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Decision Making During Labor

Writer's picture: Rainier Valley MidwivesRainier Valley Midwives

It's hard enough to navigate decisions through pregnancy--but what about when you are in labor. Imagine trying to work out complex problems with multiple streams of input and multiple and unknown results while running a marathon, taking a test, and making a presentation at the same time! The level of physical demand involved in labor makes it very difficult to both process information and communicate back what matters to you. Let's consider some simple strategies you can remember and use.


Birth is the last day of pregnancy.


For nearly ten months you will have been feeding and growing and loving and responding to your baby without help from anyone, without permission from anyone, and without alarms or a clock telling you what to do when.


It's an eventful last day to be sure, but let's start with what you've built that will work for you on your birthing day and baby's birthday:

  1. You are in relationship with your unique baby. You know when it rests, you know when it wakes, you know when it's playful and responsive and how to elicit these responses (after a meal, when you lie down after a busy day, at 3am every night!) Pay attention to how baby is responding to labor--the contractions, the rest. Labor is your baby moving down and through your muscles, ligaments, and bones. Knowing your baby has to do this work, and the way you can help is to encourage them, to release control to them, to offer loving and kind encouragement for your baby and for yourself, to remember you are great teammates on this journey today, just like you have been all along the way.

  2. As your baby has grown, you've changed how you move your body to find comfort. Something inside of you tells you to move--stop crossing your legs, sit with your knees further apart, roll onto your side, shift chairs, stand, sit, all of it--keep moving in response to what your body tells you even when you are in the middle of a contraction. Get down in a squat, child's pose, dance, walk, stomp--follow your body.

  3. You have advocated for yourself and baby, using your voice with support from your people. Lean on those skills and those people to carry you through birthing.


Knowing you have that foundation, when you are presented with options during labor (there are potentially hundreds of decisions that create more decisions so we are not going to list them here, we are just giving a way to approach how to consider during labor), there are four key questions to ask**:

  1. Am I ok?

  2. Is baby ok?

  3. Can you or someone else help us understand more about this decision/can you explain that again?/can you explain that again, but differently--I don't understand what you are offering. And can you start talking when I tell you this contraction is over and then pause when the next one starts? (It's really hard to hear during contractions, let alone think!)

  4. Can we have some time to think about this or talk it over and how much time can we have?


If the answer to 1 and 2 is "yes," then you have time. Asking number 3 gets providers and nurses to slow down and see you, it forces them to pause and provide information like risks and benefits, alternatives, and to address if something actually needs to happen. Write that in a note on your phone, or on a notecard and stick it in your birth bag. Put it on the table at the hospital or birth center.

The pause this strategy causes in the room allows your brain time to catch up, make sense of what is being offered or recommended, and gives you time to check in with yourself and your support people before you make a decision.


Here's the mantra you'll need through this process and the rest of parenting:

"I am making the best decision I can, given the information I have right now, with what I know right now."


Self-compassion in the moment sets the table for not reprimanding ourselves later for what we did not know. What we could not know. Because all we know is what we know, in the moment we are in, with the resources we have available at that moment. Which is why we love to learn from parents who have done this before about what they look back on and wish they had known.


**For this post, we have to assume that you are in a trusted location with a trusted provider. That you don't need a degree to know if your provider is trustworthy enough to give you options that are appropriate. If you are not confident about this, a doula can help navigate and translate the language and provide you with questions to ask in real time so that you navigate this with your provider. The doula should never take over that role from you--but lift you and teach you and support you to have meaningful conversations with your provider. (See the number one reason people report they have birth trauma--not feeling that they were included in decision-making--and this can originate with doulas as easily as it can from OBs or Midwives.)



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Seattle Clinic: 4704 S. Mead St. Seattle, WA 98118
Renton Birth Center:
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