Nerum, H., Halvorsen, L., Sorlie, T., & Olan, P. (2006). Birth, 33, 221-228.

The number of women requesting a cesarean section is escalating. This descriptive study conducted in Norway examined the effect of an individual, crisis-oriented intervention on women's fear of birth and decision to give birth vaginally. The sample included 86 pregnant women referred for counseling who had a fear of birth with a concurrent request for planned cesarean birth (accounting for 2% of deliveries from 2000-2002). Fear of birth was accompanied by psychosocial problems in most women, including anxiety or depression (90%), eating disturbances (43%), and abuse (63%). Of the 73 multiparous women, 69 (95%) had experienced one or more previous births as traumatic. The psychosocial counseling team consisted of two experienced midwives with additional training in mental health and a senior obstetric consultant and a social worker. The mean number of consultations per woman was 3.5 (range 1-10), and the mean duration of the intervention was 5.1 hr (range 1-15). After the intervention, 74 women (86%) changed their thinking about mode of birth and prepared themselves for vaginal birth. The 12 women who maintained their original request for a planned cesarean had untreated psychiatric disorders and symptoms consistent with posttraumatic stress disorder. A follow-up survey conducted 2 to 4 years later indicated that most women were satisfied with the counseling service and were happy with their choice of mode of birth. These results may be affected by nonresponse bias, however, because only 59 women responded to the questionnaire. Results should be generalized with caution because of the highly specialized convenience sample. The results of this study suggest that individual counseling may assist women in working through causes of their fear of birth, resulting in changing their request for a cesarean delivery. Testing the effectiveness of this type of intervention using a randomized controlled trial is warranted.

Maureen Heaman