A Phenomenological Study Investigating Women’s Experience of Written Birth Plans in Childbirth

Part One: Literature Review - Background: The birth plan was introduced as a means of addressing the medicalisation of childbirth. However there is evidence of conflict existing between patient and caregiver regarding its use. Additionally research has begun to reveal the potential adverse effects of the use of a birth plan and its possible implications. This article aimed to review that evidence. Method: Five databases were systematically searched and quality was assessed based upon standardised data extraction tools (Peersman, Oliver & Oakley, 1997) and Gough’s (2007) Weight of Evidence scale. Results: Eleven articles met inclusion criteria. A systematic approach was adopted to review the limited robust evidence base and conflicting results were discovered regarding the positive impact of the birth plan upon birth experience. Conclusions: The review highlighted a dearth of rigorously conducted research in this area. The articles were variable in their quality and in their support of the birth plan facilitating positive birth experiences. Indeed two studies reported that plans may create negative birth experiences. Routine creation of a birth plan may thus be questionable. Part Two: Research Report - Background: The birth plan is widely utilised and yet the research base is limited in its methodology and equivocal in its findings. Given the potential importance of experiences of childbirth upon the mental and physical well-being of both the mother and child, this research aimed to explore these experiences of birth with specific reference to the use of the birth plan. Method: Interviews constructed and conducted in accordance with Interpretative Phenomenological Analysis were undertaken with six primiparous women postnatally. Data from verbatim transcripts were then analysed informed by the same phenomenological perspective. Results: Analysis revealed a number of common and idiographic themes. The super-ordinate themes identified across transcripts were: - narratives that undermine the role of the birth plan, alternative approaches to the written birth plan and knowledge. Discussion: Some of the phenomenology reported by participants resonated with previous published literature. However the current data presented richer accounts of disadvantages as well as benefits. Clinical implications of these findings are discussed. Part Three: Critical Appraisal - Reflections on the overall research process, areas of learning and development, methodology issues and limitations of the study are provided.