O19 - Planning for caesarean: supporting woman-centred care through a formal birth plan

Abstract

The use of birth plans as a mechanism to communicate preferences, particularly in labour and birth, is commonplace in contemporary maternity care. There is little evidence regarding the role of birth plans in elective caesarean birth. This study aimed to explore insights from women who utilised hospital-initiated birth plans for their scheduled caesarean section and from the midwives who provided care to women using the plans. A cross-sectional survey was undertaken between September 2019 and July 2020; 294 women and 18 midwives responded. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using content/template analysis. Women responded to a series of discrete choices such as music playing in theatre, screen being lowered on request and skin-to-skin post-birth. Most indicated they received the care requested. Qualitative responses provided insight into the utility of the plan to facilitate communication with professionals, which improved women’s experience of being in control, exercising choice and emphasising the importance of their special day. Midwives indicated the value of the plan to provide advocacy for women’s choices; while systemic factors that inhibited full implementation of a plan were highlighted. Using a formal plan to communicate requests when preparing for elective caesarean birth has utility in supporting women to effect choice and control, especially when not receiving care in a continuity model. A plan enables the responsibility for awareness and implementation of each woman’s wishes to rest with the whole multidisciplinary team. Scheduled caesarean birth requires the same individualised approaches to woman-centred care that is the hallmark of midwifery. Findings of this novel study are useful to consider education, multidisciplinary practice changes and policy support for ways of respecting the uniqueness of caesarean birth for each woman and her family.