Treatment of Pregnant Women With Fear of Childbirth Using EMDR Therapy: Results of a Multi-Center Randomized Controlled Trial.

M A M Baas,J W Vanhommerig,L M Dijksman,A De Jongh,C A I Stramrood,M G Van Pampus

doi:10.3389/fpsyt.2021.798249

Abstract

Fear of childbirth (FoC) occurs in 7. 5% of pregnant women and has been associated with adverse feto-maternal outcomes. Eye Movement Desensitization and Reprocessing (EMDR) therapy has proven to be effective in the treatment of posttraumatic stress disorder (PTSD) and anxiety; however, its effectiveness regarding FoC has not yet been established. The aim was to determine the safety and effectiveness of EMDR therapy for pregnant women with FoC. This single-blind RCT (the OptiMUM-study, www.trialregister.nl, NTR5122) was conducted in the Netherlands. FoC was defined as a score ≥85 on the Wijma Delivery Expectations Questionnaire (WDEQ-A). Pregnant women with FoC and a gestational age between 8 and 20 weeks were randomly assigned to EMDR therapy or care-as-usual (CAU). The severity of FoC was assessed using the WDEQ-A. Safety was indexed as worsening of FoC symptoms, dropout, serious adverse events, or increased suicide risk. We used linear mixed model analyses to compare groups. A total of 141 women were randomized (EMDR n = 70; CAU n = 71). No differences between groups were found regarding safety. Both groups showed a very large (EMDR d = 1.36) or large (CAU d = 0.89) reduction of FoC symptoms with a mean decrease of 25.6 (EMDR) and 17.4 (CAU) points in WDEQ-A sum score. No significant difference between both groups was found (p = 0.83). At posttreatment, 72.4% (EMDR) vs. 59.6% (CAU) no longer met the criteria for FoC. In conclusion, the results are supportive of EMDR therapy as a safe and effective treatment of FoC during pregnancy, albeit without significant beneficial effects of EMDR therapy over and above those of CAU. Therefore, the current study results do not justify implementation of EMDR therapy as an additional treatment in this particular setting.

Highlights

Severe fear of childbirth (FoC), sometimes referred to as tocophobia [1], affects a relevant proportion of pregnant women (7.5%) [2] and has been found to be associated with adverse maternal and neonatal outcomes
The results were not supportive of our second hypothesis regarding the effectiveness of Eye Movement Desensitization and Reprocessing (EMDR) therapy, showing that EMDR therapy did not result in a significantly greater FoC symptom reduction compared to CAU
Studies with similar data on safety are lacking, the results are in line with a systematic review regarding the effectiveness of EMDR therapy in pregnant women with posttraumatic stress disorder (PTSD) [25], which suggests that treatment is likely safe

Summary

Introduction

Severe fear of childbirth (FoC), sometimes referred to as tocophobia [1], affects a relevant proportion of pregnant women (7.5%) [2] and has been found to be associated with adverse maternal and neonatal outcomes. Except for a few studies [3, 4], most studies include women regardless of parity, and make no distinction between primary and secondary FoC. Evidence suggests that during pregnancy, FoC may negatively affect the experience of pregnancy and the transition to parenthood [5]. FoC predisposes women to a negative delivery experience [9], a sixfold increased risk of developing childbirth-related posttraumatic stress disorder (PTSD) [10, 11] and an increased risk of postpartum depression [12]. Elevated maternal stress during pregnancy has been associated with negative outcomes such as low birth weight [13] and preterm birth [14]

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