Helsinki University Central Hospital, Department of Obstetrics and Gynaecology, Helsinki, Finland.
BJOG. 2013 Jan;120(1):75-84. doi: 10.1111/1471-0528.12011. Epub 2012 Nov 2.
To compare the numbers of vaginal deliveries and delivery satisfaction among women with fear of childbirth randomised to either psychoeducation or conventional surveillance during pregnancy.
Randomised controlled trial.
Maternity unit of Helsinki University Central Hospital.
Fear of childbirth was screened during early pregnancy by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A). Of 4575 screened nulliparous women, 371 (8.1%) scored ≥ 100, showing severe fear of childbirth.
Women with W-DEQ-A ≥ 100 were randomised to intervention (n = 131) (psychoeducative group therapy, six sessions during pregnancy and one after childbirth) or control (n = 240) (care by community nurses and referral if necessary) groups. Obstetric data were collected from patient records and delivery satisfaction was examined by questionnaire.
Delivery mode and satisfaction.
Women randomised to the intervention group more often had spontaneous vaginal delivery (SVD) than did controls (63.4% versus 47.5%, P = 0.005) and fewer caesarean sections (CSs) (22.9% versus 32.5%, P = 0.05). SVD was more frequent and CSs were less frequent among those who actually participated in intervention (n = 90) compared with controls who had been referred to consultation (n = 106) (SVD: 65.6% versus 47.2%, P = 0.014; CS: 23.3% versus 38.7%, P = 0.031). Women in intervention more often had a very positive delivery experience (36.1% versus 22.8%, P = 0.04, n = 219).
To decrease the number of CSs, appropriate treatment for fear of childbirth is important. This study shows positive effects of psychoeducative group therapy in nulliparous women with severe fear of childbirth in terms of fewer CSs and more satisfactory delivery experiences relative to control women with a similar severe fear of childbirth.
比较随机分配至孕期接受心理教育或常规监测的恐惧分娩孕妇的阴道分娩数量和分娩满意度。
随机对照试验。
赫尔辛基大学中央医院产科病房。
通过 Wijma 分娩期望问卷（W-DEQ-A）在孕早期筛查出恐惧分娩的孕妇。在筛查的 4575 名初产妇中，371 名（8.1%）得分≥100，表现出严重的恐惧分娩。
W-DEQ-A≥100 的孕妇随机分配至干预组（n=131）（孕期六次心理教育团体治疗，分娩后一次）或对照组（n=240）（社区护士照护，必要时转介）。从病历中收集产科数据，通过问卷评估分娩满意度。
分娩方式和满意度。
随机分配至干预组的孕妇更常行自然分娩（SVD），而非对照组（63.4%比 47.5%，P=0.005），行剖宫产（CS）更少（22.9%比 32.5%，P=0.05）。与转介至咨询的对照组（n=106）相比，实际参加干预的孕妇（n=90）的 SVD 更频繁，CS 更少（SVD：65.6%比 47.2%，P=0.014；CS：23.3%比 38.7%，P=0.031）。干预组的孕妇更常对分娩体验非常满意（36.1%比 22.8%，P=0.04，n=219）。
为减少 CS 数量，适当治疗恐惧分娩很重要。本研究显示，对于严重恐惧分娩的初产妇，心理教育团体治疗可减少 CS 数量，并提高分娩满意度，与具有相似严重恐惧分娩的对照组相比，具有积极作用。
