Birth Plans in Intrapartum Care: A State-of-the-Art Review of Shared Decision-Making, Communication, Documentation and Medico-Legal Implications

Birth plans are widely used to support communication, person-centered maternity care, and shared decision-making, but their effects remain heterogeneous because the term encompasses non-equivalent documents and workflows. This state-of-the-art narrative review examines how birth plans are defined and operationalized, synthesizes evidence on implementation and outcomes, and considers ethical and medico-legal implications for intrapartum consent, refusal, escalation, and documentation. Structured searches of Scopus and Web of Science Core Collection, supplemented by PubMed, covered literature published from 1 January 2000 to 20 September 2026, alongside purposive review of high-authority policy and professional guidance. Recent evidence highlights potential value when plans are accessible to the intrapartum team, revisited at preference-sensitive decision points, and treated as revisable as risk and feasibility evolve. Implementation studies identify accessibility, clinician uptake, and editability as practical implementation factors, while recent syntheses report favorable associations for selected outcomes but retain substantial heterogeneity. We conceptualize birth plans as clinical process tools and propose a Birth-Plan Traceability Bundle and Minimum Traceability Dataset as author-derived, clinically unvalidated frameworks for visibility, negotiation, and contemporaneous documentation. Their feasibility and effects require prospective evaluation.