title: Childbirth Education Class and Birth Plans Are Associated with a Vaginal Delivery.
abstract: To determine whether the mode of delivery was different between women who attended childbirth education (CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan.
  
  
  
  This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed.
  
  
  
  In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls.
  
  
  
  Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Yalda
authors.identifier: 0000-0003-3807-7022
authors.initials: Y
authors.lastname: Afshar
authors.affiliation: Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Erica T
authors.initials: ET
authors.lastname: Wang
authors.affiliation: University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Jenny
authors.initials: J
authors.lastname: Mei
authors.affiliation: Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Tania F
authors.initials: TF
authors.lastname: Esakoff
authors.affiliation: Division of Reproductive Endocrinology and Infertility in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Margareta D
authors.initials: MD
authors.lastname: Pisarska
authors.affiliation: Division of Maternal Fetal Medicine in the Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data*; D002755:Choice Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009321:Natural Childbirth / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D064186:Prenatal Education; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: birth plan; birth preference; childbirth education; choice behavior; mode of delivery