UniSA Clinical & Health Sciences, University of South Australia, City East Campus, Centenary Building, North Terrace, Adelaide, SA 5000, Australia; Rosemary Bryant AO Research Centre, University of South Australia, Australia.
Rosemary Bryant AO Research Centre, University of South Australia, Australia.
Midwifery. 2024 Dec;139:104170. doi: 10.1016/j.midw.2024.104170. Epub 2024 Aug 30.
Globally medical management of labour and birth has significantly increased, with epidurals attributed to the cascade of interventions.
There are few randomised control trials that evaluate the effectiveness of antenatal education programs. A previous trial at two Australian hospitals found an antenatal program of integrative complementary therapies significantly reduced rates of interventions for low-risk primiparous women.
To reduce rates of intervention in labour and birth, with a primary outcome of decreased epidural use during labour.
Low to moderate risk primiparous women were randomised at 24-36 weeks' gestation to the intervention group and standard care, or standard care alone. Clinical and psychological measures were analysed by intention-to-treat. Trial registration ACTRN12618001353280 FINDINGS: In total, 178 women participated (n = 88 intervention, n = 90 Standard care), demographic characteristics were similar between groups, almost half (49 %) reported a pre-existing medical condition, and wellbeing scores fell within the average range. Epidural use was lower in the intervention group (47.7% vs 56.7 %) with higher rates of vaginal birth (52.3% vs 42.2 %), however, no statistical differences for birth outcomes were found between groups. Attitude to childbirth scores were statistically higher for women who attended the intervention (59.1 vs 54.3 p00.001).
Higher psychometric scores demonstrated women in the intervention group felt an increased sense of coping and control. Antenatal education that includes complementary therapies can reduce fear and improve attitudes about childbirth.
Replicating study protocols enabled the generalisability of findings to a more diverse group of women, and data will contribute to a larger meta-analysis design to detect smaller treatment effects for operative birth.
全球范围内，分娩的医学管理已经显著增加，硬膜外麻醉被认为是干预措施的级联反应。
很少有随机对照试验评估产前教育计划的有效性。此前在澳大利亚的两家医院进行的一项试验发现，综合补充疗法的产前计划显著降低了低风险初产妇干预的发生率。
减少分娩干预率，主要结果是减少分娩时硬膜外麻醉的使用。
低至中度风险的初产妇在 24-36 周妊娠时随机分为干预组和标准护理组，或仅接受标准护理。采用意向治疗分析临床和心理测量结果。试验注册 ACTRN12618001353280
共有 178 名女性参与（n=88 名干预组，n=90 名标准护理组），两组的人口统计学特征相似，近一半（49%）报告有预先存在的医疗状况，且健康状况评分处于平均范围内。干预组硬膜外麻醉使用率较低（47.7% vs 56.7%），阴道分娩率较高（52.3% vs 42.2%），但两组的分娩结局无统计学差异。参加干预组的女性对分娩的态度评分显著更高（59.1 比 54.3，p<0.001）。
较高的心理测量评分表明，干预组的女性感到应对和控制能力增强。包括补充疗法的产前教育可以减少对分娩的恐惧并改善对分娩的态度。
复制研究方案使研究结果能够推广到更多样化的女性群体，数据将有助于更大的荟萃分析设计，以检测手术分娩的较小治疗效果。
