The effectiveness of antenatal education on improving labour and birth outcomes - A systematic review and meta-analysis

Background: The World Health Organisation has suggested antenatal education be integrated within standard antenatal care. However, evidence for the impact of antenatal education varies. This systematic review and meta-analysis evaluated randomised controlled trial evidence regarding the influence of antenatal education on labour and birth outcomes.

Methods: Electronic databases (CINAHL, PubMed, Embase and Scopus) were searched for randomised controlled trials published between 2011 and 2023. Primary outcomes were mode of birth, epidural analgesia use, and induction of labour. Subgroup analysis by type of education (general education, specific technique, birth plan use) was performed. Three authors reviewed studies and extracted data. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Meta-analysis was performed using RevMan.

Results: Seventeen studies (n=7260 participants) were included, most (n=10) had low risk of bias. Antenatal education was associated with decreased rates of planned caesarean sections (Relative Risk (RR) 0.87; 95 % confidence interval (CI), 0.83-0.92, I²=0 %), but not unplanned caesareans (RR 0.99; 95 % CI, 0.88-1.12, I²=0 %),as well as increased vaginal births (RR 1.14; 95 % CI 1.07-1.21, I²=79 %) and increased spontaneous onset of labour (n=10 studies, RR, 1.07; 95 % CI, 1.01-1.14, I²=0 %). Epidural analgesia use (RR, 0.88; 95 % CI, 0.88-1.00, I²=78 %) was not significantly affected. General education and birth plan care interventions were found to be more effective than specific technique care.

Conclusion: Antenatal education programs studied improve some labour and birth outcomes, although with substantial heterogeneity regarding mode of birth and epidural analgesia use findings. General education appeared more effective than specific technique education.