Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: This was a retrospective cross-sectional study of nulliparous and multiparous pregnant women at a large urban tertiary care center. On admission, patients are routinely asked if they participated in a childbirth education (CBE) class or have a birth plan. This information is charted by nurses and available for abstraction from the electronic medical record. Clinical data abstraction was performed to obtain self-reported attendance at a CBE class or to identify the presence of a written birth plan. A subset analysis was performed on nulliparous women only (n = 9,168).

Intervention Results: In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older (p < 0.001), more likely to be nulliparous (p < 0.001), had a lower body mass index (p < 0.001), and were less likely to be African-American (p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery (CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls.

Conclusion: Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates.

Setting: Large urban tertiary care center

Population of Focus: Women with singleton pregnancy >24 weeks gestation

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: A standardized antenatal class was developed in accordance with World Health Organization and Italian Ministry of Health indications to evaluate whether women who attend the class during pregnancy have a lower cesarean section rate. After recruitment, 1155 women (603 primiparous) were included in the study (286 participants in antenatal class and 869 non-participants).

Intervention Results: Non-participants of antenatal class showed a higher rate of cesarean section than those who participated (56.2% vs 23.1%; relative risk [RR] = 2.43; 95% confidence interval [CI] 1.95-3.03; P < .0001), as well as after adjustment for other variables. This difference was stronger in 1 hospital (RR = 2.88; 95% CI 2.13-3.89; P < .0001) than in the other hospital (RR = 1.86; 95% CI 1.36-2.55; P < .0001).

Conclusion: Our standardized antenatal class, which was performed in an area with a high rate of cesarean section, significantly reduced this rate, and this was still significant after adjustment for potential confounders.

Setting: Two health districts in the city of Caserta, Italy

Population of Focus: Primiparous and multiparous women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PROVIDER/PRACTICE, Active Management of Labor, Labor Support, Midwifery

Intervention Description: Active management of labor is a multifaceted program that, as implemented at the National Maternity Hospital in Dublin, is associated with a lower rate of cesarean delivery than the rate usually found in the United States. We conducted a randomized trial to evaluate the efficacy of this approach in lowering the rate of cesarean section among women delivering their first babies.

Intervention Results: Rate of CS among protocol-eligible women lower in AMOL group vs. control group (10.9% vs. 11.5%; p>0.05) after adjustment for epidural use and adoption of final protocol (three hours for second stage of labor with epidural); (OR=0.9, 95% CI: 0.4–1.9)

Conclusion: Active management of labor did not reduce the rate of cesarean section in nulliparous women but was associated with a somewhat shorter duration of labor and less maternal fever.

Study Design: RCT

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between June 10, 1991 and October 17, 1993

Data Source: Not specified

Sample Size: Total (n=1,915) Intervention (n=1,009) Control (n=906)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Labor Support, POPULATION-BASED SYSTEMS, State — Place of Birth, STATE, Place of Birth, Childbirth Education Classes, Midwifery, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We evaluated the effect on perinatal outcomes of an interdisciplinary program designed to promote physiologic birth and encourage active involvement of women and their families in maternity care.

Intervention Results: Compared with women receiving standard care, those in the birth program were more likely to be delivered by a midwife (41.9% v. 7.4%, p < 0.001) instead of an obstetrician (35.5% v. 69.6%, p < 0.001). The program participants were less likely than the matched controls to undergo cesarean delivery (relative risk [RR] 0.76, 95% confidence interval [CI] 0.68-0.84) and, among those with a previous cesarean delivery, more likely to plan a vaginal birth (RR 3.22, 95% CI 2.25-4.62). Length of stay in hospital was shorter in the program group for both the mothers (mean ± standard deviation 50.6 ± 47.1 v. 72.7 ± 66.7 h, p < 0.001) and the newborns (47.5 ± 92.6 v. 70.6 ± 126.7 h, p < 0.001). Women in the birth program were more likely than the matched controls to be breastfeeding exclusively at discharge (RR 2.10, 95% CI 1.85-2.39).

Conclusion: Women attending a collaborative program of interdisciplinary maternity care were less likely to have a cesarean delivery, had shorter hospital stays on average and were more likely to breastfeed exclusively than women receiving standard care.

Study Design: Retrospective cohort

Setting: 1 women’s hospital

Population of Focus: Nulliparous women who gave birth between April 2004 to October 20102

Data Source: Not specified

Sample Size: Total (n=1,660) Intervention (n=830) Control (n=830)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes, Intensive Therapy

Intervention Description: As an adjunct to standard antennal education, courses in complementary labor and delivery therapies were conducted at one of the two hospital venues over a 15-month period from May 2012 to August 2013. The underlying philosophy and specific techniques covered were designed to support a woman during pregnancy and labor by introducing tools to enhance a natural state of relaxation (visualization, yoga postures, breathing techniques, massage, acupuncture, and facilitated partner support. The courses present the concept of birth as a natural physiological process and teach methods to help laboring patients manage pain using complementary tools. The Complementary Therapies for Labour and Birth (CTLB) study protocol was based on the She Births Antenatal Education Program, with an acupressure component.

Intervention Results: There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25).

Conclusion: The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence.

Setting: Two public hospitals in Syndney, Australia

Population of Focus: Low-risk nulliparous women with a singleton pregnancy and cephalic presentation

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Childbirth Education Classes

Intervention Description: This study explored the relationship between attendance of set curriculum childbirth education class and the labor and birth process, as well as maternal satisfaction with the birth experience. The class is taught by certified educators and the general curriculum is set by the International Childbirth Education Association. Classes provide information relating to healthy pregnancy, anatomy and physiology, stages of labor, relaxation, pain management, comfort measures, labor positions, breathing and pushing techniques, common medical interventions and pain medications, birth planning, cesarean birth, postpartum care for the family, early newborn care, and basic breastfeeding information. Tours of the maternity center are encouraged and offered outside of the class. The classes average 6 couples per series with a maximum of 10. Participants in the study were 197 low-risk, primiparous women, self-selected into two groups consisting of 82 women who attended a childbirth class and 115 women who did not. Data were collected from medical records and a postpartum satisfaction survey was completed by each participant. 

Intervention Results: Data analysis revealed that women who took a class were less likely to be induced and had lower use of analgesics during labor. A logistical regression model showed that an increase in the number of interventions increased the risk for cesarean surgery for all women. Labor interventions were used significantly less in women who took a childbirth class. No statistical difference was seen in the perception of control or overall satisfaction of the birth experience.

Conclusion: Childbirth education may help women prepare for what to expect in birth and minimize the use of medical interventions.

Setting: Nonprofit mid-size hospital in Alaska

Population of Focus: Low risk primiparous women

Intervention Components (click on component to see a list of all articles that use that intervention): Psychoprophylaxis, Childbirth Education Classes, PATIENT_CONSUMER

Intervention Description: Given the rising rates of caesarean section, we aimed to determine whether there was a difference in mode of birth in women based on the type of antenatal education attended.

Intervention Results: Five hundred and five women with birth data were included. A higher proportion of women who attended psychoprophylaxis education had a vaginal birth (instrumental/spontaneous) (79%) compared with women who attended birth and parenting, other or no education (69%, 67%, 60%, respectively P = 0.045). After adjusting for maternal characteristics, birth and hospital factors, the association was attenuated (odds ratio 2.03; 95% CI 0.93–4.43).

Conclusion: Women who attended psychoprophylaxis couple-based education had a trend toward higher rates of vaginal birth. Randomised trials comparing different types of antenatal education are required to determine whether psychoprophylaxis education can reduce caesarean section rates and improve other birth outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Childbirth Education Classes, PATIENT_CONSUMER

Intervention Description: The objective of this study was to examine the associations between attendance at childbirth education classes and maternal characteristics (age, income, educational level, single parent status), maternal psychological states (fear of birth, anxiety), rates of obstetric interventions, and breastfeeding initiation.

Intervention Results: Older, more educated, and nulliparous women were more likely to attend childbirth education classes than younger, less educated, and multiparous women. Attending prenatal education classes was associated with higher rates of vaginal births among women in the study sample. Rates of labor induction and augmentation and use of epidural anesthesia were not significantly associated with attendance at childbirth education classes.

Conclusion: Future studies might explore the effect of specialized education programs on rates of interventions during labor and mode of birth.

Study Design: Prospective cohort

Setting: Perinatal Services British Columbia data

Population of Focus: Nulliparous women who gave birth after prenatal survey completion between May 2005 and July 20072

Data Source: Not specified

Sample Size: Total (n=372) Intervention (n=311) Control (n=61)

Age Range: Not Specified