Getting past unrealistic expectations

"I remember the episode of Friends when Rachel gave birth in a normal-looking room with perfect makeup and not a hair out of place," says M. Kelly Shanahan, M.D., chair of ob-gyn at Barton Memorial Hospital in South Lake Tahoe, California. Even if you're a devotee of documentary-style shows like A Baby Story, chances are you're still not thinking your own birth could be so long or painful or downright gross. But as Dr. Shanahan puts it, "Real delivery is hot, sweaty, and bloody."

The shock of that reality may be why only 16 percent of women said their delivery was the way they'd dreamed it would be. The numbers of dream-come-true births among second- and third-time moms were higher but hardly through the roof: Just 23 percent of veteran mothers said they experienced perfection. Regardless of how many babies you've had, you never expect to be the one who dilates only three centimeters despite ten hours of rock-solid contractions. You never expect to hear that the baby's heart rate is dropping, and you need surgery now.

And yet, complications like those happen all the time. In fact, 84 percent of moms said that they had a surprise during the process of giving birth  -- and that rate was the same whether the women had a doctor, a midwife, and/or a doula. Tiffany Polley had two surprises during her labor: "I expected to push my daughter out by myself," says Polley, 30, who lives in Hebron, Kentucky. "But after three hours, they broke out the forceps and pulled her out. I also thought the birth would be an intimate family moment. Instead, there were 15 people in the room standing by in case I needed a c-section."

Given the disconnect between the dream and the delivery, it's no wonder that a quarter of women experienced at least some disappointment with their birth. First-time moms were significantly more likely to feel some dissatisfaction compared with second-timers, but it was the women who had cesarean sections who were the most apt to say they felt disappointed. "I didn't get to experience one ounce of labor," says Rebecca Cahill, 32, of Alpharetta, Georgia. "I felt like I missed out on an important rite of passage to motherhood."

Despite the odds, which are nearly one in three, most women just don't think they'll need a c-section, especially if their pregnancy is healthy and normal. "I tuned out that portion of the childbirth class I took," says Cahill. Like many women, she had every reason to expect a routine birth. But that's exactly why it can be so shocking and upsetting when a complication does arise. Suddenly your supposed-to-be-perfect day is wrought with chaos, anxiety, or worse.

"It's wonderful to dream the perfect birth," says certified nurse-midwife Jerri Hobdy, former program director of the Midwifery Institute at Philadelphia University, "but you're going to have the birth you have."

That may be all well and good in theory, but most women still try to do everything they can to orchestrate the big day. In fact, more than 70 percent of moms said they had a birth plan, either written down or discussed with their practitioner. After all, having a plan for labor is what everyone  -- including this magazine!  -- has been advising women to do for years.

So we'll be the first to admit it: Maybe we've been wrong all this time. Most of the women who were disappointed with their birth experience  -- three out of four, to be exact  -- had shared their preferences in one way or another. And with that, we can't help but ask: Should women bother with birth plans at all?

Many doctors say no. "Committing your wishes to writing actually increases the likelihood that you'll be disappointed if the birth doesn't go as planned," contends Randy Fink, M.D., an ob-gyn in private practice in Miami, Florida. "Couples who have 'made a plan' about how they intend their labor to proceed can be frustrated when, for safety reasons, things don't go their way."

But that's not to say you shouldn't educate yourself. "Would you ever go into anything important in your life without some preparation?" asks Michelle Collins, a certified nurse-midwife and instructor at the Vanderbilt School of Nursing in Nashville. So perhaps the most surefire approach to getting the birth you want is simply to be open-minded. More than 60 percent of those who were very satisfied with their births said they didn't care what happened during labor as long as the babe was okay. "I prepared a birth plan but was flexible with it for the health and safety of my child and me," says Dusty Hepler, 27, from Sarasota, Florida. "I wanted to go as drug-free as possible, but in the end it was the epidural that allowed me to relax enough to be fully dilated in only a couple of hours. Giving birth was a cinch after that!"

Jaime Martietion, 28, didn't commit her wishes to paper. "I never imagined that I'd have a c-section, but it was great nonetheless," says Martietion, who lives in Rockville Centre, New York. "My son was born perfect and beautiful! Sure, the recovery was painful and longer, but I was dealt a different hand and worked with that."

The bottom line: Making a birth plan is a good way to inform yourself about labor and to ensure that you and your provider are on the same page. But be prepared to fling it  -- and wing it  -- with the first contraction.