Maternal request for cesarean section due to fear of birth: can it be changed through crisis-oriented counseling?

Abstract

Background: A psychosocial team was established to meet the needs of an increasing number of pregnant women referred for fear of birth who wished a planned cesarean. This study describes the intervention, the women's psychosocial problems in relation to degree of fear of birth, changes in their wishes for mode of birth and birth outcome, women's satisfaction with the intervention, and their wishes for future births.

Methods: The study sample comprised 86 pregnant women with fear of birth and a request for planned cesarean, who were referred for counseling by a psychosocial team at the University Hospital of North Norway in the period 2000-2002. Data were gathered from referral letters, from antenatal and intrapartum care records, and from a follow-up survey conducted 2 to 4 years after the birth in question.

Results: Fear of birth was accompanied by extensive psychosocial problems in most women. Ninety percent had experienced anxiety or depression, 43 percent had eating disturbances, and 63 percent had been subjected to abuse. Twenty-four percent of those with psychiatric conditions had previously been in treatment. After the intervention, 86 percent changed their original request for cesarean section and were prepared to give birth vaginally. The follow-up survey confirmed long-term satisfaction with having changed their request for a cesarean delivery. Of these, 69 percent gave birth vaginally and 31 percent were delivered by cesarean for obstetrical indications.

Conclusions: Impending birth activates previous traumatic experiences, abuse, and psychiatric disorders that may give rise to fear of vaginal birth. When women were referred to a specialist service for fear of birth and request for cesarean, they became conscious of, and to some degree worked through, the causes of their fear, and most preferred vaginal birth. They remained pleased with their choice later.