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Table 1 Summary of included RCTs

From: Creating a positive perception of childbirth experience: systematic review and meta-analysis of prenatal and intrapartum interventions

Study (by grouping studies according to intervention) Setting/Participants/Sample size/Follow up rate Intervention Childbirth experience measurement (definition/time points/psychometric properties) Final results and key conclusion
Supporting women during birth
 Langer et al. 1998 Mexico RCT in a social security hospital/ childbearing women/ n = 724/ 92.3% of women completed the study The trained doula (who was hired) supported labouring woman physically and emotionally and kept her informed about labour progress. Measured by asking a direct question with the Likert-scale responses in the immediate postpartum period. There was no significant difference of satisfaction with the birth experience between the support group and routine care [RR = 1.01 (95% CI 0.94–1.08)]./psychological support by hired doula didn’t had a positive effect on the childbirth experience.
 Gordon et al. 1999 USA An RCT in three health maintenance organization hospitals/nulliparous pregnant women/n = 314/completion rate was 93% Childbearing woman was supported by a trained doula (who was paid) during the labour and birth. Measurement was performed by 4 questions about birth experience; questionnaire was completed at 4–6 weeks postpartum. 82.5% of women in doula Gp felt the good birth experience versus 67.4% in control Gp (P = .005)/The doula presence was associated with a good birth experience and coping very well with labor
 Hodnett et al. 2002 USA & Canada Multi-central RCT/ childbearing women/ n = 6728/ completion rate was 90% Laboring women received continuous support by a trained nurse for a minimum 80% of the time from admission to birth. The validated LAS (Labour agentry scale) questionnaire was used in 6–8 weeks after birth. 2740/2836 women in labour support Gp were satisfied with the birth experience versus 2646/2765 OR 1.01, 95% CI 1.00–1.02)/continuous labour support did not affect birth experience or other psychological outcomes.
 Bruggmann et al. 2007 Brazil RCT in a university hospital/ nulliparous pregnant women/n = 212/all of them completed the study. Women received the labour and birth support by a chosen companion; the companion supported mother according to standardized instructions. It was assessed by four questions asking about women feelings during labour and birth (12–24 h postpartum). Birth satisfaction in support Gp N = 73 and in control Gp N = 60 (P = 0.04)/Support group had higher levels of satisfaction with the birth experience
 Campbell et al. 2007 USA An RCT in a hospital/ pregnant women/ n = 494/ 95% of them completed the study Pregnant women (1 month before the birth) and their chosen companions attended two 2-h classes about the role and expectations of continuous labour support; the chosen companions provided support to women during the labour and birth. A standardized validated questionnaire was completed by participants on average, 48 days after the birth. Overall rating of birth experience support Gp 134 versus control Gp 68 (p < 0.001)/ labour support by traind person who selected by the mother improved maternal birth experience.
 Morhason et al. 2009 Nigeria RCT at the university hospital/ childbearing women/ n = 603/ follow up rate was 97% Women received continuous support by their self-selected companion during the labour; responsibilities of the companions were explained to them and their performance were checked by attending midwives. It was assessed by asking one closed-ended question (how would you rate your labour experience?) within 24 h following the birth. The support Gp was 3.3 times likely to have satisfying labour experience (95% CI OR 2.15–5.04)/women who had labour support reported better labour outcomes and experiences.
 Yuenyoung et al. 2012 Thailand An RCT in regional teaching hospital/ pregnant women/ n = 120/ follow up rate was 95% At a antenatal visit, the woman with her chosen close female relative participated in a 2-h preparation class to understanding of the doula’s role during labour; this close relative provided support during the labor and birth.. It was assessed by a validated LAS (Labour Agentry scale) questionnaire within 24 h after the birth. Mean LAS score was 53.6 in the support Gp versus 47.9 in the control Gp (P < 0.01)/women with birth companion were more satisfied with their birth experience than other group.
Relaxation and pain relief during birth
 Rash 2000 Canada An RCT in two birth units/childbearing women/n = 635/ the main outcome (epidural analgesia) were analyzed for all women but 83.3% of them completed the postpartum questionnaire. Women were offered a bath in the labour room but they were not forced. It was measured by the validated LAS (Labour agentry scale) questionnaire before discMge from the hospital. Mean LAS score was 50.46 in bath Gp and 51.71 in control Gp (P = 0.13)/ using bath in the labour room was not recognized as an effective method to improve birth experience.
 Eckert et al. 2001 Australia RCT in a maternity tertiary referral center / Low risk Women in labor / n = 274/ follow up rate was 87% Women in birth room were permitted to use a bath as little or long as they wished but water birth was not promoted. Overall birth experience was measured using visual analog scale at 24–48 h after the birth and 8–9 months later, again. Overall birth experience in the bath Gp was 68.74 (SD 24.31) and in the routin care was 74.62 (SD 22.08) [P = 0.05]/ routine care was considered more favorable experience than bath
 Howell et al. 2001 UK RCT at the Maternity department of the hospital/nulliparous labouring women/ n = 369/ 87% of them completed the study Participants were given continuous epidural analgesia using 0.25% Bupivacaine during the labour. It was assessed using two questions in the postpartum questionnaire. Measurement time points were 24–48 h, 3 months and 12 months after birth. Maternal satisfaction with the experience of childbirth was high in both groups without significant differences (P < 0.40)
 Kimber et al. 2008 UK Pilot RCT in a Maternity Unit/ pregnant women booked for prenatal and birth care/ n = 90/ 91% of them completed the follow up questionnaire Massage and relaxation techniques were taught to mothers and their birth companion in one session between 35 and 37 weeks by the midwife/therapist. It was measured by the validated LAS (Labour Agentry scale) questionnaire at 6 weeks following birth Music versus usual care MD = 6.1 (95% CI 11.9 to _0.3) and massage versus usual care MD = 6.1 (95% CI 11.6 to _0.6)/ regular massage with relaxation techniques was associated with more positive perception of labour and sense of control
 Cyna. 2011 Australia RCT using 3-arm group design at single center maternity unite/34–39 weeks’ pregnant women/n = 450/100% of participants completed the study Women were given self-hypnosis lessons for pain control during labour in 3 sessions (37–39 weeks) by a hypnotherapist. Placebo group (Gp2) was given relaxation audio CD It was measured by one question (birth was a positive or negative experience?) during 6 weeks after birth, as a secondary outcome. Positive birth experience [Gp1 N = 108 (72.5%), Gp2 N = 105 (75.5%),control N = 118 (81.9%)]/The birth experience was unaffected by the antenatal group hypnosis training in the third trimester
 Werner et al. 2013 Denmark RCT using 3-arm group design conducted in university hospital/pregnant women/n = 1222/ 97.7% of them were followed Women attended self-hypnosis classes (three 1-h classes during the last weeks of pregnancy) for childbirth. The validated WIJMA Delivery Experience Questionnaire was used in six weeks postpartum. Wijma score was 42.9 in the hypnosis Gp, 47.2 in the relaxation Gp and 47.5 in the usual care (P = 0.01)/the positive effect of the self-hypnosis was seen on the childbirth experience.
 Simavli et al. 2014 Turkey RCT in an obstetric department/ primiparous labouring women/n = 161/ follow up rate was 87.5% During the active phase of labour, the self-selected music was played for mother, and it was continued until the end of the third stage of labour. Visual analog scale for satisfaction with childbirth experience was used in 2, 12 and 24 h postpartum. Satisfaction rate was higher in the music therapy Gp than control Gp (P = 0.001)/using music during labour declines pain and improves birth satisfaction.
Intrapartum care with minimal intervention
 Hundley et al. 1997 UK A pragmatic RCT in a maternity hospital/women booking for childbirth/n = 2844/ 86% of them completed the study Women received the midwifery labour care in a special unit with a minimum intervention during the labour and birth. Participants were asked to grade their childbirth experience on an ordinal scale from 0 to 10 (0 = thoroughly unsatisfactory), after they discharge home. There was no difference in Satisfaction with the birth experience among women in the midwives’ unit and routine labour care (P = 1.00).
 McNiven et al. 1998 Canada RCT in a teaching hospital/nulliparous women felt they were in early labour/n = 209/follow up rate was 96% In admit of labour women received the early labour assessment; if they were not found to be in active phase, special support and practical advices (when they should be returned to the hospital) were given to them. The validated LAS (Labour agentry scale) questionnaire was used in the postpartum period. LAS score in early labour assessment = 158 versus in direct admission = 142 (P = 0.001)/ early labour assessment had a potential to improve women’s perception of their birth experience.
 Spiby et al. 2008 UK Pragmatic multi-central RCT/ women felt they were in early labour/n = 3514/ 75% of them completed the study but the main outcome (C/S rate) was measured from more than 85% of subjects If woman felt she might be in early labour, a community midwife did a home visit to assess labour progress, provide support with coping strategies and guide on when to go to the hospital. Experience of labour was measured by an invalid questionnaire which included several questions with five-point Likert scales, at 6 weeks following the birth. Significant difference in mean score of questionnaire (2.02 versus 2.16 P = 0.0001) was seen between the home early labour assess and routine hospital admit/more positive birth experiences was seen in the home arm.
 McLachan et al. 2016 Australia RCT in tertiary care hospital/ pregnant women/ n = 2314/ completion rate was 88% Women received a caseload midwifery care during the pregnancy, birth and postpartum. Invalid questionnaire included several questions with Likert-scale response categories. It was used 2 months after birth. Women in the caseload group reported more positive birth experience (adjusted OR 1.50, 95% CI 1.22–1.84)/ caseload midwifery have a positive effect on maternal birth memories.
Birth preparedness and readiness for complications
 Miamburg et al. 2010 Denmark An RCT in a university hospital/ 10–22 weeks’ pregnant women were recruited/ n = 1193 / 97% of participants completed the study Women received “ready for Child” training program in three sessions between 30 and 35 weeks of gestation. The program included details about labour onset and process, pain relief, how to overcome childbirth fear, care for newborn and transition to parenthood. It was measured by a five-point Likert scale in 6 weeks and again 1 year and 5 year after the birth. No significant differences in birth experience at 6 weeks postpartum (P = 0.79), but Five years after birth 188 women (20.8%) selected a “bad or very bad birth experience” option while 601 mothers (67.0%) had a “good or very good birth experience”/ Antenatal training declines unnecessary interventions in labour and improves long-term memories of maternal experience.
 Kou et al. 2010 Taiwan A cluster RCT in 7 hospitals/childbearing women/n = 330/ 90% of them were followed. Each labouring woman had an individual “birth plan” which was designed by her obstetrician in prenatal visits. Mother was informed about the details of this plan and the labour care was according to the plan. The validated childbirth experience questionnaire was used one day after the birth. There was significant difference between the experimental Gp and the control Gp about childbirth experiences (P = 0.01)/Birth plan increased maternal positive birth experiences, and their control over the birth.