Reproductive health services focus their resources on reducing perinatal mortality rates and pay less attention to the quality of care and women's experiences (1). In European countries, some efforts have been made to change this type of care towards female-focused care and it is suggested that patient satisfaction and experiences can be considered an index of quality (2). The birth experience is defined as “an individual life event, incorporating interconnected subjective psychological and physiological processes, influenced by social, environmental, organizational and political contexts”. Say no to plagiarism. Get a tailor-made essay on "Why Violent Video Games Shouldn't Be Banned"? Get an original essay Studies in the obstetrics field have rarely assessed the mother's experience as an outcome (3). At the same time, assessing mothers' experience helps healthcare providers better understand their needs and expectations to perform needs-based interventions to improve mothers' satisfaction (4, 5). Women's negative childbirth experiences can influence posttraumatic stress disorder (PTSD) (6), postpartum depression (7), and the decision to have a subsequent pregnancy, as well as the type of birth (8). Description of the intervention Birth plan was first introduced in 1980 in response to the growing trend towards the medicalisation of childbirth (9, 10). The birth plan approach emphasizes the relationship between pregnant women and health care providers, respects women's right to be involved in decision-making, and would lead to feeling more control over the labor and birth process (11). The birth plan is a document written by a pregnant woman during the antepartum period, which describes her physical and emotional preferences regarding the labor and birth process, and which she presents to the provider at the time of labor. Two formats have been provided for the birth plan. In the first format, there is a list of choices that the pregnant woman can have during labor and delivery (playing music, support person, walking, showering, massage, breathing techniques, epidural, episiotomy, breastfeeding, … ). The second format includes some open-ended questions in which the pregnant woman can describe her preferences during labor and delivery (12, 13). Mother's participation in obstetric decision making increases satisfaction with the labor and birth experience. In medical care, the pregnant woman's feelings and wishes are often ignored and she is not involved in decision-making regarding her care (14). The positive relationship between a pregnant mother and her doctor and her involvement in the decision-making process could lead to a feeling of satisfaction regarding the birth. Women who are involved in their care process will usually have a better birth experience due to having a greater sense of control than women who are inactive in the decision-making process. Therefore, as a woman's ability to control her own care increases, her satisfaction rate will also increase (15-17). In one qualitative study, women were more satisfied with their birth experiences; despite the fact that in some women the birth did not go as expected (13). Despite the importance of women's birth experiences and its effect on short- and long-term postpartum outcomes, we found no systematic review article evaluating the effect of birth plan delivery on birth experiences. The purpose of this study was to evaluate whether a birth plan-based approach compared to the standard or routine approach innulliparous women influence childbirth experiences. Methods Data source and study identification Our search strategy involved using a valid filter to identify RCTs via PubMed MeSH terms. Search terms included “birth plan,” “birth plans,” “birth plan,” “birth experience,” “birth experiences,” and “satisfaction.” This systematic review was performed by searching several databases including English database (Cochrane Library, PubMed, Web of Science, MEDLINE, Embase, CINAHL, Scopus, Google Scholar) and Persian database (SID, Magiran, Iran med and Barakat ). The researchers also searched for references in the clinical trial articles reviewed in which the birth plan was compared to standard care. Inclusion criteria Randomized and quasi-randomised controlled trials published in English and Persian with respect to the language of publication that had compared the birth plan approach with the routine or standard approach without time limits were included. Studies were only included in the study that had measured birth experiences as an outcome. Unrelated studies such as duplicate articles, systematic reviews, case-control and cohort papers, as well as letters to the editor, were among the exclusion criteria. The PICO defined for this review article included: Participant (single pregnant women with a gestational age of 32 weeks or older and age 18 years or older without obstetric complications), intervention (implementation of birth plan), comparison group (routine or standard care) and outcome (birth experience or satisfaction). Exclusion criteria for the study included lack of comparison group and qualitative measurement of birth experiences. Assessment of risk of bias in included studies Two authors independently (SGH؛ JN() determined the risk of bias for the studies (Figure 1) through the criteria established in the Cochrane Handbook (18). Any disagreements were resolved through discussion and, if necessary, through consultation with a third person (MM). Generation of random sequences (checking for possible selection errors) The method used to create an allocation sequence was rated as low, high or low risk of bias clear When using an unpredictable randomization process, such as computer-based random numbers or random number tables, the risk of bias was reported to be low when using a non-randomized assignment method such as date of birth, even and odd numbers and row numbers for allocation sequence, risk of bias was reported to be high Allocation concealment (controlling for possible selection bias) Studies were assessed as low risk if they used the allocation method. central, sealed opaque envelopes or telephone allocation method for concealing allocation. Studies were assessed as high risk if random assignment was open. Blinding of participants and personnel (controlling for performance bias) Studies were reported with a low risk of bias where both the investigator and participant were blinded. Blinding of outcome assessment (controlling for possible detection bias) The outcome assessment method was independently evaluated for each outcome. The strategy used to hide results was rated as low, high, or unclear risk of bias. The studies were reported with a low risk of bias where the outcome assessors were blinded. Incomplete outcome data (controlling for attrition bias) The strategy used for incomplete outcomes was rated as low, high or low risk of biasclear. The studies were reported with a low risk of bias and without data loss or with relevant balance between groups. Exclusion, loss, and the number of participants recruited at each stage of the analysis were assessed relative to the total number of samples. Additionally, reasons for exclusion or loss and methods to balance missing data were reported, if described in the included studies. Selective reporting (controlling reporting bias) Studies were reported with a low risk of bias where all predetermined outcomes were reported. Studies were reported at high risk of bias if all predetermined outcomes were not reported or if there was a primary outcome in the study that was not predetermined. Data extraction and analysis Data analysis was performed using RevMan version 5.3 software. Data from only two studies were combined using meta-analysis. One of the studies was excluded from the meta-analysis because it did not quantitatively measure birth experiences. ResultsStudy selection By searching databases, 598 published articles were found, of which 548 and 47 articles were excluded by reviewing titles and abstracts, respectively. Afshar et al. (19) The study was excluded because it had just been presented in abstract form at the conference and its full text was not available. Lundgren et al. the study was excluded from the text review because it had measured outcomes qualitatively. Finally, two studies that had measured the impact of birth plan on birth experiences were included in this systematic review. Study characteristics Kuo et al. The study (2010) (11) was conducted on 330 primiparous women with at least 32 weeks of gestation who received prenatal care from one of seven Taiwanese medical centers. After written informed consent, eligible women were assigned to the birth plan or control group using block randomization. The nurse provided some explanations about the birth plan to the women in the intervention group. In the next stage, each of the participants discussed the birth plan with the obstetricians. Each woman in the intervention group wrote her own birth plan. The woman's birth plan was attached to the health record. When the woman entered the labor room, she gave her birth plan to the nurse. According to each woman's written plan, the nurse provided care. The control group received standard care. Finally, one day after giving birth, birth experiences were measured. Farahat et al. a study (2015) (20) was conducted on 260 primiparous women in Egypt. When primiparous women visited the clinic between 36 and 42 weeks of gestation to receive prenatal care, the researcher provided some explanations about the purpose of the research. After written informed consent, eligible women were assigned to the birth plan or control group using odd and even numbers. The intervention group was asked to write their own birth plan. According to each woman's written plan, the nurse and doctor provided care. The control group received routine care. Risk of bias in included studies The risk of bias for each of the included studies was described based on the Consort checklist in the table. In the study by Kuo et al. (11) an appropriate method such as block randomization method was used for the assignment sequence; however, adequate descriptions for allocation concealment were not provided. Regarding the blind trial, only the phrase "single blind" was mentioned, and there was no information about who had been blind in the