The Effectiveness of Prenatal Intervention on Pain and Anxiety during the Process of Childbirth-Northern Iran: Clinical Trial Study

Influence of Antenatal Education on Birth Outcomes: A Systematic Review Focusing on Primiparous Women

The primary objective of prenatal education programs is to furnish expectant mothers with the necessary knowledge for childbirth and early parenting. Despite the extensive implementation of these programs, the efficacy of these interventions remains unclear. This systematic review endeavored to consolidate the extant evidence pertaining to the effects of prenatal education on birth outcomes and experiences. Fourteen studies, comprising various study designs executed across diverse countries, were incorporated in this review. The outcomes assessed in these studies encompassed fear and anxiety, pain, delivery mode, interventions, postpartum depression, and self-efficacy. Additionally, the risk of bias and study limitations were also summarized. The results manifested that prenatal education was effective in diminishing the fear and anxiety associated with childbirth and enhancing self-efficacy in the majority of the studies. Moreover, several studies found that engaging in prenatal education augmented the preference for unmedicated vaginal birth. However, the effects of prenatal education on postpartum outcomes were less consistent. The primary constraints of the included studies were their minute sample sizes and brief follow-up periods. Nonetheless, the existing evidence proposes that prenatal education is beneficial for first-time mothers in terms of alleviating anxiety and augmenting agency during delivery. Prenatal education can equip pregnant individuals with the necessary knowledge and skills to navigate the perinatal period successfully. Further research is requisite to identify the optimal practices for diverse populations on a global scale.

The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis

BACKGROUND

Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health.

METHODS

We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes.

CONCLUSIONS

Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions.

PROSPERO ID

CRD42022376895.

Assessment of educational intervention and Acupressure during labor on the mother's anxiety level and arterial oxygen pressure of the umbilical cord of infants (PO2). A randomized controlled clinical Trial

BACKGROUND

Natural delivery is distressing, and the mother's anxiety in this condition can have negative impacts on the fetus, mother, and the delivery process. Hence, many women tend to use pharmacological or nonpharmacological methods for reduction of labor stress and anxiety. The aim was to assess the effect of supportive care and acupressure during labor on the mother's anxiety level and arterial oxygen pressure of the umbilical cord of infants.

MATERIALS AND METHODS

This performed on 150 pregnant women were randomly assigned to two interventions and a control group in the delivery ward of the selected educational center of Shiraz University of Medical Sciences (Shoushtari Hospital) in Iran. Mothers' anxiety scores before (beginning of the active stage of labor) and after intervention (the end of the first stage of labor) were measured using Spielberger's questionnaire. Then, infants' cord blood samples for arterial blood gas and hematologic analyses were sent to the hospital's laboratory. After all, the data with SPSS version 16 and using Pearson's correlation coefficient, one-way ANOVA, were analyzed.

RESULTS

The mean of anxiety score in the control group was 21.1% and in the supportive group and the acupressure group, respectively, decreased by 37.5% and 34.8%, respectively (P < 0.001). The mean of PO₂ was also reported in the maternal supportive, acupressure, and control groups, 40.4 ± 8.8, 27.4 ± 2.8, and 18.1 ± 3.7, respectively. Additionally, a significant correlation was found between mothers' anxiety scores after the intervention and the mean of PO₂ (P = 0.014).

CONCLUSION

The supportive care and acupressure at BL32 acupoint reduced mothers' anxiety and consequently improved fetal oxygenation. Therefore, these methods are recommended to be used during labor for improving birth outcomes.

Primiparous women's knowledge and satisfaction based on their attendance at childbirth preparation classes

AIM

To compare primiparous women's childbirth knowledge and their satisfaction with the childbirth preparation classes between regular and irregular attenders.

DESIGN

A cross-sectional study.

METHOD

This study was conducted on 136 primiparous pregnant women attending health centres in Tabriz, Iran. Women's knowledge on childbirth and their satisfaction with childbirth preparation classes were measured by using reliable tools via interviews. An independent t test was applied to compare women's knowledge and satisfaction scores between regular and irregular attenders.

RESULTS

The mean score of knowledge was significantly higher among women who were regular attenders compared to irregular attenders (p < .001). Although there were no significant differences in total satisfaction score between the women (p = .342), women with regular attendance reported that childbirth preparation classes reduced their anxiety about labour.

CONCLUSIONS

Regular attendance at childbirth preparation classes is associated with higher women's knowledge and lower feelings of anxiety regarding labour and birth.

Birth choices after caesarean in Taiwan: A mixed methods pilot study of a decision aid for shared decision making

BACKGROUND

Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. Studies suggest that women do not receive sufficient information about birth choices after caesarean in Taiwan and shared decision making (SDM) is not an expectation. This pilot study aimed to test the feasibility of using a birth choices decision aid to improve women's opportunity for engagement in SDM about birth after cesarean.

METHODS

A two-phase sequential mixed methods pilot study was conducted in a regional hospital in northern Taiwan. Phase I involved a randomized pre-test and post-test experimental design. Participants with one previous caesarean section (CS) were recruited at 14-24 weeks. A total of 65 women completed a baseline survey and were randomly allocated to either the intervention (birth choice decision aid booklet) or usual care (general maternal health booklet) group. A follow up survey at 37-38 weeks measured change in decisional conflict, knowledge, and birth mode preference. Birth outcomes and satisfaction were assessed one month after birth. Phase II consisted of postnatal interviews with women at one month after birth, to explore women's decision making experiences, using a constant comparative analytic technique and thematic analysis.

RESULTS

Decisional conflict was relatively low at baseline for all women. Although there were reductions in decisional conflict at follow up, differences between groups were not statistically significant. Women's early preferences regarding mode of birth influenced their knowledge-seeking behaviors and expectations or intention for engaging in SDM during pregnancy. Improvements in knowledge for the decision aid group were larger than for the usual care group, although differences between groups were not statistically significant. Four themes related to key factors in decision making were clarity, safety and risk, consistency, and support.

CONCLUSION

A cultural shift is needed to align expectations and relationships towards SDM for birth in Taiwan. Simulation-based strategies and tailored communication skills should be explored to enhance skills in decision coaching for providers. Use of interactive multimedia technology may provide opportunities to increase engagement with tools and support women during decision consultations. Midwife-led continuity of care models may also be beneficial in empowering women to actively share decisions and achieve the birth that is best for them.

A spiritual intervention to reduce stress, anxiety and depression in pregnant women: Randomized controlled trial

We assessed the efficacy of a spiritually-integrated cognitive-behavioral educational group intervention for reducing stress, anxiety, depression, and blood pressure during pregnancy and improving delivery outcomes. A randomized controlled trial was conducted in 84 pregnant women randomly assigned to either the intervention or a control group. Demographic information was collected at baseline, along with measures of religiosity, stress, anxiety, depression, and blood pressure. Our intervention consisted of four 90-minute group sessions over 8 weeks that utilized a spiritually-integrated cognitive-behavioral approach to help participants cope with the stress of pregnancy. Stress, anxiety and depression scores in the intervention group decreased significantly by 41%, 28%, and 41%, respectively, from baseline to 3-month follow-up. There were also significant differences in systolic and diastolic blood pressure between groups at the 3-month follow-up, favoring the intervention group. Between-group differences were also significant for these outcomes. Applying such spiritually-integrated intervention may help to improve the mental and physical health of young, healthy nulliparous pregnant women.

Comparison of the effect of educational software and booklet on anxiety and pain during labour: a randomised controlled clinical trial

This randomised clinical trial was conducted on 153 pregnant women. Participants were assigned into two intervention groups including educational software and an educational booklet and a control group through block randomisation. A training session was implemented for the intervention groups at 30-36 weeks and they were taught how to use the educational methods. Participants were followed-up until the childbirth time and the severity of pain was measured at four stage of cervical dilatation (4, 6, 8 and 10 cm) by Visual Analogue Scale (VAS). Spielberger State-Trait Anxiety Inventory was completed at 4-5 cm cervical dilatation. There was no significant difference between groups in terms of the labour pain intensity (p > .05). After intervention, mean (SD) of state anxiety score was 38.7 (2.6) in educational software group, 44.3 (7.4) in educational booklet group and 63.3 (8.2) in control group. Also, mean (SD) of trait anxiety score was 47.4 (2.7) in educational software group, 47.2 (2.4) in educational booklet group and 61.8 (3.9) in control group. The mean state and trait anxiety scores in both intervention groups were significantly lower than control group (p < .001). Both intervention groups were effective in reducing anxiety. Thus, these educational methods should be recommended for pregnant women in clinical practices.IMPACT STATEMENTWhat is already known on this subject? Childbirth is one of the most important crises in women's life, in which stress and other forms of emotional distress such as anxiety are likely to occur during it. Safe practices and effective interventions can be offered to pregnant women to tolerate the labour pain and reduce anxiety during labour.What do the results of this study add? There was no statistically significant difference between two intervention groups (educational software and educational booklet groups) and control group in terms of the pain intensity at the cervical dilatation of 4, 6, 8 and 10 cm. But the state and trait anxiety in both groups (educational software and educational booklet groups) was significantly less than the control group. Also, the anxiety level was significantly lower in the educational software group than the educational booklet group.What are the implications of these findings for clinical practice and/or future research? Educational software and booklet with educational content about position modification during pregnancy, stretching exercises, breathing techniques and exercises, relaxation and lower back massage for reducing anxiety should be recommended for pregnant women in clinical practices.

Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial1

OBJECTIVE

to evaluate the effectiveness of auriculotherapy on the anxiety of women during labor.

METHOD

this is a randomized, parallel, triple-blind clinical trial. 102 parturients with gestational age ≥ 37 weeks, cervical dilatation ≥ 4 cm and two or more contractions in 10 min were selected and randomly assigned into three groups to receive auriculotherapy, placebo or control (routine care). Auriculotherapy was applied with crystal microspheres to the shenmen, uterus, neurasthenia area and endocrine points, and anxiety was assessed by the Hamilton Anxiety Rating Scale (HAM-A). Analyzes were performed using the Kruskal-Wallis, Generalized estimating equations, Chi-square and Fisher's exact tests.

RESULTS

the groups showed no significant difference at baseline according to the HAM-A. After the intervention there was a significant increase in HAM-A scores at 120 min in the placebo versus auriculotherapy group (mean difference (MD) 3.62, confidence interval (CI) 0.42-6.81, p=0.0265) and control versus auriculotherapy group (MD 4.88, CI 1.87-7.88, p=0.0015).

CONCLUSION

the parturients with auriculotherapy presented lower levels of anxiety according to the HAM-A score after the treatment when compared to the women from the other groups; this can represent alternative care in obstetric practice. Registration: n. RBR-47hhbj.