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Title [sv]
En egen barnmorska- Den bästa behandlingen för förlossningsrädsla? En randomiserad studie
Title [en]
A known midwife-the best treatment for childbirth fear? A randomised controlled trial
Abstract [en]
A significant proportion of health care resources are used for counseling support for fear of childbirth. Women are mostly satisfied with such counseling but the treatment has not shown any noticeable effects in terms of reduced fear of childbirth, reduced proportion of caesarean section without medical indication or a more positive birth experience. Randomized studies where women are randomly assigned to a model of care with continuity with the same midwife during pregnancy and childbirth, by contrast, showed a decrease in the number of caesarean sections, more positive birth experience and higher job satisfaction among midwives. Our hypothesis is that women with childbirth fear would benefit more by treatment involving continuity with the same midwife, compared to the standard care with counseling. Women identified with fear of childbirth who receive care at two antenatal clinics, will be invited to participate in the study and to be randomized to intervention or standard care. The intervention group will receive all care during pregnancy and birth by the same midwife or her companion. The control group consists of women who receive standard care, which involves counseling. To find a 20% difference in measured childbirth fear as the treatment effect of continuity with a known midwife versus standard care, around 85 women need to be included in each study group. Data will be collected through questionnaires on five occasions during and after pregnancy. The primary outcome will be the degree of fear of childbirth after completion of treatment and one year after childbirth. Other outcomes will be a change in fear of childbirth over time, and change in birth preference, requirements for caesarean section in case of more pregnancies, childbirth experience and satisfaction with treatment and treatment costs. The midwives will evaluate the model of care in relation to job satisfaction. Several validated instruments will be used, such as HADS, EPDS, Stressful life events , Prenatal attachment, Blood and injection phobia, Cambridge worry Scale, Performance base self esteem, pain catastrophizing, and bonding Fear of birth will be followed up in all questionnaires using the FOBS-scale. Previously used questions about fear of birth, socio-demographic and obstetric background, psychosocial history, previous experiences of infertility and childbirth will be included. The participating midwives will be asked to complete a questionnaire with personal and work related background data and validated instruments about quality of life, burnout, self-efficacy, social support, depressive symptoms, anxiety and stress and two instrument measuring work related satisfaction.This is the first Swedish study offering continuity of midwife caregiver to women with childbirth fear. The project will provide new knowledge about the importance of the model of care for the outcome of the treatment. The project, if successful, could give great health benefits for the mother and the baby as well as for the family. It could also be useful for the health care sector in planning the care for women with childbirth fear. New knowledge about working in a continuity model of care for this particular group of women will be provided from the midwives’ perspective, whcih could increase the retention rate and keep a healthy workforce of midwives.
Principal InvestigatorHildingsson, Ingegerd
Coordinating organisation
Uppsala University
Funder
Period
2016-01-01 － 2018-12-31
National Category
Nursing
Identifiers
DiVA, id: project:5578Project, id: 2015-03660_VR

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