The Role of Birth Plan in Shaping Maternal and Neonatal Outcomes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Objectives: This systematic review and meta-analysis discuss how birth plans impact maternal and infant outcomes. Our main objective is to analyze maternal fear of childbirth, labor phases duration, delivery method, neonatal admission, and early breastfeeding initiation. Data Sources: We systematically searched PubMed, Embase, and Cochrane Central for studies published from inception until July 2025. Study eligibility criteria: Only randomized controlled trials involving pregnant individuals in labor that compared birth plan use (written or verbal) to standard care without a plan were included. Study appraisal and synthesis methods: A random-effects meta-analysis was conducted through RStudio version 4.4.1 to pool prevalences and rates. Heterogeneity and sensitivity analyses were performed with leave-one-out analysis. We used version 2 of the Cochrane Risk of Bias Tool for quality assessment. Results: Birth plans were associated with a higher likelihood of normal vaginal delivery (RR 3.22; 95% CI 1.49–6.95; p = 0.003) and increased odds of early breastfeeding (RR 3.68; 95% CI 1.48–9.15; p = 0.005). No significant benefits were observed for episiotomy rates (RR 0.47; 95% CI 0.02–10.49; p= 0.636), or labor augmentation (RR 0.65; 95% CI 0.30–1.41; p = 0.274). Risk of bias was low across all studies. Conclusions: Birth plans may be associated with improved maternal outcomes, including increased rates of vaginal delivery, and early breastfeeding. The overall evidence suggests birth plans as a strategy to promote a more respectful childbirth.