, and some birth centers have them too.

Birth stool

A low, U-shaped seat that holds you in a deep, supported squat for pushing, with gravity helping. Squatting is tiring, so people often use it in bursts between other positions. More common at birth centers and home births, though some hospitals have them.

Mirror during pushing

A mirror set up so you can see your baby's head as you push. Some people find that watching their progress keeps them going, especially when pushing takes a while.

Induction (starting labor)

Starting labor before it begins on its own, using medication to soften the cervix, a small balloon to open it, breaking the waters, or Pitocin to bring on contractions. It's recommended for a medical reason: going well past the due date, waters breaking without labor starting, high blood pressure, or concerns about the baby's growth or fluid. If induction is recommended, it helps to ask why, what the options are, and which order your team would try them in.

Membrane sweep

During a vaginal exam near or past your due date, your provider sweeps a gloved finger around the inside of the cervix to gently separate the membranes. This releases natural hormones that may nudge labor to start. It can be uncomfortable and may cause some spotting or cramping afterward. It's done in the office, usually from 39 weeks on, and you can say no or ask to wait.

Breaking the waters (amniotomy)

A provider uses a small hook to open the bag of waters around your baby, if it hasn't broken on its own. It doesn't hurt more than a cervix check, but once the waters are broken there's usually a clock: most teams want the baby born within a day or so to limit infection risk.

Pitocin

A synthetic version of oxytocin, the hormone that drives contractions, given through an IV to strengthen contractions when a labor that's already started slows down, or to bring on labor during an induction. The dose is started low and turned up gradually. Pitocin contractions often feel stronger and closer together than natural ones, which is one reason some people want to try other things first. Many teams do: moving, changing position, resting, and staying hydrated can all get a stalled labor going again. While it runs, your baby's heart rate is monitored continuously.

Intermittent monitoring

Your baby's heart rate is checked at regular intervals with a handheld Doppler instead of tracked the whole time by straps. In active labor that usually means a check every 15 to 30 minutes, and every 5 to 15 while pushing, each lasting about a minute. Between checks you're free to walk, shower, and change position. It takes a nurse who can come that often, so not every unit offers it. Worth asking ahead.

Continuous monitoring

Your baby's heart rate and your contractions are tracked the whole time through two soft straps on your belly. It's the default in many hospitals and is recommended when a pregnancy or labor has added risk factors, including an epidural or Pitocin. Some hospitals offer wireless monitors so you can still move around with it on. Worth asking ahead.

A quick exam where your provider uses gloved fingers to feel how far your cervix has opened (dilation) and how low your baby is. Checks are useful at a few points: when you arrive, before an epidural, before pushing, and if something changes. Between those, they're often routine, every few hours in active labor. A check is a snapshot, and the number doesn't predict how much longer labor will take, which is one reason some people would rather not hear it every couple of hours. You can always ask to skip or delay one.

What the evidence suggests

Research hasn't found that more frequent routine checks lead to better outcomes. Many people find them uncomfortable, especially mid-contraction.

Sources: Cochrane review (2022) (opens in a new tab), NICE (2023) (opens in a new tab)

Nitrous oxide

A mix of nitrous oxide and oxygen you breathe through a mask you hold yourself. It takes about 30 seconds to work, so you start breathing it as a contraction begins. It doesn't take the pain away, but many people find it makes contractions feel less intense and eases anxiety, and you stay awake and alert. People often choose it because they're in control of it, it doesn't need an IV, and it wears off within a minute or so of putting the mask down. It's also used for stitches after birth. Some people feel dizzy or queasy while using it. Not every hospital or birth center offers it, and some home-birth midwives bring it.

Epidural

An epidural is the most effective form of labor pain relief. Medication is delivered through a thin tube placed in your lower back by an anesthesiologist. It numbs the lower body while you stay awake and alert, and takes about 15 to 20 minutes to work. Once it's in, you'll stay in bed with continuous monitoring and an IV, and the dose can be adjusted so you still feel pressure when it's time to push. People often choose it for substantial relief, to rest during a long labor, or to be calm and present for the birth.

Opioid pain medication

Opioid pain medicine such as fentanyl or morphine given through an IV or as a shot. It takes the edge off contractions rather than removing pain, and it affects your whole body, so you may feel drowsy or floaty. People often choose it for a short break in a long early labor, or where an epidural isn't available or isn't wanted.

Once your cervix is fully open, there are two main ways to push. You don't have to pick one for the whole pushing stage.

What the evidence suggests

A Cochrane review found no clear difference in outcomes for mother or baby between spontaneous and directed pushing, so the choice can follow what feels right. Some research suggests breath-holding pushing may be a little harder on bladder function afterward, though the differences are small.

Sources: Cochrane review (2017) (opens in a new tab), Schaffer et al., 2005 (opens in a new tab)

How you hold your body while pushing. Lying on your back is the default in many hospitals because it's easiest for the provider to see and reach, but it works against gravity. Alternatives each have a strength: side-lying is restful and gentle on the perineum, hands and knees can help with back labor or a baby facing the wrong way, and squatting opens the pelvis most but is tiring. You can change as you go, and what feels right often shifts in the moment.

What the evidence suggests

Without an epidural, research links upright positions to slightly fewer forceps or vacuum deliveries, though possibly a bit more minor tearing. With an epidural, a large trial found that lying on your side led to more births without forceps or vacuum than upright positions.

Sources: Cochrane review (2017) (opens in a new tab), BUMPES trial, BMJ (2017) (opens in a new tab)

Warm compresses

A warm, wet cloth held against the perineum (the tissue between the vagina and anus) by your nurse or midwife while your baby's head is crowning. Of the things that can be done in the moment to protect the perineum, this has the strongest evidence, and most people find it soothing.

What the evidence suggests

Most first vaginal births involve some tearing, usually minor and healed within a few weeks. Warm compresses are one of the better-studied comfort measures: good-quality research suggests they may lower the chance of a serious tear, the less common kind that reaches the muscle around the anus.

Sources: Cochrane review (2024) (opens in a new tab), WHO (2018) (opens in a new tab)

Hands-on support during crowning

What your provider does with their hands as your baby's head emerges: gentle massage of the perineum, supporting the tissue with a hand, and coaching you to slow down and breathe rather than push hard at the moment of crowning, so the tissue has time to stretch.

What the evidence suggests

Gentle perineal massage during pushing may lower the chance of a serious tear for some people, though the evidence is mixed. Whether a provider keeps hands on or off the perineum hasn't been shown to clearly change the risk, so this often follows their training and what feels right to you.

Sources: Cochrane review (2024) (opens in a new tab)

Avoiding routine episiotomy

An episiotomy is a surgical cut to widen the vaginal opening during birth. It used to be routine. Today it's reserved for a specific reason, most often when the baby needs to be born quickly.

What the evidence suggests

Research advises against routine episiotomy. Reserving it for specific situations is linked to fewer serious tears, with no clear downside.

Sources: Cochrane review (2017) (opens in a new tab), WHO (2018) (opens in a new tab)

Lactation consultants are specialists in breastfeeding and pumping. In the hospital they help with latch, positioning, milk supply, sore nipples, and feeding a sleepy baby, and can show partners how to help. Most hospitals have one on staff, and the visit is part of your stay, but you usually have to ask. It's worth a visit even if feeding seems to be going fine, since the first day or two is when habits form.

What the evidence suggests

Research suggests that skilled, face-to-face support in the first days and weeks may help people breastfeed for longer and more exclusively than they would otherwise.

Sources: Cochrane review (2022) (opens in a new tab)

Occasionally a baby needs more milk than is available in the first days, most often for low blood sugar, jaundice, or more weight loss than expected while your milk comes in. It's usually a feed or two, not a change of plan. Donor milk is pasteurized human milk from screened donors, processed by a milk bank. People choose it to keep their baby on human milk only while their own supply comes in. Some hospitals offer it for any breastfed baby who needs a top-up; others stock it only for the NICU. Ask ahead what yours does.

A single vitamin K shot, usually given in your baby's thigh within the first hours after birth, often while they're on your chest. Babies are born with very low vitamin K, which their blood needs to clot, and breast milk contains very little. The alternative is oral vitamin K, given as several doses over the first weeks, which is less reliable.

What the evidence suggests

Pediatric guidelines have recommended the shot for all newborns since 1961, to prevent vitamin K deficiency bleeding. It's rare, but it can happen without warning up to six months of age, often as bleeding in the brain, and there's no way to predict which babies are at risk.

Sources: AAP (HealthyChildren.org) (opens in a new tab), CDC (2013) (opens in a new tab)

A thin strip of mild antibiotic ointment placed in each of your baby's eyes shortly after birth, usually within the first hour or two. It prevents a serious eye infection from gonorrhea or chlamydia passed during birth, which can cause blindness. It protects against infections the birthing parent may not know they have. Some people who tested negative in pregnancy still choose it for that reason; others decline on the same basis.

What the evidence suggests

It's recommended for all newborns. Most U.S. states require it by law, though many allow parents to decline with the provider noting it in the record. Rules vary and can change, so confirm with your hospital.

Sources: U.S. Preventive Services Task Force (2019) (opens in a new tab), AAP (HealthyChildren.org) (opens in a new tab)

The first dose of the hepatitis B vaccine, usually offered within 24 hours of birth to medically stable babies. It begins a series completed over the first months of life. Giving it at birth is a backstop for the small number of babies whose exposure isn't caught by prenatal screening, since the vaccine works best the sooner it's given after exposure.

What the evidence suggests

Pediatric guidelines recommend it routinely for all newborns.

Sources: AAP (HealthyChildren.org) (opens in a new tab)

Most cesareans happen while you're awake, numbed from the chest down by a spinal or epidural. You may feel some pressure, but not pain. Your partner usually sits by your head, your baby is born within the first 10 to 15 minutes, and the rest of the surgery is closing up, which takes another 30 to 45 minutes. A "gentle" or family-centered cesarean brings small touches to that: a clear drape so you can see your baby born, skin-to-skin on your chest in the operating room while they close, one arm left free of straps or lines so you can touch your baby, and your team explaining each step. In an urgent cesarean under general anesthesia, your partner usually can't be in the room and skin-to-skin waits until you wake in recovery. Whether each is possible depends on your hospital, so ask ahead what yours offers.