Birth plans: still worse than useless

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I wrote Birth plans: worse than useless over 5 years ago but it remains one of the most read, most commented upon pieces on this blog.

A new paper in the “journal” Birth (owned by Lamaze International), Birth plans—Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study by Afshar et al. shows that birth plans are still worse than useless, not merely failures on their own terms, but actually making women feel less satisfied than they would have without birth plans.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Having a birth plan is as effective as having a weather plan for the day of birth.[/pullquote]

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

It’s really not surprising when you consider that birth plans, like most of natural childbirth philosophy, was conjured from thin air, with no investigation as to whether they worked or if the assumptions behind them were accurate.

… Birth plans were originally introduced in the 1970s as a communication tool. In the 1980s, after criticism of an overly “medicalized” view of childbirth, the World Health Organization went on to classify birth plans in the top category of recommended practices for making pregnancy safer…

But the truth is that birth plans were created by birth paraprofessionals as a way empower themselves and stick a proverbial finger in the eye of obstetricians. Birth plans engender hostility from the staff, are usually filled with outdated and irrelevant preferences, and create unrealistic expectations among expectant mothers. And they don’t work.

This is not news.

Joanne Motino Bailey, CNM et al. in Childbirth Education and Birth Plans, noted:

There are no randomized controlled trials that analyze birth plans …

Brown and Lumley stated that “women who made use of a birth plan were more likely to be satisfied with pain relief, but did not differ from women not completing a birth plan in terms of overall rating of intrapartum care, or involvement in decision making about their care.” Whitford and Hillan found that most women who completed a birth plan found it useful and stated they would write another birth plan in a future pregnancy, although most did not believe it made any difference in the amount of control they felt during labor and many did not think enough attention had been paid to what they had written.

Birth plans do not improve outcomes. As Pennell et al, pointed out in Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans:

…Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased…

But most importantly, birth plans increase disappointment. In Is the Childbirth Experience Improved by a Birth Plan?, Lundgren et al. were surprised to find:

… A questionnaire at the end of pregnancy, followed by a birth plan, was not effective in improving women’s experiences of childbirth. In the birth plan group, women gave significantly lower scores for the relationship to the first midwife they met during delivery…

Yet in 2017, people keep studying them, apparently hoping that this time the results will be different. Afshar et al. found weren’t:

The World Health Organization, American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics have suggested that birth plans may be a vehicle for women to communicate what their preferences for childbirth are and that birth plans may be associated with improved patient safety and satisfaction. Despite these recommendations, there is little data with respect to the role of the birth plan in facilitating patient-provider communication or the efficacy of the birth plan with respect to mode of delivery.


…[D]espite receiving care consistent with their birth plan, women with birth plans described not feeling in control and were less satisfied with their birth experience than those women without birth plans.

The authors evince surprise about this results, but they shouldn’t. Having a birth plan is like having a weather plan for the day of birth. It is utterly ineffective and very likely to end in disappointment.

Birth plans reflect the fundamental fraud at the heart of natural childbirth advocacy, the insistence that a woman’s experience of childbirth is all in her head and that by planning and directing her thoughts appropriately she can have whatever experience she wants. That makes as much sense as claiming that the weather is all in one’s head and that by planning and directing your thoughts you can have whatever weather you desire.

Birth plans don’t merely fail in their stated aim, there’s no way that they could ever succeed. The key to a safe, satisfying birth experience is flexibility based on the understand that no one can control childbirth. Anything else will inevitably lead to increasing disappointment, not preventing it.

72 Responses to “Birth plans: still worse than useless”

  1. Manly Seadragon
    November 21, 2017 at 4:18 am #

    I’m usually 100% on board with Dr Tutuer but not here. I experienced sexual assault as a teenager and was very anxious about loss of privacy, dignity and unwanted ‘help’ or touching during labor and recovery. I was particularly freaked out about all the BFHI stuff like immediate skin to skin and lots of grabby midwives. With the help of a hospital social worker ( the hospital LC really didn’t get it) I managed to communicate my fears and limits through a birth plan and file notes that were shared discreetly wth all staff. I was really greatful as I ended up in theatre and no one forced me into immediate BF/skin to skin in a room with 15 medical staff. (I got my first snuggles in the privacy of my room) Even the theatre nurses were really lovely about keeping me covered up as much as possible. Birth plans can work!

    • February 25, 2018 at 2:26 pm #

      I feel like this study probably wasn’t about this kind of birth plan, which when you break it down is really about accommodating someones needs, vs their desires. I think it’s always a good idea to discuss with your doctors any other conditions (like traumatic stress) that might impact how they need to care for you. You did the right thing.

  2. Steph858
    November 14, 2017 at 12:53 pm #

    Those who advocate birth plans usually only advocate birth plans *which they agree with*. You want an unmedicated vaginal birth accompanied by whalesong? Those evil OBs better follow your birth plan to the letter! You want all the pain relief and a CS at the slightest sign of danger? Nope, not acceptable.

    I know a teen mum (she was a teen at the time; she’s knocking on 40 now) whose birth plan was ‘epidural ASAP’. The midwives pulled the ‘too early, too early, too early …. too late!’ trick. We were debating whether they were woo-type midwives and would’ve done the same to any mum or whether they wanted to ‘teach her a lesson’ for getting pregnant so young. If it were the latter: would they have denied pain relief to teach a lesson to a teen boy who broke a bone doing the kind of stupid BMX/skateboarding/parkour stunts teen boys pull?

    • Lilly de Lure
      November 16, 2017 at 5:54 am #

      I think the former, I’m married and was 40 when I gave birth and they pulled the “natural is best” trick on me too (in my case it was a c-section that they baulked at rather than pain relief which I didn’t need, it was my son who was in (as things turned out serious) trouble not me).

      I had actually previously written a birth plan (largely to shut up my midwife who kept banging on about them) and noted that I was NOT interested in natural above all else and wanted an epidural and a c-section if things started looking like they were going south (I specifically requested no forceps – if things looked bad enough to use them, just proceed straight to c-section). She looked at it with barely concealed distaste and remarked that pain relief and labour options would be determined by the doctor on call and the situation of the labour at the time and were not up to me to set in advance. So much for giving women a say in their treatment/ labour etc – it was the first of many incidents that made it clear that as far as the midwives went we were free to do exactly what they told us.

  3. Barbara Brežná
    November 13, 2017 at 4:04 pm #

    The women write birth plans not only to avoid sections, but also in the hope to have smaller or none perineal tears, to be able to brestfeed, to feel the stronger psychological attachment to the baby and to avoid the trauma of the baby. The last two psychological issues are difficult to measure, but I wonder if somebody measured the impact of birth plans on perineal tears and breastfeeding. Edit: more goals: to avoid uterine rupture (by asking to avoid Kristeller expression), to have less painful breastfeeding (it is believed the baby reflexively opens the mouth more if it searches fot the breast by itself in 2 hour window immediately after birth), to avoid child anemia by delaying the cord cutting, to avoid necessity of cleaning the uterus ( by asking the doctor not to pull the placenta forcefully out by the cord).

  4. Merrie
    November 11, 2017 at 11:17 am #

    Now that I think about it, I did have a couple of specific requests in my third birth:
    If possible, I’d like to see the placenta.
    If there’s some complication after birth that is interfering with my enjoyment of holding my baby, someone remind me that I may want to hand him off.

    The second one was based on my experience in my second birth having a retained placenta manually extracted without anesthesia. It didn’t occur to me to hand the baby off and nobody suggested it, but I might have been better able to cope with the procedure if I hadn’t been holding him.

    I told my husband and the midwife both of these things in advance. I did get to see the placenta and the midwife described all the different parts to me, and nothing happened to make the second point relevant.

    With all birth preferences, I figured they’re bracketed with a “if possible” and “unless I change my mind”.

  5. HeatheRx
    November 10, 2017 at 11:01 am #

    The nurse teaching my childbirth/infant prep class suggested picking just a couple things that were important, but to understand that things often don’t go according to plan. I picked to ambulate during labor and to do skin to skin after delivery. I changed my mind about ambulation at about 8cm and his skin to skin got delayed a bit to start his breathing as well. I honestly didn’t care that things didn’t go according to “plan” because my expectations were reasonable, and I trusted my providers to act in my best interests.

    At our hospital, all birth plans are reviewed with a nurse during the preregistration visit, so you can get an idea of how likely your requests will be in line with hospital policies. For example, my sister wanted an epidural early on, but her platelets had been running low, which was concerning the anesthesiologist. She worked with the doctors and nurses so that a CBC could be drawn as soon as she was admitted in labor to make sure her epidural wasn’t delayed.

    I think birth plans are a good thing if they are a method of communication between patients and providers and not just a list of demands. Although sometimes working with a patient on something simple (like the clothes they wear in labor), can help a patient be more flexible with something like having an IV or monitoring.

  6. MaineJen
    November 10, 2017 at 10:38 am #

    1st baby: I asked for no IV drugs and intermittent monitoring because…that’s what I was supposed to want? IDK. I ended up getting induced for SROM+no labor, so I got continuous monitoring, and by 5-6cm I was ready to try out those IV painkillers. 🙂 Got my epidural at 9 cm and it was glorious.

    2nd baby: “Low lighting, and epidural upon request. Kthankxbye!”

  7. Bugsy
    November 10, 2017 at 9:58 am #

    The best advice I ever got regarding L&D was from the nurse who worked with my OB during my first pregnancy – “go with the flow. You never know what to expect.” I ditched the idea of a birth plan, went with the flow, and ended up having exactly one goal: have a healthy child and mom.

    (If I’d had expectations, they would have been trounced on even having relatively easy, healthy births…I was sent home in the middle of active labour during my first L&D, and the second kiddo came so quickly that my epidural took effect _after_ he was born. They make for amusing stories in retrospect, without any sense of a loss of control that I never truly had.)

  8. Anna
    November 9, 2017 at 9:18 pm #

    Its almost like wanting something doesn’t always guarantee it will happen that way. You’ll never convince the NCBers though. I know a woman who just had a freebirth after two c-sections. With her first two she had GDM, high blood pressure and babies heart rates were “going funny” when she was taken off for her “unneccesary obstetric assault”. She will insist that simply choosing to opt out of the system and trust birth is what kept her baby safe this time.

  9. Amy
    November 9, 2017 at 8:56 pm #

    When I was pregnant, I was (naively) surprised by how many shocked looks I got from people when I told them I didn’t have a birth plan. My plan was: I want an epidural, but I don’t want other IV narcotics because I hate how narcotics make me feel. That’s it.

  10. rosewater1
    November 9, 2017 at 7:51 pm #

    When I worked on an L & D unit, part of my job was giving tours. When I was asked about birth plans, my response was something like, “It’s great to think about what you want and what your options are. But…” ..and then I’d point to her stomach, “…right there is your birth plan. THAT is who’s in charge.” And I believe that.

    The birth plans that I saw that worked were flexible. My favorite was a mom who said that she loved to laugh, and not to be afraid to joke around with her.

    A friend of mine had a birth plan. No drugs, water birth, etc. (She did give birth in a hospital-so there’s that.) She ended up with pit, an epi, and eventually a c/s for failure to progress. She was disappointed…until she heard her son cry. Then nothing mattered but that he was here and healthy.

  11. Dr Kitty
    November 9, 2017 at 5:38 pm #

    To be useful a birth plan has to be something your care providers are willing to actually do- whether that’s to arrange an epidural and CS on arrival or to let you labour for days on end with no monitoring.

    If they aren’t going to agree to your “plans” then birth plans aren’t worth the paper they are written on.

    Which means that a birth plan, when written as a collaborative document in discussion with your team is probably useful, but when presented as a list of demands in a hostage situation really isn’t.

  12. attitude devant
    November 9, 2017 at 3:55 pm #

    I know it wasn’t statistically significant, but I had to giggle that the c/s rate was higher in the birth plan group, because I swear to heaven that some birth plans increase your c/s risk. You people who don’t want amniotomy or oxytocin augmentation or induction of labor I’m looking at you.

    • swbarnes2
      November 9, 2017 at 4:17 pm #

      I wonder if the number of emergency C-sections differed between plan and no plan…but there probably weren’t enough subjects for that.

    • Wren
      November 10, 2017 at 2:08 am #

      I hadn’t written a detailed plan or anything, but I went into it with my first with the idea that I’d have that rosy experience and certainly not a c-section. I was so sure I didn’t even go to the c-section session in my antenatal class. Yeah, footling breech so c-section it was. I reckon it was a great first lesson in parenting. I can make all the plans I want, but if the kid doesn’t cooperate, I need a new plan.

      Ironically, I got almost what I had planned for the first birth for my second child. I went in thinking VBAC would be good as I’ll have an infant and a 20 month old to deal with in recovery, but otherwise no real plan. Got the VBAC, a fairly easy delivery, just gas and air because by the time I got there and got checked I was at 10 cm and home 12 hours after the birth. My second child fit the ncb mold far more than my first, just after I’d given up the delusion that all that mattered. She loved a sling and nursed like she had read the breastfeeding handbook before birth.

      • November 11, 2017 at 8:33 am #

        This often happens. No two births are alike but this is particularly true with the difference between first and second birth, for a number of reasons.

        I think the “birth plan” was an outgrowth of a change in nursing education in the 60s. Nursing students began making “care plans” that taught them how to organize their thinking and working methods, and “birth plans” gave pregnant women the illusion they were actually in control over what is essentially an uncontrollable process, so they felt more secure.

  13. November 9, 2017 at 3:53 pm #

    My birth plan went fine – but it consisted of “Separate my son’s life support system from mine while maintaining optimal functioning of both life-support systems.”

    I have my priorities – but other people’s priorities often confuse me.

    • Daleth
      November 9, 2017 at 4:14 pm #

      Mine too! I somehow hadn’t read up on all this woo stuff, so when the midwives asked if I had a birth plan I was like, a what? They repeated the question and I said, “That sounds like an oxymoron.” While they were laughing I thought about it and said, “My birth plan is all three of us come out alive and in good shape” (I was having twins).

      • Tigger_the_Wing
        November 10, 2017 at 3:55 pm #

        That sounds pretty much like my birth plan!

        Back in 1981, where I lived, ante-natal classes were only held a couple of times a year. Since my eldest was born the day before my first class, I had no idea what birth plans were actually supposed to be. So when the midwife, with the junior standing nervously behind her, asked me apprehensively “Do you have a birth plan?” I replied “To do whatever you tell me to do, whenever you tell me to do it.”

        Each birth was different, some more horrific than others, but the babies who made it to birth made it home with their faculties intact (mostly) and have grown into fine, intelligent and pleasant adults – and although I wish that the some of the experiences had been less traumatic, I certainly don’t have any sense of disappointment over the process.

        • November 11, 2017 at 12:03 pm #

          I do have the dubious honor of being the second generation to deliver their first child before attending a childbirth class. My twin and I were born a few hours before my mom was scheduled for her childbirth class; my son was born a few weeks before mine.

          Turns out that the high risk L&D nurses are a fine source of information in terms of what to expect from a C-section.

          Added bonus from all of the commentators here who recommended walking as soon and as often as possible afterwards. The anemia from HELLP kicked my butt – but the recovery from the C-section itself was much easier than I expected and I think a lot of it was from getting up and going for walks as soon as the nurses would let me.

      • November 11, 2017 at 11:59 am #

        I’m proud to admit that my birth plan worked as well for a emergency C-section at 26 weeks as it would have for a full-term birth.

        Because – seriously – the rest is window-dressing.

        • Daleth
          November 12, 2017 at 7:42 am #

          Whoa. I hope the baby is doing great today. That must’ve been so scary.

          • November 13, 2017 at 8:48 am #

            Spawn’s doing great.

            He was in the NICU for ~4 months and came home on a NG feeding tube and a small amount of oxygen. He was completely off the feeding tube in about three months. The oxygen took about 6 months to wean off – but I have a sneaking idea that my son was failing his overnight tests on purpose because he liked having cords and tubes to chew on.

            He had a slight fine motor delay at two months adjusted age but had caught up by 4 months. He’s been hitting all of his gross motor, speech and socio-emotional goals on time or a bit ahead. He might have a hearing loss in one ear – but we’re waiting on an audiologist consult. My deaf twin sister would be thrilled to have a hard-of-hearing nephew – but we’re trying not to get excited prematurely. 🙂

            He’s nearly a year by calendar or 8.5 months adjusted. He can sit unsupported on laps and chairs and tries to catch himself when he falls over. He’s hell-bent on learning to crawl – he’s pulling himself forward on his hands, but can’t quite get much momentum yet. He likes purees and some finger foods. He babbles and is starting to try and join conversations with my husband and I. This week he’s been attempting to join an orca pod by squealing, squeaking and screeching at the top of his lungs; he sounds like the orcas in Blackfish. He rolled away with gusto from the home health visitor yesterday after trying to hide his face on the wood floor and pulling a cloth diaper over his face.

            We’ve been so lucky – and I’m grateful everyday for the OB team and NICU staff that kept us both alive.

          • Daleth
            November 13, 2017 at 9:35 am #

            Oh fantastic. Yay. Congrats.

          • guest
            November 13, 2017 at 10:00 am #

            LOL the orcas. My husband and I always joked that my son was trying to call his alien people to come save him. He’d stare at the ceiling and carry on with all his noises for a good 10 minutes at a time.

    • Empress of the Iguana People
      November 9, 2017 at 5:55 pm #

      I joked that I was going to make one on a post-it note, reading “No damn mirrors”

    • KQ Not Signed In
      November 10, 2017 at 1:05 pm #

      That sounds like a birth plan on Vulcan.

  14. Katie Bauckman
    November 9, 2017 at 3:30 pm #

    I think birth plans have a place, but I think Dr. Tuteur nailed it with the weather comparison. You can’t control the weather – but you can have certain preferences within the context of the weather: I prefer tank tops in the sun, but maybe someone else prefers sleeves to keep from burning. You’re ok going out in the rain, but that’s my excuse to stay inside and do nothing, etc. I think thinking about the different avenues ahead of time is helpful, as is keeping your partner and medical team apprised of how you prefer things in a more general sense.

  15. KQ Not Signed In
    November 9, 2017 at 2:32 pm #

    I was punished by a nurse at my hospital for my birth plan.

    True story. I had a birth plan – a joke birth plan – that specifically included things like “unicorn tears” and “liquid goddess energy” and stuff like that. Satire. The OB thought it was hysterical. But my labor nurse kept refusing me pain relief and trying to get me to do things like use the birth ball or the shower. She kept saying very sarcastically, “But I thought you WANTED to try alternative pain relief”

    Same nurse inserted the catheter just before I got my epidural. She was so rough that she caused a lot of pain in my urethra and bladder. I actually felt every contraction – excruciatingly – in my bladder. She also continued to be nasty and make snide comments. She also instructed me that I was NOT allowed to push the self-medicate “boost” button unless I called her first every time. And then didn’t respond to my calls.

    • MaineJen
      November 9, 2017 at 2:54 pm #

      She put your cath in *before* your epidural?? :0

      • KQ Not Signed In
        November 9, 2017 at 3:08 pm #

        Memory says so, but admittedly maybe it was after? Memory is a little fuzzy. Except for the absolutely agonizing pain in my bladder. I still feel nauseous and slightly panicky if my bladder gets too full. Every contraction felt like it was about to burst – that terrible desperate feeling that you can’t hold it for another second (but I wasn’t holding anything at all since, you know, catheter).

        • MaineJen
          November 9, 2017 at 3:55 pm #

          Man…I thought pooping on the table was rough.

      • November 9, 2017 at 3:49 pm #

        That sounds rough. I had a cath placed before my CS but I wasn’t in labor at all yet. My son preceded to find the catheter and begin to kick or punch it every 30 seconds or so for the next few hours. (I got bumped back in line since two high risk women got sicker than me; I was totally fine with that since it increased Spawn’s exposure time to prenatal steroids – until he started kicking the catheter. Afterwards, my mom asked me if I remembered referring to my darling, unborn son as “that little fucker”. I looked at her and said “Yes. And he was.”)

  16. PickAUserNameForDisqus
    November 9, 2017 at 1:43 pm #

    I wholeheartedly agree that rigid thinking (aka birth plans) most often leads to disappointment, shame, and guilt. I however, really love the idea of a practical postpartum plan. Unless something terrible has happened to mother and/or baby during labor and delivery, mom and family do have some control over choices and plans postpartum. I like this ‘Realistic Postpartum Plan” document.

  17. MI Dawn
    November 9, 2017 at 1:20 pm #

    I actually liked birth plans when I was practicing. They gave me a way to discuss things with the patient, and identify unrealistic measures.

    (Note this was 20 years ago):

    No, you don’t have to have an IV but we will probably place a heplock for emergency access.

    Yes, you can ambulate/shower/dance around the room provided the fetus is tolerating labor well.

    No, I won’t promise you will not ever be monitored internally, no drugs, no c/section, no pelvic exams.

    No, I won’t promise the baby won’t get any bottles. If they are hypoglycemic, they will get sugar water/formula until they are stable.

    No, I won’t promise the baby will never leave your sight. If everything goes well and normally, he/she won’t have to. But I can’t promise everything will go perfectly.

    We pissed off a lot of women that way. Those who stayed with the practice usually thanked us for being practical. Those who left and didn’t get their birthplans followed to the letter were usually miserable.

  18. hikerrd
    November 9, 2017 at 1:18 pm #

    I wonder whether those who feel compelled to try to control the outcome (by creating a birth plan) are self selected by personality type as people who would be more likely disappointed with outcomes period.

    • Petticoat Philosopher
      November 9, 2017 at 1:53 pm #

      That honestly seems most likely to me. Maybe not personality types but it certainly seems that women who want birth plans are more likely to have rosy, idealistic views of how birth goes in reality, which means that they’re more likely to be disappointed. Higher and more specific expectations means a greater likelihood of a let-down.

    • Casual Verbosity
      November 9, 2017 at 3:27 pm #

      If I had to conduct research to investigate this, I would start with beliefs about control and what it means to lack control.

      • Roadstergal
        November 9, 2017 at 3:30 pm #

        I mean – the maximum _actual_ control during childbirth is a pre-labor CS, no?

        • Daleth
          November 9, 2017 at 4:17 pm #

          Exactly. Which is probably why that’s what I chose (and had to fight my doctors for!).

          A fellow IVF patient put it best: she said that after going through so much difficulty and grief just getting and staying pregnant in the first place, she wanted “a police escort” through that final phase–hence, a prelabor c-section.

          • Bugsy
            November 10, 2017 at 10:28 am #

            I felt exactly the same way (and am also an IVF mom) – after fighting so hard just to create my kids, I wanted full medical support to ensure that their arrival into the world was as safe as possible.

    • Life Tip
      November 9, 2017 at 3:31 pm #

      Maybe not personality type necessarily, but most women I know who talked about their birth plan were also spending a lot of time on pregnancy/birth message boards/Facebook groups and reading a lot of natural birth blogs. So, basically they were getting a lot of bad information and setting themselves up for disappointment. Also, they were surrounding themselves (at least online) with other women who will tell them their experience was wrong or deserving of disappointment if it goes against their narrative. No surprise that they are likely to end up disappointed and dwell on that disappointment for a longer period of time because they are re-living it and having their negative feelings validated constantly.

    • mostlyclueless
      November 9, 2017 at 4:03 pm #

      [raises hand]

      Guilty. I had a really hard time dealing with my c-sections because I am a control freak and really believed I could have a vaginal delivery if I just tried hard enough.

    • Merrie
      November 9, 2017 at 9:17 pm #

      Yes, exactly. These women self-selected for birth plan or no birth plan. I’d also be really curious to know what the birth plans tended to consist of. I could see birth plans being a tool to increase birth satisfaction if they are discussed and vetted with the provider ahead of time and used for the patient and provider to get more on the same page. But if the mom just shows up with an unrealistic plan and has it go sideways, of course she’s more likely to end up disappointed.

      I like to think through a situation in advance and what I might do under different circumstances. If I hadn’t learned about birth in advance I would have been more stressed out, not less. Of course, I am not an expert by any stretch of the imagination, but I read enough about birth going in to have some idea of how things typically progress, what are common things that might happen and how they might be handled. I was not too surprised by most of what happened in my births; I did get a few curveballs but I think I would have been more stressed out if I hadn’t read up on it.

      The birth I was most dissatisfied with was my third one, actually, and it was because by then I’d deconverted from the woo and I totally psyched myself out about getting or not getting an epidural. I found myself unable to make a decision and scared of the pain, even though I’d handled it fine in my previous births. In hindsight I would have done better if I’d planned a little better and been able to say to myself either that I would go for the epidural if possible, or that I would try to stick it out if possible, particularly as I wasn’t expecting the birth to be all that long (and it wasn’t). I think having thought that one through better would have helped ME. I am not a seat of my pants person. Others may vary.

      I still remember a friend posting a thread about planning for her birth on Facebook and one of her friends commented with something like “Don’t worry about it, just go to the hospital, get the epidural, and push when they say to push”. That sounds to me like someone who is happy to not plan.

  19. Heidi
    November 9, 2017 at 12:26 pm #

    I don’t even really go in with a plan when I get my hair colored and cut. Of course, I have input and do have the final say, but I figure someone that’s not me, and actually has in-depth training and experience with hair stuff, might actually be able to see better what works the best for my face shape, natural color, and texture. But worst case outcome there if I choose what I want regardless, I spent a lot of money to have ugly, unflattering hair. So no, I really had no plan in regards to my birth except, “Epidural, please!” That didn’t even go quite as planned since I went into active, it’s time to push labor so quickly, but it did work before I had him. I’m grateful of that!

  20. kilda
    November 9, 2017 at 11:24 am #

    I think I’m going to make a parenting plan. I would like my child to have no serious illnesses or disabilities. There will be no significant marital or financial stressors on our family during the early years. We will have a 3 bedroom house, and the child will be good at math, and either sports or art.

    what, that isn’t how this works?

    • Roadstergal
      November 9, 2017 at 11:57 am #

      You _really_ need to make a teenagehood parenting plan. You would like to avoid all automobile accidents and drug/alcohol use, and your preference is for straight As in all subjects. If that is not possible, just straight As in STEM.

      • kilda
        November 9, 2017 at 12:00 pm #

        oh right, I forgot! As a teen my child will only be attracted to nice, well behaved boys, and will be an excellent driver.

        • Dr Kitty
          November 9, 2017 at 5:32 pm #

          Oh goodness, my parenting plan for teenagers is:
          No one totals a car
          No one has a baby
          No one has a substance abuse problem
          No one has a criminal record
          No one is a viral internet sensation
          All the wine for me

          I may be parenting wrong.

          • Wren
            November 10, 2017 at 1:57 am #

            You’re parenting right Dr Kitty.

            My eldest turns 12 tomorrow. One last year before I have a teenager.

          • FallsAngel
            November 10, 2017 at 9:31 am #

            For both of you-never say never! Most moms of grown kids agree!

          • Tigger_the_Wing
            November 11, 2017 at 8:48 am #

            I heartily agree. What teens get up to doesn’t necessarily have any bearing on how wonderful they are when they grow up.

          • StephanieJR
            November 11, 2017 at 10:20 am #

            Every teen seems to go through an ‘embarrassing asshole’ phase. Most grow out of it. I cringe remembering mine.

          • Tigger_the_Wing
            November 11, 2017 at 8:47 am #

            I’m glad I like teenagers.

            Since my eldest turned 13 in 1994, I have had precisely 21 months – between my daughter turning 20 and the twins turning 13 (2004/2006) – when I wasn’t living in a house with at least one teenager. I have another four years to go before I get another break, this time 25 months between the sixteen-year-old grandson turning 20 and his younger brother turning 13. That last one turns 20 in 2030.

            That’s a total of roughly 32 years living with teens. Damn. That does sound a lot when I add it all up!

          • FallsAngel
            November 11, 2017 at 9:33 am #

            That’s a lot of teen time! I agree, teens are cool, in their own way.

      • Sarah
        November 9, 2017 at 1:37 pm #

        I’ve got a teenagehood plan, which involves heavy gin consumption.

        • Empliau
          November 9, 2017 at 2:12 pm #

          Dave Barry has a great line about discussing your future teenager with friends: “Wait till he gets his driver’s license. That’s when Bob and I started using heroin.”

          • Sarah
            November 9, 2017 at 2:38 pm #


        • KQ Not Signed In
          November 9, 2017 at 2:35 pm #

          You spelled Vodka wrong.

        • kilda
          November 9, 2017 at 4:16 pm #

          hopefully by you, and not the teenager.

          • Sarah
            November 10, 2017 at 3:55 am #

            Tbh I drank quite frequently as a teenager and I like to think I turned out ok. Wouldn’t waste good gin on an adolescent though. Shitty alcopops all the way.

          • Roadstergal
            November 10, 2017 at 11:46 am #

            I love a good gin and tonic. On the rocks, twist of lime.

        • PeggySue
          November 9, 2017 at 6:41 pm #

          I met a lovely gentleman who said he thought he had done well as a parent, since “I never had to go bail any of my kids out of jail.”

  21. Roadstergal
    November 9, 2017 at 11:23 am #

    OK, looking at this data – someone needs to do a case-control study with epidural analgesia being the only variable tested. I want to know if effective pain relief alone improves satisfaction and control. (In aggregate, of course, I know there are individual outliers.)

  22. BeatriceC
    November 9, 2017 at 11:14 am #

    If birth plans included things like “please keep all visitors except Joe Smith and Jane Brown out until X time after birth unless requested otherwise.”, or “In the event I am unable to relay my own wishes, I’d like Mark Jones to accompany baby until I am able to make decisions again.” or things of that nature, they’d be pretty useful. But they don’t include that kind of information. They include all sorts of stuff that can’t really be dictated ahead of time, and set women up for disappointment when things don’t happen the way the fairy tale was supposed to happen.

    • Kerlyssa
      November 9, 2017 at 12:52 pm #

      yes, this. making plans for any medical treatment is totally reasonable, but it has to be within the scope of reality.

    • maidmarian555
      November 9, 2017 at 2:30 pm #

      I think I’ve mentioned this before but the NHS one I had for my son included giving permission for the vitamin K shot- which meant they knew I was onboard with that and wouldn’t have needed to wait for my permission if I hadn’t been able to give it immediately after birth. I thought that was pretty much the only useful thing in that document.

    • swbarnes2
      November 9, 2017 at 4:28 pm #

      There are a few, trivial things, you could put down…”Dad wants to cut the cord”, and “please clean the baby before giving him/her to us”.

      I could also see room for things like “I want 4 more kids/I get panicky about surgery, so let’s keep at it with vaginal delivery unless you are sure we need a C-section” versus “I am risk averse, I don’t want an emergency C-section, if you think things aren’t moving along well, let’s do a C-section sooner, instead of hoping things change”

  23. Namaste
    November 9, 2017 at 11:07 am #

    Every time I read one of those stupid plans I think “Bless your heart, you actually think you get to control how this goes down.” If there’s ever a time to throw any and all plans straight out the window and into the compost heap, childbirth is it.

    • Tigger_the_Wing
      November 11, 2017 at 8:57 am #

      I think that vaccines are to blame. And antibiotics, of course.

      …No, I haven’t lost my marbles; most people now grow up never having encountered a serious illness in themselves or anyone close to them. They’ve never suffered as their bodies go entirely beyond their control. They simply have nothing with which to compare childbirth, so of course they think that they can plan it.

  24. CSN0116
    November 9, 2017 at 10:48 am #

    You mean trying to control something that is uncontrollable can leave one feeling less in control?

    Whoda’ thunk…

    Birth plans are just the first rite of passage for privileged women to practice their to-be obsessive compulsive, moralized, martyr-ridden from of mothering.

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