BIRTH PLANS: TICKETS TO THE O.R?

SUMMARY:
Although some nurses and physicians might suggest that women
who write birth plans are at greater risk of a cesarean birth, research
has not supported this myth. The research studies on this topic have
suggested, actually, that women who write birth plans do not have
higher cesarean rates or worse obstetric outcomes. Birth plans have
been shown to inform and empower women, and lead to more
satisfaction with their birth experiences. The purpose of this article is
to present the existing evidence on perinatal outcomes in women with
birth plans and to explore the phenomenon of divergent perceptions
among caregivers.
Some physicians and nurses seem to believe that women who
enter the healthcare system carrying birth plans are at greater risk of
a cesarean birth. Birth plans were intended to be a tool to create trust
and improve healthcare provider-patient relationships, but instead, in
some institutions and settings, they seem to have created animosity,
tension, and power struggles.
Carlton, Callister, Christiaens, and Walker (2009), in their study
of obstetrics nurses perceptions, reported that nurses have an
aversion to birth plans and consider them a jinx. One nurse stated
that she believes that 75% of her patients with birth plans end up
having a cesarean, and that the patients are setting themselves up for
failure. Many doctors and nurses believe that patients with birth plans
have unrealistic expectations and are ineflexible in making changes to
their plan when necessary.
It was only in 1930s that women began giving over control of
their births to physician and technology, some say that this led to a
paternalistic environment for childbirth. But in late 1970s, childbirth
educators introduced the birth plan in order to help women take back
some control of the birthing process.
Birth plans are written documents that list womens preferences
for their labor and birth. The birth plan was originally intended as a
tool to educate and empower women, encourage shared decision
making, facilitate communication about expectations, and develop
trust between women and their caregivers. It is thought that by
learning about the process of birth and exploring their values and
desires, womens confidence in their ability to give birth would be
increased. The ultimate goal is to have a positive childbirth

experience through a sense of increased control. Research suggests

that a sense of control is associated with a positive birth experience,
regardless of the outcome.
Most women who write birth plans want an unmedicated birth
with few interventions. Common elements of the birth plan include
requests to ambulate during labor, drink fluids as desired, to receive
the baby to the abdomen after birth, and to have support persons in
attendance. They also often contain a list of things that the women
wishes to avoid, such as continuous fetal monitoring, episiotomies,
pain medications, and epidurals.
While there is no scientific evidence to support the hypothesis
that patients with birth plans have worse outcomes, their research
demonstrates that caregivers believe that they do.
In order for birth plan to be an effective tool, it should be a
thoughtful reflection of a womans understanding of the physiology of
birth, and what she will need to feel safe and supported during her
labor. It must be used to initiate a dialogue between the patient and
her healthcare provider early in pregnancy. This process can enhance
understanding, flexibility, and the patient-healthcare provider
relationship.

REACTION:
As a mother of 2 and who has experienced childbirth, I do
believe that birth plan is a great tool in having a positive childbirth
experience. Its giving a mother-to-be an idea on what to expect
during her labor and delivery. Having a birth plan should also give an
open communication to the patient and healthcare provider early on
the pregnancy. The woman should also be flexible if ever the expected
outcome is different from what they envisioned. And they should also
be willing to set aside their birth plans if the situation calls for it.

Recommendation:
I will recommend birth plan to Mothers-to-be, so that they will
have a positive experience in childbirth and also for them to be
educated in labor and delivery. To the healthcare providers and
nursing practice, so that they will have an open communication to the
patient and also to understand better what a birth plan really is. To
the nursing educators and nursing researchers, to be able to educate
their patients, nurses, and healthcare providers so that they have a
better understanding and knowledge in birth plan.

Resources:
Shelley White-Corey, MSN, RN (September-October 2013), American
Journal of Maternal/Child Nursing