New research from Karlstad University shows that the effect is particularly noticeable among women who already during pregnancy experience strong anxiety about giving birth.
Expecting a first child can bring both anticipation and worry. Thoughts about pain, loss of control, and the unknown are, for many expectant mothers, a source of stress. Now, research from Karlstad University and Region Värmland shows that a digital support tool in the form of an app can make a difference, especially for first-time mothers who feel a pronounced fear of childbirth.
“Among women who from the start described themselves as fearful of giving birth, we saw a clear and statistically significant reduction in fear,” says Karin Ängeby, midwife and clinical lecturer in nursing at Karlstad University and Region Värmland.
The results come from the interdisciplinary research project DIGI-EL, where researchers in Sweden and Norway explored how the app—based on the method Föda utan rädsla ("Birth Without Fear")—can be used as support during pregnancy and the early stages of labor.
Digital Support Grew Out of Clinical Practice
When Karin Ängeby first began considering a digital tool for pregnant women, several threads came together. Within the research group, there was growing interest in digital health, while the Birth Without Fear method was already being used in clinical care.
“We asked ourselves how we could make the method more accessible,” says Karin Ängeby. “Not all pregnant women have the same opportunity to access support, depending on where they live or how care is organized. An app felt like a natural next step.”
Another key person in the early development of the project was Anna Nordin, associate professor and senior lecturer in nursing at Karlstad University. She works in several interdisciplinary research environments and has long experience collaborating across healthcare, technology, and informatics.
“For digital tools to work in healthcare, they need to be more than just technically well designed,” says Anna Nordin. “They also need to be grounded in nursing perspectives, user needs, and scientific evidence.”
Interdisciplinary Collaboration Across Borders
The project developed into close collaboration between nursing researchers, computer scientists, and clinically active midwives, with links to universities in both Oslo and Uppsala. The teamwork contributed to translating an established method and a book into a digital format that could be used in everyday life by pregnant women and their partners.
The app was developed in parallel with the research and was tested scientifically even before it was launched on the market—something still uncommon among apps aimed at pregnant women. Two research midwives also participated in the project and later continued into doctoral studies.
Clear Effect for Women With Fear of Childbirth
To investigate whether the digital support made a difference, a randomized controlled trial was conducted. In total, 391 first-time mothers from across Sweden participated, recruited via social media. Participants were randomly assigned to three groups: one that used the app, one that used the app plus had additional contact with a research midwife, and a control group receiving standard care.
When researchers analyzed the results, they found no major differences between the groups regarding overall birth experience or medical outcomes. However, one specific group stood out.
“Among women who initially described themselves as fearful of giving birth, we saw a statistically significant reduction in fear,” says Karin Ängeby. “The effect was particularly clear among those assigned to the app group.”
Mastery and Increased Sense of Control
That the effect was strongest among women with pronounced fear of childbirth was not obvious from the start.
“We assumed the app would help all first-time mothers more or less equally,” says Anna Nordin. “In hindsight, we think it may be about self-efficacy and self-care—that the women receive concrete tools to manage anxiety and pain, which strengthens their sense of control.”
Which specific parts of the app matter most is still unclear. The content includes mental techniques, breathing, relaxation, information, and partner involvement.
“The app can serve as a way to talk about the upcoming birth together,” says Karin Ängeby. “The partner becomes more involved and knows how to provide support, which can reduce anxiety and increase feelings of safety.”
A Complement to Maternity Care
Additional contact with a research midwife did not show any significant extra benefit compared to using the app alone. However, the researchers do not interpret this as an indication that human contact is unimportant.
“Rather, it shows how strong well-designed digital support can be,” says Karin Ängeby. “The results give midwives greater confidence in recommending evidence-based apps as a complement to standard care.”
One of the major advantages of digital tools is accessibility. The app can be used regardless of where in the country one lives, making it an issue of equality in maternal healthcare.
“This became especially clear during the pandemic,” says Karin Ängeby. “When physical visits decreased, digital solutions increased—helping ensure equal access to care.”
Research With a Ripple Effect
There are limitations to consider. Participants generally had high levels of education, were relatively older, and most lived with a partner. The results are also largely based on self-reported questionnaires.
Despite this, the research team sees strong potential moving forward.
“This is a great example of how collaboration can create ripple effects,” says Karin Ängeby.
The project has resulted not only in three published studies and an evidence-based app but also in competence development and further research. The two midwives involved in DIGI-EL are now doctoral students leading a follow-up project on digital support and childbirth preparation.
“They became curious about the results and about how clinical practice can connect with research,” says Anna Nordin. “Today, they’re deepening knowledge about how digital tools can be used in maternal healthcare.”
Next Steps in the Research
The next phase of the research aims to better understand women's personal experiences and how digital support is actually used in practice.
“With more detailed data and in-depth interviews, we want to understand how and why this method works for first-time mothers with fear of childbirth. It is at the intersection of nursing, technology, education, and clinical practice that the healthcare of the future develops,” says Anna Nordin.
