The effectiveness of decision-making support methods during pregnancy regarding epidural analgesia in labor: A scoping review.

Abstract

Introduction: This scoping review aimed to identify effective methods used for decision-making support and their effects on women considering choosing epidural analgesia in labor.

Methods: A literature search was conducted using CHNAHL, the Web version of the Central Medical Journal, and PubMed, and articles were extracted based on the eligibility criteria in September 2024. The PRISMA-ScR was followed. Studies that compared two groups of women considering epidural anesthesia for labor (subject), decision-making support (intervention), and standard care (control) were eligible.

Results: The search identified a total of 732 articles, of which 15 were eligible. Among these, 10 were randomized controlled trials (RCTs), 1 was a non-RCT, and 4 were cohort studies. The most common decision support approach was the distribution of leaflets, which were often given in the second to third trimester of pregnancy. Outcome measurements varied, limiting the identification of the most effective approach. However, most interventions, including controls, showed some effect on improving satisfaction and knowledge. Specifically, interventions incorporating shared decision-making (SDM) influenced satisfaction with the intervention, satisfaction with the birth experience, the feeling of being supported by others, and controlling emotions and attitudes.

Conclusions: This study found that decision support methods include both expert intervention and media-based approaches. However, given the scarcity of related studies and the variability in evaluation measures, the most effective method could not be identified. Nevertheless, an SDM approach may enhance effectiveness. These findings may help those who support pregnancy and childbirth in choosing more effective decision support methods.