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

Background aim: Women often feel more vulnerable during delivery, whereby the birth plan becomes most applicable, as an approach for pregnant women to present their expectations for childbirth. This systematic review was conducted to determine the effect of birth plan on birth outcomes.Methods: This systematic review was conducted by searching across databases of PubMed, Scopus, Web of Science, Cochrane Library, Medline, EMBASE, ProQuest, Magiran, IranDoc, and IranMedex using search terms of “plan birth”, “birth experience”, “pregnancy”, and “labor 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 results of meta-analysis showed that the mean score of childbirth experience was significantly higher in the birth plan compared to the control group (SMD=0.60; 95%CI: 0.07 to 1.13; P=0.03). Vaginal delivery frequency was significantly higher in the birth plan than in the control group (OR= 3.50; 95%CI: 1.78 to 6.89; P=0.0003). There was no significant difference between groups in terms of stages of labor (P 0.05). The results on neonatal outcomes were discrepant.Conclusion: The birth plan improves the childbirth experience and delivery outcomes. Clinical trials with stronger designs are suggested while also observing all RCT principles.