Effectiveness of Cognitive Behavioral Therapy and Communication Techniques Training on Fear of childbirth, Childbirth Experiences and Postpartum Depression in Nulliparous Pregnant Women

Abstract

Abstract Background: Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS) and the importance of education and counseling among primigravida women in preventing elective CS, the present study aimed at evaluating the effect of cognitive-behavioral therapy (CBT) and communication techniques training on the FOC, childbirth experience and postpartum depression (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women. Methods: This randomized clinical trial was conducted on 99 primigravida women in Tabriz. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n=33) received eight group sessions of CBT from 24-28 weeks of gestation and the other intervention group (n=33) received communication techniques training during five sessions once a week. The control group (n=33) received routine prenatal care. The data were collected using Wijma Delivery Expectancy/Eperience Questionnaire (A, B), Edinburgh Postpartum Depression Scale, and Childbirth experiences Questionnaire version 2.0. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded. The ANCOVA after adjusting the stratified factor was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. The ANCOVA after adjusting the stratified factor was used after the intervention to compare the mean scores of childbirth experience among the three groups. The ANCOVA after adjusting the stratified factor was used before the intervention and ANCOVA after adjusting the effect of base line score, and stratified factor, after the intervention to compare the mean scores of depression among the three groups. Further, chi-square test was applied to compare the intended and final birth method. Results: The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth. The means (SDs) of FOC in the communication techniques training group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively. The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P<0.001). The mean score of childbirth experience in the CBT and communication techniques training groups was 70.67 (13.70) and 70.63 (14.48), respectively, which was more than that in the control group 61.63 (14.11) (p=0.012). However, no statistically significant difference was observed between the intervention groups (P=1.000). There wasn't significant difference in the mean score of postpartum depression among CBT 7.59 (3.03), communication techniques training 7.47 (4.49), and control 9.71 (3.05) groups (P=0.099). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P=0.278), and final birth method (P=0.107). Conclusion: The findings of the present study revealed that both CBT and communication techniques training reduced FOC and improved the childbirth experience, but did not affect postpartum depression. Also there was no statistically significant difference among the three groups in terms of the intended birth method and final birth method. Considering the lack of significant difference between the CBT and communication techniques training groups in terms of childbirth experience and given that communication techniques training is employed by midwives with no need for CBT counseling skills and can be presented in fewer sessions than CBT, it can be used as a preferred intervention approach by midwives in the care of pregnant women with FOC to improve the childbirth experience.