Be Prepared

Going into childbirth knowing what to expect is key to building the confidence you need. Here's how to get there.


You wouldn’t dream of running a marathon without training first. Such an intense athletic event requires mental, physical and emotional preparation. The same is true for childbirth: Knowing what can happen during labor and delivery—and your options for pain relief—can alleviate your fears and boost your confidence. “Knowledge is power,” says Sheri Bayles, R.N., a certified Lamaze instructor who taught childbirth classes at New York-Presbyterian Hospital in New York City for more than 20 years.

Your first step should be to sign up for a childbirth education course. Many women skip these because they’re planning to use pain medication or have watched TV shows about birth. But childbirth education classes are worthwhile, even if you do anticipate using medication. “What if you can’t get an epidu­ral—or it doesn’t take?” says Maureen Corry, executive director of Childbirth Connection, an advocacy group in New York. “Having strategies for coping with labor pain is very important.” (Unintended natural childbirth is more common than you might expect.)

A class can also open your mind to possibilities you may not have considered. “Many women can deliver without drugs if they’re prepared,” says Laura Riley, M.D., medical director of labor and delivery at Massachusetts General Hospital in Boston and author of 2006’s You & Your Baby: Pregnancy. Other reasons to sign up: An educator can teach your partner how to be supportive during labor and delivery—and answer any questions you forgot to ask your doctor.

Perhaps most importantly, “the instructor can help you sort out all the other information you’ve received,” says Judith Lothian, R.N., Ph.D., a Lamaze instructor in Brooklyn, N.Y., and associate editor of the Journal of Perinatal Education.

Choose a childbirth class The childbirth approach that will work best for you is the one that most closely resembles your lifestyle, says Lisa Gould Rubin, a childbirth educator and doula and co-author of 2005’s The Birth That’s Right for You. “How do you relax?” she says. “Are you physically active? Do you meditate? If you’ve never sat still and looked inward, it could be a challenge to learn how to do that.” Also, consider the instructor’s philosophy about childbirth. There’s no right or wrong way to have a baby, so choose someone who will support you no matter what kind of birth you want. Here’s a rundown of the most common approaches:

Lamaze Best known for its unique breathing techniques for coping with labor (think “hee hee”), Lamaze is now emphasizing “normal birth,” in which labor begins on its own, there are no routine medical interventions such as an episiotomy, and a woman can move freely during labor and push spontaneously during delivery.

Bradley Natural childbirth is the goal (87 percent of Bradley-trained couples give birth without drugs), and a woman’s partner plays a big role.

Birthing From Within This approach involves preparing the body, mind and spirit for labor and delivery through self-hypnosis, visualization and meditation.

HypnoBirthing You learn how to achieve deep relaxation to manage labor pain.

Hospital classes Instructors—often labor and delivery nurses—typically discuss the stages and signs of labor, coping strategies (often Lamaze breathing as well as medication) and hospital procedures. There may also be a tour.

Create a birth plan Your next step is to create a birth plan, which will help you think through what you want—or don’t want—during your delivery. (Many childbirth classes will help you do this.) Keep in mind the term is a bit misleading because birth is unpredictable. “I call it a wish list,” says Rubin. “It’s a tool to share the things that matter to you with your care provider.”

For instance, you might mention that you want to walk around during early labor, use a doula for support or have your husband announce the baby’s sex. It’s best to keep it short (no more than a page) and write it before your sixth month because that’s when you should discuss it with your doctor or midwife. Be sure to bring a copy with you to the hospital or birth center so the nurses know your wishes.

Know your pain-relief options As you think about your birth plan, you’ll need to decide whether you want medication, plan to avoid it or see how things go. These are the most common methods:

Short-acting narcotics, such as morphine and Stadol, are given in early labor (up to 4 or 5 centimeters dilated). Pros: Can take the edge off the pain so you’re able to take a nap (for perhaps an hour or two). Cons: May not offer adequate pain relief, and the drugs used can slow the baby’s breathing.

An epidural block delivers medication through a catheter to an area outside the spinal cord. Pros: Provides pain relief in the abdomen yet usually allows enough sensation so you can push. The baby is not affected; and because the medication is given continuously, the dose can be adjusted, allowing you to move around or push when necessary. Research shows an epidural doesn’t slow labor, says Riley. Cons: Risks include fever, which requires antibiotic treatment; de-creased blood pressure; blood clots; and, rarely, a severe headache that lasts for several days.

A spinal block involves injecting pain medication into the sac that surrounds the spinal cord; it can be given before a C-section or if a vaginal delivery is expected within two hours. Pros: Takes effect immediately and provides pain relief from the chest down for up to two hours. Cons: You can’t walk during labor, and you may be too numb to push. The medication can also cause nausea, low blood pressure and, in rare cases, a severe headache.

Or perhaps you’ll want to try non-drug options such as slow, controlled breathing, which distracts from the pain of contractions; or guided imagery, in which you imagine yourself at a place where you’re relaxed (like the beach). Movement (rolling from side to side, for instance) can also decrease pain and even helps the baby rotate through the pelvis, says Lothian. Other options include acupuncture and water birth.

Learn more about labor pain, know what to expect and how to find relief