Midwives’ attitudes towards the development and implementation of birth plans

Abstract

Birth plans are written documents that outline women’s preferences for labour, birth, and the postpartum period. Despite their recognised benefits in supporting woman-centred care, birth plans are not currently implemented in Malta, and local research on midwives’ attitudes is lacking, with limited quantitative evidence in international literature. This highlights the need for this study to inform practice and policy development. This study aimed to assess Maltese midwives’ attitudes towards developing and implementing birth plans, addressing the research question: What are midwives’ attitudes towards the development and implementation of birth plans in Malta? Its objectives were to explore their views and attitudes, perceived challenges, and strategies to support readiness for its implementation into practice. A primarily quantitative, non-experimental, cross-sectional, descriptive design was adopted, using a self-administered, self-designed online questionnaire supplemented by qualitative open-ended questions. Content validity was established via expert review, with indices indicating excellent item- and scale-level content validity, and inter-rater agreement. Reliability and feasibility were confirmed through a pilot study. Convenience sampling was employed, where 281 midwives practising at Mater Dei Hospital and Gozo General Hospital were invited to participate. 128 completed questionnaires were received, yielding a 45.55% response rate. Quantitative data were analysed using descriptive and inferential statistics, and qualitative data were analysed using reflexive thematic analysis (Braun & Clarke, 2022). The findings revealed generally positive views and attitudes towards birth plans, with midwives recognising their value for woman-centred care, informed decision-making, and communication. Midwives also identified practical challenges that may affect birth plan development and implementation and suggested strategies to facilitate adoption. The Theory of Planned Behaviour helped shed light on these findings, suggesting that midwives’ positive attitudes may strengthen intentions to implement birth plans, while perceived challenges can influence perceived behavioural control and subjective norms. This study indicates that overall, Maltese midwives view birth plans positively but require organisational support, education, and structured processes for effective implementation. These findings can inform policy development, enhance woman-centred care, and help align Maltese maternity services with international standards of respectful, evidence-based maternity care.