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Mother of All Fears

Therapy can help women overcome fear of childbirth, a new study shows

FRIDAY, Nov. 2, 2001 (HealthDayNews) -- For many women, the idea of natural childbirth is one of excited anticipation. For others, the mere thought of delivering a baby induces a sense of panic so strong it can affect the entire course of the pregnancy.

Obstetricians who recognize their patients' fears -- and offer nervous moms-to-be even minimal counseling -- can make a big difference in the health and safety of the delivery for both mother and child, a new study published in the journal Obstetrics and Gynecology says.

Among the most significant effects of such counseling, say study authors, is a clear reduction in prolonged labors and, particularly, medically unnecessary Caesarean births.

"Earlier research has been estimated that six to 10 percent of pregnant women suffer from fear of childbirth. . . and the number of women requesting a Caesarean section delivery because of their fear of vaginal childbirth has increased over the years," says study author Dr. Terhi Saisto, a clinical researcher at the Helsinki University Central Hospital in Finland.

One reason for the increase, says Saisto, is a change in societal structure, with a loss of a family support system that helped many women face labor and delivery with less fear.

"First-time mothers feel lost and lonely. They can't face the normal crisis of pregnancy, labor and maternity alone," Saisto adds. The major fear, says Saisto was "that of losing control of the situation. This involves fear of intolerable pain and fear of the unknown."

For many of these women, the study showed, education was key to calming fears.

"Oftentimes all a woman needs is some reassuring information about things she's worried most about, such as the use of pain medications during labor," says Dr. Shari Lusskin, a reproductive psychiatrist specializing in the treatment of pregnant and infertile women.

Discovering there are safe alternatives for mother and baby can sometimes be a big help in overcoming childbirth fears, Lusskin, an associate professor of psychiatry at New York University Medical Center, says.

For women, for instance, with a high level of depression or anxiety before becoming pregnant, education alone is not enough. For these women, some form of psychological counseling was essential, the study showed.

"If you go into a pregnancy depressed or anxious, you will come out being depressed and anxious. So treatment was important not only to help these women get through labor and delivery with fewer problems, but also help them begin motherhood with a much healthier frame of mind," says Lusskin.

The research initially involved 176 otherwise-healthy expectant mothers. They were all sent to the researchers because of an expressed fear of a vaginal delivery.

The women were randomly assigned to one of two groups -- those who would receive traditional obstetrical treatment, and those who would receive what doctors called "intensive" treatment. This included a combination of medical care and psychological counseling. All treatments were administered by a single obstetrician and a midwife.

During the course of their care, the women were asked to fill out three questionnaires -- two during the pregnancy and one during the postpartum period. All questionnaires were designed to root out undiagnosed depression and anxiety, while the postnatal questions also included information about the labor and delivery and satisfaction with childbirth.

Of the 176 women who started the study, only 112 chose to answer all three questionnaires -- an issue that became part of the final analysis.

When questionnaires were reviewed and results tabulated, it was clear that birth-related concerns decreased in the group who underwent intensive therapy, while they increased in those who had only traditional obstetrical care. The overall length of labor was also reduced by at least two hours for the group who got the intensive therapy, compared to those who had traditional care.

Sixty-two percent of the women in both groups who requested a Caesarean delivery at the start of the study ended up having a vaginal delivery. Of those who refused to answer all three questionnaires, Caesarean deliveries were much higher: 57 percent compared to 27 percent.

Overall, says Saisto, the group that experienced the intensive therapy had far fewer anxieties about pregnancy and birth. They also had shorter labors.

Lusskin wasn't surprised at the results. "This was a well-done study, with a conclusion that matches what we see clinically -- therapy can help women overcome fears of childbirth and, in doing so, can very often help prevent some of the complications these women fear most," she says.

What To Do

Although Lusskin and Saisto both say that psychological counseling during pregnancy can go a long way in reducing complications, they also say that few obstetricians address their patients' psychological needs. Both urge women to be forthcoming about their fears and talk to their doctor.

"Ask for help. It is possible to reduce the fear and anxiety so that the normal childbirth becomes acceptable," says Saisto.

For more information on dealing with fears of childbirth, visit the University of Iowa Health Care Center .

To learn more about labor and delivery and the pain therapies available to help you cope, try the Society for Obstetric Anesthesia and Perinatology.

SOURCES: Interviews with Terhi Saisto, M.D., clinical researcher, Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland; Shari Lusskin, M.D., associate professor of psychiatry, New York University Medical Center; Nov. 1, 2001, Obstetrics and Gynecology
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