Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial.

BACKGROUND: Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown. METHODS: This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs. RESULTS: A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001). CONCLUSION: SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.

Impact of SARS-COV-2 Infection on Maternal, Obstetric and Neonatal Outcomes in a Cohort of Vaccinated Women: A Pilot Study.

We aimed to investigate the impact of COVID-19 infection on maternal characteristics and obstetric and neonatal outcomes in a cohort of women in labor previously vaccinated who tested positive for SARS-CoV-2 infection, compared to aged-matched healthy controls. A retrospective case-control study was conducted among 66 women in labor. Clinical data were obtained from medical records. The attendance rates at childbirth and parenting classes, as well as the implementation of a birth plan, were significantly lower in the COVID-19 infection group (6.1% vs. 48.5%, <0.001; 6.1% vs. 33.3%, p = .005, respectively). Women with COVID-19 had a higher prevalence of prolonged postpartum hospital stay (33.3% vs. 9.1%, p = .016), and significantly higher prevalence of spontaneous preterm birth (27.3% vs. 1.09%, p = .006). Breastfeeding within the first 24 hr was also lower in women with COVID-19 (72.7% vs. 97.0%, p = .006). Maternal characteristics and neonatal outcomes are influenced by COVID-19 infection in vaccinated women. Complications include spontaneous preterm birth, prolonged postpartum hospital stay, and lack of breastfeeding within the first 24 hr. Childbirth education, parenting classes and implementing a birth plan may be associated with a decreased risk of COVID-19 infection.

Social work practice in perinatal palliative care: an overview.

Social workers in Perinatal Palliative Care (PPC) play an essential role in caring for birthing people carrying a baby with a life-limiting condition and their families. Perinatal palliative care is consistent with social work values concerning fostering quality of life and promoting social justice and access to care. Social workers play a multidimensional role in providing a holistic approach to caring for the birthing person, baby, and family. Although social workers may be part of an interdisciplinary care team, their role is not defined solely by the goals of the greater team, nor has it been discussed in depth in the perinatal palliative care literature. The purpose of this paper is to describe the knowledge, values, and skills essential to the role of the social worker in a hospital-based perinatal palliative care team. A case study will be used to illustrate the relevant practices, and implications are outlined.

Birth plan - legal and medical aspects.

A birth plan is a document that defines mother's preferences and expectations regarding childbirth and early puerperium. The purpose of the birth plan is to establish communication about mother's birth wishes and to properly convey them to the health care providers. With increasing computerization of society, birth plan is currently the subject of heated debate. In this article, we present historical view of the birth plan, as well as current legislation regarding the birth plan, as we do not consider legal awareness of obstetricians to be sufficient at the moment. The purpose of this article is to appeal to the professional public so they have up-to-date information about the birth plan, especially in discussions with patients, but also during forensic procedures. The preservation of excellent perinatological results under our circumstances is only possible by providing professional, empathetic and very intimate health care in hospital institutions.

Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth.

BACKGROUND: To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics. METHODS: The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability. RESULTS: Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important. CONCLUSIONS: Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.

Maternal-infant outcomes of birth planning: A review study.

The birth and delivery plan is the center of clinical communication between the pregnant woman and the midwife, which is in the scope of health care services and is designed and provided to specialists with the participation of the woman and her husband during pregnancy. This document reflects the preferences, expectations, and fears of pregnant women regarding the birth process. This study was conducted with the aim of determining the maternal and neonatal outcomes of the birth plan: a review study. In this review study, Persian databases Magiran, SID, and English databases Pubmed, Scopus, SID Elsevier, Web of Sciences, and Google Scholar search engine using English keywords including Maternal outcome, neonatal outcome, birth schedule, delivery plan, birth plan, and their Persian equivalents were searched from 2000 to 2022. Numerous studies were selected and analyzed in a quantitative and qualitative manner that was related to the purpose of the present study in terms of content. Among 948 articles, 13 of the most relevant ones were selected and analyzed for this study. The results of the review of the studies showed that the birth plan has an effect on women's empowerment, satisfaction with childbirth, positive experience of childbirth, cesarean section rate, epidural use rate, episiotomy rate, Apgar, and umbilical cord pH of the newborn. The maternal and neonatal consequences of the birth plan prevail over its negative consequences, and the use of the birth plan can increase women's empowerment, satisfaction with childbirth, positive experience of childbirth, and reduce the rate of cesarean section and negative maternal-neonatal consequences.

Promoting the participation of low-risk pregnant women in the child birth process by developing a birth plan: The protocol of an action research study.

BACKGROUND: The birth plan reflects the preferences and expectations of women in the delivery process and can be designed with the participation of women and her partner and implement as a basis for midwifery care during childbirth. This research was designed to promote the participation of low-risk pregnant women in the child birth process by developing a birth plan. MATERIALS AND METHODS: The present study is a participatory action research designed in a single specialized, main maternity hospital in Isfahan, Iran. This study was conducted in four stages proposed by the Kemmis, including planning, action, observation, and reflection with the participation of all midwives, gynecologists, and managers who involved in childbirth. CONCLUSIONS: Considering the importance of childbirth as an opportunity for participation and empowerment of women, it seems that designing a birth plan based on the preferences of these women and all people involved in this process can strengthen women's participation in child birth process.

Parental experiences of prenatal education when preparing for labor and birth of infant with a lethal diagnosis.

AIM: The aim of this study was to describe the unique experiences of parents facing a Life Limiting Fetal Conditions (LLFC) diagnosis, who chose to continue with their pregnancy, as they prepare for childbirth through individual and group prenatal education. DESIGN: A qualitative study. METHODS: We employed the phenomenological approach and the Colaizzi strategy to analyse semi-structured interviews. Thirteen persons were interviewed. The participants were couples (n = 6) and women (n = 7) who received LLFC and were preparing for birth. RESULTS: We described three main paths of prenatal education chosen by parents with LLFC: 'Searching for normality' concerned people participating in conventional prenatal classes (AC) who tried to avoid confronting the situation they faced; 'Searching for communitas' concerned the participation in special AC selected for the opportunity of sharing experiences; 'Searching for an individual way' concerned people who resorted to individual preparation for childbirth, often as a result of delayed planning. Parents should have a choice of various paths of birth preparation, that best meet their preferences.

O plano de parto como mecanismo de proteção do direito à autodeterminação da mulher em contexto obstétrico em Portugal / El pla de part com a mecanisme de protecció el dret a l'autodeterminació de la dona en context obstètric a Portugal / El plan de parto como mecanismo de proteccion el derecho a la autodeterminación de la mujer en contexto obstétrico en Portugal / The birth plan as a safeguard mechanism the right to self-determination of women in obstetric context in Portugal

A violência obstétrica constitui uma das formas de violência contra a mulhere seusdireitosà saúde, segurança, integridade físicaepsíquica, e, nos casos mais extremos, o direito à própria vida. Abordaremosa violência ocorrida no parto, através de insultos, falta de informação, desrespeito pela autonomia e autodeterminação da mulher e da violação do consentimento informado. A prática de procedimentos médicos como a episiotomia, excesso de medicação, privação de movimentos, manobras de Kristeller,entre outras, são potenciadoras de risco para a saúde e vida do próprio feto/criança. Afirmamos que a violência obstétrica é, em muitos casos, não apenas uma violência contra a mulher, mas também contra a criança. Os casos em que a criança venha a nascer com malformações ou doenças resultantes dos maus-tratos que a mãe sofreu no parto, geram responsabilidade médica. Recorremosa obras e a estudos na área do Direito, Bioética e Saúde Reprodutiva assim como, procedemos à análise exaustiva de diplomas legais internacionais e nacionais. Concluímos que a violência exercida contra a mulher no contexto obstétrico atenta frontalmente contra as leges artis medicinaee constitui uma forma de discriminação de género severa que merece censura legal por parte dosEstados e por parte da própria classe médica. Afirmamosque a episiotomia é atualmente qualificada como uma espécie de mutilação genital feminina, criminalmente punível. Defendemos que o direito a acompanhamento no parto e ao cumprimento do plano de parto elaborado pela mulher ou casal são dois mecanismos essenciais a atenuar ou a eliminar a violência obstétrica.(AU)

La violencia obstétrica es una formade violencia contra las mujeres, vulnerando derechoscomo la salud, seguridad, integridad físicaypsicológica, y, en los casos más extremos, el derecho a la vida.Abordaremos la violencia que se produce en el partoa través de insultos, falta de información, falta de respeto a la autonomía y autodeterminación de la mujer y violación del consentimiento informado. La práctica de procedimientos médicos como la episiotomía, medicación excesiva, privación de movimiento, maniobras de Kristeller, entre otros, son factores potenciales de riesgo para la salud y la vida del feto/niño. Afirmamos que la violencia obstétrica es, en muchos casos, no sólo violencia contra la mujer, sino también contra el niño. Los casos en que el niño nace con malformaciones o enfermedades resultantes del maltrato que la madre sufrió en el parto, generan responsabilidad médica. Recurrimos a trabajos en el área del Derecho, la Bioética y la Salud Reproductivay textos jurídicos internacionales y nacionales. Concluimos que este tipo deviolencia contra la mujer atenta directamente contra las leges artis medicinaey constituye una forma de grave discriminación de género que merece la censura jurídica de los Estados y de la propia profesión médica. Afirmamos que la episiotomía está calificada actualmente como un tipo de mutilación genital femenina, sancionable penalmente. Sostenemos que el derecho a estar acompañada durante el parto y a cumplir con el plan de parto elaborado por la mujer o la pareja son dos mecanismos esenciales para mitigar o eliminar la violencia obstétrica.(AU)

Obstetric violence is a form of violence against women, infringingrights such as health, safety, physical and psychological integrity, and, in the most extreme cases, the right to life. We will address violence during childbirth through insults, lack of information, lack of respect for women's autonomy and self-determination, and violation of informed consent. The practice of medical procedures such as episiotomy, excessive medication, deprivation of movement, Kristeller maneuvers, among others, are potential risk factors forthe health and life of the fetus/child. We affirm that obstetric violence is, in many cases, not only violence against the woman, but also against the child. Cases in which the child is born with malformations or diseases resulting from the mistreatment suffered by the mother during childbirth, generate medical responsibility. We refer to works in the area of Law, Bioethics and Reproductive Health and international and national legal texts. We conclude that this type of violence against women is a direct violation of leges artis medicinaeand constitutes a form of serious gender discrimination that deserves legal censure by States and the medical profession itself. We affirm that episiotomy is currently classified as a type of female genital mutilation, punishable under criminal law. We maintain that the rightto be accompanied during childbirth and to comply with the birth plan drawn up by the woman or partner are two essential mechanisms for mitigating or eliminating obstetric violence.(AU)

Preferences for labor and childbirth, expressed orally or as a written birth plan: Prevalence and determinants from a nationwide population-based study.

BACKGROUND: Shared decision-making is an important component of a patient-centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. METHODS: Data came from the 2016 National Perinatal Survey, a cross-sectional nationwide population-based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. RESULTS: The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59-3.03], and aOR 1.43; 95% CI [1.19-1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49-7.15], and aOR 2.27; 95% CI [1.98-2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. CONCLUSION: Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care.

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.

The role of birth plans for shared decision-making around birth choices of pregnant women in maternity care: A scoping review.

BACKGROUND: Birth plans can be used to facilitate shared decision-making in childbirth. A birth plan is a document reflecting women's preferences for birth, which they discuss with their maternity care provider. AIM: This scoping review aims to synthesize current findings on the role of birth plans for shared decision-making around birth choices of pregnant women in maternity care. METHODS: We conducted a scoping review using the Joanna Briggs Institute three-step search strategy in multiple databases PubMed, EMBASE, CINAHL, Web of Science, PsycINFO. We synthesized the results using a metasynthesis approach to identify themes and subthemes. RESULTS: From the 21 articles included, five themes were identified: birth plan as a tool for shared decision-making, autonomy, sense of control, professionalism of the care provider, and trust. Primarily, midwives seemed to use birth plans to explore and facilitate women's choices around birth. Other healthcare providers involved in studies were obstetricians and nurses. The interrelationship between care providers and women, the attitude of care providers and women towards each other and the birth plan, and how providers and women use the birth plan influence shared decision-making. DISCUSSION AND CONCLUSION: Birth plans can facilitate shared decision-making, and women's sense of autonomy and control before, during, and after giving birth. When discussing the birth plan, exploring different scenarios may help women prepare for unforeseen circumstances. This will likely facilitate shared decision-making even if the birth process is not unfolding as hoped for.

Using a scheduled caesarean birth plan: A cross-sectional exploration of women's perspectives.

PROBLEM: There is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth. BACKGROUND: Quality maternity care requires respect for women's preferences. Evidence suggests birth plans enable communication of women's preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome. AIM: Explore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital. METHODS: A cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis. FINDINGS: Over half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women's ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories. DISCUSSION: Findings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment. CONCLUSION: All women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.

O papel do enfermeiro especialista em saúde materna e obstetrícia na implementação do plano de parto / The role of the nurse specialist in maternal health and obstetrics in implementing the birth plan

O presente Relatório de Estágio permite demonstrar, de forma crítica e reflexiva, o percurso de aquisição e desenvolvimento de competências especializadas no âmbito da Unidade Curricular Estágio com Relatório, inserida no 12º Curso de Mestrado em Enfermagem de Saúde Materna e Obstetrícia da Escola Superior de Enfermagem de Lisboa. As grávidas e respetivas famílias continuam a encontrar nas maternidades públicas e privadas um excesso de medicalização e de intervenções. A assistência humanizada ao parto é a alternativa mais adequada ao modelo biomédico vigente, já que promove cuidados individualizados, mais acolhedores e humanos, que estimulam um ambiente menos medicalizado e intervencionista, e que respeitam a fisiologia do parto e da mulher. Humanizar o parto envolve tornar a mulher a protagonista do momento, dando-lhe o direito de escolha nas tomadas de decisão. O plano de parto surgiu com o intuito de humanizar os cuidados obstétricos, sendo um documento escrito elaborado pela grávida/casal que expressa as suas preferências relativas ao parto e puerpério imediato. A investigação tem demonstrado que promove a educação, comunicação, empoderamento feminino e a participação ativa das mulheres nos seus partos, contribuindo para uma experiência de parto positiva e satisfatória. Embora reconhecido internacionalmente, a implementação do plano de parto em Portugal continua a ser controversa devido à resistência dos profissionais e instituições de saúde. Assim, este relatório pretende enquadrar a evidência científica existente sobre a temática, centrando-se também em investigar a influência do plano de parto na satisfação da mulher com o seu trabalho de parto e parto. O referencial teórico norteador deste percurso formativo foi o Modelo de Enfermagem de Laurie Gottlieb denominado O Cuidar em Enfermagem Baseado nas Forças. A metodologia usada consistiu na realização de uma scoping review, segundo as orientações do Joanna Briggs Institute com a questão de pesquisa "Qual a influência do plano de parto na satisfação da mulher com o seu trabalho de parto e parto?", e de um estudo empírico, na maternidade onde decorreu o Estágio com Relatório, com o intuito de conhecer a perceção de mulheres sobre o plano de parto e respetiva experiência de utilização. Da análise dos resultados obtidos constatou-se que o plano de parto é uma ferramenta promotora de uma experiência de parto positiva, associando-se a uma melhor preparação para o parto, melhor comunicação com os profissionais de saúde, melhor atendimento das expetativas e maior participação nas experiências de parto. Os resultados evidenciaram também a baixa implementação deste documento nas maternidades.

This document allows to demonstrate, in a critical and reflective way, the path of acquisition and development of specialized skills within the scope of the Curricular Unit Internship with Report, inserted in the 12th Master's Course in Maternal Health and Obstetrics Nursing at the Lisbon Nursing School. Pregnant women and their families continue to find in public and private maternity hospitals an excess of medicalization and interventions. Humanized childbirth care is the most appropriate alternative to the current biomedical model, as it promotes individualized, more welcoming and humane care, which encourages a less medicalized and interventionist environment, and which respects the physiology of childbirth and women. Humanizing childbirth involves making women the protagonists of the moment, giving them the right to choose when making decisions. The birth plan emerged with the aim of humanizing obstetric care, being a written document prepared by the pregnant woman/couple that expresses her preferences regarding childbirth and the immediate puerperium. Research has shown that it promotes education, communication, female empowerment and the active participation of women in their births, contributing to a positive and satisfying birth experience. Although internationally recognized, the implementation of the birth plan in Portugal continues to be controversial due to the resistance of health professionals and institutions. Thus, this report intends to frame the existing scientific evidence on the subject, also focusing on research on the influence of the birth plan on women's satisfaction with their labor and childbirth. The theoretical framework guiding this formative path was Laurie Gottlieb's Model of Nursing called Strengths-Based Nursing Care. The methodology used consisted of carrying out a scoping review, according to the guidelines of the Joanna Briggs Institute with the research question "What is the influence of the birth plan on the woman's satisfaction with her labor and childbirth?", and an empirical study, at the maternity hospital ward where the Internship with Report took place, with the aim of knowing the perception of women about the birth plan and respective experience of use. From the analysis of the results obtained, it was found that the birth plan is a tool that promotes a positive birth experience, associating with better preparation for childbirth, better communication with health professionals, better meeting expectations and greater participation in childbirth experiences. The results also showed the low implementation of this document in maternity hospitals.

Implementation of birth plans integrated into childbirth preparation classes for vaginal birth: a qualitative study of women, their husbands and clinicians' perspectives in Iran.

BACKGROUND: Understanding women's experience of birth planning is necessary for introducing and implementing this process in the Iranian maternity services. This study aims to explore perceptions of birth plan implementation in Iran from the perspective of women, their husbands, and clinicians. METHODS: This qualitative study was conducted in Iran. Qualitative data were collected from November 2020 to March 2021 by conducting semi-structured in-depth interviews with ten mothers who prepared a birth plan, and 15 key informants (obstetricians, midwives, and husbands) who were involved in the implementation process of birth plans. Data were analyzed using conventional qualitative content analysis. RESULTS: Data reduction process resulted in 380 codes that were categorized in 16 subcategories and five main categories. The main categories were "Guide and pattern of preparing for childbirth pathway", "Maternal empowerment and sense of triumph", "Facilitating and enhancing communication", "Successful transition to parenthood and women's satisfaction", and "Challenges associated with implementation of the birth plan". The overarching theme "Birth plan: The missing link in promotion of vaginal birth in Iran" was constructed from these categories. CONCLUSION: Findings of this study highlight the effectiveness of the implementation of birth plan along with childbirth preparation classes for increasing the likelihood of a successful vaginal birth and promoting empowerment and satisfaction in women during the childbirth process. The findings of this study could pave the way for developing, introducing, and implementing of birth plan in Iran.

Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial.

BACKGROUND: The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes. METHODS: This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze. RESULTS: The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group. CONCLUSION: This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020.

Birth plans: A systematic, integrative review into their purpose, process, and impact.

BACKGROUND: The birth plan was introduced in the 1980s to facilitate communication between maternity care providers and women and increase agency for childbearing women in the face of medicalised birth. Forty years on, the birth plan is a heterogeneous document with uncertainty surrounding its purpose, process, and impact. The aim of this review was to synthesise the evidence and improve understanding of the purpose, process and impact of the birth plan on childbearing women's experiences and outcomes. METHODS: This systematic review followed the PRISMA guidelines. A comprehensive search strategy was designed and applied to electronic databases CINAHL, MEDLINE, PsychINFO, Cochrane Library, Scopus, and ClinicalTrials.gov. Articles were appraised using the Crowe Critical Appraisal Tool and a five-step integrative approach to analysis followed. FINDINGS: Eleven articles were identified, all quantitative in nature. It is clear that the general purpose of birth plans is communication, with decision making a key factor. Even though the processes of birth planning were varied, having a birth plan was associated with generally positive birth outcomes. CONCLUSIONS: Despite the heterogeneity of birth plans, birth plans were associated with positive outcomes for childbearing women when developed in collaboration with care providers. The act of collaboratively creating a birth plan may improve obstetric outcomes, aid realistic expectations, and improve satisfaction and the sense of control.

The Birth Plan Experience-A Pilot Qualitative Study in Southern Spain.

BACKGROUND: Healthcare systems advocate for quality care and humanized relations in routine birth care, and have therefore created the Birth Plan, a document available to pregnant women to state their preferences in relation to the birth process. METHODS: This qualitative research with a phenomenological design was carried out to record the experiences of women who presented a Birth Plan. Sample selection was carried out using non-probabilistic, intentional and convenience sampling, selecting seven participants who were willing to participate and share their experiences. RESULTS: After analyzing the content of the interviews, four categories emerged: "respecting the woman's wishes: humanizing the birth process", "information and primary Care", "expectations regarding the care received" and "results of using the birth plan", with their corresponding subcategories. CONCLUSION: Women consider it beneficial to present a Birth Plan, because it informs them about the process and gives them the opportunity to have a better experience, which takes into account their preferences for making the delivery less instrumental. In addition, they state the importance of having trained professionals involved, and call for more attention to be paid to the birth process in general.

The complex effects of maternal expectations on postpartum depressive symptoms: when does a protective factor become a risk factor?

PURPOSE: The present study assessed the effects of several prenatal maternal expectations on postpartum depression (PPD), while considering two relevant factors - incongruence between planned and actual birth and the rigidity of the birth plan - that can affect whether maternal expectations act as protective factors or risk factors for PPD. METHODS: Primiparous women (N = 527) were recruited to a longitudinal study about women's birth choices and experiences. At time 1, during pregnancy, women completed a questionnaire assessing prenatal depression, preferred birth plan, birth plan flexibility-rigidity and maternal expectations (i.e. Natural-Fulfillment, Infant-Reflects-Mothering, Sacrifice). At time 2, two-months post-partum, they reported their actual birth mode and answered a questionnaire assessing their PPD symptoms. RESULTS: Natural-fulfillment maternal expectations were negatively related to PPD symptoms. Yet, the interaction of high natural-fulfillment expectations with an unfulfilled birth plan and the rigidity of the birth plan, served as a risk factor for PPD symptomatology. CONCLUSIONS: Understanding the conditions under which specific prenatal maternal expectations serve as a risk factor for PPD, can help healthcare providers identify women who are at high risk for developing PPD symptoms and plan preemptive interventions.