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Background  Psycho-education can reduce childbirth fear and caesarean section numbers. This study determines the cost-effectiveness of a midwife-led psycho-education intervention for women fearful of birth.    Method  One thousand four hundred ten pregnant women in south-east Queensland, Australia were screened for childbirth fear (W-DEQ A ≥ 66). Women with high scores ( n  = 339) were randomised to the BELIEF Study (Birth Emotions and Looking to Improve Expectant Fear) to receive psycho-education ( n  = 170) at 24 and 34 weeks of pregnancy or to the control group ( n  = 169). Women in both groups were surveyed 6 weeks postpartum with total cost for health service use during pregnancy calculated. Logistic regression models assessed the odds ratio of having vaginal birth or caesarean section in the study groups.    Result  Of 339 women randomised, 184 (54%) women returned data at 6 weeks postpartum (Intervention Group  n  = 91; Control Group  n  = 93). Women receiving psycho-education had a higher likelihood of vaginal birth compared to controls ( n  = 60, 66% vs.  n  = 54, 58%; OR 2.34). Mean ‘treatment’ cost for women receiving psycho-education was AUS$72. Mean cost for health services excluding the cost of psycho-education, was less in the intervention group (AUS$1193 vs. AUS$1236), but not significant ( p  = 0.78). For every five women who received midwife counselling, one caesarean section was averted. The incremental healthcare cost to prevent one caesarean section using this intervention was AUS$145.    Conclusion  Costs of delivering midwife psycho-education to women with childbirth fear during pregnancy are offset by improved vaginal birth rates and reduction in caesarean section numbers.    Trial registration  Australian New Zealand Controlled Trials Registry  ACTRN12612000526875 , 17th May 2012 (retrospectively registered one week after enrolment of first participant).

A cost effectiveness analysis of midwife psycho-education for fearful pregnant women – a health system perspective for the antenatal period