Therapy for childbirth fears may up C-section rate

NEW YORK, June 8 (Reuters) Pregnant women who receive counseling to ease their fear of giving birth may elect to have a cesarean section more often than other women, a Swedish study suggests. Whether that's a good or bad thing is an open question.

Some experts believe C-sections, which result in longer recovery times and hospital stays, should be performed only when medically necessary. But if an elective C-section helps a particularly anxious woman have a more positive birth experience, then it may be worthwhile, according to Dr Ulla Waldenstrom of the Karolinska Institute in Stockholm, the lead author of the new study.

Among the nearly 2,700 pregnant women the researchers followed, about 10 per cent reported ''very negative'' feelings about the prospect of labor and delivery. Of these women, those who received counseling for their worries were more likely to end up having a C-section than other women were.

But they also tended to feel better about their childbirth experience than women who had feared labor but received no counseling.

''Considering that counseling and the associated higher C-section rate was associated with a more normal birth experience, I think the higher C-section rate was justified,'' Waldenstrom told Reuters Health.

She and her colleagues report the findings in the medical journal BJOG.

Sweden is one of the few countries where fear of childbirth is recognized as a potentially serious problem of pregnancy.

Women who voice such worries are routinely referred for counseling, typically with a midwife who consults with the obstetrician, a psychologist and sometimes a psychiatrist.

The point is to ease women's fears as they approach their due date, but the current findings suggest that the counseling may facilitate some women's preference for a C-section.

Among patients who received therapy for their childbirth fears, 30 per cent had an elective C-section, compared with 4 percent of women who'd expressed fear about labor and delivery but received no counseling.

Women in this latter group were, however, more likely to need an emergency C-section, and they tended to have a dimmer view of their childbirth experience. Thirty per cent said they had ''negative'' or ''very negative'' feelings, whereas only 5 per cent of women who received counseling felt that way.

A C-section is major surgery, and while complication rates are low, the risks include hemorrhaging, infection and placental implantation problems in future pregnancies. There are also potential risks to the newborn, including accidental cuts during the surgery and breathing problems soon after birth.

However, Waldenstrom pointed out that a negative childbirth experience, whatever the mode of delivery, is also a concern.

It may have a lasting effect on a woman's emotional well-being, she said, possibly increasing the risk of depression during the next pregnancy, or discouraging a woman from having another child at all.

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