Birth plan

from Wikipedia, the free encyclopedia
Example of a brief birth plan for a “low-invasive” birth

In a birth plan , pregnant women or expectant parents reveal their wishes and needs for the course of the birth of their child. It can be written by the parents or filled out on a form from a clinic.

The goals of a birth plan are:

  • to deal with the impending birth and to make informed decisions about its course,
  • improve communication and collaboration between expectant parents and obstetricians , and
  • to bring the birth experience closer to parental ideas.

Written birth plans first appeared in the 1980s, after births increasingly took place in hospitals over the course of the 20th century. With birth plans, women wanted to take a more active role in planning their birth. Birth plans can express the desire for certain interventions (for example, epidural anesthesia or desired caesarean section ) or the desire to avoid supposedly unnecessary interventions. A birth plan reduces the need to make decisions under pressure.

Psychological function

Birth plans primarily have a psychological function, whereby the pregnant woman can create a feeling of control. The feeling of being in control of the birth process is a factor in satisfaction with the birth. Statistically speaking, the higher the expectations of the birth, the more positive the birth experience, while low expectations make women more likely to be dissatisfied with the birth.

Writing and applying a birth plan

If the parents want the best possible cooperation with the obstetricians, it is best to contact them before the birth. They talk through preferences, wishes and also fears that they later record in the birth plan. This creates a basis for communication that prevents obstetricians from feeling pressured. On the other hand, it reduces fears on the part of the parents and enables them to find out about the conditions in the facility. It introduces them to their choices and creates a basis for further research.

Information on the physiological birth should be submitted or obtained. For the points that are important for the women, information on scientific evidence can be gathered together with the birth attendants. On this basis, decisions can be discussed and feelings and consequences can be reflected on.

As a result of such conversations, the parents have a better idea of ​​whether their ideas can be reconciled with those of the birthing facility - or whether they should look for another facility, other obstetricians or another setting (birthing center, home birth) .

The parents or the mother draw up the birth plan before their child is born. A friendly, polite tone is recommended. The plan should be kept flexible, so that there are action standards for a complication-free birth as well as for difficult situations. In the event of a caesarean section, for example, a separate plan can be made. It is recommended that you do not hold the plan longer than an A4 page, as this increases the likelihood that it will be adequately read.

If the mother shows up at the facility for the birth, the plan is placed in her own file. If the staff changes, the existence of the birth plan is again pointed out.

Both mothers and obstetricians see the birth plan as a valid standard of action and a basis for mutual communication. However, it is a flexible document that must be adapted to the circumstances and the flow of communication. In the best case, women not only think about what their ideal birth will look like, but also how to proceed in the event of complications (such as a long opening phase or medically indicated caesarean section).

Content

Typical subject areas of birth plans are:

  • Place of birth (at home, birthplace, clinic)
  • Choice of supervisor (e.g. freelance midwife, doctor in private practice, doula)
  • Pain management (e.g., natural methods or certain anesthesia such as PDA)
  • Interventions (e.g. vaginal examinations, listening to the child’s heartbeat continuously or at intervals, perineal incision, intravenous hydration, administration of artificial hormones)
  • personal comfort (e.g., walking around during labor, birthing positions, water birth)
  • Treatment of the newborn after birth (e.g. breastfeeding, additional feeding, direct skin contact, medication / supplements)
  • Atmosphere (e.g. maintaining privacy, dim lighting)
  • Individual needs (e.g. religious or cultural perspectives, disabilities, phobias)
  • Inpatient or outpatient birth, length of stay in the clinic, type of room on the weekly ward

Influence on the birth outcome

Subjective: There are studies that show that birth plans have improved the birth experience for women and that they have felt more in control of the birth process. Their birth expectations were met to a greater extent than in a control group without a birth plan. Some women say that the birth plan gives them a better understanding of the birth process and medical choices. Some found that it helped them express their wants and preferences, improved communication with clinic staff, and increased their self-confidence. For obstetricians, the same study found that birth plans enabled critical rethinking of current practices. They promoted diversity and improved the quality of obstetrics in terms of patient rights and benefits. In both studies, clinically prepared birth plans were the basis. It is unclear whether birth plans created by the parents themselves have the same effect.

Quantitative: No statements can be made on measurable results (such as caesarean section rate, perineum section rate), as studies contradict one another. No negative effects on the birth outcome for mother and child could be proven. There is a lack of large-scale studies to make concrete statements about the influence of birth plans. The result depends very much on the type of plan (individual, adopted template from the Internet or pre-printed form from the birthing facility), on the particular birthing facility (in many studies only one) and the communication between parents and obstetricians in the run-up to the birth.

Limits and Disadvantages of a Birth Plan

"A birth plan is more an approximation of the birth process than a guarantee of a specific result."

- Wagner & Gunning

Of course, a birth plan can not predict the course of the birth . It can only provide guidance on what is expected of the obstetricians, depending on what occurs. The basis is that the parents have informed themselves comprehensively in advance about the possibilities and make decisions based on them. Parents can be disappointed if the goals set cannot be achieved. When talking to the obstetric institution, it often turns out that some things have to be put into perspective because they cannot be guaranteed. Obstetricians criticize the fact that some parents become inflexible or complicated when the slightest deviation from their plan is necessary.

Prepared birth plans (e.g. from the Internet) run the risk of not being properly understood by the parents-to-be: They should be clear about why they reject or demand certain things and what the consequences are. Birth plans from the Internet do not prepare parents for the fact that the acceptance of an intervention can lead to a whole series of further interventions (e.g. no urge to press with PDA, which means that labor enhancers / guided pressing / vacuum or forceps extraction are necessary). Often times, they span multiple pages, reducing the chances that they will be read at all. Some points in these templates have nothing to do with the conditions in the clinic in question, are sometimes not up to date (e.g. the subject of pubic hair shaving, which is rarely performed any more) or sound defensive. Custom-made birth plans are therefore to be preferred.

Some clinics have a pre-printed birthing plan where parents can tick their preferences. It is criticized that this only gives the parents the appearance of a choice, since the options do not go beyond the routine spectrum of the respective institution.

Some studies come to the conclusion that a birth plan does not affect the subjective experience of childbirth and thus contradict other studies that come to a positive result. Further research is pending.

Some midwives working in clinics feel sometimes under pressure from birth plans. This can create tensions and conflicts between parents and clinic staff. They are a mirror of the current problems in obstetrics:

  • different beliefs about birth
  • the different understanding of safe and effective accompaniment
  • the handling of informed consent or rejection of measures by parents
  • the frequent disinterest in patient wishes and rights in favor of the usual routine
  • The renouncement of evidence-based medicine in favor of personal convictions or rigid clinical routine, which often do not correspond to current "best practice", or birth attendants are in conflict with both - sensible, evidence-based things are often desired in birth plans, such as free walking around, renouncing permanent CTG or continuous infusion, water birth ... which, however, are often not guaranteed due to routine clinical practice or lack of staff

Some women complain that what they have written has not been properly taken into account. It is requested that obstetricians be more attentive to the preferences and desires that their patients reveal to them in birth plans. Birth plans force obstetricians out of their comfort zone. But this gives them the chance to enter into a dialogue with the families and to look at and question their own approach through their eyes. The willingness of the nursing staff to provide neutral and, at best, evidence-based information is also important.

Birth plans only make sense if both sides have an interest in them - parents and obstetricians - and get information or further training accordingly:

  • Parents to make informed decisions
  • Health professions, in order to perceive disclosed patient requests as an integral part of their own work and to respond to them

In practice, the birth plan binds neither the woman nor the obstetrician to what has been formulated. The woman can request a different treatment at any time, an oral statement is sufficient. A midwife or doctor can also suggest further measures at any time and will do so if they consider these measures to be useful. The woman can then decide what she wants regardless of the previous planning. In any case, the woman has legal control over the treatment, because patient rights require prior information from the treating person and the effective consent of the patient for every examination and intervention . So far there are no legal regulations or court decisions specifically on birth plans. Birth plans are not as a form of advance directive to understand because it only applies when the patient is no longer able to consent is.

Alternatives to the birth plan

There are also other ways to deal with the upcoming birth and to bring your own ideas into line with the course of the birth:

  • Birth preparation courses: They serve to convey information and to prepare physically for a birth. If they take place in the chosen birth setting, information about the routine there can be obtained at the same time.
  • 1-to-1 care by a midwife whom you get to know before the birth (e.g. in the context of prenatal care; care sheet): In conversations you get to know each other and the midwife can get to know the wishes and fears of the pregnant woman and take it. 1-to-1 care is guaranteed for out-of-hospital births ( birth center , home birth ), in midwifery delivery rooms and for births with registered midwives in a clinic.
  • Birth accompanied by a doula : Doulas are women, even children have given birth and accompany alone to support the expectant parents a birth. After getting to know each other thoroughly, she is able to communicate the needs of the woman to the clinic staff, to stand up for them and to mediate between parents and obstetricians.

Web links

Individual evidence

  1. ↑ a b c M. Moore, U. Hopper: Do Birth Plans Empower Women? Evaluation of a Hospital Birth Plan. In: Birth. Volume 22, Issue 1, March 1995, pp. 29-36.
  2. ^ PP Simkin, C. Reinke: Planning Your Baby's Birth. International Childbirth Education Association, 1980.
    PP Simkin: Birth Plans: After 25 Years, Women Still Want To Be Heard. In: Birth. 34, 1, March 2007, pp. 49-51.
  3. ^ A b P. Perez: Birth Plans: Are They Really Necessary? In: MCN: American Journal of Maternal Child Nursing. Volume 30, Issue 5, September / October 2005, p. 288.
  4. ^ A b c d e Sue Brailey: Birth plan . on: hebamme.ch. October 4, 2006.
  5. ^ A b J. Lothian: Birth Plans: The Good, the Bad, and the Future. In: Journal of Obstetric, Gynecologic, & Neonatal Nursing. Volume 35, Issue 2, March 2006, pp. 295-303.
  6. ↑ Goodman et al .: ... 2004 (quoted from Sue Brailey: Birth plan . On: hebamme.ch , October 4, 2006)
    P. Simkin: Just another day in a woman's life? Women's long-term perceptions of their first birth experience. Part I. In: Birth (Berkeley, Calif.). 18 (4), 1991, pp. 203-210.
  7. ↑ ED Hodnett: Pain and women's satisfaction with the experience of childbirth: a systematic review. In: American Journal of Obstetrics and Gynecology. 186 (5 Suppl Nature), 2002, pp. S160-S172.
  8. ↑ Green, Coupland et al. 1990, quoted from Sue Brailey: Birth plan . on: hebamme.ch. October 4, 2006.
  9. ↑ a b c d J. V. Welsh, AG Symon: Unique and proforma birth plans: a qualitative exploration of midwives ׳ experiences. In: Midwifery. 30 (7), Jul 2014, pp. 885-891.
  10. ↑ a b K. Baird: Customer service in health care: A grassroot approach to creating a culture of service excellence. Jossey-Boss Publishers and Health Forum, 2000.
  11. ↑ a b c d e T. Kaufmann: Evolution of the birth plan. In: Journal of Perinatal Education. 16 (3), 2007, pp. 47-52.
  12. ↑ a b Y. Widmer: The birth plan - a suitable instrument to promote empowerment? Technical thesis in the midwife HF course, Bern University of Applied Sciences in Health, 2007
  13. ↑ a b c d P. P. Simkin: Birth Plans: After 25 Years, Women Still Want To Be Heard. In: Birth. 34, 1, March 2007, pp. 49-51.
  14. ↑ a b c M. Aragon et al .: Perspectives of expectant women and health care providers on birth plans. In: Journal of Obstetrics and Gyaecology Canada. 35 (11), Nov 2013, pp. 979-985.
  15. ↑ K. Su-Chen, L. Kuan-Chia et al .: Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfillment: A randomized controlled trial. In: International Journal of Nursing Studies. Volume 47, Issue 7, July 2010, pp. 806-814.
  16. ↑ Women with a birth plan had comparatively less caesarean sections and more often epidurals. E. Hadar, O. Raban et al.: Obstetrical outcome in women with self-prepared birth plan. In: Journal of Maternal-Fetal and Neonatal Medicine. 25 (10), Oct 2012, pp. 2055–2057
    Women with a birth plan     had the same number of caesarean sections and less often an epidural. SH Deering et al .: Patients presenting with birth plans: a case-control study of delivery outcomes. In: The Journal of Reproductive Medicine. 52 (10), 2007, pp. 884-887.
  17. ↑ Hidalgo-Lopezosa et al .: Are birth plans associated with improved maternal or neonatal outcomes? In: MCN: American Journal of Maternal Child Nursing. 38 (3), May-Jun 2013, pp. 150-156.
  18. ^ M. Wagner, S. Gunning: Creating your birth plan: The definitive guide to safe and empowering birth. Perigee Books, New York 2006.
  19. ^ J. Neumark et al: Effects of epidural anesthesia on plasma catecholamines and cortisol in parturition. In: Acta Anesthesia Scandinavia. Vol 29, Issue 6, pp. 555-559.
  20. ↑ M. Anim-Soumah et al.: Epidural versus non-epidural or no analgesia in labor. In: Cochrane Database of Systematic Reviews. Issue 2, 2001.
  21. ^ I. Lundgren, M. Berg, G. Lindmark: Is the Childbirth Experience Improved by a Birth Plan? In: Journal of Midwifery & Woman's Health. Volume 48, Issue 5, September-October 2003, pp. 322-328.
  22. ^ HM Whitford: Women's perceptions of birth plans. In: Midwifery. Volume 14, Issue 4, December 1998, pp. 248-253.
  23. ↑ M. Gerteis et al .: Through patient's eyes: Understanding and promoting patient-centered care. Jossey-Boss Publishers, 2002.