Interventions for fear of childbirth, including fear of pregnancy

O'Connell MA, Khashan AS, Leahy-Warren P, Stewart F, O'Neill SM Interventions for fear of childbirth, including pregnancy phobia. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD013321. doi: 10.1002 /14651858.CD013321.pub2. Accessed July 31, 2021.

Commentary

This study was designed to investigate the effectiveness of non-pharmacological interventions to reduce fear of childbirth (FOC) compared to standard maternity care in pregnant women with high to severe FOC, including pregnancy phobia.

The primary outcome was a review of seven studies with a total of 1357 participants. Interventions in these studies included psychoeducation, cognitive behavioral therapy, group discussion, peer education, and art therapy.

In four studies, the risk of bias due to concealed assignment was determined to be unclear, and three studies were judged to be at high risk in view of incomplete outcome data.

Participation in a non-pharmacological intervention may reduce the level of fear of childbirth as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful.

It is also possible that non-pharmacological interventions may reduce the number of women who have a cesarean section.

There may be no difference at all between non-pharmacological intervention and usual care in depression scores as measured by the Edinburgh Postnatal Depression Scale (EPDS).

Non-pharmacological interventions may result in fewer women preferring cesarean section and may increase epidural use compared to usual care, but there is also the possibility of a small decrease in epidural use in the 95% CI.

The authors conclude that

In terms of reducing fear, the effect of non-pharmacological interventions on womenwith high to severe fear of childbirth becomes uncertain, and although fear of  childbirth as measured by the W-DEQ may be reduced, it is not certain that this represents a meaningful clinical reduction in fear.

There may be little or no difference in depression, but there may be a reduction in cesarean deliveries. Future trials should recruit a sufficient number of women to measure their satisfaction and anxiety during childbirth.