title: Effects of a midwife psycho-education intervention to reduce childbirth fear on women's birth outcomes and postpartum psychological wellbeing.
abstract: BACKGROUND
  High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention.
  
  
  METHODS
  Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here.
  
  
  RESULTS
  1410 women were screened for high childbirth fear (W-DEQ ≥66). Three hundred and thirty-nine (n = 339) women were randomised (intervention n = 170; controls n = 169). One hundred and eighty-four women (54 %) returned data for final analysis at 6 weeks postpartum (intervention n = 91; controls n = 93). Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the 'decision aid' helped reduce their fear (53 % vs 37 %, p = 0.02).
  
  
  CONCLUSIONS
  Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies.
  
  
  BACKGROUND
  Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012.
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. J.Fenwick@griffith.edu.au.|Gold Coast University Hospital, Parklands Drive, Southport, QLD, 4215, Australia. J.Fenwick@griffith.edu.au.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Fenwick
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. J.Toohill@griffith.edu.au.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Toohill
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. J.Gamble@griffith.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Gamble
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. D.Creedy@griffith.edu.au.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Creedy
authors.affiliation: University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia. a.buist@unimelb.edu.au.
authors.forename: Anne
authors.initials: A
authors.lastname: Buist
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. E.Turkstra@griffith.edu.au.
authors.forename: Erika
authors.initials: E
authors.lastname: Turkstra
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. Anne_Sneddon@health.qld.gov.au.|Gold Coast University Hospital, Parklands Drive, Southport, QLD, 4215, Australia. Anne_Sneddon@health.qld.gov.au.
authors.forename: Anne
authors.initials: A
authors.lastname: Sneddon
authors.affiliation: Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, QLD 4131, Australia. P.Scuffham@griffith.edu.au.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Scuffham
authors.affiliation: Karolinska Institutet, SE-171 77, Stockholm, Sweden. elsa.ryding@ki.se.
authors.forename: Elsa L
authors.initials: EL
authors.lastname: Ryding
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology; D019052:Depression, Postpartum / Q000517:prevention & control / Q000523:psychology; D005239:Fear; D005260:Female; D006801:Humans; D008880:Midwifery / Q000379:methods*; D036801:Parturition / Q000523:psychology*; D010353:Patient Education as Topic / Q000379:methods*; D049590:Postpartum Period / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control / Q000523:psychology; D011256:Pregnancy Outcome / Q000523:psychology; D011262:Pregnancy Trimester, Second; D011295:Prenatal Care / Q000379:methods* / Q000523:psychology; D055815:Young Adult