Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials

Abstract

IntroductionFear of childbirth (FOC) is a problematic mental health issue during pregnancy and postpartum period. It is essential to identify the most effective approaches to reduce the problem.ObjectiveUsing meta-analyses, we aimed to examine the most effective intervention for reduction of FOC.MethodWe searched the Cochran central register of controlled trials, PubMed, Embase and PsycINFO databases since inception till January 2016 without any language restriction. The reference lists of all included studies were checked for additional published reports and citations of unpublished research. We included randomised control trials and quasi-randomised control trials comparing interventions for treatment of FOC. Two review authors independently assessed trial quality and extracted data. The standardized mean differences (SMD) were pooled using random and fixed effect model. The heterogeneity was determined using the Cochran's test and I2 index and was further explored in meta-regression model and subgroup analyses. Egger's regression and funnel plot were used for assessing publication bias.ResultsTen studies totalling 3984 participants were included from two quasi-experimental and eight randomised clinical trials. Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled SMD of FOC for the education intervention and hypnosis group in comparison with control group were -0.46 (95% CI-0.73 to -0.19) and -0.22 (95% CI-0.34 to -0.10), respectively.ConclusionInterventions were effective on reducing FOC; however educational interventions reduced FOC twice as high as hypnosis. This result highlights the roll of antenatal education in enhancing childbirth expectations and experiences to enhance maternal and neonatal well-being.Disclosure of interestThe authors have not supplied their declaration of competing interest.