Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance

ObjectiveFear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. DesignRandomized controlled trial. PopulationA total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester. SettingFinland, data from obstetrical patient records and questionnaires. MethodsRandomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n=131), or surveillance and referral on demand (n=240). Main outcome measuresAll costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). ResultsThe groups did not differ in total direct costs (Euro3786/woman in psychoeducative group and Euro3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p=0.005). ConclusionsThrough an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment.