North Texas Research Forum 2024



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North Texas


Medical City Arlington


Obstetrics & Gynecology

Document Type


Publication Date



birth plans, communication, childbirth, postpartum, quality improvement


Maternal and Child Health | Medicine and Health Sciences | Obstetrics and Gynecology


Objective: Birth plans are an effective tool for a pregnant person to express their desires and expectations for labor and postpartum. Shortcomings of birth plans can be found whenever there is a lapse in communication between provider and patient. In the management of labor and emergent situations, it has been observed by patients that obstetric providers can communicate in authoritarian and dismissive manners. In response to this, birth plans were developed to serve as a guide in these scenarios. Birth plans allow a pregnant person to design a thoughtful plan of action with their healthcare provider before giving birth, rather than making critical decisions under stress. Our goal at Medical City Women’s Care clinic was to implement a standardized birth plan discussion between providers and pregnant persons. Standardized birth plan discussions would discuss analgesia in labor, emphasize breastfeeding benefits, and explain delayed cord clamping beginning at 32 weeks gestation. Methods: The Plan-Do-Study-Act (PDSA) quality improvement cycle was utilized as a conceptual framework for this quality improvement project. An overview of the quality improvement project was presented to OBGYN resident physicians and attending physicians at Medical City Women’s Care. Project personnel presented birth plan importance and instructions on how to utilize birth plan questionnaire and documentation. Physicians were instructed to discuss the standardized birth plan by 32 weeks gestation and to document the responses in the clinic's EMR. Data was reviewed by month and analyzed by percent compliance. Compliance was noted if two of the three topics were discussed. Percent compliance was calculated by the number of documented birth plans divided by the total number of patients that were at least 32 weeks gestation during that month. Planned cesarean sections were excluded from data collection. Results: Within three months of project implementation, compliance was 80% for two consecutive months. Compliance then decreased to 50% for four consecutive months. Upon which, the location of documentation in the EMR was changed for ease and efficiency. Compliance then averaged to 75% for five consecutive months. Conclusions: Implementing a standardized birth plan discussion is possible using the PDSA methodology. The future goals of this project would be to ensure documentation of the birth plan in the labor admission note, and to explore how the standardized birth plan influences patient satisfaction in the birthing and postpartum experience.

Original Publisher

HCA Healthcare Graduate Medical Education

Improving Patients’ Perception of Provider Trust and Communication with Birth Plans



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