We included seven trials with a total of 1357 participants. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. The primary outcome was a reduction in FOC. We used GRADE to assess the certainty of the evidence. A third review author checked the data analysis for accuracy. Two review authors independently extracted data and assessed the studies for risk of bias. We used standard methodological approaches as recommended by Cochrane. We excluded quasi‐randomised and cross‐over trials. Two review authors independently screened and selected titles and abstracts for inclusion. We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. We contacted researchers of trials which were registered and appeared to be ongoing.

In July 2020, we searched Cochrane Pregnancy and Childbirth’s Trials Register,, the World Health Organization (WHO) International Clinical Trials Registry Platform ( ICTRP), and reference lists of retrieved studies. To investigate the effectiveness of non‐pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia.

At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well‐being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. Many women experience fear of childbirth (FOC).

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