A Randomized Controlled Trial of a Psycho‐Education Intervention by Midwives in Reducing Childbirth Fear in Pregnant Women
Open accessAbstract
Background: Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho‐education intervention by midwives in reducing women's childbirth fear. Methods: Women ( n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention ( n = 170) or control ( n = 169) groups. All women received a decision‐aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear ( WDEQ ‐A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self‐efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. Results: There were significant differences between groups on postintervention scores for fear of birth ( p < 0.001) and childbirth self‐efficacy ( p = 0.002). Decisional conflict and depressive symptoms reduced but were not significant. Conclusion: Psycho‐education by trained midwives was effective in reducing high childbirth fear levels and increasing childbirth confidence in pregnant women. Improving antenatal emotional well‐being may have wider positive social and maternity care implications for optimal childbirth experiences.
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After adjustment for preintervention levels of fear of birth, the reduction in fear of birth was slightly higher for women in the intervention group in the Australian trial.
“After adjustment for the preintervention levels of FOB, the reduction in FOB was slightly higher for women in the intervention group.”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [27]
The Results section, “Effect of the Intervention on Childbirth Fear” (page not available), reports that after adjustment for preintervention scores, women in the intervention group had less fear at 36 weeks than controls. It describes the difference as significant with a medium effect, so “slightly higher” understates the reported magnitude. (LLM, conf=0.83)
Experimental — accuracy not yet measuredAn Australian trial comparing midwife telephone counseling on two occasions to standard antenatal care showed reduced levels of fear of birth at postintervention (gestational week 36) in both groups.
“An Australian trial compared midwife telephone counseling on two occasions to standard antenatal care, showing reduced levels of FOB at postintervention (gestational week 36) in both groups [27].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [27]
Similar decreases in FOB over time have been shown before, both among women with mixed levels of fear in early pregnancy and among women receiving support for FOB.
“Similar decreases in FOB over time have been shown before, both among women with mixed levels of fear in early pregnancy [11] and among women receiving support for FOB [27].”
From Comparing internet-based cognitive behavioral therapy with standard care for women with fear of birth: Randomized controlled trial (2018) · cites this paper as [27]
Psychoeducation is a nonclinical intervention associated with less FOC.
“Psychoeducation is a nonclinical intervention associated with less FOC, 25”
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Percentages, sums and reported differences re-computed from the paper’s own numbers.
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- Authors
- Toohill, J., Fenwick, J., Gamble, J., Creedy, D. K., Buist, A., Turkstra, E., & Ryding, E.
- Affiliations
- Griffith University (AU)
- The University of Melbourne (AU)
- Karolinska Institutet (SE)
- Corresponding author
- Toohill, Jocelyn
- Venue
- Birth
- Publisher
- Wiley
- Published
- 2014-10-09
- Volume
- 41
- Issue
- 4
- Pages
- 384-394
- ISSN
- 0730-7659 (ISSN-L)
- 1523-536X
- PMC
- PMC4257571
- OpenAlex
- W1978374197
- Cited by
- 229
- References
- 54
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 23 · 2023: 25 · 2022: 29 · 2021: 24 · 2020: 30 · 2019: 17 · 2018: 21 · 2017: 18 · 2016: 12 · 2015: 7 · 2014: 1
- FWCI
- 13.45
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Birth (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Griffith Research Online (submittedVersion)
- Funders
- National Health and Medical Research Council (APP1025099)
- 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 › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- fear of childbirth, psychoeducation, midwives, antenatal interventions, childbirth self-efficacy, decisional conflict, depressive symptoms, telephone counseling, obstetric surgery
- MeSH terms
- Adolescent, Adult, Anxiety, Counseling, Decision Support Techniques, Depression, Fear, Female, Humans, Middle Aged, Midwifery, Pregnancy, Treatment Outcome, Self Efficacy, Parturition, Young Adult, Prenatal Education
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