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Kitamura T, Takegata M, Usui Y, Ohashi Y, Sohda S, Takeda J, Saito T, Kasai Y, Watanabe H, Haruna M, Takeda S. Tokophobia: Psychopathology and Diagnostic Consideration of Ten Cases. Healthcare (Basel) 2024; 12:519. [PMID: 38470630 PMCID: PMC10931235 DOI: 10.3390/healthcare12050519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
Tokophobia is regarded as the intensive fear of childbirth that some pregnant women have. However, little is known about the psychopathological details of tokophobia (fear of childbirth). Between 2020 and 2021, a total of 10 pregnant women (nine nulliparae and one multipara) with a strong fear of childbirth were referred by obstetricians. Semi-structured psychopathological interviews were conducted, and two cases were judged to have obsession, three an overvalued idea, and one secondary delusion. Three were characterised by both obsession and overvalued idea and one by both obsession and secondary delusion. In total, six cases had features of an overvalued idea. All of the participants except one had a lifetime history of a specific phobia. In addition, their history included social phobia in two cases, panic disorder in one case, obsessive-compulsive disorder (other than tokophobia) in two cases, depressive disorder in two cases, bipolar disorder in two cases, and PTSD in six cases. To conclude, this study showed that tokophobia was not a phobic disorder but a kind of overvalued idea that requires specific assessment and treatment.
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Affiliation(s)
- Toshinori Kitamura
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (Y.O.)
- Kitamura KOKORO Clinic Mental Health, Tokyo 151-0063, Japan
- T. and F. Kitamura Foundation for Mental Health Research and Skill Advancement, Tokyo 151-0063, Japan
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya 464-8601, Japan
| | - Mizuki Takegata
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (Y.O.)
| | - Yuriko Usui
- Department of Midwifery and Women’s Health, the Graduate School of Medicine, the University of Tokyo, Tokyo 113-8654, Japan; (Y.U.)
| | - Yukiko Ohashi
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (Y.O.)
- Nursing Faculty, Josai International University, Togane 283-0002, Japan
| | - Satoshi Sohda
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Jun Takeda
- Department of Obstetrics and Gynaecology, School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (J.T.); (S.T.)
| | - Tomomi Saito
- Kitamura Institute of Mental Health Tokyo, Tokyo 151-0063, Japan; (M.T.); (Y.O.)
- Aiiku Research Institute for Maternal, Child Health and Welfare, Imperial Gift Foundation Boshi-Aiiku-Kai, Tokyo 106-0047, Japan
| | - Yasuyo Kasai
- Department of Obstetrics and Gynaecology, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | | | - Megumi Haruna
- Department of Midwifery and Women’s Health, the Graduate School of Medicine, the University of Tokyo, Tokyo 113-8654, Japan; (Y.U.)
| | - Satoru Takeda
- Department of Obstetrics and Gynaecology, School of Medicine, Juntendo University, Tokyo 113-8421, Japan; (J.T.); (S.T.)
- Aiiku Research Institute for Maternal, Child Health and Welfare, Imperial Gift Foundation Boshi-Aiiku-Kai, Tokyo 106-0047, Japan
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van Steensel FJA, Veringa-Skiba IK, Sauer AR, de Bruin EI, Bögels SM. Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth. J Obstet Gynecol Neonatal Nurs 2024; 53:57-68. [PMID: 37984493 DOI: 10.1016/j.jogn.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE To examine the cost-effectiveness of the Mindfulness-Based Childbirth and Parenting (MBCP) program compared with enhanced care as usual (ECAU). DESIGN Randomized controlled trial. SETTING Midwifery settings in the Netherlands, April 2014 to July 2017. PARTICIPANTS Subset of pregnant women with high levels of fear of childbirth (N = 54: randomized to MBCP, n = 32, or to ECAU, n = 22) who were selected from the parent study because they completed all four cost questionnaires. METHODS We measured self-reported health care and non-health care costs. A subset of participants from the parent study completed the questionnaires at all four assessment points. We used the Wijma Delivery Expectancy Questionnaire to measure fear of childbirth and used the EuroQol-5D to measure quality of life. We used these measures of effect together with societal costs in the primary cost-effectiveness analyses. In the secondary cost-effectiveness analyses, we used different estimates of effects and costs to test the robustness of the primary analyses. RESULTS In all but one scenario, MBCP was more effective and cost less than ECAU. As indicated by the acceptability curves, the likelihood of MBCP being cost-effective varied within a range of 70% to 98%. CONCLUSION Our findings indicate that MBCP is a cost-effective intervention to reduce fear of childbirth in pregnant women. Important next steps are to replicate the study in countries with different health care systems and to explore the potential for further integration of MBCP into midwifery care.
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Zahroh RI, Sutcliffe K, Kneale D, Vazquez Corona M, Betrán AP, Opiyo N, Homer CSE, Bohren MA. Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis. BMC Public Health 2023; 23:1851. [PMID: 37741979 PMCID: PMC10517530 DOI: 10.1186/s12889-023-16718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use. METHODS We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success. RESULTS We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components. CONCLUSION We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Katy Sutcliffe
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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den Boer I, Hendrix YMGA, Knoop H, van Pampus MG. Identifying women with fear of childbirth with the Dutch Fear of Birth Scale and its added value for consultations. J Psychosom Obstet Gynaecol 2022; 43:419-425. [PMID: 34907846 DOI: 10.1080/0167482x.2021.2013797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES Determine whether the Fear of Birth Scale (FOBS) is a useful screening instrument for Fear of Childbirth (FoC) and examine the potential added value of screening by analyzing how often pregnant women discuss their FoC during consultation. METHODS This cross-sectional survey study included nulliparous pregnant women of all gestational ages, recruited via the internet, hospital and midwifery practices. The online questionnaires included the FOBS and Wijma Delivery Expectations Questionnaire version A (W-DEQ A). The latter was used as golden standard for assessing FoC (cutoff: ≥85). RESULTS Of the 364 included women, 67 (18.4%) had FoC according to the W-DEQ A. Using the FOBS with a cutoff score of ≥49, the sensitivity was 82.1% and the specificity 81.1%, with 111 (30.5%) women identified as having FoC. Positive predictive value was 49.5% and negative predictive value 95.3%. Of the women with FoC (FOBS ≥49), 68 (61.3%) did not discuss FoC with their caregiver. CONCLUSION The FOBS is a useful screening instrument for FoC. A positive score must be followed by further assessment, either by discussing it during consultation or additional evaluation with the W-DEQ A. The majority of pregnant women with FoC do not discuss their fears, underscoring the need for screening.
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Affiliation(s)
- I den Boer
- Department of Medical Psychology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Y M G A Hendrix
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, The Netherlands
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Boz İ, Akgün M, Duman F. A feasibility study of a psychoeducation intervention based on Human Caring Theory in nulliparous women with fear of childbirth. J Psychosom Obstet Gynaecol 2021; 42:300-312. [PMID: 32319341 DOI: 10.1080/0167482x.2020.1752173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To evaluate the effects of psychoeducation program based on the Human Caring Theory on the level of fear of childbirth (FOC) by comparing the antenatal education classes. METHODS This feasibility study was conducted in a single-blinded, randomized controlled trial on 24 nulliparous women with FOC between July and October 2018. The women received five sessions of psychoeducation and four sessions of antenatal education. The primary outcome was the level of FOC in prenatal period, and the secondary outcomes were the rate of preference for vaginal birth (VB) in prenatal period, the rate of VB, and the level of FOC in postnatal period. The level of the FOC was assessed using Wijma Delivery Expectancy/Experience Questionnaire A and B. RESULTS Although the levels of FOC of the women decreased in both groups for post-treatment, the decrease in the psychoeducation group was significantly higher compared to the antenatal education group (p = 0.022). In the postnatal period, the level of FOC of psychoeducation group was statistically lower than that of the antenatal education group (p = 0.000). Furthermore, all the women in the psychoeducation group and 58.33% of the women in the antenatal education group wanted to have a VB at the end of the program (p = 0.012). However, there was statistically no difference between the groups in terms of the birth type (p = 0.342). CONCLUSIONS There seems to be an indication that the psychoeducation program based on Human Caring Theory might have a benefit to reduce the level of FOC of women compared to the antenatal education classes.
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Affiliation(s)
- İlkay Boz
- Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - Mehtap Akgün
- Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - Ferdane Duman
- Antalya Education and Research Hospital, Health Sciences University, Antalya, Turkey
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O'Connell MA, Khashan AS, Leahy-Warren P, Stewart F, O'Neill SM. Interventions for fear of childbirth including tocophobia. Cochrane Database Syst Rev 2021; 7:CD013321. [PMID: 34231203 PMCID: PMC8261458 DOI: 10.1002/14651858.cd013321.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. OBJECTIVES To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. SEARCH METHODS In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. SELECTION CRITERIA We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. MAIN RESULTS We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence). AUTHORS' CONCLUSIONS The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Stewart
- Cochrane Children and Families Network, c/o Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Sinéad M O'Neill
- School of Epidemiology and Public Health Alumna, University College Cork, Cork, Ireland
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Kemppainen V, Niinimäki M, Bloigu A, Saisto T, Rouhe H, Gissler M, Heikinheimo O, Mentula M. Fear of childbirth after medical vs surgical abortion. Population-based register study from Finland. Acta Obstet Gynecol Scand 2021; 100:743-750. [PMID: 33393097 DOI: 10.1111/aogs.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy. MATERIAL AND METHODS This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85-168 days of gestation). Primary outcome measures were the incidence of registry-identified fear of childbirth and cesarean delivery related to it. RESULTS The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not. CONCLUSIONS One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.
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Affiliation(s)
- Venla Kemppainen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Niinimäki
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Aini Bloigu
- Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Terhi Saisto
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hanna Rouhe
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- Finnish Institute of Health and Welfare (THL), Helsinki, Finland.,Karolinska Institute, Stockholm, Sweden
| | - Oskari Heikinheimo
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Mentula
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Akgün M, Boz İ, Özer Z. The effect of psychoeducation on fear of childbirth and birth type: systematic review and meta-analysis. J Psychosom Obstet Gynaecol 2020; 41:253-265. [PMID: 31718369 DOI: 10.1080/0167482x.2019.1689950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Psychoeducation is an evidence-based therapeutic intervention for women that provide information, support for a better understanding and coping with fear of childbirth (FOC). Although there have been some studies examining the effects of psychoeducation on FOC and cesarean section (CS), there is no high quality evidence. This systematic review and meta-analysis study aimed to investigate the effects of psychoeducation on FOC and CS rate. METHODS Literature research was performed in CINAHL, PubMed, Science Direct, OVID, Medline, Science Citation Index (Web of Science) and Cochrane Central Register of Controlled Trials until April 2018. This study is based on the recommendations of the Cochrane guidelines. The analysis was conducted using the Comprehensive Meta-Analysis Program Version 3. RESULTS Four randomized controlled studies and three non-randomized controlled studies were selected; six studies were combined for FOC and four studies were combined for CS rate. Meta-analysis revealed that psychoeducation is effective in reducing pregnant women's FOC (hedges' g 0.59, 95% Confidence Interval (CI) 0.46-0.72, p = .000; 931 women) and the CS rate (Odds Ratio 1.730, 95% CI 1.285-2.330, p = .000; 682 women). CONCLUSION This study provides sufficient evidence that psychoeducation is an effective to reduce FOC and CS rate.
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Affiliation(s)
- Mehtap Akgün
- Department of Obstetrics and Gynecology Nursing, Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - İlkay Boz
- Department of Obstetrics and Gynecology Nursing, Nursing Faculty, Akdeniz University, Antalya, Turkey
| | - Zeynep Özer
- Department of Internal Medicine Nursing, Nursing Faculty, Akdeniz University, Antalya, Turkey
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10
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Gluck O, Pinchas‐Cohen T, Hiaev Z, Rubinstein H, Bar J, Kovo M. The impact of childbirth education classes on delivery outcome. Int J Gynaecol Obstet 2020; 148:300-304. [DOI: 10.1002/ijgo.13016] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 08/16/2019] [Accepted: 10/22/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Ohad Gluck
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
| | - Tally Pinchas‐Cohen
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
| | - Zvia Hiaev
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
| | - Hanny Rubinstein
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
| | - Jacob Bar
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
| | - Michal Kovo
- Department of Obstetrics and GynecologyE. Wolfson Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University) Holon Israel
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11
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Badaoui A, Kassm SA, Naja W. Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues. Curr Psychiatry Rep 2019; 21:27. [PMID: 30868272 DOI: 10.1007/s11920-019-1010-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions. RECENT FINDINGS Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.
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Affiliation(s)
- Alexandra Badaoui
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon.
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
| | - Wadih Naja
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
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12
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13
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Calderani E, Giardinelli L, Scannerini S, Arcabasso S, Compagno E, Petraglia F, Ricca V. Tocophobia in the DSM-5 era: Outcomes of a new cut-off analysis of the Wijma delivery expectancy/experience questionnaire based on clinical presentation. J Psychosom Res 2019; 116:37-43. [PMID: 30654992 DOI: 10.1016/j.jpsychores.2018.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Diagnosis of tocophobia using existing instruments is an area of active investigation. Although a range of Wijma Delivery Experience Questionnaire (W-DEQ) cut-off scores has been suggested for detecting tocophobia, there is no consensus among researchers about an optimal cut-off score. The primary goal of the present study was to identify a cut-off value while referring to the DSM-5 Specific Phobia criteria as a gold standard, and to accordingly evaluate how the fearful component of the childbirth experience and psychopathology in the post-natal period are affected by tocophobia. METHODS We conducted an observational, longitudinal study on nulliparous women (n = 106). Routine pregnancy data and data from psychometric questionnaires investigating depression, anxiety, and fear of childbirth were collected. A psychiatric Structured Clinical Interview for DSM-5 (SCID-5) was also conducted. The same parameters were re-evaluated one month after parturition. RESULTS A W-DEQ score of 85 was found to be the optimal cut-off score for detecting tocophobia, with sound sensitivity (100%) and specificity (93.8%). We found substantial agreement between the W-DEQ A and SCID-5 Specific Phobia Criteria (Cohen's Kappa coefficient, κ = 0.720). CONCLUSIONS A W-DEQ cut-off value of 85 is a reliable tool for detecting clinically relevant fear of childbirth according to the DSM-5 diagnosis of Specific Phobia. Therefore, accurate psychopathological investigation must be administered to women with W-DEQ scores greater than this cut-off score.
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Affiliation(s)
- Enrico Calderani
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.
| | - Lisa Giardinelli
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Silvia Scannerini
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Susanna Arcabasso
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Elisa Compagno
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Viale Morgagni 50, Florence, Italy
| | - Valdo Ricca
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.
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14
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Sikorski C, Van Hees S, Lakhanpaul M, Benton L, Martin J, Costello A, Heys M. Could Postnatal Women's Groups Be Used to Improve Outcomes for Mothers and Children in High-Income Countries? A Systematic Review. Matern Child Health J 2018; 22:1698-1712. [PMID: 30155582 PMCID: PMC6245133 DOI: 10.1007/s10995-018-2606-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Introduction Participatory postnatal women’s groups have been shown to have a significant impact on maternal and neonatal mortality in low-income countries. However, it is not clear whether this approach can be translated to high-income countries (HICs). We conducted a systematic review to answer the question: “Can postnatal women’s groups improve health outcomes for mothers and children in high-income countries?” Methods MEDLINE, EMBASE and Cochrane databases were searched for randomised controlled trials testing any group-based intervention during the postnatal period, in HICs. No limitations were applied to stated outcomes. Results Nine trials, including 3029 women, fulfilled the criteria. Group-based interventions, facilitated by health professionals, ranged from didactic to participant-led. Three trials addressed postnatal depression, one addressed physical activity, whilst the remainder looked at multiple health or social outcomes. Three trials reported a significant association between their intervention and at least one outcome measure. Study limitations included poor and inequitable intervention uptake, low participant retention, small sample size and incomplete intervention description. Discussion This review found limited and incompletely described evidence testing the use of postnatal group-based interventions to improve health outcomes in HICs. Promising results were reported when the obstacles of sample size and group attendance were overcome. Studies reporting positive impacts on primary outcomes reported higher attendance rates and involved a psychoeducational or cognitive behavioural component in their group approaches. Further research should design and evaluate implementation strategies, assess the use of lay support workers in community settings to improve attendance and retention, and examine the effect of the group environment on outcomes.
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Affiliation(s)
| | | | - Monica Lakhanpaul
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Lorna Benton
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Jennifer Martin
- Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Anthony Costello
- Institute for Global Health, University College, London, UK.,Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Michelle Heys
- Institute for Global Health, University College, London, UK. .,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
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15
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Striebich S, Mattern E, Ayerle GM. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia - A systematic review of approaches and interventions. Midwifery 2018; 61:97-115. [PMID: 29579696 DOI: 10.1016/j.midw.2018.02.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/20/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth. AIM to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation. METHODS a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed. FINDINGS 19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions. KEY CONCLUSIONS despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC. IMPLICATIONS FOR PRACTICE theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC.
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Affiliation(s)
- Sabine Striebich
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Elke Mattern
- Department of Applied Health Sciences, University of Applied Sciences, Gesundheitscampus 6-8, 44801 Bochum Germany.
| | - Gertrud M Ayerle
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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16
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Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, Patel H, Sparud-Lundin C, Wigert H, Begley C. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth 2018; 18:28. [PMID: 29329526 PMCID: PMC5766978 DOI: 10.1186/s12884-018-1659-7] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). Conclusions Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required. Electronic supplementary material The online version of this article (10.1186/s12884-018-1659-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90, Borås, Sweden. .,Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.
| | - E Hessman
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - H Sjöblom
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - A Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - E Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - M Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery,Trinity College Dublin, 24, D'Olier St. Dublin 2, Dublin, Ireland
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17
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Toohill J, Callander E, Gamble J, Creedy DK, Fenwick J. A cost effectiveness analysis of midwife psycho-education for fearful pregnant women - a health system perspective for the antenatal period. BMC Pregnancy Childbirth 2017; 17:217. [PMID: 28693447 PMCID: PMC5504805 DOI: 10.1186/s12884-017-1404-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/03/2017] [Indexed: 11/10/2022] Open
Abstract
Background Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth. Method One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores (n = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education (n = 170) at 24 and 34 weeks of pregnancy or to the control group (n = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups. Result Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group n = 91; Control Group n = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls (n = 60, 66% vs. n = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant (p = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145. Conclusion Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers. Trial registration Australian New Zealand Controlled Trials Registry ACTRN12612000526875, 17th May 2012 (retrospectively registered one week after enrolment of first participant).
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Affiliation(s)
- J Toohill
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia. .,Office of the Chief Nursing and Midwifery Officer, Queensland Department of Health, Brisbane, 4001, Australia.
| | - E Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, 4812, Australia
| | - J Gamble
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - D K Creedy
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia
| | - J Fenwick
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, 4131, Australia.,Gold Coast University Hospital, Southport, 4215, Australia
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18
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Nilvér H, Begley C, Berg M. Measuring women's childbirth experiences: a systematic review for identification and analysis of validated instruments. BMC Pregnancy Childbirth 2017; 17:203. [PMID: 28662645 PMCID: PMC5492707 DOI: 10.1186/s12884-017-1356-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/26/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Women's childbirth experience can have immediate as well as long-term positive or negative effects on their life, well-being and health. When evaluating and drawing conclusions from research results, women's experiences of childbirth should be one aspect to consider. Researchers and clinicians need help in finding and selecting the most suitable instrument for their purpose. The aim of this study was therefore to systematically identify and present validated instruments measuring women's childbirth experience. METHODS A systematic review was conducted in January 2016 with a comprehensive search in the bibliographic databases PubMed, CINAHL, Scopus, The Cochrane Library and PsycINFO. Included instruments measured women's childbirth experiences. Papers were assessed independently by two reviewers for inclusion, and quality assessment of included instruments was made by two reviewers independently and in pairs using Terwee et al's criteria for evaluation of psychometric properties. RESULTS In total 5189 citations were screened, of which 5106 were excluded by title and abstract. Eighty-three full-text papers were reviewed, and 37 papers were excluded, resulting in 46 included papers representing 36 instruments. These instruments demonstrated a wide range in purpose and content as well as in the quality of psychometric properties. CONCLUSIONS This systematic review provides an overview of existing instruments measuring women's childbirth experiences and can support researchers to identify appropriate instruments to be used, and maybe adapted, in their specific contexts and research purpose.
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Affiliation(s)
- Helena Nilvér
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
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19
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Nieminen K, Wijma K, Johansson S, Kinberger EK, Ryding EL, Andersson G, Bernfort L, Wijma B. Severe fear of childbirth indicates high perinatal costs for Swedish women giving birth to their first child. Acta Obstet Gynecol Scand 2017; 96:438-446. [DOI: 10.1111/aogs.13091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 12/27/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Katri Nieminen
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
- Department of Obstetrics and Gynecology; Vrinnevisjukhuset; Region Council of Östergötland; Norrköping Sweden
| | - Klaas Wijma
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Sanna Johansson
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Emelie K. Kinberger
- Unit of Medical Psychology; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - Elsa-Lena Ryding
- Division of Obstetrics and Gynecology; Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning; Linköping University; Linköping Sweden
- Division of Psychiatry; Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - Lars Bernfort
- Division of Health Care Analysis; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Barbro Wijma
- Unit of Gender and Medicine; Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
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20
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Baas MAM, Stramrood CAI, Dijksman LM, de Jongh A, van Pampus MG. The OptiMUM-study: EMDR therapy in pregnant women with posttraumatic stress disorder after previous childbirth and pregnant women with fear of childbirth: design of a multicentre randomized controlled trial. Eur J Psychotraumatol 2017; 8:1293315. [PMID: 28348720 PMCID: PMC5345578 DOI: 10.1080/20008198.2017.1293315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 12/14/2016] [Accepted: 12/15/2016] [Indexed: 12/20/2022] Open
Abstract
Background: Approximately 3% of women develop posttraumatic stress disorder (PTSD) after giving birth, and 7.5% of pregnant women show a pathological fear of childbirth (FoC). FoC or childbirth-related PTSD during (a subsequent) pregnancy can lead to a request for an elective caesarean section as well as adverse obstetrical and neonatal outcomes. For PTSD in general, and several subtypes of specific phobia, eye movement desensitization and reprocessing (EMDR) therapy has been proven effective, but little is known about the effects of applying EMDR during pregnancy. Objective: To describe the protocol of the OptiMUM-study. The main aim of the study is to determine whether EMDR therapy is an effective and safe treatment for pregnant women with childbirth-related PTSD or FoC. In addition, the cost-effectiveness of this approach will be analysed. Method: The single-blind OptiMUM-study consists of two two-armed randomized controlled trials (RCTs) with overlapping design. In several hospitals and community midwifery practices in Amsterdam, the Netherlands, all eligible pregnant women with a gestational age between eight and 20 weeks will be administered the Wijma delivery expectations questionnaire (WDEQ) to asses FoC. Multiparous women will also receive the PTSD checklist for DSM-5 (PCL-5) to screen for possible PTSD. The clinician administered PTSD scale (CAPS-5) will be used for assessing PTSD according to DSM-5 in women scoring above the PCL-5 cut-off value. Fifty women with childbirth-related PTSD and 120 women with FoC will be randomly allocated to either EMDR therapy carried out by a psychologist or care-as-usual. Women currently undergoing psychological treatment or women younger than 18 years will not be included. Primary outcome measures are severity of childbirth-related PTSD or FoC symptoms. Secondary outcomes are percentage of PTSD diagnoses, percentage caesarean sections, subjective childbirth experience, obstetrical and neonatal complications, and health care costs. Results: The results are meant to provide more insight about the safety and possible effectiveness of EMDR therapy during pregnancy for women with PTSD or FoC. Conclusion: This study is the first RCT studying efficacy and safety of EMDR in pregnant women with PTSD after childbirth or Fear of Childbirth.
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Affiliation(s)
- M. A. M. Baas
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - C. A. I. Stramrood
- Department of Obstetrics and Gynaecology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - L. M. Dijksman
- Department of Epidemiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
- Department of Quality and Safety, St. Antoniusziekenhuis, Nieuwegein, the Netherlands
| | - A. de Jongh
- Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - M. G. van Pampus
- Department of Obstetrics and Gynaecology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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