Labor Often Doesn't Go as Planned

The drug-free, pain -free delivery that many expectant mothers dream of is more myth than reality, and a large number of women end up disappointed when childbirth doesn't go as planned, a new research review shows.

The studies included in the review showed that for a large number of women, expectations about pain and pain relief were often very different from experiences.

Women tended to underestimate the intensity of the pain they ended up having when questioned prior to delivery.

In one study, more than half of the women interviewed who said they would not use drugs for pain relief during labor ended up doing so, says researcher Joanne Lally of Newcastle University.

The review is published in the latest online issue of the journal BMC Medicine.

"We found a definite gap between what women expected and what they were prepared for and what they actually experienced," she tells WebMD.

Expectations and Experiences

While pregnant women increasingly expect, and are expected, to participate in decisions about childbirth, many are not being given the information they need to be prepared for any contingency, Lally says.

"Ideally, obstetricians and midwives should listen to women's hopes for delivery and support them in those hopes," she says. "But they also need to give them all the options in case things don't go as planned."

She points out that a woman who plans to have an epidural for pain may still benefit from knowing about breathing and relaxation techniques that can help her early in labor.

Likewise, a woman planning a drug-free childbirth needs to know about her drug options in case she changes her mind.

Most women who end up disappointed with the birth process aren't upset because things didn't go as planned, but because they felt like they lost control of the decision-making process, Lally says.

"Women who have all the information they need before the birth end up have a better sense of control when things do go as expected," she says.

One Mom's Story

Caroline Harris of Nashville, Tenn., agrees that women need to know about all their childbirth options, even if they think they know what they want.

Harris had a written birth plan when she gave birth to her son Jack eight years ago. Although she had the drug-free delivery she planned for, she ended up having an episiotomy she did not want and still thinks she didn't need.

"My doctor was telling me about all these bad things that might happen if I didn't have one, and I was in no shape to argue," she says.

Now a nurse practitioner, she is due to deliver her second child in three weeks and is once again planning a drug-free delivery.

But says she won't feel like a failure if the plan changes.

"My midwife knows my intentions, and she knows that I have the information I need to do something different if the unexpected happens."

By Salynn Boyles
Reviewed by Louise Chang
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