title: Patients presenting with birth plans: a case-control study of delivery outcomes.
abstract: OBJECTIVE
  To determine if labor management and outcomes, specifically epidural use, cesarean section and episiotomy rates, are different between patients presenting with formal birth plans and matched control patients without plans.
  
  
  METHODS
  Patients admitted in labor with birth plans over a 3.5-year period were identified. Patients were excluded if they required a cesarean section prior to labor or if they delivered outside the institution. For each birth plan patient, 2 age- and parity-matched controls were identified. Birth plans and medical records were reviewed for all patients and delivery outcomes recorded. Statistical analysis was performed utilizing chi2 and Fisher's exact test as appropriate. This study was approved by the institutional review board.
  
  
  RESULTS
  Seventy-one patients with birth plans were identified, with complete information available for 68. Sixty-four met the inclusion criteria, and for those 128, matched control patients were identified. There was no difference in the cesarean section rate (17% [11/64] vs. 12% [15/1281, p = 0.30) or episiotomy rate between patients with and without a birth plan (25% [13/53] vs. 23% [26/113], p = 0.83). There was a significant difference in the epidural use rate in patients having a vaginal delivery, with birth plan patients receiving an epidural less often (57% [30/53] vs. 78% [88/1131 p = 0.005).
  
  
  CONCLUSIONS
  As compared to age- and parity-matched controls, patients in our study with birth plans did not have an increased incidence of episiotomy or cesarean section but were less likely to receive epidural anesthesia during labor.
authors.affiliation: Department of Obstetrics, Georgetown University Hospital, Washington, DC, USA. deering95@hotmail.com
authors.forename: Shad H
authors.initials: SH
authors.lastname: Deering
authors.forename: Jessica
authors.initials: J
authors.lastname: Zaret
authors.forename: Kristen
authors.initials: K
authors.lastname: McGaha
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Satin
mesh_terms: D000767:Anesthesia, Epidural / Q000706:statistics & numerical data*; D000773:Anesthesia, Obstetrical / Q000706:statistics & numerical data; D016022:Case-Control Studies; D002585:Cesarean Section / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data*; D004841:Episiotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D010358:Patient Participation; D010817:Physician-Patient Relations; D011247:Pregnancy; D011256:Pregnancy Outcome