Childbirth has had a long and winding history. This is understandable since it has literally been happening since the beginning of human time. Prior to 1950, many births happened in a familiar home setting attended by a midwife, overwhelmingly a group of female providers. For a fun and fairly accurate representation, enjoy a binge of “Call the Midwife” by the BBC. While often depicted in a romantic way, childbirth prior to the 1930s and 40s was dangerous – sepsis caused 40% of maternal deaths as most deliveries were performed without sterile technique and many women died of hemorrhage (severe bleeding) or preeclampsia and eclampsia (elevated blood pressures in pregnancy and seizures) (6). As science and medicine progressed in the second half of the 20th century, new technologies and techniques moved delivery into a hospital setting attended by physicians, overwhelmingly a group of white male providers. Maternal death in the first quarter of the 20th century was quite common prior to this with as many as 7/100 deaths in the United States (6). While advancements in science and medicine and a shift towards hospital-based delivery improved maternal and fetal/neonatal morbidity and mortality, an unwanted side effect for many patients was the medicalization (and potentially over-medicalization) of the delivery experience (1). In addition, the culture of paternal medicine and the “doctor knows best” mentality meant that this shift encouraged a lack of communication and autonomy for patients. Within bioethics, autonomy means the patient’s right to choose what happens to their body and to make well-informed choices about the plan for their medical care. Currently, the rate of home birth remains low – less than 1% of all births in the United States (2). However, patients want autonomy for what is arguably one of the most impactful experiences of one’s life – the birth of a child. In the 1970s, prenatal educators introduced the idea of the Birth Plan, a standardized document that sets out the values of a patient regarding their birth experience. In 1996 the World Health Organization advocated for use of the Birth Plan with the goal of increasing patient autonomy during birth (1). Studies have demonstrated that patients feel more empowered and using a birth plan is associated with increased patient satisfaction (3). No studies have been done that address providers’ interactions with Birth Plans, but anecdotally there are few obstetrics providers that look upon them favorably. (read more...)