Improving Communication and Informed Consent Using a Birth Plan Decision Aid

Background: Birth plans are proven to have a positive impact on the birth experience and can be a useful tool for collaboration between patient and provider, but providers have historically seen little value in them. Sixty-six percent of providers do not recommend the use of birth plans to their patients, and 31% believe birth plans are associated with negative obstetrical outcomes despite the evidence. Through the creation of a shared decision-making tool, the birth plan can become a collaboration between patient and provider that improves communication, informed consent, expectations, and the birth experience. Methods: A quality improvement project was developed to create a shared decision-making tool for collaborative birth planning. Obstetrical providers were surveyed for their opinion of birth plans and suggestions for a collaborative birth plan. A birth plan decision aid was created from this feedback and implemented at prenatal appointments. These providers were then surveyed for feedback on the usefulness of the decision aid, suggestions for improvements, and barriers to implementation. Results: Survey results found obstetrical providers have less than favorable opinions about birth plans but were somewhat receptive to the use of a collaborative decision aid. The obstetrical providers that implemented the decision aid found it useful for improving communication yet reported only a slight improvement in their opinion of birth plans. None of the providers surveyed intended to continue using the decision aid due to perceived time constraints during prenatal appointments. Conclusions: Birth plans are an effective tool to include patients as active participants in their health care. More work needs to be done to determine factors that improve providers' opinions and valuation of birth plans, as well as factors that impede regular use of decision aids. More research is necessary to determine the impact of the birth plan decision aid on birth outcomes and patients' birth experiences. In addition, studies examining structural changes to prenatal appointments to promote collaborative birth planning need to be conducted.