The complete birth study : effectiveness of a complex antenatal education program incorporating complementary medicine techniques for pain relief in labour and birth for first-time mothers : a mixed methods study [The complementary therapies for labour and birth study : effectiveness of a complex antenatal education program incorporating complementary medicine techniques for pain relief in labour and birth for first-time mothers : a mixed methods study]

Abstract

Background: Reviews of maternity services in Australia have called for a reduction in interventions and an increase in education and support to increase rates of normal birth. Evidence suggests that selected complementary therapies (CM) are effective during labour to assist with the management of pain, and in decreasing interventions. Antenatal education, in the Australian maternity context, has shifted from its original focus of birth preparation, to a broader focus on overall pregnancy, birth and parenting information. The aim of this study was to evaluate the effectiveness of a complementary therapies antenatal education package: The 'Complete Birth Study', to reduce rates of epidural block (EDB) and other outcomes in low-risk first-time mothers (primiparas). Additionally, we explored the experiences of women, partners and midwives in the use and preferences of complementary therapies during birth. Method: This mixed methods study was implemented in two public hospitals in Sydney Australia, reflecting two diverse socio-economic areas. One hundred and seventy one low-risk primiparous women were recruited to the study, and were randomised to receive the Complete Birth Study package plus usual care, or to usual care alone. An RCT of the intervention was conducted, and comprised six CM techniques including: acupressure; yoga; massage; visualisation/relaxation; breathing techniques; continuous partner support; as well as education about normal birth physiology, plus standard antenatal care and compared this with standard antenatal care alone. Birth outcome data were obtained from hospital birth summaries, and women's sense of control was evaluated using the Labour Agentry Scale and Attitude Toward Birth Questionnaires. Data were analysed using an intention to treat analysis. To examine the selective use, rehearsal and preferences of women and partners in using CM techniques, in-depth interviews were conducted with a sub-group of study participants, 13 women and 7 partners, at six weeks' post-partum. To examine midwives use and preference for CM techniques, a focus group with 12 midwives at the higher recruiting study hospital was conducted following completion of recruitment. Thematic analysis was used to analyse the transcribed in-depth interview and focus group data. Results: Birth outcome data showed a significant reduction in rates of EDB as the primary outcome measure. An absolute reduction of 45%, and a relative reduction of 65% (RR=0.35 [95% C.I.: 0.23-0.52], p

Date of Award	2015
Original language	English