Table 1 Description of included studies
Study | Design | Sample population, N | Description of the intervention | Description of breathing technique | Duration and Frequency | Start time | Outcomes | ||
|---|---|---|---|---|---|---|---|---|---|
IG | CG | Maternal | Neonatal | ||||||
Abbasi, 2021 [18] | RCT | software = 50 booklet = 51 | 52 | • Education about position modification during pregnancy • Stretching exercises • Breathing techniques and exercises • Relaxation and lower back massage (both software and booklet), weekly telephone contact to remind the participants | Breathing techniques and exercises (no further information) | NI | 30–36 weeks | Childbirth self-efficacy (CBSEI), Memory of labour pain (VAS) | |
Bergström, 2009 [27] | RCT | Women = 544, Men = 529 | Women = 543 Men = 534 | • Preparation for natural childbirth • Information about non-pharmacological methods for pain relief • Partner’s role as a coach during labour • Psychoprophylactic training between sessions was encouraged and a booklet to facilitate homework was distributed | Practical training in breathing (30 min); homework practicing breathing/relaxation | 8 h (4 two-hour sessions during pregnancy, 1 follow-up session within 10 weeks after delivery); 2 h weekly session | 3rd trimester | Childbirth experience (W-DEQ A/B), Memory of labour pain (VAS), Pain medication, Mode of birth | |
Duncan, 2017 [19] | RCT | 15 | 14 | • Participants are guided to reframe childbirth pain as unpleasant physical sensations that come and go, moment by moment • Participants are taught how to uncouple the sensory component of pain from its cognitive and affective components, with the objective of decreasing fear and suffering related to the physical pain of childbirth • Participants learn how to be more aware of their own body and fearful reactivity to pain by practicing mindful coping with pain through a pain induction activity with ice • Pregnant women and their birth partners develop personalized strategies to best cope interpersonally and provide support to each other throughout the birth process. Additionally: pain coping strategies, such as mindfulness of breath, partner touch, body movement, and “sounding” | Mindfulness breath, practice at home with audio and handouts | In total 18 h; A short, time-intensive 2.5-day weekend workshop | Late 3rd trimester | Childbirth experience (W-DEQ A/B), Childbirth self-efficacy (CBSEI), Pain medication | |
Howarth, 2019 [24] | RCT | Overall = 137 | The Pink Kit Method for Birthing Better®: Self-taught methodology, anonymised version on the internet, 4 books, 2 audio CD`s, one video | Exercises directed breathing, map pelvis, deep touch relaxation | 40 h of content; 50% had to be completed | Recommended start time at 24 weeks’ gestation | Childbirth self-efficacy (CBSEI) | ||
Karkada, 2017 [21] | RCT | 270 | 270 | • Antepartum breathing exercise • A video on antenatal breathing exercises was shown (duration approx. 6 min) • Breathing exercises were shown repeatedly in individual classes | Home exercises, daily or twice daily and continued during active phase of first stage of labour | Assessed once at 36 weeks’ gestation | 36 weeks’ gestation | Birthweight < 2500 g and > 2500 g | |
Levett, 2016 [25] | RCT | 85 | 87 | • Natural state of relaxation (visualisation, breathing, massage, yoga), and facilitate labour progression (yoga, acupressure) and pain relief (breathing, acupressure, visualisation • Education about the physiology of normal birth • Partner support | 4 breathing techniques were introduced: soft sleep breaths for relaxation between contractions; blissful belly breaths (BBs) which were used during contractions for pain relief; Cleansing Calming Breaths used following contractions during the transition period of labour; and the gentle birthing breath (GB) which was for use during the second stage of labour and encouraged descent of the baby avoiding active pushing and protection of the pelvic floor | 2 days; once | Prior to 36 weeks | Duration of labour, Pain medication, Mode of birth, | 5th min Apgar score > 7 |
Miquelutti, 2013 [26] | RCT | Main outcome = 97 | Main outcome = 100 | Women participated in the physical and educational activities of the BPP conducted in addition to routine activities offered at the prenatal clinic, on the same days of the prenatal visits. During the meetings of approximately 50 min women performed nonaerobic exercises of a protocol adapted for pregnancy and designed to attempt to reduce back pain, possibly to help venous return and to prevent UI and minimize anxiety. Participants received a guide with the exercises to be performed daily at home, consisting of pelvic floor muscle training (PFMT) including rapid (30 times) and sustained maximal contractions (20 times holding for 10 s), stretching exercises to reduce back pain and exercises to improve venous return in the lower limbs | Information about breathing exercises for birth. Relaxation at home: Training of breathing techniques for contraction control during labour, Training of breathing techniques for contraction control during labour; progressive relaxation techniques; massage; mentalisation | monthly from 18–24 weeks until 30 weeks’ gestation; fortnightly till 36 weeks; Duration 50 min | 18–24 weeks’ gestation | Duration of labour, Memory of labour pain (VAS), Mode of birth | 1st min and 5th min Apgar score > 7, Birthweight > 2500 g |
Secondary outcome = 78 | Secondary outcome = 71 | ||||||||
Pan, 2019 [23] | RCT | 35 | 39 | • Adaptation of MBCP by Nancy Bardack • Transformative experience of pregnancy, childbirth, and postpartum-related adjustments in self-awareness training • Listen to programme-related audio recordings at home six times a week for 30 min each | Three-minute breathing space | 8 weeks; Series of nine three-hour classes held once per week and one seven-hour day of silent-meditation practice | After recruitment between 13 and 28 weeks’ gestation | Childbirth self-efficacy (CBSEI) | |
Prince, 2015 [22] | Quasi-experimental | 300 | 300 | • Antenatal exercises by video training (animated and easily understandable) • Antenatal techniques included breathing exercises, relaxation exercises and pelvic floor muscle exercises • Information about pregnancy and labour, benefits of selected antenatal exercise, types of exercises, selected exercises during pregnancy and labour • Each primigravid women was given a record sheet to record the exercises performed at home with relevant instructions and a compact disk (CD) was provided for their practice | NI | 34 weeks up to birth; Once (45 min), practice at home (< 200 up to > = 400 h) | NI | Memory of labour pain (VAS) | |
Timm, 1979 [20] | RCT | 31 | CG = 40 TAU (no class) = 47 | • The delivery process, anatomical, emotional and physical changes in labour • Relaxation and chest-breathing patterns for use in labour • Medications used in labour •Emotional and physical changes in postpartum • Tour of hospital • Combination of lectures, discussions, films and role-playing situations • Use of self-learning programs available in waiting rooms | NI | 6 weeks; 10 series | NI | Duration of labour | |