Background: Fears and anxieties during pregnancy and childbirth are a frequent phenomenon and can have negative consequences on wellbeing, psychological health and birth outcomes. Therefore, it is important to focus on the interventions to reduce those fears and anxieties during pregnancy and childbirth. A systematic review was conducted to examine the current literature on psychological interventions to reduce anxieties and fears during pregnancy and childbirth. Scopus and PubMed were searched from 2015 up until December 2020 for relevant studies. Included were pregnant women, with no restriction on age ranges or parity. Entered in the review were quantitative studies, including randomized controlled trials (RCTs), non-randomized controlled trials as well as treatment evaluations. After reviewing titles, abstracts and studies, 72 studies were included in this review as they met the inclusion criteria. Standard methodological procedures for systematic reviews were used. The quality assessment of included articles was done by using the Quality Assessment Tool for Quantitative Studies (EPHPP).
Results: The main results of this review concern the fear and anxiety reducing effects of psychoeducation, relaxation techniques, guided imagery, supportive care through a midwife, group discussion, “lifestyle based education”, writing therapy, cognitive behavioral therapy groups and stress intervention, individual structured psychotherapy, communication skills training, counseling approaches (except distraction techniques), a motivational interviewing psychotherapy, emotional freedom techniques, breathing awareness and different hypnotherapeutic techniques on different fears and anxieties during pregnancy and childbirth. For mindfulness-based interventions mixed results are found. The effect of an acceptance and commitment therapy, biofeedback interventions, a mind body intervention, mental health training courses, the group intervention Nyytti® as well as cognitive analytic therapy is unclear, due to weak ratings. Antenatal class attendance reduced delivery fear significantly only in first time mothers. An internet-based problem-solving treatment did not reduce anxiety during pregnancy.
Conclusion: A broad range of interventions show positive effects on fear of childbirth and fear and anxiety in pregnancy. Further research should address other acknowledged psychotherapeutic practices, like psycho-dynamic as well as systemic interventions, as they are underrepresented within this review. Furthermore , there is a need for manualized therapeutic interventions, with regards to a combination of effective intervention components.