A birth plan sounds like a brilliant idea  -- you write down your wishes so that your doctor knows how you feel about everything from pain meds to c-sections, and B Day goes exactly as you've envisioned it. Reality check: Births don't always happen the way we want them to. Still, putting together a record of your hopes and preferences will help you understand your labor and delivery options. Your plan will also be useful as you inform your caregiver of your views on variables such as induction or episiotomy. Whether or not you write down your choices, ask yourself these questions, and chat with your physician about your answers, before it's time for the big push.

Do I want to receive medication for the pain?

Whether you plan to go "natural" or to say yes to any painkiller available to you, it pays to know the options.

Systemic drugs, including narcotics and sedatives, are primarily used in the early stages of labor to take the edge off the pain. They act on your nervous system, so may cause drowsiness, disorientation, or nausea.

The pitfalls of these meds are important reasons why doctors and delivering moms usually prefer epidurals, which block the pain from the waist down, leaving you comfortable but alert. Until a few years ago, women who hadn't yet dilated to at least four centimeters were dissuaded when they asked for an epidural. Doctors believed that the painkiller's numbing effect would interfere with labor, prolonging it and possibly prompting a c-section. But the American College of Obstetricians and Gynecologists (ACOG) now advises that a woman in labor should receive pain relief at whatever point she asks for it.

The ACOG also notes that studies are inconclusive regarding a link between epidurals and c-section risk. A recent landmark study published in The New England Journal of Medicine demonstrated that a "combined spinal epidural" does not increase a woman's chances of needing a cesarean (in fact, the study notes, in some cases the procedure may hasten birth). Laura Goetzl, M.D., an assistant professor at the Medical University of South Carolina in Charleston, declares, "There's no reason to suffer in early labor. It's very reasonable to ask about the option of a combined spinal epidural."

Even if you don't plan to accept pain relief, it's good to know what choices you have should you change your mind. Discuss your thoughts with your caregiver  -- and don't wait until labor is in full swing to do it. To learn more about epidurals (including traditional, "walking," and combined spinal epidurals), sign up for the Babytalk Pregnancy Planner and visit the Birth Options Planner.

Beth Howard is a Babytalk contributing editor and mother from Charlotte, North Carolina.

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