So I've gotten a copy of the study. First, some background: In
Sweden, excessive fear of labor is recognized as being a problem
worthy of diagnosis and treatment. Nearly all obstetric departments
refer women to clinics for counseling if women express extreme fear
of labor. This study surveyed 2662 women at 16 wks of pregnancy and
2 mos afterward. They compared 3 groups: A: 47 women with extremely
negative feelings at 16 wks who got counseling, B: 50 similar women
who didn't, and C: 193 women who didn't have negative feelings at
16 wks but who had counseling (presumably they developed anxiety
later) with group D: 2372 women who neither had negative feelings
nor got counseling. Here are the important results:
* As the news summary noted, women who had negative feelings and
got counseling were more likely to have elective c/secs but be more
satisfied with the birth than women who didn't get counseling.
But there's more to it:
* Women who had negative feelings and didn't get counseling were
twice as likely to have c/secs in labor as any of the other groups
(16% vs 8%). This did not reach statistical significance probably
because the numbers are too small to detect even a doubling of
* Counselling worked. Significantly fewer women who said they
preferred a c/sec at the time of the survey had an elective c/sec.
In group A, at 16 wks, 56% wanted an elective c/sec, but only 30%
had one. In group C the percentages were 18% vs 14%. In the two
groups together, rates were 24% vs 17%.
* My calculation revealed that c/sec rates didn't change very much
in any group. This was a mixed parity group. In group A, 30% of
women had a c/sec in a prior pregnancy vs 38% in this pregnancy. In
group B, 22% had a c/sec in a prior pregnancy vs 20% in this
pregnancy. In group C rates were 19% vs 21%, and in group D the
rates were 11% vs 13%. (Note that it was assumed that women with a
prior c/sec would plan vaginal birth this time, not at all like it
is in the U.S.)
A thought comes to mind: First, in Group A, 9 of 47 women had a
previous c/sec and 14 had an elective c/sec while in group B 34 of
193 had a prior c/sec and 27 had an elective c/sec in this
pregnancy. It is possible that the combination of prior c/sec and
negative feelings about labor would be more likely to tilt the
decision toward elective repeat c/sec.
I'm not sure what the implications are, but group C, which is much
bigger than group A or B, has a different profile. At the time of
the survey, only 18% wanted an elective c/sec vs 56% of group A and
42% of group B. Group A then had a 30% elective c/sec rate vs a 14%
rate in group C. For comparison, the elective c/sec rate in group
B, the negative feelings-no counseling group, was 4%, and it was 5%
in group D, the no negative feelings-no counseling group.
Citing earlier and current studies done in England and Sweden, the
authors comment that the incidence of anxiety about labor may be
rising. Unlike here, however, they want to treat this problem, not
just send women off to surgery.
Take-home message: Women who have extreme fear of labor should be
identified and undergo counseling. They will then be able to make a
truly informed decision about birth route.
-- Henci By: Henci Goer