Communication and decision-making in labour: do birth plans make a difference?
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.
Centre for the Study of Mothers' and Children's Health, School of Public Health, La Trobe University, Carlton, Victoria, Australia.
Stephanie J
SJ
Brown
Judith
J
Lumley