Labour Pain Relief Options: Video Versus Pamphlet for Easing Fear of Birth and Improving Preparedness in Pregnant Patients, an RCT

Study Design

The study will employ a randomized controlled trial design. Participants will be randomly assigned to one of two parallel arms: (1) a written pamphlet or (2) an intervention (7-minute educational video).

On the study day, all participants will complete a baseline questionnaire assessing their knowledge of labour pain relief options and their current fear of childbirth. Following informed consent, participants in the control group will be provided an electronic version of the pamphlet; those in the intervention group will watch the video. Immediately after the intervention, all participants will complete the same questionnaires to assess changes in fear and knowledge.

Participant Selection

Participants will be recruited during their routine prenatal appointments at antenatal clinics affiliated with this hospital. Every eligible patient will be invited to participate.

Inclusion criteria

1. Adults aged 19 years and over 2. Primiparous patients over 32 weeks of gestation planning to labour

Exclusion Criteria

1. Emergency delivery / already in labour 2. Patients who are not intending to labour (i.e. primary elective cesarean sections) 3. Unable to give consent 4. Unable to communicate in English.

Recruitment

Recruitment will occur at prenatal interactions using multiple methods:

* Self-referral via posters and flyers * In-person recruitment * Clinic staff assistance

Randomization Participants will be randomized in a 1:1 ratio to either the intervention group (educational video) or the control group (written pamphlet). Allocation concealment will be preserved by randomizing the allocation table within REDCap, which will remain hidden from study personnel during the randomization process. Group assignment will be revealed only after participants have completed the baseline assessment and have been enrolled in the study.

Follow-up Questionnaires Follow-up will be conducted two weeks after their estimated due date (EDD). If the follow-up questionnaire is incomplete, one email follow-up reminder will be sent 2-weeks later (at 4-weeks post EDD).

Sample Size Calculation The primary outcome of this study is the change in fear of birth, measured using a validated 2-item Visual Analog Scale (VAS), with each item scored from 0 to 100 and averaged. To detect a 10-point difference with 90% power and a two-sided alpha of 0.05, we estimate that a total of 88 participants (44 per group) are needed. To account for an anticipated attrition rate, we plan to recruit a total of 100 participants (50 per group). This sample size will ensure the study is adequately powered to assess the effectiveness of the educational video in reducing fear of birth compared to standard pamphlet-based education.

Analysis Plan All data will be analyzed using Stata 13.1. P\<0.05 will be considered significant. Normally distributed continuous and count variables will be compared using paired t-tests. Ordinal/categorical variables will be analyzed with t-tests, and binary categorial variables (yes/no) will be analyzed using Fisher's exact or Chi-Square tests.

• Change in fear and worry scores [Time frame: From enrollment to end of post-intervention questionnaire (same day)]
• Changes in knowledge about pain relief options [Time frame: From enrollment to end of post-intervention questionnaire (same day)]
• Birth satisfaction [Time frame: From enrollment to end of follow-up (2 weeks post estimated delivery date)]
• Type of analgesia used during labour [Time frame: From enrollment to end of follow-up (2 weeks post estimated delivery date)]