Sweden has a very well attended maternal and delivery health-care system, which reaches almost 100% of pregnant women and is free of charge. The expectant mothers receive care at Antenatal Care clinics (ANC) and normally make seven to nine visits to a midwife and, if needed, additional visits with an obstetrician. Nearly all women give birth at a hospital and this service is also free of charge.
The population from which the index- and reference group was selected consisted of all pregnant nulliparous women who attended the ANC clinics and gave birth at one university hospital and one county hospital in the southeast of Sweden during 2001–2007. The average total number of deliveries per year was approximately 2 700 and 800 respectively.
The index group consisted of 608 consecutively recruited nulliparous women who had been referred between 2001 and 2007 by the ANC clinics to the special units at the Departments of Obstetrics and Gynaecology for treatment of severe FOC. The referral implicates that the midwife or the obstetrician at the ANC clinic did not succeed in treating the woman’s fear. All women were assessed by the obstetrician in charge with a semi-structured diagnostic interview in order to determine the severity of the phobia, and they were then scheduled to treatment by a staff member at the special unit. The women were diagnosed as having severe FOC according to the DSM-IV criteria: severe phobia with features of both physical and emotional signs such as avoidance, strong fear, anxiety, and panic. The symptoms of a phobia can range from mild feelings of apprehension and anxiety to a full-blown panic attack.
Women who gave birth at other hospitals, moved out of the area or had a late spontaneous abortion were excluded; the average number of exclusions was about 60 per year and thus resulting in an index group of 181 women.
The reference group consisted of 431 women who gave birth during the same period, i.e. the same day as the index woman and were given birth to her first child at the same hospitals. None of the women had had any contact with the special unit of psychosocial obstetrics at the Department of Obstetrics and Gynecology during this pregnancy.
In this presentation we have merged the results from the two hospitals since there were no differences in background data for the participants.
Data were obtained from the women’s medical records at the ANC clinics and the delivery wards. The variables extracted were city of residence, age, BMI, civil status i.e. married/cohabiting or single, occupation, smoking, spontaneous abortion, legal abortion, parity, pregnancy and delivery complications, mode of delivery, duration of active labour (defined as cervix dilated 4 cm to partus). For the index group, we determined and recorded the reasons for their referral to the special unit at the Departments of Obstetrics and Gynaecology, the number of visits, and if they had been treated by one of the staff members educated in psychotherapy i.e. a special trained midwife, an obstetrician and or a psychologist.
The treatment/counselling program is individualized and is based on; psycho-education e.g. determine the woman’s knowledge on childbirth and carefully educate her in relaxation, explain the physiological features of panic and anxiety; cognitive behaviour theory e.g. assess thoughts, measure feelings and discuss avoidance and how to alter the reactions on certain thoughts. For most of the women, an individual visit to the delivery ward was part of the treatment as an exposure for the fear situation. The number of sessions attended by each woman was based on each woman’s individual needs.
The Regional Ethical Review board in Linköping, Sweden approved the study. 2008-11-12. Nr: M 204–08.
All statistical analyses were performed using IBM SPSS Version 19 (Armonk, NY, USA). Statistical analyzes included Pearson’s chi-square in order to test for bivariate differences. Student’s t-test was used to compare mean values. A multiple multinomial logistic regression with mode of delivery as dependent variable where non-instrumental vaginal delivery was set to be the reference level. Independent variables in the model were group, age, BMI, smoking and complications during pregnancy.