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Evb Journal Review and Teaching Plan Regarding Intrapartum

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Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions

Reproductive Health volume 15, Article number:73 (2018) Cite this article

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Abstruse

Background

A negative experience in childbirth is associated with chronic maternal morbidities. The aim of this systematic review and meta-analysis was to identify currently available successful interventions to create a positive perception of childbirth experience which can foreclose psychological birth trauma.

Methods

Randomized controlled trials of interventions in pregnancy or labour which aimed to improve childbirth experience versus usual intendance were identified from 1994 to September 2016. Low risk significant or childbearing women were chosen as the study population. PEDRO scale and Cochrane risk of bias tool were used for quality assessment. Pooled effect estimates were calculated when more than two studies had similar intervention. If it was not possible to include a study in the meta-analysis, its data were summarized narratively.

Results

Later on screening of 7832 titles/abstracts, 20 trials including 22,800 participants from 12 countries were included. Successful strategies to create a positive perception of childbirth experience were supporting women during nascence (Risk Ratio = 1.35, 95% Confidence Interval: 1.07 to 1.71), intrapartum care with minimal intervention (Risk Ratio = 1.29, 95% Confidence Interval:ane.15 to 1.45) and nascency preparedness and readiness for complications (Hateful Deviation = 3.27, 95% Confidence Interval: 0.66 to v.88). Most of the relaxation and pain relief strategies were non successful to create a positive nascency experience (Mean Difference = − 2.64, 95% Confidence Intervention: − half-dozen.80 to 1.52).

Conclusion

The most effective strategies to create a positive nascency experience are supporting women during birth, intrapartum intendance with minimal intervention and nascency preparedness. This study might exist helpful in clinical approaches and designing future studies nearly prevention of the negative and traumatic birth experiences.

Peer Review reports

Obviously English summary

The negative nascency feel has been common event internationally; it may create a psychological birth trauma (PBT) for women which tin can lead to post- traumatic stress disorder (PTSD). This study's aim is to collect effective prenatal and intrapartum care practices to prevent negative birth experiences. To achieve this goal, an event-based systematic review on RCTs was conducted.

We aimed to detect any intervention which can touch on the childbirth experience among low risk pregnant or childbearing women. Among 8685 search results published betwixt 1994 and 2016, 20 unique RCTs were included.

This review categorized strategies into iv main group: supporting women during labour, relaxation and pain relief during nativity, intrapartum care with minimal intervention, and birth preparedness. Successful strategies in prevention of negative nascence feel were presence of a trained birth companion, relaxation through massage and music, early labour assessment to minimize obstetric interventions, and being prepared for childbirth through individual birth plan.

This newly found list of successful strategies can shed light on clinical exercise in order to create a positive perception of childbirth experience. We believe that emotional back up programs for childbearing women should exist implemented in countries' maternal health plans. These programs can comprise a combination of successful strategies such as continuous labour support by a familiar person, reassuring physical contact using massage, and the continuity of midwifery care. Prevention of negative birth feel using these successful practices leads to the promotion of vaginal nativity, loftier quality motherhood care and the reduction of chronic psychological complications.

Background

Childbirth is 1 of the most challenging psychological events in a mother's life, as x–34% of all childbearing women are faced with traumatic birth experiences [1, 2]. A negative experience in childbirth is associated with postal service-traumatic stress disorder (PTSD), disruption to interpersonal relationships, dysfunctional maternal-infancy bonding [3,iv,5], reduction in rates of sectional breastfeeding [6], inappropriate utilization of maternal and newborn care services [vii], fear of childbirth and increased desire for an elective caesarean department in futurity pregnancies [8, 9].

Prevention of psychological birth trauma (PBT) has been recommended every bit a new area of research in Oxford meeting. The coming together concluded that there are no published studies directly aimed at preventing psychological trauma in childbirth [ten]. However, trials that tried to create positive childbirth experiences may exist considered as an alternative approach in the prevention of PBT [xi].

Our current review of randomized controlled trials (RCTs) assesses all types of women-centered interventions designed to create a positive childbirth experience. Previous reviews did not aim to provide a comprehensive insight into the prevention strategies of negative childbirth experiences [12]. Therefore, information technology is axiomatic in that location is a lack of recommendations within national guidelines regarding the prevention of PBT [i, 13]. In 2002 a narrative systematic review of observational studies, RCTs and systematic reviews was conducted to appraise the issue of pain on women'southward sense of satisfaction with childbirth feel [14]. In addition, Cochrane reviews well-nigh specific interventions, such equally midwife-led care, have reported and analyzed perceptions of the childbirth experience as an issue [15,sixteen,17]. These reviews identified effective strategies for a positive childbirth feel, including continuous back up for women during childbirth, midwife-led continuity model of care, and behavior of the caregivers. [fourteen,15,16].

Early postpartum debriefing interventions equally a prevention of psychological trauma were not found to exist effective, therefore focusing on prenatal and intrapartum interventions was recommended [eighteen]. Such interventions straight deal with significant or childbearing women as a target population [fourteen]. The experience of childbirth involves diverse maternal feelings such as control over the birth, self-esteem, fulfillment, decision making and the sense of achievement; therefore, it is not surprising to encounter inconsistency across experience tools in different studies.

Because the serious brunt of PBT [3, 4, vi, 8, 9], identifying constructive testify-based interventions that promote positive birth feel is essential. According to our comprehensive search of available database, at that place is no review that provides a comprehensive listing of strategies for creating a positive perception of childbirth. The classification of related evidence and identification of successful approaches volition help policymakers in the planning of clinical practice. This systematic review aims to summarize the effect of prenatal and intrapartum interventions on maternal perception of the childbirth experience.

Methods

The search process was conducted betwixt July and September 2016. This research was ethically approved by Tehran University of Medical Sciences ideals committee (reference number IR.TUMS.VCR.REC.1395.374). Electronic databases included Embase, PubMed, Scopus, Web of Scientific discipline and Cochrane Central Annals for Clinical Trials; dissertations were searched in ProQuest theses database. Farsi and Turkish databases, Earth Bank literature and Proceedings of relevant conferences were also searched. Adept researchers in this field were contacted by e-post to inquire about unpublished or soon to-be-published RCT's. An electronic search strategy was constructed using text words (Additional file 1).

A comprehensive systematic search was performed on literature published between 1994 and September 2016. The fourth edition of "Diagnostic and Statistical Manual of Mental Disorder" (DSM-IV, 1994) recognized that childbirth could be a traumatic outcome that may cause PTSD [19]. Since then, studies began to assess maternal experience with regard to psychological aspects of childbirth [twenty]. Relying on this logic, we selected the year 1994 to initiate the systematic review. Randomized controlled trials (cluster or individual) that met all the following criteria, were included:

  • Population-Low risk pregnant or childbearing women; low-adventure refers to a woman aged xviii–35 with no diagnosis of complications such as hypertension, diabetes mellitus, cardio-vascular disease, multiple gestation and fetal growth restriction.

  • Intervention-Whatsoever intervention in pregnancy or labour which aimed to improve the childbirth experience.

  • Command-Usual intendance; routine care provided past personnel based on the clinical guidelines of maternity intendance unites and hospitals.

  • Outcome-Women's self-evaluation of their childbirth experiences.

Using a definition from a literature review [21], we defined childbirth experience as a woman's cocky-cess of long-term memories of their childbirth effect. This definition reflects nigh of the central elements of childbirth experience such as feelings of control, fulfillment of expectations [22], confidence and participation in conclusion making [21]. We included studies which had measured the childbirth experience using the validated "childbirth experience questionnaire" or a directly question about overall perception of the childbirth experience. Unlike before reviews [fourteen, fifteen] we did not include RCTs which defined childbirth experience as a satisfaction with care, satisfaction with pain relief and feel of pain. Besides, PTSD following negative birth experience did not considered as an inclusion criterion. In add-on, this review covers a wider range of related interventions than others and focuses on women-centered interventions designed to better the childbirth experience.

Full text of the included report needed to be in English, Western farsi or Turkish (the first author is fluent in these iii languages). As childbirth feel might be affected past maternal socioeconomic status [23, 24], we removed studies conducted amidst women belonging to a special socioeconomic situation (due east.m. disadvantaged community, migrants and high society). As well, studies performed among women with diagnosed mental affliction, pre-term (< 37 weeks)/post-term (> 42 weeks) pregnancies, obese mothers, and women with prolonged labours were excluded; diagnosis of prolonged labour was fabricated when labour progress (cervical dilatation) crossed the partogram action line.

Quality assessment and data extraction

Study inclusion, quality assessment and data extraction were conducted by two authors (M.T. and N.S) independently. A senior researcher (Z.T.) resolved disagreements by discussion. Quality assessment was based on the PEDro (Physiotherapy Testify Database) scale and a modified Cochrane chance of bias tool for quality assessment of RCTs. The PEDro scale rated the trials' methodological quality from 0 to 10 based on what they reported; the domains of calibration are random allocation, allocation concealment, baseline similarity, blinding, mensurate of central outcomes from ≥85%, intention to care for analysis, between group comparison and betoken measures. RCTs with PEDro scores ≥half-dozen were re-evaluated with the Cochrane tool [25]. Additional domains of the Cochrane tool (non available in PEDro) are addressing incomplete upshot information, selective reporting, and other sources of bias. Information technology should exist noted that double blinding was not possible for these kind of interventions, therefore studies without blinding were non considered as a high risk of bias [15, sixteen].

RCTs with low risk of bias were included in the review, without considering their results. The Cochrane Public Health data extraction template was modified to accommodate this review (Additional file ii). The modified version was piloted on eight random RCTs, and so re-modified accordingly. The extracted information were report details, characteristics of participants, setting, characteristics of interventions, outcomes, details of methods and results, the specific details of childbirth feel (upshot definition, time points measured, psychometric backdrop of measurement tool, last outcome) and fundamental conclusions.

Statistical assay

Due to the heterogeneity of interventions, a "comprehensive meta-analysis" was non appropriate [26]. Still nosotros conducted a separate analysis when 2 or more than studies had similar interventions. Four carve up meta-analyses were performed for three different types of interventions. Information of the half-dozen trials [27,28,29,thirty,31,32] with the same intervention (support during labour) were pooled and analyzed using the Review Manager software (RevMan5). Another analysis was conducted for two studies [33, 34] with similar intervention (early labour assessment). These two sets of data were dichotomous, so results were presented as take a chance ratio (RR) with 95% confidence intervals (CIs). The random-furnishings Mantel-Haenszel model was used when I2 value was greater than thirty%.

Continuous information from two studies [30, 35], that practical continuous support during labour as an intervention strategy, were pooled and reported every bit mean divergence (MD) with 95% CIs using random-effects Inverse Variance method [26]. A split analysis was performed for ii trials [36, 37] with the same intervention (water relaxation during labour). Other studies which were inappropriate for meta-analysis were summarized qualitatively. The point measures and measures of variability were recalculated or taken directly from the published reports.

Results

In total, 8685 papers were identified in the systematic literature search. We aimed to discover whatever intervention which can affect on the childbirth experience, so an consequence-based search strategy was required. Due to the nature of the search strategy, this large amount of papers was unavoidable. Duplicate papers were removed, and during initial cess 7832 titles were screened by two members of the study team (M.T and N.Due south); 6359 non-RCT manufactures were excluded at this stage. Then, they screened the abstracts of 1473 papers. The trials were removed if their abstracts did not run into the inclusion criteria. Based on the abstracts, it was apparent 41 papers had relevant interventions and outcomes. However, the information presented in 87 abstracts was insufficient for making decisions about the relevance of the trial and then the full texts were evaluated. The references of these 128 papers were checked to discover additional related manufactures. As shown in Fig. 1, 28 papers based on twenty unique trials are included in this review. Tabular array 1 shows the characteristics of the included studies.

Fig. one
figure 1

The PRISMA flow-diagram describing the screening process

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Table 1 Summary of included RCTs

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The quality cess of the included studies is shown in item (Fig. ii). Methodological quality appraisal was conducted in two steps using two different tools, therefore, included studies were at depression risk of bias in most of the items evaluated (except blinding). Given the interactive nature of the interventions, it was not possible to blind participants and blinding of the caregivers was difficult. 4 of the included studies attempted to blind the caregivers, however they were non completely successful [38,39,xl,41]. Eight of the 20 trials reported blinding status of the assessors; v of them were assessor-blinded [31, 35, 36, 39, 41] and three were non [30, 34, 42]. Almost of the included studies ended that their results were not influenced past the lack of blinding; still, they may accept been impacted by the Hawthorne effect. The design of one of the studies increased the likelihood of "recall bias" [28]; this is considered every bit "other bias" in Fig. ii.

Fig. two
figure 2

Authors' judgments most gamble of bias in included studies

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Almost 22,800 women took role in these trials. All 31 Turkish and 108 Persian articles were removed in the initial selection or quality assessment process; so, the final twenty trials were only in English. 4 studies were carried out in the Great britain, three in Australia, three in the The states, ii in Denmark, 2 in Canada and the reminder in seven other countries. Three trials did not land whether they were ethically canonical by relevant institutional review boards. In this case, the authors were contacted by electronic mail and they confirmed that upstanding approvals had been obtained prior to the implementation of interventions. From the 20 included trials, four were pregnancy interventions [38,39,xl, 42], thirteen were nativity interventions [27, 29,30,31,32,33,34, 36, 37, 41, 43,44,45] and three were the intervention of continuous care from pregnancy to birth [28, 35, 46]. The childbirth experience was measured as a primary consequence in seven studies [27, 29, 33, 40, 41, 44, 45] and as a secondary outcome in the remaining studies. Eight of the included studies used validated and reliable questionnaires for the measurement of the childbirth experience [28, 30, 33, 35, 37, 38, 42, 45]. 2 studies measured the maternal feel past a visual analog scale [36, 41] and ten studies used Likert-type questions. Studies that used summated scales of the overall childbirth experience were not excluded because perception of overall experience was influenced by important factors, such equally maternal expectations of birth, experienced complications during childbirth and the use of pain relief [47]. Most of the studies included a follow-up measurement subsequently six weeks or less.

Other outcomes which were measured in the 20 studies included labour characteristics and birth outcomes, neonatal outcomes, labour pain, feelings of command during labour, ability to cope with fearfulness, maternal cocky-esteem and self-worth, the charge per unit of cesarean sections, the rate of epidural analgesia, satisfaction with intendance, mail-partum depression and the success rate of breastfeeding. Neonatal outcomes were measured by diverse variables including nativity weight [27, 33, 35, 36, 38, xl], Apgar score [27, 30, 31, 33,34,35,36,37, 39, twoscore, 43], meconium stained liquor [31, 37, 39, 43], admission to the NICU (neonatal intensive care unit) [27, 30, 34, 36, 37, 39, 42, 43, 46], resuscitation [30, 33, 34, 36], asphyxia [30], biochemical condition [40], immediate mother-infant contact following birth [27], stillbirth/neonatal death [30, 34, 44], major built abnormality [30], and presence of complications [35, 36]. These neonatal outcomes did non associate with the childbirth experience in well-nigh studies, except ane [46]. This study ended that neonatal transfer to the NICU was associated with the negative childbirth experience.

Interventions designed to improve the childbirth feel can exist categorized into four main groups as follows:

Supporting women during birth

Seven studies compared continuous support versus usual care. Back up was provided by a member of women'due south social network (four studies) [27, 28, 32, 35], a nurse (one study) [30] or a hired companion (two studies) [29, 31]; all of them were trained to provide labour back up. A certificated trainer had trained the nascency companions in a unmarried 2-h session [28, 35], multiple sessions [29,30,31] or via educational leaflets [27, 32]. The educational content of the training was nigh the same and included information regarding the responsibilities of the nativity companions, some knowledge of the labour progress and methods of providing continuous back up. The control group of all seven trials received conventional care that did not involve continuous labour support.

Meta-analysis of six studies showed that women with companions were more likely to have a positive childbirth experience (RR = ane.35, 95% CIs: 1.07 to 1.71, P = 0.01) (Fig. 3). To asking the essential information, the respective authors of three studies [thirty, 32, 35] were contacted by email. A study conducted by Yuenyong Due south. et al. (2012) did not divide women'due south experiences into positive and negative [35]; the master author was contacted and she confirmed that they did not collect dichotomous information on the childbirth experience. Therefore, continuous information of Yuenyong's study [35] and the only homogeneous study [30] were pooled separately from the other six trials. Analysis of these ii studies, did not testify any meaning difference in the nativity feel (measured by Labour Agentry Scale [LAS]) among various groups (Dr. = 2.92, 95%CIs: − i.72 to 7.57, P = 0.22) (Fig. 4).

Fig. 3
figure 3

Comparison of positive perception of childbirth experience (dichotomous) between support and usual care

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Fig. 4
figure 4

Comparing of nativity feel scores (continuous) between support and usual care

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In summary, meta-analysis of half dozen studies indicates that supporting women during birth is an effective intervention for creating a more positive childbirth experience.

Relaxation and hurting relief during birth

Seven randomized controlled trials tested relaxation and pain relief strategies to promote a positive maternal childbirth experience. 2 trials compared h2o immersion during labour with routine care [36, 37], two studies evaluated the effect of self-hypnobirthing [38, 39], i study compared 3 arms, which were massaging during labour, placebo relaxing music and usual care [42]. One written report tested the effect of cocky-selected music during labour [41] and i written report used epidural analgesia equally a hurting relief method for childbearing women [43]. Every bit shown in Fig. five, meta-analysis of the ii similar studies involving immersion in a bath during labour found no difference betwixt the childbirth experience in the intervention and control groups (MD = − 2.64, 95% CIs: − half-dozen.80to 1.52, P = 0.21). Co-ordinate to the reports, participants in the control groups of both studies received relatively similar intrapartum intendance, which was provided by the nurse or midwife.

Fig. five
figure 5

Comparison of birth experience scores (continuous) between water relaxation and usual care

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Hypnobirthing studies did non follow the same design of intervention and outcome measurements; therefore, their combination was impossible and a narrative synthesis of them is presented. I study assessed maternal perception of the nascence feel by 1 dual-mode question; no deviation was found between three groups (hypnobirthing, placebo music relaxation and usual care) regarding the positive childbirth feel (RR = 0.89, 95% CIs:0.78 to one.00, P = 0.06). No statistical divergence was evident in other aspects of the maternal experience such every bit satisfaction with the birth feel (p = 0.45), ability to cope with birth and sense of control during labour [39]. The second study assessed the nativity experience past Wijma delivery feel questionnaire. Self-hypnobirthing was plant every bit an effective method to meliorate the nascency experience (Wijma score was 42.nine in the hypnobirthing grouping, 47.2 in the placebo relaxation techniques group and 47.5 in the usual intendance grouping, P = 0.01) [38]. The results of these two after studies seem to contradict each other.

One report addressed the effect of massaging by the mother or her nascency companion on self-reported nascency feel; more positive perceptions of labour and sense of control were detected in the intervention group versus usual care (Dr. = − half dozen.10, 95% CIs: − 11.49 to − 0.71, P = 0.03) [42]. The satisfaction score of mothers in the group receiving music therapy during labour was significantly college than the control grouping at 2, 12 and 24 h after nascence. (MD = 2.74, 95% CIs: two.59 to 2.89, P < 0.001) [41]. In 1 study early initiation of the epidural analgesia with ten ml 0.25% bupivacaine was used and information technology was followed with top-ups of 5–10 ml 0.25% bupivacaine, equally requested by the woman; Results demonstrated that pain relief by epidural analgesia during labour had no impact on early on and late satisfaction with the birth experience (RR = 0.94, 95% CIs: 0.80 to 1.09, P < 0.forty) [43].

In summary, three of seven studies signal that relaxation during labour is effective for improving the childbirth experience.

Intrapartum care with minimal intervention

In society to reduce medical interventions, two studies conducted an early labour cess [one in home [34] and 1 in infirmary [33]]; women non constitute to be in active labour were educated on the signs of truthful labour and when to go to the hospital, given encouragement, and provided relaxation as a class of support. Both studies had the same arroyo for the control group; they were direct admitted to the labour unit which was managed by midwives. Assay showed that women in the early labour assessment arm were more satisfied with their birth experience compared with those who were directly admitted to the hospital (RR = 1.29, 95% CIs:one.fifteen to 1.45, P < 0.001) (Fig. 6).

Fig. half dozen
figure 6

Comparison of satisfaction with birth experience (dichotomous) between early labour assessment and usual care

Full size image

The study that compared a caseload midwifery intendance approach (prenatal, labour and postnatal care past a primary caseload midwife) with standard care institute that participants in the intervention arm were more probable to written report positive childbirth experience (RR = i.14, 95% CIs:1.05 to 1.21, P < 0.001) [46]. In another related trial, labouring women were cared for in a special midwives' unit with minimal medical intervention. Satisfaction with the nascency experience did not significantly differ between the midwives' unit and the usual labour ward (Dr. = 0.00, 95% CIs:-0.xvi to 0.sixteen, P = one.00) [44].

In summary, three of 4 studies indicate that intrapartum intendance with minimal intervention is effective for creating a more than positive birth experience.

Birth preparedness and readiness for complications

Results of the "Ready for Child program" showed that women who had attended the antenatal nascence classes reported a more favourable childbirth experience than the control grouping at evaluation v years after the nativity (RR = 1.25, 95% CIs: 1.14 to 1.36, P < 0.001), however no difference was seen between the two groups at vi weeks postpartum (RR = 0.99, 95% CIs: 0.93 to 1.06, P = 0.79) [twoscore]. Another study used an individual birth plan to set up women for nativity and assessed the childbirth experience one day afterwards delivery. At that place was a significant divergence between the experimental and command groups in maternal birth experience (Dr. = 3.27, 95% CIs: 0.66 to 5.88, P = 0.01), feelings of control and fulfillment of expectations [45].

In summary, both studies indicate that birth preparedness is a successful strategy for improving the feel of birth.

Word

Principal findings

The study examined the effectiveness of women-based interventions on new mothers' perception of the childbirth experience. The results of this systematic review identified iv primary categories of strategies applied in studies designed to improve the childbirth experience; some of these strategies have succeeded, while others have not.

Summary of results and Comparison with other studies

The meta-analysis of trials assessing labour support revealed the positive outcome of trained companion'southward presence on maternal birth experience. While training approaches varied across studies, the common point of these interventions is physical presence and emotional back up from the companion. Results showed that labour back up from a person in a shut relationship with the childbearing woman rather than a hired companion was more effective in the promotion of a positive nascence experience. All of these findings are in keeping with the review on continuous support during childbirth [16]. In contradiction to these results, an analysis on LAS scores constitute no departure betwixt support and command arms. This may exist caused by two factors: firstly, the LAS score reflects only one aspect of the nascency feel (experienced control during birth) and secondly, in i of the two relevant studies, the nativity support was provided past staff nurses [30].

Evidence from RCTs evaluating the outcome of hurting relief methods during labour on maternal feel are alien. Water relaxation was not found as a useful technique to minimize the risk of a negative birth feel, neither was epidural analgesia. A previous review in 2002 confirmed that pain relief is not considered to be an effective variable in satisfaction with the childbirth feel [14]. Controversies in findings most the effect of cocky-hypnosis's on the birth feel is probably due to the use of different measurement tools for childbirth feel; Cyna et al. measured experience as the number of mothers who felt their birth was a positive experience [39] while another study quantitatively assessed diverse aspects of the childbirth experience using a reliable and valid instrument [38]. Since the results of these 2 existing hypnobirthing trials are contradictory, it is non easy to determine whether the hypnosis was associated with more than positive experiences of nascency. It seems that at that place is a demand to deport a more adequately powered high quality hypnobirthing trial earlier this relaxation method can exist considered every bit an effective strategy for preventing nascency trauma.

Co-ordinate to the current evidence, among all labour relaxation techniques, only massage and music can exist recommended clinically for improving women's childbirth experiences. Social support involved in the massage intervention, casts incertitude on the association betwixt the massage component of the intervention and a positive childbirth experience. This means that a more positive childbirth feel might be the consequence of receiving support during massage rather than the massage itself [42]. The relaxation induced by self-selected music has been considered as a satisfying element in the listener's experience [41].

Trials that aimed to prevent unnecessary obstetrical interventions through continuity of care from a master midwife and empowering women with information to recognize the right time to go to hospital for the labour, were successful in promoting a positive maternal experience. Continuity of midwife care, improves the nascency experience through various agents including maternal self-management of pain, ability to cope with the labour claiming, control over the birth procedure, support from trusted experts and reduction of stressful examinations and interventions [46, 48]. Intrapartum care in a specific home-like environs unit in infirmary did not touch on women's childbirth experience [44]. Nativity plans and preparedness for what would happen in the labour were identified as successful strategies for a better nascency experiences. In this category, childbirth classes which were held two months earlier birth, were not found effective in the promotion of a positive nascence experience.

In an effort to prevent negative and traumatic nativity experiences, previous studies made recommendations to reduce related gamble factors including inadequate labor support, loftier obstetric intervention rates, the occurrence of emergency cesarean department or instrumental delivery, and feelings of loss of control [46, 49,l,51]. Consistently, the strategies found in this systematic review were designed to control the higher up-mentioned take a chance factors. A common point of most all successful strategies is to provide support during labour; this support was the main component in some interventions and was establish equally a subconscious gene in the others [33, 34, 42, 46]. This finding is uniform with previous show suggesting that childbearing women demand increased emotional care to prevent a PBT [18]. Beliefs of maternity personnel plays an important part in pregnancy and birth memories. Ethically information technology is non advisable to conduct a RCT on professional beliefs of caregivers [fourteen]. Humanitarian behavior is a duty of the practitioner; therefore, information technology should non be considered as an boosted strategy in maternity care [1]. As there is no bear witness to defend postpartum interventions for the prevention of psychological trauma [xviii], there is no high-quality data available to support prenatal interventions for the prevention of PBT. According to the current findings, it is optimal to focus on intrapartum care strategies for the prevention of negative and traumatic experiences of childbirth. We also recommend conducting more high-quality prenatal researches in this area.

Implications for clinical practice

Due to the nature of this review, studies were included based on their outcomes rather than their interventions. The childbirth feel was considered equally a gilded-standard outcome for relevant interventions but it should be noted that each included study measured diverse outcomes. Some studies were unsuccessful in reducing the negative birth experience yet had a positive impact on another outcomes (labour pain, satisfaction with care, C/S rates, etc.) [37, 43, 44]. An analysis of each reported outcome is beyond the scope of this review.

The comparison of included interventions is a difficult job due to several factors including diversity in settings, socioeconomic disparities, variation in culture, and heterogeneity in outcome measurement tools. The socioeconomic variable was measured and controlled in 17 studies; they reported that socioeconomic status did not significantly differ between experiment and control groups. Other three studies did not appraise participants' socioeconomic status [28, 37, 43]. It should be noted access to motherhood care is directly influenced by socioeconomic disparities [52]; this confounding factor has been compared between groups beyond different studies and no differences were detected. Independently, "access to prenatal care" was reported in some studies and its baseline similarity was confirmed between the control and experimental groups [16, 27, 31]. These findings testify that the negative impact of socioeconomic disparities has been limited, as much every bit possible.

The quality of evidence nearly childbirth experience (outcome) is inconsistent across the studies because different tools and timings of administration had been used in trials that met the inclusion criteria. Childbirth feel is a multidimensional variable, then unidimensionality of its measurement scale might impairment the quality of findings [16], every bit was seen in some included studies [thirty, 33, 35, 37, 42, 44]. The uncertainty of optimum time to assess birth feel is the main reason for heterogeneity in timing of consequence assessment [fourteen]. All included studies measured the childbirth experience within iii months of the nascency; iii studies repeated measurements after several months [36, forty, 43]. This finding is favourable because the first six months of birth is considered as the all-time time for surveys about maternity intendance used for health planning [44]. Similar futurity trials are needed to assess childbirth feel past a comprehensive and valid scale during a 6-month postpartum period. According to electric current noesis, the Childbirth Experience Questionnaire (CEQ) is the nearly comprehensive tool that covers many aspects of the maternal childbirth experience [52]. Researchers should validate CEQ before its use.

Strengths and limitations of report

The authors of the current study attempted to include high-quality relevant trials as much as possible. The inclusion of studies from low, middle and high income countries with a considerable sample size is force of this review. Participants in the control groups of all included studies received conventional care. The divergence of the standard motherhood care across cultural and geographic boundaries is an inherent limitation of this review. We carried out the necessary investigation virtually conventional care of studies that have been pooled in the meta-analyses. As mentioned in the results section, the routine intendance of homogenous trials was relatively similar. The conventional intendance in the labour back up studies consisted relatively similar components including active management of labour, clinical assessment by obstetricians and midwives, and analgesia, as needed. The conventional care of h2o relaxation studies included midwife provided labour care, one-to-one support by nurse or midwife, and parenteral analgesia, as necessary. In early on labour cess studies, participants allocated to standard care did not received any instruction or advice related to the labour.

The lack of blinding in the included trials is an unavoidable limitation in this review. To reduce response bias, some studies had used blinded interviewers and all studies had practical self-administrated method. Although self-evaluation measures might limit the accuracy of the findings, they are the most direct and valid approach currently available to determine the subjects' perception of experience [53]. To have homogeneous studies, the target population in the selected trials were depression-risk pregnant women; as these samples exercise not correspond the full population of pregnant women, information technology tin be considered equally a limitation of this review.

Directions for futurity studies

Future researches aiming to improve the birth feel should evaluate psychological birth trauma as an outcome of their interventions. Interventions to help practitioners learn more most mother-friendly nativity should be designed and assessed. In addition, it would be useful to appraise the effectiveness of partner-based interventions on the maternal childbirth feel. 1 of the most important sub-groups requiring evidence to inform practice, is women with a fear of childbirth. Therefore, interventions designed for this special sub-grouping would deserve a separate review.

Conclusion

This systematic review provides a summary of available strategies that had been designed to amend the maternal feel of childbirth. The aim of this written report was to classify these strategies and identify those that were successful. Iv main categories of strategies are supporting childbearing women, relaxation and pain relief during birth, minimizing obstetric interventions, and nascence preparedness. Successful interventions were supporting women during labour, relaxation through massage and music, early on labour assessment to minimize obstetric interventions, and nascence preparedness. The main recommendation of this review is that emotional back up programs for childbearing women should be implemented in countries' maternal health plans. These programs tin comprise a combination of successful strategies such as continuous labour support past a familiar person, reassuring physical contact using massage, and the continuity of midwifery intendance. There is a need for more clinical strategies that outcome in positive childbirth experiences. The results of this study might be helpful in planning clinical approaches and designing future studies regarding the prevention of negative and traumatic nativity experiences.

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Acknowledgements

The authors are indebted to Dr. Mohsen Maadani, for editing the manuscript. This review was conducted as the outset part of PhD thesis in reproductive health whose aim is to design a national program for the prevention of psychological birth trauma.

Funding

This project is funded and supported by Tehran University of Medical Sciences (TUMS); grant No: 95–02–28-32630.

Availability of information and materials

The data set up supporting the conclusions is included in the article'south Table one.

Writer information

Affiliations

  1. Section of Reproductive Health, School of Nursing and Midwifery, Tehran Academy of Medical Sciences, Tehran, Iran

    Mahshid Taheri, Ziba Taghizadeh & Nasrin Sarafraz

  2. Section of Health Direction and Economics, Schoolhouse of Public Health, International Campus, Tehran Academy of Medical Sciences, Tehran, Islamic republic of iran

    Amirhossien Takian

  3. Ministry building of Health and Medical Education, Tehran, Iran

    Nahid Jafari

Contributions

MT and ZT developed the review question and drafted the study protocol. The eligibility of the studies for inclusion was assessed by MT and NS too every bit quality assessment and data extraction; ZT supervised all these processes. MT undertook the data analysis. AT contributed to the findings interpretation. All authors contributed to the manuscript drafting. ZT is the guarantor. All authors read and approved the final manuscript.

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Correspondence to Ziba Taghizadeh.

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Taheri, Yard., Takian, A., Taghizadeh, Z. et al. Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions. Reprod Wellness 15, 73 (2018). https://doi.org/10.1186/s12978-018-0511-10

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Keywords

  • Childbirth experience
  • Psychological nascency trauma
  • Back up
  • Systematic review

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