Response to requests for birth plans in a sample of Colombian institutions between 2020 and 2023: A case series

Objectives: To describe the responses issued by a sample of Colombian healthcare institutions to birth plans submitted by pregnant women between 2020 and 2023, as well as the reasons provided for denying specific requests. Material and methods: A case series study was conducted. Pregnant women who had submitted a birth plan to the healthcare institution assigned by their insurer between June 1, 2020, and October 11, 2023, within Colombian territory, and who received a positive response from the receiving institution were included. Consecutive sampling was used. The characteristics of institutions that issued positive responses were assessed, along with the proportion of accepted requests within birth plans, according to local regulations. Results: Only 10% of the responses were personalized. Between 41% and 52% of the requests received no response, except for the request for companionship, which was denied in 9% of vaginal births and 31% of cesarean sections. Other procedures frequently denied included the availability of a Pilates ball and freedom of position during childbirth, which were refused in 31% and 36% of cases, respectively. Epidural analgesia was accepted in 41% of private institutions and 7% of public institutions. The reasons given for denying these requests included lack of infrastructure, risk of infection, and lack of trained personnel. Conclusions: Health regulatory and oversight bodies are required to monitor institutional compliance with pregnant women’s requests as expressed in birth plans during prenatal care. In addition, further quantitative and qualitative studies using appropriate study designs are needed to confirm these findings and to better assess the true magnitude of the problem, its underlying causes, determinants, and potential points of intervention.