Repercussions of using the birth plan in the parturition process

Integrative literature review performed in the LILACS, PUBMED, CINAHL and SciELO, comprising 13 articles published in English, Spanish and Portuguese, in the period from 2008 through 2018.

RESULTS

The construction of the Birth Plan during prenatal influences positively the process of parturition and maternal-fetal outcomes. Unrealistic expectations can cause dissatisfaction with the experience of childbirth. Care providers play a central role in supporting its planning and fulfillment.

CONCLUSIONS

The analyzed publications justify the clinical implementation of the Birth Plan, once it represents an intensifying technology of humanized care and maternal satisfaction. There are still some challenges related to the use of this instrument concerning women’s adherence and professional support to improve the fulfillment of the Birth Plans.

Keywords:
Pregnancy; Planning; Parturition; Humanized delivery; Decision making; Review

Database	No. of publications found	Number of publications excluded	Total of selected articles
LILACS	143	142	01
CINAHL	131	127	04
PUBMED	1,254	1,247	07
SCIELO	19	18	01
ALL DATABASES	1,547	1,534	13

Authorship	Title	Year of publication/Place	Type of study/Sample	Objective(s)	Repercussions in parturition
Mouta RJO, Silva TMA, Melo PTS, Lopes NS, Moreira VA⁽³3. Mouta RJO, Silva TMA, Melo PTS, Lopes NS, Moreira VA. Plano de parto como estratégia de empoderamento feminino. Rev Baiana Enferm. 2017;31(4):e20275. doi: https://doi.org/10.18471/rbe.v31i4.20275. https://doi.org/10.18471/rbe.v31i4.20275... ⁾	Plano de Parto como estratégia de empoderamento feminino	2017 Brazil	Qualitative exploratory study 11 parturients	To analyze how the Birth Plan provided female empowerment during labor and delivery.	The construction of a Birth Plan provided the empowerment of women in the process of parturition, since all of them felt as protagonists of their childbirths, had the physiology of their bodies respected making the moment pleasurable, less painful and unforgettable.
Hidalgo-Lopezosa P, Hidalgo-Maestre M, Rodríguez-Borrego MA⁽¹²12. Hidalgo-Lopezosa P, Hidalgo-Maestre M, Rodríguez-Borrego MA. Birth plan compliance and its relation to maternal and neonatal outcomes. Rev Latino-Am Enfermagem. 2017;25:e2953. doi: https://doi.org/10.1590/1518-8345.2007.2953. https://doi.org/10.1590/1518-8345.2007.2... ⁾	Birth plan compliance and its relation to maternal and neonatal outcomes	2017 Spain	Retrospective, cross-sectional, descriptive and analytical 178 clinical records	To know the degree of fulfillment of the proposals reflected in the Birth Plans and determine their influence on the main obstetric and neonatal outcomes.	As the compliance with the Birth Plan increases, the rate of cesarean section decreases and the results in the first minute Apgar test and umbilical cord pH improve.
Anderson CM, Monardo R, Soon R, Lum J, Tschann M, Kaneshiro B⁽¹³13. Anderson CM, Monardo R, Soon R, Lum J, Tschann M, Kaneshiro B. Patient communication, satisfaction, and trust before and after use of a Standardized Birth Plan. Hawaii J Med Public Health. 2017 [cited 2018 Jan 14];76(11):305-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5694973/. https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	Patient Communication, Satisfaction, and Trust Before and After Use of a Standardized Birth Plan	2017 Hawaii	Intervention 81 women	To describe how a culturally and educationally diverse group of women evaluated communication, satisfaction, and confidence with the use of a birth plan.	The communication, confidence and satisfaction scores were high after delivery, although the increases were modest.
Afshar Y, Mei JY, Gregory KD, Kilpatrick SJ, Esakoff TF⁽¹⁴14. Afshar Y, Mei JY, Gregory KD, Kilpatrick SJ, Esakoff TF. Birth plans-impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: a prospective cohort study. Birth. 2018;45(1):43-9. doi: https://doi.org/10.1111/birt.12320. https://doi.org/10.1111/birt.12320... ⁾	Birth plans -Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study	2017 California (EUA)	Prospective cohort study 300 women (143 with Birth Plan	To examine whether the presence of a Birth Plan was associated with the type of delivery, obstetric interventions and patient satisfaction.	Women with and without the Birth Plan had similar probabilities of cesarean delivery. Although they have fewer obstetric interventions (intravenous oxytocin, amniotomy and epidural), those who had a Birth Plan were less satisfied with their experience when compared to women with no plans.
Divall B, Spiby H, Nolan M, Slade P⁽¹⁵15. Divall B, Spiby H, Nolan M, Slade P. Plans, preferences or going with the flow: an online exploration of women's views and experiences of birth plans. Midwifery. 2017;54:29-34. doi: https://doi.org/10.1016/j.midw.2017.07.020. https://doi.org/10.1016/j.midw.2017.07.0... ⁾	Plans, preferences or going with the flow: An online exploration of women's views and experiences of birth plans	2017 United Kingdom	Qualitative descriptive study Sample for convenience of unspecified size - women who have participated in parenting forums who have or have not used A Birth Plan	To explore women's views on Birth Plans and the experiences of their performance and use.	The benefits of the Birth Plans were: increased communication with health professionals; awareness of the options available and sense of control during parturition. However, many respondents believe that the idea of birth "planning" is problematic and are reluctant to perform one.
Mei JY, Afshar Y, Gregory KD, Kilpatrick SJ, Esakoff TF⁽⁹9. Mei JY, Afshar Y, Gregory KD, Kilpatrick SJ, Esakoff TF. Birth plans: what matters for birth experience satisfaction. Birth. 2016;43(2):144-50. doi: https://doi.org/10.1111/birt.12226. https://doi.org/10.1111/birt.12226... ⁾	Birth Plans: What Matters for Birth Experience Satisfaction	2016 California (EUA)	Prospective cohort study 302 women	To categorize individual Birth Plans and determine if the meeting of requests is associated with the satisfaction with the birth experience.	Having a greater number of requests met was associated with a positive birth experience and sense of control. However, having a high number of requests was associated with a percentage reduction in the overall satisfaction with the birth experience.
Suárez-Cortés M, Armero-Barranco D, Canteras-Jordana M, Martínez-Roche ME⁽⁷7. Suárez-Cortés M, Armero-Barranco D, Canteras-Jordana M, Martínez-Roche M.E. Use and influence of Delivery and Birth Plans in the humanizing delivery process. Rev Latino-Am Enfermagem. 2015;23(3):520-6. doi: https://doi.org/10.1590/0104-1169.0067.2583. https://doi.org/10.1590/0104-1169.0067.2... ⁾	Use and influence of Delivery and Birth Plans in the humanizing delivery process	2015 Spain	Quantitative, cross-sectional, observational, descriptive, comparative cohort study. 9,303 women	To know, analyze and describe the current situation of the Childbirth and Birth Plans in the context studied, comparing the process of childbirth and its completion among the women who presented and those who did not present a Birth Plan.	The study found a positive relationship between the use of the Birth Plan and the increase in skin-to-skin contact, late cord clamping and the rate of normal deliveries. In addition, it reinforced the women's autonomy.
Whitford HM1, Entwistle VA, van Teijlingen E, Aitchison PE, Davidson T, Humphrey T, Tucker JS⁽¹⁶16. Whitford HM, Entwistle VA, van Teijlingen E, Aitchison PE, Davidson T, Humphrey T, et al. Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland. Birth. 2014;41(3):283-9. doi: https://doi.org/10.1111/birt.12109. https://doi.org/10.1111/birt.12109... ⁾	Use of a birth plan within woman-held maternity records: a qualitative study with women and staff in northeast Scotland	2014 Scotland	Qualitative study 42 women 24 health professionals	To investigate the experiences of women and staff with a standard Birth Plan.	The perceived benefits included the opportunity to highlight preferences, improve communication, stimulate discussion, and cope with anxieties. However, not all women experienced these benefits or understood the purpose of the Birth Plan. Some were unaware of the tool or did not have the necessary support from the team to discuss or have confidence about their options.
Welsh Joanne V, Symon AG⁽¹⁷17. Welsh JV, Symon AG. Unique and proforma birth plans: a qualitative exploration of midwives? experiences. Midwifery. 2014;30(7):885-91. doi: https://doi.org/10.1016/j.midw.2014.03.004. https://doi.org/10.1016/j.midw.2014.03.0... ⁾	Unique and proforma birth plans: a qualitative exploration of midwives׳ experiences	2014 England	Qualitative study 9 midwives	To evaluate the midwives' view on the Birth Plan	The term “Birth Plan” has been considered inappropriate by some midwives for creating unrealistic expectations in women. In their view, the Plans are becoming 'standard' by routinely requesting the same things (childbirth without intervention), some midwives feel pressured by this document which causes irritation.
Aragon, M., Chhoa, E., Dayan, R., Kluftinger, A., Lohn, Z., & Buhler, K⁽⁵5. Aragon M, Chhoa E, Dayan R, Kluftinger A, Lohn Z, Buhler K. Perspectives of expectant women and health care providers on birth plans. J Obstet Gynaecol Can. 2013;35(11):979-85. doi: https://doi.org/10.1016/S1701-2163(15)30785-4. https://doi.org/10.1016/S1701-2163(15)30... ⁾	Perspectives of Expectant Women and Health Care Providers on Birth Plans	2013 Canada	Cross-sectional study 122 women and 110 health care providers and support people	To understand the perspectives of women, health care providers and support people use of Birth Plans.	All the women and their caregivers considered the Birth Plan a valuable communication and education tool. However, respondents noted that women may be disappointed or dissatisfied if a Birth Plan cannot be implemented.
Magoma M, Requejo J, Campbell O,Cousens S,Merialdi M,Filippi V⁽¹⁸18. Magoma M, Requejo J, Campbell O, Cousens S, Merialdi M, Filippi V. The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial. Trop Med Int Health. 201318(4):435-43. doi: https://doi.org/10.1111/tmi.12069. https://doi.org/10.1111/tmi.12069... ⁾	The effectiveness of birth plans in increasing use of skilled care at delivery and postnatal care in rural Tanzania: a cluster randomised trial.	2013 East Africa	Randomized trial 905 women	To determine the efficacy of the Birth Plans in increasing the use of specialized care during childbirth and in the postnatal period among pregnant women in a rural district with low demand for health facilities for delivery but high acceptance of prenatal care.	The implementation of Birth Plans during pregnancy may increase the demand for qualified delivery and postpartum services without adversely affecting the satisfaction of women and providers.
Pennell A, Salo‐Coombs V, Herring A., SpielmanF, Fecho K⁽⁴4. Pennell A, Salo-Coombs V, Herring A, Spielman F, Fecho K. Anesthesia and analgesia-related preferences and outcomes of women who have birth plans. J Midwifery Womens Health. 2011;56(4):376-81. doi: https://doi.org/10.1111/j.1542-2011.2011.00032.x. https://doi.org/10.1111/j.1542-2011.2011... ⁾	Anesthesia and analgesia-related preferences and outcomes of women who have birth plans	2011 USA	Prospective cohort study 63 women	Describe the anesthesia preferences and results related to analgesia of women who used a Birth Plan.	Most women agreed that the birth plan improved their birth experiences, sense of control, and communication with health care providers, and it was an enlightening tool.
Kuo SC, Lin KC, Hsu CH, Yang CC, Chang MY, Tsao, CM, Lin LC⁽¹⁹19. Kuo SC, Lin KC, Hsu CH, Yang CC, Chang MY, Tsao CM, Lin LC. Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial. Int J Nurs Stud. 2010;47(7):806-14. doi: https://doi.org/10.1016/j.ijnurstu.2009.11.012. https://doi.org/10.1016/j.ijnurstu.2009.... ⁾	Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial	2010 Taiwan	A double-blind randomized controlled study 296 women	To evaluate the effects of Birth Plans on fulfilling women's delivery expectations, their control over the childbirth process and their overall experience.	The experimental group had a higher degree of positive experiences and greater control of childbirth than the control group.

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[1] Corresponding author:
Renata Marien Knupp Medeiros. renataknupp@globo.com