Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial

Abstract

BackgroundInvolvement of women in the decision-making process during childbirth plays an important role in their physical and psychosocial preparation. A birth plan allows the woman to express her expectations and facilitates her participation in her own care. The present study is the first to assess the implementation of birth plans integrated into childbirth preparation classes in Tehran, Iran.MethodsThis study is a randomized controlled clinical trial performed on 300 pregnant women at 32–33 weeks of gestation referring to four public health centers in Tehran, Iran. The participants were randomly allocated into intervention and control groups using block randomization method. A training session on the items of the birth plan checklist was held in the fifth session of childbirth preparation classes for the participants in the intervention group. Accordingly, a birth plan was prepared according to the requests of mothers. The birth plan was implemented after the women were admitted to the maternity ward. The primary outcomes were frequency of vaginal birth, mean duration of labor stages, and mean score of childbirth satisfaction. We used a checklist of maternal and neonatal outcomes, Mackey's childbirth satisfaction questionnaire, and a partogram form for data collection. Independent t-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, and logistic regression were used for data analysis.ResultsVaginal birth rates were significantly higher in women who had birth plans compared with those without (81.9% vs. 48.7%, p < 0.001). Also, the lengths of the first and the second stages of labor were significantly shorter in women having a birth plan (p = 0.02). Women in the birth plan group were significantly more satisfied with the process of labor and childbearing (p < 0.001), and started breastfeeding after birth earlier than those in the control group (p < 0.001).ConclusionHaving a birth plan and attending childbirth preparation classes can increase the rate of normal vaginal birth. Also, according to our results, women's participation in the decision- making process and fulfilling their preferences during birth can improve maternal and neonatal outcomes and childbirth satisfaction.Trial registration: IRCT20190415043283N2. 2020-12-07.

Influence of Integrating Childbirth Preparation Program on Birth Outcomes among Pregnant Women in Western Kenya

“…This could be due to the fact that those who were prepared and educated were empowered with survival skills and had no fear of childbirth relative to the control. This findings compare with those of a recent study in Iran where birth plans integrated into antenatal classes yielded more vaginal births (Mohaghegh et al, 2023). In Turkey, an investigation on the influence of antenatal education on the option for childbirth, showed that those who underwent the education were more likely to give birth through spontaneous vaginal delivery, than those who did not go through the education (Çankaya &Şimşek, 2021).…”

“…This could be credited to the fact that the group without childbirth education had few coping strategies and increased fear and anxiety that could have led to prolonged labours. Comparatively a recent study in Iran revealed that there were shorter first and second lengths of the stages of labour in the group that had delivery plans integrated into childbirth classes (Mohaghegh et al, 2023). However the current study did not look into the duration of the different stages of delivery but rather the whole process of labour.…”

“…A comparative study in Iran between women who incorporated delivery plans in readiness for childbirth resulted in more spontaneous vaginal deliveries and less duration of first and second phases of labour compared to their counterparts who did not have the delivery plans. Additionally, they were more satisfied with the process of childbirth and initiated breastfeeding much earlier than the control group (Mohaghegh et al, 2023).…”

Effect of Birth Preparation Coaching Sessions on Women's Self Efficacy for Coping with Labor Pains and Outcomes

“…Birth preparation sessions will be effective if they are combined to provide useful, simple, proper information as well as essential skills. Before the 36th week of pregnancy, pregnant women must be fully informed about the labour and delivery process, with a focus on a childbirth plan, birthing preparation, labour onset, and techniques of pain relief (Mohaghegh et al, 2023). Participation in birth preparation coaching sessions has been linked to improved relationships between women and healthcare providers, increased levels of knowledge and skills regarding childbirth, and increased confidence and self-efficacy in primigravida women for labour and delivery.…”