Birth Plan Research Articles

Maternity care priorities for prevention of psychological birth trauma in Iran: A Delphi consensus study

Background & Aim: Promoting maternal mental health is achievable through prevention of psychological birth trauma (PBT). This study aimed to investigate experts’ opinion on best strategies in prevention of PBT among childbearing women. Methods & Materials: This Delphi, systematic interactive research was conducted in Tehran, from July to November 2017. Delphi technique and policy dialogue was used to prioritize pre-defined PBT prevention strategies which had been identified in our previous studies. 13 experts were included in the Delphi. After two rounds, panelists had come to consensus on strategies’ priorities; they rated each strategy. Priority of strategies was set based on scores. Strategies with total mean of ≥9 and interquartile range (IQR) of ≤2 were entered to the next stage. At the last stage of consensus, a 4-hours meeting was held with seven policy makers; four top strategies were selected by consensus of the all members. Results: From 38 initial strategies, nine with the mean of ≥9 were identified as the top ones. At the policy dialogue meeting, four strategies were selected: continuous support during childbirth, practical childbirth preparation classes, group prenatal care, and preparing individual birth plan in antenatal visit. Conclusion: According to the experts, top four strategies can be combined in an integrated program. All these services will be provided at Primary Health Care facilities. These strategies are suggested in supporting maternity care in Iran and other developing countries to promote maternal mental and physical health.

"It Can't Be Like Last Time" - Choices Made in Early Pregnancy by Women Who Have Previously Experienced a Traumatic Birth.

Background: A significant number of women experience childbirth as traumatic. These experiences are often characterized by a loss of control coupled with a perceived lack of support and inadequate communication with health care providers. Little is known about the choices women make in subsequent pregnancy(s) and birth(s), or why they make these choices. This study aimed to understand these choices and explore the reasons behind them.Methods: A longitudinal grounded theory methods study involving nine women was conducted. Over half of the participants had a formal diagnosis of post-traumatic stress disorder (PTSD) and/or PND related to the previous birth. Interviews were carried out at three timepoints perinatally. These findings are from the first interviews at 12–20 weeks.Results: From the first days of pregnancy, this cohort of women were focused on concerns that this birth would be a repeated traumatic experience. The women were deliberately searching out and analyzing information about their choices in this pregnancy and birth, and making plans which had two aims; firstly to avoid a repeat of their previous birth experience and secondly to avoid a loss of control to other people during the birth. The women considered a range of birth choices, from elective cesareans to freebirth. Some women felt well supported by those around them, including care providers, partners, friends, and family. Others did not feel supported and were anticipating conflict in trying to assert their birth choices. Many early relationships with healthcare professionals were characterized by fear and mistrust.Discussion: If women who have previously experienced a traumatic birth become pregnant again, they have a strong desire to avoid a repeat experience and to feel in control of their birth choices. Access to robust information appears to help reduce uncertainty and arm women in their discussions with professionals. Similarly making plans and seeking to have them agreed with care providers at an early stage is used a way to reduce the risk of having a further traumatic experience. Implications for practice include supporting women in formulating and confirming pregnancy and birth plans at an early stage to reduce uncertainty and foster a sense of control.

Association of the Great East Japan Earthquake and the Daiichi Nuclear Disaster in Fukushima City, Japan, With Birth Rates

ImportanceThe association of the Great East Japan Earthquake and the subsequent Fukushima Daiichi Nuclear Power Plant disaster of March 11 and 12, 2011, in Fukushima, Japan, with birth rates has not been examined appropriately in the existing literature.ObjectiveTo assess the midterm and long-term associations of the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster with birth rates.Design, Setting, and ParticipantsCohort study in which interrupted time series analyses were used to assess monthly changes in birth rates among residents of Fukushima City, Japan, from March 1, 2011, to December 31, 2017, relative to projected birth rates without the disaster based on predisaster trends. Birth rates from January 1, 2007, to December 31, 2017, in Fukushima City were determined using information from the Fukushima City government office.ExposureThe Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster, expressed via 5 potential models of the association with birth rate: level change, level and slope changes, temporal level change, and temporal level change with 1 or 2 slope change(s).Main Outcomes and MeasuresBirth rate, calculated from monthly data on the number of births and total population.ResultsThe mean birth rate before the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster was 69.8 per 100 000 people per month; after the disaster, the mean birth rate was 61.9 per 100 000 people per month. Compared with birth rates before the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster, there was an estimated 10% reduction in monthly birth rates in Fukushima City (rate ratio, 0.90; 95% CI, 0.86-0.93) in the first 2 years after the disaster. After that, the birth rate trend was similar to the predisaster trend. The predisaster trend suggested a continuous decrease in birth rate (rate ratio for 1 year, 0.98; 95% CI, 0.98-0.99). This gap model was optimal and parsimonious compared with others. A similar association was found when trimonthly averaged data were analyzed.Conclusions and RelevanceThe Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster were followed by significant reductions in birth rates for 2 years. There was insufficient evidence to indicate that the trend in the 3 to 7 years after the disaster differed from the predisaster trends. The recovery from the reductions in the birth rate may be indicative of the rebuilding efforts. The continuing long-term decrease in birth rates observed before the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant disaster suggests that continuing measures to support birth planning should be considered at the administrative level.

Effect of birth plans on childbirth experience: A systematic review.

The birth plans were developed as an approach for pregnant women to present their expectations for labour and childbirth. The aim of this study was to assess whether birth plans (a written document in which pregnant women describe preferences about their care during labour and childbearing) compared with standard or routine approach (supine position, continuous fetal monitoring, enema, episiotomy) affect the birth experience (woman's perception of labour and childbirth as positive or negative experience) or satisfaction with birth. This systematic review was performed by searching several databases, including Cochrane Library, Web of Science, MEDLINE, Embase, CINAHL, Scopus, PsycINFO, ACP Journal Club, Google Scholar, and Persian databases (SID, Magiran, and Barakat) up to February 10, 2018. By searching the databases, 1006 published articles were found, of which 480 and 114 articles were excluded by review of the titles and the abstracts, respectively. Finally, we included three clinical trials (1132 women) in the review. The results of two study showed that the mean score of birth experience in the birth plan group was significantly higher than the control group (P≤0.01). However, the results of a study showed that there were no statistically significant differences between birth plan and control groups (P>0.05). Quality of included studies was very low. There is not enough evidence to support or refute that birth plan can improve the birth experience or satisfaction with birth.

Pushing for Empowerment

The birth plan has become an increasingly institutionalized tool of Western birth practices, used both in medicalized and midwifery settings. Limited empirical research has been done on the efficacy of birth plans in achieving a commonly-ascribed goal: empowering women in their birth experiences. Still, less work has been done on the ethical dimensions of birth plans. As such, this tool has become nearly ubiquitous in birthing practices, yet they warrant further reflection. In this paper, I articulate the ethical goals of writing birth plans. I frame the birth plan as a narrative project: one that women are encouraged to write out, after careful consideration, as a kind of story that articulates the values, experiences, and relationships that are most important to shaping their experience of a “good birth.” Given the importance of the birth experience for many women, birth plans are ethical projects that the attempt to reframe and improve the deeper political dimensions of birth and patient choice. Birth plans are meant to structure the experience, guide women’s understanding of the process, and foster important clinical relationships. In this way, they are similar to advance directives, which are written to shape successful end-of-life care. Yet, the success of birth plans as tool for this ethical work is questionable. This tool aiming at women’s empowerment and ethical self-reflection often sets women up for a kind of ethical injury, in the attempt to avoid unwanted physical harms of labor and delivery. Birth plans are not legally binding, despite how they are framed as pseudo-contracts. Instead of resisting the challenges of a medicalized birth and to be empowered agreements, birth plans often set women up to fail, often aiming at unreasonable expectations. In my argument, I ask to identify for whom the birth plan works, and in which ways the birth plan experience can be improved. Finally, I address how the failure to give birth plans uptake during emergencies often undermines the patient-physician relationship, working against the primary goal of empowerment.

Birth Plans and Childbirth Education: What Are Provider Attitudes, Beliefs, and Practices?

We describe the perception and practices of obstetric providers on birth plans and childbirth education (CBE) classes. Using a national online survey, we collected provider and patient demographics, practice settings, and perceptions. Of 567 surveys, 77% were physicians and 22% were midwives. This cohort believed prenatal care and CBE were predictors of patient satisfaction, while they had unfavorable views of birth plans. Most providers routinely recommended (69.7%) and had favorable views on CBE (84%). Most providers (66.5%) did not recommend birth plans and 31% felt they were predictors of poor obstetrical outcomes. Further research is needed to bridge the gap between provider beliefs and patient desires about their birth experience as well as to understand how to improve childbirth-related patient satisfaction.

Individual birth planning as a teaching-learning strategy for good practices in obstetric care.

To verify students' knowledge about individual birth planning and learn their opinion about the use of this teaching-learning strategy for good obstetric practices. This is a descriptive study conducted with midwifery students who made primary health care internships. Data collection was performed digitally from 01/2017 to 05/2017 through the Google Forms®Platform. The analysis was performed by descriptive categorization statistics of statements. The study followed the required ethical standards. The form was sent to 97 students and answered by 40% of them. All respondents reported knowing the birth planning, and 87% applied it during prenatal care. The most frequent (45%) points about the birth plan were those that promoted women's empowerment and autonomy. The most cited methodological suggestions for its application were to focus on content (76%) and increase the number of meetings (50%). Individual birth planning was recognized by 79% of the participants as an important teaching strategy. In addition to knowing birth planning and applying it, the students consider it very relevant for teaching and learning good obstetrical practices.

Repercussions of using the birth plan in the parturition process.

To analyze the repercussions of using the Birth Plan in the parturition process from the national and international scientific production. Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018. The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment. The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women's adherence and professional support to improve the fulfillment of the Birth Plans.

Birth Preparedness for Safe Delivery, Readiness Planning and Associated Factors Among Mothers in North India: A Cross-Sectional Study in Bihar, India

Objectives: Birth Preparedness and complication readiness (BPCR) is a comprehensive strategy to improve the use of skilled providers at birth, based on the theory that helps women to consider all available maternal health care services during pregnancy and prepare for potential complications. Even though there are no adequate evidences on determinant factors, women and newborn need timely access to skilled care during pregnancy, childbirth, and the postpartum period. This paper aims to identify factors associated with the practice of birth preparedness and complication readiness plan among women in Bihar. Objectives: The objectives of the study were to assess the knowledge and practices regarding birth preparedness for safe delivery; and to identify the triggers and barriers for the program intervention activities. Study Design: Study design includes a cross sectional survey among the various categories of respondents including the mothers. A multi-staged cluster sampling approach used, sample size of 7646 respondents spread across 200 primary sampling units (PSUs) from Bihar, India. Methods: Community-based cross-sectional study was conducted. Pregnant women, mothers of children and mother in laws of respondents were randomly selected and interviewed using pretested structured questionnaire. The data was collected using CAPI questionnaire and analyzed using SPSS. Descriptive statistics were reported, and bivariate and multivariable logistic regression carried out to see the effect of each independent variable on the dependent variable. Results: The study reveals that the awareness on danger signs of pregnancy, when to start planning for the delivery is fairly low. The knowledge to keep the important information that might be required in emergency viz. phone numbers of frontline worker ASHA handy has been found to be minimal. The key influencer within the family i.e. respondents’ mothers-in-law who are also the main source of information have poor awareness on birth preparedness. The interactions with the frontline workers are low. Timely identification and registration of pregnancy with ASHA and seeking information on birth planning act as triggers for birth preparedness. Conclusions: The program interventions are required to improve awareness about birth preparedness including emergency preparedness, danger signs during pregnancy, across all the mothers, more particularly socially marginalized groups. There is a need to mobilize the frontline workers and increase the interaction between the beneficiaries and FLWs to clarify the benefits of preparing for the delivery in advance.

Exploring stakeholder's perception about factors affecting on implementation of physiologic birth plan: A qualitative approach

Context: Following the increase in cesarean section rate in Iran, the Ministry of Health and Medical Education has planned a program for the promotion of normal birth. The plan named as “physiologic birth” that is equal with “spontaneous labor.” Aims: This study aims to explain factors affecting the implementation of “physiologic birth plan from stakeholders” view. Setting and Design: In this qualitative study, purposive samples of 21 health-care stakeholders (2 men and 19 women) were interviewed in 2016. The participants included three obstetricians and gynecologists, six midwives, three managers and experts in charge of the plan at the Mazandaran University of Medical Science, and nine women who gave birth under the physiological delivery (Spontaneous Labor) plan. Materials and Methods: Face-to-face semi-structured interviews and one focus group discussion were employed to collect the study data. Statistical Analysis Used: Qualitative content analysis method was used. Results: From the data analysis, the main theme “integrity of designing and implementation” and five subthemes as the influencing factors, namely, The “inadequate resources,” “ambiguity in tasks and roles,” “attention to psychosocial atmosphere,” “considering of the delivery culture,” and “incomprehensive training and updating the plan,” were extracted. Conclusion: This research suggests that the success behind implementing a plan in health-care system including the physiological delivery plan depends on the factors that are requiring should be identified and investigated from the designing stage to the implementation stage and after that. Thus, health system policymakers and planners are required to pay attention to diverse above-mentioned aspects in its designing and implementation.

Health-seeking behaviour among antenatal and postnatal rural women in Kancheepuram District of Tamil Nadu: A cross-sectional Study.

Introduction:Maternal morbidity and mortality is still a major public health challenge. Lack of proper birth plan and delay in identification of pregnancy complications is one of the major causes of maternal morbidities and deaths, especially in the rural areas.Aim:The study was conducted with the aim to evaluate the health-seeking behaviour for obstetric care services among the antenatal and postnatal mothers in a rural area of Tamil Nadu.Materials and Methods:This descriptive cross-sectional study was done among antenatal and postnatal mothers registered in the Rural Health Training Centre, in Sripuram area of Kancheepuram district, Tamil Nadu during 2017. About 150 antenatal and 150 postnatal mothers were selected by simple random sampling method. A pre-tested structured questionnaire was used to collect relevant data which was analysed using the SPSS version 22.Results:Only 21% of the study participants had adequate knowledge regarding the danger signs of pregnancy and the major determinants were maternal literacy and adequate prenatal care. Regarding the health-seeking behaviour, 62.3% of them preferred primary health centres as preferred place of delivery, 87.3% of them had received adequate prenatal care and it was found to have statistically significant association with adequate gestational weight gain, exclusive breastfeeding, proper weaning practices and consumption of iron and folic acid supplements.Conclusion:The study shows the need to provide health education regarding the danger signs of pregnancy and importance of adequate prenatal care to all pregnant women and expectant mothers, to make them aware of when and how to seek medical care, which in turn could reduce the overall maternal morbidity and mortality.

Socio-Demographic and Maternal Determinants of Birth Preparedness among Pregnant Women Seeking Skilled Birth Services at a Rural General Hospital, Mid Western Uganda

Background: Although the practice of preparing for childbirth among pregnant women is associated with 24.0% and 53.0% reduction in neonatal and maternal mortality respectively in low income countries, it remains inadequately practiced in Uganda. This study sought to assess socio-demographic and maternal determinants of birth preparedness among pregnant women at one of the rural hospitals in Uganda. Methods: This was a descriptive cross sectional study conducted among 332 pregnant women in first stage of normal labour between April and May 2017 at Kagadi hospital, mid western Uganda. In order to understand socio-demographic and maternal determinants of birth preparedness, we considered overall level of birth preparedness as our dependent variable and determined it using five elements. Data were collected using a researcher administered questionnaire. We used descriptive statistics to understand characteristics of respondents and multivariable logistic regression model to determine factors associated with birth preparedness. Results: Only 94 (28.3%) of the 332 pregnant women who were included in the study were prepared for childbirth. We found that male partners having secondary level of education (aOR 1.86, CI 1.107 - 3.243, p 0.02), discussing birth plan with spouse (aOR 1.97, CI 1.06 - 3.490, p 0.03), monthly income of at least eighty three dollars (aOR 2.98, CI 1.847 - 5.981, p 0.002), being escorted by the spouse during ANC visit (aOR 1.73, CI 1.010 - 2.964, p 0.04), intention to conceive (aOR 1.99, CI 1.087 - 3.65, p 0.026) and being health educated about birth preparedness during antenatal visit (aOR 1.90, CI 1.006 - 3.59, p 0.048) were associated with birth preparedness. Conclusion and Recommendations: We observed that the level of birth preparedness among respondents was associated with many socio-demographic and maternal factors. To scale up birth preparedness in rural settings, we recommend improving household financial income, reducing contraceptive unmet needs, male involvement and health education services to couples during antenatal visits.

309: The impact of a birth plan on maternal and neonatal delivery outcomes

309: The impact of a birth plan on maternal and neonatal delivery outcomes

China's Missing Children: Political Barriers to Citizenship through the Household Registration System

AbstractApproximately 13 million Chinese lackhukou, the formal household registration. This prevents them from claiming full citizenship rights, including social welfare, formal identity documents and employment in the state sector. The government blames birth planning policies for the unregistered population, but this explanation ignores the role of internal migration. Because citizenship rights are locally determined and thehukousystem is locally managed, migrants face significant barriers to registering their children. This article systematically analyses the political determinants of the unregistered population nationwide. Based on a logit analysis of a sample of 2.5 million children from the 2000 census, I find that children born in violation of the one-child policy do have lower rates of registration and that children born to migrant mothers are four times more likely to be unregistered than registered. Continuing government focus on the effect of birth planning ignores the more fundamental institutional barriers inherent in thehukousystem.

Fear of birth: Prevalence, counselling and method of birth at five obstetrical units in Norway

BackgroundThere is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth. AimTo examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth. MethodSource data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of ≥85 was used to define fear of birth. ResultsIn total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section. ConclusionThere were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.

Birth Plans—Impact on Mode of Delivery, Obstetrical Interventions, and Birth Experience Satisfaction: A Prospective Cohort Study

(Birth. 2018;45:43–49) Birth plans are intended to serve as a communication tool between women and their providers. Patient involvement in decision-making during childbirth has been positively associated with patient satisfaction with birth. However, one study found more than half of medical personnel believed the presence of a birth plan predicted worse outcomes, while only 2% of pregnant women believed birth plans were associated with worse outcomes. There is a lack of research on birth outcomes in the presence of birth plans. The authors of this study hypothesized women with birth plans would have fewer obstetrical interventions, fewer cesarean deliveries, and greater satisfaction with their birth experience.

The Relationship Between Women’s Intention to Request a Labor Epidural Analgesia, Actually Delivering With Labor Epidural Analgesia, and Postpartum Depression at 6 Weeks: A Prospective Observational Study

(Anesth Analg. 2018;126:1590–1597) At the Beilinson Campus of the Rabin Medical Center in Petach Tikva, Israel, a proportion of women who intend to deliver with labor epidural analgesia (LEA) are often unable to receive it due to a lack of available nursing staff, labor rooms, or anesthesiologists at the time of request. As there is no study to date that has specifically examined the relationship between birth plan, satisfaction with LEA, and development of postpartum depression (PPD), the authors of the present study examined the impact of delivering without analgesia when such was not the intended plan. They hypothesized that the PPD rate at 6 weeks would be highest among women who intended to deliver with LEA but who actually delivered without.

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

AyoWahlbergGood Quality: The Routinization of Sperm Banking in ChinaBerkeley, CA: University of California Press, 2018. 248 p. $34.95 (pbk.)

Care of Women with Obesity in Pregnancy

Care of Women with Obesity in Pregnancy

PENYULUHAN KELAS IBU HAMIL TENTANG P4K

Birth Planning and Complication Prevention (P4K) Program with Stickers isan breakthrough effort in accelerating the decline in the death rate of mother andnewborn baby. The Activity build on potential of the community, to preparation andsave the mothers and newborn baby. Based on preliminary survey at clinic prumnas doresearcher interview not structur to 8 pregnant women including two pregent womenwho have been putting up stickers P4K and 6 pregnant women have not planned andhave not stick to P4K Stiker at home. Objective to know how the class counselingpregnant woment to knowledge and participation of expectant mother with theinstallation of the program on a p4k sticker. This type of research is Experimental designpre one group pretest-posttest . Samples taken by total sampling. The Data analysis doin univariat and bivariat wWilcon test at α 5%. Research Result: that that the avererageKnowledge before to the counseling and after the counseling is There is difference ofknowledge And participation of P4K sticker installation before and after the counselingin rejang lebong prumnas Bengkulu health center (p value = 0,000).