It is advisable to induce the delivery as soon as feasible after the diagnosis of death in utero. A calm environment for the woman to spend as much time as she wants with her stillborn child is beneficial, and tokens of remembrance should be collected.

Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.

The aims were to document conscious reasons for anxiety about childbirth. Pregnant women (n = 100), consecutively referred from antenatal centers to a psychosomatic outpatient clinic because of extreme fear of childbirth, were interviewed. Three subgroups are described: primiparae (n = 36), women with a normal previous delivery (n = 18) and women with a previous complicated delivery (n = 46). Anxiety over the deliver was related to lack of trust in the obstetrical staff (73%), fear of own incompetence (65%), fear of death of mother, infant or both (55%), intolerable pain (44%) or loss of control (43%). In the description of the anxiety, more than one focus could be described. A previous complicated delivery predisposed for fear of death (p < 0.001). In other aspects, the subgroups were similar. Fear of death in a previous labor was associated with this fear regarding the impending delivery (100%, 21%, p < 0.001) and with fear of loss of control (61%, 18% p < 0.01). Many women (37%) had partners who admitted anxiety over the delivery. Anxiety over childbirth is related to fundamental human feelings: lack of trust, fear of female incompetence and fear of death. Fear of pain is important but not predominant. The results are discussed with regard to stress, theoretical and psychodynamic points of view.

Sickness absenteeism caused by musculoskeletal disorders (MSDs) is a persistent and costly occupational health challenge. In a prospective controlled trial, we compared the effects on sickness absenteeism of a more proactive role for insurance case managers as well as workplace ergonomic interventions with that of traditional case management. Patients with physician-diagnosed MSDs were randomized either to the intervention group or the reference group offered the traditional case management routines. Participants filled out a comprehensive questionnaire at the initiation of the study and after 6 months. In addition, administrative data were collected at 0.6, and 12 months after the initiation of the project. For the entire 12-month period, the total mean number of sick days for the intervention group was 144.9 (SEM 11.8) days/person as compared to 197.9 (14.0) days in the reference group (P < 0.01). Compared with the reference group, employees in the intervention group significantly more often received a complete rehabilitation investigation (84% versus 27%). The time for doing this was reduced by half (59.4 (5.2) days versus 126.8 (19.2), P < .01). The odds ratio for returning to work in the intervention group was 2.5 (95% confidence interval 1.2-5.1) as compared with the reference group. The direct cost savings were USD 1195 per case, yielding a direct benefit-to-cost ratio of 6.8. It is suggested that the management of MSDs should to a greater degree focus on early return to work and building on functional capacity and employee ability. Allowing the case managers a more active role as well as involving an ergonomist in workplace adaptation meetings might also be beneficial.

We suggest that the "qualities" identified by the study findings should be implemented in clinical care, and could facilitate active guidance and counseling for bereaved parents who have experienced a stillbirth.