Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial

Abstract

Background: In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans.

Objective: The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences.

Design: A randomised, single-blind controlled trial study design was used.

Settings: This study involved seven hospitals and 10 obstetricians in Taiwan.

Participants: Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n=155) or control (n=141) groups.

Methods: The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations.

Results: The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t=2.48, p=0.01). The experimental group also showed a higher degree of childbirth control (t=9.60, p<0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t=2.63, p=0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t=3.74, p<0.001) in the experimental group than in the control group.

Conclusions: The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.