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Post-traumatic stress disorder (PTSD) after childbirth causes severe and lasting effects. Screening of childbirth experience may expedite early PTSD recognition. Systematic reviews have not provided consensus on how and when to measure childbirth experience and the clinical implications of such measurements. We aimed to identify a reliable and simple scale for screening the childbirth experience with minimum risk of missing PTSD. This cohort study evaluated the childbirth experience of 1527 unselected women with Wijma Delivery Experience Questionnaire (W-DEQ-B), Delivery Satisfaction Scale (DSS), and Visual Analogue Scale (VAS). VAS was measured first <1 week (VAS1) and then, together with the other scales, a few months after childbirth (VAS2). The scales' ability to identify PTSD (measured with Traumatic Event Scale) was evaluated and compared with receiver operating characteristic (ROC) analysis. Diagnostic accuracy and clinical usefulness were used to suggest cutoff values for scales. W-DEQ-B showed highest recognition of partial or full PTSD (area under the ROC curve 0.96 in W-DEQ-B, 0.92 in VAS2, 0.91 in DSS and 0.82 in VAS1). All included scales recognized partial or full PTSD well. Although W-DEQ-B performed best, VAS (measured twice) with cutoff value of 50 mm is most suitable for screening in clinical circumstances. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy.Material and Methods: This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85-168 days of gestation). Primary outcome measures were the incidence of registry-identified fear of childbirth and cesarean delivery related to it.Results: The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not.Conclusions: One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth. [ABSTRACT FROM AUTHOR]

Objective Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. Design Randomized controlled trial. Population A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W- DEQ) during the first trimester. Setting Finland, data from obstetrical patient records and questionnaires. Methods Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand ( n = 240). Main outcome measures All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). Results The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005). Conclusions Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment. [ABSTRACT FROM AUTHOR]