Therapy can help fearful mothers avoid C-sections

Group therapy can help women avoid risky and costly cesarean sections, especially first-time mothers fearful of childbirth, according to a new study from Finland.

While nearly half of first-time mothers with an extreme fear of childbirth opted for C-sections before counseling, researchers found, only about a third ended up choosing C-sections after attending therapy sessions.

"Our study showed that group counseling is a very effective way to treat first-time mothers with intense fears of childbirth, in order to decrease the number of C-sections and to have more satisfactory delivery," lead study author Dr. Hanna Rouhe, clinical researcher at the Helsinki University Centralö Hospital, told Reuters Health.

"Many of these women with severe fear of childbirth don't come to any maternity clinic for consultation, they just come to deliver with all the anxiety and fear, so there will be problems in delivery," Rouhe said.

Previous research has shown that giving expectant mothers a forum to voice their fears reduced C-sections, but the Finnish researchers said their randomized clinical trial of a formal intervention to address those fears was a first.

C-section is the most common surgery in the U.S., and accounted for a third of deliveries in 2010, according to the Department of Health and Human Services.

The C-section rate in Finland is half that of the U.S. Still, several medical groups have expressed alarm at the generally high number of C-sections performed in western countries, because the procedure both increases a woman's risk of bleeding, infection and infertility, and incurs higher medical costs.

It's been estimated that between six percent and 10 percent of C-sections may be scheduled by women with extreme fear of childbirth, according to the Finnish team.

"This study raises the issue that maybe we should pay more attention to why women are opting for primary cesarean sections," said Dr. Laura Riley, an obstetrician who specializes in high-risk pregnancies at Massachusetts General Hospital in Boston and was not involved in the new study.

A number of initiatives aim to reduce the first cesarean section by waiting longer to induce labor and by allowing longer delivery times before C-sections are offered, she noted. But, Riley wrote in an email, "I am not aware of initiatives surrounding childbirth fear - maybe there should be."

Most hospitals include childbirth counseling in standard prenatal care, but when obstetricians discuss the C-section option, they give unsatisfactory treatment by not addressing any underlying fears, the Finnish researchers conclude.

For their study, which is published in the British obstetrics and gynecology journal BJOG, the team used a standard psychological questionnaire to screen a total of 4,575 first-time expecting mothers for fear of childbirth or a strong desire for C-section, and identified 371 with a severe fear of vaginal birth.