Effects of a midwife psycho-education intervention to reduce childbirth fear on women’s birth outcomes and postpartum psychological wellbeing

Abstract

BackgroundHigh levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention.MethodBetween May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here.Results1410 women were screened for high childbirth fear (W-DEQ ≥66). Three hundred and thirty-nine (n = 339) women were randomised (intervention n = 170; controls n = 169). One hundred and eighty-four women (54 %) returned data for final analysis at 6 weeks postpartum (intervention n = 91; controls n = 93).Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the ‘decision aid’ helped reduce their fear (53 % vs 37 %, p = 0.02).ConclusionFollowing a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies.Trial registrationAustralian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes

“…Nevertheless, no significant difference was noted between the groups with regard to the mode of delivery, use of epidural analgesia and neonatal outcomes. These results are similar to previous studies [16,18,23] that found no differences between groups for use of pharmacological analgesia, induction of labor or neonatal outcomes.…”

“…Previous studies have demonstrated that prenatal psycho-educational interventions provided by trained midwives or other obstetrical staff, are effective in reducing high childbirth fear levels. Moreover, improving antenatal emotional well-being has beneficial effects on perinatal outcomes such as a reduction in overall CS rates and may also have wider positive, social and maternity care implications for optimal childbirth experiences [17,18]. In contrast to the favorable impact of prenatal interventions aimed at alleviating anxiety and fear of childbirth, in our study, the multivariate analysis revealed that anxiety levels were not independently associated with attending the childbirth preparedness course.…”

“…Following birth preparation courses and interventions, favorable effects such as reduction in dystocic deliveries, decreased duration of vaginal labor and CSs were noted. Moreover, reducing high childbirth fear levels and increasing childbirth confidence in pregnant women promotes antenatal emotional well-being and may have wider positive social and maternity care implications for optimal childbirth experiences [15][16][17][18]. Others have shown no reduction in the request for cesarean delivery or use of overall pain relief medication [19,20].…”

Association between fear of childbirth and maternal acceptance of pregnancy

“…National and international studies have proven that antenatal education reduces FOC (Fenwick et al. ; Karabulut et al. ; Kızılırmak & Başer ).…”

“…Identification and evaluation of FOC by midwives and nurses are important to determining the factors that cause FOC and to developing appropriate interventions (C ßic ßek & Mete 2015). National and international studies have proven that antenatal education reduces FOC (Fenwick et al 2015;Karabulut et al 2016;Kızılırmak & Bas ßer 2016).…”