Birth Plans: An opportunity for women to be autonomous, seek choice and feel in control of their childbirth experiences: an integrative literature review

Abstract

Overview:
Birth plans are tools to facilitate women to write down, negotiate and communicate their needs. Birth plans help women to participate in informed decision-making and maintain control in their childbirth experience. The World Health Organisation (WHO), goes on to classify the use of birth plans in the top category of recommended practices for making pregnancy safer. However, despite such recommendations, there seems to be a lack of consensus on the impact of birth plans on womens physical and psychological outcomes of childbirth.

Aims and Objectives:
The aim of this review was to collect, analyse and summarise results of studies that might indicate that the formulation of a birth plan in the antenatal period can potentially empower women to feel autonomous, in control and thus able to participate in shared decision-making during childbirth.

Method:
Guided by the inclusion and exclusion criteria, a comprehensive literature review was carried out involving 15 primary literature. The selected studies were critically analysed using specific critical appraisal tools with the aim to answer the research question.

Results:
Findings from this review were drawn from the 2,078 participants of which 1,231 were primiparous and 621 were multiparous. No details on parity was given on the remaining 226 participants. Two themes emerged: Theme One of the experiences of completing a birth plan with 4 further sub-themes: maternity care system, multidisciplinary team relationship and philosophy of birth, personal education and preparedness and feeling of empowerment and control. Theme Two- the experiences of using a birth plan in labour with 3 further sub-themes: health professionals mindfulness to womens birth plan, implementing the birth plan during labour and healthcare professional attitude towards the birth plan. Findings from this review suggests that the potential positive outcomes of completing a birth plan antenatally might not match the outcomes of women using a birth plan in labour. One might say that there could be is a gap between what the birth plan is meant to be offering women (a sense of empowerment and feeling of control enabling them to participate in decision-making) and what in effect they are might experiencing (a secondary effect of negative emotions circling around unrealistic expectations, disappointment and dissatisfaction with their experience).

Conclusion:
There is reason to believe that birth plans are not limited to midwifery practice alone but are in fact becoming common occurrence in obstetric care. Hence, rather than being the exception, there is evidence to suggest incorporating the birth plan as part of the woman’s maternity care. This review reinforces findings of other studies in that even when birth events do not go according to the birth plan, because women are given the opportunity to negotiate changes to their birth plan and voice their needs, regardless of the birth outcome women will recall a positive birth experience. This review proposes further research on midwives and obstetricians’ views on the concept of the birth plan, and highlights the need to organised Continuous Professional Development (CPD) study days for all maternity care providers on the use and importance of birth plans to help disseminate and bridge the gap between misconception and evidence-based practice.