Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial

Abstract

Objective To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.Design Randomised controlled trial.Setting Maternity unit of Helsinki University Central Hospital.Population Fear of childbirth was screened during early pregnancy by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A). Of 4575 screened nulliparous women, 371 (8.1%) scored ‡100, showing severe fear of childbirth.Methods Women with W-DEQ-A ‡100 were randomised to intervention (n = 131) (psychoeducative group therapy, six sessions during pregnancy and one after childbirth) or control (n = 240) (care by community nurses and referral if necessary) groups. Obstetric data were collected from patient records and delivery satisfaction was examined by questionnaire.Main outcome measures Delivery mode and satisfaction.Results Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).Conclusions To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.

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.…”

Clinical aspects of childbirth-related anxiety

“…There have been promising results of interventions to address severe FOC (Rouhe et al 2013;2015a;2015b). According to our study, in Sweden the additional societal cost of severe FOC managed in the conventional obstetrical care is around 13.43 million Euros.…”

“…When FOC is operationalized psychometrically and measured with the W-DEQ A, the prevalence of severe FOC (W-DEQ A sum score ≥85) varies between 4.8 and 11% in mixed samples in Western countries (Zar 2001;Kjaergaard, Wijma, Dykes & Alehagen 2008;Lucasse, Schei & Ryding 2014;Toohill et al 2014b), while the observed prevalence of phobic FOC (W-DEQ A sum score ≥100) varies between 2.4 and 8.1% (Zar, Wijma & Wijma 2001;Rouhe, Salmela-Aro, Toivanen, Tokola, Halmesmäki & Saisto 2013). …”

“…In a randomized controlled trial, a Finnish research group has studied several aspects of a psycho-education involving relaxation in a group (the LINNEA project) (Rouhe et al 2013;2015a;2015b) with pregnant women suffering from phobic FOC (W-DEQ A sum score ≥100). Half of the participants were offered treatment in a group and half followed their ordinary antenatal care program including the possibility of psychosocial support.…”

“…The protocol comprised six group sessions during pregnancy, and two postpartum follow up meetings, one with a psychologist, and another with a midwife. In three reports from the RCT, Rouhe et al (2013;2015a;2015b) showed that women in the treatment group had more spontaneous vaginal deliveries, a lower prevalence of CSs, and lower levels of FOC postpartum as measured with the W-DEQ B than women in the control group. The women in the psychoeducation group also had fewer depressive symptoms postpartum and a better maternal adjustment than the women in the control group.…”