The Effect of a Birth Plan on Birth Outcomes: A Systematic Review and Meta-Analysis

Document Type : Review Article


1 PhD Student, Students’ Research Committee, Tabriz University of Medical sciences, Tabriz, Iran

2 MSc, Taleghani Hospital, Tabriz University of Medical Sciences, Islamic Republic of Iran

3 Associate Professor, Department of Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran



Background and Aims: Women often feel more vulnerable during delivery and have the least decision-making ability, whereby the birth plan becomes most applicable. This systematic review was conducted to determine the effect of birth plan on maternal and neonatal outcomes.
Methods: This systematic review was conducted by searching across various databases with mesh keywords with no time limitation until January 2024. Bias assessment of randomized controlled trials was done using the Cochran handbook, while that of quasi-randomized clinical trials was done via ROBINS-I.
Results: A total of 424 articles were retrieved from database searches, and an additional 10 articles were identified through manual searches. Ultimately, 9 studies with totally 1949 participants were included in the systematic review, and 6 studies were included in the meta-analysis. The quality of the articles was low. Concerning childbirth experience, the results of meta-analysis on the three studies showed that the mean score of childbirth experience was significantly more in the birth plan group compared to the control (SMD=0.60; 95%CI: 0.07 to 1.13; P=0.03). Vaginal delivery frequency was statistically significantly higher in the birth plan group than in the control group (OR= 3.50; 95%CI: 1.78 to 6.89; P=0.0003), and the results of the meta-analysis of five studies showed that there was no statistically significant difference between groups in terms of stages of labor (P>0.05). The results on neonatal outcomes were discrepant.
Conclusions: The birth plan improves the childbirth experience and delivery outcomes. Clinical trials with stronger designs are suggested while also observing all RCT principles.


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