6 things parents should discuss and agree on before their baby is born

Parents must make many decisions when having a new baby, from choosing a hospital at which to deliver to agreeing on the baby’s name. But there are major health decisions that affect the baby’s health – and even the parents’ relationship – that many women and their partners don’t think about or discuss in advance.

I recommend looking at this list together during early pregnancy, so you can be prepared to make these decisions when the time comes. It may be that the mom has been to some of her appointments by herself and has had discussions with her care provider on these topics, but the partner hasn’t been present and is caught off-guard when a decision is required. There’s no right or wrong answer for any of these decisions – we just want you to be comfortable with your choice. 

1. Are we going to find out the sex of the baby?

Many couples want to find out the sex of their baby as soon as they can. And there’s a trend of gender reveal parties, where some couples are allowing family and friends in on the big reveal. Still others wait until the delivery to learn if they are having a boy or girl. Despite all the possibilities, it’s amazing to me how many expecting parents come in for an ultrasound having never discussed whether they want to find out!

Talk to your partner about whether you want to find out the sex (if the baby cooperates during the ultrasound) before you come to the office. Otherwise, the back and forth argument might be a distraction for the main goal of the 20-week ultrasound – to check the baby’s anatomy.

2. Should we screen for birth defects early in the pregnancy?

Parents today have the opportunity to pursue screening for congenital anomalies such as Down syndrome or spina bifida early in pregnancy. Sometimes people haven't really thought through the implication of doing so. Many expecting parents get caught up with the pregnancy and are excited about learning more about their new babies.

For example, we’ve had patients choose to have cell free DNA screening specifically because they want to know the sex of the fetus early in pregnancy. However, if we do that, we also might get a result that suggests the pregnancy is affected by other conditions.

Depending on the circumstances around the testing, the likelihood of the accuracy early in pregnancy might be low; however, I’ve had patients say, “Dr. Horsager, all I really wanted to know was the sex. I didn’t want this other information.” If the results are abnormal, we can do invasive diagnostic testing that comes with its own risks.

Frequently, couples are at odds about whether to pursue additional testing. Some want to know for peace of mind; others fear decisions they’ll have to face if further testing indicates congenital abnormalities. We do our best to prepare patients ahead of time for these situations. However, it ultimately is a decision you’ll have to make.

3. Is VBAC safe, or do we have to do C-section?

If you’ve had a cesarean section (C-section) in the past, you’ll need to think about how you will deliver your next baby. Some women opt for a second C-section, while others want to try for vaginal birth after C-section (VBAC). There are health-related pros and cons for each, which can make for a tough decision between you and your partner.

While the decision is ultimately the mother’s, it’s best for parents to make this decision jointly and for the partner to be supportive of the mother. There is a slightly increased risk of uterine rupture associated with VBAC, which can have some serious consequences for the baby. One useful tool in making this decision is an online VBAC risk calculator from the MFMU Network. The calculator, along with thorough conversations with your OB/Gyn, can help you consider your risk factors to estimate whether VBAC might be a safe option.

4. Are we planning for induction or waiting for spontaneous labor?

Research published in 2018 suggests that induction at 39 weeks might reduce maternal and fetal risks, but there are pros and cons to this decision as well. With families’ busy lifestyles, it might be preferable to plan the delivery. However, many women have preferences about not wanting intervention and letting nature take its course. Partners should get on the same page about this to plan for time off work, care of older children, and more.

5. Should our son be circumcised?

After delivery, you and your baby likely will stay at the hospital just 36 to 48 hours. In that short time, your baby will receive multiple tests and vaccinations. This also is the time when male babies are circumcised if the parents choose to have the procedure done. 

Research suggests that males who are circumcised as newborns are at reduced risk for urinary tract infections as infants and for sexually transmitted diseases later in life. However, we see a fairly even mix of families who choose and forgo circumcision, and neither is regarded as a resoundingly healthier choice. That said, it’s helpful to know what you prefer to do ahead of time so it’s one less thing to think about during your recovery.

6. Are we going to allow loved ones to visit after delivery?

From the grandparents who want to see the new addition to curious co-workers, many couples feel obligated to have guests in the recovery room. However, not only do you not have to allow visitors, it might not be recommended if the mother or baby has special health concerns, or if it’s cold and flu season. There will be plenty of time for your loved ones to meet the new baby when you go home, so make sure to discuss your preferences with your partner ahead of time to avoid hurt feelings.

With all of these discussions, there’s no definite right or wrong answer. However, these situations can cause discord between partners, and we think it’s worth taking time for thoughtful consideration beforehand as opposed to being forced suddenly into a last-minute decision, which can lead to emotional disagreements.