Can a simple assessment of fear of childbirth in pregnant women predict requests and use of non-urgent obstetric interventions during labour?

What is the authentic underlying reason of childbirth worries in Turkish population?: An observational study

This study aims to determine women's childbirth worries during antenatal. The research was carried out with 532 pregnant women in the antenatal clinic in Turkey as an observational study. Sociodemographic characteristics and scores of the Oxford Worries about Labor Scale of pregnant women were evaluated quantitatively. In addition, the answers given by the pregnant women to the open-ended question were themed. Although working status and receiving antenatal education reduce the fear of childbirth, birth scenes/stories on TV or social media, birth stories in the pregnant women's friends/family, being stressed in daily life, and dysmenorrhea increase the worries about childbirth (WaC). In addition, primiparas experience more WaC than multiparas. The reasons for WaC in pregnant women were classified as birth pain, artificial pain, cesarean section/receiving anesthesia, intervention/examination, pandemic, people's thoughts/experiences, birth process/insufficiency in birth, hospital/staff, fears about the baby, complications/death, and ignorance of the birth process. The results of this study reveal that WaC is a pivotal issue for pregnant women, for which managing the labor process, labor pain and labor fear is important. The stipulation of support for pregnant women is essential to enhance labor outcomes.

The impact of fear of childbirth on mode of delivery, postpartum mental health and breastfeeding: A prospective cohort study in Shanghai, China

BACKGROUND

The prevalence and impact of fear of childbirth (FOC) has not been sufficiently understood. We aimed to investigate the prevalence of FOC among Chinese population and its impact on mode of delivery, postpartum mental health and breastfeeding.

METHODS

We conducted a prospective cohort study, wherein pregnant women in their third trimester who underwent antenatal assessments at Shanghai Changning Maternity and Infant Health Hospital between September 2020 and March 2021 were recruited. Sociodemographic data of the participants were gathered by self-administered questionnaire, and their FOC was assessed using the Wijma Delivery Expectancy Questionnaire. Participants were followed up to 42 days postpartum. Information regarding their modes of delivery was retrieved from medical records, and data regarding postpartum mental health symptoms and one-month postpartum breastfeeding were obtained through self-administered questionnaires.

RESULTS

Among 1287 participants, 461 (35.8 %) had high-level FOC (W-DEQ ≥ 66). Logistic regressions showed that women with high-level of FOC had higher rates of caesarean delivery on maternal request (CDMR) (aOR = 1.55, 95 % CI: 1.00-2.41, p = 0.049), a higher incidence of postpartum mental health symptoms (aOR = 1.68, 95 % CI: 1.09-2.59, p = 0.018), lower rates of one-month postpartum exclusive breastfeeding (aOR = 0.33, 95 % CI: 0.16-0.69, p = 0.003) and mixed feeding (aOR = 0.44, 95 % CI: 0.21-0.91, p = 0.028).

LIMITATIONS

The long-term implications of FOC beyond the immediate postpartum period were not explored in the study.

CONCLUSIONS

High-level FOC during the third trimester was associated with increased CDMR and postpartum mental health symptoms and reduced breastfeeding establishment. These results underscore the significance of FOC screening and tailored interventions for affected women.

Swiss cohort on Traumatic Childbirth and Health (SwiTCH): protocol for a prospective, population-based cohort study on parents' mental health from pregnancy to one year postpartum

INTRODUCTION

Approximately 4%-5% of mothers develop childbirth-related post-traumatic stress disorder (CB-PTSD) and approximately 12.3% of mothers develop some CB-PTSD symptoms (CB-PTSS). To date, there is a dearth of studies on fathers and other coparents. Parental CB-PTSD and CB-PTSS may have a negative impact not only on the parents but also on the infant. Understanding risk and protective factors of CB-PTSD for both parents and its consequences on the family is key to detecting or anticipating it, to developing interventions aimed at reducing its detrimental effects and to supporting parents.

METHODS AND ANALYSIS

This study protocol describes an observational, population-based study, consisting of a longitudinal prospective cohort with online surveys at four time points. The population of interest consist of women, in the third trimester of pregnancy or at 6-12 weeks postpartum, and their partner/coparent, who will give birth or gave birth in the French-speaking part of Switzerland. The target sample size is 300-500 women and a proportional number of partners. The primary outcome of this study is the prevalence of CB-PTSD and CB-PTSS. The secondary outcomes focus on: (1) the impact of CB-PTSD and CB-PTSS on the marital and coparental relationships, the bonding with the infant, parental burnout and healthcare seeking behaviours, (2) the role of the childbirth experience in the development of CB-PTSD and CB-PTSS and (3) the social and economic determinants of CB-PTSD and CB-PTSS.

ETHICS AND DISSEMINATION

Ethical approval was granted by the human research ethics committee of the Canton de Vaud (study number 2022-00284). All study participants signed an informed consent form. Dissemination of results will occur via national and international conferences, in peer-reviewed journals, public conferences and social media.

TRIAL REGISTRATION NUMBER

NCT05865704.

Tools for Assessing Childbirth Fear: A Comprehensive Review and Psychometric Evaluation

Childbirth fear is a prevalent concern among pregnant women, and its measurement is crucial for effective clinical intervention. This article presents a comprehensive review of existing tools for assessing childbirth fear, aiming to assist researchers and health-care professionals in selecting appropriate instruments for their work. A systematic search was conducted across multiple electronic databases, resulting in the identification of twenty tools specifically developed for assessing childbirth fear. The characteristics and psychometric properties of each tool were analyzed. Most tools were Likert scale based, with some employing visual analog tools and dichotomous tools. The identified tools were employed in diverse research designs, including experimental studies and observational studies. Among the tools reviewed, the Wijma Delivery Expectancy Questionnaire emerged as a frequently used and well-validated instrument. It demonstrated good psychometric properties, assessing fear of childbirth through women's expectations and experiences. Other notable tools included the Fear of Birth Scale, Childbirth Experience Questionnaire, and Tokophobia Severity Scale, each addressing specific aspects of childbirth fear. However, some tools lacked thorough testing for validity and reliability, indicating the need for further refinement and evaluation. Researchers can utilize this comprehensive overview to select appropriate tools for their investigations. Clinicians and health-care professionals working with pregnant women can benefit from the identified tools to assess and monitor childbirth fear, aiding in early detection and timely intervention. In conclusion, this review emphasizes the need for well-validated and culturally sensitive tools, facilitating a better understanding of this complex phenomenon and ultimately contributing to improved care for pregnant women.

Cost-Effectiveness of the Mindfulness-Based Childbirth and Parenting Program for Pregnant Women With Fear of Childbirth

OBJECTIVE

To examine the cost-effectiveness of the Mindfulness-Based Childbirth and Parenting (MBCP) program compared with enhanced care as usual (ECAU).

DESIGN

Randomized controlled trial.

SETTING

Midwifery settings in the Netherlands, April 2014 to July 2017.

PARTICIPANTS

Subset of pregnant women with high levels of fear of childbirth (N = 54: randomized to MBCP, n = 32, or to ECAU, n = 22) who were selected from the parent study because they completed all four cost questionnaires.

METHODS

We measured self-reported health care and non-health care costs. A subset of participants from the parent study completed the questionnaires at all four assessment points. We used the Wijma Delivery Expectancy Questionnaire to measure fear of childbirth and used the EuroQol-5D to measure quality of life. We used these measures of effect together with societal costs in the primary cost-effectiveness analyses. In the secondary cost-effectiveness analyses, we used different estimates of effects and costs to test the robustness of the primary analyses.

RESULTS

In all but one scenario, MBCP was more effective and cost less than ECAU. As indicated by the acceptability curves, the likelihood of MBCP being cost-effective varied within a range of 70% to 98%.

CONCLUSION

Our findings indicate that MBCP is a cost-effective intervention to reduce fear of childbirth in pregnant women. Important next steps are to replicate the study in countries with different health care systems and to explore the potential for further integration of MBCP into midwifery care.

Women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor: A cross-sectional survey

INTRODUCTION

The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor.

METHODS

A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test.

RESULTS

Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants’ experiences of fear and pain were significantly associated with the implementation of pain assessment.

CONCLUSIONS

Women’s pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives’ own personal contributions were rarely offered to the women.