Responding to fear of childbirth

New work on anxiety offers insight into the importance to women of being listened to, and establishing some common ground between the "pro" and "anti" camps about caesarean section. Anxiety has been associated with pregnancy complications,9 emergency caesarean section in labour,10 postnatal depression, and impaired bonding.11 Attention has focused on early identification of anxiety, intervention, and effective treatment. In a recent randomised trial by Terhi Saisto and colleagues,12 178 anxious low-risk women with no contraindication to vaginal delivery were identified, either by request for caesarean section or a specific screening questionnaire. The intervention included three additional 45-min appointments for cognitive therapy with a trained obstetrician, a 90-min appointment with the midwife, and visits to the ward for practical information. Of the 117 women who initially requested caesarean section, 62% chose to deliver vaginally; there was a decrease that was not statistically significant in elective caesarean section for psychosocial reasons in the intensive versus the conventional groups (24% vs 29%). Intention-to-treat analysis showed lower birth concerns, lower pregnancy-anxiety scales, and shorter labours (6-8 vs 8'5 h, p=0039) in the intensive therapy group. The group of women avoiding the intervention had the highest caesarean section rate. Although this was a small trial it shows that anxiety reduction is associated with shorter labour.