Communication and decision‐making in labour: do birth plans make a difference?

Abstract

Objectives To assess usage of birth plans, and examine differences in social and obstetric characteristics, and intrapartum experiences of women who did and did not use a birth plan. Design Population‐based survey distributed by hospitals and home birth practitioners, 6–7 months post‐natally. Setting and participants Women who gave birth in Victoria, Australia over a 2‐week period in September, 1993, excluding those who had a stillbirth or neonatal death. Main outcome measures Use of a written birth plan; perceived helpfulness, advantages and disadvantages of birth plans; relationship between use of birth plans and overall rating of intrapartum care, and involvement in decision‐making. Results Twenty per cent of women (270/1336) had prepared a written birth plan and discussed it with caregivers. Women who made use of a birth plan were more likely to be satisfied with pain relief (OR = 1.74[1.3–2.3]), but did not differ from women not completing a birth plan in terms of their overall rating of intrapartum care, or involvement in making decisions about their care. Conclusions The lack of association between use of a written birth plan and variables assessing women's views of intrapartum care suggest there are insufficient grounds for continuing to advocate a policy of encouraging pregnant women to complete written birth plans, unless it is within the context of a well‐designed randomized trial able to provide further evidence regarding their effectiveness.

Anesthesia and Analgesia–Related Preferences and Outcomes of Women Who Have Birth Plans

“…The rate of epidural analgesia reported here is similar to that reported by Deering et al 12 for women with birth plans. In contrast, the rate of unplanned cesarean births is higher than the 17% rate reported by Deering et al 12 and the 7% rate reported by Brown and Lumley 9 and is higher than the overall rate of cesarean births at our institution (University of North Carolina Hospitals). The reason or reasons for the high rate of cesarean births among women with birth plans is unclear.…”

“…The majority also agreed that the birth plan added control to the birth process. Prior studies have found that although women are satisfied with the birth plan, the birth plan does not provide a sense of empowerment or control regarding labor and birth 9–11,13,15 . In the present study, women reported that the birth plan did add control, but this finding should be interpreted cautiously because it may reflect a nonresponse bias if, for example, only women who were pleased with their labor and birth experiences completed the follow‐up survey.…”

“…Over the same period as the present study, 40.4% of parturients were white, 28.7% were primigravida, and the majority of women received care from an obstetrician as opposed to a certified nurse‐midwife. Brown and Lumley 9 likewise found that women with birth plans were less likely to use an obstetrician and more likely to use a certified nurse‐midwife. The predominance of white women in our study population might be indirectly related to educational level because racial disparities favoring higher levels of education among white people are well‐established 14 .…”

“…The present study has several limitations that should be considered when interpreting the results. First, the sample size is relatively small, although it is similar to that used in previous studies on birth plans 9–11,13,15 . Second, only English‐speaking women were enrolled in the study, which could influence the findings.…”

“…Of those, only 1 was conducted in the United States. The results of those studies provide mixed support for the success of the birth plan as a tool of communication and trust 9–13 . The primary focus of earlier studies was on women's experiences and health care providers’ attitudes regarding birth plans.…”