Effects of Psychoprophylactic Antenatal Education Combined With Pethidine Analgesia on Labour Pain Perception and Childbirth Experience: A Randomised Controlled Trial

Abstract

ABSTRACT Background Labour pain is among the most intense forms of human pain. Although pharmacologic methods such as opioids are widely used, maternal satisfaction with childbirth is shaped by more than pain relief alone. Psychoprophylactic antenatal education, which emphasises preparation, coping, and non‐pharmacological strategies, may influence women's overall childbirth experience. However, its combined effect with standard analgesia in African settings remains underexplored. This trial evaluated the impact of a structured Psychoprophylactic Antenatal Education Module alongside pethidine analgesia on labour pain perception and childbirth experience. Methods A parallel‐group randomised controlled trial was conducted at Lagos State University Teaching Hospital, Nigeria. One hundred and eighty eligible pregnant women (aged ≥ 18 years, singleton, cephalic presentation, 35–38 weeks gestation) were allocated to either an intervention group (PAEM + pethidine, n = 90) or a control group (routine antenatal education + pethidine, n = 90). The PAEM consisted of two sessions on childbirth preparation, relaxation, breathing, coping strategies, and a labour ward tour. The primary outcome was labour pain perception measured by a Visual Analogue Scale (VAS) and an 8‐point Likert scale. Secondary outcomes included duration of active labour, mode of delivery, and maternal childbirth experience (rated on a 6‐point Likert scale where 0=extremely fantastic and 5=not at all fantastic). Analysis was by intention‐to‐treat with pre‐specified subgroup analyses by age and delivery mode. This trial was prospectively registered with the Pan African Clinical Trial Registry with Trial number PACTR202411534456230. Results One hundred and sixty‐four women (83 intervention, 81 control) were analysed. There was no significant difference in median pain scores between groups (VAS: median 8 [IQR 3–9] vs. 6 [IQR 2–8], p = 0.316; Likert: median 5 [IQR 2–6] vs. 4 [IQR 1–6], p = 0.325). For childbirth experience (where lower scores indicate better experience), the control group reported significantly more favourable outcomes overall (median 1 [IQR 0–2] vs. 1 [IQR 1–2], p = 0.011). Notably, this significant difference disappeared when caesarean section cases were excluded ( p = 0.145). The effect of the intervention on pain differed significantly between women who delivered vaginally versus by caesarean section ( p = 0.041). Among women who underwent caesarean section, the intervention group reported significantly less favourable childbirth experiences ( p = 0.007). Subgroup analysis revealed that women aged 31–35 years in the intervention group had significantly worse childbirth experience ( p = 0.0007), while women aged > 35 years showed improved pain scores ( p = 0.049). Obstetric and neonatal outcomes were similar between groups. Conclusion Psychoprophylactic antenatal education did not reduce labour pain intensity in our target population of women delivering vaginally and showed no significant effects on obstetric outcomes. The differential effects observed by delivery mode suggest that the intervention may have raised expectations for natural birth that, when unmet due to caesarean section, resulted in psychological distress and less favourable appraisal of the childbirth experience.