Non-Pharmacological Strategies for Managing Peri-operative Anxiety Among Women Undergoing Cesarean Delivery: A Systematic Review

Background: Maternal anxiety during cesarean delivery is a common perioperative concern associated with adverse psychological and physiological outcomes, including increased stress responses, heightened pain perception, delayed recovery, and reduced maternal satisfaction. Non-pharmacological interventions have emerged as safer alternatives to pharmacologic anxiolytics for managing anxiety during cesarean section.
Objective: To evaluate the effectiveness of non-pharmacological interventions in reducing perioperative maternal anxiety among women undergoing cesarean delivery.
Methods: A systematic review was conducted following PRISMA 2020 guidelines. Electronic searches were performed in PubMed/MEDLINE, Cochrane Library, ProQuest, ScienceDirect, and Google Scholar for studies published between 2016 and 2026. Randomized controlled trials, quasi-experimental studies, evaluating non-pharmacological anxiety-reduction strategies during cesarean delivery were included. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools, and findings were synthesized narratively.
Results: Of 1,184 records identified, 23 studies met the inclusion criteria. Interventions included aromatherapy (n = 6), music therapy (n = 4), virtual reality (n = 4), massage/reflexology/relaxation interventions (n = 4), and educational or psychological support interventions (n = 5). Most studies reported significant reductions in maternal anxiety and improvements in perioperative emotional well-being. Aromatherapy, music therapy, and virtual reality demonstrated the most consistent anxiolytic effects.
Conclusion: Current evidence supports the effectiveness of non-pharmacological interventions in reducing perioperative maternal anxiety during cesarean delivery. These approaches offer feasible, patient-centered strategies that may enhance maternal psychological outcomes while avoiding pharmacologic risks. Further high-quality studies are needed to support standardization and wider clinical implementation.