I learnt a lot about babies in 2011. I read piles of books about them. I received advice from doctors, midwives, doulas, friends, relatives, strangers and a hypnobirthing instructor. On December 14th a brand new baby entered the world, into my hands. Looking back there’s things I wish I knew at the outset and things I think are worth sharing.

Get tough. Be direct. Learn to say no.

On top of navigating our first pregnancy, my wife and I were navigating the US health care system for the first time. With wide eyes and nodding heads we’d agree to every suggestion, procedure and test. You don’t have to. Some things can’t be negotiated, but most can. If you don’t feel like you’ve had enough time to make a decision, ask for it. Defer it till your next appointment (don’t worry there are plenty of them) and use the time to research and consider your options.

Get even tougher with your relatives and loved ones. Tell them what you need, what you don’t want, and when you need space.

Carefully consider genetic counseling

Your primary provider should offer a genetic counseling service, usually provided by a third party. These services are designed to screen for, test and advise on fetal genetic abnormalities (e.g. down syndrome, cystic fibrosis, and spina bifida). The service is often free and entirely optional. Don’t sign up just because it seems like a cheap way to get extra ultrasounds, tests, and peace of mind.

We nodded our heads and signed up. The first step is a detailed ultrasound that looks for indicators that a genetic abnormality is present. Our baby had a higher than ‘normal’ nuchal translucency measurement. We were bluntly told our baby had a 1 in 5 chance of having down syndrome (these calculations did not include the outcomes of my wife’s blood tests, our family history, or any other indicators).

It was strongly suggested we move on to a CVS test (chorionic villus sampling) – an invasive, but very accurate test that involves removing and testing DNA cells from the placenta. We apprehensively agreed and nervously waited two weeks for the result. Our baby was cleared of all genetic defects but further tests were scheduled.

At this point we had more information than we expected or needed, had been through 4 very stressful weeks (at a time you’re meant to be quietly celebrating), had no worrying family history, and were both well under 35. It was at this point we pulled out, wishing we’d had the strength to say no earlier.

Consider and discuss your level of risk with your doctor. Give even more thought to if this type of information is useful to you. Would it help you to make decisions about your pregnancy?

You can choose (and change) your health providers

The US healthcare system is crazy but I suppose it has one thing going for it: you can choose (and change) your healthcare provider. Most expecting parents go out and chose a hospital or doctor in the early stages of their pregnancy – not a bad idea. Unfortunately we met many new parents who did so, but later realized they wanted something different. Sadly and strangely they felt obligated to stick it out with their original choice.

Be wary if the hospital has beautiful artwork and a delicious sounding menu, but won’t give a clear answer when asked their c-section rate, or doesn’t allow doulas in their labor and delivery rooms. If the way you want to have your baby changes and your healthcare provider is not a natural fit: change your provider.

Consider a doula

I believe that women in labor for the first time deserve support beyond their bumbling inexperienced partner and a hospital midwife who visits sporadically.

Consider bringing in a true expert employed by you, to help you navigate the most difficult and challenging experience of your life. After 30 hours of helping your partner through labor consider if you might like a helping hand, or some words of wisdom and support.

Your doula will visit you before and after the labor, and help you develop your birth plan. She will also have access to all the resources and people you’ll ever need. The best $1600 I ever spent. When choosing a doula go with your gut instinct. This person will see you at your most vulnerable. Make sure it feels right.

Consider independently testing for GBS (Group B Strep Infection)

Your doctor or provider will test Mum for GBS. A totally normal bacteria commonly found in women. If GBS is present at the time of birth there is a chance that mum can pass it on to baby, which can present risks.

To counter this hospitals use an IV to pump Mum (and baby) full of antibiotics. Being constantly connected to an IV can be a real departure from the type of labor you might have envisioned.

Luckily there’s things you can do to avoid this. Ask a doula for providers in your region that can independently test for GBS (once you test positive with your hospital there’s little you can do). If you test positive ask for information about a range of natural treatments you can utilize to better your chance of testing negative with your healthcare provider.

Read Ina May’s Guide to Childbirth

An honest and wise book from America’s most influential midwife.