Summary of findings 1. Non‐pharmacological interventions for fear of childbirth (tocophobia) compared to usual care.
| Non‐pharmacological interventions for fear of childbirth (tocophobia) compared to usual care | ||||||
| Patient or population: women with fear of childbirth (tocophobia) Setting: antenatal clinics in hospitals in Australia, Sweden, Finland and Turkey, and primary care setting in Iran Intervention: non‐pharmacological interventions for fear of childbirth (psychoeducation, discussion, Internet cognitive behavioural therapy, art therapy, peer education) Comparison: usual care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with usual care | Risk with non‐pharmacological interventions for fear of childbirth | |||||
| Fear of childbirth assessed with: Wijma Delivery Expectancy Questionnaire Scale from 0 to 165; higher score = greater fear | The mean fear of childbirth score in the control group ranged from 57 to 108 | MD 7.08 lower (12.19 lower to 1.97 lower) | ‐ | 828 (7 RCTs) | ⊕⊕⊝⊝ LOWa,b | May reduce fear of childbirth score but the reduction may not be clinically meaningful |
| Caesarean section | Study population | RR 0.70 (0.55 to 0.89) | 557 (5 RCTs) | ⊕⊕⊕⊝ MODERATEa | Probably reduces number of women having caesarean section | |
| 400 per 1000 | 280 per 1000 (220 to 356) | |||||
| Anxiety ‐ not reported | ‐ | ‐ | ‐ | ‐ | ‐ | |
| Depression
assessed with: Edinburgh Postnatal Depression Scale Scale from 0 to 30; higher score = greater depression |
The mean depression score in the control group ranged from 5.46 to 8.1 | MD 0.09 higher (1.23 lower to 1.4 higher) | ‐ | 399 (2 RCTs) | ⊕⊕⊝⊝ LOWa,c | May be little to no difference in postnatal depression |
| Birth preferences: prefer caesarean section | Study population | RR 0.38 (0.08 to 1.85) | 208 (2 RCTs) | ⊕⊕⊝⊝ LOWa,c | It is uncertain if there is any effect on number of women who prefer caesarean section | |
| 314 per 1000 | 119 per 1000 (25 to 581) | |||||
| Epidural analgesia during labour | Study population | RR 1.21 (0.98 to 1.48) | 380 (2 RCTs) | ⊕⊕⊝⊝ LOWa,d | May increase number of women having epidural | |
| 442 per 1000 | 535 per 1000 (433 to 654) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RR: risk ratio; OR: odds ratio | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: we are moderately confident in the effect estimate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: our confidence in the effect estimate is limited. The true effect may be substantially different from the estimate of the effect Very low certainty: we have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded one level for risk of bias (due to lack of blinding of participants and outcome assessors). bDowngraded one level for inconsistency (due to lack of overlap of 95% confidence intervals and differing size and direction of effect). cDowngraded one level for imprecision (due to few participants and 95% confidence intervals crossing the line of no effect). dDowngraded one level for imprecision (single trial only with 95% confidence intervals crossing the line of no effect).