Artemis, Xochiquetzal, Mana Genita, Atahensic, Haumea, Sinivali, and Partula — these are just a smattering of the deities from various cultures around the world whose job it is to help with human reproduction. Some specialize in the getting pregnant part, enhancing fertility and sexual function of men and women, whereas others specialize more in childbirth. To cement their credentials in guiding us mere mortals through giving birth, these deities have often supernaturally conquered serious birth challenges themselves. Did you know that right after being born, Artemis helped deliver her own twin brother, Apollo? Pretty impressive, indeed.
Mythology seeks to explain the most important events of humanity, especially focusing on what we don’t understand or control — how the world began, seasons, weather, natural disasters, and childbirth. Childbirth’s inclusion in mythology is no surprise. In an individual’s life, the journey of giving birth remains unpredictable, mysterious, and, myth-provokingly, out of our control.
Throughout time, prayers, rituals, and even sacrifices were offered to ensure healthy childbirth for the mother and baby. In Christianity, at least five saints are said to help during childbirth — St. Gianna, St. Erasmus, St. Raymond Nonnatus, St. Ursus of Aosta, and St. Gerard. During the Middle Ages, birthing women in England wrapped ribbons, wax, and cloths inscribed with prayers or Latin palindromes around their legs or bellies to ensure safe delivery.
In light of this history, how do we reconcile humanity’s amazing stories about the birthing superpowers of gods, goddesses, and saints with our current cultural birth icon — the birth plan? We may not know exactly when birth prayers first emerged in human imagination and culture, but the birth plan has a relatively set “birth date” in the 1980s. Birth plans emerged as an attempt to combat what was considered the overmedicalization of the birth process. Often in checklist form, they tend to focus on which interventions are acceptable and desirable for a given person’s birth and which are hard no’s.
The journey from birth prayers to birth plans mirrors the evolution in birth itself. Birth became medicalized and moved toward hospitals instead of homes in the 1930s, a recent development when you consider the entire timeline of human birth history. Birth is and should always be more than a medical procedure, and yet at times, medical procedures, including those that may be prohibited in certain birth plans, are needed for birth to occur safely for both mother and baby. This is one of the conundrums of both modern obstetrical practice and living as a human in the modern world.
As clinicians, we often view birth plans in a dramatically different way than our patients do. On labor and delivery units and in prenatal offices, a birth plan can trigger emotions that range from dread to hostility. Many view a birth plan in and of itself as an independent risk factor for a C-section. We encourage childbirth education classes, pregnancy books and apps, but our hearts sink when we are asked, especially in the first and second trimesters, “So, when will we talk about my birth plan?”
However, as much as birth plans may rankle and annoy us, we must acknowledge that our history of twilight anesthesia births, routine episiotomy, rising C-section rates, and continuous fetal monitoring without proven benefit all contribute to making women feel they need to protect themselves from over-intervention.
So as a tool for healthy birth, does this modern form of birth preparation work any better than the prayers, chants, charms, and sacrifices of our ancestors? Or is it indeed a ticket to the OR? Surprisingly to me, a breadth of research exists investigating the effectiveness of birth plans with regard to childbirth satisfaction, C-section, episiotomy, IV analgesia and epidural use, and more. Kuo et al. even performed a randomized controlled study of birth plans among women in Taiwan.
Despite medical professionals’ biases and what often seems to be our lived experience, birth plans in general do not seem to either increase or decrease the incidence of C-section. Some studies, including Kuo’s trial, showed that birth plans increase mothers’ satisfaction with their birth experience, while others actually show the opposite, that women with birth plans have lower childbirth satisfaction. A nuanced analysis showed that, as with most things, less can be more: The more requests made in a birth plan, the more likely the person was to be disappointed in their birth experience. Parsing the birth plan journey further, a 2014 study from Scotland suggested that the process of making a birth plan and the discussion it can engender is more beneficial than the actual plan.
Whether or not we like them or they work, birth plans are here to stay. Perhaps our bristling as physicians all comes down to that one word, “plan.” As we navigate our patients’ labors, praying to deities, rather than making a plan, seems to better acknowledge the seemingly random and unpredictable complications and difficulties that can emerge along the way. Sometimes, a birth is uneventful, without any speed bumps; we call this normal. Other times, through no one’s fault, it is long and arduous, and requires interventions that no one would have planned or wanted. This type of “unplanned” birth can happen even if you gain the right amount of weight, exercise regularly, labor at home first, wait to get an epidural, or don’t get an epidural at all. It can happen when you make a birth plan, don’t make a birth plan, or pray to whichever birth goddess, god, or saint you prefer. Personally, I would recommend Sinivali, the Indian goddess who presides not just over birth, but easy birth.
Anxiety and fear lurk behind any event we cannot control. What birth prayers and birth plans have in common is that they give us something to do, create a feeling of control in the tidal wave of the unknown and, let’s not forget, painful process of birth. After all, birth can be normal and difficult, physiologic and potentially dangerous, all at the same time. Interventions can have risks and can also be lifesaving. What I have come to understand more fully with each year — and what I now tell patients when we talk about birth plans — is that how birth unfolds can’t be planned. But it is our job, as obstetricians, to respect and try to understand our patients’ wishes. And, most importantly, to be there for them, when things don’t go according to plan.
What role do you believe birth plans have in modern medicine? Share your thoughts in the comment section.
Dr. Jennifer Boyle is an ob/gyn in Boston, MA. She also works as a soccer coach and a cheer, hockey, and lacrosse mom. To stay sane, she runs, reads and bonds with her fourth baby, a labradoodle named Teddie. Dr. Boyle is a 2022-2023 Doximity Op-Med Fellow.
Illustration by April Brust