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f6b3b11d13885856 | #### Introduction
atient's immunizations, an assessment for immunity, and other screenings and tests, as appropriate. All those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and gender nonconforming individuals. Pregnancy co... |
71e39e7b56c6d812 | #### Introduction
optimized during the prepregnancy period, reducing the chances of pregnancy-related complications. Additionally, understanding aspects of patients' social context during prepregnancy counseling may identify ways to help improve prenatal care usage, including understanding barriers that patients may f... |
00b6bd7963879a28 | # Timing of Prepregnancy Counseling
Direct screening for a patient's pregnancy intentions, as stated in the "One Key Question Initiative," is a core component of high-quality, primary preventive care services (2). Any patient encounter with nonpregnant women or men with reproductive potential (eg, not posthysterectomy... |
dec5dc16249fa6f0 | #### Family Planning and Pregnancy Spacing
Family planning is a foundational aspect of prepregnancy counseling. Approximately 45% of the pregnancies |
fd1baaeb0827b699 | #### Family Planning and Pregnancy Spacing
in the United States are unintended, and unintended pregnancy increases the risk of pregnancy complications (3). Education and enhanced awareness of the effect of age on fertility (4) and planning for family size are essential in counseling the patient who desires pregnancy. ... |
e6daeb7d8fc48a14 | #### Family Planning and Pregnancy Spacing
for women undergoing labor after cesarean (also referred to as trial of labor after cesarean) (7). The Centers for Disease Control and Prevention's (CDC) U.S. Medical Eligibility Criteria for Contraceptive Use and U.S. Selected Practice Recommendations for Contraceptive Use (... |
4ffa47c2ac7443f7 | #### Family Planning and Pregnancy Spacing
An ovulatory woman who is younger than 35 years who desires pregnancy and who does not have a clearly identifiable risk factor for infertility should be expeditiously evaluated if she has not become pregnant after 12 months of unprotected intercourse. A woman who is 36 years ... |
efba9029c69fa4f6 | #### Family Planning and Pregnancy Spacing
Referral to a fertility specialist for males and females may be considered at any point if the infertility etiology, indicated treatment, or attempted treatment failures exceeds the expertise of the obstetrician–gynecologist. Monthly ovulation is likely in women with regular ... |
3dacc1a091894c1b | #### Family Planning and Pregnancy Spacing
days before ovulation and that intercourse every 1–2 days yields the highest pregnancy rates (11). Patients may inquire about ovulation predictor kits or electronic apps for fertility. These tools vary in quality, and data on their usefulness are limited (12). |
a60e2986d460c064 | # Review of Medical, Surgical, and Psychiatric Histories
Many chronic medical conditions such as diabetes, hypertension, psychiatric illness, and thyroid disease have implications for pregnancy outcomes and should
be optimally managed before pregnancy (Table 1). Consideration may be given to referral to a maternal–fe... |
5d76fae5021039dd | #### Review of Current Medications
All prescription and nonprescription medications should be reviewed during prepregnancy counseling. This review also should include nutritional supplements and herbal products that patients may not consider to be medication use but could affect reproduction and pregnancy. The pregnan... |
8c8315ac8ada22ce | #### Review of Family and Genetic History
A genetic and family history of the patient and her partner should be obtained (17–20). This may include family history of genetic disorders, birth defects, mental disorders, and breast, ovarian, uterine, and colon cancer. When any genetic disease carrier status is diagnosed i... |
af092147c722b1f9 | #### Review of Family and Genetic History
men, though insurance coverage for screening may be lacking and may be a barrier for some patients. Screening in the prepregnancy period offers the additional advantages of identifying, before pregnancy, couples at risk of having children with genetic diseases and offering app... |
6dfce7e2823dab38 | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|-------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------... |
f3a415167f7d3c12 | #### Review of Family and Genetic History
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| Pregestational diabetes mellitus | Congenital anomalies and pregnancy-related complications | The importance of euglycemic control before and during pregnancy should be emphas... |
14ae1ec377538058 | #### Review of Family and Genetic History
-----------------------------------------------------------------------------------------------|--|
| Chronic hypertension | Preeclampsia and intrauterine growth restriction | Assessment of the teratogenic risk of hypertensive medications should be performed. Angiotensin conve... |
dc5852e34de4bdc5 | #### Review of Family and Genetic History
-----------------------------------------------------------------------------------------------|--|
| Hypothyroidism (untreated) | Spontaneous abortion, preeclampsia, preterm birth, placental abruption, and fetal death | Screening based on risk factors, rather than universal s... |
3b4737debf4891fe | #### Review of Family and Genetic History
-----------------------------------------------------------------------------------------------|--|
| Bariatric surgery | A period of rapid weight loss typically occurs in the first 12–24 months postoperatively. During this period, pregnancy is less desirable because of potent... |
1df72e094e1f775b | #### Review of Family and Genetic History
-----------------------------------------------------------------------------------------------|--|
| Mood disorders | Impaired maternal infant bonding, risk of maternal self-harm, or neglect. Antidepressants and antipsychotic medications increase anovulation and decrease fecu... |
401442b4ea647b1c | #### Review of Family and Genetic History
(Continued)
Table 1. Major Medical Conditions That Affect Pregnancy (continued) |
0b8d2fe9dc75091b | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------... |
de6facbb577ccda0 | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------... |
3bf3623ecc16a84b | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------... |
1f9fe1f6d2448365 | #### Review of Family and Genetic History
| Condition | Associated Risks | Treatment | Goals | |
|------------------------------------------|--------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------... |
161e1314478f885c | #### Review of Family and Genetic History
Abbreviations: DVT, deep vein thrombosis; HbA1C, hemoglobin A1C ; HIV, human immunodeficiency virus; LARC, long-acting reversible contraception; PE, pulmonary embolism.
Management of diabetes in pregnancy: standards of medical care in diabetes—2018. American Diabetes Associat... |
e7121ad3e4909443 | #### Review of Family and Genetic History
y Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. American Association of Clinical E... |
67df34c3c2a8ebcf | #### Review of Family and Genetic History
diseases can be counseled about the disease inheritance and course and offered referral for potential interventions, such as preimplantation genetic testing. See Table 2 for counseling and screening recommendations. |
7caf95b8a045e14a | # Immunizations
Women of reproductive age should have their immunization status assessed annually for Tdap, measles– mumps–rubella, hepatitis B, and varicella. All patients should receive an annual influenza vaccination; those women who are or will be pregnant during influenza season will have additional benefits (21)... |
d0e3f8ed1071f2a2 | # Immunizations
tion (HPV) and cervical cancer screening should be performed in accordance with current guidelines. The HPV vaccination currently is not recommended during pregnancy but should not be avoided or delayed because a woman may want to become pregnant or may be actively trying to become pregnant. If the HPV... |
37a6b41b46105f3a | # Immunizations
ld be given at least 28 days before pregnancy, or in the postpartum period if not previously given. Because two doses of the varicella vaccine are recommended, and the CDC recommends that women not become pregnant for 1 month after being vaccinated, a woman who desires pregnancy should begin vaccinatio... |
3b5222a1c2f93bf9 | # Immunizations
| Condition | Who to Counsel | Considerations |
|----------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------... |
16ec44afcea73a33 | # Immunizations
| Condition | Who to Counsel | Considerations |
|----------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------... |
8f9f8ad6f698ef24 | # Immunizations
Carrier screening for genetic conditions. Committee Opinion No. 691. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;129:e41–55.
y Hemoglobinopathies in pregnancy. Practice Bulletin No. 78. American College of Obstetricians and Gynecologists. Obstet Gynecol 2007;109:229–37.
z... |
e2da4a65b43aec64 | # Infectious Disease Screening
Assessment of the need for STI screening should be performed at the time of prepregnancy counseling. Guidance on recommended STI screening is available from the CDC (28) and ASRM (29). Gonorrhea, chlamydial infection, syphilis, and human immunodeficiency virus (HIV) should be screened fo... |
41b10fa72ff6dafd | # Infectious Disease Screening
tional programs to reduce maternal Toxoplasma gondii infection and, thus, congenital toxoplasmosis. However, despite the successes demonstrated in some observational studies, several reviews (including a Cochrane review) suggest that weaknesses in study design prevent the conclusion that... |
b71a6d78ee1dce4f | # Infectious Disease Screening
er. The CDC offers up-to-date guidance on Zika precautions (32) and other infectious diseases (33). Information and guidance on the Zika virus also is available from ACOG (34) and ASRM (35). |
876c17bd406c5692 | # Individuals with Human Immunodeficiency Virus
All reproductive-aged patients living with HIV should receive prepregnancy counseling if considering pregnancy (36). Prepregnancy counseling should include a detailed discussion of interventions to reduce the risk of perinatal transmission, ways to optimize long-term hea... |
1c5cb611fbe8bb7b | # Individuals with Human Immunodeficiency Virus
e to become pregnant while minimizing the risk of HIV transmission to an HIV-negative partner (37). Prepregnancy administration of antiretroviral preexposure prophylaxis for HIV-uninfected partners may offer an additional tool to reduce the risk of sexual transmission (3... |
9b2be6743b708965 | # Individuals with Human Immunodeficiency Virus
of the women before pregnancy and to identify risk factors for adverse maternal and fetal outcomes. Safe sex practices and avoidance of STIs should be discussed, and both partners should be screened for STIs, which should be treated if present. The choice of antiretrovir... |
dfcdf41d10817d6d | #### Substance Use Assessment
All patients should be routinely asked about their use of alcohol, nicotine products, and drugs, including prescription opioids and other medications used for nonmedical reasons (39, 40). Adverse effects associated with smoking during pregnancy include intrauterine growth restriction, pla... |
d336b66bdda7f03b | #### Substance Use Assessment
uring pregnancy are at an increased risk of asthma, infantile colic, and childhood obesity (45–47). Pregnancy appears to motivate women to stop smoking; 46% of prepregnancy smokers quit smoking directly before or during pregnancy (48); however, women who are unable to quit during pregnanc... |
8a7c5255a7d43754 | #### Exposure to Violence, Intimate Partner Violence, and Reproductive and Sexual Coercion
More than one in three women in the United States have experienced rape, physical violence, or stalking by an intimate partner in their lifetime (54). Screening for intimate partner violence should occur during prepregnancy coun... |
edc668d5fd32f06d | #### Exposure to Violence, Intimate Partner Violence, and Reproductive and Sexual Coercion
m patients about what it is necessary, under state laws, for physicians to disclose to authorities. Sample questions to begin the conversation are provided in ACOG Committee Opinion No. 518, Intimate Partner Violence (54). Self-... |
13357ce07b51991e | #### Exposure to Violence, Intimate Partner Violence, and Reproductive and Sexual Coercion
oercion include sabotage of contraceptive methods, pregnancy coercion, and pregnancy pressure (56). If ongoing abuse is identified, assessment of the immediate safety of the patient and her family should be ascertained and commu... |
23037e3028e4a632 | # Assess Nutritional Status
Fruits, vegetables, and daily multivitamins are good sources of antioxidants and vitamins that may assist in reproductive health for males and females. Female prepregnancy folic acid supplementation should be encouraged to reduce the risk of NTDs. All women of reproductive age (15–45 years)... |
a565bc6fe75254b6 | # Assess Nutritional Status
pregnancy with an NTD or women with seizure disorders, should be counseled to take 4 mg of folic acid daily (57). Because of the risk of vitamin A toxicity, women who need additional folic acid should not take additional prenatal vitamins; instead, women at higher risk of NTDs should be pre... |
52dd73b141329d4e | # Assess Nutritional Status
Patients should be screened regarding their diet and vitamin supplements to confirm they are meeting recommended daily allowances for calcium, iron, vitamin A, vitamin B12, vitamin B, vitamin D, and other nutrients. The U.S. Department of Agriculture offers tools for self-dietary assessment... |
7d659dd4546796f0 | # Assess Nutritional Status
, 65) and the U.S. Food and Drug Administration provides a patient resource for fish to avoid (66). Maternal listeria infection has been associated with preterm delivery and other obstetric and neonatal complications, and pregnant women should be advised to avoid eating foods with a high ri... |
bdca8b04f73fc716 | # Achieving and Maintaining a Healthy Body Weight
Patients should be encouraged to try to attain a BMI in the normal range before attempting pregnancy because abnormal high or low BMI is associated with infertility and maternal and fetal pregnancy complications (68). The reproductive risks of obesity include, but are ... |
7c1ada298b5006af | # Assess Exercise and Physical Activity
Regular physical exercise improves cardiovascular health, reduces obesity and associated medical comorbidities, and improves longevity. Patients should exercise moderately at least 30 minutes a day, 5 days a week, for a minimum of 150 minutes of moderate exercise per week (73). ... |
0e53e98d079cbda1 | # Assess for Teratogens and Environmental and Occupational Exposures
Mounting and robust evidence suggests there are reproductive and pregnancy risks associated with environmental pollutants, workplace teratogens, and endocrine disruptors. By the time a woman presents with pregnancy, disruptions of organogenesis may h... |
12824b1b06949968 | #### Pregnancy Dating
Women should be counseled to seek medical care before attempting to become pregnant or as soon as they believe they are pregnant to aid in correct dating and to be monitored for any medical conditions in which treatment should be modified during pregnancy. Correct first-trimester pregnancy dating... |
d7dc80572dcc7490 | #### American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920
Prepregnancy counseling. ACOG Committee Opinion No. 762. American College of Obstetricians and Gynecologists. Obstet Gynecol 2019;133:e78–89. |
6cfd33454966e601 | #### American College of Obstetricians and Gynecologists 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920
This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considere... |
b2d62fb1acb772b1 | #### **Background**
Preconception care (PCC) entails a comprehensive suite of interventions to improve the health of potential parents, their babies and future generations. PCC is not limited to a first pregnancy, and addressing health and wellbeing is equally important in the interconception period. |
3e0b6c485dccb53a | #### **Objective**
The aims of this paper are to discuss the evidence for and components of PCC, as well as the role of the general practitioner in the delivery of PCC. |
bba323660d2a660a | # **Patient-centred care and reproductive life plan**
PCC is underpinned by the principles of patient-centred care and shared decision making, and discussion should focus on the individual's or couple's reproductive life plan. Tools to discuss pregnancy intention are outlined in Table 2. A detailed mental health histo... |
6a7236f0c6f74b57 | #### **Folate supplementation**
A daily folate supplement of at least 400 mcg has been demonstrated to lower neural tube defects (NTDs) by 72% compared with no supplementation.13 Women with additional risk factors (refer to Table 1) require increased supplementation.14 Data show that women in Australia have suboptimal... |
3651bcc2932ef7bf | #### Reproductive health
- Family planning and reproductive life plan
- Discussion on desired number of children (if any) and timing of pregnancies
- Discussion about contraception options, including safety, efficacy and timing for intended pregnancies
- Discussion about options for unintended pregnancies |
0232ab02023e3cbc | #### Physical activity
- 150 min exercise per week or 30 min/day
- Pelvic floor training |
cb51ea68ee0f6896 | #### Weight assessment
- Respectful and supportive assessment of weight including BMI measurement
- Advise of healthy weight range and assist with goals to achieve this
- Refer to Institute of Medicine recommendations for weight gain in pregnancy [\(www.health.gov.au/resources/pregnancy-care-guidelines/](http://www.he... |
7c2c41d137d56643 | #### Nutrient intake
- Supplementation
- Folate 400 mcg daily or 5 mg if increased riskA
- Iodine 150 mcg daily
- Adequate intake of iron, calcium, vitamin D
- Restricted intakeB
- Vitamin A (retinol) 800 mcg/day
- Restricted caffeine intake (200 mg/day from all sources)
- Mercury-containing fishC |
e1045d6fb3f82834 | # Infectious diseases and conditions
- Recommended screening investigations for all potential parents
- Blood-borne viruses: HIV, hepatitis B, hepatitis C
- STIs: syphilis
- Infectious diseases: rubella, varicella zoster
- Recommended screening investigations determined by individual situation
- STIsD: chlamydia, ... |
816203c837371292 | ## Medical conditions
- Review and optimisation of pre-existing conditions; referral to specialist as required
- Diabetes: optimise glycaemic control |
4cc50ab9e64094b7 | #### Parental exposure
- Alcohol
- Ask about alcohol use with AUDIT-C tool and advise there is no safe level in pregnancy
- Provide support for reducing alcohol intake
- Smoking and e-cigarettes
- Ask about smoking and e-cigarette use and advise on benefits of quitting
- Consider cessation support, including refer... |
8bb203485f82189c | #### Family and genetic history
- Detailed genetic history and referral to genetics counsellor for positive family history, known genetic conditions or previous affected pregnancy
- Carrier screening to be discussed |
c9ccbce485eebad2 | #### Medication
- Review prescription and over-the-counter medications for safety in pregnancy
- Cease and prescribe alternative medications as required |
c79092a427da56a4 | # Preventive health
- Cervical screening and breast self-examination
- Dental review |
b224007e344c91f1 | #### Obstetric history
• Review previous pregnancy outcomes: miscarriages, stillbirth, disorders of placentation
AFamily history or previous pregnancy affected, body mass index (BMI) ≥30 kg/m2, diabetes, on anticonvulsant medication, malabsorptive condition.
BFor patient information resources, refer to Food Standard... |
a1ccfec405a7a942 | ependent
manner, with women whose body mass index increased by ≥3 kg/m2 having the higher risk.18
Empowering women with type 1 and type 2 diabetes, by providing support and tailored education about the benefits of glycaemic control (target HbA1c <6.5%), can reduce the risk of congenital malformations.19,20 Contracept... |
3439aee04cea4199 | Smoking remains an important preventable risk factor for preterm birth, low birthweight and perinatal death. Up to 22% of women smoke in the preconception and early pregnancy period, with higher rates among First Nations people, younger people and people living in rural and remote areas.22 The use of e-cigarettes is in... |
043cab564a1a2f5e | | Pregnancy and postpartum (current or recent pregnancy) | |
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76e1a4e65edcb89a | The effects of vaping in pregnancy remain unknown, but many e-cigarettes contain harmful substances and their use during pregnancy and preconception is not recommended.23,24
Approximately 77% of adults in Australia drink alcohol.25 There is no safe level of alcohol consumption in the preconception period or during pre... |
b760bd4b4c3056e2 | A thorough medical history should be taken, and any medical conditions optimised prior to pregnancy. Contraception should be offered
Preconception care **Focus** | **Clinical** |
17cb0068225a1708 | prior to pregnancy. Contraception should be offered
Preconception care **Focus** | **Clinical**
where appropriate while stabilising chronic conditions. All medications, both prescription and complementary, should be reviewed, considering the drug indication, dosing, route of administration and alternatives to ensure ... |
b1edca0a5ad1ce55 | # **Previous pregnancy outcomes**
Previous pregnancy outcomes can inform risk factor modification and interventions in the interconception period. Disorders of placental insufficiency, such as intra-uterine growth restriction, pre-eclampsia or gestational diabetes, might require targeted interpregnancy diet and exerci... |
77b51ac730dcf30f | # **Preventive health and screening, including sexually transmissible infections and infectious diseases**
All potential parents should be educated about infectious diseases and have a review of their vaccination history for measles, mumps, rubella, varicella zoster, diphtheria, tetanus and pertussis and hepatitis B u... |
cc68f2745bc888c8 | #### **Offering the test**
Sequential: one person offered screening; screen partner as indicated
Couple screening: both people screened |
9b597c5d2770955d | # Pregnant (antenatal testing)
- No antenatal testing
- CVS from 11 weeks
- Amniocentesis from 15 weeks |
754be38bab2c31b2 | # Postpartum
• Postnatal testing on baby (newborn screening)
CVS, chorionic villus sampling; IVF, in vitro fertilisation.
improves with provision of CMV education resources.36 Individual risk assessment and screening should be performed for women with a risk of exposure, such as childcare workers and those with youn... |
543098a5cf1a0f16 | #### For policy makers
- 14. Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Vitamin and mineral supplementation and pregnancy. RANZCOG, 2019. Available at [https://](https://ranzcog.edu.au/wp-content/uploads/2022/05/Vitamin-and-Mineral-Supplementation-and-Pregnancy.pdf%20) [ran... |
cbaa67cd837ad6fb | #### For policy makers
- 15. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.... |
5b3ebfa22adaaaca | #### For policy makers
- 16. Wrottesley SV, Lamper C, Pisa PT. Review of the importance of nutrition during the first 1000 days: Maternal nutritional status and its associations with fetal growth and birth, neonatal and infant outcomes among African women. J Dev Orig Health Dis 2016;7(2):144–62. [doi: 10.1017/](https:... |
3974fd36574d591d | #### For policy makers
- 33. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Clinical Guidance Statement: Pre-pregnancy and pregnancy related vaccinations (C-Obs 44). RANZCOG, 2023. Available at [https://ranzcog.](https://url.au.m.mimecastprotect.com/s/0_hbC4QOM8uJ3Zq0SOfYC4... |
e621bb107bdb7f1d | # Birth plans: definitions, content, effects, and best practices
Taylor Ghahremani, MD; Kathleen Bailey, MA, MS, CNM; Julie Whittington, MD, LCDR, MC, USN; Amy M. Phillips, MD; Bethany N. Spracher, BA, MA; Sheila Thomas, MA (LS); Everett F. Magann, MD |
57328754ff7f7ea1 | ## Background
In 1980, the first guide on how to construct a birth plan was written by Simkin and Reinke and was produced by the International Childbirth Education Association.1 This document was designed to assist
From the Department of Obstetrics and Gynecology, University of Arkansas for Medical Sciences, Little R... |
513e591cfbdb425f | ## Background
Note from the authors: Where possible, we attempt to use the preferable terms "birthing person," "birthing people," and "pregnant people," and gender-neutral pronouns in lieu of gender-specific terminology. When studies were cited, "women" may have been specified, and thus the term was used when referenc... |
ce66742b08af62ce | ## Background
Click Video under article title in Contents at ajog.org The first written guide for birth plans was introduced in 1980 as a means for birthing people to document their choices in the child birthing experience. The birth plan offers an opportunity for the patient and the provider to discuss the birthing p... |
6547425fa6f87c11 | ## Background
ead to posttraumatic stress disorder, but following a birth plan may also be protective against it. Birthing people who use a birth plan may be less likely to use epidural anesthesia, have early amniotomy, or use oxytocin. The first stage of labor may be longer when a birth plan is used; however, there d... |
9e798309b9856b48 | ## Background
expectant parents in the communication of their wishes and expectations for birth with each other, their providers, and hospital staff, highlighting the importance of shared decision-making and informed consent in preparation for birth. However, the birth plan quickly became controversial, with some prof... |
c7a125798aaf00d7 | ## Background
In 2006, recognizing that birth plans may have eroded this trust, it was suggested that expecting parents should focus on: (1) how to feel safe and confident as a patient, (2) how to manage pain with contractions, and (3) choice of support person and delineation of requirements for that person.
More rec... |
2a07fbbdae61f012 | ## Background
need to be "individualized according to needs and preferences."5 Developing a birth plan can be a spontaneous decision by the birthing person or may be encouraged by the provider or the facility in which they are to give birth. This communication tool between the birthing person and the birth team can al... |
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