What Factors Influence Participation in Online Therapy for Women After Difficult Childbirths?

What you need to know

• Women with higher education, first-time mothers, and those born in Sweden were more likely to participate in the online therapy program.
• Women who experienced complications during childbirth were more likely to stay in the study.
• The most common reason given for not participating was feeling fine and not needing support.

Background

Giving birth can be a challenging experience for some women, occasionally leading to negative feelings or even post-traumatic stress. While online therapy programs exist to help women cope with these difficulties, many women choose not to participate or drop out of such programs. This study aimed to understand what factors influence whether women join and stay in an online therapy program for negative birth experiences.

Who was studied?

The researchers looked at data from 1,523 women who gave birth at a hospital in Sweden between 2013 and 2018. These women were eligible for the study because they either:

1. Rated their overall birth experience as negative (5 or lower on a 0-10 scale)
2. Had an emergency cesarean section
3. Experienced severe bleeding after birth (2000 mL or more)

Out of these eligible women, only 300 (about 20%) agreed to participate in the online therapy program.

Factors affecting participation

Who was more likely to participate?

The study found that certain groups of women were more likely to join the online therapy program:

• Women with higher levels of education
• First-time mothers
• Women born in Sweden

Additionally, women who had experienced certain complications during pregnancy or childbirth were more likely to participate:

• Those who had received counseling for fear of childbirth
• Women who had preeclampsia (a condition involving high blood pressure during pregnancy)
• Those who experienced tearing during delivery
• Women whose babies showed signs of distress during labor
• Those who had a vacuum-assisted delivery

Who was less likely to participate?

On the other hand, some groups were less likely to join the program:

• Women with lower levels of education
• Mothers who already had children
• Foreign-born women
• Those who had a vaginal delivery without complications

Reasons for not participating

When contacted about the study, 693 women gave reasons for why they didn’t want to participate. The most common reasons were:

1. Feeling fine and not needing support (47%)
2. Not speaking Swedish (19%)
3. Not being interested (11%)
4. Already receiving professional support (5%)
5. Not feeling fine but receiving or waiting for other support (5%)

Factors affecting dropout

Even among women who initially agreed to participate, some dropped out at different stages of the study. The researchers found that:

• Women who didn’t experience severe bleeding after birth were more likely to drop out before starting treatment.
• Women who had a vaginal delivery (as opposed to a cesarean section) and those who reported a less negative birth experience were more likely to drop out during treatment.
• Women who had a vaginal delivery and those whose babies didn’t show signs of distress during labor were more likely to be lost to follow-up (meaning they didn’t complete final assessments).

Why these findings matter

Understanding who is more or less likely to participate in online therapy programs can help researchers and healthcare providers improve these services. For example:

1. Tailoring recruitment: Efforts could be made to encourage participation among groups less likely to join, such as women with lower education levels or those born outside of Sweden.

2. Addressing language barriers: Offering the program in multiple languages could increase participation among non-native speakers.

3. Timing of intervention: The study found that many women felt fine and didn’t need support when contacted. It may be worth exploring whether offering the program at a different time point after birth would be more beneficial.

4. Focusing on high-risk groups: Women who experienced complications during childbirth were more likely to stay in the program. This suggests that these women may benefit most from such interventions.

5. Improving retention: Understanding why women drop out at different stages can help in designing programs that keep participants engaged throughout the treatment process.

Limitations of the study

It’s important to note some limitations of this research:

• The study was conducted in Sweden, so the findings may not apply equally to other countries or cultures.
• The researchers didn’t have information about participants’ psychological status or attitudes towards online therapy, which could have provided additional insights.
• The birth experience rating was done shortly after delivery, but women’s feelings about their birth experience can change over time.

Conclusions

• Both demographic factors (like education level and country of birth) and childbirth experiences influence whether women participate in online therapy programs for negative birth experiences.
• Many eligible women felt they didn’t need support, suggesting that the criteria for offering such programs may need refinement.
• Women who experienced complications during childbirth were more likely to participate and stay in the program, indicating that these women may be an important target group for such interventions.
• Future research should explore ways to make online therapy programs more accessible and engaging for a wider range of women, particularly those from disadvantaged backgrounds or those who have had uncomplicated deliveries but still experience negative feelings.