Seven keys to creating a successful baby sleep, feeding, and play schedule

Getting into a regular schedule for sleep, feeding, and activities can make life easier for you and your baby. But how to start? Below, find seven great guidelines for establishing a routine that works.

Get your baby used to a bedtime routine early on

Once you have a consistent bedtime worked out, a daytime routine will fall into place, says Tanya Remer Altmann, a pediatrician and editor-in-chief of The Wonder Years: Helping Your Baby and Young Child Successfully Negotiate the Major Developmental Milestones.

And the easiest way to establish a regular bedtime is to start a bedtime routine that you and your baby can depend on night after night.

The bedtime routine is the most important thing to consider when establishing a schedule," says Altmann. "You can't force it in the first few months, but you can start practicing at around 2 months."

Altmann says to keep it simple: a warm bath, jammies, a feeding, then lights-out. It's fine if feeding lulls your baby to sleep in the early months, Altmann says, but by 3 or 4 months you may want to try putting him down awake so he'll learn to fall asleep on his own.

Teach your baby the difference between night and day

Many babies mix up their days and nights at first, sleeping long stretches during the day only to perk up once the sun goes down. Helping your baby learn to tell day from night is a key first step to getting into a workable routine.

Amy Shelley, mom to 8-month-old Alex, offers these tips: "During the day, keep the house bright. Do the exact opposite at night: Keep the house dim and quiet. Don't talk to your baby much during night feedings. Let him learn that night is for sleeping and daytime is for socialization and playtime."

Learn to read your baby's cues

Websites, books, your baby's doctor, and other parents can all help as you figure out an appropriate schedule for your baby. But your child will be an important guide, and he'll tell you what he needs – if you learn to read his cues.

"When parents take the time to be with their baby, the information they receive gets sifted through their own experience. 'Instincts' come from learning about your baby's temperament and what works for him," says pediatrician Daniel Levy, past president of the Maryland chapter of the American Academy of Pediatrics.

Mom Liana Scott says paying close attention to 9-month-old Keaton has helped her anticipate his needs, which makes life easier and more fun for both of them.

"Now I'm able to feed him before he's really hungry and put him to bed before he's overtired and fussy," says Scott.

Learning what your baby needs when takes time and patience. But you'll see patterns emerge over time. And if you log your baby's naps, feedings, playtime, and so on in a notebook or on the computer, you can use this record to come up with a timetable for doing things.

When starting out, put your baby's schedule first

If you're encouraging your baby to follow a schedule or observing his patterns to figure out a routine that works, make this process a top priority for at least the first couple of weeks. Avoid deviating from the routine with vacations, meals on the go, outings that push naptime back, and so on.

Once you establish a pattern for your baby's sleeping, awake, and feeding times, changing things for an afternoon isn't likely to undo his habits. But it's best to keep your baby's schedule as consistent as possible while he's getting used to it.

Expect changes during growth spurts and milestones

Your child accomplishes so much in the first year. He'll nearly triple his weight and achieve some major feats like sitting up, crawling, even walking.

During periods of growth or when he's working to achieve a new milestone, don't be surprised if your baby diverges from his usual routine. He may be hungrier than usual, need more sleep, or return to waking up several times a night. Hang in there – your baby may be back on schedule shortly, or this may be a sign that you need to adjust your routine.

Adjust your baby's schedule to suit his age

It may feel like just when you've gotten into a predictable groove with your little one, it's time to change it again. As your baby gets older, he'll need fewer daytime naps and more playtime and stimulation. He'll also need to eat solid foods – first just once a day, but eventually several times a day.

As these developmental shifts happen, your child's schedule will shift as well. Reading up on these milestones and checking out our sample schedules for babies of all ages can help you know what to expect.

Don't expect perfection

Some parent-led schedules set the expectation that your baby's routine will always run like clockwork. And though babies do like consistency, you can expect changes from day to day and as your baby grows.

Sometimes, for whatever reason, your baby will want to skip a nap, have an extra snack, wake up before dawn, and so on. And life happens as well – vacations, older siblings, plans with friends and family, errands you need to take care of, and other factors will all come into play in your daily life with your baby. Variation is okay, as long as your baby is getting the sleep, play, food, care, and love he needs to thrive.

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Pregnancy and Babies

Pregnancy

ALL ABOUT PREGNANCY

Welcome to pregnancy! This is the start of an incredible journey. To help you along, we offer info on pregnancy aches and pains, weight gain and nutrition, what's safe during pregnancy and what's not, pregnancy stages, labor and delivery, and more -- plus how to sift through all those baby names to find the perfect one.

• Pregnancy Week by Week
• Pregnancy Health & Safety
• Your Life During Pregnancy

PREGNANCY HEALTH & SAFETY

Birth plan: Your expectations and preferences

IN THIS ARTICLE

• What is a birth plan?
• Labor
• After delivery

Reviewed by the BabyCenter Medical Advisory Board

Last updated: January 2015

What is a birth plan?

A birth plan is a document that lets your medical team know your preferences for things like how to manage labor pain. Keep in mind that you can't control every aspect of labor and delivery, and you'll need to stay flexible in case something comes up that requires your birth team to depart from your plan. But a printed document gives you a place to make your wishes clear.

A written birth plan also helps refresh your healthcare provider's memory when you're in labor. And it informs new members of your medical team – such as your labor-and-delivery nurse – about your preferences when you're in active labor.

Most hospitals and birth centers provide a birth plan worksheet or brochure to explain their policies and philosophy of childbirth, and to let you know what your birth options might be. That information can help guide you in a discussion with your provider about your preferences when you face choices along the way. And that discussion can be the basis for a birth plan, if you decide to create one.

Read on to find out what typically happens at the hospital and what alternatives you may have. Not all the options will be available in every setting or make sense for your situation, especially if your pregnancy is high-risk. But this should give you a place to start your discussion.

Labor

• When you arrive at the hospital, a nurse or doctor evaluates you to see how far your labor has progressed. You may be asked to walk around a bit or even to return home for a while before being admitted.
• Once you're admitted, the hospital may allow you to invite family and friends to be with you, bring in comfort objects (such as photographs, flowers, or pillows) or food and drink for your support team, play music, dim the lights, and move around as you need to for comfort. If you plan to have the birth photographed or filmed, ask ahead of time what the hospital's policy is. Not all hospitals allow it.

Creating a calm and intimate delivery room (Advice from moms)

• To allow you to move around as you choose during labor, most hospitals won't routinely start an IV when you're admitted. (You'll be encouraged to drink clear liquids to stay hydrated.)
• Most hospitals no longer order enemas or shave you before delivery.
• You may want to ask about the hospital's policy on fetal monitoring. Your baby will likely be monitored externally for 20 or 30 minutes when you're admitted. If your baby's heart rate is reassuring, you might only need to be intermittently monitored after that. Not being tied to a monitor allows you to move around more easily during labor. (And some hospitals have wireless monitors, so patients can walk around while being continuously monitored.)
• Discuss your preferences for pain management with your healthcare provider. If you're trying for an unmedicated birth, you might plan to work with a support team or use various labor props, such as a shower, tub, birthing ball, birthing stool, squatting bar, and so on. (You may want to ask your provider what kinds of props you're allowed to bring with you and which ones the hospital can provide.) If you prefer to use pain medication or have an epidural, it's a good idea to discuss your options ahead of time.
• If your labor stops progressing, your medical team may recommend interventions such as breaking your amniotic sac (if your water hasn't already broken) or augmenting your labor with Pitocin.
• When it's time to push, your medical team can coach you on when and how to bear down. Another option might be to follow your body's natural urges and push when and how you feel is right for you.
• You may be able to choose the position you deliver in, such as squatting, semi-sitting, lying on your side, or on your hands and knees.
• Most hospitals don't routinely perform episiotomies, so you probably won't need to communicate your preference.  But be aware that your provider may recommend one in some situations.
• If an assisted delivery is required, your provider will use a vacuum device or forceps to help your baby out of the birth canal.
• If you end up having a c-section, it's likely that you'll be awake and your support person will be able stay with you. In rare cases, you'll need general anesthesia and your support person will be asked to wait outside the operating room.
• You may want to ask your practitioner if you can view your c-section delivery through a clear plastic drape or have the drape lowered and have your baby placed directly on your chest afterwards.

After delivery

• After a vaginal delivery, the baby is usually placed on you and covered with a warm blanket. You can let your provider know if you prefer to hold your baby skin to skin immediately after delivery or want your baby dried off or bathed first.
• Unless your baby needs special medical care, you can usually ask for all procedures and tests to be done while your baby is in the room with you. Some procedures (such as bathing and measuring) can be delayed for an hour to give you a chance to feed and bond with your baby. If your baby does need to be taken from your for special medical care, your partner or attendant can go with him.
• The umbilical cord is clamped in two places and cut between the two clamps. Let your provider know if your support person wants to cut the cord.
• You may want to ask your caregiver about delaying the clamping and cutting of the umbilical cord. Recent research shows that waiting a few minutes allows extra blood to flow from the placenta to the baby and reduces the risk of newborn anemia and iron deficiency.
• If you've chosen to bank your baby's cord blood, the blood will be collected at this time. (You'll need to arrange for the process well in advance.)
• Whether you choose to breastfeed or formula-feed, you can begin whenever you and your baby are ready. If you're nursing, let your medical team know if you'd like a lactation consultant to help you get started.
• Consider whether you want your baby to have a pacifier and let the hospital staff know your feelings.
• Most hospitals encourage you to be with your baby as much as possible during your stay. They tend to support "rooming in" – rather than keeping the baby in the nursery – to promote bonding. Ask about your hospital's policy on this if you have any questions.

Birth Complications

What are the pros and cons of letting my water break naturally?

Vaginal birth after cesarean (VBAC)

Breech birth

What are the pros and cons of letting my water break naturally?

Vaginal birth after cesarean (VBAC)

Whether you're preparing for an induction or breech birth or simply trying to make sense of something unexpected in your childbirth experience, we have plenty of solid information to help you navigate birth complications.

What does it mean if my baby is breech?

By around 8 months, there's not much room in the uterus. Most babies maximize their cramped quarters by settling in head down, in what's known as a cephalic presentation. But if your baby is breech, it means he's poised to come out buttocks or feet first.

When labor begins at term (37 weeks or later), nearly 97 percent of babies are set to come out head first. Most of the rest are breech. (In rare cases, a baby will be sideways in the uterus with his shoulder, back, or arm presenting first — this is called a transverse lie.)

There are several types of breech presentations, including frank breech (bottom first with feet up near the head), complete breech (bottom first with legs crossed Indian-style), or footling breech (one or both feet are poised to come out first).

By the beginning of your third trimester, your practitioner may be able to tell what position your baby is in by feeling your abdomen and locating the baby's head, back, and bottom. About a quarter of babies are breech at this point, but most will turn on their own over the next two months.

If your baby's position isn't clear during an abdominal exam at 36 weeks, your caregiver may do an internal exam to try to feel what part of the baby is in your pelvis. In some cases, she may use ultrasound to confirm the baby's position.

What if my baby is still breech at 37 weeks?

Babies who are still breech near term are unlikely to turn on their own. So if your baby is still bottom down at 37 weeks, your caregiver should offer to try to turn your baby to the more favorable head-down position, assuming you're an appropriate candidate.

This procedure is known as an external cephalic version (ECV). It's done by applying pressure to your abdomen and manually manipulating the baby into a head-down position. (If your caregiver is not experienced in this procedure, she may refer you to someone who is.)

ECV has about a 58 percent success rate in turning breech babies (and a 90 percent success rate if the baby is in a transverse lie.) But sometimes a baby refuses to budge or rotates back into a breech position after a successful version. ECV is more likely to work if this isn't your first baby.

Not all women can have ECV. If you're carrying twins or your pregnancy is complicated by bleeding or too little amniotic fluid,you won't be able to have the procedure. And, of course, you won't have a version if you're going to deliver by cesarean anyway — for example, if you have a placenta previa, triplets, or have had more than one previous c-section.

What is an ECV like?

Having a version isn't entirely risk-free and some women find it very uncomfortable. You'll want to discuss the pros and cons with your caregiver.

Severe complications, while relatively rare, can occur. For example, an ECV may cause the placenta to separate from the uterine wall so that your baby has to be delivered right away by c-section. The procedure may also cause a drop in your baby's heart rate, which, if it doesn't resolve quickly on its own, will require an immediate delivery.

For these reasons, a doctor should do the procedure in a hospital with facilities and staff available for an emergency c-section in case any complications arise. You'll be told not to eat or drink anything after midnight the night before the procedure, in case you end up needing surgery.

When you go in, you'll have blood drawn and an IV may be started. Women who are Rh-negative should get an injection of Rh immune globulin for the procedure unless the baby's father is also Rh-negative. Your baby's heart rate will be monitored for a time before and after the procedure.

You'll have an ultrasound beforehand to check your baby's position, the location of the placenta, and the amount of amniotic fluid. The ultrasound will be repeated after the maneuvers are performed. (Some doctors also use ultrasound during the procedure.)

Some studies show higher success rates for ECV when uterus-relaxing drugs are used.

If my baby doesn't turn, will I have a c-section?

It depends. You may have a vaginal breech delivery if you have a twin pregnancy where the first baby is in the head-first position and the second baby is not, or if your labor is so rapid that you arrive at the hospital just about to deliver.

However, the vast majority of babies who remain breech arrive by c-section. A large international study published in 2000 showed that planned c-sections resulted in the safest outcomes for term singleton breech babies. The following year the American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion advising against planned vaginal delivery of these babies.

Longer-term follow-up of the babies in this study led the researchers to question this conclusion. And other recent reports suggest that certain patients may have safe vaginal deliveries. This includes women whose pelvis seemed large enough, whose labor started and progressed well on its own, and whose babies were term frank or complete breeches and appeared to be of average weight with no abnormalities shown by ultrasound.

In recognition of these studies, ACOG issued a new Committee Opinion in July 2006. This time the organization noted that it may be reasonable for some women to plan to deliver vaginally. ACOG cautioned that the caregiver must be experienced in performing vaginal breech deliveries (fewer and fewer of them are) and the woman must be made aware that the risks to her baby may be higher than with a planned cesarean delivery.

If a c-section is planned, which is likely for most women, it will usually be scheduled for no earlier than 39 weeks. To make sure your baby hasn't changed position in the meantime, you'll have an ultrasound at the hospital to confirm his position just before the surgery.

There's also a chance that you'll go into labor or your water will break before your planned c-section. If that happens, be sure to call your provider right away and head for the hospital.

What alternative techniques might I try to coax my baby to turn?

Below are some alternative methods you may hear about. There's no proof that any of them work or are even safe. Consult your practitioner before trying them.

• Let gravity help. Get into one of the following positions twice a day, starting at around 32 weeks. The idea is to employ gravity to help your baby somersault into a head-down position.
  
  Be sure to do these moves on an empty stomach, lest your lunch comes back up. And make sure there's someone around to help you get up if you start feeling lightheaded.
  
  Lie flat on your back and raise your pelvis so that it's 9 to 12 inches off the floor. Support your hips with a pillow and stay in this position for five to 15 minutes.
  
  Alternately, get on your knees with your forearms on the floor in front of you, so that your bottom sticks up in the air. Stay in this position for five to 15 minutes.
  
  Be aware that no studies to date have showed that the mother's position has any effect on the baby's position. And if you find these positions uncomfortable, stop doing them.
• Ask your caregiver about moxibustion. This ancient Chinese technique burns herbs to stimulate key acupressure points. To help turn a breech baby, an acupuncturist or other practitioner burns mugwort near the acupressure point of your pinky toes. According to Chinese medicine, this should stimulate your baby's activity enough that he may change position on his own.
  
  One study showed that moxibustion in combination with acupuncture and positioning methods (like those described above) may be of some benefit. If you've discussed it with your caregiver and want to give it a try, contact your state acupuncture or Chinese medicine association and ask for the names of licensed practitioners.
• Try hypnosis. One small study found that women who are regularly hypnotized into a state of deep relaxation at 37 to 40 weeks are more likely to have their baby turn than other women. If you're willing to try this technique, ask your caregiver whether she can recommend a skilled hypnotherapist.

Vaginal birth after cesarean (VBAC)

What are my chances of giving birth vaginally after having a c-section?

As long as you're an appropriate candidate for a vaginal birth after a cesarean, also known as a VBAC, there's a good chance you'll succeed. Of course, your chances of success are higher if the reason for your previous c-section isn't likely to be an issue this time around.

For example, a woman who has already had an easy vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful VBAC than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)

That said, it's impossible to predict with any certainty who will be able to have a vaginal delivery and who will end up with a repeat c-section. Attempting a VBAC is called a trial of labor after cesarean (TOLAC). Overall, about 60 to 80 percent of women who attempt a VBAC deliver vaginally.

If you decide to try it, you'll need a caregiver who supports the idea. Your caregiver must also have admitting privileges at a hospital that allows VBACs and where appropriate coverage is available around-the-clock.

Not all hospitals meet the criteria for offering a VBAC. In addition, some hospitals simply avoid the controversy – and the potential for legal issues – surrounding VBACs by not allowing them. Most often, however, it's up to individual doctors whether they're willing to provide a VBAC.

VBACs are controversial, and it may be challenging to find a practitioner who's willing to do one. Give yourself plenty of time to look around.

What would make me a good candidate for a VBAC?

According to the American College of Obstetricians and Gynecologists, you're a good candidate for a vaginal birth after a c-section if you meet all the following criteria:

• Your previous cesarean incision was a low-transverse uterine incision (which is horizontal) rather than a vertical incision in your upper uterus (known as a "classical" incision) or T-shaped, which would put you at higher risk for uterine rupture. (Note that the type of scar on your belly may not match the one on your uterus.)
• Your pelvis seems large enough to allow your baby to pass through safely. (While there's no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)
• You've never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.
• You've never had a uterine rupture.
• You have no medical condition or obstetric problem (such as a placenta previa or a large fibroid) that would make a vaginal delivery risky.
• There's a doctor on site who can monitor your labor and perform an emergency c-section if necessary.
• There's an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.

What factors would make it less likely for me to have a successful VBAC?

• Being an older mom
• Being overweight
• Having a baby with a high birth weight (over 4,000 grams, about 8.8 pounds)
• Having your pregnancy go beyond 40 weeks of gestation
• Having a short time between pregnancies (18 months or less)

Talk with your practitioner about your individual chance of success and carefully weigh the benefits and the risks.

What are the benefits of having a VBAC?

A successful VBAC allows you to avoid major abdominal surgery and the risks associated with it.

These include a higher risk of excessive bleeding, which can lead to a blood transfusion or even a hysterectomy in rare cases, as well as a higher risk of developing certain infections and other organ damage during the procedure. All the potential complications of major abdominal surgery increase with each cesarean delivery because the scarring can make each procedure technically more difficult.

A c-section requires a longer hospital stay than a vaginal birth, and your recovery is generally slower and more uncomfortable.

If you plan to have more children, you should know that every c-section you have raises your risk in future pregnancies of placenta previa and placenta accreta, in which the placenta implants too deeply and doesn't separate properly at delivery. These conditions can result in life-threatening bleeding and a hysterectomy.

What are the risks of attempting a VBAC?

Even if you're a good candidate for a VBAC, there's a very small (less than 1 percent) risk that your uterus will rupture at the site of your c-section incision, resulting in severe blood loss for you and possibly oxygen deprivation for your baby.

Also, if you end up being unable to deliver vaginally, you could endure hours of labor only to have an unplanned c-section. And while a successful VBAC is less risky than a scheduled repeat c-section, an unsuccessful VBAC requiring a c-section after the onset of labor carries more risk than a scheduled c-section.

With an unplanned c-section after laboring, you have a higher chance of surgical complications, such as excessive bleeding that could require a blood transfusion or a hysterectomy, in rare cases, and infections of the uterus and the incision. And the risk of complications is even higher if you end up needing an emergency cesarean.

Finally, there is the risk of the baby having a serious complication that could lead to long-term neurological damage or even death. While this risk is very small overall, it may be higher in women who undergo an unsuccessful VBAC (which would mean a c-section after failed labor) than in women who have a successful vaginal delivery or a scheduled c-section.

What kind of interventions will I need if I attempt a VBAC?

A change in your baby's heartbeat is usually the earliest sign that there might be a problem. So if you decide to try for a vaginal birth after a cesarean, you'll need continuous electronic fetal monitoring. You'll also need an IV (which most women in labor have), and you'll have to refrain from eating anything during labor in case you require an emergency c-section later.

Labor complication: Big baby (macrosomia)

What is macrosomia?

Macrosomia means "large body" and is used to describe a newborn who's much larger than average. (The average newborn weighs about 7 pounds.)

Babies with macrosomia weigh more than 8 pounds, 13 ounces (4,000 grams) at birth. Macrosomic babies are more likely to have a difficult delivery. But the risk of complications is significantly greater when a baby is born weighing more than 9 pounds, 15 ounces (4,500 grams).

The Centers for Disease Control estimates that 8 percent of infants born in 2015 weighed at least 4,000 grams at birth, and 1.1 percent weighed 4,500 grams or more.

It's difficult to tell how big your baby is while she's still in the womb, but your healthcare provider may suspect macrosomia if you're measuring large for dates. In this case, you may have an ultrasound to estimate your baby's size, but it's not likely to be very accurate late in pregnancy.

What causes macrosomia?

Some women are just genetically predisposed to have larger babies, and birth weight also tends to increase with each successive pregnancy.

Most women who have a baby weighing more than 4,500 grams have no risk factors, but macrosomia may be more likely if you:

• Already had a large baby. If you previously delivered a macrosomic baby, you're five to 10 times more likely to have another large baby.
• Are obese
• Have unmanaged high blood sugar levels from diabetes or gestational diabetes
• Gain an excessive amount of weight during pregnancy
• Go more than two weeks past your due date

Also, male babies are more often macrosomic than females, and Hispanic women are more likely to have large babies than women of other ethnicities.

How does a big baby affect delivery?

With a big baby, you have a greater chance of a difficult vaginal delivery. You may also have an increased risk of perineal tearing, blood loss, or damage to your tailbone.

Some healthcare providers may recommend inducing labor early, but this doesn't have any proven benefit, according to the American College of Obstetrics and Gynecologists.

A large baby also means you're more likely to have a cesarean. Although it's difficult to determine a baby's exact size before birth, your doctor may want to schedule a c-section if you're measuring large or have other risk factors for macrosomia.

Can macrosomia cause problems for my baby?

There's a small chance of shoulder dystocia, a rare but potentially serious complication in which the baby's shoulder gets caught behind your pubic bone, causing the baby to get stuck in the birth canal during delivery.

This situation is a medical emergency. Your healthcare provider will need to do some maneuvering or perform an episiotomy to get your baby out safely.

In rare cases, your baby could end up with a broken collarbone or upper arm bone. (The treatment is to immobilize the arm as much as possible until the fracture heals.) A more serious complication of shoulder dystocia is nerve damage to the arm on the side where the shoulder was trapped.

What is recovery like after giving birth to a large baby?

If you had a perineal tear or an episiotomy after a vaginal delivery, be sure to follow your provider's instructions for perineal care, and watch for signs of infection. If your tailbone was injured, read about how to recover from a bruised or broken tailbone.

If you had gestational diabetes, your blood glucose levels should return to normal after birth. But you still have an increased risk of developing diabetes in the future, so within a few months of your baby's birth, schedule a follow-up appointment with your provider to be tested for postpartum diabetes or other problems with glucose metabolism.

Emergency home birth

How common is it to give birth before you even get to the hospital?

It's highly unlikely that you'll find yourself unexpectedly giving birth at home or in the backseat of a taxi – particularly if it's your first baby – but it can happen. In less than 1 percent of births, a woman who's had no labor symptoms or only intermittent contractions suddenly feels an overwhelming urge to push, which may signal the imminent arrival of her baby.

If you've had a previous labor that was fast and furious, it's important to be especially attuned to the signs of labor. Be prepared to make a mad dash for the hospital or birth center, because subsequent labors can go even faster. But if it feels like you're not going to make it and you find yourself at home (or elsewhere!) with contractions coming fast and strong or a sudden overwhelming urge to push, the following steps can guide you while you wait for the emergency team to arrive.

What should I do first?

• Call 911. Tell the dispatcher that your baby is coming and that you need an emergency medical squad immediately.
• Unlock your door so the medical crew can open it. You may not be in a position to get to the door later.
• If your partner isn't there with you, call a neighbor or nearby friend.
• Call your doctor or midwife. She'll stay on the phone to guide you until help arrives.
• Grab towels, sheets, or blankets. Put one underneath you and keep the rest nearby so you can dry your baby immediately after birth. (If help doesn't arrive in time and you forget this step, you can use your clothes instead.)
• If you feel an overwhelming urge to push, try to put it off by panting, using breathing techniques, or lying on your side. Be sure to lie down or sit propped up. If you deliver standing up, your baby could fall and suffer a serious injury. And don't forget to take off your pants and underwear.

What should I do if my baby arrives before help does?

• Try to stay calm. Babies that arrive quickly usually deliver with ease.
• Do your best to guide him out as gently as possible.
• If the umbilical cord is around your baby's neck, either ease it over his head slowly or loosen it enough to form a loop so that the rest of his body can slip through. When he's fully out, don't pull the cord, and don't try to tie off or cut the cord. Leave it attached to your baby until help arrives.
• Stay where you are until you deliver the placenta, which should arrive shortly. Leave the placenta attached to the cord, too – medical personnel will take care of it.
• Dry your baby immediately. Then rest him on your tummy, skin to skin, and warm him with your body heat. Cover yourself and your baby with a dry blanket.
• Ease any mucus or amniotic fluid from his nostrils by gently running your fingers down the sides of his nose.
• If your baby doesn't cry spontaneously at birth, stimulate him by firmly rubbing up and down his back.
• While you're waiting for medical help, try to get your baby to nurse – but only if you can keep the umbilical cord slack, not taut (sometimes, if the placenta is still inside you, the cord won't be long enough to allow you to bring your baby to your breast). Besides offering him comfort and security – and giving you a chance to see him close up – his suckling will prompt your body to release more oxytocin, the hormone that stimulates contractions, which will help the placenta separate and be delivered. After the placenta is out, keep nursing to help your uterus continue to contract – a well-contracted uterus is necessary to keep bleeding in check. 

• What are the pros and cons of letting my water break naturally?

  The BabyCenter Editorial Team

  If your water hasn't already broken on its own and your labor is not progressing well, your practitioner may try to augment your labor – or stimulate more effective contractions – by rupturing the membranes (the amniotic sac or "bag of waters") that surround your baby.

  Your practitioner can break your amniotic sac by inserting a slim, plastic hooked instrument through your vagina and dilated cervix. This should cause no more discomfort than a regular vaginal exam.

  This procedure allows the amniotic fluid to flow out of the cervix. The fluid contains hormones like prostaglandins that usually lead to stronger contractions. And with the buffer of fluid around the baby gone, the baby's head can now press on the cervix and cause it to dilate.

  Your practitioner may choose to do this because the longer your labor is allowed to go on without making progress, the greater the chance that you'll be exhausted when it's time to push or that you'll end up with a c-section.

  While this procedure, known as amniotomy, has been used for a long time to augment labor, experts continue to debate its risks and benefits. Having an amniotomy may mean a somewhat shorter labor and less chance that you'll need Pitocin (a synthetic version of the hormone that stimulates contractions).

  But it also increases your risk of infection. Also, an intact amniotic sac offers greater protection against umbilical cord compression during and even between contractions. Umbilical cord compression can cause your baby's heart rate to slow down, which may, in some cases, lead to a c-section.

  If you do end up needing an amniotomy or Pitocin, it will likely cause more painful contractions than you have been having. But this usually means that the contractions are more effective and are causing your cervix to dilate so your labor can progress.

  Your practitioner will consider whether amniotomy is a good choice for you based on factors such as how much your cervix is dilated, how low the baby is in your pelvis, whether you need internal fetal monitoring, and your risk of infection.
  If your labor is progressing well, you probably don't need an amniotomy until you're very close to delivering. Some practitioners even deliver the baby in the sac.urse right away, manually stimulate your nipples to release the hormones.

After you deliver the placenta, firmly massage your uterus by vigorously rubbing your belly right below your navel. This will help your uterus contract and remain contracted.

Is it true that some of my organs will be moved outside of my body during a c-section?

The BabyCenter Editorial Team

Your uterus might. But as for other organs, probably not. That said, every surgeon performs a c-section slightly differently, and every delivery is unique.

In most c-sections, the patient's bladder and intestines are just moved aside – still within the abdominal cavity – so the surgeon can better see and reach the uterus.

In rare cases, the intestines may need to be temporarily lifted out of the patient's body if they were harmed during the surgery and need attention.

The uterus, on the other hand, is commonly brought at least partway outside the body after a c-section. "This allows the surgeon to better see the incision that was made in the uterus and ensure that it's repaired properly," says Catherine Hansen, assistant professor of obstetrics and gynecology at the University of Texas Medical Branch Galveston.

The fallopian tubes are attached to the uterus, so if the upper uterus is brought outside the body, they are too. Some women who have scheduled c-sections opt to have their tubes tied right after their baby is born.