Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial
Article first published online: 2 NOV 2012
© 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 1, pages 75–84, January 2013
How to Cite
Rouhe, H., Salmela-Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E. and Saisto, T. (2013), Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial. BJOG: An International Journal of Obstetrics & Gynaecology, 120: 75–84. doi: 10.1111/1471-0528.12011
- Issue published online: 12 DEC 2012
- Article first published online: 2 NOV 2012
- Accepted 23 August 2012. Published Online 23 October 2012.
- Delivery mode;
- delivery satisfaction;
- fear of childbirth
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.