a request that repeatedly apears in virtually all birth plans is to avoid the use of episiotomy. although we expected to find major differences in the use of episiotomy between women who presented a birth plan and women without a birth,like deering et al. , we found no significant differences. one of the results that surprised us was the high percentage of pregnant women with a birth plan who used epidural anesthesia. this result is in contrast to other studies, in which researchers reported that a lower percentage of pregnant women with a birth plan used epidural anesthesia. in our study, the majority of women with a birth plan expressed their rejection of women with birth plans in the study by pennel, salo-coombs,herring, spielman, and fecho. however,75% of women in both groups in our study eventually requested an epidural as labor progressed and the pain increased.