A randomized controlled trial of a psycho-education intervention by midwives in reducing childbirth fear in pregnant women

Jocelyn Toohill, Jennifer Fenwick, Jenny Gamble, Debra K Creedy, Anne Buist, Erika Turkstra, Elsa-Lena Ryding, Jocelyn Toohill, Jennifer Fenwick, Jenny Gamble, Debra K Creedy, Anne Buist, Erika Turkstra, Elsa-Lena Ryding

Abstract

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.

Keywords: RCT; childbirth fear; childbirth self-efficacy; decisional conflict; depression; midwife counseling; psycho-education.

© 2014 The Authors. Birth Published by Wiley Periodicals, Inc.

Figures

Figure 1
Figure 1
Validated measures used in the study.
Figure 2
Figure 2
The Consolidated Standards of Reporting Trials (CONSORT) flow diagram.

References

    1. Salomonsson B, Bertero C, Alehagen S. Self-efficacy in pregnant women with severe fear of childbirth. J Obstet Gynecol Neonatal Nurs. 2013;42(2):191–202.
    1. Zar M, Wijma K, Wijma B. Pre- and postpartum fear of childbirth in nulliparous and parous women. Scandinavian J Behav Therapy. 2001;30(2):75–84.
    1. Adams S, Eberhard-Gran M, Eskild A. Fear of childbirth and duration of labour: A study of 2206 women with intended vaginal delivery. BJOG. 2012;119:1238–46. doi: .
    1. Kjaergaard H, Wijma K, Dykes A, Alehagen S. Fear of childbirth in obstetrically low-risk nulliparous women in Sweden & Denmark. J Reprod Infant Psyc. 2008;26(4):340–350.
    1. Rouhe H, Salmela-Aro K, Halmesmaki E, Saisto T. Fear of childbirth according to parity, gestational age, and obstetric history. BJOG. 2009;116(1):67–73.
    1. Fenwick J, Gamble J, Nathan E, et al. Pre- and postpartum levels of childbirth fear and the relationship to birth outcomes in a cohort of Australian women. J Clin Nurs. 2009;18:667–677.
    1. Haines H, Pallant J, Karlstrom A, Hildingsson I. Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample. Midwifery. 2011;27(4):560–567.
    1. Toohill J, Fenwick J, Gamble J, Creedy DK. Prevalence of childbirth fear in an Australian sample of pregnant women. BMC Pregnancy Childbirth. 2014;14:275. DOI: .
    1. Johnson R, Slade P. Does fear of childbirth during pregnancy predict emergency caesarean section? BJOG. 2002;109(11):1213–1221.
    1. Ryding E, Wijma B, Wijma K, Rydhstrom H. Fear of childbirth during pregnancy may increase the risk of emergency cesarean section. Acta Obstet Gynecol Scand. 1998;77:542–547.
    1. Cumberland S. Cause for concern: Maternal fear around childbirth and caesarean section as a mode of delivery. MIDIRS. 2010;20(3):297–304.
    1. Saisto T, Halmesmaki E. Fear of childbirth: A neglected dilemma. Acta Obstet Gynecol Scand. 2003;82:201–208.
    1. Laursen M, Hedegaard M, Johansen C. Fear of childbirth: Predictors and temporal changes among nulliparous women in the Danish National Birth Cohort. BJOG. 2008;115(3):354–360.
    1. Rouhe H, Salmela-Aro K, Gissler M, et al. Mental health problems common in women with fear of childbirth. BJOG. 2011;118(9):1104–1111.
    1. Storksen H, Eberhard-Gran M, Garthus-Niegel S, Eskild A. Fear of childbirth; the relation to anxiety and depression. Acta Obstet Gynecol Scand. 2012;91:237–242.
    1. Bewley S, Cockburn J. Responding to fear of childbirth. Lancet. 2002;359(9324):2128–2129.
    1. Otley H. Fear of childbirth: Understanding the causes, impact and treatment. Br J Midwifery. 2011;19(4):215–220.
    1. Halvorsen L, Nerum H, Sorlie T, Oian P. Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth? Midwifery. 2010;26:45–52.
    1. Saisto T, Salmela-Aro K, Nurmi J, et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001;98(5):820–826.
    1. Rouhe H, Salmela-Aro K, Toivanen R, et al. Obstetric outcome after intervention for severe fear of childbirth in nulliparous women – randomised trial. BJOG. 2013;120(1):75–84.
    1. Fenwick J, Gamble J, Creedy D, et al. Study protocol for reducing childbirth fear: A midwife-led psycho-education intervention. BMC Pregnancy and Childbirth. 2013;13(190) Internet]. ):[Published online October 20th, 2013 pp.]. Available at: .
    1. Wijma K, Wijma B, Zar M. Psychometric aspects of the W-DEQ; a new questionnaire for the measurement of fear of childbirth. J Psychosom Obstet Gynecol. 1998;19(2):84–97.
    1. Institute for Statistics and Mathematics. The R Project for Statistical Computing 2012 Accessed January 19, 2012. Available at:
    1. Lowe N. Maternal confidence for labor: Development of the childbirth self-efficacy inventory. Res Nurs Health. 1993;16(2):141–149.
    1. Cox J, Holden J, Sagousky R. Detection of postnatal depression development of the 10 item Edinburgh Depression Scale. BMJ. 1987;150:782–786.
    1. Downe S, Butler E, Hinder S. Screening tools for depressed mood after childbirth in UK-based South Asian women: A systematic review. J Adv Nurs. 2007;57:565–583.
    1. O'Connor A. User Manual - Decisional Conflict Scale (16 item statement format). Ottawa, Ontario, Canada: Ottawa Hospital Research Institute; 1993, updated 2010. Available at: .
    1. Gamble J, Creedy D. A counselling model for postpartum women after distressing birth experiences. Midwifery. 2009;25:e21–e30.
    1. Queensland Centre for Mothers and Babies. The Having a Baby in Queensland Book - Your choices during pregnancy and birth. Accessed November 6, 2011. Available at: .
    1. IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.; 2012.
    1. Kazis J, Anderson J, Meenan R. Effect sizes for interpreting changes in health status. Med Care. 1989;27:s178–s188.
    1. Streiner D, Norman G. Biostatistics: The Bare Essentials. 2. Hamilton, Ontario, Canada: B.C. Decker Inc; 2000.
    1. Cohen J. Statistical Power Analysis for the Behavioural Sciences. Hillsdale, NJ: Erlbaum Associates; 1988. Vol. 2nd.
    1. Nerum H, Halvorsen L, Sorlie T, Oian P. Maternal request for cesarean section due to fear of birth: Can It be changed through crisis-oriented counseling? Birth. 2006;33(3):221–228.
    1. Salmela-Aro K, Read S, Rouhe H, et al. Promoting positive motherhood among nulliparous pregnant women with an intense fear of childbirth: RCT intervention. J Health Psychol. 2012;17(4):520–534.
    1. Drummond J, Rickwood D. Childbirth confidence: Validating the childbirth self-efficacy inventory (CBSEI) in an Australian sample. J Adv Nurs. 1997;26(3):613–622.
    1. Berentson-Shaw J, Scott K, Jose P. Do self-efficacy beliefs predict the primiparous labour and birth experience? A longitudinal study. J Reprod Infant Psychol. 2009;27(4):357–373.
    1. Byrne J, Hauck Y, Fisher C, et al. Effectiveness of a Mindfulness-Based Childbirth Education pilot study on maternal self-efficacy and fear of childbirth. J Midwifery Women's Health. 2014;59(2):192–197.
    1. Ip W, Tang C, Goggins W. An educational intervention to improve women's ability to cope with childbirth. J Clin Nurs. 2009;18:2125–2135.
    1. Gau M, Chang C, Tian S, Lin K. Effects of birth ball exercise on pain and self-efficacy during childbirth: A randomised controlled trial in Taiwan. Midwifery. 2011;27:e293–e300.
    1. Sun Y, Hung Y, Chang Y, Kuo S. Effects of a prenatal yoga programme on the discomforts of pregnancy and maternal childbirth self-efficacy in Taiwan. Midwifery. 2010;26(6):e31–e36.
    1. Gattelari M, Ward J. Decisional conflict forgoing PSA testing for prostate cancer. J Med Screen. 2004;11:165–9.
    1. Shorten A, Shorten B, Keogh J, et al. Making choices for childbirth: A randomized controlled trial of a decision-aid for informed birth after cesarean. Birth. 2005;32(4):252–261. Issues in Perinatal Care.
    1. Montgomery A, Emmett C, Fahey T, et al. Two decision aids for mode of delivery among women with previous caesarean section: Randomised controlled trial. BMJ. 2007;334:1305. doi: .
    1. Toohill J, Fenwick J, Gamble J, et al. Psycho-social predictors of childbirth fear in pregnant women: An Australian study. Open J Obstet Gynecol. 2014;4(9):531–543. .
    1. Nordeng H, Hansen C, Garthus-Niegel S, Eberhard-Gran M. Fear of childbirth, mental health, and medication use during pregnancy. Arch Womens Ment Health. 2012;15:203–209.
    1. Waldenstrom U, Hildingsson I, Ryding E. Antenatal fear of childbirth and its association with subsequent caesarean section and experience of childbirth. BJOG. 2006;113(6):638–646.
    1. Barclay L, Lloyd B. The misery of motherhood: Alternative approaches to maternal distress. Midwifery. 1996;12(3):136–139.
    1. Lyberg A, Severinsson E. Midwives’ supervisory styles and leadership role as experienced by Norwegian mothers in the context of a fear of childbirth. J Nurs Manag. 2010;18(4):391–399.
    1. Kirkham M. Emotion work around reproduction: Supportive or constraining. In: Hunter B, Deery R, editors. Emotions in Midwifery and Reproduction. New York: Palgrave Macmillan; 2009.
    1. Nieminen K, Stephansson O, Ryding EL. Women's fear of childbirth and preference for cesarean section – a cross-sectional study at various stages of pregnancy in Sweden. Acta Obstet Gynecol Scand. 2009;88(7):807–813.
    1. Garthus-Niegel S, Knoph C, von Soest T, et al. The role of labor pain and overall birth experience in the development of posttraumatic stress symptoms: A longitudinal cohort study. Birth. 2014;41(1):108–115.
    1. Murray D, Cox J. Screening for depression during pregnancy with the Edinburgh Depression Scale (EPDS). Special Issue: Psychiatric disorders associated with childbearing. J Reprod Infant Psychol. 1990;8:99–107.
    1. Beyondblue. Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. Melbourne, Australia: A guideline for primary care health professionals.; BeyondBlue: The National Depression Initiative, 2011. Accessed January 7, 2014. Available at: .

Source: PubMed

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