During your prenatal visits, talk with your health professional about what you would like to happen during your labor. Consider writing up your labor and delivery preferences in a birthing plan, either in a childbirth education class or on your own. You can find various examples of birthing plans on parenting Web sites.

Because no labor or delivery can be fully anticipated or planned in advance, be flexible. Your experience after labor begins may be totally different from what you expected. If an emergency or an urgent situation arises, your plans may be changed for your own or your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When making plans for your baby's birth, consider the location of your delivery, who will deliver your baby, and whether you want continuous labor support from a designated health professional or a doula, a friend, or family members. If you haven't already, this is also a good time to decide whether you'll attend a childbirth education class, starting in your sixth or seventh month of pregnancy.

After you've set the stage, think through your preferences for comfort measures, pain relief, and medical procedures and fetal monitoring, as well as how you want to handle your first hours with your newborn.

Comfort measures may include:

• Nonmedication pain management ("natural" childbirth), such as focused breathing, distraction, massage, imagery, and continuous labor support, which can reduce pain and help you feel a sense of control during labor. Acupuncture and hypnosis are also low-risk ways to manage pain that work for some women.¹²
• Laboring in water, which helps with pain, stress, and may also help prevent slow, difficult labor.^{13, 14}
• Walking during labor, including whether you prefer continuous electronic fetal heart monitoring or occasional monitoring. Most women prefer the freedom to walk and move around, which helps reduce discomfort, but a high-risk delivery would require constant monitoring.
• Eating and drinking during labor. Some hospitals allow you to drink clear liquids while others may only allow you to suck on ice chips or hard candy. Solid food is often restricted because the stomach digests food more slowly during labor. This may make you vomit or feel like vomiting. An empty stomach is also best in the rare event that you may need general anesthesia.
• Playing music during labor.
• Birthing positions during pushing, including sitting, squatting, or reclining or using a ball, whirlpool, or birthing chair, stool, or bed.

Pain medication may include:

• Epidural anesthesia, which is an ongoing injection of pain medication into the epidural space around the spinal cord, to partially or fully numb the lower body. A "light" epidural allows the mother to feel enough so that she can push, reducing risks of stalled labor and cesarean delivery.
• Pudendal and paracervical blocks, which are injections of pain medication into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where the baby will come out. Paracervical has been generally replaced by epidural, which is more effective.
• Narcotics, typically Demerol, which are sometimes used to reduce anxiety and pain. Narcotics have limited pain-relief effectiveness and can have troubling side effects for mother and baby.

Should I use epidural anesthesia during childbirth?