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Essay / Reproductive health services focus resources on reducing perinatal mortality rates and pay less attention to quality of care and women's experiences (1). In European countries, efforts have been made to move this type of care towards care provided to women and it is suggested that patient satisfaction and experiences can be considered as an index of quality (2). The experience of childbirth is defined as “an individual life event, integrating interdependent subjective psychological and physiological processes, influenced by social, environmental, organizational and political contexts”. Say no to plagiarism. Get a tailor-made essay on “Why Violent Video Games Should Not Be Banned”? Get an original essay Studies in the field of obstetrics have rarely assessed maternal experience as an outcome (3). While assessing mothers' experience helps healthcare providers better understand their needs and expectations to carry out needs-based interventions to improve mothers' satisfaction (4, 5). Women's negative experiences during childbirth may affect post-traumatic stress disorder (PTSD) (6), postpartum depression (7), and the decision to have the next pregnancy as well as the type of delivery (8). Description of the Birth Plan intervention was first introduced in 1980 in response to the growing trend toward medicalization of childbirth (9, 10). The birth plan approach emphasizes the relationship between pregnant women and health care providers, respects a woman's right to be involved in decision-making, and would lead to feeling more control over her birthing process. labor and delivery (11). The birth plan is a written document prepared by a pregnant woman during the antepartum period, which describes her physical and emotional preferences regarding labor and the birth process and which she presents to the provider at the time of labor. Two formats have been provided for the birth plan. In the first format, we find a list of choices that the pregnant woman can have during labor and delivery (play music, accompanying person, walk, take a shower, massage, breathing techniques, epidural, episiotomy , breastfeeding, etc.). The second format includes open-ended questions in which the pregnant woman can describe her preferences during labor and delivery (12, 13). Maternal participation in obstetric decision-making increases satisfaction with the labor and birth experience. In medical care, the pregnant woman's feelings and desires are often ignored and she is not involved in the decision-making process related to her care (14). The positive relationship between a pregnant mother and her health care provider and her involvement in the decision-making process could lead to a feeling of satisfaction regarding childbirth. Women who are involved in their care process will generally have better birth experiences due to feeling more control than women who are inactive in decision-making. Therefore, as women's ability to control their own care increases, so does their satisfaction rate (15-17). In a qualitative study, women were more satisfied with their birth experiences; despite the fact that in some women, delivery did not go as planned (13). Despite the importance of women's childbirth experiences and their effects on short- and long-term outcomes after childbirth, we found no systematic review articles evaluating the effectbirth plan on childbirth experiences. The purpose of this study was to evaluate whether a birth plan approach compared to a standard or routine approach in nulliparous women affects birth experiences. Methods Data source and study identification Our search strategy involved the use of a valid filter to identify RCTs by PubMed MeSH terms. Search terms included “birth plan,” “birth plans,” “birth plan,” “birth experience,” “birth experiences,” and “satisfaction.” This systematic review was carried out by searching several databases including the English database (Cochrane Library, PubMed, Web of Science, MEDLINE, Embase, CINAHL, Scopus, Google Scholar) and the Persian database (SID, Magiran, Iran med and Barakat). The researchers also searched for references in reviewed clinical trial articles in which the birth plan was compared to standard care. Inclusion criteria Randomized and quasi-randomized controlled trials published in English and Persian with respect to language of publication that had compared the birth plan approach with a routine or standard approach without time limit were included . Trials were only included in the study that measured birth experiences as an outcome. Unrelated studies such as duplicate articles, systematic reviews, case-control and cohort articles as well as letters to the editor were among the exclusion criteria. The PICO defined for this review article included: Participant (singleton pregnant women with a gestational age of 32 years) weeks or more and age 18 years or more without obstetric complications), intervention (implementation of birth plan), comparison group (routine or standard care) and outcome (birth experience or satisfaction). Exclusion criteria for the study included lack of a comparison group and qualitative measurement of birth experiences. Assessment of risk of bias in included studies. Two authors independently (SGHÛ JN) determined the risk of bias for the studies (Figure 1) using the criteria set out in the Cochrane Handbook (18). All disagreements were resolved by discussion and, if necessary, consultation with a third party (MM). Random sequence generation (check for possible selection bias) The method used to create an allocation sequence was rated as low, high or unclear risk of bias. use of an unpredictable randomization process, such as computerized random numbers or tables of random numbers, the risk of bias was low when using a non-randomized allocation method such as date of birth, Even and odd numbers and file numbers for allocation sequence, risk of bias was high. Trials were rated as high risk if randomization was open. Detection bias) The method of outcome assessment was evaluated independently for each outcome. The strategy used for blinding results was rated as having low, high, or unclear risk of bias. Trials were reported with low risk of bias in which outcome assessors were blinded. Incomplete outcome data (checking for possible attrition bias) The strategy used for incomplete outcomes was rated as low, high, or unclear risk of bias. Trials were reported with low risk of bias, no loss of data or appropriate balance between groups. Exclusion, lossand the number of participants recruited at each stage of the analysis were evaluated in relation to the total number of samples. Additionally, reasons for exclusion or loss and methods to balance missing data, if described in the included studies, were reported. Selective reporting (checking reporting bias) Trials were reported with low risk of bias in which all predetermined outcomes were reported. . Trials were reported at high risk of bias if not all predetermined outcomes were reported or if there was a primary outcome in the trial that was not predetermined. Data extraction and analysis Data analysis was carried out using RevMan software version 5.3. Data from only two studies were combined using meta-analysis. One of the studies excluded from the meta-analysis because it did not quantitatively measure childbirth experiences. Results Study selection By searching the databases, 598 published articles were found, of which 548 and 47 articles were excluded by review of titles and abstracts, respectively. Afshar et al. (19) The study was excluded because it had just been presented as an abstract at the conference and its full text was not available. Lundgren et al. The study was excluded through text review because it measured outcomes qualitatively. Finally, two trials that measured the impact of the birth plan on birth experiences were included in this systematic review. Study characteristics Kuo et al. (2010) (11) was conducted among 330 primiparous women with at least 32 weeks of gestation who received prenatal care at one of seven Taiwanese medical centers. After written informed consent, eligible women were allocated to either a birth plan or a control group using block randomization. The nurse gave some explanations about the birth plan to the women in the intervention group. In the next step, each of the participants discussed the birth plan with the obstetricians. Each woman in the intervention group wrote her own birth plan. The woman's birth plan was placed with her health manual. When the woman entered the labor room, she gave her birth plan to the nurse. According to each woman's written plan, the nurse provided care. The control group received standard care. Finally, one day after delivery, birth experiences were measured. Farahat et al. (2015) (20) was conducted among 260 first-time women in Egypt. When the primiparous women visited the clinic between 36 and 42 weeks of gestation for prenatal care, the researcher provided some explanation of the purpose of the research. After written informed consent, eligible women were assigned to either a birth plan or a control group using even and odd numbers. The intervention group was asked to write their birth plan. According to each woman's written plan, the nurse and doctor provided care. The control group received routine care. Risk of bias in included studies The risk of bias for each of the included studies was described based on the Consort checklist in the table. In the study by Kuo et al. (11), an appropriate method such as block randomization method had been used for the allocation sequence; however, no adequate description had been provided for the attribution concealment. Regarding the blinding process, only the term “single blind” was mentioned, and there was no information about who was blinded in the study. It seems that the study
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