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.

• Childbirth experience
• fear of childbirth
• maternal adjustment
• postnatal depression
• post traumatic stress syndrome

Declaration of interest

The authors report no conflicts of interest.

Current knowledge on the subject

• Mental health problems during and after pregnancy are known to relate to poorer maternal adjustment.

• Mental health problems are common in women with fear of childbirth.

• Fear of childbirth is known to be a risk factor for traumatizing delivery experience and postnatal depression.

What this study adds

• Group psychoeducation improves maternal adjustment and has a positive impact on delivery experience in women with fear of childbirth.

• It is possible that postnatal depressive symptoms in fearful women can be decreased by group psychoeducation.