What do women want in birth? Analyzing the birth plan

Background The birth plan is a written document where women can express expectations and preferences for their upcoming births. It can also serve as a tool for the labour care midwife, to quickly assess the unique needs of... [ view full abstract ]

Background The birth plan is a written document where women can express expectations and preferences for their upcoming births. It can also serve as a tool for the labour care midwife, to quickly assess the unique needs of each woman, before assisting her in birth. In Sweden, there are no national recommendations for the use of a birth plan, and the ones used vary in design. Also, not all women write a birth plan. The aim of the study was to analyze the birth plan from a gender perspective.

Method 400 women giving birth in a Swedish hospital between March and June 2016, were asked to participate in the study. 260 consented whereof 132 had written a birth plan, primiparas (n=78), multiparas (n=54). The plans were designed locally and contained four open-ended questions inquiring about the woman’s personality traits that could be of significance during birth; preferences regarding pain relief; how the midwife could support the woman and her partner; how the woman imagined the first days postpartum. The answers were analyzed using qualitative content analysis.

Preliminary results Women expressed a need to be continuously informed throughout the birth process, a fear of losing control of their bodies, and fear of vaginal tearing; the first-hand choice for the majority of women was non-pharmacological pain relief; women took partner’s active participation for granted; women strongly wished that there would be room at the hospital for their partners to stay with them and the newborn the first days postpartum.

Discussion Despite certain fears before birth, women put their trust in the midwife and her expertise. The birth plan can promote a positive birth experience as it encourages women to clarify their wants and needs and communicating them to the care providers. It can also be seen as an expression of informed consent, acknowledging women’s rights to approve or disapprove of interventions done to their bodies.

Conclusion Analyzing the birth plan is one way to learn about women’s wishes and fears about birth, as well as reflecting on the plan’s value in an increasingly medicalized labour care.