Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study

Abstract

Objective: The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT).

Design: Prospective, longitudinal cohort study.

Setting: A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women.

Sample: Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013.Methods: The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system.

Main outcome measures: Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B).

Results: A statistically significant (p < 0.0005) decrease of FOC [W-DEQ sum score decreased pre to post-therapy, with a large effect size (Cohen’s d = 0.95)].

Conclusions: The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.

• Fear of childbirth
• Internet CBT
• Pregnancy
• psychotherapy

Acknowledgements

We would like to thank all the women who participated in the project as well as registered midwife Anna Cleveson, psychologists Linnea Adenskog, Jesper Arvidsson, Charlotte Lindberg, Anna Trüschel, and Anna Vestlinder for the valuable help during the project. This study has been approved by the Central Ethical Review Board of Sweden on 21 June 2011 (Reg.no. Ö 18–2011).

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content.

The study was supported by the Swedish Research Council for Health, Working Life and Welfare (FORTE), The Medical Research Council of Southeast Sweden (FORSS) and The County Council in Östergötland (LIÖ).

Current knowledge on this subject

• Severe FOC interferes substantially with a pregnant woman’s life, and is a risk factor for a complicated delivery and postpartum mental health problems.

• Pregnant women with severe FOC, also have more FOC during labor and delivery as well as postpartum, than women with lower FOC during pregnancy and postpartum.

• There are few previous studies on treatment of women with severe FOC, but trials using elements of CBT show promising results.

What this study adds

• This is the first quantitative report on psychotherapy for severe FOC over the Internet.

• This study indicates new treatment possibilities for pregnant women suffering from severe FOC.

• ICBT appears to be feasible in the treatment of severe FOC.

• The results can be seen as offering general support for using CBT for severe FOC in nulliparous women.