Birth Plans: Tickets to the Operating Room?

Birth plans allow women to take control of their birth and often contain wishes for an unmedicated birth with few interventions. However, in this era of evidence-based practice, a superstition exists. Many physicians and nurses believe that women who enter the health care system with birth plans are at greater risk of a cesarean birth.

Shelley White-Corey, M.S.N., RNC-OB, WHNP-BC, assistant professor of nursing at the Texas A&M Health Science Center (TAMHSC) College of Nursing explores this phenomenon in her manuscript titled “Birth Plans:  Tickets to the Operating Room?” published online in The American Journal of Maternal/Child Nursing.

“There is no scientific evidence to support the hypothesis that patients with birth plans will be more likely to have a cesarean birth, but research shows that caregivers believe they do,” White-Corey says.

In a study by Grant, Sueda, and Kaneshiro, 65 percent of caregivers believed patients with birth plans had an overall worse obstetric outcome, whereas only 2.4 percent of patients held that belief.

“This is important because it may influence the way they care for the patient during labor,” White-Corey says.

White-Corey presents several studies in the manuscript highlighting this perception among caregivers, including a study by Carlton, Callister, and Walker that reported that nurses have an aversion to birth plans and consider them a “jinx.” Another study she explores shows that many doctors and nurses believe patients with birth plans have unrealistic expectations and are inflexible in making changes to the plan when necessary.

For a birth plan to be an effective tool, it must be more than a checklist of options, White-Corey notes. It must be a reflection of the woman’s careful preparation for her birth and used to initiate a dialogue between the patient and her health care provider early in pregnancy.

“Nurses need to educate themselves about the evidence-based care practices that promote physiological birth and develop skills in supporting a woman through an unmedicated birth,” White-Corey says. “Perhaps in doing so, we can dispel the myths that surround the birth plan and help to create satisfying birth experiences for women.”

The article will be available in the print version of The American Journal of Maternal/Child Nursing in September, where it will also be a continuing education offering for current registered nurses. Nurses will be able to obtain continuing education credits by reading and completing a test on content in the manuscript.

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