Antenatal education incorporating complementary medicine techniques for labour and birth to reduce the rates of epidural in primiparous women: A randomised control trial

• Published in: Midwifery 2024-12, Vol.139, p.104170, Article 104170
• Main Authors: Fleet, Julie-Anne, Adelson, Pamela, McKellar, Lois, Steen, Mary
• Format: Article
• Language: English
• Subjects: Adult; Analgesia, Epidural - methods; Analgesia, Epidural - statistics & numerical data; Antenatal education; Australia; Childbirth preparation; Complementary therapies; Complementary Therapies - methods; Complementary Therapies - standards; Complementary Therapies - statistics & numerical data; Epidural; Female; Humans; Labor, Obstetric - psychology; Parity; Pregnancy; Prenatal Care - methods; Prenatal Care - standards; Prenatal Education - methods; RCT
• ISSN: 0266-6138; 1532-3099; 1532-3099
• DOI: 10.1016/j.midw.2024.104170

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 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.