Because labor rarely happens as you imagine, doctors recommend having a flexible birth plan. But not making it to the hospital? Well, even though it’s extremely rare, pregnant women have faced the daunting task of having their baby on the way there.

Take Christina Liceaga, of New York City, who was intent on laboring at home, knowing the hospital was a short distance from her apartment. Because her previous two deliveries had been induced, this time she was determined to have a more natural experience.

Although Liceaga went to the hospital in early labor, she requested to be sent home because her contractions were mild. Later on, back at her apartment, she found she could barely stand. Once she got into their SUV with her husband, Ulises, at the wheel, she knew this baby wasn’t going to wait. “Don’t stop at any lights!” she yelled.

Madeline Liceaga was born on 58th Street in the back of the Suburban. While Ulises drove and offered advice, Christina, with one knee on the floor and one out to the side, delivered her own child. They reached the hospital shortly after with the healthy baby girl. “I guess this is just the way it was supposed to happen for us,” Christina says. “Fear just wasn’t an option.”

Is It Time Yet?
In general, women can count on their second and third labors being much faster than their first. But many doctors recommend that first-time moms don’t leave for the hospital until the initial stages of active labor. The only exception is if your water breaks; then you should call the hospital right away.

Sarah McMoyler, R.N., author of The Best Birth, also recommends that birth partners observe the laboring woman’s disposition to determine when it’s time. “You will see her affect change,” she says. “Her shoulders are rising; her brow is furrowing; she’s holding her breath.”

Once a woman can no longer talk or walk through a contraction, McMoyler suggests heading out the door (always call the hospital first). McMoyler adds that it’s imperative for couples to factor in their location. “Do you have bridges to cross? What is the time of day and traffic pattern?”

Waiting at home might not have been a big deal if Ariane Coleman lived close to the hospital, but it’s an hour’s drive from her home in Big Sky, MT, to Bozeman Deaconess Hospital. And Coleman’s first labor was speedy—her son Orrin was born four hours after her water broke.

But when Coleman finally sat down and called her doctor during her second labor, her contractions were only two minutes apart. She and her husband, Ben, had barely made it past their driveway before she started feeling extreme pressure in her lower abdomen. About 10 miles down the road, her water broke. “Pull over!” she hollered. “We’re having the baby right here!”

With Ben’s help, Chloe Coleman was born in the front seat of the pickup. Ariane delivered the placenta on the way to the hospital, and the Colemans arrived with a healthy baby in their arms. “I’m a very realistic, rational person,” Ariane says. “I don’t know what I was thinking leaving so late.”

Built for Speed
McMoyler recommends that women who had a speedy first birth head to the hospital at the first signs of labor for their subsequent deliveries. Some women are more susceptible to fast labors, McMoyler explains, but the traits are often difficult to detect. If all the women in your family had fast first births, this could mean that your delivery will be speedy, too.

If you’re in labor en route and feel extreme pressure, call 911 for guidance and to prep the hospital staff. If the baby comes, make sure he’s crying well to ensure his breathing passage is clear, advises Susan Connell, the maternal newborn manager at Bozeman Deaconess; if not, you may need to give him a gentle pat on the back or lightly flick a foot. Keep him warm by cranking the heat in the car and wrapping him in a blanket or shirt on the new mother’s chest to start breastfeeding immediately. Don’t cut the cord—this isn’t necessary and could cause risky bleeding.

Don’t panic: First-time moms shouldn’t add delivering in a taxi to their list of worries. Out of the 1,200 annual births in her area, Connell reports only 1 to 2 deliveries occurring on the way to the hospital.“You will be very hard-pressed to find a first baby accidentally born out of the hospital,” McMoyler says, “because they notoriously take their sweet time coming to planet Earth.”

Early Labor
• Mild to moderate contractions every 7 to 20 minutes, lasting for 30 to 60 seconds; the pains gradually get closer together

• Can last hours or days

Active Labor
• Moderate to intense contractions every 2 to 3 minutes, lasting for 60 seconds; it’s difficult to walk and talk through them

• Lasts 5 hours on average for first-time moms; head to hospital at its start

Transition
• Very strong contractions every 1 to 2 minutes, lasting for 60 to 90 seconds

• Averages about 1 hour for first-time moms and directly precedes pushing

Corinne Garcia just experienced a much faster birth with her second child this past July. She is a freelance writer and editor living with her family in Montana.

You wouldn’t dream of driving without a seat belt or skipping sunscreen at the beach. So why would you settle for anything less than the most up-to-the-minute facts about labor and delivery—the event that will bring your child into this world and change your life forever?

“We’re finally stepping up this century to help women give birth with modern information,” says California-based labor nurse Sarah McMoyler, R.N., author of The Best Birth. “The more that expecting parents know going into childbirth, the more they can participate in the decision-making and the easier it is for them to keep their focus on what’s really important, a healthy mom and a healthy baby—however you get there.”

To have the most positive, satisfying birth experience possible, arm yourself with the newest thinking on labor and delivery from doctors, nurses, and midwives with the following do’s and don’ts.

DO draw up a realistic birth plan.
On one hand, it’s great to have a personal vision for your labor. It can help you explore your feelings about birthing methods, pain medications, and medical interventions and prompt you to find out which are available at the health care facility you’ve chosen—all good.

On the other hand, it’s unwise to plot out a single path and call it a day. A recent study from England’s Newcastle University found that women’s expectations of labor and delivery differed markedly from reality—they were totally unprepared for the intensity of the pain, lack of access to pain relief, their own level of participation in the decision-making, and their amount of control during labor.

“No one can predict how your labor is going to go,” McMoyler says. “If complications arise, you need to have options. Just like if you’re going skydiving, you should have a parachute.”
How? McMoyler recommends discussing with your partner not just your dream birth but contingency plans as well. For example, you may want to get an epidural immediately, but if your doctor says it’s not time yet—or that the window of opportunity has passed—what pain-management techniques will you use? Narrow your list to five or six major points and discuss them with your caregiver in advance. Then write them on an index card for the labor and delivery nurses.

DO tell your doctor you’d like to avoid an episiotomy.
Doctors used to believe that an episiotomy—a cut into the perineum to enlarge the vaginal opening—would help you out: Save you from a jagged tear that would be tough to fix, lower your risk of urinary stress incontinence, improve healing, and prevent fetal trauma. But researchers have since found that not only doesn’t the episiotomy deliver on those promises, but it also introduces new risks, including excessive blood loss, blood clots, and infection.

“It’s still used occasionally to speed up delivery if the baby’s in distress or if you’re having a hard time getting baby over that last little hump,” says Shelley Chapman, M.D., assistant professor of maternal fetal medicine at Greenville Hospital System Children’s Hospital in Greenville, SC. “But it need not be done routinely.” And many doctors actually believe natural tearing heals better than a cut.

How? Add “Try to avoid episiotomy” to your wish list. To prevent tearing, apply a warm compress to the perineum and have your partner perform perineal massage to make the skin more pliable. While you’re at it, skip the pre-delivery enema. It’s absolutely not medically necessary.

DON’T blow off childbirth classes, even if you’re banking on an epidural.
Lamaze, Bradley, and even your hospital’s generic childbirth classes are not a waste of time. They’ll show you what to expect on D-day, arm you with information that will empower you to make informed choices, and give you coping mechanisms that can help you feel more in control.

“At some point during labor and delivery, you will feel pain, guaranteed,” McMoyler says. “Without realistic childbirth education, you may not be able to cope with the pain, your partner will be clueless as to how to help you, and neither of you will know how to communicate with the health-care team.”

How? Take a childbirth class, be it Lamaze, Bradley, or a hybrid offered at your hospital. Also consider an educational title such as The Best Birth DVD. The more you know, the easier your labor will be.

DON’T opt for a Caesarean section, unless it is medically necessary.
There’s no doubt that C-sections save lives when mom and baby are in distress, when baby is in a breech position, or under other emergency circumstances. But electing to have one for non-medical reasons—your doctor’s leaving town, you don’t want your baby born on Halloween, or you fear for your future sex life—is downright risky.

“I discourage elective Caesarean,” Chapman says. “It’s major abdominal surgery with all the risks that that entails, including wound infection, infections in general, blood transfusions because of blood loss, damage to other organs—plus a longer, more intense recovery.”

A recent study of more than 97,000 deliveries, published in British Medical Journal, found that women who opted for Caesareans had twice the risk of illness and even death, as women who had a vaginal delivery. C-section babies were also twice as likely to have to stay in a neonatal intensive care unit.

How? Give vaginal birth your best shot. “For most women, the cons of a C-section outweigh any benefits,” Chapman says.

DON’T get induced early just because it’s convenient.
A full-term pregnancy is 39 weeks, according to the American College of Obstetricians and Gynecologists, but because of medical advances, it’s getting more and more common to induce earlier, even at 36 weeks. In 1996, 6.9 percent of all births occurred between weeks 34 and 36, and by 2005, that number had jumped to more than 8 percent.

“The hottest topic right now is inducing late preterm birth out of convenience instead of necessity,” says James Woods, M.D., professor of obstetrics and gynecology at the University of Rochester Medical Center in Rochester, NY. “It’s a big deal,” Woods says.

Going a little earlier may feel like a godsend to an expecting mom, but several new studies confirm the risks to both mom and baby: In a review of multiple studies, published in Clinical Obstetrics and Gynecology, researchers found that first-time moms who undergo elective induction are more likely to have a C-section or instrumental deliveries (with forceps or vacuum extraction) and are more likely to hemorrhage.

In another study, from The Ohio State University Medical Center, delivering a baby just two weeks early was linked to several newborn complications.

How? Avoid induction before 39 weeks, unless it’s a true medical necessity. And if you must induce for non-emergency reasons, Woods advises, do an amniocentesis first to check for proper lung development.

DO consider hiring a doula.
Who couldn’t use a personal cheerleader—especially when it comes to the physical triathlon we call childbirth? That’s why many women choose to hire a doula, a layperson trained in the basics of childbirth who provides laboring moms with continuous support through the birth and sometimes beyond.

Research shows that having a doula present is linked to decreased use of pain medications, fewer instrumental deliveries (forceps), a lower C-section rate, and increased breastfeeding.

How? Visit DONA International, the professional organization of doulas, for more information and a referral.

DON’T rush to the hospital at the first twinge of a contraction.
In spite of how it’s portrayed by Hollywood, labor can be slow. There may be as many as 14 to 28 or more hours between your first contraction and baby’s arrival. In fact, studies show that waiting to head to the hospital until you’re in active labor can help you progress with fewer interventions and increase your odds of having a vaginal delivery.

“First-time moms should wait till contractions are under 10 minutes apart and it’s difficult to walk around and breathe through them before going to the hospital,” Woods says. When timing your contractions, count from the start of one contraction to the start of the next.

How? Spend the hours of your early labor in the comfort and quiet of your own home. Try soaking in the tub, watching a movie, or other comforting activities to distract yourself.

DO be patient when it comes to an epidural.
Many moms will tell you that epidural anesthesia—a medication that numbs the nerves to the uterus, vagina, and perineum—is a gift to laboring women. But the drug, which is administered via a long needle into your lower back, is not without risk, especially if given too early.

A recent review of previously published research has found that if epidural anesthesia is given before active labor (when the cervix is dilated at least 4 centimeters and contractions are less than 5 minutes apart), it can more than double the likelihood that you’ll end up giving birth via Caesarean. “If it’s given too early, you have relaxation of the pelvic floor and diaphragm, and it’s conceivable that baby will not stay lined up and rotated in the right way to exit,” Woods says.

The result, if not a C-section, can be increased use of Pitocin, a drug that intensifies contractions; use of forceps and vacuum extraction; greater trauma to the perineum; and even maternal fever. You should also know that an epidural can have some ugly side effects: intense headache, shaking, and itching and numbness in the limbs.

How? If you want an epidural, note that on your wish list. But be prepared to wait until you’re in active labor.

DON’T accept narcotics without reading this.
While you’re waiting for your epidural—or trying to go without one—your doctor may recommend a narcotic such as Demerol, Stadol, or Nubain. These depressant drugs, called opioids, work by dulling the brain’s perception of pain. Or do they?

In a 2002 study published in American Journal of Obstetrics and Gynecology, researchers reported that women were dissatisfied with narcotics only marginally less than they were with a placebo (71 percent versus 83 percent), meaning the narcotics eased pain only slightly better than sugar pills. Other downsides are the side effects, including nausea, vomiting, extreme drowsiness (which can make it difficult to cope with the contractions), and a drop in blood pressure. Narcotics also cross the placenta and may make your baby sleepy and unresponsive at birth.

How? Talk to your health-care provider about your concerns about narcotics and explore alternative pain-management options.

DO stay on the move as much as possible during labor.
“A bed is not the best place for a laboring woman to be,” McMoyler says. “Getting out of bed and into different positions and environments will help you cope with the pain and move labor along.” She recommends these maneuvers:

• Get on your hands and knees or lean over a bed to take the pressure off the lower back and help baby’s head descend into the right position.

• Squat, which opens the pelvis and allows it to expand during labor.

• Slow dance with your partner and gently sway your hips to bring on stronger, more frequent contractions.

• Sit in a rocking chair between contractions to help you release and allow the baby to descend.

• Sit on an exercise ball, which loosens the pelvic muscles.

• Stand in a warm shower, which enhances your ability to manage contractions, allowing labor to progress.

How? Practice the maneuvers with your partner in advance and jot them down on an index card for easy referral during labor.

DON’T clamp the umbilical cord immediately.
Umbilical cord blood is a rich source of iron for baby, who won’t begin producing her own iron for several months. That’s why researchers are now recommending that instead of clamping the cord immediately, doctors wait a minimum of two minutes—about the time it takes to gently suction baby’s mouth and nose (a routine procedure), according to Woods—before making the cut.

How? Let your health-care team know in advance that you’d like to delay the cord-cutting by two minutes if possible.

DO give baby some skin right away
It’s a great idea to put naked baby on mom’s bare chest as soon as possible after birth to promote both breastfeeding and mother-baby attachment, according to a recent review of the best research. “Babies are more likely to be breastfed, and for longer, if they have early skin-to-skin contact right after birth,” says Maureen Corry, M.P.H., executive director of Childbirth Connection, a national nonprofit organization that uses research, education, advocacy, and policy to improve maternity care. “There is no need to separate you and your healthy baby after delivery.”

How? Let your delivery team know that you want your baby placed on your chest as soon as possible after delivery.

“In one second I went from the worst pain in my life to feeling wonderful. The second after I gave birth, I felt great, even while they were stitching me up. I had the same feeling—both without an epidural and with one.”

—Lisa Swanson, Bloomington, MN

“I was very surprised at how painful it was getting the epidural! It took the nurse a long time, the injection was quite painful, and it was extremely uncomfortable to bend far over my big stomach, so much so that I yelled out!”

—Jan Gunneson, Montville, NJ

“Once the baby is delivered, the doctor is pretty much ‘done’ with you. That was surprising to me. The doctor who delivered my son said, ‘I never hold the babies, I just get them here.’”

—Robin Nolan, Raleigh, NC

“I was surprised that even though I got a small epidural at 10 centimeters with my first child, they wouldn’t give me one at 8 centimeters with my second! So, with the second birth, it was natural childbirth and hurt so badly. On the other hand, the recovery period after natural childbirth is an hour. An hour! I had my body back and didn’t feel all drugged out like when I recovered from an epidural.”

—Juliette Coulter, Dallas

“I was surprised that the doctor was sewing up my episiotomy while I was trying to hold and ‘bond’ with my baby. I mean, c’mon, couldn’t you wait a couple minutes?”

—Kathryn S. Mahoney, Groton, MA

“Recovery was the worst part. I experienced a spinal headache two days after my son Luis was born. I was told that I was leaking spinal fluid caused by the epidural injection or needle. I had caffeine pumped through an IV for 15 hours!”

—Marilyn Fajardo, Coral Gables, FL

“You think you will love your baby, but when you finally meet that baby, there are no words to express the love and emotions you experience, regardless of whether it’s your first, second, third, or beyond.”

—Jodi Arlen, Bethesda, MD

Aviva Patz has written for Parenting, Self, and Redbook. She learned many of these lessons the hard way with the births of her two daughters, now 7 and 4.

You know exactly what you want to pack in your birthing bag, but do you know who you want carrying it into L&D for you? These days, many moms are taking doulas and midwives into labor and delivery rooms. They’re also bring their mothers, sisters, best friends, and even their own fathers with them. And this isn’t something new. Ancient Malaysians and Indonesians gathered all the mothers in the family or community around a woman in labor, while Navajos would often have members of the community chant and sing “unraveling” songs to speed labor along.

“During the most intimate time of their life, women need support beyond what their doctors, and often their husbands, can offer during labor and delivery,” says Leslie Ludka, M.S.N., senior technical advisor at the American College of Nurse-Midwives and a certified nurse-midwife who has attended the births of nearly 4,000 babies. That all sounds lovely, but are you really up for having a standing room–only crowd in the delivery room? Read on to find out.

Why Draft a Team?
Many dads are uncomfortable in the delivery room. They don’t want to see their wives in pain, or they can’t handle the sight of blood and needles. “A dad’s comfort level in the delivery room is not a measure of his love or commitment to his family,” says Breck Hawk, R.N., a midwife in San Diego, CA, and author of Hey! Who’s Having This Baby Anyway?, “but it’s often a factor in women bringing another person into the room.”

Even if he has a stomach for pain and hospital food, it’s hard for a man to understand the emotions, sensations, and experiences a woman experiences during labor and delivery. “That’s why many moms-to-be also choose to bring a female counterpart in with them. They’re comforted by having someone who’s either “been there” or who’s shared other milestones with them,” Hawk says.

Like you, a dad-to-be is anxiously waiting to count 10 tiny fingers and toes. “That anxiety can inadvertently divert his attention away from tending to your needs,” Hawk says. Having someone there just for you helps you to “let go” of distractions, because you know your needs will be taken care of. A birth buddy also lets dad take a food or bathroom break without feeling he’s choosing between caring for you and taking care of himself. “A refreshed father can be an invaluable asset to a woman in labor,” Hawk notes.

Who gets the nod?
Hiring a doula or midwife to be with you—in addition to your obstetrician—is one option. “A doula provides physical and emotional assistance before, during, and/or after childbirth based on your preferences,” Ludka says. You can usually find one through referrals either from other new moms, your doctor, a birthing center, or
dona.org.

Your circle of family and friends is another place to look for a birth buddy. But asking a family member or friend to join you in the delivery room isn’t at all like hiring a doula. “Doulas and midwives can be formally interviewed and screened,” Ludka says. Your best friend probably doesn’t have a list of five references for prior births she’s attended.

But that doesn’t mean you can’t ask some questions. To narrow your search, assess how your potential birth coach handles stressful situations. How does he or she react to you in emotionally charged settings? “Trust your instincts,” Ludka says. Ask yourself if the person will support your decisions, even ones that change during labor or are decisions she might not have made for herself. Pick someone who won’t pass judgment. “If you want an epidural, don’t bring a friend who will lecture you about her disapproval of them,” Ludka says.

It is a good idea to bring someone you know can stay cool in stressful situations. “You want to focus on your labor, not trying to be happy or avoid upsetting someone else,” Moore says, “Everyone in the room should be there to help you, not for you to worry about them.”

Once you’ve compiled your “short list” of possible birth partners, approach candidates about a playing a role in your delivery in a manner similar to the way you would interview a doula. Ludka says, “Do this weeks or even months before your due date to have time to find someone who is comfortable being part of a vulnerable and intimate moment.”

Talk about their comfort level with parts of your body being exposed during labor and birth. Don’t bring anyone in the room who will be embarrassed by this, or who you’ll be embarrassed in front of. And don’t be afraid to change your mind. “I have seen many women initially refuse having their mother in the room, but then ask for her a few hours into labor,” says Marianne Moore, R.N., certified nurse midwife at The University of Texas Health Science Center at Houston School of Nursing, in Houston, “or ask someone to leave the room after planning on them being present for the labor and birth.”

Can’t choose between two special people? Ask one to stand by to be sure at least one of them can make it to the birth. Or to ask one person to coach during labor and the other to be with you during delivery and the first minutes of after. “Do whatever feels the most natural and comforting to you,” Moore says.

Thanks, But I’ll Pass
Don’t assume whomever you ask will agree to be present. People say no for a variety of reasons, Ludka says. The delivery room is not a comfortable place for everyone. “We all know our limitations. If someone has reservations and attends anyway, the atmosphere in the room can be affected in a negative way.”

If someone declines being in the delivery room with you, try to be grateful they were honest. “A ‘no’ isn’t a representation of their feelings for you or their level of excitement for your baby,” Ludka says.

Getting Ready to Go
At the birth of her second son, J.J., Schambow, a Menomonee Falls, WI, mom to 1 and 3-year-old sons, hired a doula and asked her sister and sister-in-law to join her and her husband in the delivery room. “We wrote a birth plan and discussed the roles with everyone ahead of time so they all knew their functions,” she says. “Everyone worked like a team and made me feel well-supported. It helped me do what I needed to do. We credit open and direct communication about roles and expectations with everyone’s proactive and supportive attitudes,” Schambow says, “and with our sons’ births being so calm.”

Moore says everyone you choose needs to understand your vision of the birth partners’ roles in the delivery room. “Talk openly and honestly about what you want them to do.” Whether it’s offering supportive words, holding your hand, or wiping your forehead, they need to know your expectations. Moore says, “Even if you just want their presence in the room, tell them where you’d like them to ‘hang-out’ during labor and delivery.”
Share your written or verbal birth plan with your birthing buddy so she can speak up communicate your wishes to the staff if you’re unable to. Discuss and write down your preferences for everything from epidurals and breastfeeding right after delivery, to taking photos, before heading to the hospital. “You’ll avoid any misunderstanding and confusion,” Moore says.

If your birth buddy has never attended a birth, Moore recommends reviewing birth literature and watching a birthing video together so everyone knows what to expect. Ask the leader of your birthing class if you can bring two coaches. “Schedule a tour with everyone you’re planning on having in the delivery room at the birthing unit to familiarize everyone with the facility’s resources such as Jacuzzis, showers, birth balls, rockers, policies on food and fluids, etc.,” Moore suggests.

What to Expect
Birth partner’s roles vary from mom to mom. “One of the most important hats my sister-in-law wore was that of the videographer. It let my husband focus on the moment,” Schambow says.

Birthing teammates can keep the atmosphere calm by just being quietly present, sitting at the bedside, and offering appropriate words of encouragement. They can also provide levity if you’re up for hearing juicy gossip, keep you focused on your breathing during each contraction, or provide hourly phone or email updates to family members and friends. “They can do virtually any supportive activity that is comforting to the mom,” Hawk reminds.

The Big Day
When you check-in to at your hospital or birth center, Hawk says it’s a good idea to tell the staff who you want in the room with you. Birthing centers and obstetric floors have very tight security and you don’t want a member of your birthing team delayed or blocked from getting to you because the staff wasn’t expecting them.

• Cell phone and charger

• Toothbrush and toothpaste

• A bathing suit, because you never know when a tub or shower is going to be involved

• A full change of clothes including socks, shoes, and underwear. Your partner may wind up in the shower with you or wanting to freshen up for photos.

• Over-the-counter headache and antacid medication, plus any prescription medications (inhalers, and so on)

• High-energy snacks, such as trail mix, and bottled water. Just make sure
the snacks don’t have strong smells because mom may not tolerate the
odor or crunching.

Her pre-term labor and delivery meant author Gina Roberts-Grey’s room was off limits to extras. If she could have asked someone to join her and her husband, she would have asked her grandmother to be with her.

Considering who you want to support you through labor can be a challenging decision.  The birthing room cast can include relatives, friends, doctors, nurses and midwives.

There is one more person you should consider bringing with you – a doula.  These professional labor assistants use their experience supporting women through labor and birth to aid in your efforts to have the healthiest and safest birth possible.  Here are five ways doulas can help you:

Better Births – Hiring a doula is a simple way to reduce your risk of experiencing complications.  Researchers have found doula-attended births are often shorter with fewer cesarean sections and labor inductions needed.

Communicate Your Preferences – Many moms spend time writing out birth plans, but often they end up sitting untouched and ignored on the big day.  A doula can remind hospital staff of your wishes, whether those are to avoid unnecessary interventions or to move around freely during labor.

Support – Genuine and loving support can have a huge influence on the duration, pain management and enjoyment of birth.  Many moms-to-be expect to get that support from nurses, but they often care for multiple patients at the same time.  Having a doula will ensure you receive consistent support through every single contraction.

Experience – It is often assumed that birth partners will provide labor support, when in reality most are nervous and unsure of themselves in this important role.  Doulas have assisted many women through birth and can provide support for both the mother and father based on their rich experience.

Breastfeeding Assistance – Research has shown babies breastfeed more easily when a doula is present during delivery.  Some doulas also offer breastfeeding support and other postpartum services to nurture you and your birth partner in your new roles.

Many Lamaze Instructors are also doulas and may be able to provide more information on doula services in your area. Moms-to-be who want to know more about how a doula can help them get off to the best start can find more information at www.Lamaze.org.

Marilyn Curl, CNM, MSN, LCCE, FACCE, is the president of Lamaze International (www.lamaze.org), which promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices based on the best and most current medical evidence available.  Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years.

By Amelia Glynn

During a recent dinner party, Serin, a mom in Livermore, CA, overheard a new dad casually announce that his wife pushed so hard that she pooped.

Welcome to the brave new world of full disclosure. And according to Sue Fox, author of Etiquette for Dummies, it’s here to stay. “Birth just isn’t considered private anymore.” Fox admits that she’s on the fence about sharing certain details of a baby’s birth, but etiquette changes just like everything else. “Technology is evolving so quickly, we simply haven’t had time to put new rules in place,” she says.

We now have the ability to spontaneously (and frequently) share whatever we desire about our lives—including the details of the labor and delivery of our children. But is this a good thing? And when does sharing the arrival of that new bundle of joy veer into the territory of TMI (too much information)?

What is etiquette, anyway?
P.M. Forni, Ph.D., Johns Hopkins University professor and author of Choosing Civility says that ultimately, “Etiquette isn’t about which fork we choose for our salad, but how we treat each other.” He believes that because birth is such an intimate part of the human experience, it should be governed by restraint. “Privacy is owed as a form of respect for the mother, baby, and the birth itself,” he says.

“Facebook friends: My doctor is sewing up my episiotomy now. Thank God I can’t feel a thing!”

Forni also believes that our urge to document birth is an automatic response to the growing desire to publicly announce the changes in our lives. Sometimes this includes broadcasting things that could be awkward or embarrassing.

“It’s a party!”
Kaiser’s Calhoun says there’s no limit to the number of family and friends allowed in their delivery rooms, as long as everyone is respectful of the patient and staff.

Although Asia didn’t plan for a crowd, nearly 20 witnessed the birth of her son. Says the mother of one in Mill Valley, CA, “I had a long and difficult labor. People just kept showing up.” She still remembers the party-like atmosphere when her son arrived on the scene. “Everyone cheered and someone popped open a bottle of champagne,” she says.

Twittering through transition
For some moms, blogging is just so 2001; they need the drama to unfold in real-time. So when Sara Morishige Williams, known on Twitter as @sara, went into labor, she sent out a tweet: “Dear Twitter, My water broke. It wasn’t like Charlotte in Sex and the City.” Five hours later, after she was admitted to the hospital, she sent another: “Epidural, yes please.” Sara also happens to be the wife of Twitter CEO Evan Williams. Publicity stunt or not, tweeting takes the sharing of intimate pregnancy details to a whole new extreme.

Some moms claim that using their cell phones during labor comes as a welcome distraction from the pain and help them feel less alone. “We’ve had a lot of moms who have tweeted and texted through their entire labors and deliveries,” says Amanda Calhoun, M.D., assistant director for women’s health at Kaiser Permanente Northern California.

But why are we sending so many messages through the Internet in the first place? Because we can, Forni says. “It’s a technology-driven behavior, and to a large extent, it’s a trivial exchange.”

When her contractions began, Pamela, a mother of one in Philadelphia, was on her BlackBerry with three friends, but she chose not to share anything publicly. “I find it kind of a turn-off,” she says. “I would think you’d be too involved in your child’s birth to inform anyone but those who truly need to know.”

Lights, camera, contraction!
Tara and Travers from Santa Rosa, CA, describe the video of their son’s dawn arrival as more “art film” than documentary. “I think an argument can be made for aesthetics,” Travers says. “The way a birth is filmed can make it a lot less ‘in your face’ and more about the actual experience.”

“Dear Twitter: I think I just lost my mucus plug. Wonder when my water will break!”

Unbeknownst to Pamela until several days after the fact, her husband videotaped her C-section. “I was both surprised and horrified,” she says. But once she watched it, she felt grateful to have it: “It has all these things that I replay in my mind—including the image of my son in his first moment of life.” As for sharing this footage, Pamela says it’s not something she would post for public consumption.

But a lot of moms-to-be do consider birth videos an important resource. Ann from San Francisco, who is pregnant with her first child, says she intends to watch one on BabyCenter.com as part of her own preparation.

Although YouTube established what it calls “community guidelines” to regulate what’s posted, some of the childbirth videos are surprisingly graphic, showcasing screaming moms and full-frontal crownings. According to Victoria Grand, YouTube’s head of policy, the site relies on a community policing mechanism that allows viewers to flag videos they find offensive, which are then reviewed by staff. The majority of birth footage lives in an age-restricted area of the site.

Last November, Lynsee and her husband, Anders, from Minneapolis, upped the ante by setting up a webcam in their hospital room (with special permission) so visitors to the social networking site MomsLikeMe.com could follow every push—live—during their baby’s delivery. Why did they subject themselves to such scrutiny? According to the site, they wanted to help take some of the mystery out of the process.

SFGate.com and BabyCenter.com mom blogger Amy Graff thinks that some women push the envelope too far by sharing inappropriate information online just to get attention, but says that most moms feel compelled to help prepare other women for their own births or hope to demystify childbirth by presenting a candid experience—one that is a far cry from the heavily edited and often outdated videos shown in birthing classes. “I just worry that a lot of these women aren’t prepared for the feedback they receive. There are a lot of mean and creepy people out there,” she says.

Setting boundaries
To avoid awkward discussions during the throws of labor, Kaiser’s Calhoun encourages parents-to-be to decide on a birth plan and write it down. “This helps open up the conversation and ensure that everyone involved knows the rules ahead of time,” she says. “It also helps the mother feel more comfortable and relaxed.”

“OMG! I can’t handle another contraction! Where’s my epidural?! Somebody get me some DRUGS!” —sent via iPhone

Farra, a new mom in Oakland, CA, told her husband: “No crotch shots,” while Anne, a mother of four girls in Denver, CO, made sure that she had final say on all photos that went out to family and friends. Anne recommends taking a break from technology and embracing the downtime that giving birth affords us. “It’s one of the only times when the outside world becomes non-existent,” she says. “It’s like a little baby honeymoon and new parents should take the time to enjoy it.”

However you decide to document your birth should be OK with you, your partner, and your immediate family, Fox advises. And know in advance that not everyone will approve. “It wasn’t so long ago that we had to wait for baby announcements to arrive in the mail,” she says. “For some, sharing the very intimate details of a baby being born can be offensive.”

“It’s not me, it’s you.”
Pamela, who describes herself as being “less squeamish than most,” has occasionally been put off by what some people have chosen to share. “A friend posted what I considered to be highly offensive pictures of his semi-nude wife and still-bloody child on Facebook,” she says, adding that this same couple also set up a Facebook page for their child when he was only a week old.

So what should we do when we encounter folks who are, in our opinion, guilty of over-sharing? “If your friends, say, hold an unexpected birth screening during a party that you aren’t comfortable watching, simply excuse yourself,” P.M. Forni, Ph.D., says, “offer to take the dog for a walk or head out to the terrace to watch the sunset.” Basically don’t make a big deal out of it.

San Francisco–based writer Amelia Glynn grew up reading Emily Post. She secretly dreams of going back to charm school.

By Andy Garreffa-Orizotti

I could barely sleep during the last weeks of my second pregnancy. But this time, I had something new to worry about as I lay awake—shaking up my two-year-old son’s little world with a needy sibling. But my first child was, ultimately, why I decided to attempt a vaginal birth after Cesarean, or VBAC. I knew the physical limitations of recovering from a second C-section would exclude me even more from his daily life.
My endeavor was a success—and I’m not alone: According to the American College of Obstetricians and Gynecologists, statistics show that 60 to 80 percent of women who try for a VBAC do have a successful vaginal delivery. So, in spite of increase in the number of C-sections performed each year, women should know that having a Cesarean is not always necessary.

The Advantages
There are many positives to a VBAC: less risk of surgical complications and infection, shorter hospital stay, immediate contact with baby, and reduced recovery time. But the risks and benefits of a VBAC have to be weighed on a personal level.
“With family at a distance and unable to help me, it would have been nearly impossible to come home and be a mother to my toddler with the lifting restrictions and pain a second C-section would have imposed,” says Rachel Marvin of Flemington, NJ, who delivered by VBAC in August 2008.
For some, a VBAC provides what they feel they missed by having a surgical birth. Nadine Jensen of Tulsa, OK, says the main reason she chose to deliver her second baby by VBAC was for the “fairy-tale experience of ‘Here’s your baby!’ The instant skin-to-skin contact and immediate chance to breastfeed.”

The Concerns
Not all vaginal births after Cesarean follow this “fairy tale,” of course. There’s no guarantee that after a long labor, your delivery won’t result in another surgery.
One of the main things doctors look at when considering patients for a VBAC is the incision from the previous C-section. You must have a low transverse cut, one that crosses horizontally just above your pubic hair, because it creates a sturdy scar that has little likelihood of splitting. This incision is used in more than 90 percent of Cesareans.
The main risk of a VBAC, in fact, is the slight percentage increase in uterine rupture, compared to women who’ve never had a C-section. This percentage greatly increases with incisions other than low transverse. But for women who’ve had the proper incision, the risk percentage is “anywhere from .2 to 1.5 percent, depending on the resource,” according to Tyler Bradford, M.D., an ob/gyn in Bozeman, MT. You may still be a VBAC candidate if your incision is low and vertical, but your risks increase.

Other Issues
The controversy over VBACs and Cesareans has moms caught in the middle. In June 2008, The New York Times reported that some women who’ve had C-sections have actually been denied insurance coverage or were charged higher premiums because they’re considered a risk to insure. And hundreds of hospitals don’t offer VBACs because of the aforementioned risk of uterine rupture, so you may to have to change doctors if you want to avoid another Cesarean.
Bradford believes this issue will eventually come full circle, because the more C-sections a woman has, the higher her risk of future health complications. But until then, if the benefits greatly outweigh the risks for you, start a conversation with your ob/gyn now.

Read and Decide
• Birth After Cesarean: The Medical Facts, by Bruce L. Flamm, M.D.
• The VBAC Companion, by Diana Korte
• Vaginal Birth After Cesarean: The Smart Woman’s Guide to VBAC, by Elizabeth Kaufman

Andy Garreffa-Orizotti loves using her experiences as a mom to write articles that inform other new moms. Her work has also appeared in Montana Parent.

By Bob Gulla

The woman I love lies before me, about to give birth to our child. She is in obvious distress as we near the moment of truth. There is much sweat and gnashing of teeth. She is in a very compromising position, and unfamiliar people bustle about the room. So what do I do? Like all good and sensitive husbands, I encourage her to do one thing: “Smile, honey!” I lean in and snap a picture, flash and all. OK, honestly, I didn’t actually do that.

This is not to say that the delivery room isn’t a place for photography. In fact, the experience provides a critical backdrop for some very valuable pictures. “Our first family shots with the three of us all together were taken in the delivery room,” says Melissa Moody, a new mom from Mountain View, CA. “If I didn’t have those pictures, I’d be devastated.”

Fortunately, in our digital world, getting those images is quicker and easier than ever. Bill Camann, M.D., director of obstetric anesthesiology at Brigham and Women’s Hospital in Boston and co-author of Easy Labor, has become something of an expert on photography during and after the actual birth. “Digital cameras have changed the delivery-room experience. With C-sections, especially, the first time the mother sees her baby is usually on the screen of a digital camera. And dad can actually have the baby’s picture on the Internet before mom is all sewn up.”

Cameras in the delivery room might be ubiquitous, but taking quality pictures is another story. Tensions can run high, the lighting isn’t ideal, and the bustle of activity makes snapping any real keepers a challenge for the best photographer.

Melissa Moody’s husband, Brian, went in with a plan and a nice new digital SLR camera around his neck, but was soon ordered by the head nurse to “grab a leg.” Melissa recalls, laughing, “He was white as a sheet. He had his camera around his neck, but he wasn’t taking any pictures!”

Certainly, there is a time and place for photos in the delivery room. But the most important thing to remember is that the room itself will be a very busy and crowded place, and you will be engaged caring for your partner. There will be precious little time to take photographs, and when you do take them, they will be more like what a war correspondent might get on the job.

“I was holding a leg,” remembers one dad. “I was consumed with being in the moment. I didn’t want to be snapping pictures. I wanted to be there, not weighed down by a camera.”

If you’re concerned about the idea of taking pictures in the delivery room, here are some things to consider:

The delivery room is illuminated by a combination of tungsten and fluorescent lighting. If you’re slated to deliver by C-section, the operating room will be plenty well lit, making a flash unnecessary. In vaginal deliveries, the birthing rooms are a little darker, rather small, and the shooting range will likely be about 5 to 6 feet. During the delivery experience, a safe film speed is 400 or 800. You can use a slower setting, or even a small tripod, when the commotion subsides and relatives and siblings enter the picture.

Even then, Camann explains, you should give particular deliberation to those intimate family portraits. “Let’s say the mom or dad is sitting there holding the baby. Well, they usually look down at the baby, which doesn’t make for a great photo. Have the parents look up and at the camera. Also, the babies are often swaddled so much that only a little sliver of face is showing. Loosen it up a little, or at least make sure that the camera angle picks up the baby’s face.”

And, of course, make sure you shoot lots and lots of pictures of the new mother. Chances are she’ll be ready with a big, beautiful smile.

More tips for delivery-room photographers:

• Check your hospital’s policy. Some won’t allow flash photography, and some don’t allow cameras at all. Sometimes the decision is left up to the obstetrician.

• Make a prenatal hospital visit and envision your task before it happens. Check the lighting, the space, and the possible angles of photography.

• Make a checklist of photos you want to get and stick to it, no matter how stressed you feel.

• If possible, take the moment of delivery.

• Consider taking photos in black and white. There’s timelessness about them and it eliminates the unflattering color palette—pale mom, ruddy baby, ashen dad—of the experience.

• Other essential shots you might not consider:
– The hospital room
– The clock showing time of birth
– Baby on the scale
– The nurses and medical staff
– Some people actually photograph the placenta!

• Take more pictures than you’ll need. You can always delete them, but you can never recreate that moment.

Bob Gulla has been at his wife’s side for all four of his kids’ deliveries—two in the harsh light of the operating room. Oddly, he didn’t take pictures at any of them. In hindsight he’s disappointed, but glad that his pasty gaze and dark, encircled eyes were left undocumented.

With today’s advances in technology, waiting for birth announcements via snail mail seems so 1988. Now you can instantly share baby’s specs—name, height, weight—and maybe even photos, video, and sound in several geek-chic ways.

Blog it: Set up a pregnancy and baby blog and ask pals to add it to their RSS reader, so when you or your partner publish birth stats and pics, they’ll know right away. “It was great because we could get the word out quickly with multiple photos. Folks could leave a message for us and our new addition and it was totally green,” says Krista Pille of Cincinnati.

Twitter it: You’ll need your partner’s help with this one. Twitter.com allows a play-by-play, minute-by-minute text recap, uploaded by cell, laptop, or wireless device. Close friends can follow the “tweets” from contractions to first cries, receiving automatic updates by instant message, text, or your Twitter page.

YouTube it: “I shot images and video on a small digital camera, went home the afternoon of her birth, edited them and added music, uploaded the video to YouTube, then sent the link to all of our friends and family—all within 24 hours,” says dad Rick Julian of Atlanta. You can create high-tech videos with zero tech skills using One True Media or Animoto. Both let you integrate photos, video, music, and text.

Text it: Too tired to write a mass e-mail or mess around with baby pics? Spinvox converts your voice announcement to text and sends an email to friends and family.
Baby Birth Notifications will distribute a text message to 100 people with your short and sweet sentiment; similarly, phonevite can deliver a voice message to 25 recipients at once for free. Or record baby’s first cries and Snappy Baby forwards it to your predefined list by email and phone.