WASHINGTON — Having a birth plan may be associated with improved maternal outcomes, including increased rates of vaginal delivery and early breastfeeding, according to a study presented at the American College of Obstetricians and Gynecologists (ACOG) 2026 Annual Meeting. The study was also published in the American Journal of Perinatology.

In a meta-analysis of six peer-reviewed studies, researchers from Brazil found that birth plans — documents or verbally expressed information that detail expectant mothers’ preferences regarding labor, delivery, and postpartum care — were associated with a higher likelihood of normal vaginal delivery (risk ratio [RR], 3.22; 95% CI, 1.49-6.95; P = .003) and increased odds of early breastfeeding (RR, 3.68; 95% CI, 1.48-9.15; P = .005). No significant benefits were observed for episiotomy rates (RR, 0.47; 95% CI, 0.02-10.49; P = .636) or labor augmentation (RR, 0.65; 95% CI, 0.30-1.41; P = .274).

Birth plans may include information such as women’s preferences regarding their position to give birth, birth environment, pain management, fetal monitoring, delivery preferences, umbilical cord clamping, immediate skin-to-skin contact, and early breastfeeding.

“We expected that birth plans would be linked to better experiences for women, and that’s what we found,” said lead study author Giovanna Cristina de Castro Martin, final-year medical student at Faculdade Santa Marcelina in São Paulo, Brazil. Martin said she became interested in evaluating the role of birth plans during her training in the Brazilian public healthcare system, where she saw many women going into labor feeling anxious and not being fully understood.

“Overall, the results highlight that when women are heard, informed, and actively involved, it doesn’t just improve how they feel about childbirth, it also positively shapes maternal and neonatal outcomes,” she said. “Even when medical interventions are needed, they’re more likely to understand and accept them. In practice, that can make the difference between a negative experience and a positive one.”

Martin and colleagues searched PubMed, Embase, and Cochrane Central for studies published from inception until July 2025. Only randomized controlled trials involving pregnant individuals in labor that compared birth plan use (written or verbal) with standard care without a plan were included. They conducted a random-effects meta-analysis (through RStudio, version 4.4.1) to pool prevalences and rates. Heterogeneity and sensitivity analyses were performed with a leave-one-out analysis. They used version 2 of the Cochrane risk of bias tool for quality assessment.

Primary outcomes were defined as the normal vaginal delivery rate, early breastfeeding, labor augmentation, episiotomy rate, and admission to the neonatal ICU. They also assessed a childbirth experience score (CEQ 2.0), which measures sense of control, professional support, perceived safety, and participation; a fear of childbirth score; and stages of birth duration.

Researchers identified 1129 studies. After removing duplicates and excluding those that didn’t match the inclusion criteria, six studies were included in the final analysis, comprising a total of 1419 women; 47% of them had a birth plan. These studies were conducted in Iran, China, Taiwan, and Spain.

Overall, women who had birth plans had higher rates of noninstrumental vaginal delivery, early breastfeeding, lower rates of NICU admission, and more positive childbirth experiences. Birth plans were not associated with reductions in episiotomy rates, labor augmentation rates, the duration of labor stages, or fear during labor or fear of childbirth during pregnancy.

To maximize their effectiveness, birth plans should be supported by comprehensive prenatal counseling that ensures women understand the possibilities and limitations of their choices and feel actively involved in any decisions, Martin and colleagues wrote. There should always be a conversation between ob/gyns and patients to set expectations, discuss what can go as planned, what might not, and how to ensure the best possible experience for the patient while keeping care safe and appropriate, Martin told Medscape Medical News.

“In the end, it’s not about following a plan perfectly,” Martin said. “It’s about ensuring that every woman feels like an active participant in her own care. That shift from doing things to patients to deciding with them, can completely transform the childbirth experience.”

There may have been significant heterogeneity in what information was included in birth plans among the various studies evaluated, said Katherine Grette, MD, general obstetrician and gynecologist with the University of South Alabama in Mobile, Alabama. “But one of the things that [this study] highlights is that the people that are going to be successful are the people that are really dedicated to a vaginal birth, and often those are the patients who come in with birth plans anyway,” Grette said in an interview.

Grette said she wasn’t necessarily surprised by the results. “I think this is similar to the evidence that’s emerging about doulas and their role in labor and delivery,” she said. While her practice site has a “pretty low rate of patients that actually employ a birth plan, it’s becoming more and more common for sure.”

Martin and Grette reported having no relevant financial disclosures.

Karen Blum is a freelance medical and science writer in the Baltimore area.