A randomized controlled trial of intervention in fear of childbirth

Objective: To compare intensive and conventional. therapy for severe fear o f childbirth. Methods: In Finland, 176 women who had fear of childbirth were randomly ass igned at the 26th gestational week to have either intensive therapy (mean 3 .8 +/-1.0 sessions with obstetrician and one with midwife) or conventional therapy (mean 2.0 +/-0.6 sessions), with follow-up 3 months postpartum. Pre gnancy-related anxiety and concerns, satisfaction with childbirth, and puer peral depression were assessed with specific questionnaires. Power analysis , based on previous studies, showed that 74 women per group were necessary to show a 50% reduction in cesarean rates. Results: Birth-related concerns decreased in the intensive therapy group bu t increased in the conventional therapy group (linear interaction between t he group and birth-concerns P=.022). Labor was shorter in the intensive the rapy group (mean standard deviation 6.8 +/-3.8 hours) compared with the con ventional group (8.5 +/-4.8 hours, P=.039). After intervention, 62% of thos e originally requesting a cesarean (n=117) chose to deliver vaginally, equa lly in both groups. Cesarean was more frequent for those who refused to fil l in the questionnaires than for those who completed them (57% compared wit h 27%, P=.001). In the log-linear model, parous women who had conventional therapy and refused to fill in the questionnaires those a cesarean more oft en than expected (standardized residual 2.54, P=.011). There were no differ ences between groups in satisfaction with childbirth or in puerperal depres sion. Conclusion: Both kinds of therapy reduced unnecessary cesareans, more so in nulliparous and well-motivated women. With intensive therapy, pregnancy- a nd birth-related anxiety and concerns were reduced, and labors were shorter . (Obstet Gynecol 2001;98:820-6. (C) 2001 by the American College of Obstet ricians and Gynecologists.).