Obstetric outcome in 100 women with severe anxiety over childbirth

Abstract

Background. Extreme fear of delivery with request of cesarean section is a problem. The obstetric outcome in women given psychological and obstetric support is described. Methods. Women, consecutively referred to the Psychosomatic outpatient clinic because of fear of delivery (n= 100), were compared to a matched reference group (n=100). Results. The women in the study group had higher frequency of psychic problems than the references. The majority, 68 of the women (68%) initially requested cesarean section (CS). After individualized psychological and obstetrical support, 38 of these women agreed to vaginal delivery (38%) and 30 had an elective CS (30%). In the end another 13 (13%) women had a CS for obstetric or mixed reasons. Complication rate was low and similar in the groups. The 57 women who eventually had a vaginal delivery (57%) showed an obstetric outcome similar to the reference group. They had a higher frequency of induction of labor (p=0.02), and of epidural and pudendal blocks for pain relief (p=0.002 and 0.05 respectively). They had shorter labor time (p=0.05). The cost of the psychological therapy was well compensated for by the savings due to the reduction in the number of CS. Conclusions. Psychosomatic support for women with severe fear of delivery resulted in a 50% reduction of CS for psychosocial indications and vaginal deliveries similar to a reference group. The cost of psychosomatic support was less than savings due to fewer cesarean sections.