title: Group psychoeducation with relaxation for severe fear of childbirth improves maternal adjustment and childbirth experience--a randomised controlled trial.
abstract: BACKGROUND
  Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode. Women with fear of childbirth often suffer from anxiety and/or depression, and treatment therefore also needs to target postnatal psychological well-being and the early mother-infant relationship.
  
  
  METHODS
  Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospective screening (Wijma Delivery Expectancy Questionnaire, W-DEQ-A), indicating severe fear of childbirth. These women were randomised to psychoeducative group intervention with relaxation (n = 131; six sessions during pregnancy, one postnatal) or to conventional care (n = 240) by community nurses (referral if necessary). Psycho-emotional and psychosocial evaluations [Edinburgh Postnatal Depression Scale (EPDS), social support, Maternal Adjustment and Attitudes (MAMA), Traumatic Events Scale (TES) and the Wijma Delivery Experience Questionnaire (W-DEQ-B)] were completed twice during pregnancy and/or 3 months postpartum.
  
  
  RESULTS
  Postnatal maternal adjustment (MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0, p = 0.001) and childbirth experience (mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32, p = 0.008) were better in the intervention group compared with controls. In hierarchical regression, social support, participating in intervention, and less fearful childbirth experience predicted better maternal adjustment. The level of postnatal depressive symptoms was significantly lower in the intervention group (mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04). There were no differences in the frequency of post-traumatic stress symptoms between the groups.
  
  
  CONCLUSIONS
  In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital , Helsinki , Finland .
authors.forename: Hanna
authors.initials: H
authors.lastname: Rouhe
authors.forename: Katariina
authors.initials: K
authors.lastname: Salmela-Aro
authors.forename: Riikka
authors.initials: R
authors.lastname: Toivanen
authors.forename: Maiju
authors.initials: M
authors.lastname: Tokola
authors.forename: Erja
authors.initials: E
authors.lastname: Halmesmäki
authors.forename: Elsa-Lena
authors.initials: EL
authors.lastname: Ryding
authors.forename: Terhi
authors.initials: T
authors.lastname: Saisto
mesh_terms: D000223:Adaptation, Psychological; D036861:Delivery, Obstetric / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006801:Humans; D009035:Mothers / Q000523:psychology*; D036801:Parturition / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D037841:Pregnant People / Q000523:psychology; D011615:Psychotherapy, Group / Q000379:methods*; D012064:Relaxation Therapy / Q000379:methods*; D012944:Social Support; D011795:Surveys and Questionnaires
keywords: Childbirth experience; fear of childbirth; maternal adjustment; post traumatic stress syndrome; postnatal depression