A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

摘要

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress.ududObjectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sectionsudud2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience.ududInclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention.ududSearch strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material.ududMethodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute.ududData extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute.ududData synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken.ududResults: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found.ududDefinitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning.ududConclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence.ududImplications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice.ududImplications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered.ududMore research is needed on the effectiveness of group interventions and the role of midwives in administering interventions.ududA standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made.ududOutcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion.