Single Session Therapy as a useful intervention to support women who declare fear of childbirth in a first pregnancy

In today’s article we propose a study carried out in Great Britain in 2021 which aimed to evaluate the feasibility and acceptability of an Acceptance and commitment therapy (ACT) intervention, a single-session cognitive behavioral therapy (Hayes & Hofmann, 2017) designed to help women manage the fear of childbirth during their first pregnancy .

The fear of childbirth.

Worry and fear of childbirth are widespread phenomena, especially among women who are experiencing this type of experience for the first time. However, a recent meta-analysis estimated that 14% of women worldwide experience significant fear of childbirth (O’Connell et al., 2017). This fear can have several implications for women , children and health services , including the increased use of:

• of health care (Andersson et al., 2004);
• of caesarean sections (Waldenström et al., 2006);
• and epidural analgesia a priori (Van den Bussche et al., 2007);
• as well as negative birth experiences, birth trauma, lower rates of breastfeeding, and increased risk of postnatal depression and post-traumatic stress disorder (Ayers & Ford, 2016; Veringa et al., 2016).

 

 What are the consequences of this phobia?

Research suggests that women who have a phobia of childbirth:

• receive significantly greater amounts of psychotropic drugs (Nordeng et al., 2012);
• experience greater difficulties with attachment to their baby (NHS London Clinical Networks, National Health Service (NHS) London Clinical Networks, 2018) and are more likely to delay or not become pregnant again (Sydsjö et al., 2013);
• exposure to maternal distress both before and after birth can negatively influence children’s development (Schetter & Tanner, 2012);
• The presence of prenatal depression and anxiety is associated with an increased risk of emotion regulation difficulties (Glasheen et al., 2010; Leis et al., 2014) and social behavior problems among children (Field, 2010).
• Finally, adverse perinatal mental health outcomes impact children’s cognitive development (Evans et al., 2012) and may contribute to poor growth (Lampard et al., 2014).

  

What are the constructs underlying this phobia?

From a study conducted to identify the key constructs underlying women’s fears , the following were found:

• fear of the unknown;
• fear of injury and pain;
• concerns about their bodies’ ability to give birth, loss of control, and limited support from healthcare providers (Sheen & Slade, 2018).

Childbirth uncertainty together with pain catastrophizing are predictors of childbirth fear (Rondung et al., 2019). Uncertainty intolerance is also described as a type of cognitive bias that can influence how a person perceives, interprets and responds cognitively, emotionally and behaviorally to uncertain situations in general (Robichaud & Dugas, 2012), leading to controlling and/or avoiding difficult emotions, thoughts and sensations (Birrell et al., 2011).

  

How is this discomfort managed at a healthcare level?

In the UK for example, assessments of fears of childbirth are not required (Richens et al., 2015) and guidelines only recommend asking about anxiety and depression (National Institute for Health and Care Excellence [NICE], 2014). In general, antenatal care interventions have been found to be heterogeneous (O’Brien et al., 2017) and this appears to be due in particular to the lack of integration between maternity and psychiatry/psychology disciplines and the limited funding allocated to perinatal mental health.

 

 Ce cos’è l’Acceptance and commitment therapy (ACT)?

ACT is a cognitive behavioral therapy that focuses on the relationship between a person’s thoughts and emotions rather than the content and styles of thinking (Hayes & Hofmann, 2017). The therapy offers techniques that develop mindfulness skills with the practice of self-acceptance to help people engage with difficult thoughts and emotions in more helpful ways. This is further facilitated by engaging in actions that help facilitate the experience and embrace challenges (rather than avoid them).

  

Why is ACT an effective intervention with women?

ACT advocates a courageous willingness (also referred to as acceptance) to be present with feelings of uncertainty during pregnancy, combined with actions aimed at living a rich and meaningful life through valued activities (Hayes & Smith, 2005). Higher levels of acceptance have been found to be related to better adjustment and quality of life (Pakenham & Fleming, 2011).

  

Participants

Thirty-three expressions of interest were received, 21 women enrolled, 15 participated, and 11 completed follow-up measures.

  

Search procedure

Women participated in a single-session ACT intervention lasting up to 3 hours . The session was available to a maximum of 12 women per session. After introductions and informed consent, women completed questionnaires covering both emotional aspects ( fear of childbirth, anxiety and well-being ) and potential mechanisms for change ( uncertainty and values ). Throughout, time was provided for embedded experiential learning exercises, opportunities for women to ask questions and share reflections. Time was also provided to discuss the application of ACT skills in daily life. Finally, women were interviewed and provided with a copy of the presentation and self-help toolkit. Additional support was provided by the midwife consultant if required. Two weeks after the session, women were contacted to repeat the assessment questionnaires.

 

 Results

The results demonstrated clinical and statistical reductions in fear of childbirth and anxiety along with positive feedback on the intervention. Intolerance of uncertainty and well-being was low at baseline and remained unchanged. For a more in-depth study of the research data.

  

Conclusion

A single-session ACT intervention has been shown to be potentially acceptable and feasible in supporting women to cope with the uncertainties of childbirth in a first pregnancy. This study has demonstrated preliminary signs of positive treatment, with reductions in fear of childbirth and anxiety along with an increase in activities that can enrich the woman’s life. This aspect highlights an important role played by single-session interventions in the phases of prevention .

 

 

Angelica Giannetti
Psychologist, Psychotherapist
Team of the Italian Center
for Single Session Therapy

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