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A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth: A study protocol
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. (Internationell sexuell och reproduktiv hälsa)ORCID iD: 0000-0003-2207-9365
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Mid Sweden Univ, Dept Hlth Sci, Sundsvall, Sweden.. (Internationell sexuell och reproduktiv hälsa)
Univ Melbourne, Rural Hlth Acad Ctr, Melbourne, Vic, Australia..
Mid Sweden Univ, Dept Nursing, Sundsvall, Sweden..
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2017 (English)In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 13, p. 75-82Article in journal (Refereed) Published
Abstract [en]

Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.

Place, publisher, year, edition, pages
Elsevier, 2017. Vol. 13, p. 75-82
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:uu:diva-332598DOI: 10.1016/j.srhc.2017.06.001ISI: 000411305800011PubMedID: 28844361OAI: oai:DiVA.org:uu-332598DiVA, id: diva2:1153745
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2018-04-09Bibliographically approved
In thesis
1. Identification and Treatment of Women with a Fear of Birth
Open this publication in new window or tab >>Identification and Treatment of Women with a Fear of Birth
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although a fear of birth affects many women during pregnancy and is associated with adverse birth outcomes, it is rarely measured in clinical practice and evidence-based treatments are lacking. The aim of this thesis was to assess the clinical utility of the Fear of Birth Scale, and to evaluate the effect of guided Internet-based cognitive behavior therapy compared with standard care on the levels of fear of birth in pregnant and postpartum women.

This thesis consists of four papers originating from three studies. The Fear of Birth Scale was used to measure fear of birth among pregnant women in all three studies. In Study I, prevalence of fear of birth among Swedish-born and foreign-born pregnant women was measured, and in Study II, 31 pregnant women were interviewed about their thoughts when assessing fear of birth. In Study III, a multicenter randomized controlled trial was conducted to compare guided Internet-based cognitive behavior therapy (ICBT) with standard care for pregnant women with a fear of birth.

Fear of birth was identified among 22% of the pregnant women. Prevalence was twice as high among the foreign-born women (37%) compared to the Swedish-born women (18%). When asking the participants what they thought when assessing their fear on the Fear of Birth Scale, they confirmed that they had understood the measurement intent of the scale. The randomized controlled trial showed that fear of birth decreased during pregnancy and postpartum in both groups. However, the levels of fear decreased more in the guided ICBT-group when measuring fear of birth up to one year postpartum. The changes in fear of birth over time did not differ between parity groups.

Altogether, these results suggest that the Fear of Birth Scale is a suitable screening instrument for identifying pregnant women with a fear of birth in a clinical setting and that such screening would be beneficial, as it probably would increase the chance of achieving a more equitable care. As the effect of time during pregnancy and postpartum was most evident in reducing fear of birth, this can be communicated to pregnant women, along with a continuous dialogue about how the women experience fear during pregnancy.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 84
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1459
Keywords
Fear of birth, Fear of Birth Scale, foreign-born, guided Internet-based cognitive behavior therapy, midwifery, pregnancy, randomized controlled trial, screening, treatment
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-347569 (URN)978-91-513-0320-8 (ISBN)
Public defence
2018-05-30, Sal IV, Universitetshuset, Biskopsgatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2018-05-08 Created: 2018-04-09 Last updated: 2018-05-28

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Ternström, ElinHildingsson, IngegerdSegebladh, BirgittaLarsson, BirgittaRubertsson, Christine

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