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Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience – a randomised controlled trial
Abstract
BACKGROUND: Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode. Women with fear of childbirth often suffer from anxiety and/or depression, and treatment therefore also needs to target postnatal psychological well-being and the early mother-infant relationship. METHODS: Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospective screening (Wijma Delivery Expectancy Questionnaire, W-DEQ-A), indicating severe fear of childbirth. These women were randomised to psychoeducative group intervention with relaxation (n = 131; six sessions during pregnancy, one postnatal) or to conventional care (n = 240) by community nurses (referral if necessary). Psycho-emotional and psychosocial evaluations [Edinburgh Postnatal Depression Scale (EPDS), social support, Maternal Adjustment and Attitudes (MAMA), Traumatic Events Scale (TES) and the Wijma Delivery Experience Questionnaire (W-DEQ-B)] were completed twice during pregnancy and/or 3 months postpartum. RESULTS: Postnatal maternal adjustment (MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0, p = 0.001) and childbirth experience (mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32, p = 0.008) were better in the intervention group compared with controls. In hierarchical regression, social support, participating in intervention, and less fearful childbirth experience predicted better maternal adjustment. The level of postnatal depressive symptoms was significantly lower in the intervention group (mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04). There were no differences in the frequency of post-traumatic stress symptoms between the groups. CONCLUSIONS: In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.
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“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 [25]
In the citing paper
“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 [25]
In the citing paper
“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 [25]
In the citing paper
“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 [25]
In the citing paper
“In Finland, a psychologist-led randomised control trial (RCT) of six group-based psychoeducation and relaxation sessions, found the intervention group reported more vaginal births, less fear, and fewer medical interventions.”
From The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. (2023) · cites this paper as Rouhe et al., 2015
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“Previous studies about childbirth experience have shown that a positive evaluation of experience is more common after a spontaneous vaginal delivery [23] and the highest risk for traumatizing experience is after an emergency CS [24].”
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Experiences of Fears Associated with Pregnancy and Childbirth: A Study of 329 Pregnant Women
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Psychological perspectives on fear of childbirth
Rondung, E., Thomtén, J., & Sundin, Ö. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.10.007 · Cited by 200
Molgora, S., Fenaroli, V., Prino, L. E., Rollè, L., Sechi, C., Trovato, A., Vismara, L., Volpi, B., Brustia, P., Lucarelli, L., et al. (2018) · Women and Birth · doi:10.1016/j.wombi.2017.06.022 · Cited by 122
Ghanbari-Homayi, S., Fardiazar, Z., Meedya, S., Mohammad-Alizadeh-Charandabi, S., Asghari-Jafarabadi, M., Mohammadi, E., & Mirghafourvand, M. (2019) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-019-2333-4 · Cited by 121
Striebich, S., Mattern, E., & Ayerle, G. M. (2018) · Midwifery · doi:10.1016/j.midw.2018.02.013 · Cited by 162
Moghaddam Hosseini, V., Nazarzadeh, M., & Jahanfar, S. (2018) · Women and Birth · doi:10.1016/j.wombi.2017.10.007 · Cited by 124
Metadata
- Authors
- Rouhe, H., Salmela-Aro, K., Toivanen, R., Tokola, M., Halmesmäki, E., Ryding, E.-L., & Saisto, T.
- Affiliations
- Helsinki University Hospital (FI)
- Karolinska Institutet (SE)
- Corresponding author
- Rouhe, Hanna
- Venue
- Journal of Psychosomatic Obstetrics & Gynecology
- Publisher
- Informa UK Limited
- Published
- 2014-11-24
- Volume
- 36
- Issue
- 1
- Pages
- 1-9
- ISSN
- 0167-482X (ISSN-L)
- 1743-8942
- OpenAlex
- W2092434157
- Cited by
- 129
- References
- 64
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 13 · 2023: 12 · 2022: 12 · 2021: 17 · 2020: 16 · 2019: 14 · 2018: 16 · 2017: 8 · 2016: 10 · 2015: 2
- FWCI
- 6.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Obstetrics & Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
- Keywords
- fear of childbirth, group psychoeducation, relaxation training, maternal adjustment, childbirth experience, postpartum depression, social support, posttraumatic stress symptoms, nulliparous women, pregnancy, postpartum period
- MeSH terms
- Adaptation, Psychological, Fear, Female, Humans, Mothers, Patient Education as Topic, Pregnancy, Pregnancy Complications, Psychotherapy, Group, Surveys and Questionnaires, Relaxation Therapy, Social Support, Parturition, Delivery, Obstetric, Pregnant People, Postpartum Period
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