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Implementation Study of a Birth Preferences Worksheet During Prenatal and Intrapartum Care
Objective:
To explore the implementation of a birth preferences worksheet to facilitate shared decision-making during prenatal and intrapartum care.
Design:
Cross-sectional, descriptive study.
Setting:
University-affiliated hospital in an urban setting.
Participants:
Postpartum people, physicians, certified nurse-midwives, and nurses.
Methods:
This is a cross-sectional study of implementation of a birth preferences worksheet. Both patients and providers are included. Postpartum patients were recruited on the inpatient unit and completed a survey before hospital discharge. Clinicians included nurses, midwives, and physicians on the birthing unit. A separate survey was developed for clinicians.
Results:
There were 81 participants in the study sample: 36 patients and 45 clinicians. Fifty percent of patient participants (n = 18) completed the birth preferences worksheet during prenatal care, and 36% (n = 13) completed it in the hospital. Ninety-two percent of patient participants (n = 33) stated that the health care team in the hospital reviewed their birth preferences with them, and all agreed that the worksheet provided clear information. Sixty-eight percent of clinician respondents (19 of 28) agreed that they understood why the birth preferences worksheet was introduced. Forty-seven percent of clinicians (18 of 38) reported integrating the worksheet into their practice, and 40% (8 of 20) stated they use it with all their prenatal encounters. Barriers to implementation included time constraints, difficulty accessing the worksheet, trouble remembering that it was available, and the inability to edit the worksheet after patient encounters.
Conclusion:
Birth preferences worksheets are a promising intervention that should be considered part of routine perinatal care. For new practices, repeated implementation strategies are necessary for successful uptake by patients and providers. By identifying barriers and facilitators to implementation, this study contributes to a deeper understanding of how to approach implementation and strengthen shared decision-making in maternity care settings.
