ST. LOUIS, MO – A new study just published in the latest Obstetrics and Gynecology Journal demonstrated that the longer a woman’s birth plan was, the greater the likelihood of her going for a Cesarean section (C-section).  Not only were C-section rates higher, but the C-section scars increased substantially with longer birth plans (specifically detailed instructions that dictate medical-decision making without a four-year medical degree and without another 4 years of residency training).

“I better cut down on the birth plan length”

When the authors compared C-section rates between St. Louis Woman’s Hospital (SLWH) (34%) and Hope Mercy (14%)  they noticed that SLWH had birth plans that were approximately 10-times longer, a recipe for disaster. “According to the study, detailed and lengthy birth plans lead to a higher chance for Cesarian sections,” said Dr. Tiffany Rubinski, an OB/GYN at SLWH.

“Women with lengthy and extravagant birth plans were more likely to need emergent Cesarean deliveries, possibly due to alternative therapies that push current medical guidelines for safety.  Most emergency C-sections result in bigger incisions due to the urgency of the situation.”

The study recommended if you do decide to write a birth plan, keep it simple.  Authors concluded a birth plan of one page or less seemed to be okay, but beyond that the odds of unplanned C-section dramatically increase 10-fold for every extra page.

In response to the new study, the American College of Obstetricians and Gynecologists (ACOG) developed a sample birth plan, printed below:

  • Deliver baby vaginally
  • Epidural for pain control if pain too bad
  • Be flexible if issues develop
  • Listen to OB/GYNs and labor nurses for recommendations

“In fact, if you come to the hospital with a long intricate birth plan, the safest thing you can do for you and your baby is to throw it in the trash can on the way in,” Dr. Rubinski advised.

Authors of the study also observed a 250% increase in labor deck fires with patients who light five or more candles in the room.  Although patients that had doulas in the room did not lead to an increased C-section rate, snide comments and eye rolls were very prevalent at the nurses station.

Probably just a coincidental finding, the study also mentioned that listening to Nickelback in the labor rooms led to an increased risk of Cesarean delivery.  Causation could not be proven linking the two, but on account of thousands of labor room nurses and OB/GYNs, the authors recommend against playing Nickelback songs for a more pleasant experience for everyone.



  • Show Comments

  • Lindsay T

    Well, that’s lovely for the people who can birth their children without intervention. However, with my first I was quite toxic, had been in labour for 2 days and ended up with a C-section (saved HIS life and mine) The second time around I had HELLP syndrome, which is a shut down of some very major systems in your body. Now, had I not had health care intervention (WAY above and beyond good hygiene and nutrition, I might add) I wouldn’t have survived that birth to begin with, let alone the second. If not for the Dr.’s and nurses who cared for me I wouldn’t be here today. Now, yes, it was scary being strapped naked to an operating table when you pictured 2 days ago that by now you’d be holding a baby. But are you having a baby to have a delivery story? or are you having a baby to build your family? There are many possibilities now for women to have their children at home, and if you feel safe doing such, a person should. But don’t attack a Dr. and countless nurses whose ONLY goal is to have you deliver a safe, healthy baby and call them rapists. The fact is many women and children died in childbirth, not JUST because of hygiene and nutrition, but because there are actual medical emergencies going on. Yes we’re built to have babies, some better than others, but that does not make it simple, easy or without risk. I’d rather feel embarrassed for a few hours about people seeing my naked body, a line of people getting prepped to help me; than to have a Dr take my hand and tell me he’s sorry my baby died because there was no intervention available that he was allowed to perform.

  • John

    Women like you are the reason I avoided OB/GYN like the plague. Physicians fight hard for their patients every day. For what- to be accused of rape? If you feel that strongly, take your chances and pop that child out at home. Good luck, lord knows you don’t want some obstetrician and neonatologist using every ounce of their knowledge keeping your child alive. You can always have another.

    Sadly, the average patient has no idea what went into their visit. The family of the physician sure as hell knows whats involved.

  • phippsju

    I’m going to assume that none of yours were performed until you were properly administered medication that numbs sensation. I, on the other hand, was not so lucky. An impatient anesthetist and/or obstetrician made for an experience I will remember until the day I die. Thank god they had the where-with-all to have the equipment necessary to sedate me completely nearby, because I felt every few inches of cutting before my lights went out.

  • Rachel Self

    Seriously? It”s not her doctor’s decision, OR YOURS, how many children she should have.

    Why is it that “my body, my choice” never seems to apply to anything but preventing or ending pregnancy these days???

  • Caroline

    You have clearly never been raped. You also lack a sense of humour, but that’s by the by. Since the beginning of humanity women have died in droves, indeed, in some parts of the world they routinely do, either during or shortly after birth. They would give anything to have the obstetric rapists you mention to help them through. The solution to your own concerns around birth is quite simple; go somewhere like… say… Monrovia and give birth there. It will absolutely be natural, no interventions at all.

  • Caroline

    I think the OB’s and midwives etcetera are more concerned with medical necessities and not hugely interested in how special a snowflake each of us is. Of course, unnecessary interventions are a reality, but surely years of objective experience trump ”trusting my body”, because if it all goes horribly and tragically wrong, guess who gets sued?

  • amyj156

    I tried to have a sense of humor about this realizing it was satire, however the title alone made me feel punched in the gut. It’s offensive and incredibly disrespectful of women who attempt to educate themselves about childbirth so they can work WITH the process for a healthier outcome. I’m so sorry it’s such a pain for some drs / nurses to have patients who are proactive about their health. No one wants to be told how to do their jobs, but if women are making requests that are educated, reasonable, non-intrusive, and healthful for both them and baby, why is it so hard to be respectful of that? Fortunately, I had an incredible team of nurse midwives who took one look at my plan and said “this is no problem – it’s pretty typical for us!” I’m not saying everyone in obs shares the condescending tone of this post, and maybe it’s just not an issue for some until they have had an experience in childbirth in which they were disrespected and / or injured.I can’t help but wonder how many women would have better outcomes if they took the time to educate and prepare themselves (mentally, physically, emotionally) on one of the most significant physical undertakings they’ll experience in their lives.

  • Lisa

    I’m sure my last 2 beautiful children would disagree! I trust in God….I don’t think He read the “research” either.

  • Kelly Voros

    Wow….5 caesareans! That is extremely risky. Your doctor should have told you to stop having children after 3. It is not safe, and the medical literature shows a substantial increased risk to mother and child with each subsequent surgical delivery. I am sorry you were so ill informed regarding your own body. Shame you didn’t bother to do the research yourself….

  • redthistle

    What is OK and works for you may not work for everyone. Pretty rude to tell people to shut up.

  • Lisa

    5 successful c-sections and I can just say…shut up!! Just go to the hospital and let the good people help you have a healthy baby. Geez. It’s not that hard.

  • Young CC Prof

    Yes, it is important for mothers and medical professionals to communicate during labor. Yes, labor is an intense experience, and can be traumatizing if it goes badly. But realize something: The doctor can be scared, too.

    When a mother walks into the hospital with a long and detailed birth plan that basically amounts to “no interventions” the obstetrician is scared. She might look angry, but fear is a big part of what’s going through her mind. Fear that, if something goes wrong and interventions are needed, the mother might not believe it, or might delay until a treatable problem turns into a dire emergency. They’ve seen bad things happen. They might not happen often, but if you’re a doctor who delivers hundreds of babies a year, you see disaster several times in your career, and one dead or seriously injured baby is a sight that can haunt a doctor for life and come back in memory every time a similar situation appears.

    When doctor and patient start out on the same side, communication is clearer, everyone can be polite, and emergencies can often be prevented. When the relationship is adversarial from the start, it’s tougher.

    Sometimes, yes, doctors are rude, impatient, or mistaken. Everyone is sometimes ride, impatient or mistaken, including you and I. I hope when I give offense, my friends, family and professional contacts will take the extra step to keep the relationship positive, rather than giving up on me.

    Also, it can help to discuss labor with your doctor well before it happens. Find out if there are any standard procedures like monitoring, what interventions might be needed, and why they might be needed.

  • Carmel O’Dwyer

    Yes, that is the knowledge I like to rely on now and have relied on for my last two births, which were not only physically healthier but also mentally and emotionally healthier for myself and my babies than my previous highly medicalised birth.. I don’t know where you got those figures from but they are incorrect for low risk healthy women living in hygienic environments in the twenty first century. The high rates of neonatal and maternal mortality in the past were due to poor hygiene, poor nutrition, lack of skilled birth attendants and misinformation.

  • AB

    You refer to “since-the-beginning-of-humanity years old instinctive birthing knowledge”… Of course humans have been successfully reproducing for the entirety of our existence, but is this the knowledge you’d like to rely on for your own child, which resulted in > 30% infant and neonatal mortality just within the past century?

  • Liz Kelly

    Obstetric violence or assault, whether verbal, physical, mental or emotional, whether by
    the inappropriate and unnecessary use of intervention, many of which have
    been shown to be detrimental when not medically indicated, – interventions which are often made by coercion or intimidation without proper consultation or consent,- whether by the withholding of appropriate pain relief, or by the refusal to listen to a woman who may be aware that things are not as they should be, are a far far different matter to the
    appropriate use of life saving interventions when needed and which so many mothers, babies, and their families have reason to be grateful for, and to the professionals who perform them and strive so hard for a good outcome for mothers and babies in emergency and high risk situations. This is not dispute.

    There are very many professionals who treat women with such respect, kindness and dignity in spite of all the stress and challenges they encounter and are aware of the importance and the impact of their actions in supporting a woman at this time. They strive to support, protect and ensure that even in the case of complications or circumstances which require further intervention, that these are carried out in such a manner, with consultation and explanation, allowing her to make informed decisions and thus ensure the best outcome, ensuring that her mental and emotional health are not compromised and enabling her to cope with confidence with whatever arises and the early days of bonding and parenting.

    It has been shown in several studies, (most notably Ford & Ayers 2009) that it is not the nature of the intervention or stressful event that is the cause of trauma, but the support (or lack of it) given by hospital staff, and that this is significant. The conclusion of this study states: [that the] ‘Level of support from hospital staff during birth has a greater effect on women’s emotional reactions than stressful events. Supportive care during birth increases perceived control and reduces anxiety and negative mood.’

    There is absolutely no justification for any type of aggressive or bullying behaviour towards a woman in labour and childbirth by claiming it is in the interests of the mother and baby, and anybody who tries to use this as an excuse is compounding such unethical and unprofessional behaviour.

    Neither is there justification for EVER treating someone who entrusts the care of themselves and their baby at this most important and significant and, at times, critical time, with such disrespect, derision, disregard and contempt. Would this be acceptable if it was your wife, partner or sister on the receiving end of such treatment /abuse?

    With all the information already available why isn’t this simple, yet far-reaching quality implemented as the normal standard of professional behaviour?
    ….but really the most difficult thing of all to understand is – why does it even need to be said, surely it has nothing to do with medical expertise, – it is simple decency…

  • Carmel O’Dwyer

    Ok, perhaps ‘rape’ was not the correct word to use here, let me change that to ‘violate’, I felt utterly violated, as many women do. The point is that without respect, reverence and fully informed consent a woman can feel violated by even the most basic medical procedures performed on her during birth. The purpose of the birth plan for most women, is not to undermine the wonderful work that OBs and Midwives do when needed if a birth genuinely becomes high risk, but to help them understand that this woman trusts her body, has done her research into up-to-date best practice and therefore does not wish to accept the ‘menu del dia’ of procedures of the particular establishment in which she is giving birth. The birth plan of a woman who has previously felt violated by her caregivers during birth also carries her plea for it not to happen again and this is something all OBs and Midwives should be aware of and sensitive to

  • Carmel O’Dwyer

    Ok, perhaps ‘rape’ was not the correct word to use here, let me change that to ‘violate’, I felt utterly violated, as many women do. The point is that without respect, reverence and fully informed consent a woman can feel violated by even the most basic medical procedures performed on her during birth. The purpose of the birth plan for most women, is not to undermine the wonderful work that OBs and Midwives do when needed if a birth genuinely becomes high risk, but to help them understand that this woman trusts her body, has done her research into up-to-date best practice and therefore does not wish to accept the ‘menu del dia’ of procedures of the particular establishment in which she is giving birth. The birth plan of a woman who has previously felt violated by her caregivers during birth also carries her plea for it not to happen again and this is something all OBs and Midwives should be aware of and sensitive to.

  • R. R.

    This article is mean to point out how ridiculous some people are with birth plans. For example, the patient that refuses to wear external monitors even though she was sent from the birthing center to the hospital by her midwife because her baby was having decels. Then ends up delivering a dead baby. The interventions we do during labor and delivery are meant for the safety of mom and baby. For someone to call it” rape” Is frankly offensive to those of us who spend our time working our asses off for you and to actual rape victims. I always try my best to accommodate a birth plan but if your baby comes out blue and floppy with its eyes wide open and is basically dead and needs immediately attention forgive me if I don’t give u 1 hour of skin-to-skin the second he or she is born. It will be much more enjoyable for you if the baby is alive.

  • Liz Kelly

    As a piece of satire this article does an excellent job in highlighting what is already widely perceived to be the ill-informed, ignorant, disrespectful, and arrogant attitudes of the obstetric profession towards the very people they are trained and profess to serve, and, judging by the amount of shares it has received, and by the derisory amused comments below, it confirms just how correct this perception is. Thank you for highlighting this. This article can only serve to bring the, already tarnished, reputation of the obstetric profession into further disrepute, and, sadly, cause further difficulties for those trying to provide evidence based care in this field. The fact that a woman even needs a birth plan in the first place is surely an indictment of the lack of basic knowledge of the professionals of the needs and requirements for a safe, healthy birth, and is an attempt by her, far too often, in the face of aggression and intimidation, to protect herself from these standards of care and thus protect her baby. Maybe it is only in satire that the disrespectful, derisory, arrogant, and dismissive way a woman is so often treated when presenting in labour can be accurately depicted, and maybe as a result of this article a serious discussion around this can be instigated and continued …there is much to be said, listened to and discussed to begin to remedy the situation and improve the attitudes which inform the levels of care which are so clearly highlighted in this piece. I am aware that this is probably not the forum for this discussion but every opportunity should be taken to highlight these issues, as you have already done so, and which sadly culminate all too frequently in further breaches of human rights towards women in these situations and, really, basic human rights begins with respect, and, as has been so clearly outlined in the article above this respect is often lacking in even the most basic and simple interactions, where, at such an important time, it has such a far-reaching effect. It really should go without saying that, in addition to the highest standards of training, respect for those in their care should always be a fundamental, and the most important requirement for anyone involved in this field and should be rigorously maintained and ensured.

  • Carmel O’Dwyer

    Women write birth plans to protect themselves from medical assault which happens on a daily basis in obstetrics. I have nothing against satire but in some areas it is totally inappropriate and this is one of them. A woman perceives obstetric medical assault (unecessary drugs and medical procedures foisted on a womans body during birth without her fully informed consent, which inhibit her since-the-beginning-of-humanity years old instinctive birthing wisdom) as rape. I know this because I am one of those women. I find this article extremely offensive and on behalf of all the women who have been obstetrically raped, I ask you to please consider removing it.

  • Harold Arthur Fowler

    jadi harus bilang WOW ga nih Gomerblog …hehehe?

  • Tracy Jonse

    I already read it Minka Green. Haha

  • Minka Green

    Tracy Jonse

  • Emily Crossman

    Lol! We all know this is true!!

  • Harold Arthur Fowler

    jadi harus bilang WOW ga nih Gomerblog …hehehe?

  • Mel Hollis

    OMG, this sure always seemed to be true back in my L&D days.

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