The Birth Plan Experience—A Pilot Qualitative Study in Southern Spain

Background: Healthcare systems advocate for quality care and humanized relations in routine birth care, and have therefore created the Birth Plan, a document available to pregnant women to state their preferences in relation to the birth process. Methods: This qualitative research with a phenomenological design was carried out to record the experiences of women who presented a Birth Plan. Sample selection was carried out using non-probabilistic, intentional and convenience sampling, selecting seven participants who were willing to participate and share their experiences. Results: After analyzing the content of the interviews, four categories emerged: “respecting the woman’s wishes: humanizing the birth process”, “information and primary Care”, “expectations regarding the care received” and “results of using the birth plan”, with their corresponding subcategories. Conclusion: Women consider it beneficial to present a Birth Plan, because it informs them about the process and gives them the opportunity to have a better experience, which takes into account their preferences for making the delivery less instrumental. In addition, they state the importance of having trained professionals involved, and call for more attention to be paid to the birth process in general.

Exploring women’s experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain

Background Women’s engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women’s experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women’s experiences of participation in shared decision-making during hospital childbirth. Methods An exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process. Results Twenty-three women participated in three focus groups. Three major themes emerged from the data: “Women’s low participation in shared decision-making”, “Lack of information provision for shared decision-making”, and “Suggestions to improve women’s participation in shared decision-making”. The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women’s participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women’s participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care. Conclusion Enhancing women’s involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women’s participation in shared decision-making during childbirth, is highly recommended.

Brazilian women’s use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study

Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.

Utilization of Individual Birth Plan Among Women Attending Postnatal Clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu Kenya

Background: Kenya has a maternal mortality rate (MMR) of 362 women per 100,000, partly attributed to inadequate or lack of birth and emergency preparedness, including the individual birth plan. Moreover, a paucity of data on determinants of individual birth plan use hampers its promotion and utility against MMR. This study assessed the determinants of individual birth plan use among women attending the postnatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital in Kisumu, Kenya. Methods: Hospital-based survey was conducted among 354 expectant women between November 2018 and February 2019. Data were collected using questionnaires and a Focus Group Discussion guide. A Logistic regression model was also used to determine factors associated with IBP utilization, where only p-value's <0.05 were considered significant. Textual data were analyzed thematically using NVIVO. Results: Most mothers (68.6%) had an individual birth plan. Determinants for having birth plans included client factors such as education, OR 8.93, p<0.001, occupation, OR=2.40, p=0.020, and parity, AOR=3.29, p=<0.034; knowledge of danger signs, AOR 8.1, p=0.001. Health facility factors included birth plan counseling, OR=3.45, p=0.013, emergency preparedness, OR=2.06, p=0.034, access to motorized transport such as a car, OR=3.8, p=0.035 or motorcycle, OR=2.7, p=0.006 and attending a clinic in a referral hospital, OR=5.8, p=0.003 Conclusion: This study has demonstrated most women utilize individual birth plans. However, they were ill-prepared for an emergency. Determinants of IBP use included client factors such as education level, employment status, parity, knowledge of danger signs, maternal attitude; and facility factors including counseling, attending a clinic in a referral hospital, the use of an automobile to reach the hospital, and hostility by the health care providers. Therefore, we recommend that prenatal counseling should emphasize emergency preparedness among pregnant women. There is a need to empower women through education and employment to enhance IBP utilization.

Birth plan presentation to hospitals and its relation to obstetric outcomes and selected pain relief methods during childbirth

Background The information on birth plan (BP) usage in Spanish hospitals is scant. Aim To identify the percentage of pregnant women presenting a BP at five hospitals in Spain, the reasons why some women failed to do so and how BP presentation relates to obstetric outcomes and selected pain relief methods. Methods In this descriptive, multi-centre study, data were retrospectively collected. During the postpartum visits at primary healthcare centres in various health districts in Barcelona (Catalonia, Spain), a data collection sheet about obstetric outcomes and analgesia was administered to 432 mothers who had completed a BP during their pregnancies. The main outcome was the rate of BP presentation to the hospital. The sociodemographic and obstetric characteristics and pain relief measures were compared to identify any differences between mothers who presented a BP and those who did not. Results A total of 422 (99.7%) women were studied; 51.2% of women (95% confidence interval (CI): 46.4–55.9) had presented a BP. The main reason for not presenting a BP was because the hospital midwives did not request them (61.2%). No differences were observed in BP presentation according to age, the country of origin, education, employment or hospital. Mothers who presented a BP were more likely to start breastfeeding in the birthing room (82.4% vs. 73.3%; p = 0.024). Epidural analgesia was the most common method used for pain relief (88.9%), and women who presented a BP attempted to use concomitant non-pharmacological methods more often (50.5% vs. 38.8%; p = 0.012). Conclusion Almost half of the mothers failed to present a BP, usually because midwives did not request it.

Social perceptions and bioethical implications of birth plans: A qualitative study

Background The birth plan is a tool that allows the self-learning and thoughtful analysis of the women during the birthing process, facilitating their making of decisions and participation, in agreement with the bioethical principles of autonomy and no malfeasance. Goal: To understand the perception and satisfaction of women who presented a birth plan. Methodology: Qualitative, descriptive, observational, retrospective and cross-sectional study. The population of the study was composed of 21 women who presented a birth plan regulated in a Hospital ever since the recording of the presentation of the birth plan was started (2011) until 2015. Place: Cartagena (Murcia, Spain). Techniques/methods: Semistructured interview. Results-Discussion: Most women considered the plan as a useful self-learning tool on the meaning of the birthing process, as it favored the communication between the expectant mothers/health professionals. Our informants sought information related to the birthing process from informal sources; most perceived a level of respect of their wishes during the process of giving birth. The use of the birth plan did not imply the perception of loss of the degree of control during the birth, although attention to the written document could be improved. Conclusions The use of the birth plan is a very satisfactory and useful experience for their involvement in their self-care, although in some cases, the births did not proceed according to their plans. Nevertheless, the prevalence of the principle of Non-Malfeasance over Autonomy was evidenced.