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How to Choose the Best Birth Plan for You and Your Family

Nancy D. Gaba, MD, FACOG, and Whitney Pinger, CNM, FACNM, discuss the importance of preparing for childbirth with a solid birth plan in place. Dr. Gaba and Whitney advise expectant mothers to seek information and guidance from friends and medical professionals to tailor a plan that best fits their desires and family preferences. They also explain the differences between medicated vs. non-medicated birth, and normal vaginal birth vs. operative birth (whether vaginal or abdominal).
How to Choose the Best Birth Plan for You and Your Family
Featured Speaker:
Nancy D. Gaba, MD & Whitney Pinger, CNM
Nancy D. Gaba, MD, FACOG is the Chair, in the Department of Obstetrics and Gynecology at The George Washington University Hospital.

Learn more about Nancy D. Gaba, MD

Whitney Pinger, CNM, FACNM is the Director of Midwifery at The George Washington University Hospital.

Learn more about Whitney Pinger, CNM

Dr. Michael Smith (Host): Welcome to GW Hospital Health Cast. I’m Dr. Mike Smith. The topic today is how to choose the best birth plan for you and your family. A panel discussion today. My guests are Dr. Nancy Gaba and Whitney Pinger. Dr. Gaba is the chair in the department of Obstetrics and Gynecology at the George Washington University Hospital, and Whitney is the director of Midwifery at the George Washington University Hospital. Dr. Gaba and Whitney, welcome to the show.

Dr. Nancy Gaba (Guest): Thanks for having me.

Whitney Pinger (Guest): Thank you.

Dr. Smith: So, let’s start off with Whitney. I would like for you to talk a little bit about when it comes to birth planning, when should a family actually begin the planning?

Whitney: Well, birth planning begins with pregnancy. It begins with having a healthy pregnancy and focusing on nutrition, and exercise, and increasing a sense of wellbeing, and mindfulness during the pregnancy. And then, being educated by a provider or a child birth educator about the different options involved with planning for a birth. So, that’s the labor and delivery component of the pregnancy, and then making based on your education and training and learning. And those choices would reflect what your personal preferences are, and what your goals are for your impending birth.

Dr. Smith: So, there’s a lot of talk, I know about the difference between natural child birth and medicated child birth. Dr. Gaba, can you describe or give us a nice description of both of those, and help maybe some of the listeners make a decision on what might be appropriate for them.

Dr. Gaba: Sure. So, I think there’s a lot of misconceptions about what constitutes a natural birth, and sometimes people confuse that term with vaginal delivery, which people can have a vaginal delivery at any time with or without medication. So, I prefer to use the term unmedicated birth or medicated birth, and I think that clarifies what the difference is a little bit better.

Natural birth often refers to somebody who is trying to achieve delivery without medications, but to me anytime somebody has a successful vaginal birth with or without medications where the mother is healthy and the baby is healthy at the end. That is often viewed by some people as a natural birth. We would contrast that with situations where we have to assist a little bit more with the process. So for example, if we had an operative vaginal delivery with an instrument like forceps or a vacuum or an operative abdominal delivery with a cesarean. Those would be some examples of non-natural ways to have a baby.

Dr. Smith: And when you are discussing these options with pregnant women, how do you begin this? Do you offer these up right at the beginning or do most women come in kind of already have an idea of how they want to move forward with their birth?

Dr. Gaba: That’s a great question, Mike. Actually, I would echo what Whitney said earlier about planning early on, and I actually start this planning with my patients even before they become pregnant because it’s really important for people to know that they do have some control over what the outcome is.

So, for example a woman who is obese has a much higher likelihood of having an indicated cesarean birth. Women who are over 35 are much more likely to have a cesarean delivery. So, helping women plan for their family early on in their life is something that’s very important to me because it’s very important to my patients, and helping people to understand that. That they can have an impact on what the outcome of their delivery is likely to be, is something that as a doctor, I can assist somebody in. So, also helping people to understand other risk factors that might make them more likely to require an alternative form of delivery other than a vaginal birth. For example, if there’s a complication with the mother’s health, she might not be a candidate for a vaginal birth or she might not be a candidate for certain kinds of anesthesia. So, it’s really important to start thinking about that early on, and as Whitney mentioned, we often discuss that starting at the first visit.

Dr. Smith: Right. And so, Whitney, there’s another option out there now to today about home versus hospital delivery. Can you help us there? How do you help a woman make a decision about where is that best place to deliver?

Whitney: Well, most women who are coming to us at the GW Medical Faculty Associates are planning a hospital delivery. Okay, and our collaborative practice is committed to helping women have a birth that they want in a hospital environment, and that can range on a full continuum from a planned cesarean delivery to a water birth, for instance in our hospital setting. So, we have women with significant medical complications who need every level of physician management and care to help them have a safe outcome with their planned delivery even by cesarean. Laboring next door to women who are planning a completely unmedicated child birth with the support of a doula and the Midwifery team, and our Medical students, and our Midwifery students, and even planning a natural underwater birth at GW.

Dr. Smith: So, if there’s a woman who’s listening to the show, Whitney. If she’s made that decision, though, to do a home birth, is there… Do you have some advice on how she could maybe prepare the home for the delivery?

Whitney: Well, that’s not my area of expertise. There are Midwives locally and nationally, who are experts in out of hospital deliveries. Out of hospital delivery can be accomplished in the home or in a nationally certified birth center, and it is a large and growing trend, according to the CDC. But that’s out of my expertise and skillset, but what I would say is that at GW Hospital, we are experts in helping women achieve a normal vaginal, unmedicated delivery in the hospital setting within the context of having all the backup that we may need to support that woman and her baby.

Dr. Smith: When helping a woman make her birthing plans… How valuable are things like the child birth classes, labor playlists? How valuable are those Dr. Gaba?

Dr. Gaba: Those things are incredibly valuable. I think that a lot of physicians are trained to feel some level of anxiety when they hear somebody say the term birth plan. However, here at GW, we really, really value the pre-delivery planning that we do with our patients, and when patients come to us with a list of their preferences that they’ve created after getting all the possible information that they can. Going to a birth class, reading a book, talking to their friends. That’s the situation where we are best prepared to help them because then we know that they understand what the process is like in general, and then as a doctor, I can help them make a decision or make informed choices based on their own personal medical history and what’s important to them.

So, when they come with their list of preferences I can help them understand how realistic it is, and how likely it is that we’ll be able to honor them, and also guide them towards things that might be more appropriate based on their medical history.

Dr. Smith: So, in some summary, Whitney. What would you like people to know about birth planning?

Whitney: What I would I say is that there are very strong scientific evidence to support specific care strategies, to support unmedicated vaginal delivery. And vaginal birth is best for mother and for baby. We have science that supports that, and there are strategies that we at GW are experts, both the doctors and the midwives in using… these are evidence-based strategies. We call them referrals for normal birth. That should be components on anyone’s birth plan, and they can… people can read them on the GW Midwifery Website, and they can access referrals for normal birth online as well. And increasingly those… these evidence-based strategies are accepted by doctors and midwives across our country, as being the best model of care for planning for your birth and birth plan.   

Dr. Smith: How about you Dr. Gaba, is there something you would like people to know about birth planning?

Dr. Gaba: Well, I would definitely echo what Whitney said, I think that there are evidence-based strategies that we’re very proud of following here at GW. I think the most important thing is that a patient trusts the provider that she’s working with, and trust that we are in a partnership with you as a patient, so that we’re helping you have the safest possible and best possible experience that you can have when you’re having your baby. And sometimes it’s not exactly what you expected, and those things are not always necessarily in your control, but if you trust that the team that’s taking care of you has your best interests at heart, in the end the experience is going to be a great one.

Dr. Smith: Dr. Gaba and Whitney, thank you guys so much for the work that you’re doing and thank you for coming on this show today. You’re listening to GW Hospital Health Cast with the George Washington University Hospital. For more information, you can go to, that’s Physicians are independent practitioners who are not employees or agents of the George Washington University Hospital. The hospital should not be liable for actions or treatments provided by physicians. This is Dr. Mike Smith, thanks for listening.