June 3, 2024

Yes, you’ve got options when it comes to labor and delivery — even if your pregnancy is high-risk.

When it comes to delivering a baby, having a birth plan in place is key. But if your pregnancy is high-risk, you may be wondering what options you’ll have when planning your delivery. Is it even worth filling out a birth plan?

Absolutely, says Dr. Etoi A. Garrison, an obstetrician/gynecologist at Vanderbilt Center for Women’s Health. There are plenty of options to consider, even when a pregnancy is considered high-risk.

“Often, the concern is that the high-risk label will prevent patients from being able to enjoy the birth experience and their new baby. Neither are true,” Garrison said. “A lot of women with high-risk pregnancies have ‘low-risk’ births. In fact, many of our high-risk patients are delivered by midwives who specialize in low-risk births.”

“A lot of women with high-risk pregnancies have ‘low-risk’ births.”

As such, everyone should work with the obstetrician on a birth plan.

“Birth planning can be very helpful for patients as well as for the clinical team, because it gives everyone an opportunity to think about the various decision points along the birth process,” Garrison said. “We want both patients who are both low-risk and high-risk to think about all of their options and talk about them with their physicians, because individualization is really the key with the birth plan.”

Here are some of the topics you’ll want to cover when developing a birth plan for a high-risk pregnancy.

Vaginal birth or C-section?

The first major decision you’ll want to make with the help of your OB is how you’ll deliver your baby. Many patients with high-risk pregnancies can safely deliver vaginally, which Garrison encourages whenever possible.  

“For most patients — particularly patients who’ve never had a cesarean delivery before — our goal is always to help them have a vaginal delivery if at all possible,” she said.

There are times, though, when a C-section will be recommended, Garrison said, such as if mom has a heart condition that makes it unsafe to labor and push, as well as fetal conditions that would make it unsafe to expose the baby to the birth canal.

“Sometimes there can be an increased risk of injury to the baby with a vaginal delivery,” Garrison said. “It’s not absolute, but that’s something we have to consider.”

Even with a C-section, there are choices to be made.

“With the cesarean, we have unique drapes where there’s a window that allows the patient to see the baby as it is delivered,” Garrison said. “We also talk about how to facilitate bonding with the baby after delivery. How long the baby stays in the operating room will really depend on how stable baby is and if there are other additional considerations that the pediatric team and our nursing staff will need in order to evaluate the baby, but we’ll do our best to keep baby with mom so bonding can begin.”

Pain control

Some people having a vaginal birth opt for less-invasive pain control methods or request to delay an epidural as long as possible. But women who have high blood pressure or certain heart conditions may benefit from having an epidural earlier.

“We always look at mom’s history to determine the safest way to help her through the pain,” Garrison said. “It’s all individualized, but an early epidural might be something that we would encourage to protect mom’s blood pressure.”

Fetal monitoring

Birthing location is important in high-risk situations, and one reason for that is fetal monitoring.

“Birth centers typically have very limited ability to monitor the baby or offer intermittent monitoring, which is usually fine for low-risk pregnancies,” Garrison said. “But if you have a high-risk pregnancy, intermittent monitoring may not be the best option for ensuring baby is tolerating labor. We’ll want continuous monitoring.”

Then, of course, there’s the ability to deal with complications and emergencies that may arise during labor and delivery.

“Moms with high-risk pregnancies should be in a place that can handle all possible complications for both mom and baby,” Garrison said. “If there’s any thought that baby might need intervention, then delivering at a center with a high-level neonatal intensive care unit is preferred.”

Flexibility is vital

“The birth plan is kind of like a roadmap, but sometimes baby will cause a detour. We always encourage flexibility.”

Having a birth plan can help you prepare for and know what to expect with labor and delivery. But it’s important to understand that birth plans are just that — plans — and sometimes plans change.

“The birth plan is kind of like a roadmap, but sometimes baby will cause a detour in one direction or the other,” Garrison said. “We always encourage flexibility with birth planning because there are factors that we won’t really know until we’re in the moment and have to think about whether or not an alternate strategy is going to be best for mom or baby.”


Expert care for you and your baby

Each pregnancy and delivery is unique and yours should be too. Learn more about how Vanderbilt Health’s high-risk obstetrics team, known as maternal-fetal medicine specialists, can provide you and your baby unmatched expert care. With the region’s most advanced care, you and your baby have everything you need, all in one place.

To learn more, call 615-343-5700.

Learn More