Complying with the Birth Plan

By: Gail Tully |
2019-01-24 |
Provider Tips
pregnant couple speaking with doctor

The last two posts have focused on listening to the birth giver. We continued listening by returning to the birth plan as a diagnostic tool (see previous post). Now we see where and how we, as providers, can comply with their birth plan for the purpose of better birth outcomes.

Do birth plans evoke intervention?

Sometimes there is a thought that writing a birth plan is asking for trouble. Parents might be considered rigid or naive. But recent data shows benefits of having parents write their preferences and expectations in a simple format to share with their providers.
Birth satisfaction ratings are improved when birth follows the parent’s plan. This could be interpreted two ways. When birth meets the birth giver’s expectations, birth is experienced as validating. But does this mean when the birth progress matches the ease expected by the parent, of course, the outcome is better? This is also possible. Or when the medical staff complies with the parent request there are actually better outcomes? Yes! Regard and respect for the person giving birth becomes a variable in the two perspectives. How we care for pregnant people is important. Long term self-assessment is often connected to how we were cared for during our childbirth.
Many birth plans include freedom of movement, and therefore not being on fetal monitoring full time but rather intermittently, alternatives to drugs for pain relief, and avoiding an episiotomy (cutting of the perineum).
The World Health Organization supports the natural process of birth and less technological intervention.
“The birth plan is a tool that contributes to this fact since it is a written document that the woman presents before delivery to the professionals who will assist her and reflect her preferences, expectations, and fears about her own birthing process. The birth plan facilitates communication with professionals, improves women’s satisfaction, and promotes their participation and decision-making in their own birthing process,” states researchers in Spain.

Respecting the birth plan

Soo Downe and her research team looked at 35 studies in 29 countries for the effect of meeting women’s wants in childbirth. Upholding respect in autonomy and care was primary. “What mattered to most women was a positive experience that fulfilled or exceeded their prior personal and socio-cultural beliefs and expectations.” While everyone hopes for a healthy baby, Downe’s team heard the importance of a “psychologically safe environment with practical and emotional support from birth companions, and competent, reassuring, kind clinical staff.” Women recognize some births need intervention but deserve to be included when there are necessary changes in the birth plan. Urgent or emergency care best includes women’s needs as well, “If intervention was needed or wanted, women wanted to retain a sense of personal achievement and control through active decision-making.”

Just another day in a person’s life?

The creator of the birth plan is one of Childbirth Education’s founding voices, Penny Simkin. Ms. Simkin describes the importance of birth in a woman’s entire life in the article that helps shape both doula training and birth as a human rights issue. Just another day in a woman’s life? Her research found, “…years later, women’s memories are generally accurate, and many are strikingly vivid, especially of onset of labor; rupture of the membranes; arrival at the hospital; actions of doctors, nurses, and partners: particular interventions; the birth; and first contact with the baby.” Ms. Simkin is the creator of the birth plan. You can read more about this in a previous blog post and at her website.

Communicating better birth outcomes

Hidalgo-Lopezosa and team found compelling statistics in following a birth plan: “[T]he percentage of vaginal deliveries increased as the fulfillment of the birth plan increased. Thus, when compliance was 50% or less, the proportion of vaginal deliveries was 81.3%, while when compliance was greater than or equal to 75%, vaginal deliveries reached 93.9%. Regarding the proportion of cesarean sections, when adherence was low (less than or equal to 50%), the percentage of cesarean deliveries was 18.8%; while when compliance was high (75% or higher), the percentage of cesarean sections dropped to 6.1%; p=0.023.“

Low compliance to birth plan – High cesarean rate
High compliance to birth plan – Low cesarean rate

As providers who value physiological birth, we verify that the birth plan deserves compassionate attention. Birth plan compliance is worth flexibility in care practices. Nurturing our ability to meet parent expectations will improve birth outcomes for mother, baby, and provider services.
Downe, S., Finlayson, K., Oladapo, O., Bonet, M., & Gülmezoglu, A. M. (2018). What matters to women during childbirth: a systematic qualitative review. PloS one, 13(4), e0194906.
Hidalgo-Lopezosa, P., Hidalgo-Maestre, M., & Rodríguez-Borrego, M. A. (2017). Birth plan compliance and its relation to maternal and neonatal outcomes. Revista latino-americana de enfermagem, 25. English full article.
Simkin, P. (1991). Just another day in a woman’s life? Women’s long‐term perceptions of their first birth experience. Part I. Birth, 18(4), 203-210.
World Health Organization (WHO). Care in normal birth: a practical guide [Internet]. 1996.

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