Miedo grave al parto: Sus rasgos, evaluación, prevalencia, determinantes, consecuencia y posibles tratamientos

The review summarizes the relevant literature regarding fear of childbirth. A substantial number of (pregnant) women are more or less afraid of childbirth and a significant minority; report a severe fear of childbirth. The focus will be on definition problems, its features, prevalence, assessment methods and measurements, determinants, consequences and treatment methods. To date, there is still no consensus about the exact definition of severe fear of childbirth. However, there is agreement that women with severe fear of childbirth are concerned about the well-being of themselves and their infants, the labor process, and other personal and external conditions. In studies on prenatal anxiety and fear of childbirth, various kinds of diagnostic methods have been used in the past. Recently, there is a consensus to determine severe fear of childbirth by using the Wijma Delivery Expectancy/Experience Questionnaire. The aetiology of fear of childbirth is likely to be multi-factorial and may be related to more general anxiety proneness, as well as to very specific fears. Furthermore, pregnant women are influenced by the many healthcare professionals, such as midwives, nurses, gynaecologists, therapists and pregnancy counselors and the interactions with them. Trying to design a universal treatment for fear of childbirth will not likely be the ultimate solution; therefore, future research is needed into multidisciplinary treatment and predictors to establish which therapies at the individual level are most effective and appropriate.La reseña resume la literatura relevante en cuanto al miedo al parto. Un número considerable de mujeres (embarazadas) tienen cierto miedo al parto y una minoría significativa demuestra miedo grave al parto. El foco será en la definición del problema, sus rasgos, prevalencia, métodos de evaluación y mediciones, determinantes, consecuencias y métodos de tratamiento. Todavía no hay consenso sobre la definición exacta del miedo grave al parto. Sin embargo, todos están de acuerdo que las mujeres con el miedo grave al parto están preocupadas por su bienestar y por el bienestar de sus hijos, por el proceso del parto y otras condiciones personales y externas. En los estudios sobre la ansiedad prenatal y el miedo al parto, diferentes métodos de diagnóstico se usaron en el pasado. Recientemente, existe un acuerdo para determinar el miedo grave al parto usando el Cuestionario de Wijma de expectativa/experiencia de parto. La etiología del miedo al parto parece ser multifactorial y podría relacionarse con la propensión a la ansiedad más general, tanto como con algunos miedos muy específicos. Además, muchos profesionales sanitarios influyen en las mujeres embarazadas, como p. ej. comadronas, enfermeras, ginecólogos, terapeutas y consejeros prenatales. Intentar diseñar un tratamiento universal para el miedo al parto no parece ser la solución final; por lo tanto, se necesitan investigaciones futuras en el tratamiento multidisciplinario y predictores que establecerían qué terapias al nivel individual son las más eficaces y apropiadas

Resistance to fear of child birth and stability of mother-child bond

In order to examine (1) the stability of the mother-child-bond and (2) associations between mother-child-bonding and aspects of maternal-well-being, pregnant women (N = 170) completed measures on well-being and mother-child-bonding at two antepartum and two postpartum time points. We found relatively weak associations between mother-child-bonding at 20 weeks of gestation and mother-child-bonding at 6 months postpartum. Fear of childbirth was weakly, but statistically significantly associated with mother-child-bonding at 6 weeks (but not at 6 months) postpartum. Correlations between antepartum general well-being and social support, on the one hand, and mother-child-bonding, on the other, failed to reach statistical significance. Women with a partner had a better mother-child-bonding at 36 weeks of gestation and 6 months postpartum, than women without a partner, and older women had better mother-child-bonding at 20 weeks of gestation, than younger women. Our findings thus suggest that mother-child-bonding is not a very stable phenomenon, but it is quite robust against potential negative influences of poor maternal mental health.Funding Agencies|Dutch Working Group of Psychosomatic Obstetrics and Gynaecology [2]; Dutch Association of Haptotherapists [1]</p

Treatment of severe fear of childbirth with haptotherapy: design of a multicenter randomized controlled trial

Background: About six percent of pregnant women suffer from severe fear of childbirth. These women are at increased risk of obstetric labour and delivery interventions and pre- and postpartum complications, e.g., preterm delivery, emergency caesarean section, caesarean section at maternal request, severe postpartum fear of childbirth and trauma anxiety. During the last decade, there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women. The present study has been designed to evaluate the effects of such intervention. Methods/Design: Included are singleton pregnant women with severe fear of childbirth, age greater than= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction. Discussion: The treatment, a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology

Treatment of severe fear of childbirth with haptotherapy: design of a multicenter randomized controlled trial

Background: About six percent of pregnant women suffer from severe fear of childbirth. These women are at increased risk of obstetric labour and delivery interventions and pre- and postpartum complications, e.g., preterm delivery, emergency caesarean section, caesarean section at maternal request, severe postpartum fear of childbirth and trauma anxiety. During the last decade, there is increasing clinical evidence suggesting that haptotherapy might be an effective intervention to reduce fear of childbirth in pregnant women. The present study has been designed to evaluate the effects of such intervention. Methods/Design: Included are singleton pregnant women with severe fear of childbirth, age greater than= 18 year, randomised into three arms: (1) treatment with haptotherapy, (2) internet psycho-education or (3) care as usual. The main study outcome is fear of childbirth. Measurements are taken at baseline in gestation week 20-24, directly after the intervention is completed in gestation week 36, six weeks postpartum and six months postpartum. Secondary study outcomes are distress, general anxiety, depression, somatization, social support, mother-child bonding, pregnancy and delivery complications, traumatic anxiety symptoms, duration of delivery, birth weight, and care satisfaction. Discussion: The treatment, a standard haptotherapeutical treatment for pregnant women with severe fear of childbirth, implies teaching a combination of skills in eight one hour sessions. The internet group follows an eight-week internet course containing information about pregnancy and childbirth comparable to childbirth classes. The control group has care as usual according to the standards of the Royal Dutch Organisation of Midwives and the Dutch Organization of Obstetrics and Gynaecology