Labor and Delivery

During prenatal visits, talk with your health professional and IP's about what you would like to happen during labor. Consider writing up your labor and delivery preferences in a birthing plan, either with the help of a childbirth education class or on your own. You can find various examples of birthing plans on parenting Web sites.  Because no labor or delivery can be fully anticipated or planned in advance, be flexible. Your experience may be totally different from what you expect.

When making plans for the baby's birth, consider the location of your delivery, who will deliver the baby, and whether you want continuous labor support from a designated health professional or a doula, a friend, or family members or your Intended Parents. If you haven't already, this is also a good time to decide whether you'll attend a childbirth education class with or without your IP's, starting in your sixth or seventh month of pregnancy. After you've set the stage, think through your preferences for comfort measures, pain relief, and medical procedures.

Comfort measures may include:

• Nonmedication pain management ("natural" childbirth), such as focused breathing, distraction, massage, imagery, and continuous labor support, which can reduce pain and help you feel a sense of control during labor. Acupuncture and hypnosis are also low-risk ways to manage pain that work for some women.
• Laboring in water, which helps with pain, stress, and may also help prevent slow, difficult labor.
• 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, which helps reduce discomfort, but a high-risk delivery would require constant monitoring.
• 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.
• Birthing positions during pushing, including sitting, squatting, or reclining or using a ball, whirlpool, or birthing chair, stool, or bed.

Pain medication may include:

• Epidural anesthesia, which is an ongoing injection of pain medication into the epidural space around the spinal cord, to partially or fully numb the lower body. A "light" epidural allows the surrogate mother to feel enough so that she can push, reducing risks of stalled labor and cesarean delivery.
• Pudendal and paracervical blocks, which are injections of pain medication into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where the baby will come out. Paracervical has been generally replaced by epidural, which is more effective.
• Narcotics, typically Demerol, which are sometimes used to reduce anxiety and pain. Narcotics have limited pain-relief effectiveness and can have troubling side effects for the surrogate mother and baby.

Some pain relief medications are not the type that you would request during labor. Rather, they are used as part of another procedure or emergency delivery. However, it's a good idea to be familiar with them. They include:

• Local anesthesia, the injection of pain medication into the skin, which numbs the area before episiotomy or before inserting an epidural.
• Spinal block, the injection of pain medication into the spinal fluid, which rapidly and fully numbs the pelvic area for assisted births, such as for forceps or cesarean delivery. If you have a spinal block, no pushing is possible.
• General anesthesia, the use of inhaled or intravenous (IV) medication, which renders you unconscious. It has more risks, yet takes effect much faster than epidural or spinal anesthesia. General anesthesia is therefore only used for some emergencies that require a rapid delivery, when an epidural catheter has not been installed in advance.

If an emergency or an urgent situation arises, your plan may have to change for you or the baby's safety. You may still be allowed to participate in some decisions, but some of those choices may be modified to increase the safety margins.

Medical procedures for aiding a safe delivery may include:

• Labor induction and augmentation, including rupturing of the membranes and medications for softening the cervix and stimulating contractions. This can be a medically necessary decision, such as when a surrogate mother has high blood pressure or another health problem that may endanger the fetus.
• Electronic fetal heart monitoring, either continuous for a high-risk delivery, or periodic, to check for signs that the fetus might be in distress.
• Episiotomy, which widens the area between the vagina and anus (perineum) with an incision. Episiotomy is done to shorten the time until the baby is delivered. Perineal massage and controlled pushing may also prevent or reduce tearing.
• Forceps delivery or vacuum extraction to assist a vaginal delivery, such as when labor is stalled at the pushing stage or the baby has signs of distress and needs to be delivered quickly.
• Cesarean section during a labor in progress. If you have had a cesarean delivery before, you may have a choice between a vaginal trial of labor and a planned cesarean birth.