The concept of the birth plan was introduced over 40 years ago in recognition of women as the decision makers in maternity care.  The intent was to provide a sense of agency to women in an increasingly medicalised maternity care system in which the cultural messaging and power imbalances dismiss women’s experiences.

With collaborative and supported birth preparation, women report greater satisfaction, greater sense of control and more aligned expectations. In the absence of collaboration and support, women are less satisfied and at greater risk of trauma, and the validity of consent is drawn into question. The Birth Map was developed from a consumer perspective to be a woman-led, collaborative, structured approach to birth preparation.  The Birth Map acknowledges the importance of communication and confident decision making for women.  In the form of a book, The Birth Map provides an overview of the Australian maternity system, with question prompts to assist women to engage with care providers and suggested resources to aid in knowledge building.

The Birth Map was evaluated using Realist Evaluation methodology, with self-selected participants from various models of care throughout Australia.  Participants were asked to record periodical reflections throughout pregnancy and after birth; and a cross-section of participants provided in-depth interviews postpartum.  Short postpartum surveys provided quantitative information on their experiences focusing on respect and decision making.

The evaluation found that The Birth Map facilitated communication, enhanced experience and aided decision making for the women participating in the study.  However, barriers included short appointment times and dismissive care providers, which impacted the experience negatively and impeded decision making.  The Birth Map helped alleviate this impact but does not negate the need for effective communication and relationship-based care.

The refined theory presents an Informed, Supported, and Confident maternity journey based on effective communication, with a guideline for how to put this into practice.  Women are acknowledged as the decision makers with an understanding that the context of each journey will differ.  This context includes the woman’s background and circumstances, the care providers’ skills, and the facility provisions.  Effective communication requires a process of sensemaking in pregnancy, building support through relationships with care providers and support people, and then making confident decisions as their birth unfolds.

Embedding this approach into the maternity system involves two critical aspects, which address the systemic barriers identified in standard and obstetric maternity approaches.  The first is to provide women with a comprehensive overview and prompts for questions in early pregnancy.  The second is resourcing care providers towards relationship-based care, effective communication and Supported Maternal Decision Making. This may look like training and support for practising care providers and inclusion in the curriculums for emerging practitioners.  Systemic change would shift us from a consent seeking process to a decision supporting one that recognises women as capable decision makers regarding their own experiences.

The Birth Map approach supports effective communication, through sensemaking, relation building and supported maternal decision making, for women accessing maternity services.