Objective To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. Design A prospective study using between-group comparisons. Setting About 600 antenatal clinics in Sweden. Sample A total of 2662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. Methods Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. Main outcome measures Elective and emergency caesarean section and overall childbirth experience. Results In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. Conclusions At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.
To describe the expectations concerning imminent childbirth before and after 8 weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth.
Qualitative study of nulliparous pregnant women's narratives before and after CBT.
The first ICBT programme for treating severe fear of childbirth.
Fifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme.
Semi-structured open-ended questions over the internet before and after 8 weeks of ICBT. The data were analysed using thematic analysis.
The participants' narratives pertaining to five different situations during labour and delivery before and after ICBT.
After therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth.
Following the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.
BACKGROUND: The study aimed at answering the following questions: Do women experience emergency cesarean section as traumatic? Do women experience any posttraumatic stress reactions or even posttraumatic stress disorder (PTSD) one to two months after emergency cesarean section? METHODS: Twenty-five consecutive women were interviewed a few days and one to two months after emergency cesarean section. RESULTS: Nineteen (76%) of the 25 women had experienced their delivery by emergency cesarean section as a traumatic event. One to two months postpartum none of these women met all the diagnostic criteria of PTSD. However, 13 women had various forms of posttraumatic stress reactions and in eight cases (33%) symptoms of serious posttraumatic intrusive stress reactions. CONCLUSIONS: The emergency cesarean section was in the majority of the cases experienced as a mental trauma. Although none of the women suffered from PTSD one to two months postpartum, one third had serious posttraumatic intrusive stress reactions. The concept of traumatic stress thus seems to be relevant for investigations of psychological aspects of emergency cesarean section.