Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans


  • Angela Pennell MD,

  • Victoria Salo-Coombs RN,

  • Amy Herring SciD,

  • Fred Spielman MD,

  • Karamarie Fecho PhD

Fred Spielman, MD, University of North Carolina at Chapel Hill, Department of Anesthesiology, CB #7010, Chapel Hill, NC 27599-7010. E-mail:


Introduction: This study described anesthesia and analgesia–related preferences and outcomes of women who used a birth plan for labor and birth.

Methods: A prospective cohort study was conducted (N = 63). Data were abstracted from medical records, birth plans, and a follow-up survey. Descriptive statistics were used for analysis.

Results: Women who elected birth plans were primarily white, college-educated, primigravida, and under the care of a certified nurse-midwife. One-third of births were induced, 10% required instrumentation, and 29% were cesarean births. Nearly every birth was associated with at least 1 labor and birth complication, although most complications were minor. Analgesic preferences were reported to be the most important birth plan request. Greater than 50% of women requested to avoid epidural analgesia; however, 65% of women received epidural analgesia. On follow-up, greater than 90% of women who received epidural analgesia reported being pleased. The majority of women agreed that the birth plan enhanced their birth experiences, added control, clarified their thoughts, and improved communication with their health care providers.

Discussion: Anesthesia and analgesia–related preferences were an important component of the birth plans. The majority of women favorably viewed the use of a birth plan, whether or not preferences were fulfilled or complications occurred.