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.