title: Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance.
abstract: OBJECTIVE
  Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester.
  
  
  METHODS
  Finland, data from obstetrical patient records and questionnaires.
  
  
  METHODS
  Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand (n = 240).
  
  
  METHODS
  All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale).
  
  
  RESULTS
  The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005).
  
  
  CONCLUSIONS
  Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment.
authors: Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.
authors: Hanna
authors: H
authors: Rouhe
authors: Katariina
authors: K
authors: Salmela-Aro
authors: Riikka
authors: R
authors: Toivanen
authors: Maiju
authors: M
authors: Tokola
authors: Erja
authors: E
authors: Halmesmäki
authors: Terhi
authors: T
authors: Saisto
mesh_terms: D000328:Adult; D005239:Fear / Q000523:psychology*; D005260:Female; D005387:Finland; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008427:Maternal Health Services / Q000191:economics; D008429:Maternal Welfare; D010298:Parity; D036801:Parturition / Q000523:psychology*; D010549:Personal Satisfaction; D011247:Pregnancy; D064186:Prenatal Education / Q000191:economics; D011615:Psychotherapy, Group / Q000191:economics*; D011788:Quality of Life; D012064:Relaxation Therapy / Q000191:economics*; D011795:Surveys and Questionnaires
keywords: Fear of childbirth; cesarean section; cost-effectiveness; group psychoeducation; life satisfaction