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

Abstract

Introduction: Fear of childbirth is a problematic mental health issue during pregnancy. But, effective interventions to reduce this problem are not well understood.

Objectives: To examine effective interventions for reducing fear of childbirth.

Material and methods: The Cochrane Central Register of Controlled Trials, PubMed, Embase and PsycINFO were searched since inception till September 2017 without any restriction. Randomised controlled trials and quasi-randomised controlled trials comparing interventions for treatment of fear of childbirth were included. The standardized mean differences were pooled using random and fixed effect models. The heterogeneity was determined using the Cochran's test and I² index and was further explored in meta-regression model and subgroup analyses.

Results: Ten studies inclusive of 3984 participants were included in the meta-analysis (2 quasi-randomized and 8 randomized clinical trials). Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled standardized mean differences of fear 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.

Conclusions: Both types of interventions were effective in reducing fear of childbirth; however our pooled results revealed that educational interventions may reduce fear with double the effect of hypnosis. Further large scale randomized clinical trials and individual patient data meta-analysis are warranted for assessing the association.

Keywords: Antenatal class education; Fear of childbirth; Hypnosis; Meta-analysis; Systematic-review.