[Perineal prevention and protection in obstetrics: CNGOF Clinical Practice Guidelines (short version)]

Consensus on the Structure and Content of Birth Plans: A Modified Delphi Study

BACKGROUND

Few pregnant women in France wrote birth plans as in many other countries. The literature stresses the heterogeneity of birth plan content, which limits the utility of assessing the effects of birth plans on women's experience of childbirth. This study aimed to obtain a French national consensus on the structure and content of birth plans.

METHODS

A multidisciplinary steering committee was established. An electronic modified Delphi study was conducted to develop a structure and content for birth plans between November 2022 and June 2023. During three Delphi consensus rounds, panellists, including perinatal health care professionals and user representatives, were asked to rate individually and independently each proposed section and subsection formulation of the birth plan for its appropriateness. An external board assessed the understandability of the final birth plan's preamble and content.

RESULTS

The steering committee proposed 103 formulations corresponding to items to be covered in a birth plan, categorized into 8 sections and 30 subsections, for evaluation in the Delphi rounds. The first round was completed by 42 panellists (mainly midwives), the second by 39, and the third by 36. Finally, the steering committee approved the final components of the structured birth plan in 8 sections and 19 subsections, after its reviewing by the 21 members of the external board.

CONCLUSION

A French national Delphi process, after three rounds and validation by an external board, made it possible to reach a consensus on the structure and content of a birth plan in 8 sections and 19 subsections.

PATIENT OR PUBLIC CONTRIBUTION

User representatives were included as experts in the Delphi rounds, and in the external board to approve the final version of the structured birth plan.

A novel classification for evaluating episiotomy practices: application to the Burgundy perinatal network

Background

Though the rate of episiotomy has decreased in France, the overall episiotomy rate was 20% in the 2016 national perinatal survey. We aimed to develop a classification to facilitate the analysis of episiotomy practices and to evaluate whether episiotomy is associated with a reduction in the rate of obstetric anal sphincter injuries (OASIS) for each subgroup.

Methods

This population-based study included all the deliveries that occurred in the Burgundy Perinatal Network from 2011 to 2016. The main outcome was episiotomy, which was identified thanks to the French Common Classification of Medical Procedures. An ascending hierarchical cluster analysis was performed to build the classification. A clinical audit using the classification was conducted yearly in all obstetric units. The episiotomy rates were described throughout the study period for each subgroup of the classification. The OASIS rates were evaluated by subgroup and the association between mediolateral episiotomy and OASIS was investigated for each subgroup.

Results

Our analyses included 81,290 pregnant women. The classification comprised 7 subgroups: ₍₁₎ nulliparous single cephalic at term, ₍₂₎ nulliparous single cephalic at term with instrumental delivery, ₍₃₎ multiparous single cephalic at term, ₍₄₎ multiparous single cephalic at term with instrumental delivery, ₍₅₎ all preterm deliveries (< 37 weeks gestation), ₍₆₎ all breech deliveries, ₍₇₎ all multiple deliveries.

Episiotomy rates ranged from 6.2% in Group 3 to 40.9% in Group 2. From 2011 to 2016, every group except breech deliveries experienced a significant decrease in episiotomy rates, ranging from − 28.1 to − 61.0%.

The prevalence of OASIS was the highest in Groups 2 (3.0%) and 4 (2.2%). Overall OASIS rates did not significantly differ with episiotomy use (P = 0.25). However, we found that the use of episiotomy was associated with a reduction in OASIS rates in Groups 1 and 2 (odds ratio 0.6 [95% CI 0.4–0.9] and 0.4 [0.3–0.5], respectively). This reduction was only observed in Group 4 with forceps delivery (odds ratio 0.4 [0.1–0.9]).

Conclusion

We developed the first classification for the evaluation of episiotomy practices based on 7 clinically relevant subgroups. This easy-to-use tool can help obstetricians and midwives improve their practices through self-assessment.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2424-2) contains supplementary material, which is available to authorized users.