Some women know exactly what they want their birth experience to look like, while others do whatever their provider tells them, and others are somewhere in the middle. When I went in for my 36-week appointment and was asked all these detailed questions about how I wanted my birth experience to go, I was at a loss. I knew I wanted to have my birth at the birthing center and I really didn’t want to tear, but other than that, I had no concrete preferences. As a first time mom, the 36-week appointment can sometimes feel overwhelming because often times you don’t know what you want during labor until you experience it. In this post, I will go over all of the options so that you can attend your appointment informed and ready to make the best decision for your family.

Labor Preferences

The first section you will go over with your provider will most likely be your labor preferences. This will include everything from where and in what position you want to birth your baby to who is present for the birth. The options will vary depending on whether or not you are birthing your baby at a hospital with a traditional OB/GYN or a midwife at a birthing center or in your home.

If you have not selected a provider yet, you may want to check out my posts, How to Choose the Best Provider for You and 6 Reasons You Should Consider a Home Birth.

Before we dive into the details, I want to say that while you can have your plan before you go into labor, our birth stories don’t always turn out the way we hope. And that is okay! What matters most is that you and your baby are happy and healthy. So if your birth doesn’t go exactly according to your 36-week appointment plan, give yourself grace, and know that the birth of your baby happened the way God intended.

Now, on to the options:

Room Setting

The beauty of a home birth is that you have the opportunity to birth your baby from the comfort of your own home and you can set up your birth space however you choose. Birthing centers often have very welcoming and home-like atmospheres for their birthing suites and many will allow you to bring your own diffuser, lights or other decorations.

In a hospital, it can be more difficult to set up the room to feel as comfortable as your home, if for no other reason than the hustle and bustle of people coming in and out of the room during labor. Many midwives or doulas will recommend turning off the bright fluorescent lights in the room and bringing your own string lights or other small lights that are not as bright. Some hospitals will allow you to bring a diffuser or decorative lights, but make sure you check with your specific hospital before you arrive to have your baby.

Who Is Present

Besides your midwife and your husband, is there anyone else you want to have present for the birth? For me personally, I’ve only ever had my midwife and husband present, but some women like to include other family members, their children, and a videographer/photographer.

Water Birth

A lot of people rave about the benefits of water during labor and experiencing a water birth. While many hospitals do offer tubs for water births, keep in mind that depending on how busy the labor ward is during your birth, your access to a tub may be limited. Birthing centers almost always have a tub in the birthing suites, and at home you will have the option to use your existing tub or you can rent or purchase your own birth pool through companies like this one.

Benefits of water birth include¹:

• Reduced labor pain for the mother
• Lower blood pressure during labor
• Use of less pain medicine during labor
• On average, labor may be shorter
• Increased mobility for mom as she can move around more easily in the water.
• Lower rate of episiotomy and perineal tears (Episiotomies do not typically take place with midwives.)

Benefits of water births for baby:

• Gentle transition from inside mom’s tummy to the outside world
• Less stress – the warm water may help keep baby more calm
• Less chance of low APGAR scores²

Labor Positions:

If you are having your baby at a birthing center or at home, they you will be free to labor in whichever position feels best to you. This may be limited in the hospital setting, but some hospitals do offer squat bars that attach to the bed and yoga balls if you request them.

Labor Aids

Labor aids can include a TENS machine, rebozo shawl, tennis balls, a birth comb (any comb will do), warm water either in a shower or tub, birthing stool, peanut ball, and yoga ball.

Pushing Positions

The traditional hospital birth has mothers lying on their back with their feet up. The only person this benefits is the doctor. This position makes the pelvic opening smaller, making it harder for baby to come out without any tearing or an episiotomy occuring. At home or at a birthing center, you will have freedom to move and birth your baby in whatever position feels right to you. Some hospitals – and especially if you have a doula with you – may be more accommodating with your freedom of movement, but some hospitals may not be so kind.

Birth of Your Baby

One of the fun options with midwives (and sometimes with hospitals depending on your OB), is the question of who wants to catch the baby? You can allow your midwife or your husband to catch your baby, or you can even catch your baby yourself! If you have a preference, your provider will want to know so that they can facilitate that opportunity. In addition to this, you may be asked if you want to be able to see or touch your baby as you birth him or her. If you do, your midwife will have a small mirror that can be used or will guide your hands down to feel the top of their head.

If you are not sure what you want to do, remember, you can always change your mind during labor. What you pick in your 36-week appointment is not fixed, you will have the freedom to change your mind if you want to in the moment.

The Use of Pitocin

Pitocin is very commonly administered in the hospital setting as a way to help induce labor or help labor progress. It is the synthetic version of oxytocin which plays a major role in the labor and birth process. While it is commonly used, I highly advise you become familiar with it prior to your labor beginning or before agreeing to an induction in the hospital. For more information on Pitocin click here.

The reason I bring up Pitocin is because during all three of my pregnancies I had a low blood platelet count. This did not affect any of my babies, my pregnancies, or my births, but because of the low platelet count, I was at a higher risk for excessive bleeding following birth.

During my first birth, I was transferred to the hospital from my birthing center due to irregular heart tones for our baby girl. If you want to read more about my first birth, click here. I do not know for certain, but I am almost positive they administered Pitocin to me following birth because that is pretty standard practice in the hospital setting. With my other two births, I did something different when it came to Pitocin.

With my second, during my 36-week appointment, we planned on my midwife administering Pitocin immediately following our my baby’s birth as a precaution against excess bleeding. However, at the birth itself, my midwife did tell me after the fact that I was not excessively bleeding and so the Pitocin may not have been totally necessary but at the time I appreciated the peace of mind.

With my third birth, and because my previous midwife had said that she did not notice any excessive amounts of bleeding, I planned on expectant management. Instead of just deciding to administer it, no matter the actual situation, I asked my midwife to make a judgment call and have the Pitocin ready to be administered if needed. If there was no excessive bleeding, then I wanted to hold-off. This option worked really well for us and I plan on doing this same management protocol for any future births.

Antibiotics in Labor

Around 28 weeks of pregnancy, it is routine practice to check mom for Group B Strep. This is a bacteria that is commonly found in the genital tract of pregnant women. If a woman comes back GBS positive, then she will typically be recommended or required to receive antibiotics during labor to prevent passing it on to the baby. However, I have recently learned that this test may not be all that it’s cracked up to be. Your GBS status can actually change rather quickly, so even though you may test positive at 28 weeks, it may clear up by the time your baby is born around 40 weeks. For more information so that you can make your own informed decision, check out this podcast episode from the Free Birth Society Podcast.

Preferences for Baby

Delayed Cord Clamping

The umbilical cord is your baby’s life source throughout pregnancy, which I’m sure you know. But did you know that within minutes of birth, blood is being transferred from the umbilical cord into your baby? Within just three minutes of birth, between 80 – 100ml of blood is transferred through the umbilical cord into your little one.³

If the cord is cut too soon, your baby will be missing all of that blood from their system so it is important to indicate that you want delayed cord clamping for your little one. In the hospital, “delayed” is often as little as 30 seconds. With a midwife, it is fairly common for them to wait until the cord stops pulsing before cutting it or waiting until it turns white.

Vitamin K

With all three of my pregnancies we decided to have the preservative-free Vitamin K shot administered immediately following birth. However, if I could go back and do it again – and this is what I will be doing for any future pregnancies – I would elect to do the Vitamin K drops instead.

To be 100% honest, I didn’t research the Vitamin K shot like I should have, and I didn’t know that the Vitamin K shot does in fact carry a black box warning on it. All three of our kids have been fine but I won’t be doing it again and here is why:

The reason that the Vitamin K shot is recommended and is routine, is because Vitamin K helps with the ability to clot. So if there was a problem and there was bleeding happening, then there is a chance your baby won’t have enough Vitamin K in her system and could potentially bleed out. The biggest warning with the Vitamin K is that a baby could have a brain bleed, it is very very rare, but it is a possibility. Vitamin K does pass through breast milk but at very low rate. But there is a God-designed reason for why baby’s have a low level of Vitamin K at birth.

As I mentioned above, between 80 and 100 ml of blood passes from the umbilical cord to your baby within the first three minutes of birth, and that’s why delayed cord clamping is so important. But did you know that if your baby had high levels of Vitamin K, it would make the transfer of blood much more difficult from the placenta to your baby?

God designed everything perfectly; it isn’t the healthcare system’s job to fix it.

For more information on the Vitamin K shot, check out Just The Inserts.

Hepatitis B

As I mentioned in my post, What You Need to Know About Childhood Vaccines, Hepatitis B vaccination is definitely a standard practice that you’ll want to look into. Hepatitis B is a viral infection that may cause short- or long-term liver damage and it spreads through contact of contaminated bodily fluids. The Hep B vaccine is administered in the first 24 hours of birth because the HBV status of the mother may be in question. However, your prenatal bloodwork typically checks for HBV in the mother’s system so unless you are having extramarital sex or exposed to someone using needles routinely, your chances of contracting it during pregnancy are very low.

For more information on the Hepatitis B vaccine, click here.

Erythromycin

Erythromycin is another standard practice whether you are in a hospital, birthing center or at home. It is an antibiotic cream that’s put on your baby’s eyes after birth to prevent eye infections from potentially bad bacteria that could be encountered during birth. The most common cause of an eye infection following birth is from exposure to Chlamydia.

For our family, we chose not to administer erythromycin to any of our children because I do not have any sexually transmitted diseases and because my husband has had a reaction to this family of antibiotics in the past, so we did not want to risk one of our kids having a reaction as well.

Full information on the Erythromycin cream can be found here, from Just The Inserts.

What to do with the Placenta?

One of your final questions will have to do with your placenta. Full disclaimer, I do not know if a hospital will give you these same options, but with a midwife you will have the option to either discard it, have it sent off to be encapsulated or turned into a tincture, or used in a form of artwork.

The placenta is what nourished your baby for your whole pregnancy and therefore has properties unique to you and your baby. If you choose to encapsulate your placenta, many women take these after birth and say that they help with postpartum mood disorders, lowering stress, restoring iron levels after birth, and they may even increase your milk supply. For more information, click here.

Now I don’t think I would personally do this but, one midwife out of Orange County, California, Lindsey Meehleis has said that if she has a mother who is bleeding more than usual, she will have the woman put a piece of the raw placenta in her mouth, and within seconds the bleeding stops. See her post here.

The benefits of turning your placenta into a tincture include hormonal balancing, return of your menstrual cycle post-birth, relief from hot flashes, natural replenishment of hormones during menopause, reduced anxiety or emotional stress and more. If you are interested in creating a tincture with your placenta, click here.

If you are interested in keeping your placenta for any of these uses, your midwife or doula will often know who offers the encapsulation or tincture services.

Final Thoughts

Your birth experience is for you and your little one, and while we can plan for our dream birth, it is important to also be open to how God has written your birth story. I do believe that it is important to be well informed, so going into your 36 week appointment with the knowledge you need to make the best decisions for your family is of the utmost importance. I hope this post helps prepare you for your 36-week appointment with your OB or midwife. If you have any questions or comments, let me know below or send me a message.