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.

Objective To describe the expectations concerning imminent childbirth before and after 8 weeks of internet-based cognitive behavioural therapy (ICBT) among nulliparous pregnant women with severe fear of childbirth.Design Qualitative study of nulliparous pregnant women's narratives before and after CBT.Setting The first ICBT programme for treating severe fear of childbirth.Sample Fifteen nulliparous pregnant Swedish women with severe fear of childbirth participating in an ICBT self-help programme. MethodsSemi-structured open-ended questions over the internet before and after 8 weeks of ICBT. The data were analysed using thematic analysis.Main outcome measures The participants' narratives pertaining to five different situations during labour and delivery before and after ICBT.Results After therapy, participants described a more realistic attitude towards imminent childbirth, more self-confidence and more active coping strategies. They perceived their partners and the staff as more supportive. They were more aware of the approaching meeting with their baby when giving birth.Conclusions Following the ICBT programme, participants changed their attitude towards imminent childbirth from negative to more positive. This was manifested in positive and more realistic expectations regarding themselves, their partner and the staff that would look after them.

C esarean section (CS) upon maternal request is common in many countries. Whether or not abdominal delivery should be carried out upon maternal request is a complex and controversial issue involving maternal fear of pain during labor, pelvic floor injuries, loss of baby, or of being left without assistance during labor weighed against the risk of CS versus instrumented vaginal delivery. This prospective cohort study investigated whether the birth expectations of vaginal delivery differ between first-time mothers with a normal pregnancy who request a CS, firsttime mothers with a scheduled elective CS due to breech presentation, and first-time mothers planning a vaginal delivery. A second analysis examined how emergency CS or delivery with vacuum extraction (VE) or forceps among women planning a vaginal birth affected their impression of the birth experience.A total of 496 healthy first-time mothers were recruited at 37 to 39 weeks' gestation. Of those who planned a birth with elective CS either upon maternal request or for nonvertex presentation, 104 underwent CS on maternal request and 128 had CS for a breech. These groups were compared with 264 women planning a vaginal birth, who were divided into those who had a spontaneous vaginal delivery, those who had assisted VE vaginal delivery (16%), and those who had an emergency CS (14%). The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ; both versions A and B) was used to assess maternal experience, which measures the degree of fear of childbirth or negative reactions to delivery. The score was scaled between 0 and 100. The higher the score, the greater the fear of childbirth manifested. The usual maternal demographic data were recorded and compared.Of a total of 204 first-time mothers having CS on maternal request, 104 were included in the study. The main reason for the dropout before birth was the short time between the arrival of the posted questionnaire and the baby's birth. There were no statistically significant differences in dropouts in the three groups in relation to age, university education, experience of poor health, or smoking habits. Women who requested CS were more often born outside Sweden (P<0.003) and were older (33.9 vs. 30.8 years; P<0.001) than women in the other groups. Women requesting a CS had a significantly higher W-DEQ total score (80.8 versus 59.0; P<0.001) compared with women in the other groups (vaginal delivery, emergency CS, assisted vaginal delivery, CS due to breech presentation). A score above 84, the cut-off point for clinically significant fear of childbirth, was found in 13.2% of the vaginal group, 6% in those having CS due to breech presentation, and 43.4% in the CS on maternal request group. A very severe fear of childbirth (score >100) was present in 28% of the ''requesting CS'' group compared to 5% and 3%, respectively, for the vaginal and CS due to breech presentation groups (P<0.001). Mothers in the maternal CS request group were more afraid than the other groups, felt less happy before delivery, and were more af...