Table 3 Characteristics of included intervention studies
Author | Sibling studies | Country & study years | Intervention | Comparison | Methods | Settings | Type of women | Study sample | Baseline CS rates | Relative effect | CS outcomes | Risk of Bias* |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
Interventions targeting women | Â | Â | Â | Â | Â | Â | Â | Â | Â | Â | ||
Fraser 1997 [38] | None | Canada 1992—1994 | Individualised prenatal education and support programme versus written information in pamphlet | Pamphlet | Randomized controlled trial | Hospital | Women with previous CS | 1,301 | Baseline CS rates were not stated but high preference in region of CS was cited | RR 0.88 (0.58–1.33) | Little or no difference | Some concerns |
Fenwick 2015 [41] | 4 studies: protocol [50], randomized controlled trial [51], cost-effectiveness [52], economic evaluation [53] | Australia 2012—2013 | Midwife psychoeducation by telephone | Usual maternity care | Randomized controlled trial | Delivered by telephone | Women with fear of childbirth | 339 | Baseline CS rates were not stated but increasing CS in the country was cited | RR 0.81 (0.56–1.18) | Little or no difference | Some concerns |
Masoumi 2016 [39] | None | Iran 2012—2013 | Antenatal education programme for physiologic childbirth | Routine prenatal education | Randomized controlled trial | Hospital | Women with low-risk pregnancy | 150 | 48% at country level | RR 1.03 (0.72–1.49) | Little or no difference | Some concerns |
Montgomery 2007 [43] | 7 studies: protocol [43], formative qualitative [54, 55], cost analysis [56], qualitative evaluation [57, 58], observational [59] | UK 2004—2006 | Computer decision aids versus usual care | Usual care | Randomized controlled trial | Maternity units | Women with previous CS | 742 | 22%-25% at facility level | Decision analysis group: RR 0.90 (0.79–1.02) & information group: RR 1.02 (0.90–1.14) | Little or no difference | Some concerns |
Navaee 2015 [40] | None | Iran Unclear | Role-play education versus standard education using lectures | Lecture education group | Blind clinical trial | Health centres | Women with fear of childbirth | 67 | 47% at country level | RR 0.66 (0.39–1.12) | Little or no difference | Some concerns |
Saisto 2001 [42] | None | Finland 1996—1999 | Intensive group therapy (cognitive behavioural therapy and childbirth psychotherapy) | Conventional therapy | Randomized controlled trial | Outpatient clinic | Women with fear of childbirth | 176 | Baseline CS rates were not stated but high preference for CS was cited among women with fear of birth (region not stated) | RR 0.90 (0.65–1.36) | Little or no difference | Some concerns |
Bastani 2005 [70] | 1 study: randomized controlled trial [60] | Iran 2002—2003 | Nurse-led applied relaxation (breathing techniques & muscle relaxation) training programme | Routine prenatal care | Randomized controlled trial | Prenatal clinics | Women with fear of childbirth | 110 | Baseline CS rates were not stated but increasing CS worldwide was cited | RR 0.22 (0.11–0.43) | Decrease | Some concerns |
Feinberg 2015 [71] | USA 2004—2006 | Psychosocial couple-based prevention programme | Routine care (no educational classes) | Randomized controlled trial | Unclear | Women with low-risk pregnancy | 169 | Not stated | RR 0.53 (0.32–0.90) | Decrease | Some concerns | |
Rouhe 2013 [37] | Finland 2007—2009 | Psychoeducation | Conventional care group | Randomized controlled trial | Hospital | Women with fear of childbirth | 271 | 19.9% at country level | RR 0.70 (0.49–1.01) | Decrease | Some concerns | |
Sharifirad 2013 [68] | None | Iran Unclear | Prenatal education for husbands | Unclear | Randomized controlled trial | Unclear | Women with low-risk pregnancy | 88 | 41.6% at province level | CS rate in case and control groups was 29.5% and 50% (P < 0.05) | Decrease | Some concerns |
Valiani 2014 [69] | None | Iran Unclear | Childbirth training workshop | Mothers (alone), couples (mothers and partners), and control | Randomized controlled trial | Healthcare centres | Women with low-risk pregnancy | 180 | 60% at province level | Mother group: RR 0.55 (0.33–0.89) & couple group: RR 0.59 (0.37–0.94) | Decrease | Some concerns |
Interventions targeting women and health providers | Â | Â | Â | Â | Â | Â | Â | Â | Â | |||
Zhang 2020 [49] | None | China 2015—2017 | Targeted health education to pregnant women, improved hospital CS policy, and training of midwives/doulas for 8 months | Usual practice | Randomized controlled trial | Tertiary and secondary hospitals | Women with low-risk pregnancy | 10,752 | 42.50% at facility level | OR = 0.92; 95% CI 0.73, 1.15 | Little or no difference | Some concerns |
Borem 2020 [46] | None | Brazil 2014—2016 | A coalition of stakeholders, empowerment of pregnant women to choose mode of delivery, psychologic birth promotion, information system for providers | Baseline | Interrupted time series | Hospitals | Women with low-risk pregnancy | 119,378 | 78.3% at facility level | Vaginal deliveries RR 1.62 (95% CI 1.27 to 2.07, p < 0.001) | Decrease | Not serious |
Clarke 2020 [48] | 3 studies: process evaluation [65], protocol [66], formative qualitative [67] | Italy, Ireland, Germany 2012—2016 | Education of clinicians and women with one previous CS, appointment of opinion leaders, audit/peer review, and joint discussions by women and clinicians | Usual practice | Randomized controlled trial | Maternity units | Women with previous CS | 2,002 | VBAC rates < 35% at facility level | RR 0.9 (95%CI 0.85 to 0.98) | Decrease | Some concerns |
Runmei 2012 | None | China 2005—2011 | Continuous quality improvement programme (education for staff and women, audits, public health education, monitoring CS rates, and neonatal outcomes) | Baseline | Controlled before-after study | Regional referral centre | Women with low-risk pregnancy | 25,280 | 53.5%-56.1% at facility level | OR 0.56 (0.52–0.59) | Decrease | Some concerns |
Yu 2017 [45] | None | China 2006—2014 | Face-to-face weekly educational meetings between patients and hospital staff, training for providers, new regulations adoption and projects on CS (i.e. encourage mothers to choose vaginal delivery, strictly control indications for CS and maternal request for CS) | Baseline | Pre-post intervention study | Tertiary public hospitals | Women with low-risk pregnancy | 131,312 | 55–56% at facility level | Overall CS rate declined by 1.29% (p = 0.002) | Decrease | Not serious |
Xia 2019 [44] | None | China 2010—2016 | Programs for population health education, skills training for healthcare professionals, equipment and technical support for local healthcare facilities, and capacity building for the maternal near-miss care system | Baseline | Uncontrolled before-after study | Hospitals and community | Women with low-risk pregnancy | 1,923,687 | 42% at facility level | Decreasing trend in the monthly CS rates (Z = 75.067, p < 0.001) | Decrease | Low risks of bias |