Birth Plan vs. Birth Reality

“Do I need to write a birth plan?”

This is a frequent third trimester question. My answer is always the same: if you want to, go ahead, but if you don’t, things will still be OK.

A birth plan, in general, is a list of wishes that a pregnant woman and her partner have for their labor, delivery, and postpartum experience. It usually contains information about what kind of pain control she wants, who is going to be in the room for the delivery, who will cut the umbilical cord, etc. I have no idea when this concept came into vogue, but now is a commonplace discussion on most pregnancy websites and in childbirth classes. There are even online “create your birth plan” tools with multiple choice options to create your personalized plan with a few easy clicks.

From my perspective, the main benefit of the birth plan is to give families reassurance that they have some control over a frightening situation. Many women fear that once in the hospital, they will be subjected to interventions against their will, and the birth plan is a way of expressing their wishes ahead of time and making sure that they are heard (or at least seen). If you need that kind of reassurance, then, yes, you should write a birth plan. But the truth is that you really don’t need one. After delivering thousands of babies, with and without plans, there are a few things that I have learned.

  1. Birth is totally unpredictable, and no matter how well you plan for it, no one–not you, your partner, your doctor, or your nurse–knows what will happen.
  2. Patients often choose (on their own) to deviate from their plan in the course of labor and delivery. This is normal and expected, as they wrote their plans long before they experienced labor first-hand.
  3. Most birth plans say the same thing, and most patients who do not have birth plans have the same wishes as those who do.
  4. Birth plans are almost always a first baby thing. Second time moms rarely write them because they realize that they are not necessary.
  5. Real births almost never follow the plan exactly.

These observations alone should be reassuring to you if you are feeling apprehensive. Why? The reality is that your doctor’s only goal in managing your labor and delivery is getting you and your baby through it safely. We will treat you the same whether or not you have a birth plan; that is, we will let labor proceed as naturally as possible and intervene only when necessary if that is what you prefer. If you don’t want pain medication or if you want to listen to a particular song while you push, that’s fine. If your Marina doctor (or Monterey, Salinas, and Carmel doctors) thinks that things are getting complicated and some sort of intervention is required, you must give your consent before it can be done. The bottom line is that when you are in the hospital, nothing can be done against your will (the one exception being a dire emergency where you are incapable of providing consent).

Perhaps more important than writing a birth plan is researching hospitals in Salinas, CA and surrounding areas and choosing a hospital that adheres to “baby-friendly” principles (note that this is this does not necessarily mean the hospital must be certified “Baby-Friendly”–many hospitals practice these principles without that certification from the state and very few hospitals have obtained certification to-date). This means that the hospital has a commitment to encouraging bonding between parents and their newborn and will automatically do the things you probably would request in your birth plan, such as skin-to-skin contact immediately after delivery (when safe), procedures and tests administered to the baby in your room whenever possible, and exclusive breastfeeding. At Salinas Valley Memorial Hospital, where we work, these practices are standard, so when reading patients’ birth plans, I am able to reassure them that half of what they request will be done without them saying a word.

Other things, like whether or not you need an IV, are generally negotiable, and if you discuss your concerns with your doctor ahead of time, you can often reach a mutually acceptable decision. If you do write a birth plan, you absolutely should bring it in to your prenatal appointments to discuss it with your doctor ahead of time>. We see your birth plan as a way of exploring your concerns about labor, and often a short discussion of your requests can allay many of your worries.

The bottom line: communication is key. If you want to write a plan, by all means, go ahead. But even if you don’t, tell us your concerns so that we can take those worries off your mind!

Pregnancy and Prenatal Care

The Importance of Prenatal Care

According to the U.S. Department of Health and Human Services Maternal and Child Health Bureau, ”Babies born to mothers who received no prenatal care are three times more likely to be born at low birth weight, and five times more likely to die, than those whose mothers received prenatal care.”

Prenatal care is much more than just health care while you’re pregnant. Prenatal care is a key factor in any healthy pregnancy and vital to the health of both the pregnant mother and the unborn baby. Pregnancy causes physical, biochemical and hormonal changes in the pregnant mother that may sometimes lead to a difficult pregnancy or complications at birth. These may go undetected without regular examinations by experienced obstetricians, a physician trained in the field of obstetrics.

For more information about the importance of prenatal care and working with qualified obstetricians, please visit the HEALTH CARE FOR WOMEN in Monterey County California website or call 831-758-8223 to schedule an appointment with a qualified ob-gyn.

Early Pregnancy Detection

If you suspect that you are pregnant, it’s important to verify the pregnancy as soon as possible. The most common event associated with pregnancy is a missed menstrual cycle. Women who don’t have regular menstrual cycles should be alert for other signs of a possible pregnancy such as unusual fatigue, nausea, frequent urination, heartburn or tenderness in the breasts. Once you’ve missed a menstrual cycle or had some other indication of a possible pregnancy, it’s important to visit your ob-gyn as soon as possible. Even if you’ve taken a home pregnancy test, it’s still wise to follow-up with your obgyn doctor. Your obstetrician will test for the presence of a hormone called chorionic gonadotropin, which is produced by the placenta. The presence of this hormone in the blood or urine confirms the pregnancy.

If you need help confirming your pregnancy, call 831-758-8223 to schedule your pregnancy test. Health Care For Women can also help you get started with your prenatal care.

Prenatal Care

Proper prenatal care means more than just doubling up on your vitamins and watching what you eat. Remember that it’s not just the health of the mother that needs to be monitored, but also the health of the baby.

In monitoring the health of the mother your obgyn doctor will test for conditions that can arise as a result of the pregnancy itself. Some of these can be high blood pressure, insufficient or overly substantial weight gain and diabetes (which can develop even though diabetes was not present before the pregnancy). The presence of these special conditions or any others may be indicators of a difficult pregnancy. Early detection allows your ob-gyn the opportunity to prescribe any specialized treatments or procedures that may be required to insure a healthy pregnancy and the health of the mother and child.

Your obstetricians will also monitor the health of the baby. Early detection of abnormalities for example, in the fetal heartbeat or the size and position of the fetus, will indicate to your ob-gyn that specialized procedures may be required to insure a successful pregnancy. The early detection of any abnormalities also allows your doctor the opportunity to make certain that any specialized equipment or medical personnel that may be needed will be present at the birth in order to safeguard the health of both the mother and the newborn baby.

If you’re interested in finding out more about the gynecological and obstetrical services offered by the medical professionals at Health Care For Women, please visit, or call 831-758-8223 and set up an appointment for a visit to the Health Care For Women offices today.

Meet Our Board-Certified Obstetricians & Gynecologists (OB/GYNs)

Recently, each of our Salinas doctors were interviewed for a promotional video.

Here’s the long version:

Yes we said “new video.”  Perhaps we’ve been a little shy in the past, but here are our previous TV bits, en espanol:

Doctora Analisa Marki-Dunn (Dr. Analisa Marki-Dunn): La Magia Del Cuidado Prenatal, Part I

Doctora Analisa Marki-Dunn (Dr. Analisa Marki-Dunn): La Magia Del Cuidado Prenatal, Part II

Now Offering Patients Touch MD, an Online Patient Education & Collaboration System

With TouchMD you can

  • Learn more about your obgyn doctor, their staff and facilities
  • Explore videos about your procedure, pregnancy or medical condition
  • View or print any images saved by your obgyn doctor during your office visit
  • Share your medical experience with your loved ones

Existing patients in our system may use the registration code “hcfw” and login here,

Your Ultrasound Appointment

Getting your first ultrasound can be one of the most exciting moments during your pregnancy, and the experience undoubtedly marks a major milestone in the process of slowly getting to know your baby before he or she is born. From laying eyes on those first precious images, to finding out whether the decorations are going to be blue or pink, having your ultrasound test performed by the best obstetricians can help reassure you that your growing baby is healthy and safe.

An ultrasound is a procedure that allows you to see images of your baby during your pregnancy, with the sonogram being the name of the actual picture taken of your baby during the ultrasound. Health Care For Women‘s 4D ULTRASOUNDS take 3D ULTRASOUND images and then adds an elapsed time element to the process, which in turn allows you the unique experience of viewing live-action images of your baby that are of a quality that you most likely never thought possible.

As one of the most useful and reliable diagnostic tests for proper prenatal care, the performance of an ultrasound test by obstetricians is one of the key components in evaluating and protecting the health of an unborn baby.

A prenatal ultrasound test utilizes high-frequency sound waves that are transmitted through the woman’s abdomen via a transducer so that the OB and GYN doctor can look inside the abdomen. The echoes are recorded and transformed into photographic or video images of the baby. The ultrasound can be used during pregnancy and in prenatal care to show images of the baby, placenta, ovaries, and amniotic sac, and the ultrasound test can also detect major birth defects or abnormalities. Ultrasounds do not use any radiation and are safe during all stages of pregnancy.

Most patients will get one or two ultrasounds during their pregnancy, depending on when they start prenatal care. Additional ultrasounds might be indicated to perform special kinds of tests or to more closely monitor high-risk pregnancies.

So what can an ultrasound do?

An ultrasound performed early in your pregnancy can determine:

  • Your expected due date
  • The gestational age (the age of the fetus)
  • The presence of more than one fetus
  • Measurement of the Nuchal Translucency to help detect chromosomal abnormalities

An ultrasound performed later in your pregnancy can determine:

  • The general health of the baby and detect many types of birth defects
  • The amount of amniotic fluid around the baby
  • Location of the placenta
  • The expected weight of the baby
  • The position of the baby
  • The baby’s gender

With the state-of-the-art 4-D ultrasound, Health Care For Women will allow you the amazing opportunity to see pictures and video of your baby before he or she is born, and the stunning image quality provided by this high-tech equipment is detailed beyond anything that has been available up until now.