Intervention(s), exposure(s)
We will include any psychosocial and educational interventions that aim to help women during the latent phase of labour. The timing of the interventions is not only in early labour (the latent phase), but also in the antepartum period. Antepartum interventions that aim to support women to cope with their early labour will be included (e.g., providing information and strategies for the latent phase of labour). We will include interventions that are provided either by healthcare professionals caring for labouring women (e.g., physicians, nurses, or midwives), or by a trained female companion (e.g., doula). Both individual or group interventions will be included. Interventions that are administered at the maternity unit, the woman's home, over the telephone, online (e.g., websites or social media), or via electronic devices will be included.
Examples of psychosocial interventions are:
psychosocial supportive interventions (e.g., emotional support for the labouring woman and her birth companions, advice and guidance about her labour, attention to physical comfort, non-directive counselling, maintaining conversation, telephone-based peer support, counselling visits at home);
cognitive behavioural therapy (CBT), cognitive and behavioural interventions (e.g., mental image training, stress reduction program, relaxation training program);
exercise therapies (e.g., exercise program, fitness, physical activity);
non-pharmacological alternative strategies (e.g., acupuncture, Reiki, hypnosis, guided imagery, meditation);
massage, aromatherapy, music therapy.
Educational interventions aim to distribute new knowledge or promote coping skills to pregnant women, such as information about the progress of labour, managing the latent phase, or when to go to the labour ward. Examples of educational interventions include:
information about relaxation;
information about coping with labour pain;
information about labour progress.
Psychosocial and educational interventions will be compared to no intervention, placebo, pharmacological intervention, or another psychosocial or educational intervention. Usual care is defined as the care that might be provided to pregnant women if they were not included in the clinical trial.
Any psychosocial or educational intervention versus no intervention (untreated control groups; usual care)
Any psychosocial or educational intervention versus placebo
Any psychosocial or educational intervention versus pharmacological intervention
Different types of psychosocial or educational interventions against each other (e.g., interventions delivered at the labour ward versus interventions delivered at home)
Combined interventions that consist of two or more types of psychosocial or educational interventions will be included in this review. We will exclude studies that include psychosocial interventions combined with pharmacological treatments. We will exclude any educational interventions that provide women with information without any personal contact and communication, e.g., giving women a booklet. We will not apply any language restrictions.
Comparator(s)/ control
Psychosocial and educational interventions will be compared to no intervention, placebo, pharmacological intervention, or another psychosocial or educational intervention. Usual care is defined as the care that might be provided to pregnant women if they were not included in the clinical trial.
Any psychosocial or educational intervention versus no intervention (untreated control groups; usual care)
Any psychosocial or educational intervention versus placebo
Any psychosocial or educational intervention versus pharmacological intervention
Different types of psychosocial or educational interventions against each other (e.g., interventions delivered at the labour ward versus interventions delivered at home)
Outcome(s)
Primary outcomes
Maternal outcomes
Length of labour
Rate of caesarean section or instrumental vaginal birth
Neonatal outcomes
Baby born before arrival at hospital or unplanned home birth
Secondary outcomes
Maternal outcomes
Serious maternal morbidity (e.g., uterine rupture, admission to intensive care unit, septicaemia, postpartum haemorrhage (defined by trialist))
Augmentation of labour
Use of epidural or any regional anaesthesia
Prolonged labour (defined by trialist)
Duration of hospital stay (antenatal, postnatal)
Maternal satisfaction (intrapartum, postpartum) with the childbirth (defined by trialist)
Postpartum depression (defined by trialist)
Neonatal outcomes
Perinatal death (stillbirth and/or early neonatal death)
Neonatal admission to special care and/or intensive care unit
Apgar score at five minutes less than seven
Exclusive breastfeeding at discharge
Exclusive breastfeeding at three months
Data extraction, (selection and coding)
Selection of studies
Two review authors (N Hanada (NH), M Matsuzaki (MM)) will independently assess for inclusion all po