None listed
Conditions
Brief summary
The Birth Course: Evidence based childbirth education program to reduce rates of caesarean section in first time mothers. Maternal and child health are priority public health areas listed by the World Health Organisation (WHO). Successive reviews of maternity services for more than four decades, both in Australia and internationally, have called for a decrease in medical interventions, particularly caesarean section (CS), due to it associated morbidity and mortality. It is well established in the literature that medical interventions in labour significantly increase the risk of caesarean section (CS). In 2014, only 56% of women experienced a normal vaginal birth, with more than half receiving an epidural, and more than a third giving birth by caesarean section. However, there is a major practice gap in how to address the rising rates of intervention in childbirth, and strategies to provide effective and cost-effective methods to support women and reduce medical interventions are required. The Birth Course is a complementary medicine (CM) package of antenatal care combining education about normal physiology and pain dynamics in labour, with five different evidence-based CM techniques for the management of pain in normal labour and birth. The Birth Course education program is an intervention which introduces the concepts of: Physiology and hormones of birth, the Fear-Pain-Tension cycle, working with pain, the relaxation response, and uses the five techniques of: upright positions/yoga and movement for birth, acupressure techniques, guided visualisation, breathing techniques and massage. We hypothesise that this study will provide an effective antenatal education program to reduce rates of medical intervention in labour and birth, and provide women with non-pharmacological pain management options.
Interventions
BirthCourse: an antenatal education intervention, consisting of 5 different non-pharmacological (complementary therapy) techniques for the management of pain in normal labour and birth.
Materials – a booklet of materials is provided to participants during BirthCourse. The booklet contains information on the physiological processes of birth and explanations of the 5 non-pharmacological techniques taught during the course. This booklet has been specifically designed for the purpose of this study
BirthCourse: an antenatal education intervention, consisting of 5 different non-pharmacological (complementary therapy) techniques for the management of pain in normal labour and birth. Materials – a booklet of materials is provided to participants during BirthCourse. The booklet contains information on the physiological processes of birth and explanations of the 5 non-pharmacological techniques taught during the course. This booklet has been specifically designed for the purpose of this study. Workshop checklists will be kept to monitor attendance and it is also possible to check if participants are accessing course materials by downloading them. Procedures – The Birth Course education program is an intervention which introduces the concepts of: Physiology and hormones of birth, the Fear-Pain-Tension cycle, working with pain, the relaxation response, and uses the five techniques of: upright positions/yoga and movement for birth, acupressure techniques, guided visualisation, breathing techniques, and massage. Who – The course will be delivered by an experienced childbirth educator (over 3 years) who also has a background in counselling and working with clients with anxiety and depression. Mode of delivery – The program is run face-to-face in group sessions of aprox 8-12 couples per session. Number of times, duration – participation in a 2-day or 4-module workshop from around 24-36 weeks gestation; practice of techniques until birth using the program materials; follow-up within 72 hours following birth; 6 week follow up questionnaire; longer term follow up if centres choose; some participants will participate in the in-depth interviews, not before 6 weeks post-partum. Location – The BirthCourse antenatal education program will be delivered at Royal Prince Alfred Hospital, Sydney. Other hospitals may join at a later date and site specific approval will be sought. We plan to introduce the RCT study to 400 women and their birth partners over a period of 24-36 months. Participants and their birth partners will be recruited from antenatal clinics at participating hospitals, from around 24 weeks of gestation and randomly allocated to attend the BirthCourse education program plus standard care or to standard care alone.
Sponsors
University of Notre Dame Australia
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
17 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
• Pregnant (with no congenital abnormalities) women (including: first time mothers (nulliparous)/ or women who have previously given birth (multiparous) – This is local choice i.e. each participating site can decide who to include, and this will be specified in their site specific study. The other sites where the trial will be performed as of yet unknown but we will seek the relevant ethics approval when they are identified). The risk status of pregnant women is determined by a 'risk assessment' conducted during pregnancy. Women who are classified as low risk or moderate risk will be included. (Risk status is determined by a scoring system at the hospital and measures can include age, marital status, socio-economic factors, smoking, threatened miscarriage, previous low birthweight baby, previous stillbirth, maternal weight and height. This scoring system enables clinicians to identify women at increased risk of adverse outcomes, and subsequently management options to reduce this risk). Inclusion criteria: • Singleton pregnancy, baby in vertex position, placenta not low lying (>20mm from the cervical os) • No contraindications to vaginal birth • Intending to have a vaginal birth • Gestation between 24 and 36 weeks • Mixed risk (local choice i.e. each participating site can decide who to include within their site specific study) • Fragmented and continuity of care programs (stratified analysis) • Sufficient English for participation in a two-day workshop, • LOTE if educator or translator is able to provide full class in language of choice
Exclusion criteria
• High risk pregnancies • Congenital abnormalities • Any indication for planned caesarean section • Participation in similar program of independent antenatal education (including for example, ‘CalmBirth’, ‘Hypnobirthing’, ‘Active Birthing’, ‘Yoga Birth’, ‘She Births', 'Genetle Birth', 'Lamaze' etc)
Outcome results
None listed