| Study |
Intervention |
Details |
| Bastani 2006 |
Nurse‐led applied relaxation training programme |
Applied relaxation education based on Ost's description of applied relaxation, including progressive muscle relaxation and breathing (see Öst 1988 for details). Seven 90‐minute group education sessions over seven weeks led by a nurse, under the supervision of a clinical psychologist ‐ session 1: introductory group discussion of anxiety and stress‐related issues in pregnancy and purpose of applied relaxation; session 2: teaching subjects to relax with a shortened version of progressive relaxation; session 3: includes 'release‐only' relaxation; session 4: deep breathing techniques; session 5: 'cue‐controlled' relaxation; session 6: 'differential relaxation'; session 7: 'rapid relaxation'. Participants are advised to practise the applied relaxation regularly and keep daily home relaxation practice records during the study |
| Bergstrom 2009 |
Antenatal education on natural childbirth preparation with training in breathing and relaxation techniques |
Education model included four, two‐hour sessions during pregnancy and one follow‐up session within 10 weeks after delivery. Classes started in the third trimester with groups of 12 people (6 couples). Focus was on preparation for natural childbirth. Information was given about non‐pharmacological methods for pain relief and the partner's role as a coach during labour. In each session, 30 minutes were spent on practical training in breathing, relaxation and massage techniques. Psychoprophylactic training between sessions was encouraged and a booklet to facilitate homework was distributed. The attitude of the educator was encouraged to be in favour of natural birth. Information about breastfeeding was provided but no other postnatal issues were addressed. If possible, one of the sessions could include a visit to the delivery ward. The sessions were led by one midwife. |
| Eden 2014 |
Computerised decision aid versus educational brochures |
Computerised decision aid
The decision aid was designed for women with low literacy and used multiple media (text, graphics, voice‐over narration for all text). The reading level was sixth to eighth grade, depending on the screen. This decision aid provided brief summaries of the medical evidence for the two options in plain language. The decision aid intervention also provided an explicit values clarification activity so that the women could set priorities around avoiding risk to herself, her baby, and to future pregnancies while also considering cost and her desired birth and recovery experience. Value clarification helps the women combine beliefs with their own values and helps them recognise they may have competing values.
Educational brochures
The most current ACOG brochures on VBAC published in August 1999 and caesarean birth published in January 2005. The women could choose from the English or Spanish versions. The evidence‐based brochures were developed by the Committee on Patient Education of ACOG. The VBAC brochure provided a description of the delivery, vaginal delivery rate range, benefits and reasons for a VBAC, explanation of type of caesarean incision, and potential risks to mother and infant. Similarly, the caesarean brochure described the delivery and recovery, benefits and reasons for a repeat caesarean, and potential risks of caesarean to the mother.
|
| Feinberg 2015 |
Psychosocial couple‐based prevention programme |
The psychosocial programme consisted of nine classes, with four weekly classes conducted during the second or third trimester of pregnancy and four weekly classes conducted within the first six months postpartum. Classes focused on emotional self‐management, conflict management, problem solving, communication and mutual support strategies that foster positive joint parenting of an infant. A male–female facilitator team led each class; the female was a childbirth educator in all cases, and males came from various backgrounds but were experienced working with families and leading groups. |
| Fenwick 2015 |
Psychoeducation by telephone |
Two sessions of psychoeducation provided at 24 and 34 weeks' gestation by telephone at a scheduled time convenient to participants. The sessions were around one hour duration (first session range: 22 to 125 minutes; second session range: 10 to 104 minutes). The midwife‐led counselling intervention aims to support the expression of feelings and provide a framework for women to identify and work through distressing elements of childbirth. The intervention develops women's individual situational supports for the present and near future, affirming that negative events during childbirth can be managed, and developing a simple plan for achieving this. This combination of strategies diminishes emotional distress, builds constructive coping mechanisms and facilitates recovery. |
| Fraser 1997 |
Individualised prenatal education and support programme versus written information in pamphlet |
Prenatal education and support programme
Prenatal education and support programme provided by two individuals: a research nurse with experience in prenatal instruction and a resource person selected on the basis of communication skills and personal experience of a vaginal birth after caesarean section. Two individualised contacts: the research nurse on the day of randomisation and four to six weeks later by the research nurse and resource person.
First contact, duration (minutes ± SD): stratum 1 (low motivation), 57 ± 20; stratum 2 (high motivation): 54 ± 20;
second contact, duration (minutes ± SD): stratum 1: 54 ± 22, stratum 2: 54 ± 20.
Pamphlet group
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| Masoumi 2016 |
Antenatal education programme for physiologic childbirth (birth preparation training) |
Training preparation for childbirth was formed in eight sessions of two hours. These classes were held every two weeks from 20 to 34 weeks of pregnancy in the study hospital. The content of these classes included the mother's physical and mental changes, common problems and complications of pregnancy and ways to solve them, warning signs in pregnancy, nutrition and exercise during pregnancy and lactation, education about labour and the delivery process, and ways of coping with them, non‐pharmacological methods for pain relief and the partner’s role as a coach during labour. 10 to 15 people were in one group. In each session, 40 minutes were spent on practical training in breathing, relaxation, massage techniques and special exercise. |
| Montgomery 2007 |
Computer decision aids versus usual care |
Two computer‐based interventions delivered using a laptop computer, usually in the women's own home.
Information programme and website providing information and descriptions on outcomes for mother and baby associated with planned vaginal delivery, planned caesarean section and emergency caesarean section. Probabilities of having or not having the event are given and presented in numerical and pictorial format. Decision analysis comprising of four steps: draw‐up a decision tree that maps the likely outcomes of the strategies in question. Outcomes are assigned utilities that represent how an individual values a particular outcome. Probability information is included in the tree to represent the chance of each outcome occurring. Strategies are compared by calculating the weighted sum of the utilities of all possible outcomes. Recommended strategy is that with the highest expected utility value (the one that gives an individual the best chance of achieving an outcome that is valued).
Usual care: this comprised the usual level of care given by the obstetric and midwifery team. Women in the two intervention groups also received usual care. |
| Navaee 2015 |
Role play education versus standard education using lectures |
Role‐playing group
The role‐playing group was divided into two subgroups of 10 subjects each and another two subgroups of nine subjects each (38 subjects). Each group was instructed in a 90‐minute session about the advantages and disadvantages of normal delivery and CS. In the warm‐up stage, the researcher narrated two true stories about the individuals who were wondering about the selection of the mode of delivery due to fear of childbirth and asked the participants to voluntarily accept to play the role of pregnant woman with the researcher and two co‐researchers. Then the participants helped the researcher to prepare and process the scene (scene preparation was conducted with the needed equipment for role play in two scenarios), and the observers were asked to pay close attention to the scenarios, taking important notes, and discussing them at the end of the scenario. In the scenarios, the reasons for mothers' fear of natural delivery and CS were discussed. In the first scenario, one of the participants (a pregnant woman) played the role of a woman who was referred to a midwife's office to select the mode of delivery and witnessed the events occurring in the office. Then, she was referred to the midwife and consulted with her about her concerns. The second scenario was about a woman with a normal delivery and the benefits and complications experienced by her. The next step was similar to the first scenario. In the third scenario, one of the co‐researchers defended CS and another defended normal delivery. After these three scenarios, participants were asked to talk about their friends'/relatives' experiences of the two types of delivery.
Standard education (lecture group)
Two subgroups of 10 subjects each and two subgroups of 9 subjects each was instructed using a PowerPoint presentation, marker, and whiteboard in a 90‐minute session. At the end of the session, participants' questions were answered.
|
| Rouhe 2013 |
Psychoeducation |
The psychoeducative group therapy was led by four different psychologists with special group therapeutic skills in pregnancy‐related issues. Each group consisted of a maximum of six nulliparous women. Each group was led by the same psychologist from the beginning to the end. The starting point of group therapy was planned to be at approximately the 26th week of pregnancy. Six group sessions were held during pregnancy and one session with the newborns six to eight weeks after delivery. Each two‐hour session had a certain structure: a focused topic and a 30‐minute guided relaxation exercise using a compact audio disk developed for this purpose. This relaxation exercise guided the participants through stages of imaginary delivery in a relaxed state of mind with positive, calming and supportive suggestions. The topics covered included: information about fear and anxiety, group therapy and effects of relaxation; information about fear of childbirth, normalisation of individual reactions and information about stages of labour; hospital routines, birth process and pain relief (led by therapist and midwife); becoming a family, changes in relationship, parenthood and enhancing mutual understanding between becoming parents; becoming a mother, recognising the signs of postnatal depression and bonding with the foetus; completing preparation for delivery and birth plan. Meeting two to three months after delivery with newborns, discussion of delivery experiences, detection of trauma and depression symptoms, discussion of mother–infant relationship. |
| Saisto 2001 |
Intensive group therapy (cognitive behavioural therapy and childbirth psychotherapy) |
Intensive group therapy by obstetrician who had attended a 185‐hour course of cognitive therapy, 40 hours in childbirth psychology and was qualified as a therapist in addition to several years' experience in treating women suffering from fear of childbirth. Therapy comprised of provision of information and conversation regarding previous obstetric experiences, feelings and misconceptions. Appointments for the group therapy were based on routine obstetric check‐ups to assure the normal course of pregnancy. All women allowed to phone for advice between sessions. Written information on the pros and cons of vaginal delivery and modes of pain relief was provided. |
| Sharifirad 2013 |
Prenatal education for husbands |
Husbands were divided into three 13‐ to 15‐member groups; and each group participated in an educational session for 90 minutes. Educational content was about mechanism of natural vaginal and caesarean deliveries as well as their advantages and disadvantages. Various educational methods (lecture with picture slides, question, and answer) and educational tools (overhead, pamphlet, and white board) were used. No educational session was held for pregnant women. The training was done by a 'MSc expert' in health education. |
| Shorten 2005 |
Decision‐aid booklet |
Decision‐aid booklet constructed using the Ottawa Decision Framework (O'Connor 1999) as a format, incorporating evidence‐based information, explicit probability illustrations and values clarification exercises. Presents risks and benefits in a format that encourages the user to make individual judgments about the information, according to personal values, needs and priorities. Decision booklet given at 28 weeks gestation. |
| Valiani 2014 |
Childbirth training workshop |
The educational workshop was held in three, four‐hour sequential weekly sessions in groups of 30 members separately. Lecture method, questions and answers, role play, problem solving, and educational pamphlets were used to promote subjects' knowledge and group dynamicity, as well as to attain the highest participation of the subjects. Educational content included issues on couples' communication, parental role, the role of the spouse in mother's selection of delivery mode, attendance of the spouse or a relative at delivery stages, childbirth fear, delivery pain, delivery mechanism, medicational pain relief techniques and their effects, non‐medicational pain relief methods, advantages and disadvantages of CS and vaginal delivery, indications and contraindications of CS, haemorrhage and infection after every mode of delivery, postpartum sorrow and depression, mother–infant attachment, breast feeding, and infants' intelligence, growth, and development. |
| Wang 2014 |
PFMT with telephone follow‐up |
PFMT course topics included the female pelvic anatomy, the function of the female pelvic floor muscles, causes of pelvic floor muscle dysfunction, and possible symptoms. Using a discussion teaching method, the nurse explained the influence of pregnancy and delivery on the function of the pelvic floor muscles, the benefits of controlling maternal and foetal body weight, and how to perform PFMT. Women were given guidance in the correct muscle contraction method by a pelvic floor physiotherapist while performing pelvic floor muscle strength measurements during the first antenatal examination. Programme details: training could be conducted at any time of day in a standing, supine, or sitting position. The women were asked to empty the bladder and then contract the anal and vaginal muscles for no less than three seconds. The muscles were then relaxed. This contraction–relaxation sequence was repeated twice and followed by five rapid contractions of the perineal muscles. Women were instructed to repeat the exercises for 10 to 15 minutes, two to three times a day; alternatively, contraction of the perineal muscles could be conducted 150 to 200 times per day at any time. The women were told to gradually prolong the duration of each contraction and the total training time. If the women felt unwell during the training, they were instructed to immediately stop the contraction movements. The test group was followed up by telephone every two weeks until six weeks postpartum; they were given a one‐on‐one consultation regarding any problems or questions that may have arisen during their home practice, and they were encouraged to persistently practice PFMT at home. The PFMT course was delivered in one session instructed by one full‐time health education nurse. |
