Birth is a paradox. On one hand, it's a very natural body event, just like eating and digestion, and not an illness that needs to be medicated or that requires an operation.

On the other hand, when and how your labor will unfold are mysteries that even to the most astute medical geniuses aren't able to always predict or decipher.

As your delivery date nears, it's quite normal to feel a little anxious about how things are going to turn out. But, before you get too worried about the high stakes involved, please note that giving birth is not like gambling everything you own in Las Vegas. What happens in Las Vegas stays in Vegas. What happens in birthing centers usually comes out wearing a little cap and booties.

No matter how much you'd like to control the dimensions of your unique, individual birth, a lot of what is going to happen on that day will just have to remain fuzzy until it really happens.

Estimates about the date your particular baby will arrive, or how much he will weigh, are notoriously inaccurate, even when predicted by such advanced technological imaging devices as 4-D sonograms. Your health care provider won't be able to predict by blood tests or peering inside whether your labor will happen tomorrow or 10 days from now, or if it will be short and only last, say, four hours or drag on beyond 24.

The chances are really superb, however, that you will give birth to a very healthy and hardy baby, and you both will survive and thrive very nicely. Sometimes, though, even the well-laid plans somehow go awry.

Creating a Birth Plan

Hospitals have birth plans about what they routinely do (or won't do) with women in labor, and patients can have birth plans, too. Some parents choose to create a birth plan to provide guidelines to health care providers and hospital personnel during birth.

Similar to a living will, a birth plan is a written document that expresses a woman's wishes regarding how she would like to be treated during her birth under the best of circumstances.

However, unlike a living will that is supposed to be enforced when someone is incapacitated and unable to express their own preferences, a laboring woman's birth plan is NOT considered a legal document, nor is it a directive that doctors, midwives, or nurses are required to follow regarding what is to be done (or not done) during her labor and birth.

Instead, a birth plan is usually considered more of an informal starting point for a conversation between a pregnant patient and her physician or midwife about what she'd like to have happen during her birth as long as labor proceeds on course. Later, the same document can be shared between the patient and the hospital's medical staff when she is admitted for birth, but before her health care provider arrives to dictate what is done.

A typical birth plan will indicate a woman's preferences, such as giving a "yes" or "no" to the most common hospital procedures, such as: induction; augmentation; amniotomy; IVs and heparin locks; pubic shaving; enemas; epidurals; narcotics; eating and drinking during labor; freedom of movement; continuous (or intermittent) monitoring for mother or baby; hydrotherapy (showers, baths and waterbirths); forceps; vacuum extraction; and self-directed pushing.

There are many forms a birth plan can take. It can be huge and long, be a preprinted checklist generated by the software on an Internet site, or be only a brief paragraph stating a couple's philosophy and how they would ideally like to be treated. Birth plans that are too long and too detailed become counter-productive, as hospital staffs are generally pretty busy and probably won't have the time required to go over a long plan in much detail.

A birth plan can also specify what's to happen to the baby during and immediately after birth. For example, it may say that your husband wishes to catch the baby or cut the cord, or express your intentions regarding tests medications and vaccines and whether or not you plan to breastfeed or bottle-feed.

Creating a birth plan can be a very positive experience, and it may well help to alter the course of your birth experience.

First, composing your plan will require that you become familiar with most of the intervention and testing options that you may encounter offered during a medically oriented birth experience. Thinking about what you want (and don't want) can help you to get a better sense about the realities of birth in a hospital and to rehearse in advance so there are no surprises.

Developing your plan will also help you to become a more informed consumer regarding your medical care. You will have a way to test the responsiveness and reasonableness of your chosen health care provider, and to rehearse in advance what the drill will look like should you find yourself faced with scary procedures.

It is also highly likely you'll be quite distracted and foggy in the midst of your labor, and that can affect your ability to make good judgment calls. Having a plan in writing can also help the person you've chosen to serve as your advocate, (a.k.a. your birth partner) in a similar way that someone given Medical Power of Attorney does.

Birth plans can also have some disadvantages. Unfortunately, not all medical professionals appreciate patients' birth plans, no matter how exquisitely they are drafted or how clearly their grasp of medical interventions. A physician or midwife may take offense to being told by patients what they can, or cannot do.

After all, it is health care providers and not patients, who have been trained and had all the experience in guiding the birthing process. Should something go wrong, too, they may also have to professionally account for it.

There's also the risk that some nurses, residents and other hospital staff members may label you and your partner as "control freaks" based on your detailed plan, and secretly surmise that you'll probably end up undergoing the very interventions you're trying so hard to prevent because you're so uptight and unable to relax.

The Principle of Informed Consent

"Informed consent" is an important medical concept that every prospective hospital patient should understand. Not only is informed consent the law, it is also an essential element of ethical medical practice. It dictates that the patient is to have the ultimate say-so about her (or his) medical treatment. The rule applies equally to an impoverished laboring woman on Medicaid as it does to a Fortune 500 CEO in his private suite preparing to undergo prostate surgery.

Basically, all patients have the right to be fully informed about any test or procedure that is being proposed for them (and their babies) in a language they can understand. That discussion is required to include not only the benefits of the procedure, but also its risks, no matter how remote.

Keep in mind, though, that there is a fine line between being a well-informed consumer of medical services, and entrusting your health care provider to apply her, or his, training, judgment and experience when it comes to deciding what is the healthiest and safest thing to do at any given moment.

It helps to have a backup of leading questions you can ask your doctor or midwife whenever you're being presented with a recommendation of which you are unsure:

1. Is this a true emergency or do we have time to talk about it?
2. What are the benefits of doing this?
3. What are the risks of doing this?
4. If we do agree to this, what other procedures or treatments might we end up needing as a result?
5. What else could we try first (or instead)?
6. What would happen if we waited an hour or two before doing it?
7. What might be the outcome if we elected not to do it at all?

• Choose your caregiver carefully. Again, your caregiver will wield the ultimate power and influence when it comes to how your labor will be handled in the hospital. Sometimes it's hard to gauge where your caregiver actually stands on issues until your actual birth, but you'll most likely be able to tell within the first minutes of an interview if your chosen provider is a scalpel-happy interventionist, or a concerned and caring listener. Most providers are willing to reveal their cesarean section rates (hopefully 15 percent or less), or their policies about inducing labor. If at any point, your provider seems peeved with your concerns; brushes them off as frivolous or unimportant; or adopts a "father (or mother)-knows-best" attitude that leaves you feeling diminished as a person, then perhaps you should consider firing that person and hiring someone else. Don't burn your bridges behind you, though, until you're confident you've found someone who is more honoring, and willing to take you as a patient, even if you're due in only a few weeks.
• Read other people's plans. The Internet now offers numerous birth plan templates developed from real-life birth experiences. Often the authors will discuss what worked for them in real birth situations and what they might do differently the next time. Some couples report that their plans worked great, while others may say that their plans had to be totally scrapped in the face of unanticipated emergencies.
• Condense, condense, condense. There's no need to create a dissertation on birthing practices complete with footnotes, when a simple checklist will do. Use the barest number of words and tailor different pages to different parts of your birth. Some topics may better be handled by the nurses in the postpartum recovery unit, such as having your son circumcised, or getting help with breastfeeding, rather than nurses in the labor and delivery area. Consider composing a "Plan A" (for an uneventful birth), and a "Plan B" (in case you need a c-section or your baby has to be kept in a Neonatal Intensive Care Unit), and make them detachable from one another so you can pull out only the part that's appropriate at the time.
• Use non-threatening language. Instead of: "We demand;" "we must;" "it is imperative that," use kinder, and more conciliatory phrases, such as, "we would prefer;" "we feel; "we hope;" "we're concerned about;" "it is important to us that;" or "we would like to be free to." Also stress your desire to be an integral part in the decision-making process: "We would like to be consulted." "We would like to be presented with our options." "We would like to be continually informed."
• Review each topic with your caregiver, but not all at once. If possible, plan to cover a few lines of your birth plan at each appointment, rather than taking up too much of your caregiver's time while other patients are waiting. Or, let the receptionist know in advance the amount of time you'll need when making your "birth plan" appointment.
• Request that your caregiver sign off on your plan. Your doctor or midwife will wield the most power when it comes to what is done, or not done during your hospital stay, no matter what you've written in your plan. For that reason, he, or she, will need to be formally "on board" for your desires to be enacted. One way to accomplish that is to create a cover statement, such as: "I have reviewed the following birth plan for ______ and ______ (your names), and have approved all requests. Then place a line for your provider's signature with a printed version of the name, and a place for the date the document is signed. Make multiple copies, including several for your trip to the hospital during birth.
• Consider alternate birth management options. Hire a doula or birth assistant to accompany you through your labor (and set up an alternate, and alternate's alternate). She will be able to advocate for your wishes during labor and birth, and may be able to fend off unnecessary interventions by making your intentions clear and undeniable. (But remember that she's human and will need a break, will get tired, and hungry, too).
• Stay home as long as you can. Research shows that women who arrive at the hospital too soon, before their labors have had time to become seriously active, are more vulnerable to hospital interventions, such as inductions, instrumental deliveries and cesarean sections, which may be based on how long a labor appears to be taking. One option is to hire the services of a midwife to work with you at home during the earliest part of your labor and to advise you when the timing is optimal for contacting your health care provider based on the dilation of your cervix.
• Call ahead for reservations. Although your health care provider's office will notify the hospital that you will be arriving soon, if you encounter special problems with your labor, become ill, get stuck in a traffic jam, or have questions about when you should come in, consider contacting the hospital's labor and delivery area yourself. That will enable the nurses to prepare your room, complete preliminary paperwork, and streamline your admission process. While you're at it, mention that you are hoping for an all-in-one birthing room if one is available, and let them know if you are hoping to be able to use a birthing tub.
• Keep talking during labor. Even though you've brought your birth plan with you and submitted it for your record, keep talking and expressing your labor preferences to every staff member you encounter. Even though you've put your preferences down in writing, there's no assurance that every person will remember what you've requested in the pressure of the moment, including your health care provider. Voicing your wishes when things are happening is far more effective than anything on paper. If you don't want to be repeatedly asked about getting an epidural, say so (and post a note on the outside of your door); if you don't want non-essential medical personnel observing your birth, then ask them to leave; if you want your bag of waters to stay intact, are planning a non-medicated birth and prefer not to have an IV, let the person interviewing you know as soon as your admission into the labor area begins. During the pushing stage, if you don't want pushing commands from others, or want to have perineal massage and hot and cold packs to help your perineum stretch, rather than risking an episiotomy, remind your provider about your agreement.
• Be prepared to change your game plan. If an emergent condition arises and you realize you're going to have to change your game plan without a lot of time to think it over, it makes sense to go ahead and yield. If you or your baby's life appears to be endangered, then complying immediately could be lifesaving.
• If time is on your side, use it. Unless your care provider makes the case for your baby being in serious fetal distress, or presents another serious and immediate problem, request time to think over your decisions, and consider calling for a second opinion, such as that of the medical head of the hospital. Or, when the decision affects your baby -- a specialist in maternal-fetal medicine or the head of pediatrics. Sometimes all you may really need is just a few more hours for everything to happen.
• Then, try to relax. Breathe deeply, relax all of your tense muscles, and just let your body do what she innately knows how to do: give birth.

About the Authors
	Sandy Jones and Marcie Jones are nationally-known pregnancy and baby care experts and best-selling authors. Their pregnancy book: Great Expectations: Your All-in-One Resource for Pregnancy & Childbirth, is available from Barnes & Noble.com. Click here to buy your copy today!