Psychoprophylaxis - Antenatal preparation and actual use during labour

The aim of this thesis was to study the effects of a model of antenatal education, focusing on natural childbirth preparation by including psychoprophylaxis, breathing and relaxation techniques to cope with labour pain, and the actual use of psychoprophylaxis during labour. Satisfaction with antenatal education and experiences of a subgroup of men with antenatal fear of childbirth were also explored. The principal design was a randomised controlled trial where the new model, ―natural birth‖, was compared with standard antenatal education, ―standard care‖, as practised in Sweden at the commencement of the trial. The trial was conducted at 15 antenatal clinics spread over Sweden between January 2006 and May 2007. About 1300 women and their partners were eligible for the study and the 1087 women and 1064 men who were recruited were randomised into 106 natural birth and 101 standard care groups. Both models for antenatal education had the same structure: 12 persons per group, four 2hour sessions during third trimester of pregnancy and one follow-up after delivery. The natural birth model focused on childbirth preparation with practical training in psychoprophylaxis, whereas in standard care the time was divided between preparation for childbirth and for parenthood and no psychoprophylaxis was included. Data were collected by questionnaires in mid-pregnancy, before randomisation, and at three months after birth. A total of 986 (91%) women and 896 (84%) men completed the follow-up questionnaire. Data were also collected from the Swedish Medical Birth Register. No statistical differences were found between the two models of antenatal education among women and men regarding use of epidural analgesia, experience of childbirth or parental stress, three months after the birth. Seventy percent of the women in the natural birth group reported having used psychoprophylaxis during labour. A minority in the standard care group (37%) had also used this method, but subgroup analysis where these women were excluded did not change the principal findings. Use of psychoprophylaxis during labour was investigated by an observational design where the randomised groups were merged. Actual use of psychoprophylaxis during labour was associated with a lower risk of emergency caesarean section, but did not affect the experience of childbirth. Women who used psychoprophylaxis were older, more often Swedish-born and had higher socioeconomic status compared with women who did not use the method. More women and men randomised to the natural birth group than those in the standard care group were satisfied with the education. Overall, issues related to the approaching birth were rated as more important than postnatal issues by women and men when they were asked during pregnancy. After the birth only about one third of the participants were satisfied with the education content related to preparation for parenthood, but these numbers were higher in the standard care group. Childbirth was more often experienced as frightening by men with antenatal fear of childbirth than by men without such fear. Fearful men in the natural birth group rated the experience of childbirth as frightening less often compared with the standard care group. In conclusion, the findings of this thesis suggest that antenatal preparation with psychoprophylaxis has no more beneficial effects on labour-related outcomes or experience of childbirth than antenatal education without psychoprophylaxis. However, men suffering from antenatal fear of childbirth may benefit from this model. Actual use of psychoprophylaxis during labour may possibly reduce the risk of emergency caesarean section. The findings also suggest that antenatal education focusing on childbirth preparation increases parental satisfaction compared with content related to parenthood.