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

Abstract

Introduction

Fear 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.

Objective

Using meta-analyses, we aimed to examine the most effective intervention for reduction of FOC.

Method

We 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 The reference lists of all included studies were checked for additional published reports and citations of unpublished research.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.

Results

Ten 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.

Conclusion

Interventions 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 interest

The authors have not supplied their declaration of competing interest.