A midwife said to me recently that often women today have “no idea about labour.” She said they often have no idea how painful labour contractions will be and have almost romantic ideas about what will happen.

The attitude of some women is comparable to their attitude when planning their wedding. They have an expectation of how it will go when they are in labour. I suspect often their views are formed from incorrect ideas they learn on social media.

Consistent with this is when a pregnant woman arriving at the hospital in labour presents to the midwife a lengthy birth plan, with instructions on their expectations and their management. Such a birth plan is comparable to the plan that would have been given to the wedding organiser when planning her wedding. But in contrast to a wedding what will happen in their labour and with childbirth is totally unpredictable, and so a strict birth plan is totally unrealistic and sets an expectant woman up for disappointment.

Midwives and I agree that they have never seen a birth plan that works. That is because it has been prepared by someone who has no knowledge of what can happen in labour or childbirth, or with information from mothers or friends who may have an anti-doctor bias, or only their own experience to go by.

Some of these women with unfulfilled birth plans, to save face, will say medical intervention that was needed in their labour or with childbirth was done unnecessarily. They can tell their friends the midwife or the doctor insisted when something happened that was not in their list. They do not want to accept that their medical management was what was appropriate because of adverse developments in labour and with childbirth and that an intervention was done to safeguard their and their baby’s wellbeing.

I remember a couple who were arguing about an epidural. She realised when she was in labour how painful labour contractions were and so requested an epidural. Her husband said: “No. We agreed in preparing our birth plan – no epidural.” There was another woman who decided “No episiotomy.” She was being delivered by a colleague who was nervous about a nasty perineal tear happening without an episiotomy being done to prevent it.  He tried to encourage her to have an episiotomy to minimise this risk. But she insisted. She had no episiotomy, and she had a bad 3rd degree tear.

As well social media and friends can cause them to have unnecessary anxiety. Social media can result in considerable management challenges. One example, it is not unusual for a woman to say she does not want an epidural because she has read it is dangerous. Yes, there is potential danger with inserting an epidural. But when an epidural done by an experienced fully trained anaesthetist the likelihood of an adverse development is minimal. I have managed thousands of women who have had epidurals in labour, and I have never had a patient who has had a long-term problem because of the epidural.

Obviously, every woman wishes is for a quick labour, without much pain and a normal delivery without any tearing. That is my goal also. But there is no guarantee.

While it is good to have an idea of what you want in labour, be open minded with the awareness that developments in labour may be such that what you hope for does not happen. It is important to talk about your wishes at an antenatal visit. Some requests are easy to agree to. For example, some women want an elective Caesarean section, some want an early epidural, some do not want to go overdue and so want an induction of labour.

Gain information from credible sources, not from friends and social media.

My advice. Because labour and childbirth developments are totally unpredictable have an open mind. If you are finding the labour contractions too painful have an epidural. If certain management is needed because of adverse developments then trust and agree. The primary consideration is a healthy outcome for mother and baby.

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