Birth Plan: 62 Key Decision Factors

A New Consensus Identifies 62 Key Factors for Birth Plan Decisions

A new study proposes a framework for what information pregnant women should receive to make an informed choice between a planned vaginal or caesarean birth. The preprint research, led by Anwuli Ekong and colleagues, identified 62 outcomes—44 for mothers and 18 for children—considered critically important for inclusion in a future decision aid. This work matters because while healthcare providers generally agree that women should be supported in making informed choices, there has been little agreement on precisely which benefits and risks must be discussed.

How Researchers Built the List of Critical Outcomes

Ekong’s team used a formal consensus method to build a comprehensive and balanced list.

A Three-Phase Process

The research unfolded in three distinct phases. First, the team created a long list of 71 possible outcomes. They pulled these from existing systematic reviews, the UK’s National Institute for Health and Care Excellence (NICE) guidelines, and interviews with mothers, partners, midwives, and obstetricians.

Next, that long list went through a two-round Delphi survey. Over 100 participants, including healthcare professionals, researchers, and—critically—women and their partners, rated how important each outcome was for decision-making. An outcome reached consensus as “critically important” if 70% or more of all participants, or 70% of the women and partners group, gave it a top rating of 7-9 on a 9-point scale. At the same time, fewer than 15% had to rate it as “not important.”

Finally, two virtual consensus meetings with stakeholders were held to discuss the survey results, debate contentious points, and finalise the list.

The Final Tally: What Made the Cut

From the initial 71, the process confirmed 54 outcomes as critically important. Another 17 were consistently rated as not critical across the survey and meetings, meaning over 70% of participants did not see them as essential for informing pregnant women. However, 8 of these 17 were kept because they are mandated by NICE guidelines. In the end, 9 outcomes were removed entirely, resulting in the final set of 62.

The Comprehensive Scope of Maternal and Child Outcomes

The final list is extensive and covers the immediate, short-term, and long-term implications of birth mode.

44 Maternal Outcomes Spanning Years

For mothers, the outcomes stretch far beyond the day of birth. They are organised into seven categories:

• Assistance with birth: This includes the likelihood of needing an unplanned caesarean after labour begins, or requiring instruments like forceps or a ventouse.
• Complications at birth: Serious events like major haemorrhage, injury to organs like the bladder or bowel, and the need for unplanned surgery.
• Recovery issues: Pain levels, infection risk, and the time it takes to return to normal activities.
• Pelvic floor health: The risk of urinary incontinence, anal incontinence, and pelvic organ prolapse in the short and long term.
• Psychological well-being: The experience of birth satisfaction or trauma, and the risk of postpartum anxiety and depression.
• Sexual function: Concerns about pain during sex after childbirth.
• Future pregnancy: Critical risks in subsequent pregnancies, including placenta accreta spectrum, uterine rupture, and stillbirth.

18 Child Outcomes, From Birth to Development

For the baby or child, outcomes also cover a wide timeframe:

• Morbidity and death: Immediate risks like stillbirth, neonatal death, and admission to a neonatal intensive care unit (NICU).
• Disease: Conditions linked to birth mode, such as asthma, eczema, and immune-related illnesses.
• Physical effects: The risk of accidental cuts to the baby during a caesarean and later childhood obesity.
• Development: Potential issues with cognitive development, motor skills, and coordination.

Study Limitations and the Preprint Status

This research provides a strong foundation, but several limitations must be acknowledged. Most significantly, this paper is a preprint. It has not undergone the rigorous peer-review process where independent experts scrutinise the methodology, analysis, and conclusions. The findings are provisional and could be revised.

Other limitations are noted by the authors. The consensus process, while robust, involved a specific group of stakeholders. Their priorities might not fully represent the views of all communities or cultural groups. Furthermore, the study determines *what* outcomes should be discussed, but not *how* the complex probabilities and trade-offs should be communicated effectively to support a clear choice.

What This Means for Expectant Parents and Clinicians

This consensus study has direct practical implications, even in its preprint form.

For pregnant women and their partners, the list of 62 outcomes acts as a potential roadmap for prenatal conversations. It empowers them to ask specific questions: “What is my personal risk of a major haemorrhage with each option?” or “How does planning a caesarean affect my pelvic floor health long-term?” The study validates that concerns about future pregnancies, mental health, and a child’s development are relevant and important to consider.

For midwives, obstetricians, and family doctors, the research highlights the vast scope of information needed for true informed consent. It challenges the healthcare system to move beyond discussing only immediate birth risks. The findings support developing a structured, standardised decision aid that ensures every woman has access to the same comprehensive information, reducing variation in care based on a provider’s personal preferences or knowledge gaps.

The next step, which the authors are likely pursuing, is to turn this list of outcomes into an actual decision aid tool. This tool would need to present clear, unbiased data on the likelihood of each outcome for different birthing scenarios, tailored where possible to a woman’s individual health profile.

Key Takeaways

• A new consensus study, not yet peer-reviewed, identified 62 outcomes considered critically important for women deciding between a planned vaginal or caesarean birth.
• The final list includes 44 maternal outcomes and 18 child outcomes, covering immediate risks, recovery, long-term health, psychological effects, and implications for future pregnancies.
• Researchers used a multi-stage method, gathering input from healthcare professionals, researchers, and, most importantly, women and their partners.
• The study provides a blueprint for creating a much-needed standardised decision aid for birth mode, aiming to support more consistent and comprehensive prenatal counselling.
• Pregnant women can use the list of outcomes to guide more detailed conversations with their healthcare providers about the full range of potential benefits and risks.
• The findings are provisional as the study is a preprint, and the next challenge will be effectively communicating the complex probabilities associated with each outcome.

This article is for informational purposes only. Consult a qualified professional for personalised advice.

Source:
What outcome information do women need to support an informed choice between planning a vaginal or caesarean birth? – a consensus study. (medRxiv preprint, 2026-05-17)