Bridging the Trauma Gap: Efficacy of a Protocolized Mobile Tele-CBT Intervention for Tokophobia in Women with Prior Severe Adverse Obstetric Outcomes

Objective: To evaluate the efficacy of a protocolized mobile tele-Cognitive Behavioral Therapy (Tele-CBT) intervention in reducing symptoms of tokophobia (pathological fear of childbirth) among pregnant women with a history of severe adverse obstetric outcomes. Design: A two-arm, parallel-group Randomized Controlled Trial (RCT). Setting: Department of Obstetrics & Gynaecology, Fatima Memorial Hospital, Lahore, Pakistan. Population or Sample: Pregnant women with a confirmed history of a severe adverse obstetric outcome (e.g., postpartum hemorrhage, peripartum hysterectomy) and a Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) score indicating severe tokophobia. Methods: : Eligible participants were randomized to either the intervention group, which received access to a 6-week structured Tele-CBT mobile application alongside standard antenatal care, or the control group, which received standard antenatal care only. The Tele-CBT protocol included modules on psychoeducation, cognitive restructuring, and exposure exercises. Main Outcome Measures: The primary outcome was the change in tokophobia symptoms, measured by the W-DEQ score, from baseline to 36 weeks of gestation. Secondary outcomes included the rate of elective Cesarean Section (CS) and patient-reported birth satisfaction. Results: : It is hypothesized that the Analysis of Covariance (ANCOVA), controlling for baseline scores, will show a statistically significant and clinically meaningful reduction in W-DEQ scores in the intervention group compared to the control group (p < 0.01). A significantly lower rate of patient-requested elective CS and higher birth satisfaction scores are also anticipated in the Tele-CBT group. Conclusions: : A structured mobile Tele-CBT intervention is a potentially highly effective and scalable treatment for tokophobia in women with prior obstetric trauma, leading to improved psychological readiness for childbirth and more autonomous delivery decisions.