Non-pharmacological strategies for coping with labour and birth

: how they have been evaluated in trials and healthcare professionals’ views of supporting them in clinical practice.

Abstract

Negative birth experiences impact women’s psychological wellbeing. Effective non-pharmacological coping strategies (NPCSs) may improve outcomes.
Aims:
1) To systematically scope NPCSs investigated, and outcomes measured and establish if it is possible to synthesise data to identify effective strategies.
2) To investigate healthcare professionals’ views of NPCSs and how women can be supported to develop and use them.
Method:
i) Systematic scoping review: Randomised controlled trials (RCTs) evaluating NPCS interventions for labour were identified from seven databases. Two researchers identified studies and extracted data. Studies were grouped by intervention type and outcome/s.
Pre-specified criteria were used to identify which could be combined in meta-analyses.
ii) Qualitative focus group study: Focus groups using a semi-structured topic guide were conducted with maternity staff to identify NPCSs and barriers and facilitators to their use. Data were thematically analysed.
Results:
i) 40 RCTs describing 12 intervention types were identified. 80 unique outcomes were grouped into five domains. Interventions, outcomes assessed, and measurement tools were heterogenous. Pain was the most frequently assessed outcome. Meta-analysis may be possible for acupuncture, antenatal education, birth positions and support, hypnosis, massage, music, TENS and water on pain, clinical and neonatal outcomes. Meta-analysis cannot be undertaken for experiential and psychosocial outcomes.
ii) Staff identified multiple NPCSs in use, particularly hypnobirthing. Conditions perceived to support coping included being flexible and resilient around changes to birth plans, and the midwife-woman relationship. Barriers to developing and deploying strategies included personal finances, NHS resources and differing perceptions of NPCSs across clinical areas.
Conclusion: The scoping review will inform future meta-analyses for combinable interventions and outcomes. High-quality intervention studies evaluating experiences, and a core outcome set will support identification of effective NPCSs. Women should be supported to develop flexible birth plans. Trusting staff-women relationships will support use of NPCSs. Co-produced training could facilitate continuity of support across settings.

Date of Award	10 Dec 2024
Original language	English
Awarding Institution	University of Bristol
Sponsors	South West Clinical Research Network, Bristol
Supervisor	Anna Davies (Supervisor) & abi merriel (Supervisor)