During your prenatal visits, talk with your health professional about your labor and delivery options. As you identify your preferences, it's a good idea to make them clear in a written birth plan. Since no labor and delivery can be predicted or planned in advance, be flexible. As you consider how you'd handle possible complications, give yourself permission to change your mind at any time.

A birth plan isn't a contract for your health professional to follow-if an emergency situation arises, he or she has a responsibility to ensure both your safety and your baby's safety. You may still be allowed to share in some decisions, but your choices may be limited.

When writing your birth plan, first 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 6th or 7th month of pregnancy. Once 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'd like to handle your first hours with your newborn.

Comfort measures

There are many ways to lessen the stresses of labor and delivery. Consider:

• Continuous labor support from early labor until after childbirth, which has a proven, positive effect on childbirth. Women who have continuous one-on-one support (for example, from a mother's support person, or doula; nurse; midwife; or childbirth educator) are more likely to give birth without pain medication and are less likely to describe their birthing experience negatively.¹ Although there is not a proven direct connection between continuous support and less labor pain, having a support person does help you feel more control and less fear, which are strong elements of mental pain control.
• Laboring in water, which helps with pain, stress, and sometimes slow, difficult labor (dystocia).^{2, 3}
• Nonmedication pain management ("natural" childbirth), such as continuous labor support, focused breathing, distraction, massage, and imagery, which can reduce pain and help you feel a sense of control during labor. Acupuncture and hypnosis are also low-risk ways of managing pain that work for some women.⁴
• 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, but a high-risk delivery would require constant monitoring.
• Issues about 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. An empty stomach is also best in the rare event that you may need general anesthesia.
• Playing music during labor.

Pain relief with medication