Because this study does not involve human participants or patient-level data, institutional ethics approval is not required. This protocol was developed in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) reporting guidelines, and the completed scoping review will be conducted and reported following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) framework to ensure methodological transparency and rigor [14,15]. The protocol has been registered with the Open Science Framework. Any important protocol amendments will be documented with the date of modification and description of the change in the final review manuscript.

Our review questions are as follows:

The population, concept, and context (PCC) framework (Figure 1) was used to establish eligibility criteria for this scoping review. The population of interest is pregnant women eligible for neuraxial analgesia during labor. The concept focuses on educational interventions delivered by health care professionals during prenatal care to improve knowledge, awareness, or acceptance of neuraxial analgesic techniques, including epidural, spinal, and combined spinal-epidural analgesia. The context is perinatal care settings in the United States. Eligible studies include peer-reviewed original research published in English using observational or experimental designs and reporting outcomes related to knowledge, awareness, or acceptance of neuraxial analgesia. Excluded studies include reviews, editorials, commentaries, letters, conference abstracts without full manuscripts, non–peer-reviewed publications, articles without available full text, studies unrelated to obstetric populations, and animal studies.

The review will use PubMed, Scopus, and Embase as the primary data sources to provide broad coverage of biomedical, interdisciplinary, and public health literature relevant to obstetric analgesia and patient education. The search strategy was developed using the PCC framework to align database searches with the review objectives. Both controlled vocabulary terms (eg, MeSH [Medical Subject Headings] and Emtree terms) and free-text keywords were used to maximize search sensitivity. Search terms included concepts related to pregnant women, neuraxial analgesia, epidural analgesia, spinal analgesia, combined spinal-epidural analgesia, educational interventions, prenatal education, counseling, and labor analgesia. Boolean operators and subject headings were adapted for each database. Elements of the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses literature search extension) guidance were considered to improve the transparency and reproducibility of the literature search methodology [16]. Table 1 summarizes the PCC-guided search concepts, representative search terms, and database-specific search strategies used in this review. All retrieved records will be imported into Rayyan (Rayyan Systems, Inc) for deduplication and screening. After deduplication, titles, abstracts, and full texts will be independently reviewed by 2 researchers according to the inclusion and exclusion criteria. Disagreements will be resolved through discussion or consultation with a third reviewer. The reference lists of included studies may also be reviewed to identify additional relevant articles.

Information extracted from each study will include the author or authors, year of publication, study location and setting, study design, participant characteristics such as age and parity, eligibility for neuraxial analgesia, type and method of education delivery, timing of the intervention, educational content, and materials used. Outcomes such as knowledge, awareness, acceptance, patient satisfaction, and uptake of neuraxial analgesia will also be recorded, along with the key findings and reported limitations.

Because this is a scoping review, a formal risk-of-bias assessment will not be conducted.

The data extracted from the selected studies will be summarized in tables and charts that reflect the review objectives and eligibility criteria. Expected findings will include details such as study design; year of publication; geographic setting; study population characteristics; type of educational intervention; delivery method; and outcomes related to knowledge, awareness, or acceptance of neuraxial analgesia. Educational interventions will be categorized according to intervention modality (eg, written, verbal, digital, or multimedia approaches), timing of delivery (prenatal vs intrapartum), delivery setting, and personnel involved in delivering the intervention. Outcomes will be mapped descriptively across domains, including knowledge, awareness, acceptance, satisfaction, and uptake of neuraxial analgesia. In addition to descriptive tabulation, a narrative synthesis approach will be used to identify recurring themes, implementation patterns, variations in intervention design, and gaps in the literature across studies.

Findings will be disseminated through submission to a peer-reviewed journal and presentation at relevant academic and professional conferences.

This scoping review will map the existing literature and characterize the range, design, and delivery of educational interventions and how outcomes such as knowledge, awareness, and uptake are reported across studies. Existing literature suggests that multimodal, culturally sensitive, and linguistically appropriate approaches may play a role in supporting patient understanding and informed decision-making [1,2,4,9,11].

In relation to intervention format, this review will examine how different educational modalities, including visual, written, and verbal components, are used and described in the literature. Prior research in maternal health literacy suggests that layered, culturally relevant formats may improve comprehension and decision-making confidence, particularly for patients with limited English-language proficiency or lower baseline health literacy [9,11,17]. The role of trusted messengers such as bilingual nurses or community health workers in health literacy will be explored in relation to addressing persistent misconceptions about neuraxial analgesia [7,9].

With respect to timing, this review will assess how educational interventions are delivered across the prenatal and intrapartum periods. Existing studies suggest that prenatal education may be associated with improved knowledge retention and reduced anxiety compared to intrapartum counseling alone [10]. Additionally, prior findings indicate that patients who receive limited or rushed counseling during labor may report lower satisfaction and less clarity in decision-making [18]. These observations highlight areas that this review will further contextualize.

This review will also examine how structural and systemic factors intersect with educational interventions. Existing literature highlights persistent barriers, including language discordance, provider bias, and limited access to interpreter services, that may influence use patterns regardless of educational exposure [6,8,9,19]. This review will explore how studies address these factors and whether interventions are implemented alongside broader institutional support.

In addition to traditional approaches, this review will map the use of digital technologies as emerging modalities for patient education. Mobile apps, SMS text messaging–based platforms, and video modules have been described as potential tools to expand access, particularly in rural or resource-limited settings [20]. The literature also suggests that their effectiveness may depend on accessibility considerations, including digital literacy, language options, and integration with in-person care [9,11].

Finally, this review will identify gaps in the current literature. Prior studies have frequently focused on short-term outcomes such as immediate knowledge or uptake, with limited evaluation of longer-term outcomes, including patient satisfaction, perceived autonomy, or postpartum well-being [2]. Additionally, certain populations—including Black, Indigenous, Asian American, and rural communities—remain underrepresented in many studies despite ongoing disparities in maternal health outcomes [6,8,9,19]. By mapping these gaps, this review may help inform future research and support the development of more consistent and contextually appropriate educational approaches.

This scoping review will have several limitations. First, heterogeneity among the included studies is anticipated due to differences in research design, intervention type, participant populations, and outcome measures. Such variability may limit the ability to make direct comparisons across interventions and prevent generalizable conclusions. Second, although steps will be taken to ensure rigor, there is an inherent risk of reviewer bias. To mitigate this, we will maintain transparency in our methodology, engage subject matter experts throughout the review process, apply standardized quality assessment tools, and perform sensitivity analyses where feasible to account for the influence of lower-quality studies. Third, despite implementing a comprehensive search strategy across multiple databases, it remains possible that some relevant studies may be missed, particularly unpublished or nonindexed literature. This could result in publication bias favoring studies with positive findings. Finally, many outcomes of interest such as trust, perceived respect, satisfaction, and feelings of autonomy are subjective in nature and may not be consistently measured across studies. As a result, our synthesis will rely on both quantitative and qualitative evidence to present the most complete picture possible while recognizing these interpretive constraints.

An additional limitation is that some educational practices may not be captured in the published literature. In many clinical settings, patient education occurs through routine clinical interactions such as anesthesia consultations in the labor and delivery unit, which may be effective but are not consistently evaluated using standardized or measurable tools. Because this review relies on published studies, it may underrepresent these informal or institution-specific educational approaches, which could contribute to gaps between reported interventions and real-world practice.

This scoping review will provide a structured overview of existing educational interventions designed to improve understanding and uptake of neuraxial labor analgesia in the United States. By systematically mapping key characteristics of these interventions, including modality, timing, delivery setting, and target populations, this review will describe the range and nature of approaches currently represented in the literature. It will also identify patterns in how outcomes such as knowledge, awareness, acceptance, satisfaction, and uptake are defined and measured across studies.

The findings may help inform future research aimed at optimizing patient education strategies and improving accessibility of information for diverse populations. In addition, this review will highlight gaps in the existing literature to identify where further investigation is needed, including the representation of underserved populations, variability in educational approaches, and inconsistencies in outcome reporting.

Overall, this work aims to support the development of more consistent and contextually appropriate educational interventions while providing a foundation for future research and evidence synthesis in this area.