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Objective Although wide-spread and appreciated, the benefit of Balint group work has been difficult to determine. Qualitative studies provide new angles for research. The aim of this study is to explore how participants in a Balint group for at least 1.5 years experienced the group work and how they were affected by their participation. Method Focus group interviews were conducted with a total of 19 members of four different Balint groups. The participants were experienced residents or younger specialists in general practice as well as from hospital specialities. A thematic analysis was performed. Results The main themes that emerged were: Investigating emotions, Development of the physician’s identity as well as Safety in the group and with the leader. The participants reported relief from stress as well as increased ability to understand the emotional side of patient encounters. They struggled to find their identity as doctors and specialists, often gaining a sense of pride in their work and becoming more secure. The group with a certified Balint leader felt like a safe place. Conclusions For younger doctors, participation in a Balint group for at least 1.5 years can help them build their professional identity by means of a deeper understanding of doctor-patient relationships. The role of Balint group work in relation to professional identity warrants further study.

Introduction The Female Sexual Function Index (FSFI) has been validated for use in many countries. It has been used for clinical and research purposes in Sweden, but the reliability and validity of the Swedish version have never been tested. Aim The aim of this study was to investigate the psychometric properties of the Swedish version of the FSFI. Methods After informed consent, 50 women with a diagnosis of hypoactive sexual desire disorder (HSDD) and 58 age-matched healthy volunteers completed the questionnaires. Main Outcome Measures Reliability was tested by Cronbach's alpha and test–retest by Pearson's correlation, convergent validity by correlation of the FSFI and the Sexual Function Questionnaire (SFQ), divergent validity by correlation of FSFI and the Symptoms Checklist-90-Revised (SCL-90-R), and discriminant validity by Student's t-test and chi-square test to assess differences between women with and without HSDD. Results Cronbach's alpha was 0.90–0.96 and test–retest reliability was good (r = 0.86–0.93) for all domains in the whole sample; reliability was low for lubrication and pain in the control group. Correlations between all corresponding domains of the FSFI and the SFQ were high for the whole sample (r = 0.74–0.87) and moderate to high for both the clinical and the control group. There was no correlation between most FSFI domains and the SCL-90-R. Discriminant validity was very good for each of the FSFI domains (P = 0.001, t = 7.05–15.58), although the controls reported relatively low scores on the desire domain. The total FSFI score was 31.37 (standard deviation [SD] 2.66) for the clinical group and 17.47 (SD 5.33) for the controls (P = 0.001, t = 15.99). Conclusion The Swedish version of the FSFI can be used as a validated and reliable instrument for assessing sexual function in women with HSDD.

Background Little is known about the psychological status of partners of women with severe fear of childbirth (FOC). In this longitudinal study from Helsinki University Central Hospital, we investigated FOC, depression, and posttraumatic stress in the partners of women with severe FOC, and possible effects of group psychoeducation and mode of birth.Methods: During pregnancy, 250 partners of nulliparous women with severe FOC participated, 93 in the intervention group and 157 in the control group. At 3 months postpartum, 52 partners in the intervention group and 93 in the control group participated. Both the partners and the childbearing women filled in the Wijma Delivery Expectancy/Experience Questionnaire and the Edinburgh Postnatal Depression Scale mid‐pregnancy as well as 3 months postpartum, when they also filled in the Traumatic Event Scale. Results Partners of women with severe FOC reported less antenatal and postnatal FOC and fewer depressive symptoms than the childbearing women. No partner reached the threshold of severe FOC. No partner reported a possible posttraumatic stress disorder. Group psychoeducation with relaxation was not associated with better or worse psychological well‐being of the partners. An emergency cesarean delivery was associated with a more fearful delivery experience in the partners. Conclusion Partners of nulliparous women with severe FOC neither seem to suffer from severe FOC nor reported posttraumatic stress symptoms after childbirth. They reported better psychological well‐being than the mothers both during pregnancy and after delivery. An unexpected cesarean may be a negative experience even for partners of childbearing women. peerReviewed

Previous studies on the treatment of women with fear of childbirth have focused on the delivery mode. Women with fear of childbirth often suffer from anxiety and/or depression, and treatment therefore also needs to target postnatal psychological well-being and the early mother-infant relationship.Three hundred and seventy-one nulliparous women out of 4575 scored ≥100 in prospective screening (Wijma Delivery Expectancy Questionnaire, W-DEQ-A), indicating severe fear of childbirth. These women were randomised to psychoeducative group intervention with relaxation (n = 131; six sessions during pregnancy, one postnatal) or to conventional care (n = 240) by community nurses (referral if necessary). Psycho-emotional and psychosocial evaluations [Edinburgh Postnatal Depression Scale (EPDS), social support, Maternal Adjustment and Attitudes (MAMA), Traumatic Events Scale (TES) and the Wijma Delivery Experience Questionnaire (W-DEQ-B)] were completed twice during pregnancy and/or 3 months postpartum.Postnatal maternal adjustment (MAMA mean score 38.1 ± 4.3 versus 35.7 ± 5.0, p = 0.001) and childbirth experience (mean W-DEQ-B sum score 63.0 ± 29 versus 73.7 ± 32, p = 0.008) were better in the intervention group compared with controls. In hierarchical regression, social support, participating in intervention, and less fearful childbirth experience predicted better maternal adjustment. The level of postnatal depressive symptoms was significantly lower in the intervention group (mean sum score 6.4 ± 5.4 versus 8.0 ± 5.9 p = 0.04). There were no differences in the frequency of post-traumatic stress symptoms between the groups.In nulliparous women with severe fear of childbirth, participation in a targeted psychoeducative group resulted in better maternal adjustment, a less fearful childbirth experience and fewer postnatal depressive symptoms, compared with conventional care.

Objectives This study set out to compare the prevalence, content and associated factors of fear of childbirth in six European countries. Method A cross-sectional study of 6870 pregnant women attending routine antenatal care in B elgium, I celand, D enmark, E stonia, N orway and S weden (Bidens). Main outcome measure: Severe fear of childbirth, defined as a Wijma Delivery Expectancy Questionnaire score of ≥85. Results Eleven percent of all women reported severe fear of childbirth, 11.4% among primiparous and 11.0% among multiparous women. There were significant differences between the countries for prevalence of severe fear of childbirth, varying from 4.5% in Belgium to 15.6% in Estonia for primiparous women and from 7.6% in Iceland to 15.2% in Sweden for multiparous women. After adjusting for age, education and gestational age, only primiparous women from Belgium had significantly less fear of childbirth, AOR 0.35 (0.19–0.52) compared to Norway (largest participating group). Exploratory factor analyses revealed significant differences between the countries for the six factors extracted. Conclusion FOC appears to be an international phenomenon, existing with similar proportions in the participating European countries, except for primiparous women in Belgium who in our study reported significantly less severe fear of childbirth. Our study suggests that the content of fear of childbirth may differ between countries.

Background: Around 20% of birthing women report high levels of childbirth fear. Fear potentially impacts women’s emotional health, preparation for birth, and birth outcomes. Evidence suggests that personal and external factors contribute to childbirth fear, however results vary. Aim: To identify pyscho-social factors associated with childbirth fear and possible antenatal predictors of childbirth fear according to women’s parity. Method: 1410 women in second trimester and attending one of three public hospitals in south-east Queensland were screened for childbirth fear using the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Other measures included the Edinburgh Depression Scale (EPDS), Decisional Conflict Scale (DCS) and items from the EuroQol (EQ-5D) targeting Anxiety/Depression and Pain/Discomfort. In addition items measuring a previous mental health condition, social support and knowledge were used. Preferred mode of birth was also collected. Psycho-social factors were analysed to determine associations with childbirth fear. Multivariate analysis was used to determine predictors of fear. Results: Thirty-one percent (n = 190/604) of nulliparous and 18% (n = 143/782) of multiparous women reported high fear levels. Having a mental health history, desiring a caesarean section, reporting moderate to high pain during pregnancy, having a non-supportive partner and perceiving less childbirth knowledge than peers, were associated with childbirth fear. Standard multiple regression analyses by parity determined that depression, decisional conflict, low social support and less perceived knowledge predicted levels of childbirth fear. The model explained 32.4% of variance in childbirth fear for nulliparous and 29.4% for multiparous women. Conclusion: Psychosocial factors are significantly associated with childbirth fear. The identification of predictive psychosocial factors for childbirth fear indicates the importance of observing, assessing, and developing support strategies for women. Such strategies are required to decrease anxiety and depression for women during pregnancy, promote normal birth, and build social support to improve women’s feelings and positive expectations of birth.

Objective to describe perceptions of participating in a study testing the effectiveness of a perinatal emotional support intervention (Promoting Resilience in Mothers Emotions; PRIME) by women identified as experiencing emotional distress after birth. Design qualitative descriptive approach. Semi-structured telephone interviews with 33 women recruited as part of a larger RCT to test the efficacy of a counselling intervention (PRIME). Women who received either (1) the intervention (counselling (or PRIME)) ( n =16), (2) active control (Parenting support) ( n =12), or (3) matched control (standard care) ( n =5), were interviewed at 12 months postpartum. Thematic analysis of data was used. Findings ‘promoting reflection' and ‘feeling cared for', were phrases that all participants used to describe their experience in the project regardless of group allocation. Women receiving PRIME reported ‘getting in touch with (their) feelings' and ‘moving on' as beneficial outcomes. Two women who received counselling reported ‘having things left unresolved' indicating that their needs had not been met. Some women in both the active control and intervention identified that contact was ‘nice but not hugely helpful or needed'. Implications and conclusions positive outcomes of PRIME were evident and most participants desired postpartum contact. Some women needed additional follow up and targeted assistance. Findings support the importance of providing personalised postnatal care that addresses women's emotional health needs.

Objectives: This study aims to describe the prevalence of emotional, physical, and sexual abuse and analyze associations with symptoms of depression and posttraumatic stress (PTS) in pregnancy, by ethnic background. Study design: This is a cross-sectional study of the Swedish data from the Bidens cohort study. Ethnicity was categorized as native and non-native Swedish-speakers. Women completed a questionnaire while attending routine antenatal care. The NorVold Abuse Questionnaire (NorAQ) assessed a history of emotional, physical or sexual abuse. The Edinburgh Depression Scale-5 measured symptoms of depression. Symptoms of Posttraumatic Stress (PTS) included intrusion, avoidance and numbness. Results: Of 1003 women, 78.6% were native and 21.4% were non-native Swedish-speakers. Native and non-native Swedish-speakers experienced a similar proportion of lifetime abuse. Moderate emotional and physical abuse in childhood was significantly more common among non-native Swedish-speakers. Sexual abuse in adulthood was significantly more prevalent among native Swedish-speakers. Emotional and sexual abuse were significantly associated with symptoms of depression for both natives and non-natives. Physical abuse was significantly associated with symptoms of depression for non-natives only. All types of abuse were significantly associated with symptoms of PTS for both native and non-native Swedish-speakers. Adding ethnicity to the multiple binary regression analyses did not really alter the association between the different types of abuse and symptoms of depression and PTS. Conclusion: The prevalence of lifetime abuse did not differ significantly for native and non-native Swedish-speakers but there were significant differences on a more detailed level. Abuse was associated with symptoms of depression and PTS. Being a non-native Swedish-speaker did not influence the association much. Author preprint - © 2016. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Objective: The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT). Design: Prospective, longitudinal cohort study.Setting: A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women.Sample: Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013. Methods: The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system. Main outcome measures: Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B). Results: A statistically significant (p Funding agencies: Swedish Research Council for Health, Working Life and Welfare (FORTE); Medical Research Council of Southeast Sweden (FORSS); County Council in Ostergotland (LIO)

Introduction: The rate of cesarean section (CS) for non-medical reasons has risen and it is a concern for health care. Women’s preferences may vary across countries for psychosocial or obstetric reasons. Methods: A prospective cohort study of 6549 women in routine antenatal care giving birth in Belgium, Iceland, Denmark, Estonia, Norway or Sweden. Preference for mode of birth was self-reported in mid-pregnancy. Birth outcome data were collected from hospital records. Results: A CS was preferred by 3.5% of primiparous women and 8.7% of the multiparous women. Preference for CS was associated with severe fear of childbirth (FOC), with a negative birth experience in multiparous women and with depressive symptoms in the primiparous. Women were somewhat more prone to prefer a cesarean in Iceland, odd ratio (OR) 1.70 (1.02–2.83), adjusted for age, education, depression, FOC, history of abuse, previous cesarean and negative birth experience. Out of the 404 women who preferred CS during pregnancy, 286 (70.8%) delivered by CS, mostly for a medical indication. A total of 9% of the cesareans in the cohort had a non-medical indication only. Conclusions: Women’s preference for CS often seems to be due to health concerns. Both medical and psychological factors need to be addressed in antenatal counseling. Obstetricians need to convey accurately to women the risks and benefits of CS in her specific case. Maternity professionals should identify and explore psychosocial reasons for women’s preferences. This is a manuscript of an article published by Taylor & Francis in Journal of Psychosomatic Obstetrics & Gynecology on 08 Jun 2016, available online: http://www.tandfonline.com/doi/full/10.1080/0167482X.2016.1181055

Objectives The aim was to describe women with and without symptoms of post-traumatic stress (PTSS) following emergency caesarean section (EmCS), and how they perceived the support received in connection with the birth of their child. Study design In this qualitative study 42 women with post-traumatic stress syndrome and 42 women without symptoms were interviewed by telephone six months after childbirth. Their responses were analysed using content analysis. Findings The midwives’ action, the content and organisation of care, the women’s emotions, and the role of the family were main categories that seemed to influence the interviewees’ perceptions of support in connection with childbirth. Women with PTSS further mentioned nervous or non-interested midwives, intense fear and feelings of shame during delivery, lack of postnatal follow-up, long-term postpartum fatigue and inadequate help from husbands as influencing factors. Women without symptoms reported involvement in the EmCS decision and a feeling of relief. Conclusions Staff and family members alike have important roles concerning support in connection with an EmCS. Women with PTSS seem to experience less support than women without symptoms.

Objective. To investigate Swedish women’s level of antenatal fear of childbirth at various gestational ages, and factors associated with intense fear and with preference for cesarean section. Design. A cross-sectional study. Setting. All antenatal clinics in four geographical areas. Sample. Thousand six hundred and thirty-five pregnant women at various gestational ages recruited during SeptemberOctober 2006. Method. A questionnaire completed at the antenatal clinic. The women reported their appraisal of the approaching delivery according to the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ). Main outcome measures. The level of fear of childbirth and preferred mode of delivery. Results. Mean W-DEQ score was 62.8. The prevalence of intense fear of childbirth (W-DEQ score ]85) was 15.8% and very intense fear (tocophobia) (W-DEQ score ]100) 5.7%. Nulliparous women had a higher mean score than parous women, but more parous women reported an intense fear. Preference for cesarean section was associated with fear of childbirth (OR 11.79, 6.122.59 for nulliparous and OR 8.32, 4.3615.85 for parous women) and for parous women also with a previous cesarean section (OR 18.54, 9.5535.97), or an instrumental vaginal delivery (OR 2.34, 1.025.34). The level of fear of childbirth was not associated with the gestational age. Conclusions. When a woman requests a cesarean section, both primary fear of birth and traumatic childbirth experiences need to be considered and dealt with. The W-DEQ can be used at any time during pregnancy in order to identify pregnant women who suffer from intense fear of childbirth.

Aim: To investigate the quality of women’s sex life 12–18 months after first, episiotomy-assisted childbirth and risk factors for long-term dyspareunia after childbirth. Methods: Two hundred and six women who gave birth vaginally at the Karolinska University Hospital between September 1997 and February 1998 and from June 1998 to January 1999 received postal questionnaires at 12–18 months postpartum. Obstetrical, psychological and sexological data, concerning 110 primiparae who underwent episiotomy and 153 age-matched women who did not, were compared. Possible risk factors for postpartum dyspareunia were investigated in the entire sample. Results: Women who underwent episiotomy experienced a more complicated and emotionally difficult delivery. They reported a higher frequency of dyspareunia and insufficient lubrication than women who had given birth without episiotomy. Arousal, orgasm and satisfaction with sex were not affected. Episiotomy, perineal lacerations, fundal pressure at delivery and a history of dyspareunia were independent risk factors for dyspareunia 12–18 months postpartum. Conclusion: Episiotomy may affect women’s sex life during the second year post partum with more frequent pain and vaginal dryness at intercourse. Other obstetrical factors and pain history may also influence the propensity for dyspareunia.

Socioeconomic factors and previous experiences of delivery are known to influence pregnant women's fear of childbirth. The aim of this study was to investigate the associations between stable personality traits, fear of childbirth during late pregnancy, and experience of the delivery.Self-report questionnaires were completed twice, during gestation week 34-37, and at 1-week postpartum. Comparisons were made between 85 women who had sought help from a fear-of-childbirth team, and a group (n=177) from routine antenatal care. Correlations between fear of childbirth, personality variables and experience of childbirth were calculated.The women who had sought help tended to be more anxiety-prone, more short-tempered, and lower in socialisation, although within the normal range. In spite of counselling, they reported more intense fear of delivery and fear of pain compared with the comparison group. Women with intense fear of childbirth, who were low in socialisation and high in psychasthenia, had a more negative experience of their current childbirth.Women with intense fear of childbirth differ from other pregnant women also in personality. Methods for treating fear of childbirth should be further developed in order to diminish the risk of a negative birth experience.

Introduction The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC. Material and methods In a prospective case–control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared. Results When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC. Conclusion Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual.

High levels of childbirth fear impact birth preparation, obstetric outcomes and emotional wellbeing for around one in five women living in developed countries. Higher rates of obstetric intervention and caesarean section (CS) are experienced in fearful women. The efficacy of interventions to reduce childbirth fear is unclear, with no previous randomised controlled trials reporting birth outcomes or postnatal psychological wellbeing following a midwife led intervention. Between May 2012 and June 2013 women in their second trimester of pregnancy were recruited. Women with a fear score ≥ 66 on the Wijma Delivery Expectancy / Experience Questionnaire (W-DEQ) were randomised to receive telephone psycho-education by a midwife, or usual maternity care. A two armed non-blinded parallel (1:1) multi-site randomised controlled trial with participants allocated in blocks of ten and stratified by hospital site and parity using an electronic centralised computer service. The outcomes of the RCT on obstetric outcomes, maternal psychological well-being, parenting confidence, birth satisfaction, and future birth preference were analysed by intention to treat and reported here. 1410 women were screened for high childbirth fear (W-DEQ ≥66). Three hundred and thirty-nine (n = 339) women were randomised (intervention n = 170; controls n = 169). One hundred and eighty-four women (54 %) returned data for final analysis at 6 weeks postpartum (intervention n = 91; controls n = 93). Compared to controls the intervention group had a clinically meaningful but not statistically significant reduction in overall caesarean section (34 % vs 42 %, p = 0.27) and emergency CS rates (18 % vs 25 %, p = 0.23). Fewer women in the intervention group preferred caesarean section for a future pregnancy (18 % vs 30 %, p = 0.04). All other obstetric variables remained similar. There were no differences in postnatal depression symptoms scores, parenting confidence, or satisfaction with maternity care between groups, but a lower incidence of flashbacks about their birth in the intervention group compared to controls (14 % vs 26 %, p = 0.05). Postnatally women who received psycho-education reported that the ‘decision aid’ helped reduce their fear (53 % vs 37 %, p = 0.02). Following a brief antenatal midwife-led psycho-education intervention for childbirth fear women were less likely to experience distressing flashbacks of birth and preferred a normal birth in a future pregnancy. A reduction in overall CS rates was also found. Psycho-education for fearful women has clinical benefits for the current birth and expectations of future pregnancies. Australian New Zealand Controlled Trials Registry ACTRN12612000526875 , 17th May 2012

Objectives. To assess the prevalence and current suffering of experienced abuse in healthcare, to present the socio-demographic background for women with a history of abuse in healthcare and to assess the association between abuse in healthcare and selected obstetric characteristics. Design. Cross-sectional study. Setting. Routine antenatal care in six European countries. Population. In total 6923 pregnant women. Methods. Cross-tabulation and Pearson’s chi-square was used to study prevalence and characteristics for women reporting abuse in healthcare. Associations with selected obstetric factors were estimated using multiple logistic regression analysis. Main outcome measures. Abuse in healthcare, fear of childbirth and preference for birth by cesarean section. Results. One in five pregnant women attending routine antenatal care reported some lifetime abuse in healthcare. Prevalence varied significantly between the countries. Characteristics for women reporting abuse in healthcare included a significantly higher prevalence of other forms of abuse, economic hardship and negative life events as well as a lack of social support, symptoms of post-traumatic stress and depression. Among nulliparous women, abuse in healthcare was associated with fear of childbirth, adjusted odds ratio 2.25 (95% CI 1.23–4.12) for severe abuse in healthcare. For multiparous women only severe current suffering from abuse in healthcare was significantly associated with fear of childbirth, adjusted odds ratio 4.04 (95% CI 2.08–7.83). Current severe suffering from abuse in healthcare was significantly associated with the wish for cesarean section, and counselling for fear of childbirth for both nulli- and multiparous women. Conclusion. Abuse in healthcare among women attending routine antenatal care is common and for women with severe current suffering from abuse in healthcare, this is associated with fear of childbirth and a wish for cesarean section. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology. This is the authors' accepted and refereed manuscript to the article.

OBJECTIVE: To investigate the prevalence of fear of childbirth in a nationwide sample and its association with subsequent rates of caesarean section and overall experience of childbirth. DESIGN: A prospective study using between-group comparisons. SETTING: About 600 antenatal clinics in Sweden. SAMPLE: A total of 2,662 women recruited at their first visit to an antenatal clinic during three predetermined weeks spread over 1 year. METHODS: Postal questionnaires at 16 weeks of gestation (mean) and 2 months postpartum. Women with fear of childbirth, defined as 'very negative' feelings when thinking about the delivery in second trimester and/or having undergone counselling because of fear of childbirth later in pregnancy, were compared with those in the reference group without these characteristics. MAIN OUTCOME MEASURES: Elective and emergency caesarean section and overall childbirth experience. RESULTS: In total 97 women (3.6%) had very negative feelings and about half of them subsequently underwent counselling. In addition, 193 women (7.2%) who initially had more positive feelings underwent counselling later in pregnancy. In women who underwent counselling, fear of childbirth was associated with a three to six times higher rate of elective caesarean sections but not with higher rates of emergency caesarean section or negative childbirth experience. Very negative feelings without counselling were not associated with an increased caesarean section rate but were associated with a negative birth experience. CONCLUSIONS: At least 10% of pregnant women in Sweden suffer from fear of childbirth. Fear of childbirth in combination with counselling may increase the rate of elective caesarean sections, whereas fear without treatment may have a negative impact on the subsequent experience of childbirth.

Background. No population-based study has evaluated the effects of third trimester ultrasound screening on prognosis. Objective. To study the effects of routine ultrasound screening in the third trimester on perinatal/infant mortality, prevalence of small for gestational age infants (SGA) and low Apgar score. Study design. Two university clinics using routine ultrasound screening in the third trimester were compared with seven county or district hospitals with no routine screening. Deliveries between 1985 and 1996 were included. In all, 16 municipalities including 56 371 pregnancies with routine screening were compared with 59 municipalities and 153 355 pregnancies without third trimester screening. An observational design was applied, using data stored during pregnancy, delivery, and during the first year (infant mortality) at the Swedish Medical Birth Registry, The National Board of Health and Welfare. Odds ratio with 95% confidence interval was used in the evaluation. End-points included incidence of S...

Background: An emergency cesarean section is often a traumatic experience for women, and can be associated with postnatal depression and posttraumatic stress. Various types of interventions have been tested to prevent such consequences. The purpose of this study was to test a model of group counseling for mothers after emergency cesarean section, and to examine its possible effects. Method: After undergoing an emergency cesarean section, 162 Swedish-speaking women were randomized to group counseling or the control group. The participation rate was 75 percent. The counseling consisted of 2 sessions, conducted at about 2 months postpartum; 72 percent of the women randomized to the counseling group actually attended the sessions. At 6 months postpartum, all study participants completed a postal questionnaire (response rates were 92% in the counseling group and 89% in the control group). Results: No difference between the groups was found in terms of the level of fear after childbirth, symptoms of posttraumatic stress, or postnatal depression at 6 months after the emergency cesarean. The group counseling was much appreciated by the participating women, some of whose experiences are reported in this paper. Conclusion: Group counseling for mothers after emergency cesarean section did not influence their views on the recent delivery or prevent symptoms of posttraumatic stress or postnatal depression. It was, however, appreciated and did no harm. In future studies, other outcomes should be measured.

Acta Obstet Gynecol Scand 2003; 82: 10–17. © Acta Obstet Gynecol Scand 2003 Background. The aim of this clinical evaluation was to study birth experience, post-traumatic stress symptoms, and satisfaction with care in new mothers who had consulted specially trained midwives because of a fear of childbirth during pregnancy. Methods. Sixty-two women were eligible for the study, of whom 53 (85%) participated at 1–14 months postpartum. For comparison, a group of 53 women were matched for parity and mode of delivery. All 106 women completed two self-rating scales, the Wijma Delivery Experience Questionnaire (W-DEQ) and the Impact of Event Scale (IES), and answered several open questions about their opinion of the antenatal preparation given. Results. Those women who had been treated for fear of childbirth reported a rather more frightening experience of delivery, and more frequent symptoms of post-traumatic stress related to delivery than did the women in the comparison group. Nevertheless, satisfaction with care was manifest in the study group. Conclusions. Women who seek help for fear of childbirth are a vulnerable group. Because the counseling received by the women in this study did not accord them the same positive experience of childbirth as the average parturient at the unit, more effective forms of treatment may be necessary. However, as most of the women were very satisfied with their care and with the outcome, one may assume that the care given had improved their situation to some degree.

The experience of emergency caesarean section (EmCS) is traumatic for many women. Up to now, a possible relationship between psychological variables before and after EmCS has not been studied. Therefore, the present study was designed, to examine whether the women's psychological condition during pregnancy correlates with their psychological well-being after EmCS. Questionnaires were administered in gestation week 32, a few days and one month after EmCS. A consecutive sample of pregnant women (N = 1981) completed questionnaires (the predictors) at Time 1. Predictors were operationalized by means of the Wijma-Delivery Expectancy/Experience Questionnaire (W-DEQ vers. A), the Spielberger Trait Anxiety Inventory (STAI) and the Stress Coping Inventory (SCI). Of those women who had an EmCS (N = 97), a selection (N = 40) completed questionnaires (the criterion variables) at Times 2 and 3. The criterion variables were operationalized by means of the W-DEQ vers. B, the Impact of Event Scale (IES), and the Symptom Checklist (SCL). Fear of childbirth (W-DEQ vers. A) was the best overall predictor of the three criterion variables, whereas general anxiety (STAI) was the best predictor of mental distress (SCL) after EmCS. In conclusion, according to the results of this study, particularly fear of childbirth during late pregnancy, but also general anxiety, is associated with mental distress after a subsequent EmCS. Maternal follow-up after a complicated delivery should perhaps be directed especially to women with a history of serious fear of childbirth and/or other anxiety difficulties during gestation.

Background Childbirth fear is associated with increased obstetric interventions and poor emotional and psychological health for women. The purpose of this study is to test an antenatal psycho-education intervention by midwives in reducing women's childbirth fear. Methods Women (n = 1,410) attending three hospitals in South East Queensland, Australia, were recruited into the BELIEF trial. Participants reporting high fear were randomly allocated to intervention (n = 170) or control (n = 169) groups. All women received a decision-aid booklet on childbirth choices. The telephone counseling intervention was offered at 24 and 34 weeks of pregnancy. The control group received usual care offered by public maternity services. Primary outcome was reduction in childbirth fear (WDEQ-A) from second trimester to 36 weeks’ gestation. Secondary outcomes were improved childbirth self-efficacy, and reduced decisional conflict and depressive symptoms. Demographic, obstetric & psychometric measures were administered at recruitment, and 36 weeks of pregnancy. Results There were significant differences between groups on postintervention scores for fear of birth (p

Background Studies have suggested several risk factors for a negative birth experience among primiparas. Factors that are mentioned frequently include labour dystocia, operative intervention such as acute caesarean section or vacuum extraction, or the infant being transferred to neonatal care. Another important factor mentioned is lack of support from the midwife. Methods A study was made of the deliveries of 446 healthy primiparas in a prospective cohort study performed at Soder Hospital, Stockholm, Sweden. Samples of amniotic fluid were collected at delivery and the levels of amniotic fluid lactate (AFL) were measured to give an indication of the metabolism of the uterine tissue. Obstetrical data were collected from birth records. Postpartum, all the women included in the study were asked to complete the Wijma Delivery Experience Questionnaire (W-DEQ B) that measures the experience of a woman’s delivery. The main objective of the project was to study well-known as well as new factors associated with negative experience of childbirth among a group of healthy primiparas. Results Risk factors for reporting a higher level of negative childbirth experience were shown to be a high level of AFL (AOR 3.1, 95%, CI; 1.1-8.9), a longer latent phase (AOR 1.8, 95%, CI; 1.03-3.1), and a low Apgar score (

Objective The main aim of this study was to assess whether a history of abuse, reported during pregnancy, was associated with an operative delivery. Secondly, we assessed if the association varied according to the type of abuse and if the reported abuse had been experienced as a child or an adult. Design The Bidens study, a cohort study in six European countries (Belgium, Iceland, Denmark, Estonia, Norway, and Sweden) recruited 6724 pregnant women attending routine antenatal care. History of abuse was assessed through questionnaire and linked to obstetric information from hospital records. The main outcome measure was operative delivery as a dichotomous variable, and categorized as an elective caesarean section (CS), or an operative vaginal birth, or an emergency CS. Non-obstetrically indicated were CSs performed on request or for psychological reasons without another medical reason. Binary and multinomial regression analysis were used to assess the associations. Results Among 3308 primiparous women, sexual abuse as an adult (≥18 years) increased the risk of an elective CS, Adjusted Odds Ratio 2.12 (1.28–3.49), and the likelihood for a non-obstetrically indicated CS, OR 3.74 (1.24–11.24). Women expressing current suffering from the reported adult sexual abuse had the highest risk for an elective CS, AOR 4.07 (1.46–11.3). Neither physical abuse (in adulthood or childhood

The purpose of this study was to investigate the possibility to categorize women's experiences of emergency cesarean section based on the patterns displayed in their narration of the event, and to describe, if possible, typical features of those categories. Twenty-five consecutive women were interviewed a few days and 1-2 months after emergency cesarean section. The narratives of the women were recorded according to a time-spatial model from disaster psychiatry. The occurrence of a traumatic delivery experience and of posttraumatic intrusive stress reactions 6 weeks postpartum in the various categories was assessed. The narratives of the 25 women can be categorized as follows: Pattern 1 - confidence whatever happens (n = 5), Pattern 2 - positive expectations turning into disappointment (n = 7), Pattern 3 - fears that come true (n = 9), and Pattern 4 - confusion and amnesia (n = 4). In the second and third groups all women had experienced the delivery as traumatic. The women in the second group had the highest prevalence of posttraumatic intrusive stress reactions 6 weeks after the emergency cesarean section.

The aim of this study was to try a model of early postpartum counselling for women after emergency cesarean section. A counselling group (n=50) received three to four consultations during the first 2–3 weeks after delivery. Exposure to traumatic events, and discussion of the implications and consequences of the emergency cesarean section were important parts of the sessions. The women's cognitive appraisal of the delivery was more positive, and posttraumatic stress reactions less serious than in a comparison group (n=49), at 1 and 6 months postpartum. General mental distress of the women in the counselling group was less marked, compared with the comparison group 1 month postpartum. Thus, the women in general appeared to have benefited from the counselling. However, the counselling had no demonstrable effect on two extreme groups; those with the most serious posttraumatic stress reactions and those with the most serious mental distress. Copyright © 1998 John Wiley & Sons, Ltd.

Background. The purpose of our study was to elucidate the association between fear of childbirth, general anxiety, and stress coping during the third trimester of pregnancy, and a subsequent delivery by emergency cesarean section. Methods. In a case-control study, 1,981 Swedish-speaking women completed three self-assessment questionnaires at 32 weeks' gestation. Ninety-seven of these women were delivered by emergency cesarean section. Fear of childbirth, general anxiety and the stress coping ability of these 97 cases were compared with the same features in 194 controls, matched for age and parity. Results. Women, subsequently delivered by emergency cesarean section, reported a greater anxiety and a poorer stress coping ability, and, most obviously, a greater fear of childbirth at 32 weeks' gestation. After elimination of possible confounders, the odds ratio for emergency cesarean section was examined for women whose scores were above various cut-off points according to the fear of childbirth measuring instrument. For women with a serious fear of childbirth the odds ratio was 3.0 (95% confidence interval 1.4 to 6.6), and the population attributable risk 0.167. Conclusion. Fear of childbirth during the third trimester of pregnancy may increase the risk of subsequent emergency cesarean section.

The study aimed at answering the following questions: Do women experience emergency cesarean section as traumatic? Do women experience any posttraumatic stress reactions or even posttraumatic stress disorder (PTSD) one to two months after emergency cesarean section?Twenty-five consecutive women were interviewed a few days and one to two months after emergency cesarean section.Nineteen (76%) of the 25 women had experienced their delivery by emergency cesarean section as a traumatic event. One to two months postpartum none of these women met all the diagnostic criteria of PTSD. However, 13 women had various forms of posttraumatic stress reactions and in eight cases (33%) symptoms of serious posttraumatic intrusive stress reactions.The emergency cesarean section was in the majority of the cases experienced as a mental trauma. Although none of the women suffered from PTSD one to two months postpartum, one third had serious posttraumatic intrusive stress reactions. The concept of traumatic stress thus seems to be relevant for investigations of psychological aspects of emergency cesarean section.

Objectives. The primary objective was to investigate the prevalence of a history of abuse among women attending routine antenatal care in six northern Euro- pean countries. Second, we explored current suffering from reported abuse. Design. A prospective cohort study. Setting. Routine antenatal care in Belgium, Iceland, Denmark, Estonia, Norway, and Sweden between March 2008 and August 2010. Population. A total of 7174 pregnant women. Methods. A ques- tionnaire including a validated instrument measuring emotional, physical and sexual abuse. Main outcome measure. Proportion of women reporting emo- tional, physical and sexual abuse. Severe current suffering defined as a Visual Analogue Scale score of 6. Results. An overall lifetime prevalence of any abuse was reported by 34.8% of the pregnant women. The ranges across the six countries of lifetime prevalence were 9.7–30.8% for physical abuse, 16.2–27.7% for emotional abuse, and 8.3–21.1% for sexual abuse. Few women reported current sexual abuse, 0.4% compared with 2.2% current physical abuse and 2.7% current emotional abuse. Current severe suffering was reported by 6.8% of the women who reported physical abuse, 9.8% of those who reported sexual abuse and 13.5% for emotional abuse. Conclusion. A high proportion of preg- nant women attending routine antenatal care report a history of abuse. About one in ten of them experiences severe current suffering from the reported abuse. In particular, these women might benefit from being identified in the antenatal care setting and being offered specialized care. © Wiley. This is the authors’ accepted and refereed manuscript to the article.

We investigated the impact of pre-existing mental ill health on postpartum maternal outcomes. Women reporting childbirth trauma received counselling (Promoting Resilience in Mothers' Emotions; n = 137) or parenting support (n = 125) at birth and 6 weeks. The EuroQol Five dimensional (EQ-5D)-measured health-related quality of life at 6 weeks, 6 and 12 months. At 12 months, EQ-5D was better for women without mental health problems receiving PRIME (mean difference (MD) 0.06; 95 % confidence interval (CI) 0.02 to 0.10) or parenting support (MD 0.08; 95 % CI 0.01 to 0.14). Pre-existing mental health conditions influence quality of life in women with childbirth trauma.

To describe mental health status in native and non-native Swedish-speaking pregnant women and explore risk factors of depression and posttraumatic stress (PTS) symptoms.A cross-sectional questionnaire study was conducted at midwife-based antenatal clinics in Southern Sweden.A non-selected group of women in mid-pregnancy.Participants completed a questionnaire covering background characteristics, social support, life events, mental health variables and the short Edinburgh Depression Scale.Depressive symptoms during the past week and PTS symptoms during the past year.Out of 1003 women, 21.4% reported another language than Swedish as their mother tongue and were defined as non-native. These women were more likely to be younger, have fewer years of education, potential financial problems, and lack of social support. More non-native speakers self-reported depressive, PTS, anxiety and, psychosomatic symptoms, and fewer had had consultations with a psychiatrist or psychologist. Of all women, 13.8% had depressive symptoms defined by Edinburgh Depression Scale 7 or above. Non-native status was associated with statistically increased risks of depressive symptoms and having ≥1 PTS symptom compared with native-speaking women. Multivariate modeling including all selected factors resulted in adjusted odds ratios for depressive symptoms of 1.75 (95% confidence interval: 1.11-2.76) and of 1.56 (95% confidence interval: 1.10-2.34) for PTS symptoms in non-native Swedish speakers.Non-native Swedish-speaking women had a more unfavorable mental health status than native speakers. In spite of this, non-native speaking women had sought less mental health care.

Background: Childhood abuse affects adult health. The objective of this study was to examine the association between a self-reported history of childhood abuse and fear of childbirth. Methods: A population-based, cross-sectional study was conducted of 2,365 pregnant women at five obstetrical departments in Norway. We measured childhood abuse using the Norvold Abuse Questionnaire and fear of childbirth using the Wijma Delivery Expectancy Questionnaire. Severe fear of childbirth was defined as a Wijma Delivery Expectancy Questionnaire score of ≥85. Results: Of all women, 566 (23.9%) had experienced any childhood abuse, 257 (10.9%) had experienced emotional abuse, 260 (11%) physical abuse, and 290 (12.3%) sexual abuse. Women with a history of childhood abuse reported severe fear of childbirth significantly more often than those without a history of childhood abuse, 18 percent versus 10 percent (p = 0.001). The association between a history of childhood abuse and severe fear of childbirth remained significant after adjustment for confounding factors for primiparas (adjusted OR: 2.00; 95% CI: 1.30-3.08) but lost its significance for multiparas (adjusted OR: 1.17; 95% CI: 0.76-1.80). The factor with the strongest association with severe fear of childbirth among multiparas was a negative birth experience (adjusted OR: 5.50; 95% CI: 3.77-8.01). Conclusions: A history of childhood abuse significantly increased the risk of experiencing severe fear of childbirth among primiparas. Fear of childbirth among multiparas was most strongly associated with a negative birth experience. (BIRTH 37:4 December 2010). Language: en

Objective The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience. Design A prospective group-comparison cohort study. Setting Danderyd Hospital, Stockholm, Sweden. Sample First-time mothers (n= 496) were recruited to the study in week 37–39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between ‘caesarean section on maternal request’, ‘caesarean section due to breech presentation’ and ‘controls planning a vaginal delivery’. Methods The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ). Main outcome measures Expectations prior to delivery and experiences at 3 months after birth. Results Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001). Conclusions Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support.

In this study of women who had undergone an emergency caesarean section (EmCS), the aim was to examine the associations between, on the one hand, the new mother's sense of coherence (SOC) and obstetric and demographic variables a few days postpartum, and on the other hand, post-traumatic stress symptoms 3 months' postpartum.In a prospective study, 122 Swedish- or English-speaking new mothers completed 2 self-assessment questionnaires, at 2 days and 3 months after an EmCS. To measure SOC, we used the Sense of Coherence Scale (SOC-13), and to measure reactions to traumatic events, the Impact of Event Scale (IES-15).Independent risk factors associated with post-traumatic stress symptoms were: imminent fetal asphyxia as an indication for the operation, and low SOC in the woman. The group of women with low SOC were those with an intense fear of childbirth during pregnancy, immigrants, and socially underprivileged women.Symptoms of post-traumatic stress following EmCS are associated both with the new mother's personal coping style and with the circumstances of the event. We recommend that women who belong to groups who more often report a low SOC or who had imminent asphyxia as an indication for the operation should be offered support and follow-up.

In Sweden, ultrasonography is routinely carried out in the second trimester of pregnancy to confirm gestational age and to detect multiple pregnancies and fetal malformations. In some units, the study is repeated in the third trimester to detect a small-for-gestational age (SGA) fetus. Earlier studies of this practice preceded the advent of modern surveillance methods such as Doppler ultrasound. For this reason, an observational population-based study was carried out to learn whether routine third-trimester sonography (at 33-34 weeks) lowers the risk of an SGA fetus and of cesarean and instrumental deliveries for these infants as well as perinatal complications. The study group, covering the years 1985 to 1996, included 56,371 pregnancies at two university clinics where third-trimester sonography was routine and 153,355 pregnancies at 59 institutions not practicing routine sonography late in gestation. The prevalence of SGA infants was not significantly different in the two study populations. No difference in birth weight distribution was apparent in relation to whether or not late-pregnancy sonography was performed. Perinatal and infant mortality rates were also the same in both groups. Limiting analysis to deliveries at 35 to 37 weeks gestational age did not substantially alter the findings. The prevalence of low Apgar scores increased considerably in cases with low birth weight, but there was no obvious difference related to routine third-trimester sonography. Similarly, type of delivery correlated with decreased birth weight but without any clear trend favoring units that routinely do late-pregnancy sonography. The rate of cesarean section increased with lower birth weight regardless of whether or not sonography was routinely performed late in pregnancy. These observational findings fail to demonstrate any clinical advantages for routinely performing sonography in the third trimester of pregnancy.

The aim of this clinical evaluation was to study birth experience, post-traumatic stress symptoms, and satisfaction with care in new mothers who had consulted specially trained midwives because of a fear of childbirth during pregnancy.Sixty-two women were eligible for the study, of whom 53 (85%) participated at 1-14 months postpartum. For comparison, a group of 53 women were matched for parity and mode of delivery. All 106 women completed two self-rating scales, the Wijma Delivery Experience Questionnaire (W-DEQ) and the Impact of Event Scale (IES), and answered several open questions about their opinion of the antenatal preparation given.Those women who had been treated for fear of childbirth reported a rather more frightening experience of delivery, and more frequent symptoms of post-traumatic stress related to delivery than did the women in the comparison group. Nevertheless, satisfaction with care was manifest in the study group.Women who seek help for fear of childbirth are a vulnerable group. Because the counseling received by the women in this study did not accord them the same positive experience of childbirth as the average parturient at the unit, more effective forms of treatment may be necessary. However, as most of the women were very satisfied with their care and with the outcome, one may assume that the care given had improved their situation to some degree.

At Helsingborg Maternity Clinic the rate of elective cesarean section on psychosocial indications has increased. The purpose of this study was to identify and characterize those women requiring cesarean section despite the absence of obstetrical complications of pregnancy and childbirth and their reasons for doing so. Hospital case records from 1983 to 1987 were examined retrospectively. Nine women (20%) were primiparae, who for different reasons refused vaginal delivery; 34 (80%) were multiparae, half of whom (n = 17) had been delivered previously by an unanticipated cesarean section and 4 women by elective cesarean. Seven women had experienced obstetrical complications during vaginal delivery. Five had a diagnosis of other serious medical conditions during the previous or the present pregnancy. The final parous woman demanded a cesarean in spite of perfect health and a normal previous delivery. The patients' reasons for demanding a cesarean, as understood from hospital records, were primarily a very serious fear of childbirth. A psychotherapeutically trained member of the obstetrical staff is well equipped to offer help. The impact of previous complicated birth is obvious in this study. Hopefully, we can avoid some future cesarean sections by means of better care for patients in crisis resulting from complicated childbirth.

Background:Childbirth by emergency cesarean section can be a traumatic experience, but since the result is often a healthy mother and baby, its seriousness is open to doubt.Method:Fifty-three women were interviewed approximately two days after emergency cesarean section to ascertain whether or not the trauma met the stressor criterion of posttraumatic stress disorder. A time-spatial model from disaster psychiatry was used to chart the women's thoughts and feelings during consecutive phases of the delivery process. The women's causal attributions of the event were also assessed.Results:Generally speaking, the feeling of the women after they had arrived at the delivery ward changed from one of confidence and safety to one of fear. The decision to undertake a cesarean section brought a feeling of relief, but this was again replaced by fear as the operation approached. The women's thoughts centered around the impending delivery and operation until after the event, when the newborn baby occupied their attention and happiness predominated. In retrospect, 55 percent of the women experienced intense fear for their own life or that of their baby. Eight percent felt very badly treated by the delivery staff and were angry. Almost all the women had adequate knowledge of the reasons for the emergency cesarean section. One in four blamed themselves to some extent for the event.Conclusions:The stressor criterion of DSM IV is applicable to the trauma of emergency cesarean section. Even if and when a new mother is happy to meet her baby, negative feelings, such as fear, guilt, or anger, may dominate her memories of the birth. (BIRTH 25:4 December 1998)

The purpose of the study was to compare the psychological reactions of women after emergency Cesarean section (EmCS), elective Cesarean section (ElCS), instrumental vaginal delivery (IVD) and normal vaginal delivery (NVD). The participants (EmCS, n = 71, ElCS, n = 70, IVD, n = 89, and NVD, n = 96) answered questionnaires a few days postpartum and 1 month postpartum. The EmCS group reported the most negative delivery experience at both times, followed by the IVD group. At a few days postpartum the EmCS group experienced more general mental distress than the NVD group, but not when compared with the ElCS or the IVD groups. At 1 month postpartum the EmCS group showed more symptoms of post-traumatic stress than the ElCS and NVD groups, but not when compared to the IVD group. An unplanned instrumental delivery (EmCS or IVD) should be regarded as a pointer with respect to possible post-traumatic stress.

The purpose of this study was to obtain a better understanding of women who demand a cesarean section when obstetricians do not think it is necessary. Thirty-three pregnant women were interviewed about their reasons for the demand. The 28 parous women referred to previous childbirth experiences and feared mainly for intractable labor pain and for the life and health of the child. The most prevalent fear of the five nulliparae was for vaginal rupture. According to their wishes and prerequisites the women received counselling or short-term psychotherapy by a psychotherapeutically trained obstetrician. At term 14 women chose vaginal delivery and 19 had elective cesareans, three on obstetric indications and 16 at their own choice.

(1998). Predisposing psychological factors for posttraumatic stress reactions after emergency cesarean section. Acta Obstetricia et Gynecologica Scandinavica: Vol. 77, No. 3, pp. 351-352.

The effects of pregnancy and childbirth on sexuality were studied in 50 women. Dyspareunia was more common in primiparae, but in other respects the same reactions and changes in behaviour were reported by multiparous and primiparous women. Coital frequency and orgasmic capacity decreased during pregnancy. The period of abstinence from coitus before and after delivery varied considerably. During pregnancy 72% of the women experienced a waning of sexual desire. Three months after childbirth 20% of the women still had little desire for and a further 21% had a complete loss of desire for or aversion to sexual activity. Sexual desire increased for a few women both during pregnancy as well as after childbirth. Pre-disposing factors in relation to diminished desire are discussed. The role of Maternity Clinic staff in providing information and advice is emphasized.