A randomized controlled trial of intervention in fear of childbirth

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Abstract

OBJECTIVE: To compare intensive and conventional therapy for severe fear of childbirth.

METHODS: In Finland, 176 women who had fear of childbirth were randomly assigned at the 26th gestational week to have either intensive therapy (mean 3.8 ± 1.0 sessions with obstetrician and one with midwife) or conventional therapy (mean 2.0 ± 0.6 sessions), with follow-up 3 months postpartum. Pregnancy-related anxiety and concerns, satisfaction with childbirth, and puerperal depression were assessed with specific questionnaires. Power analysis, based on previous studies, showed that 74 women per group were necessary to show a 50% reduction in cesarean rates.

RESULTS: Birth-related concerns decreased in the intensive therapy group but increased in the conventional therapy group (linear interaction between the group and birth-concerns P = .022). Labor was shorter in the intensive therapy group (mean ± standard deviation 6.8 ± 3.8 hours) compared with the conventional group (8.5 ± 4.8 hours, P = .039). After intervention, 62% of those originally requesting a cesarean (n = 117) chose to deliver vaginally, equally in both groups. Cesarean was more frequent for those who refused to fill in the questionnaires than for those who completed them (57% compared with 27%, P = .001). In the log-linear model, parous women who had conventional therapy and refused to fill in the questionnaires chose a cesarean more often than expected (standardized residual 2.54, P = .011). There were no differences between groups in satisfaction with childbirth or in puerperal depression.

CONCLUSION: Both kinds of therapy reduced unnecessary cesareans, more so in nulliparous and well-motivated women. With intensive therapy, pregnancy- and birth-related anxiety and concerns were reduced, and labors were shorter.

Section snippets

Materials and methods

Between August 1996 and July 1999, a total of 176 obstetrically low-risk and physically healthy pregnant women were referred to the outpatient clinic of the Department of Obstetrics and Gynecology in Helsinki University Central Hospital because of fear of vaginal delivery, as diagnosed by a specific questionnaire10, 11 (Table 1). The cut-off point for diagnosis of fear of childbirth was five or more affirmative answers or request for cesarean. The only exclusion criterion was a

Results

In total, 112 women (64%) completed all three questionnaires (participants); percentages were distributed similarly in both groups (Table 2). All the women were of Finnish background, spoke Finnish, were middle or upper social class, and from the urban capital area of Helsinki. In logistic regression analysis, those who did not complete the questionnaires (nonparticipants) were characterized by older age (adjusted OR 0.93 [95% CI 0.87, 1.00], P = .045), fewer appointments (adjusted OR 2.03 [95%

Discussion

The question as to the right to choose a cesarean without a medical indication is of the utmost relevance: on the one hand, because of universally growing cesarean rates, and on the other, because of the fundamental medical principle of not to harm but to benefit the patient.18, 19 The main goal of this study was to evaluate the possibility of reducing requests for cesareans by helping women choose vaginal delivery without fear. We found this possible by personal cognitive therapy.

Conversely,

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  • Cited by (0)

    This study was supported by the Signe and Ane Gyllenberg Foundation, the Emil Aaltonen Foundation, Helsinki University Central Hospital, and the Academy of Finland.

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