Despite increasing evidence and WHO’s (1985,1996) recommendations, birth care practices continue to include numerous intervention and a medicalized approach. In Spain, for example, where our study was conducted, the overall rate of cesarean birth in the National Health System is approximately 22 % , which is higher than the 10 % to 15 % rate recommended by WHO (Ministry of Health, 2005). Moreover, incorporation of birth plans in Spanish care practices has been a slow process. More than a decade the WHO’s toppriority classification, birth plans finally became a part of the humanization Project for Perinatal Care in Andalusia (Andalusian Public Health Service, 2009), (see this birth plan, Supplemental Digital content 1, (http://links.lww.com/MCN/A7).