Birth plan compliance and its relation to maternal and neonatal outcomes.
Pedro Hidalgo-Lopezosa, María Hidalgo-Maestre, Maria Aurora Rodríguez-Borrego
PMID 29236838WHAT IT FOUND
Among 178 women with birth plans, higher compliance was associated with lower cesarean proportion and better umbilical cord pH and 1-minute Apgar scores; 5-minute Apgar did not differ.
Only 7.9% had all preferences met.
Key findings
01Most birth plans were only partly fulfilled: 7.9% were fully met and 3.4% were met in none of the points.
02When compliance was 50% or less, 18.8% had cesarean delivery; when compliance was 75% or higher, 6.1% had cesarean delivery.
03Newborns of mothers with high compliance had better umbilical cord pH and 1-minute Apgar scores than those with low compliance, while 5-minute Apgar scores did not differ.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study included only women who had presented a birth plan, so it cannot compare them with women who did not present one. It was retrospective and cross-sectional, and it excluded scheduled and urgent cesarean sections without labor, so it does not describe all births. The birth plans varied, including institutional forms and women's own manuscripts, and caregivers varied, which may affect how requests were recorded and met. Because the study was retrospective and cross-sectional, it can show association but not cause.
The easy way to misread this
Do not conclude that writing or enforcing a birth plan causes fewer cesareans or healthier babies. The study only compared women who already had birth plans and grouped them by how much of the plan was met; it had no group without a birth plan, so the association may reflect other differences between women or care settings.