| Providers should be familiar with the options in their community |
- Home birth and birth center options
- Are home birth midwives licensed in your state?
- Does insurance cover home birth or birth center care?
- Local doula networks
- Are doulas covered by insurance in your state?
- Pain management options in your facility – both pharmacologic and nonpharmacologic
- Local childbirth education options or online options
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| Issues to address in the first trimester |
- Assessment of the patient's pregnancy risk status to determine what options may be appropriate for them (eg, midwifery care, group prenatal care, out-of-hospital birth)
- Introduce resources on choosing the place of birth and the provider
- Encourage the patient's chosen partner and/or labor support person to attend prenatal care appointments to help prepare everyone for the birth and beyond
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| Issues to address in the second trimester |
- Introduce resources on birth options and values
- Introduce doula care
- Referral to a doula if the patient is interested
- Introduce the importance of childbirth education/preparation
- Refer for childbirth education if the patient is interested, or provide online resources
- Introduce the option of creating a written birth plan
- Review pain management options at your facility
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| Issues to address in the third trimester |
- Re-refer to childbirth education or doula care, as needed
- Review the planned labor support team
- Give childbirth preparation information to labor support people
- Review birth goals/plan and document in the patient's record so other labor providers can see it
- Review communication style and preferences
- Review pain management goals
- Review labor, birth, and immediate postpartum preferences
- Discuss other preparations including
- Transportation to and from the birth facility
- Care of other children
- Items the newborn needs at the hospital and at home
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| Supporting families in the postpartum period |
- Ahead of visit, be mindful of patients who may be at higher risk because of experiencing their birth as difficult or traumatic. This can include:
- Unplanned cesarean birth
- Operative vaginal birth
- Medical complication for birthing person or baby
- Extended hospital stay for the patient or baby
- Large difference between the patient's goals and what happened
- For all patients, inquire about their feelings/processing of the events of the birth
- If a patient needs more time to process birth, offer follow up with yourself, delivering provider, or other appropriate team members
- Offer professional resources on processing birth stories through March of Dimes or Postpartum Support International
- If a patient is exhibiting symptoms of post-traumatic stress disorder, depression or anxiety following birth, begin treatment and refer the patient to a perinatal mental health professionals
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September 2025
