Pregnancy usually involves a flurry of activity and planning, from painting the baby’s room to arranging for childcare. But along with picking out onesies and stocking up on diapers, you can take several steps that ensure your baby’s best possible arrival.

That starts with choosing healthcare providers who share your values and staying up to date with the most recent evidence and recommendations.

1. Choose Your Hospital

The approach to childbirth varies dramatically from hospital to hospital, even in the same community. Consumer Reports' hospital ratings can help you compare hospitals in your area on C-section rates. And it's a good day to do this even before your pick your obstetrician or midwife (see below) because your chosen provider may not be available when you deliver.

If you live in California, our California Healthcare Compare tool can also provide information about a hospital’s episiotomy and breastfeeding rates.

2. Pick a Provider

Do this early in your pregnancy, because it's one of the most important choices you can make. Decide what’s important to you—then ask friends and family for a recommendation (and check your insurance).

If your pregnancy is low-risk, consider using a certified midwife or certified nurse midwife, health professionals who can provide a range of women’s healthcare services during pregnancy, childbirth, and the postpartum period.

A certified nurse midwife (C.N.M.) or a certified midwife (C.M.) has completed an accredited education program and must pass a national certification exam, though C.M.s are not available in all states. C.N.M.s also have a nursing degree.

Those midwives can provide many of the same services as physicians, including prescribing medication and ordering tests. Their care is based on the philosophy of not intervening unless there is a current or potential health problem.

That approach has several benefits, according to a 2015 review of 15 studies involving more than 17,000 women who delivered in a hospital. Women who used midwives were more likely to have a spontaneous vaginal birth and less likely to need an epidural, forceps, or vacuum extraction. And, at the time of delivery, they were more likely to be cared for by a healthcare provider they had received prenatal care from than by whomever happened to be on call. Most insurance plans cover midwifery care.

The American College of Nurse-Midwives maintains a list of CNMs and CMs.

Childbirth Connection, a program of the nonprofit National Partnership for Women & Families, has a guide to understanding and making informed decisions about which type of provider is best for you.

3. Make a Plan—and Have a Backup

Discuss with your healthcare provider what's important to you in your child's birth. For example, if you’ve had a C-section before and would like to consider a vaginal birth with your current pregnancy, discuss that up front because not all doctors and hospitals provide care for attempted vaginal births after C-section.

Other preferences may relate to pain management, breastfeeding, or whether a baby is given to the mother to hold immediately after birth or taken to a nursery. Develop a plan with your healthcare provider that works for your situation. Here is an example of a birth plan from the California Pacific Medical Center.

But be flexible, too, says Neel Shah, M.D., an assistant professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. “Plans can change, especially during childbirth.” So have a backup in mind if things don't go exactly according to plan. For example, you might want a delivery without pain medication—but consider what you will do if it turns out you need pain relief after all.



4. Get Prenatal Care and Recommended Vaccinations

Attend all of your prenatal appointments, even if everything seems fine. Healthcare providers may spot symptoms or potential complications that you aren't aware of.

For example, blood pressure that begins creeping up could signal preeclampsia, a pregnancy complication that strains the heart and, if it worsens, has no treatment except inducing labor early. And glucose testing can help diagnose gestational diabetes.

You should also use those visits to make sure you are up to date on vaccinations. The Centers for Disease Control and Prevention recommends that pregnant women get the flu shot. (Ask for the inactivated flu vaccine—not the live nasal one.) Research shows that the flu vaccine is safe for pregnant women and their baby. It not only keeps you and your fetus healthy but it also may reduce the risk of miscarriage or stillbirth and offers your newborn protection against the flu for six months.

Pregnant women should also receive the Tdap—tetanus, diphtheria, and pertussis vaccine—during their third trimester. The antibodies the mother makes against pertussis, or whooping cough, pass through the placenta to her newborn and are up to 90 percent effective in protecting against this disease until infants receive their first pertussis vaccine at 2 months old.

5. Reduce the Risks of an Early Delivery

Women who have a history of spontaneous premature delivery can reduce the risk of another preterm birth by about a third by taking a special form of progesterone, if indicated by her doctor.

In addition, women with a significant risk of delivering early—due to their water breaking, for example—and who are in their third trimester can reduce risks to the baby by taking corticosteroids such as betamethasone and dexamethasone.

Some women at risk for preterm birth may undergo a cerclage, a procedure that stitches together the cervix to reduce the likelihood of preterm birth.

6. Ask If a Breech Baby Can Be Turned

Because a baby delivered buttocks- or feet-first can be in danger, many practitioners recommend a C-section when the baby is not coming out headfirst. But a skilled practitioner can often turn a breech baby in the last weeks of pregnancy.

Because that carries some risk—membranes might rupture, for example, or in rare cases the baby can become tangled in the umbilical cord—it should be done in a hospital, where both mother and baby can be monitored closely.

With the increasing use of C-sections, some practitioners have little training or experience with the external version procedure. If your practitioner is not comfortable with the procedure, consider asking for a referral to someone who is.

Nearing your due date. Image of baby in maternity ward.

7. Stay Home During Early Labor

Discuss with your provider at what point in labor you should go to the hospital or maternity center. Don’t be disappointed, though, if the staff checks you and sends you home. “Until a woman’s cervix is dilated to 3 or 4 centimeters, she usually doesn’t need to be in the hospital setting,” says Elliott Main, M.D., medical director of the California Maternal Quality Care Collaborative. “She’ll usually be more comfortable and labor will even progress more smoothly at home.”

Some of the interventions that increase your risk of an unnecessary C-section can be avoided by delaying your admission to the hospital. If this is your first baby, a helpful way of remembering what to do is “311”—after conferring with your doctor or midwife, consider delaying your trip to the hospital until your contractions are less than 3 minutes apart, last for 1 minute, and have been like that for 1 hour. (Note that some women and their providers prefer “411” or “511,” especially if their hospital is not nearby.)

8. Be Patient

Mothers today often labor longer than women did 50 years ago, research suggests. That may be because they tend to be heavier or older when they give birth, or it may be a side effect of epidural anesthesia.

In any case, most doctors learned about labor from timetables set in the 1950s, and it can take a while for all providers to adopt the newer recommendations that allow women to labor longer. “Obstetricians may be too quick to intervene because they think labor is not progressing as quickly as it should,” Main says. Talk with your providers in advance about your desire to allow your labor to progress on its own.

9. Get Labor Support

Women in labor who receive continuous support tend to labor for shorter periods and are less likely to need medical intervention. The most effective support may come from someone who is not a member of the hospital staff and is not in your social network—a doula, or trained birth assistant, for example—according to a review of 22 studies involving more than 15,000 women.

“They are people who are well-trained to cope with pain and to improve mobility,” says Michelle Drew, C.N.M., nurse midwife for Christiana Care Health System’s Department of Obstetrics and Gynecology in Newark, Del. Research shows lower C-section rates among women who receive doula support as well as increased satisfaction with their birth experience.

Ask your provider for a referral, and see whether your insurance company will cover doula care. Medicaid will cover doula care in a handful of states, and one recent study suggests doula care beginning mid-pregnancy may reduce preterm birth risk.

10. Listen to Yourself

Walking, rocking, or moving during contractions, and changing positions between contractions, can make you more comfortable and speed labor along. “Each labor-coping strategy, such as walking or showering, tends to last for about 20 minutes,” Main says. “It’s good to plan five or six strategies and then rotate through them.” When it comes time to push, being upright or on your side rather than flat on your back allows your pelvis to open and keeps you working with rather than against gravity. Hollywood-style pushing, in which the woman is coached to hold her breath and push hard according to someone else’s count, turns out to be less effective than trusting your instincts.