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Table 1 Key elements of the PRIME counselling intervention on which BELIEF is based[35]

From: Study protocol for reducing childbirth fear: a midwife-led psycho-education intervention

Strategy Key elements of intervention
Therapeutic connection between midwife and woman. Show kindness; affirm competence of the woman, simple non-threatening open questions about the birth, attentive listening and acceptance of the woman’s perspective.
Accept and work with women’s perceptions. Prompt the woman to tell her own story, listen with encouragement but not interruption.
Support the expression of feelings. Encourage expressions of feelings by open questions, actively listening, reflecting back the woman’s concerns.
Filling in the missing pieces Clarify misunderstandings, offer information, answer questions realistically and factually, ask questions about key aspects to check understanding. Do not defend or justify care provided.
Connect the event with emotions and behaviours. Ask questions to determine if the woman is connecting current emotions and behaviours with prior birthexperiences. Acknowledge and validate emotions. Gently challenge and counter distorted thinking such asself-blame and a sense of inadequacy, Encourage the woman to see that inappropriate or hasty decisionsmay be a reaction to the birth.
Review prior labour management. Ask if the woman felt anything should have been done differently during labour. Offer new or more generous or accurate perceptions of the event. Realistically postulate how certain courses of action may have resulted in a more positive outcome. Acknowledge uncertainty.
Enhance social support. Initiate discussion about existing support networks. Talk about ways to receive additional emotional support. Help the woman understand that her usual support people may be struggling with their own issues.
Reinforce positive approaches to coping. Reinforce comments by women that reflect a clearer understanding of the situation, plan for the way forward or outline positive action to overcome distress. Counter oblique defeatist statements.
Explore solutions. Support women to explore and decide upon potential solutions, e.g., support group(s), further one-to-one counselling, seeking specific information.