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.
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The effects of psychoeducational group sessions on psychological variables were small.
“When comparing psychoeducational group sessions with standard care (SC) for women with severe FOB, fewer cesarean births, more positive birth experiences, and less depressive symptoms postpartum were found in the intervention group, however, with small effect sizes for the psychological variables [24-26].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [24]
Psychoeducational group sessions compared with standard care for women with severe fear of birth resulted in fewer cesarean births.
“When comparing psychoeducational group sessions with standard care (SC) for women with severe FOB, fewer cesarean births, more positive birth experiences, and less depressive symptoms postpartum were found in the intervention group, however, with small effect sizes for the psychological variables [24-26].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [24]
Psychoeducational group sessions compared with standard care for women with severe fear of birth resulted in less depressive symptoms postpartum.
“When comparing psychoeducational group sessions with standard care (SC) for women with severe FOB, fewer cesarean births, more positive birth experiences, and less depressive symptoms postpartum were found in the intervention group, however, with small effect sizes for the psychological variables [24-26].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [24]
Psychoeducational group sessions compared with standard care for women with severe fear of birth resulted in more positive birth experiences.
“When comparing psychoeducational group sessions with standard care (SC) for women with severe FOB, fewer cesarean births, more positive birth experiences, and less depressive symptoms postpartum were found in the intervention group, however, with small effect sizes for the psychological variables [24-26].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [24]
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“…psychoeducational group sessions with standard care (SC) for women with severe FOB, fewer cesarean births, more positive birth experiences, and less depressive symptoms postpartum were found in the intervention group, however, with small effect sizes for the psychological variables [24-26].”
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- Authors
- Rouhe, H., Salmela‐Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E., & Saisto, T.
- Affiliations
- Helsinki University Hospital (FI)
- University of Helsinki (FI)
- Corresponding author
- Rouhe, H
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2012-11-02
- Volume
- 120
- Issue
- 1
- Pages
- 75-84
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2112815144
- Cited by
- 190
- References
- 45
- Citations by year
- 2026: 3 · 2025: 11 · 2024: 10 · 2023: 12 · 2022: 13 · 2021: 16 · 2020: 19 · 2019: 15 · 2018: 21 · 2017: 15 · 2016: 16 · 2015: 12 · 2014: 18 · 2013: 7
- FWCI
- 14.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Helsingin ja Uudenmaan Sairaanhoitopiiri
- Signe ja Ane Gyllenbergin Säätiö
- Emil Aaltosen Säätiö
- Fondation des Fondateurs
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
- Keywords
- fear of childbirth, nulliparous women, psychoeducation, group therapy, cesarean section, vaginal delivery, Wijma Delivery Expectancy Questionnaire, pregnancy surveillance
- MeSH terms
- Adult, Fear, Female, Finland, Humans, Parity, Patient Education as Topic, Pregnancy, Pregnancy Outcome, Psychotherapy, Patient Satisfaction, Parturition, Delivery, Obstetric
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