Satisfaction Clinical Trial
Official title:
Effectiveness of a Counseling Intervention in the Birth Plan for Pregnant Women (APLANT)
This study assesses the effectiveness of a birt plan (BP) counseling intervention in pregnant
women.
Half of the pregnant women receive the intervention and the other half receive the usual
practice
The birth plan (BP) is the written expression of the preferences of the pregnant woman about
the management of her birth, in those cares in which there are equally effective and safe
alternatives. In Spain, it was introduced into the National Health System when the "Normal
Birth Attention Strategy" was developed, and in Catalonia when the Department of Health
published the "Protocol to the natural assistance of normal childbirth", all with the purpose
of responding to the demand of women to participate actively in their birth. Its main purpose
is to promote decision-making not influenced by the emotions that arise during the birth
process and to provide a communication vehicle between the future parents, the care provider
and the hospital team. In addition, it allows pregnant women to understand their personal
values, needs and concerns in the process of birth. The preparation of the BP can help the
pregnant woman to have real expectations of childbirth, make her involved in the decision
making process, thus increasing control over the birth process and having a satisfactory
experience with the experience of childbirth .
Studies on the impact of the birth plan in reference on the satisfaction of women in
childbirth, on obstetric outcomes and on the perception that women and professionals have of
them, are scarce and inconclusive. Observational studies related that the use of BP was
associated with an increase in: normal birth, late clamping of the umbilical cord, the
realization of skin with skin and less use of epidural analgesia. In addition, there are
researches with quantitative and qualitative methodology in which they relate the fulfillment
of the BP with a greater satisfaction of the women, a greater fulfillment of the expectations
and a better control of the delivery. However, others studies they do not relate it to a
higher delivery satisfaction. There is also disparity between the views of midwives and women
on the utility of the effect of BP on obstetric outcomes In 2016 a survey carried out in
Catalonia on the satisfaction of women in the care of the maternity process showed that the
overall level of satisfaction with the care received was high, 8.30 out of 10. However, women
only refer who received sufficient information in pregnancy, delivery and postpartum in
67.2%, 64.2% and 57.6% respectively.
Of the different models of care relationship, the deliberative model focuses on joint
collaborative work between patient and professional, in which the dialogue has a central role
and shared decision-making (SDM) is present in said model . There is a large bibliography on
the definition of SDM, as well as the elements that should be present in this process.
According to Epstein et al, clinical decision making should be approached from the creation
of a collaborative relationship with the patient and family using the best available
evidence, consistent with the values, objectives and capacities of the patients. The use of
decision support tools, such as support material, can help health professionals to provide
information and advice on options during pregnancy and to support women in shared
decision-making.
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