Non-pharmacological interventions to reduce fear of childbirth: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Teng ¹ ,  ZHANG Yongai ¹ , ZHANG Haimiao ¹ , ZENG Juan ²

1. School of Nursing and Rehabilitation, Xi'an Medical University, Xi'an 710021, P. R. China;
2. The Second Affiliated Hospital of Xi'an Medical University, Xi'an 710021, P. R. China;

Corresponding author：

ZHANG Yongai, Email: yongai129@163.com

Keywords：

Non-pharmacological intervention; Fear of childbirth; Network meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202201135

Video：

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Objective To systematically review the efficacy of non-pharmacological interventions to reduce fear of childbirth. Methods The Cochrane Library, PubMed, EMbase, Web of Science, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of the efficacy of non-pharmacological interventions to reduce fear of childbirth from inception to December 2021. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies; then, a network meta-analysis was performed using Stata 15.0 software. Results A total of 19 RCTs involving 3 409 patients were included. Ten non-pharmacological interventions (prenatal education, scenario-based health education, psychological guidance, yoga training, hypnosis, mobile learning education, cognitive behavioral therapy, physical relaxation guidance, breathing guidance, and usual care) were included. The results of the reticulated meta-analysis of the Wijma Delivery Expectancy Questionnaire (W-DEQ-A) showed that the rankings of the interventions were as follows: prenatal education > yoga training > cognitive behavioral therapy > situational simulation health education > psychological guidance > physical relaxation guidance > conventional care. The results of the Wijma Experience of Childbirth Questionnaire (W-DEQ-B) mesh meta-analysis showed that the rankings of the interventions were as follows: mobile learning education > prenatal education > scenario-based health education > cognitive behavioral therapy > breathing instruction > hypnosis > psychological instruction > physical relaxation instruction > usual care. Conclusion The current evidence suggests that prenatal education, mobile learning education, situational simulation health education, and yoga training may be effective interventions in improving maternal fear of childbirth. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusion.

Citation： LI Teng, ZHANG Yongai, ZHANG Haimiao, ZENG Juan. Non-pharmacological interventions to reduce fear of childbirth: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2022, 22(12): 1410-1418. doi: 10.7507/1672-2531.202201135 Copy

1.	Uçar T, Golbasi Z. Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process. J Psychosom Obstet Gynaecol, 2019, 40(2): 146-155.
2.	Nilsson C, Hessman E, Sjöblom H, et al. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth, 2018, 18(1): 28.
3.	Hasanjanzadeh P, Faramarzi M. Relationship between maternal general and specific-pregnancy stress, anxiety, and depression symptoms and pregnancy outcome. J Clin Diagn Res, 2017, 11(4): VC04-VC07.
4.	Fatima M, Srivastav S, Mondal AC. Prenatal stress and depression associated neuronal development in neonates. Int J Dev Neurosci, 2017, 60: 1-7.
5.	Newham JJ, Wittkowski A, Hurley J, et al. Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depress Anxiety, 2014, 31(8): 631-640.
6.	Toohill J, Fenwick J, Gamble J, et al. A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth, 2014, 41(4): 384-394.
7.	Kızılırmak A, Başer M. The effect of education given to primigravida women on fear of childbirth. Appl Nurs Res, 2016, 29: 19-24.
8.	Dai L, Shen Q, Redding SR, et al. Simulation-based childbirth education for Chinese primiparas: a pilot randomized controlled trial. Patient Educ Couns, 2021, 104(9): 2266-2274.
9.	Abdollahi S, Faramarzi M, Delavar MA, et al. Effect of psychotherapy on reduction of fear of childbirth and pregnancy stress: a randomized controlled trial. Front Psychol, 2020, 11: 787.
10.	Çankaya S, Şimşek B. Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: a prospective randomized controlled study. Clin Nurs Res, 2021, 30(6): 818-829.
11.	Boz İ, Akgün M, DumanF. A feasibility study of a psychoeducation intervention based on Human Caring Theory in nulliparous women with fear of childbirth. J Psychosom Obstet Gynaecol, 2021, 42(4): 300-312.
12.	Koyuncu SB, Bülbül M. The impact of yoga on fear of childbirth and childbirth self-efficacy among third trimester pregnants. Complement Ther Clin Pract, 2021, 44: 101438.
13.	Amiri P, Mirghafourvand M, Esmaeilpour K, et al. The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial. BMC Pregnancy Childbirth, 2019, 19(1): 534.
14.	钟碧珍, 冯彤玉, 陈翠荣, 等. 情景模拟健康教育对初产妇分娩恐惧及分娩自我效能的影响. 沈阳医学院学报, 2016, 18(2): 92-94.
15.	张海清, 吴雅丽, 吴玉可. 静默疗法在初产妇分娩中的应用效果. 全科护理, 2020, 18(31): 4307-4309.
16.	谢珊珊. 静默疗法对初产妇产前分娩恐惧的干预效果研究. 郑州: 郑州大学, 2018.
17.	Rouhe H, Salmela-Aro K, Toivanen R, et al. Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience-a randomized controlled trial. J Psychosom Obstet Gynaecol, 2015, 36(1): 1-9.
18.	Werner A, Uldbjerg N, Zachariae R, et al. Antenatal hypnosis training and childbirth experience: a randomized controlled trial. Birth, 2013, 40(4): 272-280.
19.	Atis FY, Rathfisch G. The effect of hypnobirthing training given in the antenatal period on birth pain and fear. Complement Ther Clin Pract, 2018, 33: 77-84.
20.	Irmak V P, Aslan E. Emotional freedom techniques and breathing awareness to reduce childbirth fear: a randomized controlled study. Complement Ther Clin Pract, 2019, 35: 224-231.
21.	王秀玉, 张洁清, 黄桂慧, 等. 孕晚期分娩预演对初产妇的妊娠结局及心理应激反应的影响. 广东医学, 2019, 40(14): 2050-2053.
22.	傅玛丽, 伍颖玲, 陈丽华. 情景模拟宣教对初产妇孕晚期心理状态和分娩方式的影响. 系统医学, 2020, 5(13): 160-162.
23.	李英. M-Learning对住院初产妇分娩恐惧和分娩结局的影响研究. 武汉: 武汉轻工大学, 2019.
24.	Moghaddam HV, Nazarzadeh M, Jahanfar S. Interventions for reducing fear of childbirth: a systematic review and meta-analysis of clinical trials. Women Birth, 2018, 31(4): 254-262.
25.	Karabulut Ö, CoşkunerPotur D, DoğanMerih Y, et al. Does antenatal education reduce fear of childbirth. Int Nurs Rev, 2016, 63(1): 60-67.
26.	Matsuda M, Kono A. Development and evaluation of a psychoeducation practitioner training program (PPTP). Arch Psychiatr Nurs, 2015, 29(4): 217-222.
27.	Garner SL, Killingsworth E, Bradshaw M, et al. The impact of simulation education on self-efficacy towards teaching for nurse educators. Int Nurs Rev, 2018, 65(4): 586-595.
28.	Finlayson K, Downe S, Hinder S, et al. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour. BMC Pregnancy Childbirth, 2015, 15: 229.
29.	Rancour P. The emotional freedom technique: finally, a unifying theory for the practice of holistic nursing, or too good to be true. J Holist Nurs, 2017, 35(4): 382-388.

1. Uçar T, Golbasi Z. Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process. J Psychosom Obstet Gynaecol, 2019, 40(2): 146-155.
2. Nilsson C, Hessman E, Sjöblom H, et al. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth, 2018, 18(1): 28.
3. Hasanjanzadeh P, Faramarzi M. Relationship between maternal general and specific-pregnancy stress, anxiety, and depression symptoms and pregnancy outcome. J Clin Diagn Res, 2017, 11(4): VC04-VC07.
4. Fatima M, Srivastav S, Mondal AC. Prenatal stress and depression associated neuronal development in neonates. Int J Dev Neurosci, 2017, 60: 1-7.
5. Newham JJ, Wittkowski A, Hurley J, et al. Effects of antenatal yoga on maternal anxiety and depression: a randomized controlled trial. Depress Anxiety, 2014, 31(8): 631-640.
6. Toohill J, Fenwick J, Gamble J, et al. A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women. Birth, 2014, 41(4): 384-394.
7. Kızılırmak A, Başer M. The effect of education given to primigravida women on fear of childbirth. Appl Nurs Res, 2016, 29: 19-24.
8. Dai L, Shen Q, Redding SR, et al. Simulation-based childbirth education for Chinese primiparas: a pilot randomized controlled trial. Patient Educ Couns, 2021, 104(9): 2266-2274.
9. Abdollahi S, Faramarzi M, Delavar MA, et al. Effect of psychotherapy on reduction of fear of childbirth and pregnancy stress: a randomized controlled trial. Front Psychol, 2020, 11: 787.
10. Çankaya S, Şimşek B. Effects of antenatal education on fear of birth, depression, anxiety, childbirth self-efficacy, and mode of delivery in primiparous pregnant women: a prospective randomized controlled study. Clin Nurs Res, 2021, 30(6): 818-829.
11. Boz İ, Akgün M, DumanF. A feasibility study of a psychoeducation intervention based on Human Caring Theory in nulliparous women with fear of childbirth. J Psychosom Obstet Gynaecol, 2021, 42(4): 300-312.
12. Koyuncu SB, Bülbül M. The impact of yoga on fear of childbirth and childbirth self-efficacy among third trimester pregnants. Complement Ther Clin Pract, 2021, 44: 101438.
13. Amiri P, Mirghafourvand M, Esmaeilpour K, et al. The effect of distraction techniques on pain and stress during labor: a randomized controlled clinical trial. BMC Pregnancy Childbirth, 2019, 19(1): 534.
14. 钟碧珍, 冯彤玉, 陈翠荣, 等. 情景模拟健康教育对初产妇分娩恐惧及分娩自我效能的影响. 沈阳医学院学报, 2016, 18(2): 92-94.
15. 张海清, 吴雅丽, 吴玉可. 静默疗法在初产妇分娩中的应用效果. 全科护理, 2020, 18(31): 4307-4309.
16. 谢珊珊. 静默疗法对初产妇产前分娩恐惧的干预效果研究. 郑州: 郑州大学, 2018.
17. Rouhe H, Salmela-Aro K, Toivanen R, et al. Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience-a randomized controlled trial. J Psychosom Obstet Gynaecol, 2015, 36(1): 1-9.
18. Werner A, Uldbjerg N, Zachariae R, et al. Antenatal hypnosis training and childbirth experience: a randomized controlled trial. Birth, 2013, 40(4): 272-280.
19. Atis FY, Rathfisch G. The effect of hypnobirthing training given in the antenatal period on birth pain and fear. Complement Ther Clin Pract, 2018, 33: 77-84.
20. Irmak V P, Aslan E. Emotional freedom techniques and breathing awareness to reduce childbirth fear: a randomized controlled study. Complement Ther Clin Pract, 2019, 35: 224-231.
21. 王秀玉, 张洁清, 黄桂慧, 等. 孕晚期分娩预演对初产妇的妊娠结局及心理应激反应的影响. 广东医学, 2019, 40(14): 2050-2053.
22. 傅玛丽, 伍颖玲, 陈丽华. 情景模拟宣教对初产妇孕晚期心理状态和分娩方式的影响. 系统医学, 2020, 5(13): 160-162.
23. 李英. M-Learning对住院初产妇分娩恐惧和分娩结局的影响研究. 武汉: 武汉轻工大学, 2019.
24. Moghaddam HV, Nazarzadeh M, Jahanfar S. Interventions for reducing fear of childbirth: a systematic review and meta-analysis of clinical trials. Women Birth, 2018, 31(4): 254-262.
25. Karabulut Ö, CoşkunerPotur D, DoğanMerih Y, et al. Does antenatal education reduce fear of childbirth. Int Nurs Rev, 2016, 63(1): 60-67.
26. Matsuda M, Kono A. Development and evaluation of a psychoeducation practitioner training program (PPTP). Arch Psychiatr Nurs, 2015, 29(4): 217-222.
27. Garner SL, Killingsworth E, Bradshaw M, et al. The impact of simulation education on self-efficacy towards teaching for nurse educators. Int Nurs Rev, 2018, 65(4): 586-595.
28. Finlayson K, Downe S, Hinder S, et al. Unexpected consequences: women's experiences of a self-hypnosis intervention to help with pain relief during labour. BMC Pregnancy Childbirth, 2015, 15: 229.
29. Rancour P. The emotional freedom technique: finally, a unifying theory for the practice of holistic nursing, or too good to be true. J Holist Nurs, 2017, 35(4): 382-388.

Chinese Journal of Evidence-Based Medicine

Non-pharmacological interventions to reduce fear of childbirth: a network meta-analysis

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