1. Childbirth Choices Choosing a Health-Care Provider Creating a Birth Plan

2. Choices WHO: Obstetrician Nurse-Midwife General Practitioner WHERE: Hospital Traditional – labor room and delivery room Birthing suite Alternative Birth Center Home Birth

3. Choosing an Obstetrician What kind of doctor do we need? Is the doctor well-qualified? Will the doctor be available if labor begins at an unexpected time? What hospital is the doctor affiliated with? Will the doctor allow the father in the delivery room (what are the hospital procedures)? How much will it cost (do they participate in your insurance plan)?

4. First Visit to the Doctor Diagnose pregnancy Thorough physical examination Full medical history Various tests – weigh, measure, heart and pulse rates, blood and urine samples, blood test, PAP test for cervical cancer Pelvic examination Set up regular check-ups Explains aspects of good prenatal care, nutritional needs, environmental concerns, etc.

5. Tests, Etc. Throughout pregnancy, weight and fundal height is monitored, urine is routinely checked for protein and glucose, baby’s heart rate is checked First trimester Blood tests – HcG, plasma protein Ultrasound Second trimester Blood test – Alpha-fetoprotein, etc. Amniocentesis, Chorionic villus sampling if necessary Third trimester Glucose tolerance test Fetal monitoring

6. Certified Nurse-Midwife Registered nurses who receive specialized training in obstetrics Work both in hospitals or free-standing birth centers

7. Alternative Birth Centers Only one in the Pittsburgh Area Home-like atmosphere No specialized equipment to handle emergencies, therefore they do not handle high-risk pregnancies Home Birth May be attended by a midwife or doctor in some rural areas

8. Doula Receive specialized training in childbirth Hired to be an advocate or childbirth companion or coach Can also be hired post-partum to help with the baby

9. Birth Plan Put your wishes in writing so health-care professionals know what you want Things to include – your wishes in regard to routines and care of the baby; who is allowed at the delivery, etc.

10. Prepared Childbirth (Lamaze) Valuable for information – what to expect Classes where couples learn techniques that will help a woman maintain control of her body during childbirth Special breathing and muscle control exercises Relaxation techniques Special eye-focusing exercises

11. Non-medicinal Pain Relief Accupuncture Hypnosis Transcutaneous electronic nerve stimulation Laboring in water (jacuzzi) Relaxation and positive visualization Other – music, massage, position change, counter-pressure, support, adequate hydration

12. Cesarean Section Operation whereby baby is delivered through an incision in the abdomen and uterus Recovery period at least 10 days longer than vaginal delivery Reasons: Pelvis may be too small Birth canal may be infected Mother had one before Breech presentation Multiple births Fetal distress