The effect of education given to primigravida women on fear of childbirth

Ethiopian women's tokophobia of childbirth and its predictors: a systematic review and meta-analysis

Background

Fear of childbirth is recognized as a growing problem in developing countries, including Ethiopia. The impact of this fear on women's reproductive choices and decisions is significant. Therefore, the systematic review and meta-analysis will help to consolidate the existing research on childbirth-related fear in Ethiopia. Synthesizing the findings and providing a pooled prevalence estimate, can contribute to a better understanding of the scale of the problem in the country.

Objective

This systematic review and meta-analysis assessed the pooled prevalence of childbirth-related fear and its associated factors among pregnant mothers in Ethiopia.

Methods

PubMed, Google Scholar, and African Journals Online were searched for included articles. A weighted inverse-variance random-effects model was used to estimate the prevalence of childbirth-related fear. Variations in the pooled estimates of the prevalence were adjusted through subgroup analysis according to the specific region where the study was conducted. Funnel plot and Egger's regression test were used to check for publication bias. STATA version 14 statistical software was used for meta-analysis.

Results

A total of 2,015 pregnant mothers were included. The combined prevalence of fear of childbirth among pregnant mothers was found to be 21% (95% CI: 19-22; I 2 = 0.00%, p value < 0.001). Based on the subgroup analysis, the prevalence of fear of childbirth among pregnant mothers was 24% in SNNPRs, 25% in Oromia, and 11% in Addis Ababa.

Conclusion

The findings of the meta-analysis indicating a high prevalence of fear of childbirth among pregnant mothers in Ethiopia and identifying associated risk factors highlight the importance of addressing this issue within the healthcare system. Integrating prevention-based services for mothers with childbirth fears into the antenatal care model could be a valuable approach to support women and mitigate the impact of fear on their reproductive experiences.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier [CRD42023411103].

The changes in fear of childbirth in pregnancy during and before the COVID-19 pandemic

We aimed to investigate how factors such as age, education level, planned delivery method and fear of childbirth were affected in pregnant women before and during the pandemic. This cross-sectional study compared a pre-pandemic pregnant group (July 2019 and December 2019) and a pandemic group (November 2020 and May 2021) of patients at Kütahya Health Sciences University Evliya Çelebi Training and Research Hospital. A total of 696 pregnant women in their second trimester were included in the study. All of them were literate and voluntarily agreed to participate in the study. Data were collected with the Wijma delivery expectancy/experience questionnaire (WDEQ-A), and the outpatient doctor asked the questions face-to-face. The mean age of the pregnant women participating in the study was 31.6 ± 6.8 years. While the total Wijma score was 62.1 ± 25.1 in the pre-pandemic group, it was 61.3 ± 26.4 in the pandemic group, and there was no significant difference between the two groups (p = 0.738). Upon analyzing the fear of childbirth among groups based on education level, no statistically significant differences were observed between the pre-pandemic and pandemic periods within any of the groups. While 25.7% (n = 179) of all participants had a normal fear of childbirth, 22% (n = 153) had a mild fear of childbirth, 27% (n = 188) had a moderate fear of childbirth, and 25.3% (n = 176) had a severe fear of childbirth (Wijma score of 85 and above). When the pre-pandemic and the pandemic period were compared, the fear of childbirth was unchanged in pregnant women at all education levels (p = 0.079, p = 0.957, p = 0.626, p = 0.539, p = 0.202). When comparing fear of childbirth before and after the pandemic, it was found that patients with a high school education level have a significantly higher fear of childbirth. To alleviate the fear of childbirth in pregnant women who have completed high school, training or psychosocial support interventions may be prioritized.

"I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing

BACKGROUND

Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice.

AIM

To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented.

METHOD

A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews.

RESULTS

Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period.

CONCLUSION

The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.

The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review

BACKGROUND

The Fear of Childbirth (FOC) is regarded as a general problem, which affects women's health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies.

OBJECTIVE

This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers.

METHODS

In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021.

RESULTS

After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly.

CONCLUSION

According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Informing about childbirth without increasing anxiety: a qualitative study of first-time pregnant women and partners' perceptions and needs

BACKGROUND

Complications requiring medical interventions during childbirth are far from rare, even after uncomplicated pregnancies. It is often a challenge for maternity healthcare professionals to know how to prepare future parents for these eventualities without causing unnecessary anxiety. Studies on traumatic birth experiences have shown that feelings of loss of control, insufficient information, and lack of participation in medical decisions during childbirth are factors of difficult experiences. However, little is known about the information and communication needs of expectant parents about childbirth during the prenatal period. To gain a deeper understanding of the information and communication needs of first-time pregnant women and partners, we explored their perceptions and expectations for their upcoming childbirth, and the actions they initiated to prepare for it.

METHODS

Semi-structured interviews were conducted individually with first-time pregnant women and partners of pregnant women aged 18 years or older, with an uncomplicated pregnancy. Thematic analysis was used to identify themes and sub-themes.

RESULTS

Twenty expectant parents (15 pregnant women and five partners of pregnant women) were interviewed. Six themes were identified: Childbirth event; Childbirth experience; Childbirth environment; Organisation of care; Participation in decision making; Roles within the couple and transition to parenthood.

CONCLUSIONS

This study contributes to a better understanding of the information needs of future parents expecting their first child. Results highlighted that the notion of "childbirth risks" went beyond the prospect of complications during birth, but also encompassed concerns related to a feeling of loss of control over the event. Expectant parents showed an ambivalent attitude towards consulting risk information, believing it important to prepare for the unpredictability of childbirth, while avoiding information they considered too worrying. They expressed a desire to receive concrete, practical information, and needed to familiarise themselves in advance with the birth environment. Establishing a respectful relationship with the healthcare teams was also considered important. The findings suggest that information on childbirth should not be limited to the transmission of knowledge, but should primarily be based on the establishment of a relationship of trust with healthcare professionals, taking into account each person's individual values and expectations.

The effect of antenatal education on expectant mother's childbirth attitudes, maternal role attainment, and self-confidence levels

We aim to determine the effect of antenatal education on the attitudes of expectant mothers toward birth, maternal role attainment and self-confidence levels. We carried out this quasi-experimental, non-randomized, prospective study in a hospital located in Istanbul, in the pre- and post-education model. Women in the education group (EG = 60) attended 6 weeks of education. Women in the control group (CG = 60) participated in a periodic follow-up visit. We collected the data using Childbirth Attitudes Questionnaire (CAQ), Pharis Self-Confidence Scale (PSCS), and Semantic Differential Scale-Myself as Mother (MMS). We made three measures in total: in the first visit, after six weeks and in the sixth week postpartum. We found the mean scores of second measurement of CAQ, PSCS, third measurement of MMS statistically significant in favor of EG (p < 0.05). Antenatal educations positively affect childbirth attitude, maternal role attainment and self-confidence levels.

The Effect of Structured Antenatal Education on Childbirth Self-Efficacy

INTRODUCTION

Antenatal (prenatal) education is a vital role of midwives when giving antenatal care to pregnant women. Particularly in the late stages of pregnancy, antenatal education regarding the natural-labor process, the introduction of labor rooms, coping strategies, and labor-pain management may enhance maternal self-efficacy and perceptions of childbirth. However, educational programs that include birth plans, pain-relief measures, and birth preparation are not a structured part of the Saudi healthcare system. This is the first study to investigate the effect of antenatal education on maternal self-efficacy in Saudi Arabia. The aim of this study was to investigate the effect of an antenatal education program on maternal self-efficacy in primiparous pregnant women and to determine the relationship between maternal self-efficacy and their sociodemographic characteristics in Jeddah, Saudi Arabia.

METHODS

A randomized control trial (pretest/posttest) design was conducted with 94 primiparous pregnant women. Two groups were compared: an intervention group, which received a structured antenatal educational program (n = 46), and a control group, which received routine antenatal care (n = 48). The childbirth self-efficacy inventory (CBSEI) was used to assess maternal self-efficacy. The data were analyzed using IBM SPSS Statistics for Windows, Version 24 (Released 2016; IBM Corp., Armonk, New York, United States).

RESULTS

The mean score on the CBSEI pretest was 238.5 ± 237.4 compared to 242.9 ± 276.2 in the posttest mean score, with significant differences (p < .05) in maternal self-efficacy between the pretest and posttest scores for both groups.

CONCLUSION

The findings of this study suggest that an antenatal educational program could serve as an essential tool, providing access to high-quality information and skills during the antenatal period and significantly enhancing maternal self-efficacy. It is crucial to invest resources to empower and equip pregnant women in ways that promote positive perceptions and boost their confidence regarding childbirth.

Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review

OBJECTIVE

The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women.

INTRODUCTION

Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics.

INCLUSION CRITERIA

This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts.

METHODS

The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review.

RESULTS

A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n   =  13; 38%) or with the participation of other health professionals ( n   =  7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n   =  12; 35%) and psychoeducation ( n   =  8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women.

CONCLUSIONS

Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.

Investigation of the effect of pregnant women's childbirth-related Internet use on fear of childbirth

This research was carried out to examine the effect of childbirth-related Internet use by pregnant women on fear of childbirth (FOC). The descriptive study was conducted with 350 pregnant women who applied to the Outpatient Polyclinic of Gynaecology and Obstetrics. Of the pregnant women who used the Internet, 72.9% did so to research information about childbirth. The pregnant women used the Internet mostly to obtain information about coping with labour pain (43.4%), the delivery process (46.9%), the needs list at delivery (39.4%), about C-section/epidural analgesia for labour (26.8%), and about the environment of the delivery room (25.7%). It was determined that there was a statistically significant difference (p < .05) between the delivery-related video viewing status of the pregnant women, the mean score of the W-DEQ Version A (p < .05), and the FOC was lower in those who watched videos about delivery.IMPACT STATEMENTWhat is already known on this subject? Previous studies have shown that pregnant women frequently use the Internet as a source of information about childbirth.What do the results of this study add? The findings of this study reveal that watching videos and listening to or reading the narrations significantly affected the FOC.What are the implications of these findings for clinical practice or further research? Nurses who provide preconception and antenatal care should consider Internet use as a risk factor for FOC and should guide pregnant women to reliable sources.

Online solution-focused psychoeducation as a new intervention for treating severe fear of childbirth: A randomized controlled trial in the pandemic period

PURPOSE

This study was conducted to determine the effect of solution-focused psychoeducation (SFP) and childbirth preparation training (CPT) on women's fear of childbirth and self-efficacy.

METHODS

This randomized controlled trial was carried out at the family health center in Turkey. The sample of the study consisted of a total of 119 healthy primigravid women. These women were randomized into the SFP group (n = 39), CPT group (n = 40), and control group care (n = 40).

FINDINGS

After the intervention, the women in the experiment groups had decreased fear of childbirth and increased self-efficacy.

PRACTICE IMPLICATIONS

Midwifery care based on education and counseling provided by online synchronous video conferencing method during the pandemic period is an effective and safe method in reducing fear of childbirth in women and increasing their self-efficacy.

Does Childbirth Preparation Education Affect Prenatal Adaptation?

OBJECTIVE

To determine the effect of childbirth preparation education on the prenatal adaptation of pregnant women.

METHODS

This study design was a quasi-experimental; one-group pretest-posttest. This study was conducted with the participation of 42 pregnant women and their spouses. The educations were given in four sessions in a special area designed for childbirth preparation educations in a private hospital where the study was conducted. The data of the study were collected using the Pregnant Women Information Form and the Prenatal Self-Evaluation Questionnaire. Prenatal Self-Evaluation Questionnaire consists of seven subscales which are the well-being of pregnant women and their infants, acceptance of pregnancy, acceptance of motherhood, fear of childbirth, relationship with her mother and relationship with her spouse. The Wilcoxon signed rank test statistics were used to analyze the difference between the pretest and posttest PSEQ scores.

RESULTS

The concerns about the well-being of pregnant women and their infants (p < .05), acceptance of pregnancy (p < .05), acceptance of motherhood (p < .05), fear of childbirth (p < .05), relationship with her mother (p < .05), relationship with her spouse (p < .05) subscale and total adaptation score (p < .05) were significantly higher before the education compared with the after the education. However, there was no significant difference between pre and post-education scores regarding readiness for birth subscale (p > .05).

CONCLUSION

This study showed that childbirth preparation education improves prenatal adaptation, acceptance of pregnancy and motherhood, relationship with her mother and relationship with her partner of pregnant women. In addition, it decreased fear of childbirth of pregnant women.

Comparing the effect of childbirth preparation courses delivered both in-person and via social media on pregnancy experience, fear of childbirth, birth preference and mode of birth in pregnant Iranian women: A quasi-experimental study

Background and aim

Rates of cesarean section in Iran are unnecessarily high largely due to fear of childbirth (FOC), yet this may be reduced through education. Iranian women are keen to obtain information about pregnancy and birth online though sources may not be reliable. Consequently, the present study aimed to compare the effect of childbirth preparation courses delivered both online via the social media platform ‘Telegram’ and in-person on pregnancy experience, FOC, birth preference, and mode of birth.

Methods

This quasi-experimental study included 165 primiparous pregnant women referred to the prenatal clinic in Tehran, Iran. Convenience sampling was used to recruit participants, who were subsequently divided into three groups; (A) social media-based educational intervention (n = 53); (B) in-person educational intervention (n = 52), and (C) a control group who received no prenatal education (n = 50). During the 18th and 20th weeks of pregnancy, demographic questions along with the pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ‑A) were completed. In the 36th and 38th weeks of pregnancy, the PES and WDEQ‑A questionnaires, as well as birth preference form were further completed. Mode of birth was recorded in the first few days of postpartum. The Fisher’s exact test, along with ANOVA and Chi-square tests were used to determine associations between variables. A paired t-test was used to examine within-group comparisons. The Kruskal–Wallis non-parametric test was used to investigate the intervening effect of economic status.

Results

Post intervention, the mean score of pregnancy experience and FOC did not differ significantly between the three groups. Also, 86.8% of participants in group A, 90.4% of participants in group B, and 62% of participants in the control group preferred to give birth vaginally, which was statistically significant (p = 0.001). Moreover, 66% of participants in group A, 61.5% of participants in group B, and 50% of participants in the control group ultimately gave birth vaginally. None of the participants in group A underwent an elective cesarean section, while this rate was 7.7% and 24% for groups B and control, respectively (p = 0.002).

Conclusion

Despite the non-significant differences identified between the three groups in terms of pregnancy experience and FOC, prenatal education delivered via social media may be usefully offered to Iranian women keen to receive education flexibly online.

Trial registration

Name of the Registry: Iranian Registry of Clinical Trials. Trial registration number: IRCT20180427039436N2. Date of registration: 15/06/2018. URL of trial registry record: https://www.irct.ir/trial/30890.

The Construct Structures of Psychological and Behavioral Responses to COVID-19 Pandemic in Pregnant Women

AIM

The present study aimed to investigate the construct structure behind the psychosocial response, behavioral response, prenatal depression, and post-traumatic stress disorder (PTSD) in pregnant women during the COVID-19 pandemic in China.

METHOD

The validated Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), PTSD CheckList (PCL)-6, and two newly established scales for COVID-19-related psychological and behavioral responses were used. Structural equation modeling (SEM) analysis was applied to evaluate the structural relationships of psychological and behavioral responses during the COVID-19 pandemic.

RESULTS

Of the 1,908 mothers who completed the questionnaires, 1,099 met the criteria for perinatal depression, and 287 were positively screened for PTSD, where 264 women exceed the cut-off points for both. Pregnant women with full-time or part-time jobs tended to have the lowest scores of EPDS (10.07 ± 5.11, P < 0.001) and stress levels (23.85 ± 7.96, P = 0.004), yet they were more likely to change their behavior in accordance with the COVID-19 outbreak (13.35 ± 3.42, P = 0.025). The structural model fit the data (χ² = 43.260, p < 0.001) and resulted in satisfactory fit indices (CFI = 0.984, TLI = 0.959, RMSEA = 0.072, and χ²/df = 10.815), all path loadings were significant (p < 0.05). The SEM indicates that the level of QoL was attributable to the occurrence of PND, leading to PTSD, and COVID-19 related behavioral and psychological responses.

CONCLUSION

The inter-relationships between the COVID-19-related psychosocial and behavioral responses have been assessed, indicating that the pandemic increased the burden of perinatal depression. Psychoeducation, as well as other psychological interventions, may be needed to alleviate the COVID-19-based anxiety and increase their engagement in protective behaviors.

Effects of antepartum education on worries about labor and mode of delivery

AIM

This study evaluated the effects of antenatal education, which was provided in a pregnancy education class, on pregnant women's concerns about labor and the mode of delivery.

MATERIALS AND METHODS

Primigravid pregnant women (n = 144) were enrolled into the study between May 2017 and November 2018. Pregnant women received standard education on nutrition during pregnancy, exercise, methods of coping with pain, and breastfeeding. The participants completed the "Introductory Information Form" and "Oxford Worries about Labour Scale" to collect data.

RESULTS

A statistically significant difference was found between the participants' pain, distress, uncertainty, and interventions in the pre-education, post-education, and postpartum periods and mean total score on the Oxford scale (p<.05). However, education had no significant effect on the mode of delivery (p>.05).

CONCLUSION

Education provided during pregnancy significantly decreased women's worries about labor, but it did not lead to a significant difference in the modes of delivery.

Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial

OBJECTIVE

To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas.

METHODS

A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected.

RESULTS

Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05).

CONCLUSION

Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future.

PRACTICE IMPLICATIONS

Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.

Interventions to treat fear of childbirth in pregnancy: a systematic review and meta-analysis

Background

Between 5% and 14% of women suffer from fear of childbirth (FOC) which is associated with difficulties during birth and in postnatal psychological adjustment. Therefore, effective interventions are needed to improve outcomes for women. A systematic review and meta-analysis was used to identify effective interventions for treating women with FOC.

Methods

Literature searches were undertaken on online databases. Hand searches of reference lists were also carried out. Studies were included in the review if they recruited women with FOC and aimed to reduce FOC and/or improve birth outcomes. Data were synthesised qualitatively and quantitatively using meta-analysis. The literature searches provided a total of 4474 citations.

Results

After removing duplicates and screening through abstracts, titles and full texts, 66 papers from 48 studies were identified for inclusion in the review. Methodological quality was mixed with 30 out of 48 studies having a medium risk of bias. Interventions were categorised into six broad groups: cognitive behavioural therapy, other talking therapies, antenatal education, enhanced midwifery care, alternative interventions and interventions during labour. Results from the meta-analysis showed that most interventions reduced FOC, regardless of the approach (mean effect size = −1.27; z = −4.53, p < 0.0001) and that other talking therapies may reduce caesarean section rates (OR 0.48, 95% CI 0.48–0.90).

Conclusions

Poor methodological quality of studies limits conclusions that can be drawn; however, evidence suggests that most interventions investigated reduce FOC. Future high-quality randomised controlled trials are needed so that clear conclusions can be made.

Psychosocial predictors of the fear of childbirth in Turkish pregnant women

INTRODUCTION

Fear of childbirth (FOC) affects women's emotional health, preparation for birth, and outcomes of birth. Identifying the predictors of FOC can aid in identifying strategies for reducing women's FOC.

OBJECTIVE

This descriptive, cross-sectional study was aimed at determining the psychosocial predictors of FOC in pregnant women.

METHODS

The participants were 624 nulliparous and multiparous pregnant women in their last trimester. Data were collected using a personal information form, Wijma Delivery Expectancy/Experience Questionnaire A, Childbirth Self-Efficacy Inventory, Multidimensional Scale of Perceived Social Support, State-Trait Anxiety Inventory, and Prenatal Self-Evaluation Questionnaire. Hierarchical regression analysis was performed to determine the predictors of FOC.

RESULTS

FOC was high among this study's participants and severe for one fifth of them. The psychosocial variables predicting FOC were self-efficacy and trait anxiety level, and spousal support was found to be a mediator variable in the relationship between self-efficacy and FOC.

CONCLUSION

The findings suggest that psychosocial variables are key to predicting FOC.

Students' Attitudes Towards Birth Decisions

Background:Numerous approaches have been examined to reduce unnecessary cesarean sections. Recently, concerns regarding both the psychosocial and behavioral factors that affect birth decisions have been raised. Adolescents perceive conception, pregnancy, and birth as important aspects of sexual health education; however, they exhibit poor knowledge regarding the aforementioned concepts. Aim:To identify data that examine attitudes toward birth choices among adolescents and young adults. To indicate the necessity of educational interventions, among young populations, in order to provide positive attitudes towards birth choices. Materials and methods:We reviewed PubMed, MEDLINE, and Google Scholar for research - and respective reference lists - published between 1997 and 2020. Results:We found a total of 13 papers, all in English, that examined attitudes and beliefs toward birth options in young populations. Conclusion:Regardless of a recorded rise in the rates of cesarean sections, young students who are introduced into a medicalized birth culture report vaginal birth preference in a healthy future pregnancy. Future research must examine all circumstances and factors that influence the discrepant correlation of the aforementioned vaginal birth preference and the high rates of cesarean sections.

Causes and Grounds of Childbirth Fear and Coping Strategies Used by Kurdish Adolescent Pregnant Women in Iran: A Qualitative Study

BACKGROUND

Fear of childbirth is one of the most common problems among pregnant women that can threaten their and their baby's health. Therefore, the purpose of this study was to explore the causes and grounds of childbirth fear and the strategies used by pregnant adolescent women in Iran to overcome such fears.

METHODS

In this study, which was conducted among primiparous Kurdish women in Iran, conventional qualitative content analysis was used. Data were selected through purposive sampling and semi-structured interviews. Data saturation was reached with 15 participants. The Lincoln and Guba criteria were used to strengthen the research.

RESULTS

After analyzing the data, two main categories were resulted. The first category was fear of childbirth with subcategories of fear of child health, fear of childbirth process, fears about inappropriate medical staff performance, fears about hospital environment, and postpartum fears. The second category was strategies to reduce childbirth fear with subcategories of choosing appropriate medical centers, increasing information on childbirth, avoiding stressful sources, improving self-care, getting prepared for delivery day in advance, and resorting to spirituality.

CONCLUSION

Pregnancy in adult age is better than adolescent age. The women's fear can be reduced by increasing their assurance about child health, providing appropriate training during pregnancy, explaining the whole process of childbirth and making it easier, improving the hospital environment and medical staff specialization, as well as providing appropriate conditions for further care and support after birth.

Connecting with Families through Virtual Perinatal Education during the COVID-19 Pandemic

The COVID-19 pandemic has caused many changes in health care. The status quo has been upended. We have been challenged in many ways to maintain our ability to meet the needs of our clients while keeping them safe. The Center for Perinatal Education and Lactation at NYU Langone Hospitals, in one of the initial epicenters of the pandemic in New York City, had to abruptly transition the childbirth education program to a virtual format in March of 2020. The goal for this change was to continue to provide evidence-based support and guidance our to our expectant and new families through this crisis. This report focuses on the process and challenges of transitioning to and implementation of the virtual format in the context of the COVID-19 crisis. We discuss the rapidly evolving programmatic changes to our approach and reflect on the themes and changing landscape of our newly structured model. Questions and answers live discussion webinars "Ask the Educator" on various topics were a valuable tool in connecting with families and allaying anxiety and fear.

The effect of individual counseling intervention on health practices in pregnancy: a randomized controlled trial

This research was carried out to determine the effect of individual counseling intervention on health practices in pregnancy. This research is a single-blind randomized controlled experimental and follow-up design. Population of the research consisted of 126 pregnant women in total, with 64 of them being in the training group and 64 being in the control group. The research data were collected by using a 'Pregnant Identifying Information Form' and 'Health Practices in Pregnancy Questionnaire (HPQ)'. In this research, it was found that there was no significant difference in total score average of the HPQ before the individual counseling training between the pregnant women in the training and control groups (P > 0.05). It was also determined that there was a statistically significant difference in total score average of the HPQ after the individual counseling training during the second trimester between the two groups (P < 0.05). It was determined that there was a statistically significant difference in total score average of the HPQ during the third trimester between two groups (P < 0.05). It has been determined that the training provided with individual counseling to pregnant women is an effective initiative in increasing the health practices of pregnant women.

Effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women: a randomized clinical trial

Background: Psychological birth trauma has persistent adverse effects on the performance and health of women during and after childbirth. Therefore, Interventions to prevent and mitigate psychological birth trauma are of paramount importance.Objective: The present study aimed to investigate the effects of counseling based on Gamble's approach on psychological birth trauma in primiparous women.Materials and methods: This randomized clinical trial was conducted on 60 primiparous women referring to the health centers in Mashhad, Iran in 2018. In the intervention group, counseling was provided by an obstetrician based on Gamble's strategy to each participant in three sessions before delivery and one session postpartum. The participants in the control group only received routine prenatal care. Data were collected using demographic and obstetrics characteristics questionnaire and psychological birth trauma questionnaire. The data were analyzed using SPSS, version 21 and chi-square and independent t-test. p-value less than .05 was considered significant.Results: The mean age of the women in the intervention and control groups was 23.3 ± 3.9 and 24.4 ± 4.4, and the mean prenatal age upon delivery was 40.8 ± 5.7 and 39.8 ± 1.2 weeks respectively. The mean score of psychological birth trauma in the intervention (counseling) and control groups was 37.2 ± 10.4 and 47.6 ± 16.3, respectively, which was significantly lower in the intervention group (p = .003).Conclusion: According to the results, counseling based on Gamble's approach could reduce psychological birth trauma in primiparous women. Therefore, this effective, simple, cost-effective, and harmless approach could be employed to reduce intrapartum and postpartum maternal traumas and prevent adverse events for the mother and the newborn.

The role and outcomes of music listening for women in childbirth: An integrative review

AIM

To synthesise primary research on the role and use of music listening for women in childbirth.

DESIGN

Integrative review.

METHODS

Whittemore and Knafl's (2005) five-stage integrative review method was utilized to complete a systematic search of the literature. Studies were included if they were (a) peer-reviewed, (b) written in the English language, (c) published between 1 January 1979 and 5 April 2019 and (d) described the use of music listening during labour and birth. Studies were appraised for quality and methodological rigor using standardised assessment tools including the Critical Appraisal Skills Programmes (CASP) checklist for the qualitative studies and the Joanna Briggs Institute Critical Appraisal Tool for the quasi-experimental studies and randomised control trials. Data extrapolation, methodological quality assessment and Thematic Content Analysis (Braun and Clarke, 2006) were carried out.

FINDINGS

A total of 931 articles were retrieved and 24 papers were included in the review (12 randomized controlled trials, 9 quasi-experimental and 3 qualitative). The quality of the studies was moderately good overall. Two overarching themes emerged including 'outcomes of using music in childbirth' and, 'music application during childbirth'. Within 'outcomes of using music in childbirth' four subthemes are described: 'pain', 'anxiety', 'psychological supports' and 'progression of labour'. Within 'music application during childbirth' four themes are presented: 'timing of the music application', 'type of music', 'birth preparation using music' and 'mode of music listening'.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The findings indicate that music listening has a significant role to play for women in childbirth. This non-pharmacological intervention can reduce pain and anxiety while offering a multifaceted form of psychological support to alleviate stress and promote an increased sense of control in women during labour. However, further awareness is needed around the idiosyncratic nature of the music listening experience.

Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process

Objective: This study determined the effect of an educational program based on cognitive behavioral techniques (CBT) provided for pregnant women to address their fear of childbirth. Methods: This study was conducted experimentally using pretest-posttest and a control group. A total of 111 Turkish pregnant women were recruited with 52 in the intervention group and 59 in the control group. The intervention group attended the educational program on coping with childbirth fears based on CBT, which took 3 weeks over six sessions. The Wijma Delivery Expectancy/Experience Questionnaire, version-A (W-DEQ-A) was administered to both groups as the posttest. The researchers monitored the pregnant women's labor and delivery and the State Anxiety Inventory (SAI), Numeric Pain Rating Scale (NPRS) and Birth Process Evaluation Form were completed. Results: The post-education W-DEQ-A score was 63.5 in the control group and 39.4 in the intervention group (p < .001). Their labor pain was lower, the second stage of labor was shorter and birth was more satisfactory for the intervention group than for the control group (p < .05). The CBT-based educational program and pain severity during childbirth were the significant predictors of satisfaction with childbirth (β = 0.354; β = -0.324, respectively; p < .05 for all). Conclusions: The CBT-based educational program on coping with childbirth fears reduced pregnant women's fear of childbirth and positively affected their birth experience.

From experiences to expectations: A quantitative study on the fear of childbirth among multigravida women

There is a strong relationship between women's previous birth experiences and their predetermined expectations. Childbirth expectations play an important role in the women's response to the birthing experience and postpartum period. The negative emotions and expectations, such as fear of childbirth, may result in negative experiences in subsequent childbirths. The aim of this study is to examine the relationship between previous birth experiences and the fear of childbirth in current pregnancy. A sample of 309 healthy women with normal pregnancies was recruited for this study. A chi-square test of independence and a multinomial logistic regression were used to explain the association between previous birth experiences and the fear of childbirth in current pregnancy. The level of childbirth fear that pregnant women feel appears to differ based upon their previous pregnancy experiences. Pregnant women who describe their previous births as happy and proud tend to experience a moderate level of childbirth fear about their current pregnancies, whereas pregnant women who remember their previous births as either fearful or painful have lower levels of childbirth fear. The level of childbirth fear tends to decrease as pregnant women have more children. Gestational week does not seem to be influential on the level of childbirth fear. According to the findings of this study, counterintuitively there is a negative relationship between the previous birth experience and childbirth fear. The level of childbirth fear is lower for pregnant women who remember their previous births as a negative experience compared to those who remember their previous births positively.

Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues

PURPOSE OF REVIEW

This paper seeks to identify the risk factors of fear of childbirth (FOC) and posttraumatic stress disorder (PTSD) related to birth and reviews the efficacy of their respective screening tools and therapeutic interventions.

RECENT FINDINGS

Biofeedback, hypnosis, internet-based cognitive behavioral therapy, and antenatal education are promising treatments for FOC. Training midwives to address traumatic birth experiences could help in preventing PTSD. A shorter more pragmatic screening tool for FOC than the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ) is needed. Women with PTSD attributed a mismatch between the expected mode of delivery (MOD) and the actual MOD as the cause of their trauma. A history of mental health disorders, lack of social support, previous negative birth experiences, and MOD are correlated to FOC and postpartum PTSD. Psycho-education and CBT-based treatments have been found to reduce levels of FOC and PTSD.

Pregnant Women in Turkey Experience Severe Fear of Childbirth: A Systematic Review and Meta-Analysis

Background: Culture is an important factor to determine fear of childbirth which is shaped by social learning processes. The purpose of this study is to determine the level of fear of childbirth among Turkish healthy pregnant women. Method: The researchers reviewed the eight databases considering inclusion criteria and 14 studies were included. The data analysis was conducted using meta-analysis. Results: Pregnant women experienced severe levels of fear, 67.26 ± 4.08, 95% confidence interval [59.26, 75.26], and 21 out of every 100 women experienced clinical level of fear. Between study variance was significant for parity (Qb = 6.40, p = .04) and region (Qb = 19.14, p = .00) moderators. Conclusions: The high level of FOC, particularly in the Eastern region, suggests that some of the cultural factors in the Eastern region in Turkey negatively affect the birth expectations. In a country like Turkey with a multicultural population, the health care professional should provide culturally sensitive care.

Consumer Evaluation of Antenatal Physiotherapy Education: How Useful Was It Really?

Antenatal education programs that help women better prepare themselves for labor are commonly offered at maternity hospitals. Physiotherapy-led sessions are often incorporated into these programs and are geared toward providing practical advice to equip women with the skills to better cope with labor using nonpharmacological methods and to help promote physical recovery postnatally.

A two-phase consumer satisfaction evaluation project was completed: Phase 1 determined participants’ satisfaction immediately after session attendance; Phase 2 determined participants’ satisfaction and practical usefulness of the session when considered retrospectively following childbirth.

The Phase 1 consumer survey indicated strong consumer support and satisfaction—participants could clearly see the potential usefulness of the skills they had learnt and strongly believed they were going to apply these skills in labor.

When considered in retrospect (Phase 2), the overall value of the antenatal Physiotherapy session appears to be enhanced with a greater percentage of respondents strongly agreeing/agreeing that they felt better prepared approaching labor after session attendance in Phase 2 than Phase 1 (96.9% vs 90.7%). Women reported feeling empowered by the new skills but, more importantly, felt they were able to apply this information practically to help them better cope and recover.

A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth

BACKGROUND

Despite a sharp increase in the number of publications that report on treatment options for pregnancy-specific anxiety and fear of childbirth (PSA/FoB), no systematic review of nonpharmacological prenatal interventions for PSA/FoB has been published. Our team addressed this gap, as an important first step in developing guidelines and recommendations for the treatment of women with PSA/FoB.

METHODS

Two databases (PubMed and Mendeley) were searched, using a combination of 42 search terms. After removing duplicates, two authors independently assessed 208 abstracts. Sixteen studies met eligibility criteria, ie, the article reported on an intervention, educational component, or treatment regime for PSA/FoB during pregnancy, and included a control group. Independent quality assessments resulted in the retention of seven studies.

RESULTS

Six of seven included studies were randomized controlled trials (RCTs) and one a quasi-experimental study. Five studies received moderate quality ratings and two strong ratings. Five of seven studies reported significant changes in PSA/FoB, as a result of the intervention. Short individual psychotherapeutic interventions (1.5-5 hours) delivered by midwives or obstetricians were effective for women with elevated childbirth fear. Interventions that were effective for pregnant women with a range of different fear/anxiety levels were childbirth education at the hospital (2 hours), prenatal Hatha yoga (8 weeks), and an 8-week prenatal education course (16 hours).

CONCLUSIONS

Findings from this review can inform the development of treatment approaches to support pregnant women with PSA/FoB.

Childbirth Fear: Relation to Birth and Care Provider Preferences

INTRODUCTION

The purpose of this study was to assess how preferences for place of birth and mode of birth relate to different dimensions of childbirth fear and whether there is an association between Canadian women's prenatal fear of childbirth and the type and quality of prenatal care they received.

METHODS

A link to an online survey was posted on Canadian pregnancy and birth websites; 409 women completed the survey that included sociodemographic questions, questions about the current pregnancy and previous pregnancy experiences (if applicable), and the Childbirth Fear Questionnaire, a validated 40-item scale that measures 9 dimensions of childbirth fear.

RESULTS

Women under physician care and those with a preference for cesarean birth were generally more fearful of pain associated with vaginal birth, fear of loss of sexual pleasure and attractiveness, and fear of harm to themselves or their infant. Conversely, women under the care of midwives and women who preferred to give birth vaginally were more fearful of interventions. Women who preferred a cesarean birth were significantly more likely to report that fear of childbirth interfered with daily functioning, compared to women who preferred a vaginal birth. Satisfaction with care was associated with lower scores on the Childbirth Fear Questionnaire full and subscales, especially among midwifery clients.

DISCUSSION

At present there are no guidelines in Canada or the United States for the treatment and/or referral of pregnant women who suffer from childbirth fear. Until such guidelines are developed, findings from the current study can help maternity care providers identify and address specific fears among women in their care and understand how different fear domains relate to care provider choice, satisfaction with care, and women's preferences for place and mode of birth.

Exploring factors behind pregnant women's quality of life in Iran: a qualitative study

BACKGROUND AND OBJECTIVE

Pregnancy-related physiologic and psychosocial alterations can impact on the body and cause symptoms which may affect quality of life. Since qualitative studies can provide more in-depth understanding of quality of life and its determining factors, this study was conducted with the aim of exploring factors affecting pregnant women's quality of life.

METHODS

A qualitative descriptive study with conventional content analysis approach was made using the conventional content analysis approach on a purposeful sample of sixteen pregnant Iranian women in Hamadan, Iran from May 2015 to December 2015. Sampling was continued until data saturation. Data were collected through in-depth semi-structured personal interviews, and were analyzed using the conventional content analysis approach.

RESULTS

Data analysis resulted in three main categories, namely, the effects of pregnancy on different aspects of health (including psychological disorders, impaired interactions, disturbances in doing daily activities, disturbed body image, alterations in sexual relationships, physical disorders, and alterations in dietary habits and treatment regimens), pregnancy-related concerns (regarding the gender of the fetus, financial problems, childbirth, health, and the future), and coping with pregnancy (through strategies such as spirituality, positive attitude toward pregnancy, distraction and imagination, and support).

CONCLUSIONS

This study showed that different factors can affect pregnant women's quality of life. Nonetheless, prenatal care services are mainly focused on pregnancy-related physical problems, and other aspects of care are usually taken for granted. Consequently, healthcare professionals need to pay greater attention to pregnant women's quality of life and its contributing factors.

Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials

INTRODUCTION

Fear of childbirth is a problematic mental health issue during pregnancy. But, effective interventions to reduce this problem are not well understood.

OBJECTIVES

To examine effective interventions for reducing fear of childbirth.

MATERIAL AND METHODS

The Cochrane Central Register of Controlled Trials, PubMed, Embase and PsycINFO were searched since inception till September 2017 without any restriction. Randomised controlled trials and quasi-randomised controlled trials comparing interventions for treatment of fear of childbirth were included. The standardized mean differences were pooled using random and fixed effect models. The heterogeneity was determined using the Cochran's test and I² index and was further explored in meta-regression model and subgroup analyses.

RESULTS

Ten studies inclusive of 3984 participants were included in the meta-analysis (2 quasi-randomized and 8 randomized clinical trials). Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled standardized mean differences of fear for the education intervention and hypnosis group in comparison with control group were -0.46 (95% CI -0.73 to -0.19) and -0.22 (95% CI -0.34 to -0.10), respectively.

CONCLUSIONS

Both types of interventions were effective in reducing fear of childbirth; however our pooled results revealed that educational interventions may reduce fear with double the effect of hypnosis. Further large scale randomized clinical trials and individual patient data meta-analysis are warranted for assessing the association.