Larsson Birgitta, Karlström Annika, Rubertsson Christine, Ternström Elin, Ekdahl Johanna, Segebladh Birgitta, Hildingsson Ingegerd
Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, 846 53 Sundsvall, Sweden.
Department of Nursing Sciences, Mid-Sweden University, 851 70 Sundsvall, Sweden.
Women Birth. 2017 Dec;30(6):460-467. doi: 10.1016/j.wombi.2017.04.004. Epub 2017 May 8.
Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment.
Pregnant women classified with childbirth fear (≥60 on the Fear Of Birth Scale) (n=258) were recruited at one university hospital and two regional hospitals over one year. The participants were randomised (1:1) to intervention (Internet-based Cognitive Behaviour Therapy (ICBT)) (n=127) or standard care (face-to-face counselling) (n=131). Data were collected by questionnaires in pregnancy week 20-25 (baseline), week 36 and two months after birth.
Caesarean section preference decreased from 34% to 12% in the ICBT group and from 24% to 20% in the counselling group. Two months after birth, the preference for caesarean increased to 20% in the ICBT group and to 29% in the counselling group, and there was no statistically significant change over time. Women in the ICBT group were less satisfied with the treatment (OR 4.5). The treatment had no impact on or worsened their childbirth fear (OR 5.5). There were no differences between the groups regarding birth experience.
Women's birth preferences fluctuated over the course of pregnancy and after birth regardless of treatment method. Women felt their fear was reduced and were more satisfied with face-to-face counselling compared to ICBT. A higher percentage were lost to follow-up in ICBT group suggesting a need for further research.
分娩恐惧是无医学指征要求剖宫产最常见的潜在原因。这项随机对照研究的目的是调查接受分娩恐惧治疗的女性的分娩偏好，并调查分娩经历及对所分配治疗的满意度。
在一家大学医院和两家地区医院，一年内招募了分娩恐惧分类（分娩恐惧量表得分≥60）的孕妇（n = 258）。参与者被随机（1:1）分为干预组（基于互联网的认知行为疗法（ICBT））（n = 127）或标准护理组（面对面咨询）（n = 131）。在妊娠第20 - 25周（基线）、第36周和产后两个月通过问卷收集数据。
ICBT组剖宫产偏好从34%降至12%，咨询组从24%降至20%。产后两个月，ICBT组剖宫产偏好增至20%，咨询组增至29%，且随时间无统计学显著变化。ICBT组女性对治疗的满意度较低（比值比4.5）。该治疗对她们的分娩恐惧没有影响或使其恶化（比值比5.5）。两组在分娩经历方面无差异。
无论治疗方法如何，女性的分娩偏好在孕期及产后都会波动。与ICBT相比，女性感觉面对面咨询使她们的恐惧减轻且更满意。ICBT组失访率更高，表明需要进一步研究。
