Prevalence, characteristics, and satisfaction of women with a birth plan in The Netherlands

The use of birth plans to facilitate shared decision making in childbirth is widely recommended by international agencies and by the Dutch Integrated Birth Care protocol (2016). This study evaluated the use of birth plans in The Netherlands.

A retrospective study was conducted during 2017 in a Dutch academic hospital. Women who gave birth after 33 weeks of gestational age were included (N = 1159). Medical records were searched for a birth plan, either a note or attached file. Socio-demographic, relevant medical and obstetrical characteristics fulfilling criteria for secondary care, and postpartum satisfaction were collected and related to birth plans. Postpartum satisfaction was scored on a scale from 0 to 10. The "net promoter score" (NPS), a quality of care indicator, was also computed. For analysis, independent t test, chi-square test, ANOVA, and two-way between ANOVA were used.

A birth plan was noted in the medical records of 34.7% of women. Women with a birth plan were on average older, primiparous, of Dutch ethnicity, and more likely to have a complicated medical history, psychological condition, or fertility treatment. The mean postpartum satisfaction score was 8.28 and the NPS for customer satisfaction was 36.1, falling in the good range. No significant differences in postpartum satisfaction related to birth plans were found.

Although birth plans are recommended for every pregnant woman, this is not everyday practice yet. The purpose of birth plans, to facilitate shared decision making, is therefore not fully realized. Implementation strategies are needed to increase adoption of birth plans for every woman.