This blog series is designed to help women who are developing a birth plan join together with like-minded birthing professionals so as to have a shorter and safer labor and birth. Although written primarily for professional birth attendants, I hope information will be helpful to lay women planning their birth. Today we’ll look at the seventh “P” of my 10 “P’s” of keeping labor shorter and birth safer — patient preparation (or psychological prep).
Most maternity care givers seem to accept the proposition that a prepared patient is infinitely preferable to an unprepared one. The medical literature in this area is best summed up by saying that “all patients should receive basic (prenatal) education …”(5)
If a care giver helps or encourages a woman to prepare an individualized birth plan, the literature would seem to indicate, then labor is more likely to remain normal, primarily because a woman becomes aware of their options.
“95% of women said that they would encourage other women to use the (birth) plan. It increased their understanding about the labor and birth, and the hospital options open to them … Women said (the birth plan) was helpful, helped them express their needs and preferences, enhanced their confidence, and improved communication between them and staff … Birth plans show the commitment of health caregivers to recognizing and supporting diversity, allow for critical reappraisal of existing hospital policies and practices, and provide an opportunity for quality improvement in the context of client rights and preferences.”(30)
What is even more interesting is the research that seems to indicate that prenatal preparation may effect even postpartum psychosocial outcomes.
For example, “prenatal parenting communication classes had a significant impact on postpartum anxiety, postpartum marital satisfaction, and postpartum adjustment.”(73)
Also this: “An increasing body of evidence in the scientific literature indicates that the well-prepared woman, with good labor support … is unlikely to need analgesia or anesthesia and is unlikely to require cesarean section.”(42)
However, not only patients benefit from education about non-interventional options and interventions that can increase the chance of keeping normal labor normal, because “… we know that the rate of cesarean section can be reduced by half by education programs based in community hospitals. Such programs teach physicians techniques of labor, active management of labor, and the appropriate use of electronic monitoring.”(15)
Here’s the entire series:

• Introduction
• The Costs of Abnormal Labor
• THE 10 P’s

1. Philosophy,
2. Partners,
3. Professionals,
4. Pain control,
5. Procedures,
6. Patience,
7. Preparation,
8. Positions,
9. Payment, and
10. Prayer.

• Summary

Citations:
(5)Smith MA, Acheson LS, Byrd JA, et. al. A critical review of labor and birth care.   J Fam Pract 1991;33:281-292.
(15) Paul RH.  Toward fewer cesarean sections: the role of the trial of labor (editorial).  NEJM 1996;335:735-6.
(30) Moore M, Hopper U.  Do birth plans empower women?  Evaluation of a hospital birth plan.  Birth 1995;22:29-36.