Outcomes for patients with birth plansThis months Journal of Reproductive Medicine contains an interesting paper on birth plans which shows that birth plans have essentially no impact on reducing interventions aside from pain relief. The article is Patients Presenting with Birth Plans, Deering, et al., J Reproductive Medicine, 2007, 52:10, 884-887. It is a case control study that compared 68 women with birth plans to 128 control women who were matched for age and parity. The results for various interventions:
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The results are notable for three reasons. First, the expressly stated desire to avoid a C-section or an episiotomy had no effect on the eventual need for a C-section or an episiotomy. Second, more than half the women who expressly stated that they did not want an epidural subsequently changed their minds. Third, the lower epidural rate in the birth plan group did not lead to a lower C-section rate.
This leads to the fundamental question: do birth plans have any value? As I would expect, wishing for a certain kind of delivery does not make it happen, so what is the point of a document that is confrontational and ineffective?