Nobody has ever shown that expecting less helps
The advice to lower your expectations sounds wise. It has never been tested, and the best evidence points the other way.
You will hear a version of this from well-meaning people: do not get your hopes up, then you cannot be disappointed. It is the most natural advice in the world. It is also unsupported.
We looked for a study that tested lowering expectations as a deliberate intervention and measured whether women did better. We did not find one. Not a trial, not a cohort study, nothing.
What has been measured repeatedly is something different: whether expectations were met. In a study of 560 women in Belgium and the Netherlands, questioned once at 30 weeks and again within two weeks of the birth, the authors reported that Satisfaction with childbirth benefited most consistently from the fulfilment of expectations.
That study reports direction, not size; no effect sizes were available for it, so no magnitude should be attached to that sentence.
The classic review of the subject pulled together 137 reports and found four things that shape how a woman rates her birth: what she expected, how much support she got from the people caring for her, the quality of her relationship with them, and whether she was part of the decisions. Its conclusion, in the author's own words: The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
That review is a written summary across many different studies, not a pooled calculation, and it is now more than twenty years old.
And WHO's own definition, quoted in the previous topic, requires an experience that fulfils or exceeds
what a woman expected. You cannot build a guideline on fulfilment and then advise people to expect nothing.
Only the three-week difference reached statistical significance. Across the whole six months the odds ratio was 0.67 (95% confidence interval 0.47 to 0.97), and the number of women who needed the programme for one to benefit was 16, with a range running from 9 to 112. That range is honest and it is wide: somewhere between very efficient and barely worth doing.
Note what the programme did. It did not tell women to expect less. It told them accurately what was coming.
"What do most women find hardest about this that nobody warns them about?"