It is never too early to start thinking about your options for labour. Knowing what to expect and how you would like things to proceed will help make childbirth a more satisfying experience. Usually, labour choices such as the decisions of whether to have a hospital or home birth, which method of pain relief to have and who you want with you at the birth are up to you. Occasionally, however, where there are complications, your obstetrician or midwife may advise against certain options to ensure your safety and that of your baby.

If you are having your baby in hospital you may find it beneficial to visit the delivery suite beforehand. Arriving into unfamiliar surroundings, which can appear very clinical, can add to your stress levels at a time when you are already apprehensive. A tour of the delivery suite is usually offered as part of many hospital-run antenatal classes and you should use this as an opportunity to familiarise yourself with all the various pieces of medical equipment so you do not feel overwhelmed and confused when it is time for delivery.

Your choices in childbirth include a natural birth, an active birth or an actively (medically) managed birth.

Natural childbirth

A natural birth avoids the use of drugs for pain relief, encourages active labour positions and favours the use of natural or alternative methods of pain relief, including water births, aromatherapy, acupuncture, herbal therapy and the TENS machine.

If you are aiming for an intervention-free, natural birth, it is wise to prepare well in advance as some natural or alternative therapies may be limited or unavailable in your area. You should also speak to your midwife or obstetrician to ascertain if the type of natural approach you are interested in is suitable or practical for you.

It is important to remain aware that circumstances change and things can go wrong in any labour. Medical intervention is sometimes necessary to ensure your baby's safety so it is important to remain flexible and leave your options open. Remember also that you can change your mind during labour if the pain is getting too much and you would like some help in dealing with the pain.

Active childbirth

An active childbirth advocates working with your body and with gravity to promote an easier and quicker labour. It may be combined with natural pain relieving methods. The principles of this type of birth are usually covered in antenatal classes where you will be taught to trust your body and your instincts.

In active childbirth women are encouraged to move around during the first stage of labour and to give birth in any position other than the traditional way of lying on a bed on your back, such as sitting, standing, squatting or kneeling on all fours. Flexibility during labour will allow you to seek a position that is most suited to you. It is advisable to try out different positions during your pregnancy to find one that you are comfortable with and to increase your strength.

Studies show that active positions may help your labour to progress through the use of gravity. They can make your contractions more effective in the first stage of labour, increase your stamina and help your cervix to open up more easily. In the second stage of labour an upright position can also help the baby descend through the birth canal.
Active childbirth may be inhibited slightly by other circumstances of labour.

For example, if you wish to have narcotic drugs such as pethidine for pain relief you will be unable to walk around as you may feel dizzy or unsteady. However, you will be able to lie on your side or be supported in a sitting position. If you have an intravenous infusion this may influence your choice of position.

The use of a cardiotocograph (foetal monitor) may also limit your choice of position in an active labour. Some hospitals have a telemetric apparatus that may allow you to walk around within a limited area.
If you have had an antepartum haemorrhage or your membranes have ruptured and the baby's head is still high you will be unable to be active in labour and will be confined to bed.

Actively managed childbirth

An active childbirth should not be confused with the 'active management of labour'. Active management of labour originated in Dublin in the 1960s and aims to confine the duration of labour to 12 hours. To achieve this, cervical dilation, contractions and foetal heartbeat are closely monitored. Upon arrival at hospital your waters/membranes may be broken, you will be linked to a foetal monitor and an IV drip may be inserted. If your labour is not progressing satisfactorily, labour may be induced or accelerated with the labour-inducing drug syntocinon or by artificial rupture of the membranes (ARM), also termed amniotomy.

Some women are against this level of medical intervention, while others find comfort in medical technology and the knowledge that their labour will not last much longer than 12 hours. Find out if the hospital you are attending practises the active management of labour and ask your obstetrician or midwife any questions you have about it. If you do not want an amniotomy or accelerated labour unless your baby is in distress discuss this with your doctor during pregnancy and put it in your birth plan.