Effect of Cognitive-Behavioral Therapy Focused on Self-esteem on Fear of Childbirth: A Counseling Approach in Prenatal Care and a Randomized Clinical Trial

Objectives: This study aimed to evaluate the effect of cognitive-behavioral therapy focused on self-esteem (CBT-S) on fear of childbirth in nulliparous women. Materials and Methods: In this randomized clinical trial, 24 nulliparous women willing to cesarean section delivery referred to Milad hospital, Tehran, Iran, between July to August 2015 were enrolled with a convenient sampling method. Participants were assigned into two CBT-S and control groups (24 in each group) using randomized blocks of 4. Seven sessions were performed for the CBT-S group, but the control group received routine prenatal classes. FOC was assessed using Harman’s childbirth attitudes questionnaire. The Rosenberg self-esteem scale was used to assess self-esteem at the beginning of the study. Two weeks after the intervention, both groups filled out the FOC and self-esteem questionnaire. Results: The mean score of fear at the end of the study in the CBT-S and control group was significantly different (P=0.001). Also, self-esteem scores increased after intervention in the CBT-S counseling group (4.77 ± 4.07vs -1.79 ± 2.26; P=0.001). Conclusions: This study confirms the importance of the CBT-S approach focusing on self-esteem in reducing FOC.