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Are Birth Plans Associated with Improved Maternal or Neonatal Outcomes?

Hidalgo-Lopezosa, Pedro PhD student; Rodríguez-Borrego, Maria Aurora PhD; Muñoz-Villanueva, Maria Carmen PhD, MD

MCN: The American Journal of Maternal/Child Nursing: May/June 2013 - Volume 38 - Issue 3 - p 150–156
doi: 10.1097/NMC.0b013e31827ea97f

Purpose: The purpose of this study was to determine whether birth plans are associated with improved obstetric and neonatal outcomes.

Study and Design: This retrospective case–control study (N = 182) was conducted at a hospital in Córdoba, Spain, between August 2008 and September 2011. Obstetric and neonatal outcomes were compared between groups (women with and without birth plans). Chi-square statistics and Student's t-tests were used for statistical analysis.

Results: Women with birth plans were older and had a higher academic background than the control group. There were no significant differences between groups for any of the obstetric outcomes or 5-minute Apgar scores; however, there was a significant difference in umbilical artery cord blood pH values (p = .019). The percent of babies with umbilical cord blood pH < 7.24 among nulliparous women with birth plans (14.7%, n = 5) was lower than among babies of nulliparous women without birth plans (37.5%, n = 26).

Clinical Implications: Findings of this study provide evidence that birth plans may be helpful and are not associated with any negative obstetric or neonatal outcomes. Mothers with birth plans and their babies have at least as good outcomes as those without a birth plan. Babies of nulliparous women with birth plans had better umbilical cord blood pH values than babies of nulliparous women without birth plans. Healthcare professionals can promote the use of birth plans as a resource to enhance communication of women's desires for labor and birth.

Maternal and newborn outcomes of laboring women who presented with birth plans in one hospital in Spain are reported.

Pedro Hidalgo-Lopezosa is a PhD student, Midwife, University Hospital Reina Sofía Maimonides Institute of Biomedical Research in Cordoba (IMIBIC) at University of Cordoba, Córdoba, Spain. He can be reached via e-mail at;

Maria Aurora Rodríguez-Borrego, PhD, is the Director of the Department of Nursing at IMIBIC/University Hospital Reina Sofía at University of Córdoba.

Maria Carmen Muñoz-Villanueva, PhD, MD, is the Quality Control Coordinator, IMIBIC/University Hospital Reina Sofía at University of Córdoba.

The authors declare no conflict of interest.

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