Who is going to give birth to your baby?

What kind of birth experience do you imagine having?

Do you picture your baby coming into the world without your experiencing any sensation of his or her passing through your body?

Will you have a cesarean? Are you expecting twins and therefore (as is standard in many places) have your c-section date scheduled, even if you are newly pregnant?

Do you want to know what birth feels like, even if it is painful and lasts for several hours with increasing intensity?

Are you undecided?

Perhaps you have heard from other women that no one receives a medal for having an unmedicated birth, and you are determined not to exhibit any unnecessary heroics. Maybe you are so scared of birth, having heard too many times that it is the most painful sensation women have ever felt, and you want to avoid the pain. After all, we have medications that make it a pain-free experience, so what excuse do you have to refuse them?

Quite honestly, as a doula, an educator, a woman, and a mother, I don't care what women visualize for their births. What they want does not matter nearly as much as their approach to it.

If a woman is educated about birth, she will know what the benefits and consequences of her decisions are. She will know that:

• There may be unexpected hazards with low-risk, uncomplicated births, but cesareans are always riskier. The recovery after a cesarean is much longer, too, and it will change your body forever.

• Epidurals are relatively safe, but the anesthetic and narcotics used DO pass to and affect the baby.

• Epidurals don't have the same effect on every woman. Sometimes the chemicals have a partial or even NO effect on the physical sensations of labor. If you are one of those women, what will your next course of action be?

• Often, when a medically-trained person claims that a medical procedure has no risk, the meaning is that there are risks but they can be medically treated. An example of this is the use of narcotics as painkillers during labor. The narcotics may cause respiratory problems in the baby, and there is a pharmacological treatment for respiratory distress that usually takes effect swiftly. While that does not truly equal NO RISK, it does for medical purposes.

• Women cannot depend upon the medical personnel to support them during labor. They may have a nurse who completely supports her goals, but that nurse may be attending twenty other women in labor that day, and her good intentions do not count as 'support'. Women need to go into the hospital with their own team.

• Doctors and nurses do not necessarily know more about birth than women do. They know how to treat complications. As a whole, they rarely see the birth process untouched by medical procedure.

I am certain this sounds very anti-hospital, but I assure you I am not. I wish to challenge the notions many women harbor that they do not need to think about their own births, that they can simply give the experience over to the medical staff AND have the births they want. You are not guaranteed anything by going into the hospital to have your baby. The medical personnel will operate by their own protocols, and those may or may not agree with what you have envisioned for yourself. In the absence of an emergency, it is up to YOU.

I want to rally women into education. If you are choosing to have an epidural because you are scared of the pain, then research how women have coped with it and what they have said about their labor experiences. Epidurals may have no effect on you. Have a backup plan. Know how to cope with difficulty, just in case you cannot have the pain meds or they do not work for you. If you have had a cesarean but want to have a VBAC for your subsequent birth(s), you need as much support, knowledge, and strength as you can muster. Go to it.

Find the location and the care providers, the doulas, and every community resource you can, to have the birth you want. Do everything you can.

No one else is going to give birth to this baby. You need to be the woman you envision, not one making choices out of ignorance or even operating on the advice of a few friends or your sisters. Be strong and take the responsibility that is yours.

We are no longer in the age of absolute trust in our doctors. The choices are largely yours. The path you take is one you alone determine. Learn all you can, from all sources. If something sounds too good to be true, do more research to find the truth, because what you have heard is probably misleading. People and doctors pass along bald lies about birth. Find out what they are.

Drop your laziness and apathy. You are becoming a mother, and any bit of knowledge and toughness with benefit you in this capacity. It will help you in labor. It will serve you when you are in the trenches of parenthood. You will not be handed the tools you require; you must seek them out.

Nobody cares about your birth as much as you do. Take up your burden of authority and find out what you will do with it. Bear it well. Educate yourself.