Fear of Childbirth - Comparison of Two Treatment Options: Internet Given Behavioral Therapy and Counseling by Midwife- a Clinical Randomized Controlled Trial

Project area

Childbirth related fear is a public health issue strongly related to subsequent reproduction and women's and children's health. It could be assumed that previous negative birth experiences are caused by interventions and/or lack of support from staff during birth which in turn could be linked to women's emotional wellbeing. Childbirth related fear often involves a request for a caesarean section, which in turn could have short and long term consequences for women's and children's health. The majority of studies on childbirth related fear have focused on maternal characteristics and the reasons for childbirth fear. Fewer studies have addressed treatment options for curing childbirth fear. Standard care for women with childbirth related fear in Sweden, is usually counseling with midwives and sometimes this counseling leads to an elective caesarean section. In general, women are satisfied with counselling. However, research shows no major effect of counselling, neither in decreased numbers of cesarean sections on maternal request nor in decreased levels of childbirth related fear one year after birth. Today a substantial financial amount of the budget for women's health care is allocated to treatment of childbirth fear using counselling teams. The introduction of such counseling teams was introduced without being preceded by any randomized trials about its effects. In other areas of health care, cognitive behavior therapy is recommended for psychosocial issues. The present project will compare Internet based cognitive behavior therapy (iCBT) with standard care (SC).

Survey of the field Childbirth related fear has gained major research interest particularly in the Scandinavian countries.Severe fear of childbirth has been reported to 6-10% in a Finish study, and fear comparable to PTSD 1.3%. Measures of childbirth related fear: The FOBS scale was developed in a cross-cultural comparative study where two VAS scales (measuring worries and fears in relation to childbirth) were combined.

Reported reasons for fear of childbirth are; fear of pain, childhood abuse, and feelings that the woman or the baby will be damaged during birth or even die, being denied help from caregivers or felt badly treated by delivery staff and, for multiparous women previous emergency caesarean sections or previous negative experiences of birth.

Treatment for childbirth fear Most Swedish hospitals have special counseling teams for women with childbirth fear, often called Aurora groups. Their antenatal midwife refers women to these special teams. The most common treatment model for these women are visits with a specially trained midwife, but psycho-somatic support, cognitive behavior therapy, and relaxation techniques are also used. This counseling treatment in Sweden has not been preceded by large randomized studies, but studies indicate that women are satisfied with the treatment. It has also been shown that women who are referred to the Aurora services more frequently have caesarean sections.