Evolution of the birth plan

Birth plans: definitions, content, effects, and best practices

The first written guide for birth plans was introduced in 1980 as a means for birthing people to document their choices in the child birthing experience. The birth plan offers an opportunity for the patient and the provider to discuss the birthing process and determine how to safely accommodate patient preferences. Patient satisfaction with birthing plans is variable and may depend on how many requests they have, how many of their plans are accomplished, route of delivery, and whether complications arise during or after delivery. Unmet expectations may lead to posttraumatic stress disorder, but following a birth plan may also be protective against it. Birthing people who use a birth plan may be less likely to use epidural anesthesia, have early amniotomy, or use oxytocin. The first stage of labor may be longer when a birth plan is used; however, there does not seem to be a decrease in the length of the second stage of labor among patients with a birth plan. Some providers believe that a disadvantage of birth plans is disappointment when birth plans are not able to be followed, and others consider that birth plans interfere with professional autonomy.

The application of a continuous partnership-based birth plan in China: A randomized controlled trial

BACKGROUND

The cesarean section rate is as high as 36.7% in China, much higher than the average cesarean section rate of 27% in Asia. With the implementation of the two-children and three-children policy, the primipara with cesarean will also face the choice of repeated or even multiple cesareans, which will increase the risk of maternal perinatal mortality and serious fetal pulmonary morbidity. To reduce the cesarean section rate, a series of midwifery service measures such as the birth plan have been taken in China and it has played a certain role in improving the birth outcome and maternal birth experience. However, the areas carrying out birth plan are often economically developed with advanced medical conditions. the application effect of birth plan in economically underdeveloped areas with limited medical conditions in China is unknown.

OBJECTIVE

To evaluate the effects of a continuous partnership-based birth plan on local women's birth outcomes and experience in Haikou which is an economically underdeveloped city in China.

DESIGN

A randomized controlled trial study design was used.

PARTICIPANTS

90 primiparous women who received pregnancy service from the obstetrics clinic of one of tertiary hospitals in Haikou city, Hainan Province between July 2020 and December 2020 and planned to give birth in this hospital were recruited.

METHODS

After eligibility was determined, consents obtained and baseline surveys completed, 90 participants were randomly allocated to study groups with concealed opaque envelopes by a blinded research assistant and each group were 45 participants. Participants in control group received routine obstetric health service and nursing care, while participants in the experimental group received the continuous partnership service of midwives on the basis of routine care. At the same time, the birth plan was formulated and implemented, and the relevant indicators were recorded and analyzed during and after birth, including cesarean section rate, non-medical indication cesarean section rate, oxytocin use rate, perineal lateral resection rate and anxiety degree.

RESULTS

The cesarean rate in the experiment and control groups were 20.45% and 57.14%, of which the non-medical indication cesarean rate in the experiment and control groups were 22.22% and 50.00%, respectively, whereby the difference of cesarean rate and nonmedically indicated cesarean section rate between the groups was statistically significant (χ² = 12.231, p < 0.001;χ² = 9.101, p = 0.003). Besides, the differences in anxiety degree, neonatal NICU transfer rate and satisfaction of birth between the two groups were statistically significant (p < 0.05). While there was no significant difference in oxytocin use rate, perineal lateral resection rate, neonatal 1-min and 5-min Alzheimer's score between the two groups (P > 0.05).

CONCLUSION

The birth plan based on continuous partnership can reduce medical intervention, improve birth outcomes, reduce anxiety and optimize maternal birth experience of women, which is worthy of promotion in economically underdeveloped areas of China.

Exploring women's experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain

BACKGROUND

Women's engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women's experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women's experiences of participation in shared decision-making during hospital childbirth.

METHODS

An exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process.

RESULTS

Twenty-three women participated in three focus groups. Three major themes emerged from the data: "Women's low participation in shared decision-making", "Lack of information provision for shared decision-making", and "Suggestions to improve women's participation in shared decision-making". The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women's participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women's participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care.

CONCLUSION

Enhancing women's involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women's participation in shared decision-making during childbirth, is highly recommended.

Prevalence, characteristics, and satisfaction of women with a birth plan in The Netherlands

BACKGROUND

The use of birth plans to facilitate shared decision making in childbirth is widely recommended by international agencies and by the Dutch Integrated Birth Care protocol (2016). This study evaluated the use of birth plans in The Netherlands.

METHODS

A retrospective study was conducted during 2017 in a Dutch academic hospital. Women who gave birth after 33 weeks of gestational age were included (N = 1159). Medical records were searched for a birth plan, either a note or attached file. Socio-demographic, relevant medical and obstetrical characteristics fulfilling criteria for secondary care, and postpartum satisfaction were collected and related to birth plans. Postpartum satisfaction was scored on a scale from 0 to 10. The "net promoter score" (NPS), a quality of care indicator, was also computed. For analysis, independent t test, chi-square test, ANOVA, and two-way between ANOVA were used.

RESULTS

A birth plan was noted in the medical records of 34.7% of women. Women with a birth plan were on average older, primiparous, of Dutch ethnicity, and more likely to have a complicated medical history, psychological condition, or fertility treatment. The mean postpartum satisfaction score was 8.28 and the NPS for customer satisfaction was 36.1, falling in the good range. No significant differences in postpartum satisfaction related to birth plans were found.

CONCLUSIONS

Although birth plans are recommended for every pregnant woman, this is not everyday practice yet. The purpose of birth plans, to facilitate shared decision making, is therefore not fully realized. Implementation strategies are needed to increase adoption of birth plans for every woman.

Birth Plans and Childbirth Education: What Are Provider Attitudes, Beliefs, and Practices?

We describe the perception and practices of obstetric providers on birth plans and childbirth education (CBE) classes. Using a national online survey, we collected provider and patient demographics, practice settings, and perceptions. Of 567 surveys, 77% were physicians and 22% were midwives. This cohort believed prenatal care and CBE were predictors of patient satisfaction, while they had unfavorable views of birth plans. Most providers routinely recommended (69.7%) and had favorable views on CBE (84%). Most providers (66.5%) did not recommend birth plans and 31% felt they were predictors of poor obstetrical outcomes. Further research is needed to bridge the gap between provider beliefs and patient desires about their birth experience as well as to understand how to improve childbirth-related patient satisfaction.

Effect of birth plans on childbirth experience: A systematic review

AIM

The birth plans were developed as an approach for pregnant women to present their expectations for labour and childbirth. The aim of this study was to assess whether birth plans (a written document in which pregnant women describe preferences about their care during labour and childbearing) compared with standard or routine approach (supine position, continuous fetal monitoring, enema, episiotomy) affect the birth experience (woman's perception of labour and childbirth as positive or negative experience) or satisfaction with birth.

METHODS

This systematic review was performed by searching several databases, including Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL, Scopus, PsycINFO, ACP Journal Club, Google Scholar, and Persian databases (SID, Magiran, and Barakat) up to February 10, 2018.

RESULTS

By searching the databases, 1006 published articles were found, of which 480 and 114 articles were excluded by review of the titles and the abstracts, respectively. Finally, we included three clinical trials (1132 women) in the review. The results of two study showed that the mean score of birth experience in the birth plan group was significantly higher than the control group (P ≤ 0.01). However, the results of a study showed that there were no statistically significant differences between birth plan and control groups (P > 0.05). Quality of included studies was very low.

CONCLUSIONS

There is not enough evidence to support or refute that birth plan can improve the birth experience or satisfaction with birth.

Autonomous and dependent-The dichotomy of birth: A feminist analysis of birth plans in Sweden

OBJECTIVE

To elicit pregnant women's perceptions of childbirth as expressed in their birth plans, and through a feminist lens analyse their wishes, fears, values, and beliefs about childbirth, as well as their expectations on partner and midwife.

DESIGN

This study used qualitative content analysis, identifying subcategories, categories, and an overall theme in data gathered from women's written birth plans. A feminist theoretical framework underpinned the research.

SETTING

A middle-sized city in northern Sweden.

PARTICIPANTS

132 women who gave birth in an obstetrician-led hospital labour ward between March and June 2016 and consented to grant access to their birth plans and antenatal and intrapartum electronic medical records.

FINDINGS

Three categories emerged: 'Keeping integrity intact through specific requests and continuous dialogue with the midwife', 'A preference towards a midwife-supported birth regardless of method of pain relief", and '"Help my partner help me" - Women anticipating partner involvement.' The overall theme linking the categories together was: 'Autonomous and dependent - The dichotomy of birth', portraying women's ambiguity before birth -expressing a wish to remain in control while simultaneously letting go of control by entrusting partner and midwifewith decision-making regarding their own bodies.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Women primarily desired a natural, midwife-supported birth and favoured a relationship-based, woman-centred model of care, based on the close interaction between woman, partner, and midwife. Midwives need to be aware of women's ambiguous reliance on them and the power they have to influence women's birth choices and birth experiences. Feminist theory and values in midwifery practice may be useful to inspire a maternity care based on women's wishes and expectations, acknowledging and valuing women's voices, and embracing the sanctity of birth and of the birthing woman's body.

Birth plans-Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study

OBJECTIVE

To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.

METHODS

This was a prospective cohort study of singleton pregnancies greater than 34 weeks' gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi-squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.

RESULTS

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

CONCLUSION

Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth-related patient satisfaction.

Online Birth Plans and Anticipatory Guidance: A Critical Review Using Web Analytics and Crowdsourcing

We assessed the content of online birth plans using Web analytics and crowdsourcing to identify the most commonly accessed online birth plans. We analyzed the first 14 websites of 6 different searches across time. We repeated this search using 200 individuals recruited by a commercial crowdsourcing service. We identified the 12 URLs that appeared most frequently from all searches then categorized the content by relevance to stages of labor or newborn care. Twenty-five different URLs with customizable birth plans were identified by clinical and crowdsourced searches, with considerable overlap. Among the most commonly identified birth plans, we found prompts for outdated practices in a minority (18%-37%). The majority of online birth plans can be positive tools for shared decision making.

A critical review of the birth plan use in Catalonia

INTRODUCTION

The birth plan allows the woman to express her expectations and needs with regards to the childbearing continuum but its use has been debated in the clinical context and in published literature. The birth plan was first introduced in the Spanish Health Service in 2008 through the Strategy for the Care in Normal Childbirth. In Catalonia, the Normal Childbirth Care Programme has promoted the use of birth plans in hospitals participating in this Programme.

OBJECTIVE

This works describes and analyses the birth plans produced by the participating hospitals in order to gather knowledge about the options available to women.

METHOD

Qualitative study in which the content of birth plans is systematically and quantitatively described in order to evaluate options available to women. The final sample includes all the birth plans provided by 30 Catalonian public hospitals. Following an initial assessment, it was decided to devise a grading scale which allowed to code and assign a value to each of the items contained in the birth plans.

RESULTS

Three different types of birth plan are identified: a) those which present a list of items with no (or very little) associated explanations, b) list of items with some explanations and c) plans without items which only explain normal working practices in the hospital and/or protocols.

Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery

BACKGROUND

To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan.

METHODS

This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed.

RESULTS

In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls.

CONCLUSION

Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.

From birth plan to birth partnership: enhancing communication in childbirth

Birth plans were developed with the intention of enhancing a woman's prepared decision-making in the labor and delivery process and to offer obstetric care providers with important details about those decisions. Through the use of birth plans, women can reflect on their values and choices regarding what care practices and interventions they do and do not want in birth; they can communicate these values in advance to their care providers. However, birth plans are often ineffective at accomplishing their goals for a number of reasons. They may reflect outdated concerns about routine practices or overly emphasize minor matters. Many popular pregnancy websites offer birth plans that use checklist formats, and women who use these are not counseled about which options may require or preclude other options. Some women may have inappropriately rosy expectations of how their labor and delivery processes will progress or have received poor advice. The use of a birth plan may invoke hostility from hospital staff members who may disregard the plans and look down on the women who make them. An alternative approach to the use of birth plans to enhance a woman's participation and informed consent in the birth process is the birth partnership, in which women and their obstetric care providers take time to discuss thoroughly the choices to be made in birth in advance to have those choices best reflect the values of the woman giving birth. Meeting to discuss values and choices before labor offers the opportunity for mutual education between provider and patient about the choices to be made and the values that inform those choices. Effective communication and working to build mutual trust can serve as preventive measures to avoid many conflicts that arise in the birth process.

Birth Plans: What Matters for Birth Experience Satisfaction

BACKGROUND

To categorize individual birth plan requests and determine if number of requests and request fulfillment is associated with birth experience satisfaction.

METHODS

This is a sub-analysis of a prospective cohort study of 302 women with singleton pregnancies with and without birth plans. Women with a hard copy of their birth plans who completed a postdelivery satisfaction survey were included in this study. We described the number and type of birth plan requests and associated the number of requests and request fulfillment with overall satisfaction, expectations met, and sense of control. Differences between groups were analyzed using chi-square, Spearman rank correlation, and logistic regression.

RESULTS

One hundred and nine women presented to Labor and Delivery with a hard copy of their prewritten birth plan. We identified 23 unique requests. The most common requests were no intravenous analgesia (82%) and exclusive breastfeeding (74%). The requests most fulfilled were avoidance of episiotomy (100%) and no operative vaginal delivery (89%). Having a higher number of requests fulfilled correlated with greater overall satisfaction (p = 0.03), higher chance of expectations being met (p < 0.01), and feeling more in control (p < 0.01). Having a high number of requests was associated with an 80 percent reduction in overall satisfaction with the birth experience (p < 0.01).

CONCLUSIONS

Having a higher number of requests fulfilled was positively associated with birth experience satisfaction, while having a high number of requests was inversely associated with birth experience satisfaction. Further research is needed to understand how to improve birth plan-related birth experience satisfaction.

Birth Plans: Encouraging Patient Engagement

Patient engagement is defined as a set of actions by patients, family members, and health-care providers that promotes patients and family members as active participants of the health-care team. As focus turns toward patient engagement where patients have an active role in their health care, childbirth educators and nurses are in a position to support patient choices. The focus is to assist the engaged woman to stay engaged and to encourage those not engaged to become engaged. The results can be improved patient care outcomes and improved patient satisfaction. One way to promote patient engagement can be the birth plan. This process can be facilitated through education of choices and assisting with writing choices into a formal birth plan.

Mindfulness-Based Childbirth Education: Incorporating Adult and Experiential Learning With Mindfulness-Based Stress Reduction in Childbirth Education

Informed choice is an expectation of today's parents. Concern is evident around whether education models are evolving to ensure flexibility for parents to access options perceived as meeting their needs. Historical and current evidence around childbirth education models including the introduction of mindfulness to parent education will be presented. The aim of this article is to describe the rationale for incorporating adult and experiential learning with mindfulness-based stress reduction in a childbirth education program implemented in Western Australia. The curriculum of the Mindfulness Based Childbirth Education 8-week program is shared with corresponding learning objectives for each session. Examples of educational materials that demonstrate how adult and experiential learning were embedded in the curriculum are presented.

Use and influence of Delivery and Birth Plans in the humanizing delivery process

OBJECTIVES:

get to know, analyze and describe the current situation of the Delivery and Birth Plans in our context, comparing the delivery and birth process between women who presented a Delivery and Birth Plan and those who did not.

METHOD:

quantitative and cross-sectional, observational, descriptive and comparative cohort study, carried out over two years. All women who gave birth during the study period were selected, including 9303 women in the study.

RESULTS:

132 Delivery and Birth Plans were presented during the first year of study and 108 during the second. Among the variables analyzed, a significant difference was found in "skin to skin contact", "choice of dilation and delivery posture", "use of enema", "intake of foods or fluids", "eutocic deliveries", "late clamping of the umbilical cord" and "perineal shaving".

CONCLUSIONS:

the Delivery and Birth Plans positively influence the delivery process and its outcome. Health policies are needed to increase the number of Delivery and Birth Plans in our hospitals.

Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland

BACKGROUND

Birth plans are written preferences for labor and birth which women prepare in advance. Most studies have examined them as a novel intervention or "outside" formal care provision. This study considered use of a standard birth plan section within a national, woman-held maternity record.

METHODS

Exploratory qualitative interviews were conducted with women (42) and maternity service staff (24) in northeast Scotland. Data were analyzed thematically.

RESULTS

Staff and women were generally positive about the provision of the birth plan section within the record. Perceived benefits included the opportunity to highlight preferences, enhance communication, stimulate discussions, and address anxieties. However, not all women experienced these benefits or understood the birth plan's purpose. Some were unaware of the opportunity to complete it or could not access the support they needed from staff to discuss or be confident about their options. Some were reluctant to plan too much. Staff recognized the need to support women with birth plan completion but noted practical challenges to this.

CONCLUSIONS

A supportive antenatal opportunity to allow discussion of options may be needed to realize the potential benefits of routine inclusion of birth plans in maternity notes.

Perspectives of expectant women and health care providers on birth plans

OBJECTIVE

A birth plan is a document detailing a woman's preferences and expectations related to labour and delivery. Empirical research exploring the value of birth plans has shown conflicting findings about whether birth plans have a positive or negative effect on labour and delivery, suggesting a need for further study. This study aimed to understand the perspectives of women, health care providers, and support persons regarding the use of birth plans.

METHODS

A cross-sectional questionnaire was distributed to a convenience sample of expectant or postpartum women, health care providers, and support persons from January 2012 to March 2012 in British Columbia.

RESULTS

In total, 122 women and 110 health care providers and support persons completed the questionnaire. Both women and their attendants viewed the birth plan as being valuable for acting as both a communication and education tool. However, the respondents noted that women may be disappointed or dissatisfied if a birth plan cannot be implemented. The most important elements of a birth plan identified included pain management, comfort measures (e.g., mobility during labour), postpartum preferences (e.g., breastfeeding), atmosphere (e.g., privacy), and birthing beliefs (e.g., cultural views).

CONCLUSION

This is the first study to identify advantages and disadvantages of using a birth plan as well as the most important aspects of a birth plan from the perspectives of both women and their attendants in Canada. The findings could be applied to optimize the efficacy of birth plans in Canada and potentially internationally as well.

Unique and proforma birth plans: a qualitative exploration of midwives׳ experiences

BACKGROUND

birth plans detailing a woman׳s preferences for intrapartum care are a common feature in British maternity units, and are a means of encouraging the implementation of choice. Proforma versions may be incorporated routinely in antenatal case notes, or the woman may devise her own unique birth plan. Although women׳s views of birth plans have been explored, the views of midwives have not to date been evaluated. The growth of midwife-led units in the UK has highlighted different philosophies of care, some of which can be reflected in the different types of birth plan. Given the increasingly diverse nature of UK midwifery workplaces we set out to explore and compare the experience of midwives working in midwife-led and obstetric-led settings in relation to unique and proforma birth plans.

METHOD

qualitative study using focus groups of midwives in a midwife-led unit (MLU; n=5) and obstetric-led unit (OLU; n=4) in the East of England. We used an interpretative phenomenological analytical approach.

FINDINGS

three main themes arose from the data. Firstly, the term 'birth plan' can be misleading, and was criticised for encouraging the belief that birth can be 'planned'. In addition, midwives claimed that 'unique' birth plans, especially those influenced by some consumer advocacy groups, are becoming standardised in their rejection of policies and procedures and requests for intervention-free birth. Secondly, birth plans were a source of irritation for midwives in both groups, although the cause of the irritation differed between groups. Finally, it was found that midwives in both groups felt that birth plans put pressure on them, although again, the source of the pressure, and therefore the way in which midwives reacted to this pressure, differed between groups.

CONCLUSIONS

the term 'birth plan' can be misleading and create false expectations. If 'unique' birth plans are becoming 'standardised' in the sense that they routinely request the same things, they are little different to proforma birth plans. Some midwives perceive pressure both from women and the wider multidisciplinary team as a result of birth plans, a perception that causes some irritation.