Effectiveness of birth plan counselling based on shared decision making: A cluster randomized controlled trial (APLANT)

Abstract

Background A birth plan (BP) is a written document in which the pregnant woman explains her wishes and expectations about childbirth to the health professionals and aims to facilitate her decision-making. Midwives’ support to women during the development of the BP is essential, but it’s unknown if shared decision making (SDM) is effective in birth plan counselling. We hypothesized that women who receive counselling based on SDM during their pregnancy are more likely to present their BP to the hospital, more satisfied with the childbirth experience, and have better obstetric outcomes than women who receive standard counselling. We also aimed to identify if women who presented BP to the hospital have better obstetric outcomes and more satisfied with the childbirth experience. Methods This was a randomised cluster trial involving four Primary Care Units. Midwives provided BP counselling based on SDM to the women in the intervention group (IG) during their pregnancy, along with a leaflet with evidence-based recommendations. Women in the control group (CG) only received the standard birth plan counselling from midwives. The primary outcomes were birth plan presentation to the hospital, obstetrics outcomes and satisfaction with childbirth experience. The Mackey Satisfaction with Childbirth Scale (MCSRS) was used to measure childbirth satisfaction. Results A total of 461 (95.5%) pregnant women received BP counselling (IG n = 214 and CG n = 247). Fewer women in the intervention group presented their BP to the hospital compared to those in the control group (57.8% vs 75.1%; p <0.001). Mean satisfaction with childbirth experience was high in the IG as well as the CG: 150.2 (SD:22.6) vs. 153.4 (SD:21.8); p = 0.224). The information received about childbirth during pregnancy was high in both groups (95.1% vs 94.8%; p = 1.0). Fewer women in the IG used analgesia epidural compared to those in the CG (84.7% vs 91.7%; p = 0.034); women who combined non-pharmacological and pharmacological methods for pain relief were more in number in the IG (48.9% vs 29.5%; p = 0.001) and women who began breastfeeding in the delivery room were more in number in the IG (83.9% vs 66.3%; p = 0.001). Women who presented their BP had a greater probability of using combined non-pharmacological and pharmacological methods for pain relief aOR = 2.06 (95% CI: 1.30–4.30) and early skin-to-skin contact aOR = 2.08 (95% CI: 1.07–4.04). Conclusion This counselling intervention was not effective to increase the presentation of the BP to the hospital and women’s satisfaction with childbirth; however, it was related to a lower usage of analgesia epidural, a higher combination of pharmacological and non-pharmacological methods for pain relief and the initiation of breastfeeding in the delivery room. Presenting the BP to the hospital increased the likelihood of using pharmacological and non-pharmacological methods for pain relief, and early skin-to-skin contact.

Effectiveness of shared decision‐making for mode of delivery after caesarean section: A systematic review and meta‐analysis of randomized controlled trials

“…2022 (Eden et al, 2014;Hadizadeh-Talasaz et al, 2021;Kuppermann et al, 2020;López-Gimeno et al, 2022;Montgomery et al, 2007;Shorten et al, 2005;Wise et al, 2019). Among the seven studies, one was from the United Kingdom, one was from the United States, one was from Australia, two were from Spain, one was from Iran and one was from New Zealand.…”

“…Three (Hadizadeh-Talasaz et al, 2021;Montgomery et al, 2007;Shorten et al, 2005) of the seven studies were rated as high risk due to inappropriate randomization procedures, deviation from the intended intervention, measurement of the outcome results, missing data and the choice of reported outcomes. Four (Eden et al, 2014;Kuppermann et al, 2020;López-Gimeno et al, 2022;Wise et al, 2019) were judged to have some concerns due to the choice of reported outcomes (Figure 4). The overall GRADE SoF table score was low due to heterogeneity and indirectness (Supplementary File 3).…”

“…control group received standard VBAC care. At the initial consultation, the women discussed their previous delivery experiences with midwives and obstetricians, a four-page educational booklet was provided to review the risks and benefits of planned VBAC or ERCS and a comprehensive consultation was conducted (López-Gimeno et al, 2022). Midwives provided standard consultations related to the BP during prenatal control visits.…”

Women's autonomy for managing labour pain in a relational context: An interpretive description study

“…Experiencing pain during the birthing process, which is unpredictable, requires decisions about how to manage it. Shared decisions between women and healthcare providers can minimise decisional conflicts involving autonomy and beneficence and improve women's relational autonomy for decisions (López‐Gimeno et al, 2022; Mann & Sutton, 2021). The concept of autonomy recognises that people are not entirely independent but interconnected beings whose identities and interests are framed by their relationships with others (Dove et al, 2017).…”