Rethinking the birth plan after the pandemic: A qualitative study of the view of Spanish midwives.

Background: The birth plan promotes women's autonomy allowing them to express their care preferences and to participate actively in decision-making. During the Covid-19 pandemic, concerns about infection placed limitations on women's decision-making and infringed upon some of their rights. The role of the birth plan, after the pandemic, needs to be reassessed to protect women's rights and ensure high-quality maternity care. Research aim: To explore Spanish midwives' perspective on the principle of respect for autonomy and how this is reflected in the birth plan, and to identify aspects that can be improved in the new post-pandemic scenario. Methods: A descriptive phenomenological study of the experiences of Spanish midwives before, during and after the COVID-19 pandemic that addresses the use of the birth plan and the impact that the pandemic has had on women's rights. Individual online interviews and face-to-face focus groups were used. Results: Prior to the pandemic, midwives felt that birth plans had problems related to the unrealistic expectations of some women as well as to a lack of awareness of their usefulness. During the pandemic, women mobilized to challenge restrictive regulations, but faced problems with information dissemination and professional coordination, leading to continued infringement of women's rights post-pandemic. Conclusion: To enhance the effectiveness of the birth plan in supporting women's autonomy, a deliberative approach is needed, along with improvements in midwives' ethical and communication skills. The COVID-19 pandemic has created a new scenario in which the discussion about the possibility of increasing the number of birthing centres or offering home birth care funded by the public system, should be debated.