Effectiveness of birth plan counselling based on shared decision making: A cluster randomized controlled trial (APLANT)

Abstract

Background: It's unknown if shared decision making (SDM) is effective on birth plan (BP) counselling. We evaluate the effectiveness of a BP counselling intervention based on SDM, in pregnant women, with the presentation of BP to the hospital and the satisfaction with the childbirth experience. To identify if the BP presentation to the hospital was related to obstetric outcomes and satisfaction with the childbirth experience. Methods This was a randomised cluster trial involving 4 Primary Care Units. During pregnancy the women in the intervention group (IG) received BP counselling based on SDM together with a leaflet with evidence-based recommendations. The control group (CG) received standard midwife counselling. Mackey Satisfaction with Childbirth Rating Scale (MSCRS) was used. Findings A total of 461 (95.5%) women received BP counselling (IG n=214 and CG n=247). The results showed women of the IG presented the BP less frequently to the hospital compared to CG (57.8% vs 75.1%; p <0.001), the satisfaction with childbirth experience of the IG was high and similar to the CG (146.3 vs 149.3; p=0.247). Likewise, the IG used less analgesia epidural (84.7% vs 91.7%; p= 0.034), more frequently combined non-pharmacological and pharmacological methods for pain relief (48.8% vs 29.3%; p< 0.001) and began breastfeeding early (83.9% vs 66.3%; p< 0.001). Women who presented BP had a greater probability of spontaneous vaginal birth aOR=2.07 (95% CI: 1.23-3.5) and early skin-to-skin contact aOR=2.29 (95% CI: 1.2- 4.2). Conclusion: This counselling intervention was not effective in increasing presentation of the BP to the hospital and women's satisfaction with childbirth but was related to use a higher combination of pharmacological and non-pharmacological methods for pain relief and initiation of breastfeeding in the delivery room. Presenting the BP to the hospital increases the likelihood of spontaneous vaginal birth and early skin-to-skin contact.