Beyond the birth plan Enhancing communication between patients and - PowerPoint PPT Presentation

Beyond the birth plan Enhancing communication between patients and providers I have nothing to disclose Rebecca Amirault, CNM Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences UCSF June 13, 2019 2 How do you feel about birth plans? I believe that birth plans increase risks of: A. Cesarean birth A. I encourage all my patients to write birth plans. 66% B. Chorioamnionitis B. I feel comfortable supporting patients with birth 60% plans. C. Postpartum hemorrhage C. I don’t feel strongly about birth plans. D. Perineal lacerations or episiotomy D. I think birth plans have no use. E. Low Apgar scores 23% 18% E. I think birth plans are dangerous and can lead to F. All of the above 8% 7% worse outcomes. 3% 3% 5% 3% 1% 0% 1% G. None of the above F. What is a birth plan? s e h . s e e t i g e v What is a birth plan? t . . v I encourage all my patien.. I feel comfortable suppor... r i a e r o o I don’t feel strongly abou... I think birth plans have n... i n h o I think birth plans are da... b b b o r r c o s a a n i r a n o m s r e e e m n a h h r a o g t t a e p o i f f s h t A i a o o e r m C o r w l e e l h u A n c o C t o r a L N a l l p a t e s o n P r i e P 1

Provider feelings on birth plans of medical personnel believe that having a birth plan is associated with overall worse obstetrical outcomes including  No difference between groups for: increasing the rate of cesarean delivery. - Cesarean birth - IV analgesia use of patients believe that having a birth plan is associated - Chorioamnionitis with overall worse obstetrical outcomes. - Postpartum hemorrhage - Perineal lacerations or episiotomy So why are we seeing this document so differently? - Low Apgar scores (1 and 5 minute) Grant et al Expertopinion vs. patient perception of obstetrical outcomes in laboring women with birth plans The Journal of reproductive medicine, 01/2010, Volume 55, Issue 1-2 What is a birth plan? The history of birth plans  A written document composed prior to delivery by the birthing  First seen in the 1980s in response to a more “medicalized” patient to: birthing environment - clarify desires and expectations for childbirth - provide information regarding preferences for their care and support during labor  Birth Plan vs Birth Preferences 7 2

Goals for a birth plan Shared Decision making in Obstetrics Communication Communication ACOG- Ethical Decision making on Obstetrics and Gynecology #390 Preparation Preparation with providers with providers “ Respect for a patient’s autonomy acknowledges an For birth For birth and staff and staff individual’s right to hold views, to make choices and to take actions based on her own personal values and beliefs. Respect for autonomy provides a strong moral foundation for informed consent in which a patient, adequately informed Promoting a Promoting a Sharing Sharing about her medical condition and the available therapies, supportive birth supportive birth personal values personal values freely chooses specific treatments or nontreatments." environment environment and beliefs and beliefs Inside Amy Schumer “Patients are telling Birth plan sketch me how to Place do my job!” YOUR Inflexibility criticism here Criticisms of birth Unrealistic Outdated expectations information plans Non Aggressive evidence or based accusatory information language Attempt to control the uncontrollable 3

Provider Patient Control Control Expertise Expertise Capabilities Capabilities Preparedness Preparedness Preferences Preferences Apparently The World's Top Ob-Gyns Don't Agree With Meghan Markle's At-Home birth plan Who influences a birth plan? If you are not happy with the information provided by the internet, childbirth educators and other Childbirth sources then you need to take a more active role in educators educating your patients. Family Internet Friends Popular culture Obstetric Providers 15 4

A talk for another day  Person Centered Communication  Patient Led Communication  Shared Decision Making  Mother’s Autonomy in Decision Making (MADM) Scale  Trauma Informed Care How do we educate our patients?  Presenting evidence based medicine to patients  ACOG committee opinions  Etc. etc. etc. 18 Effects of birth plan on Taiwanese women’s childbirth experiences First randomized controlled trial, published 2010  N=296  Prior to recruitment the nurses participating in the study received a 12 hour seminar to review the concept of “friendly childbirth”  Patients were divided into a birth plan group and a control group  The birth plan group discussed the items on the generic birth plan with a nurse in an education session. What is the evidence regarding birth plans?  Each patient had a follow up session with their Obstetrician to discuss every item on the birth plan and reach a consensus together.  The birth plan was then signed by the patient and the Obstetrician and placed in the chart. Kuo S, Lin L, Lin K, et al. Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: A randomized controlled trial. International Journal of Nursing Studies . 2010;47:806-814. 19 5

Use and influence of delivery and birth plans in What did they find? the humanizing delivery process The birth plan group Quantitative study, Spain in 2015  Patients in the birth plan group were significantly more likely to  n=9,303 report that they had better childbirth experiences and their expectations were better met than the patients in the control  Patients who arrived on Labor and Delivery with a birth plan had group. a significant - Birth plans may help patients have realistic expectations - Increase in Skin to Skin contact - Birth plans may help the patients to think about how to deal - Increase in use of different positions with the labor process. - Decrease in episiotomy  Involvement in decision making, increased patient’s feelings - Increase is NSVD of control over the childbirth process , which in turn is - Decrease in induction associated with a more positive experience and greater overall - Increase in delayed cord clamping satisfaction with childbirth. Suárez-Cortés M, Armero-Barranco D, Canteras-Jordana M, Martínez-Roche ME. Use and influence of Delivery and birth plans in the humanizing delivery process. Revista latino-americana de enfermagem . 2015;23:520-526. 22 Birth plans--Impact on mode of delivery, Differences in outcomes obstetrical interventions and birth experience  No difference between  Patients with birth plans satisfaction groups for: were less likely to: Prospective cohort study from 2017 - Cesarean birth - Have Pitocin augmentation - IV analgesia use  n= 300 - AROM - Chorioamnionitis  Patient were recruited on admission to Labor and delivery and - Use an epidural - Postpartum hemorrhage divided by those who came with a birth plan or without one. - Have a baby admitted to - Perineal lacerations or the NICU episiotomy  Though there was no - Low Apgars (1 and 5 difference in total length minute) of stay for neonates What did they find? Afshar Y, Mei JY, Gregory KD, Kilpatrick SJ, Esakoff TF. Birth plans—Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study. Birth . 2018;45:43- 49. 6

Difference in patient satisfaction I can’t get no…  On postpartum day 0 they were asked about: - Overall satisfaction with birth experience - If the birth experience was what they expected - If they felt in control of their birth experience  The birthing parents with birth plans consistently reported lower scores on all measures of the satisfaction questionnaires.  Specifically they were less satisfied with their birth experience, less frequently felt their birth experience met their expectations and felt less in control. 26 Why did these studies show different outcomes Childbirth education and birth plans for patient satisfaction? Retrospective cross- sectional study for singletons >24 weeks  The glaring difference between these studies is prenatal  Cedars- Sinai Medical Center in 2017, n=14,630 education and discussion.  2015 and 2017 studies both report prenatal discussion could be  4 categories: a influencing factor. - Those who attended CBE and wrote a birth plan - Those who just attended CBE “ A supportive antenatal opportunity to allow discussion of options - Those who wrote a birth plan, but did not attend CBE may be needed to realize the potential benefits of routine inclusion - Those who did not attend CBE or write a birth plan of birth plans”  Primary outcome was mode of delivery Whitford HM, Entwistle VA, Teijlingen E, et al. Use of a birth plan within Woman ‐ held Maternity Records: A Qualitative Study with Women and Staff in Northeast Scotland. Birth . 2014;41:283- Afshar Y, Wang ET, Mei J, Esakoff TF, Pisarska MD, Gregory KD. Childbirth Education Class and birth plans Are Associated with a Vaginal Delivery. Birth . 2017;44:29-34. 289. 7