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Treatment for childbirth fear with a focus on midwife-led counselling: A national overview, women’s birth preferences and experiences of counselling
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being.

Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling.

Methods: Study I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy.

Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden.

Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.  

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 77
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1341
Keywords [en]
Birth experience, caesarean section, childbirth fear, internet-based cognitive behaviour therapy, midwife-led counselling, treatment
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:uu:diva-326007ISBN: 978-91-513-0003-0 (print)OAI: oai:DiVA.org:uu-326007DiVA, id: diva2:1118141
Public defence
2017-09-08, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2017-08-17 Created: 2017-06-29 Last updated: 2017-09-08
List of papers
1. Counseling for childbirth fear: a national survey
Open this publication in new window or tab >>Counseling for childbirth fear: a national survey
2016 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 8, p. 82-87Article in journal (Refereed) Published
Abstract [en]

Background

Counseling by experienced midwives is offered to women with childbirth fear in most obstetric clinics in Sweden, but information about the content of such counseling is lacking. Aim To study comprehensiveness, content and organization of the midwife-led counseling for childbirth fear in all obstetric clinics in Sweden.

Methods

In this cross-sectional study, data were collected using a questionnaire sent to all obstetric clinics in Sweden (n = 45); a total of 43 clinics responded. Descriptive and one-way ANOVA was used in the analysis.

Results

All responding obstetric clinics in Sweden offer midwife-led counseling to women with childbirth fear. Major differences were found regarding the time allocated to counseling, with a range between 5.7 and 47.6 minutes per childbirth. Supplementary education for midwives and the availability of treatment options varied at the different clinics and were not associated with the size of the clinic.

Conclusion

The midwife-led counseling conducted at the different Swedish obstetric clinics showed considerable disparities. Women with childbirth fear would benefit from care on equal terms irrespective of place of residence. Consequently, it would be valuable to develop a national healthcare program for childbirth fear.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-289181 (URN)10.1016/j.srhc.2016.02.008 (DOI)000376839500013 ()27179382 (PubMedID)
External cooperation:
Available from: 2016-04-29 Created: 2016-04-29 Last updated: 2017-11-30Bibliographically approved
2. The effects of counseling on fear of childbirth
Open this publication in new window or tab >>The effects of counseling on fear of childbirth
2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 6, p. 629-636Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE:

To investigate women's experiences of attending existing counseling programs for childbirth-related fear and the effect of this counseling over time.

DESIGN:

A longitudinal survey.

SETTING:

Three hospitals in the central north of Sweden.

SAMPLE:

A selected sample of 936 women. Of these, 70 received counseling due to fear of childbirth (study-group).

METHODS:

Data were collected with questionnaires 2 months and 1 year after giving birth with background data collected during midpregnancy. Comparisons were made between women with or without counseling. Crude and adjusted odds ratios (OR) were calculated.

MAIN OUTCOME MEASURES:

Self-reported childbirth fear, experience of counseling, birth experience and preferred mode of birth.

RESULTS:

Women in the counseling group reported higher childbirth fear 1 year after giving birth (OR 5.0, 95% confidence interval (95% CI) 2.6-9.3), they had a more negative birth experience that did not change over time (OR 2.1, 95% CI 1.2-3.9) and they preferred cesarean section to a greater extent (OR 12.0, 95% CI 5.1-28.1) in the case of another birth. Also, they were more often delivered by planned cesarean section (OR 4.7, 95% CI 2.4-9.1). However, 80% were satisfied with the given support.

CONCLUSION:

Although women were satisfied with the treatment, this study shows that counseling had a minor effect on fear of childbirth, birth experiences or cesarean section rates. To help women with their fear of childbirth, more effective methods of treatment are needed.

National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-254711 (URN)10.1111/aogs.12634 (DOI)000354398300012 ()25772528 (PubMedID)
Available from: 2015-06-10 Created: 2015-06-10 Last updated: 2017-12-04Bibliographically approved
3. Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial
Open this publication in new window or tab >>Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial
Show others...
2017 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 30, no 6, p. 460-467Article in journal (Refereed) Published
Abstract [en]

Background: Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason.  The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment.

Methods: Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n=258) were recruited at one university hospital and two regional hospitals over one year.  The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n=127) or standard care (face-to-face counselling) (n=131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth.

Results: Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience.

Conclusion: Women’s birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.  

Keywords
caesarean section, childbirth fear, counselling, internet based cognitive behavioural therapy, randomised controlled trial
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-325923 (URN)10.1016/j.wombi.2017.04.004 (DOI)000418296300007 ()28495462 (PubMedID)
Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2018-01-30Bibliographically approved
4. Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study
Open this publication in new window or tab >>Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study
Show others...
2019 (English)In: Women and Birth, ISSN 1871-5192, E-ISSN 1878-1799, Vol. 32, no 1, p. e88-e94Article in journal (Refereed) Published
Abstract [en]

Background: Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women’s views about counselling for childbirth fear.

Aim: To explore women’s experiences of midwife-led counselling for childbirth fear.

Method: A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth.

Findings: The overarching theme ‘Midwife-led counselling brought positive feelings and improved confidence in birth’ was identified. This consisted of four themes describing ‘the importance of the midwife’ and ‘a mutual and strengthening dialogue’ during pregnancy. ‘Coping strategies and support enabled a positive birth’ represent women’s experiences during birth and ‘being prepared for a future birth’ were the women’s thoughts of a future birth.

Conclusions: In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.

Keywords
Childbirth fear, Counselling, Experience, Midwifery, Qualitative research
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-325924 (URN)10.1016/j.wombi.2018.04.008 (DOI)000455681800012 ()29709431 (PubMedID)
Note

Title in thesis list of papers: Women’s experience of midwife-led counselling and its influence on childbirth fear

Available from: 2017-06-29 Created: 2017-06-29 Last updated: 2019-02-05Bibliographically approved

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