Gagnon A J, Sandall J
McGill University/McGill University Health Center, School of Nursing and Department of Obstetrics and Gynaecology, 3506 University Street, Montreal, Quebec, Canada, H3A 2A7.
Cochrane Database Syst Rev. 2007 Jul 18;2007(3):CD002869. doi: 10.1002/14651858.CD002869.pub2.
Structured antenatal education programs for childbirth or parenthood, or both, are commonly recommended for pregnant women and their partners by healthcare professionals in many parts of the world. Such programs are usually offered to groups but may be offered to individuals.
To assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, labour and birth support, breastfeeding, infant-care abilities, and psychological and social adjustment.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (April 2006), CINAHL (1982 to April 2006), ERIC (1984 to April 2006), EMBASE (1980 to April 2006) and PsycINFO (1988 to April 2006). We handsearched the Journal of Psychosomatic Research from 1956 to April 2006 and reviewed the reference lists of retrieved studies.
Randomized controlled trials of any structured educational program provided during pregnancy by an educator to either parent that included information related to pregnancy, birth or parenthood. The educational interventions could have been provided on an individual or group basis. Educational interventions directed exclusively to either increasing breastfeeding success, knowledge of and coping skills concerning postpartum depression, improving maternal psycho-social health including anxiety, depression and self-esteem or reducing smoking were excluded.
Both authors assessed trial quality and extracted data from published reports.
Nine trials, involving 2284 women, were included. Thirty-seven studies were excluded. Educational interventions were the focus of eight of the studies (combined n = 1009). Details of the randomization procedure, allocation concealment, and/or participant accrual or loss for these trials were not reported. No consistent results were found. Sample sizes were very small to moderate, ranging from 10 to 318. No data were reported concerning anxiety, breastfeeding success, or general social support. Knowledge acquisition, sense of control, factors related to infant-care competencies, and some labour and birth outcomes were measured. The largest of the included studies (n = 1275) examined an educational and social support intervention to increase vaginal birth after caesarean section. This high-quality study showed similar rates of vaginal birth after caesarean section in 'verbal' and 'document' groups (relative risk 1.08, 95% confidence interval 0.97 to 1.21).
AUTHORS' CONCLUSIONS: The effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown. Individualized prenatal education directed toward avoidance of a repeat caesarean birth does not increase the rate of vaginal birth after caesarean section.
在世界许多地区，医疗保健专业人员通常向孕妇及其伴侣推荐有关分娩或为人父母，或两者兼有的结构化产前教育项目。此类项目通常以小组形式提供，但也可能提供给个人。
评估此类教育对知识获取、焦虑、控制感、疼痛、分娩及分娩支持、母乳喂养、婴儿护理能力以及心理和社会适应的影响。
我们检索了Cochrane妊娠与分娩组试验注册库（2006年4月）、护理学与健康领域数据库（1982年至2006年4月）、教育资源信息中心数据库（1984年至2006年4月）、荷兰医学文摘数据库（1980年至2006年4月）以及心理学文摘数据库（1988年至2006年4月）。我们手工检索了1956年至2006年4月的《身心研究杂志》，并查阅了检索到的研究的参考文献列表。
由教育工作者在孕期向父母任何一方提供的任何结构化教育项目的随机对照试验，其中包括与妊娠、分娩或为人父母相关的信息。教育干预可以以个体或小组形式提供。专门针对提高母乳喂养成功率、产后抑郁症的知识及应对技巧、改善包括焦虑、抑郁和自尊在内的产妇心理社会健康或减少吸烟的教育干预被排除。
两位作者评估了试验质量，并从已发表的报告中提取数据。
纳入了9项试验（涉及2284名女性）。排除了37项研究。8项研究聚焦于教育干预（合并样本量n = 1009）。未报告这些试验的随机化程序、分配隐藏和/或参与者招募或失访的详细情况。未发现一致的结果。样本量非常小至中等，范围从10至318。未报告有关焦虑、母乳喂养成功率或一般社会支持的数据。测量了知识获取、控制感、与婴儿护理能力相关的因素以及一些分娩及分娩结局。纳入的最大规模研究（n = 1275）考察了一项教育和社会支持干预措施，以增加剖宫产术后阴道分娩率。这项高质量研究表明，“口头”组和“文档”组的剖宫产术后阴道分娩率相似（相对危险度1.08，95%置信区间0.97至1.21）。
有关分娩或为人父母，或两者兼有的一般产前教育的效果在很大程度上仍然未知。旨在避免再次剖宫产的个体化产前教育并不会提高剖宫产术后阴道分娩率。
