Establishing Healthy Expectations for Birth

Many first-time mothers aspire to have a non-medicated birth, i.e., a natural birth. This is a wonderful goal, but it’s important to understand that birth doesn’t always unfold as expected. The reality is that while many mothers are able to cope without medicated pain relief, over 60% of women birthing vaginally get an epidural.

When childbirth doesn’t go as planned or goals are not met, this does not equate to failure in any way. However, having a labor and birth experience that doesn’t match expectations can be difficult for new mothers to process.

A new study out of Australia, published in BMC Pregnancy and Childbirth, found that it’s common for women to experience a “mismatch” between their expectations about childbirth and what actually happens during their births. When this happens, many women experience a kind of dissonance—or inner conflict and turmoil—which the study researchers call “birth dissonance.”

“We suggest that birth dissonance arises when women experience a fundamental disparity between what they had expected of birth and their body, and what actually occurs,” the study researchers explain. This can result in a kind of birth trauma, where mothers may feel disempowered and distressed. Some even begin to develop symptoms of post-traumatic stress disorder (PTSD) related to their experience of birth dissonance, according to the study researchers.

Areas that contribute to dissonance and subsequent trauma

Birth dissonance is primarily caused by a disconnect between expectations of what birth will be like and what actually happens, but various factors can add to the sense of dissonance and disempowerment. Some likely causes of birth dissonance include:

• A lack of preparation or understanding of what the experience of childbirth may be like.
• Outside pressure or expectations about what it means to have a “good” birth; this may include perceived social pressures to birth a certain way, such as without pain medication.
• Feeling that you weren’t given proper attention and care during childbirth, such as having requests for pain medications ignored or feeling pressured to use pain medication without being given other options or support.

How to avoid birth dissonance

Here’s the good news: birth dissonance can be avoided—or at least reduced—with some simple adjustments. The study researchers outline four main ways to avoid birth dissonance.

1. Better pre-birth education about pain in labor

The authors advocate for mothers to get a fuller and more realistic picture of what pain during labor might be like. The reality of labor pain shouldn’t be sugar coated, nor should it be presented as impossible to cope with it. This education should emphasize that all mothers experience pain differently, all births are different, and all women cope differently with pain.

2. Better education about pain relief options

A less biased way of presenting pain relief options during labor can help with birth dissonance, the study authors contend. This should include detailed information about medicated pain relief during labor, including risks/benefits, different types, and various uses. It should also include a comprehensive guide to non-medical forms of pain relief.

3. More equitable decision-making during labor

Health care providers need to listen more intently to women during labor, the study researchers contend. Whenever possible, they should leave their biases about pain relief during labor out of the decision about whether or not to give a mother pain medication.

4. Prompt delivery of pain relief

Finally, the study researchers advocate strongly for women to be given pain relief when they ask for it during labor. This should happen at the time these mothers ask for the pain relief, without complicated negotiations or delays.

Bottom Line

Having a positive childbirth experience isn’t just about a healthy mom and baby at the end, nor is it about whether or not pain medication is used. Women remember how they were treated, if they were heard, and if they were respected during birth. This is such an important—and often neglected—aspect of childbirth. If an expectant mother is encouraged to focus her birth expectations on this area (being respected, heard and treated well), rather than the use or absence of medication, she can have a positive experience no matter how the specific details unfold.

Our book, Birth Choices, emphasizes the importance of mothers having an affirming, empowering childbirth experience above all else. Our four steps to achieving this are:

1. Understand the context
2. Know your options and preferences
3. Take action
4. Communicate

Birth Choices provides educators and health care professionals an excellent tool to serve as a “starter guide” for expectant parents and set mothers up for success in achieving a healthy and positive birth. Preorder our new second edition Birth Choices book coming this spring!

Wendy Wisner, Freelance Writer and Lactation Consultant (IBCLC)

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