For a long time, women’s expectations of labour and birth were fairly straightforward. Most planned for a natural birth, assumed their partner would be by their side, and that they’d have relative control of their experience.

These days, with the media and reality television often sensationalising the birthing experience, editing the process, and regularly presenting worst-case scenarios or extreme situations, birth planning isn’t so simple.

Thanks to an abundance of sometimes exaggerated, and often conflicting, information, an increasing number of women have a distorted view of what birth is like, which can lead to unrealistic expectations and ultimately, disappointment.

“Programs such as One Born Every Minute focus on the abnormal, and largely, on a very technological view of birth, because of course that is what makes for interesting and dramatic television,” says Maralyn Foureur, Professor of Midwifery at the University of Technology Sydney.

“Quiet, calm, powerful, straightforward birth is apparently not a plot for ‘good television’.”

Conversely, when birth is presented as normal, a waterbirth or similar is often depicted, resulting in many women expecting the same, having equated these experiences with a “normal” birth. 

But while a waterbirth may be considered normal, it’s not the norm at many hospitals.

“Some hospitals actually have birth pools but the hospital policy may forbid women to use it- so choices are denied and expectations cannot be met,” says Dr Foureur.

The internet also plays a part in forming expectations.

“Women often do research on the internet and will be exposed to a range of experiences from some who want to extol the benefits of home birth or water birth or particular childbirth preparation programs like calmbirth,” says Dr Foureur.

“Other websites talk about the risks of childbirth, particularly many of the hospital based childbirth preparation courses where the unwritten ‘policies’ of the hospital are espoused as something that should be followed unquestioning.”

Many hospital births fall somewhere in the middle of the two extremes, meaning the chances of birthing ideals not being fulfilled is significant.

“They are not of course unrealistic expectations but they will not be realised.”

So it’s more important than ever for midwives to be mindful of managing the changing and diverse expectations of women, as mounting evidence suggests that unmet expectations during birth can have a detrimental impact on the mental health of new mums.

“Women at one end of the spectrum may develop post-traumatic stress disorder if their expectations for kind and respectful care are not met, particularly if their birth results in injury to themselves or their baby,” says Dr Foureur.

“But some women who appeared to have had a straightforward birth may still experience this as traumatic because it did not meet their expectations.

“For women who see birth as a quiet, calm, welcoming of their baby into the world through a gentle and seemingly pain free waterbirth – to arrive at a hospital that says well there is only one bath and someone else is using it or there are no midwives on duty at the moment who are prepared to support you to have a waterbirth – this can be shattering news and they also may feel extremely unsupported and traumatised.

“There is at least one study that shows that women’s expectations are set during pregnancy - so we need opportunity to find out what their expectations are.”

Midwives have a huge role to play in managing and influencing the expectations of pregnant women, however to do so effectively, it’s important they have an opportunity to talk with women before the birth experience,

But according to Dr Foureur, to what extent women’s expectations are met, and how well unmet expectations are managed, depends on the model of care the woman is receiving.

“Women in continuity of midwifery care models where they have an opportunity to get to know the midwife during pregnancy, and she is the person with them throughout labour, report having their expectations well met and are satisfied with the experience,” says Dr Foureur.

Unfortunately though, the Continuity of Care Model is not yet standard, and midwives need to do their best to determine, and then manage, expectations as early as possible, and throughout the process.

“Ask what they’re expectations are in a comfortable and calm environment with plenty of time to explore them with an open mind and knowing what the birthplace is likely to support,” says Dr Foureur.

Midwives should attempt to assess whether expectations are being met as the birthing experience unfolds, and manage unmet expectations through open, honest, respectful communication about what is happening and providing choices about the steps to be taken wherever possible.

“Post birth conversations to ‘de-brief’ and explore why events occurred as they did is the only process available that may help women through the process.”