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birth plans, childbirth, decision making



  1. Carlton, Troy MSN, RN
  2. Callister, Lynn Clark PhD, RN, FAAN
  3. Stoneman, Eva MSN, RN


The decision-making process in childbearing women regarding birth preferences raises ethical dilemmas related to caring for women during labor and birth. Giving birth is a powerful, life-changing event that leaves a lasting impact on the childbearing woman. The birth experience may be perceived positively or negatively or with feelings of ambivalence. This descriptive qualitative study asked what factors influence a woman's change in her stated birth preference from an unmedicated birth to a medicated birth. A purposive convenience sample of 33 primiparous and multiparous childbearing women who had changed their stated birth preference for pain management during labor participated in interviews conducted within a month of giving birth. Themes included wanting an unmedicated birth; changing to a medicated birth; feeling disappointed, ambivalent, or satisfied; and reflecting on the change. Changing birth preferences is a result of many complex factors, including the influence of professional support by nurses. Ethical principles such as autonomy, veracity, beneficence, informed consent, standard of best interest, and obligations should be applied when caring for laboring women, framed by the ethics of caring.