The aim of this systematic review
is therefore to consider how antenatal education interventions could facilitate
the development of coping strategies during labour. It was hypothesised that women participating in antenatal
education programs/interventions would employ those coping strategies during
childbirth, and would report on experiencing less anxiety and pain, as well as
there being a reduction in the epidural analgesia use.

Combinations of key words were used
in this literature review such as antenatal education, antenatal preparation,
antenatal intervention, anxiety, pain, labour, childbirth, and epidural
analgesia.  A systematic review was completed
using a range of nursing, midwifery and medical databases, such as COCHRANE
(2005-2017); Medical Literature Analysis and Retrieval System (MEDLINE),
(2005-2017); ELSEVIER (2009-2017); Google Scholar (2005-2017); British Medical
Journal (BMJ), (2005-2017); Cumulative Index to Nursing and Allied Health
Literature (CINAHL, 2005-2017); Midwifery Journal (2007-2017) (Appendix 1). The title of each
article was reviewed for relevance, and a further review completed on the
abstract of those articles identified. Finally, eight articles were selected including
three observational cohort studies and five randomised controlled trials
(RCTs). The aim of this systematic review was focused on using multiple study
designs as, according to Peinemann et al
(2013), is necessary to obtain efficacy in the information and results of the
systematic review.

Studies were included only if they
had been published in English; if they had used specific antenatal education
action to measure women’s anxiety and pain during labour and/or saw an
augmentation or reduction in the rates of epidural use after having received
the antenatal program action. Studies were excluded if they were published
before 2007 (10 years old), however the Escott et al (2005) study was included because it was realized in the UK
and the information was relevant and representative. In addition, all studies
selected were assessed in terms of validity; methods used; analysis of the
results; ethical considerations and limitations (Appendix 2).

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From the research, eight relevant studies
were extracted to observe the difference between two or three groups when
receiving extra antenatal education or standard/routine care. Three of these
studies used a qualitative cohort study in order to assess the impact of pain
and anxiety during labour (Firouzbakht et
al 2013; Escott et al 2005;
Pascual et al 2008), while two
studies used a randomised controlled trial to analyse the impact of pain and
labour during childbirth using different measures such as Visual Analogue
Scales (VAS) ( Ip et al 2009;
Bonapace et al 2013).               Furthermore, Escott et al (2005) and Pascual et al (2008) also assessed how antenatal
education interventions can impact to ease birth and therefore assessing the
epidural analgesia rate in labour while Maimburg et al (2010); Bergstrom et al
(2009) and Levett et al (2017) used a
randomised controlled trial in order to evaluate if the supplemental antenatal
education had an influence on the epidural rate.


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