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  • Writer's pictureEmily McMichael

Advocacy During Labor and Birth: Discovering your Birth Preferences

Have you begun thinking about what type of birth you want? As a professional in the birth world, I can tell you that no two births are the same. Two birthing people may be in good physical health with healthy babies but wind up having completely different births. Why is that??

Well, of course, birth can take various unexpected twists and turns. And, certainly, being able to adapt your mindset and your birth plan is important and healthy in various situations. However, for the majority of healthy pregnant people with healthy babies, BIRTH WORKS (especially when interventions are avoided). And if it didn't? Well, we probably wouldn't be such a prolific species, would we?

Some may make the argument that it's western medicine that has made birth so safe for birthing people and babies. However, we know that the rapid and dramatic increase in cesarean surgery over the last few decades has not decreased the maternal or infant mortality rates worldwide when performed more than 10% of the time (3). Oh, by the way, the national rate of cesareans in the US was 31.8% in 2020 (1). We also know that the rapid increase in cesarean rates since the 1970's in the United States has occurred alongside an increase in the maternal mortality rates and that this rate is disproportionately higher for birthing people of color (2). Of course, cesarean surgery is often life-saving and important for many birthing people. However, we know medical interventions like this are not the reason low-risk birthing works.

So what accounts for the differences in birth stories? Well, lots of things. Providers matter (see my post: Advocacy During Labor and Birth: I'm Pregnant! Where Should I Begin?), childbirth preparation matters, emotional and mental state during labor and birth matter, birth choices matter, and so much more. These are all things you can control during your birthing time.

One of the biggest myths among birthing people that I often hear is: Birth is unpredictable, so planning for my birth would just be dumb. The opposite couldn't be more true. Would you say the same about other life events? Should you not carefully choose your marriage partner regardless of the fact that this person is not under your complete control? The facts remain:

Preparation and planning for your birth is integral to having the birth you desire.


Advocacy during labor and birth begins with understanding your birth choices.

Have I convinced you yet? Let's talk about what you might consider as you begin thinking about birth. Here are some questions you might ask:

  • Who will be at your birth and what role(s) will they have?

  • Where will you birth your baby?

  • Will you hire professional labor support (i.e. a doula)?

  • How will you handle discomfort during labor?

  • Would you like your medical provider to be more hands-off or are you interested in the active management style of care?

  • Would you like to breastfeed?

  • How about have skin-to-skin with your baby for the first hour after birth?

These are just a few of the many questions we talk about in my childbirth education classes. After you have a good idea of the general choices you'd like to make, you might consider thinking about more specific choices such as:

  • When you will arrive at your birthing place

  • Eating and drinking during labor

  • IV fluids

  • Vaginal exams

  • Laboring positions

  • Birthing positions

  • Use of water/hydrotherapy

  • Fetal monitoring options

  • Medical induction or augmentation

  • Vitamin K/Hepatitis B/Eye Ointment for your baby

This is just a short list of the many, many things you might consider as you near your birthing time and begin to plan. The best way to begin to make your choices is to (1) do extensive self-study along with speaking to others who have given birth AND/OR (2) take a comprehensive childbirth class that will overview your options as well as provide you with context for making your decisions.

We are just beginning our discussion about advocacy! Next up: Talking with Your Provider

Emily McMichael M.Ed., CD(DONA), AAHCC, HBCE, CLC, LLL

Oh, and by the way, your body was made for birth.


(1)National Center for Health Statistics, final natality data. Retrieved August 22, 2022, from

(2) Singh GK. Maternal Mortality in the United States, 1935-2007: Substantial Racial/Ethnic, Socioeconomic, and Geographic Disparities Persist. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau. Rockville, Maryland: U.S. Department of Health and Human Services; 2010.

(3) Ye J, Zhang J, Mikolajczyk R, Torloni MR, Gülmezoglu AM, Betran AP. Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG. 2016 Apr;123(5):745-53. doi: 10.1111/1471-0528.13592. Epub 2015 Aug 24. PMID: 26331389; PMCID: PMC5014131.

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