You have been through the first and second trimesters and have completed the tests you chose.  You are now in the 3rd trimester and you can see the light at the end of the tunnel.  Your delivery is the culmination of your pregnancy, resulting in a wonderful new life entering the world.  It can be both an exhilarating and tiring experience.  It's an emotional time- and a time you will always remember.  So many things you may be thinking of ...you, the baby, the family and future, and the delivery itself.  It's a very personal time, and the time you finally get to meet your baby.  

The birth of your baby should be right for you.  Vaginal birth or cesarean delivery (C section)? The experiences of others might help, but only you will know what is best for you.  The goal your choice and a positive experience, whether you have a vaginal birth or cesarean delivery.  Some women say they feel they were pressured into either vaginal birth or cesarean delivery, so it's worth considering both sides and deciding what is right for you.  Because it's so personal, and emotional, I have used many excerpts from other sources so the words are not mine, but from others.  The current page addresses 

• Vaginal birth vs Cesarean delivery
• Natural Vaginal Birth
• Birth and birth options
• Cesarean birth
• Unplanned cesarean birth
• Induction of Labor (IOL)
• A story of a complicated pregnancy
• Stillbirths
• Other 3rd Trimester complications
• MAMA Academy
• Identification of pregnancies at risk
• Other issues

1. Vaginal birth after cesarean (VBAC)
2. Breech
3. Placenta previa

 "Childbirth is a very personal thing. It's about weighing up the pros and cons for each individual. There are risks and benefits in whatever you do," she tells me. 

(This section taken from the Guardian)

Sher, 38, chose an elective caesarean. Not because she was too posh or too scared to push but because she decided it was the safest method. In fact, Sher makes decisions on delivery and surgery every day, and she understands the consequences more than most - she is a consultant obstetrician.  The official disapproval of elective C-sections means Sher daren't talk under her real name; Stephanie Sher is a pseudonym. 

 One London study published in the Lancet in 1996 reported that 31% of female obstetricians would personally prefer a caesarean birth. In the US, the figure is almost 50%. Many female surgeons and GPs quietly take this option too - though, as one told me, "to admit as much is still massively un-PC". 

 In April 2007, the then health secretary, Patricia Hewitt, launched her strategy for the future of maternity care. Maternity Matters trumpeted "choice", promising better access to "normal" deliveries via home births and midwife units. Her plans chimed with recent guidelines from the National Institute for Clinical Excellence (Nice) drawn up to reduce caesareans - currently 23% of all births - by advising obstetricians against granting them without medical justification. 

 It's important to remember that it is the obstetrician's and the surgeon's task to remedy the rarer complications and consequences of childbirth. Unlike midwives, who oversee successful, normal births every day, doctors bear witness to the worst-case scenarios. REF

Maternity experts across the board believe that a straightforward vaginal delivery is by far the best for both mother and baby. Most women agree: 63% of mothers see childbirth as a natural experience that should not be interfered with unless necessary. In "putting women at the centre of maternity provision", the government's strategy reflects the overwhelming consensus.

Nevertheless, among all the furor that surrounds the issue of childbirth, for Sher and her colleagues, one thing is clear: the government's promotion of delivery "choice" is a promise rarely kept. "There is nothing wrong with hoping for a natural event," Sher says, "and for everything to happen beautifully. But it just isn't like that for a large proportion of women."

Sher's greatest fear was not the pain of spontaneous labour. It was the prospect of emergency intervention, if the birth went wrong. According to the most recent NHS maternity statistics made available (2005-6), just under half (47%) of expectant mothers have a regular, uncomplicated "normal" labour. The rest have interventions ranging from induction, to forceps, to an emergency caesarean. In other words, when a woman tries for a normal birth and the best, safest kind of delivery, she has only a 50% chance of achieving it. For a significant number of others, the birth will be more complex.

With odds like this, it is not illogical to consider alternatives, particularly not if your line of work exposes you to the most extreme of cases. Many obstetricians find the second safest solution is a planned caesarean. The National Caesarean Section Audit (2001) revealed half of obstetricians think this is the safest delivery method for the baby - though not for the mother.

 The following is nearly verbatim from WhatToExpect.com  

Currently about 30% of babies are delivered by C-section — which means, all things being equal, you have about a 1 in 3 chance of having to go that route (closer to 1 in 4 in the UK). While any surgery is a proposition that should be taken seriously, with some mental and emotional preparation, you can feel empowered if a C-section seems in the cards. 

As @onestep.doula (Instagram) says: 'Most would agree that delivering vaginally is best and the recovery is better but that doesn't mean that having a cesarean means you or your body has failed at giving birth....Sometimes in order to have a healthy baby and mom a cesarean is required and they have save many lives!...My hope is that every mother who has gone through a cesarean birth or belly birth as we call it in the Doula world feels proud and powerful.'

The latest guidelines by the American College of Obstetricians and Gynecologists (ACOG) recommend that moms and their doctors always plan for a vaginal delivery unless a C-section is medically required. The group also suggests that other labor interventions be delayed or avoided completely if possible in women with low-risk pregnancies where Mom and baby are progressing normally.For women who decide to go through with an elective C-section, ACOG recommends scheduling the procedure no earlier than 39 weeks of pregnancy. The group asks that doctors remind women that the of risk of placenta previa, placenta accreta and hysterectomy increase with every cesarean delivery you have. Once you've already had a C-section, the group adds, you're more likely to require another in the future.Since cesareans are safe and can prevent the pain of labor, some women (particularly those who've had a C-section before) prefer them to vaginal deliveries and ask for them in advance. The rate is dropping, however, since there has been quite a push to lower C-section rates in the U.S.Obstetricians and other experts are encouraging more trials of labor to promote vaginal births after prior cesarean deliveries (VBAC) and more widespread use of vacuum and forceps during delivery to prevent unnecessary surgical deliveries.They're also suggesting that moms be given more time to labor and to push, and/or that doctors use Pitocin as needed to nudge labor along (assuming all is going well) before moving on to a C-section. Finally there's a growing recognition that while C-sections are very safe, they're still major surgery, which comes with greater risk.Experts agree: C-sections shouldn't be the delivery of choice, at least when there is a choice. Ultimately, the best time for your baby to make that grand entrance is when she's ready. And when an elective C-section is planned, there’s always the possibility that the baby will inadvertently be born too soon.Still wondering if you should ask your practitioner for an elective C-section? Before you raise the topic, ask yourself a few key questions:

• Are you afraid of the pain of labor? Most women share your fear (how many people do you know who look forward to pain, after all?), but there are many effective pain-relief options for laboring womenundergoing a vaginal birth, including an epidural. 
• Have you heard that vaginal birth causes urinary incontinence? While it's true that a vaginal birth can increase the risk of leaking, regular pelvic floor exercises (yup — it's those Kegels again) significantly reduce that risk.  
• Do you want your delivery to fall on a convenient day? Keep in mind that a C-section is major abdominal surgery. That means that you'll have a longer recovery time and hospital stay (certainly not convenient or especially fun — unless you really enjoy hospital food). And you'll also be exposing yourself to the risks that surgery entails. 
• Is there another baby in your future? Remember that opting for a C-section now may prevent you from delivering vaginally next time around — although VBACs are generally safe (especially for the 95 percent of women who receive low, horizontal incisions). C-sections also increase your risk for complications including placenta previa, placenta acreta and retained placenta in future pregnancies.

Your doctor may peg you for the procedure in advance of your due date. A few factors that might necessitate a C-section include:

• Certain medical conditions. You have a medical condition like diabetes, high blood pressure or kidney disease that makes vaginal delivery dangerously stressful to your body (and a cesarean birth is a safer option).
• Infections. If you’re HIV-positive or have an active genital herpes infection, a scheduled C-section is necessary because both viruses can be transmitted to your baby during delivery.
• Your baby’s health. An illness or a congenital condition might make the already tricky journey through the birth canal even more treacherous for your baby.
• A large baby. Sometimes your baby is considered too large (a condition called macrosomia) to move safely, if at all, through the birth canal.
• Your weight. Being extremely overweight or obese significantly increases your chance of needing a C-section delivery, partly because of the other risk factors that often accompany obesity (like gestational diabetes), and partly because obese women tend to have longer labors (which, in turn, ups your risk of ending up on the operating table).
• Your age. While being older doesn’t guarantee a cesarean by any means, the odds of having one increase with age. 
• Breech position. When your baby is either feet-first or butt-first in a breech position and can't be turned, your practitioner might decide that a C-section is necessary.
• Multiples. The likelihood of the procedure increases with the number of babies you’re carrying.
• Placental problems. If the placenta is partly or completely blocking the cervical opening (placenta previa) or has separated from the uterine wall (placental abruption), a C-section is likely safer for you and your baby.
• Other complications.  If you develop preeclampsia (pregnancy-induced high blood pressure) or eclampsia (a progression of preeclampsia that affects the central nervous system, causing seizures) and treatment isn't working, your practitioner might opt for a C-section to protect both of you.
• Previous C-sections. More than one prior C section increases the risk of uterine rupture during labor.  While having a first cesarean raises your risk of subsequent procedures, vaginal birth after c-section or VBAC, is frequently successful and often recommended.

If your practitioner says that a C-section is necessary — or likely necessary — ask for a detailed explanation of the reasons and any possible alternatives.  See what happens during a C section. 

Also from WhatToExpect.com

  If you’re a mom-to-be with your heart set on a vaginal birth, the news that your baby needs (or may need) to be delivered by cesarean section might feel disappointing. However, sometimes it's the safest, or rarely only, way to delivery 

Far more frequently, the need for a cesarean section isn't obvious until a woman is well into labor. A few of the most common reasons for an unscheduled or unplanned C-section include:

• Labor doesn’t start. If your labor just can't seem to get moving in the first place (your cervix isn't dilating even though you're having contractions) — after 24 or 25 hours in a first-time mother and fewer for subsequent deliveries — your doctor might decide on surgery.

• Labor stalls. You might sail right through the early stage of labor (dilation to 3 centimeters), only to grind to a halt. While it's possible that Pitocin or another labor stimulator could jump-start the contractions, if the problem is that your baby's head is too big to fit through your pelvis (which is the case about half the time) a cesarean birth is necessary.

• Exhaustion or fetal distress. If your doctor determines that you’re becoming too exhausted, or if the fetal monitor is picking up signs of your baby in distress, he or she may opt for a cesarean.  

• A prolapsed umbilical cord. If the umbilical cord slips into the birth canal before baby does, it will be compressed as your little one comes through, which could cut off her oxygen supply.

• Uterine rupture. If your uterus tears, a C-section is required.

If you're still concerned, talk with your practitioner. Together, you can decide what's right for you and your baby. 

  Read Heidi's story here

The pregnancy progressed normally, but Heidi developed gestational diabetes which affects  one in 10 women, who develop higher than normal levels of glucose in their blood. These pregnancies are classified as high risk, as complications include high birth weight babies, miscarriage and still birth. But, says Heidi, ''No one explained what it meant in practice. I had been assured there was nothing to worry about.’’

 Heidi had planned a leaving party from work for May 14, 2009, her 37th week of pregnancy, after a routine midwife appointment. But the midwife listened to Aidan and asked Heidi when she had last felt her baby kick. '’I couldn’t remember; I wasn’t keeping track. She told me to go straight to St Peter’s Hospital in Chertsey for a scan.’’

 ''At the time I was in blissful ignorance. I called Steve and was surprised that he insisted on coming with me.’’ At the hospital a sonographer was waiting. ''She said, 'I’m sorry, he’s gone.’ 

Having gone in thinking it was just a routine check and that there was nothing to really worry about, Heidi was engulfed by shock. Thinking maybe she was asleep and experiencing a nightmare, her first instinct was to 'pull at my eyelids believing I needed to open them, to wake up.’ At her side, Steve was trying to make sense of what was happening too and comfort his screaming wife. 

 We quickly learnt by talking to the doctors that his low birth weight showed he had been growth restricted, which could have been picked up earlier. If I’d have known to monitor his movements, that might have helped. There could have been a different outcome.’’ 

Having researched antenatal restricted growth extensively and found a programme called GAP (see below) which uses very accurate measurements of the mother’s bump to analyse the baby’s development, she campaigned for their local hospital St Peters to implement the programme.

Keen to empower other mums with key pregnancy information: knowing signs of infection, how to monitor movements, and when they should call their midwife for advice, she also launched the charity MAMA Academy which stands for mums and midwives awareness and equips midwives with current guidelines and research. 'We want to aid consistent maternity care across the country.’’

Her efforts and the efforts of GAP protocol have been very successful in both increasing awareness of the issue of stillbirth, but also in dramatically reducing the number of stillbirths in the UK by enlisting more trusts and units to embrace the GAP protocol. 

Birth of your baby should be right for you.  The experiences of others might help, but only you will know what is best for you.  Taking control of your pregnancy and birth plan with normal vaginal delivery is possible for the majority of women.  For others, cesarean delivery is the best or only option and those women should feel equally proud of their achievement.   In either case, you too can  'Give Birth Like a Feminist'   However, also realize constraints and biases of your own healthcare system

Pregnancy doesn't always go perfectly but with early detection and help, you can delivery a normal baby.  The data from the GAP protocol indicates that women considered at risk benefit from closer monitoring with serial ultrasound scans, including Doppler studies (to evaluate blood flow from the baby to the placenta, or from you to the placenta, or both).   Don't ignore symptoms,  warning signs, or risk factors (see GAP protocol above) and keep regular checkups.  I would also still advise Vitamin D through breast feeding at least, while folate is not as important after the first trimester.

 It may not always be according to your original birth plan, but your midwife, obstetrician and other healthcare providers will always strive to help you have the delivery you'd like.  Let them help you in your journey, and say hello to your amazing new baby.  Any concerns or issues regarding birth will quickly disappear with the joy you feel with your new baby.