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Background A significant number of primiparous women lack awareness of labor epidural analgesia, resulting in lower acceptance of labor epidural analgesia. Additional prenatal education may help primiparas understand labor epidural analgesia and increase labor epidural analgesia rates. This randomized controlled trial (RCT) will evaluate the effects of an online and offline prenatal labor epidural analgesia education program for primiparas to improve their labor epidural analgesia rate and to reduce their misunderstanding of labor epidural analgesia and fear of birth. Methods A single-blinded, randomized, controlled, parallel-design trial will be conducted. Based on the Theory of Planned Behavior, online and offline prenatal labor epidural analgesia education program has five modules: (a)elementary knowledge, (b)attitude, (c)subjective norm, (d) perceived behavioral control and (e)behavioral intention. Primiparous women will be recruited in the obstetrics department or midwife clinic of a tertiary hospital in Shenzhen, China. The participants ( N  = 196) will be randomly allocated to the intervention group ( N  = 98) that receives routine prenatal education and access to the online and offline prenatal labor epidural analgesia education program and the control group ( N  = 98) that receives routine prenatal education. Labor epidural analgesia rate will be extracted from the electronic medical record; misunderstanding and intention of labor epidural analgesia and fear of birth will be measured at baseline and immediately after the intervention. The study was ethically approved in November 2023. Discussion If the online and offline prenatal labor epidural analgesia education program has positive outcomes, it may offer an effective intervention program to decrease misperceptions of labor epidural analgesia and fear of birth and to improve the labor epidural analgesia rate for Chinese primiparas. As the first RCT study to evaluate the effect of the online and offline prenatal labor epidural analgesia education program with a strict research design and a theoretical framework, this research will provide evidence on prenatal labor analgesia health education for clinical practice in China. Trial Registration Registered at the Chinese Clinical Trials.gov on January 11th, 2024. Trial Registration Number: ChiCTR2400079767.

Background Congenital cytomegalovirus (CMV) is the most common congenital infection globally, however information about CMV is not routinely included in antenatal education in the United Kingdom. This feasibility study aimed to gather the essential data needed to design and power a large randomised controlled trial (RCT) to investigate the efficacy of a digital intervention in reducing the risk of CMV acquisition in pregnancy. In order to do this, we carried out a single-centre RCT, which explored the knowledge, attitudes and risk reduction behaviours in women in the intervention and treatment as usual groups, pre- and post-intervention. Methods CMV seronegative women living with a child less than four years old, receiving antenatal care at a single UK tertiary centre, were randomised to the digital intervention or ‘treatment as usual’ groups. Participants completed questionnaires before the digital intervention and after and at 34 gestational weeks, and responses within groups and between groups were compared using tailored randomisation tests. CMV serology was tested in the first trimester and at the end of pregnancy. Results Of the 878 women screened, 865 samples were analysed with 43% ( n  = 372) being CMV seronegative and therefore eligible to take part in the RCT; of these, 103 (27.7%) women were enrolled and 87 (84%) of these completed the study. Most participants ( n  = 66; 64%) were unfamiliar with CMV at enrolment, however at 34 gestational weeks, women in the intervention group ( n  = 51) were more knowledgeable about CMV compared to the treatment as usual group ( n  = 52) and reported engaging in activities that may increase the risk of CMV transmission less frequently. The digital intervention was highly acceptable to pregnant women. Overall, four participants seroconverted over the course of the study: two from each study group. Conclusions A large multi-centre RCT investigating the efficacy of a CMV digital intervention is feasible in the United Kingdom; this study has generated essential data upon which to power such a study. This single-centre feasibility RCT demonstrates that a digital educational intervention is associated with increase in knowledge about CMV and can result in behaviour change which may reduce the risk of CMV acquisition in pregnancy. Trial registration Clinicaltrials.gov, NCT03511274 , Registered 27.04.18, http://www.Clinicaltrials.gov

Antenatal education is part of antenatal care in many countries. Physical and mental preparation for childbirth and information on pain management are considered key elements of antenatal education classes. Evidence suggests that women who participate in antenatal education classes appear to benefit in terms of self-efficacy and childbirth experience. In particular, women with increased fear of childbirth benefit from trained breathing and relaxation techniques in antenatal education. However, little is known about the effect of breathing and relaxation techniques on the outcomes of healthy pregnant women without fear of childbirth or who do not have medical or obstetric risks, or on neonatal outcomes. The aim of this study is to test whether including a breathing and relaxation technique in an antenatal education class will improve self-efficacy towards birth compared to a standard antenatal education class. The study will be a two-armed randomised controlled trial (RCT). Healthy pregnant women between the 12th and 30th week of gestation with singleton low-risk pregnancies and who are receiving routine antenatal care will be recruited in a hospital in Switzerland. All women included will attend an 8-hour antenatal education class. The intervention group will additionally practise a breathing and relaxation technique, receive a handbook to guide their exercise practice at home, and be provided with access to an online brochure with video and audio recordings for guidance. Data on maternal and neonatal outcomes will be collected after recruitment, in the 37th week of pregnancy, and two to four weeks postpartum. The effectiveness of including a breathing and relaxation technique in antenatal education classes on women's self-efficacy is discussed as a means to improving women's pregnancy and childbirth outcomes. NCT06003946, SNCTP000005672.

Background Breast milk is the primary source of nutrition for newborns, containing both macro- and micronutrients. However, breastfeeding practices vary from setting to setting and have an effect on a newborn’s growth and development. Ethiopian women frequently demonstrate poor breastfeeding practices due to cultural norms and limited access to health information. Null-parous pregnant women have no previous experience of breastfeeding, so they can easily be influenced by others, such as their mother-in-law, who are influential people in the family. Evidence from interventional studies regarding whether involving influential people like mothers-in-law in breastfeeding education interventions in addition to educating pregnant women alone improves breastfeeding practices or not is limited in the study areas. Therefore, this study aimed to evaluate the effect of breastfeeding education interventions on breastfeeding practices in rural South Ethiopia. Methods A community-based, three-arm, parallel, cluster randomized controlled trial design will be conducted among 510 pregnant women who will be enrolled between the end of the first trimester and the early second trimester (< 16 weeks) of their pregnancy. The three arms are: pregnant woman alone, pregnant woman with her mother-in-law (paired), and pregnant woman in control arm (routine care). The study includes 51 non-adjacent clusters (kebeles) for the three arms. This helps minimize information contamination. We implement a simple randomization technique to allocate interventions and control clusters. Interventions will be given at home in eight phases: six times during pregnancy (monthly starting from the 4th month up to the 9th month), and two times after delivery (within one week and the last week of the 3rd month). The outcomes are pre-lacteal feeding, colostrum feeding, early initiation of breastfeeding, and exclusive breastfeeding. Discussion Recruitment is ongoing, and the final trial is expected to be completed on May 20, 2025. The trial results will have implications for the future involvement of influential family members, such as mothers-in-law, in breastfeeding education, which may improve good breastfeeding practices to enhance child health and survival. Protocol registration ClinicalTrials.gov identifier (NCT number): NCT06236412, January 23, 2024.

Background Childbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education. Methods This study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n  = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL) : Working with Pain in Childbirth , based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected. Results In a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls. Conclusions This study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects. Trial registration The ClinicalTrials.gov identifier for the PEARLS  study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.

Breastfeeding is widely recognized as the optimal form of infant nutrition; however, exclusive breastfeeding (EBF) rates remain low worldwide. Psychological factors such as maternal self-efficacy and satisfaction play a key role in breastfeeding success. This randomized controlled trial evaluated whether a mixed-reality educational strategy could improve maternal self-efficacy and breastfeeding satisfaction. A total of 58 pregnant women in their third trimester were randomly assigned to receive either mixed reality plus traditional counseling or traditional counseling alone. Breastfeeding self-efficacy and satisfaction were measured one week postpartum using validated instruments. No statistically significant differences were found between the groups in self-efficacy (mean scores 63.3 vs. 63.1) or satisfaction (133.5 vs. 134.0). However, both groups demonstrated remarkably high rates of exclusive breastfeeding during the first week of life (93.1%), far exceeding the national and global average. Although the mixed-reality intervention did not yield superior outcomes within the short follow-up period, the findings highlight the potential benefits of structured prenatal education in enhancing breastfeeding practices. This low-cost immersive approach may be particularly relevant in middle- and low-income settings. Further research with a larger sample size and extended follow-up is required to assess the long-term impact and broader applicability of mixed reality in maternal health education. Clinical trial registration: https://ClinicalTrials.gov (NCT06800521; registered on 30/01/2025).

People across the world have been greatly affected by the ongoing coronavirus disease (COVID-19) pandemic. The high infection risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in hospitals is particularly problematic for recently delivered mothers and currently pregnant women who require professional antenatal care. Online antenatal care would be a preferable alternative for these women since it can provide pregnancy-related information and remote clinic consultations. In addition, online antenatal care may help to provide relatively economical medical services and diminish health care inequality due to its convenience and cost-effectiveness, especially in developing countries or regions. However, some pregnant women will doubt the reliability of such online information. Therefore, it is important to ensure the quality and safety of online services and establish a stable, mutual trust between the pregnant women, the obstetric care providers and the technology vis-a-vis the online programs. Here, we report how the COVID-19 pandemic brings not only opportunities for the development and popularization of online antenatal care programs but also challenges.

To investigate whether a structured inquiry during pregnancy of medical factors and social factors associated with low socioeconomic status, and subsequent patient-centred maternity care could increase maternal empowerment. Cluster-randomised controlled trial. This study was conducted among pregnant women in selected urban areas in the Netherlands. This study was part of the nationwide Healthy Pregnancy 4 All-2 programme. Pregnant women listed at one of the sixteen participating maternity care organisations between July 1, 2015, and Dec 31, 2016. All practices were instructed to provide a systematic risk assessment during pregnancy. Practices were randomly allocated to continue usual care (seven practices), or to provide a patient-centred, risk-guided approach to addressing any risks (nine practices) identified via the risk assessment during pregnancy. Low postpartum maternal empowerment score. We recruited 1579 participants; 879 participants in the intervention arm, and 700 participants in the control arm. The prevalence of one or more risk factors during pregnancy was similar between the two arms: 40% and 39%, respectively. In our intention-to-treat analysis, the intervention resulted in a significant reduction in the odds of having a low empowerment score [i.e. the primary outcome; adjusted OR 0.69 ((95% CI 0.47; 0.99), P 0.046)]. Implementation of additional risk assessment addressing both medical and social factors and subsequent tailored preventive strategies into maternity care reduced the incidence of low maternal empowerment during the postpartum period. Introducing this approach in routine maternity care may help reduce early adversity during the postpartum period.

Background and aim Health anxiety is a mental disorder that characterized by an excessive fear about health and physical symptoms. High anxiety in pregnancy is associated with adverse outcomes. The aim of this study was to investigate the effect of prenatal education on health anxiety of primigravid women. Methods The present study was quasi-experimental study. 122 primiparous pregnant women referred to comprehensive health services Shahrekord (A city in the southwest of Iran) clinics in 2019, after receiving consent to participate in the study, randomly divided into two intervention and control groups. The intervention group participated in 8 sessions (1.5-h), once every 2 weeks, from 20 to 37th weeks of gestation. The health anxiety questionnaire was completed on 20th (before the beginning of the courses), 28th and 37th weeks by two groups. Consequences of pregnancy included weight, Apgar score, delivery type, labor time and first breastfeeding time. SPSS version 16 software was used for data analysis. Results No significant difference was found type of delivery, gestational age, height, weight, head length, Apgar score, duration of hospitalization and first breastfeeding time. The duration of the active and latent phase of labor was significantly lower and the weight of newborn was significantly higher in the intervention group than the control group ( P  < 0.05). At 37th week, the scores of illness concern, negative consequence and total health anxiety in the intervention group decreased by 3.42, 0.93 and 4.36 respectively and in control group increased by 2.82, 0.03 and 2.86. Conclusion Pregnancy educational courses has positive effects on health anxiety, decrease duration of labor time and increased newborn weight. In order to improve the outcome of pregnancy, educational classes during pregnancy should be considered.

Background The first months postpartum can be challenging for parents, leading to elevated symptoms of parenting stress, depression and anxiety. In turn, distressed parents are at higher risk for providing suboptimal quality of caregiving. As psychoeducational interventions can be effective in reducing psychological distress, the goal of this randomized controlled trial was to examine the effectiveness of low-intensity universal psychoeducational program to prevent postpartum parenting stress, and to enhance parental well-being and caregiving quality. Method Between 26 and 34 weeks of pregnancy, 138 pregnant women and 96 partners were randomized to the intervention or a waitlist control group. The intervention consisted of a booklet, a video, a home visit, and a telephone call. Information was provided on (1) sensitive responsiveness, adapting to the parental role, and attending to own needs; (2) crying patterns; (3) feeding (arrangements); and (4) sleeping (arrangements). The primary outcome was parenting stress postpartum. Secondary outcomes were additional measures of distress (depression and anxiety), parental well-being, and caregiving quality. Results Both groups showed a rise in distress after birth. No between-group differences were observed on parenting stress, nor on the secondary outcomes. The intervention was rated as useful and of added value by the parents. Conclusion This study offered no evidence that our universal prevention program was effective in decreasing parental distress or in increasing caregiving quality. However, parents found aspects of the intervention useful. More research is needed, including a longer period of follow-up as well as observational measures of parents’ responsiveness. Trial registration This trial has been registered on 15 September 2016 in the Netherlands National Trial Register, ID: NTR6065, https://www.trialregister.nl/trial/5782 .