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Elsharkawy NB, Alruwaili MM, Mohamed Elsayed Ramadan O, Alruwaili AN, Ouda MMA, Oraby FA, Mansy AMA, Abdelaziz EM. Prevalence and determinants of fear of childbirth among pregnant women in Egypt: A cross-sectional study. Midwifery 2024; 136:104088. [PMID: 38968683 DOI: 10.1016/j.midw.2024.104088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 06/06/2024] [Accepted: 06/28/2024] [Indexed: 07/07/2024]
Abstract
PROBLEM Fear of childbirth (FOC) is a significant public health concern, and understanding its determinants is crucial for developing effective interventions to support women during pregnancy and childbirth. BACKGROUND Fear of childbirth (FOC) is increasingly recognized as an essential psychological health concern among pregnant women globally. However, research elucidating the prevalence and multifaceted determinants of FOC in the Egyptian context remains scarce. This knowledge is pivotal to informing maternal health practices. AIM This study aimed to investigate FOC prevalence and its determinants among pregnant women in Egypt. METHODS A cross-sectional study was conducted among 460 low-risk pregnant women attending antenatal clinics in El-Beheira Governorate, Egypt, from February 2023 to July 2023. Data were collected using structured questionnaires on sociodemographic and obstetric profiles, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the Multidimensional Scale of Perceived Social Support. RESULTS The prevalence of FOC ranged from mild to severe, with 70.4% of women displaying some degree of fear and 11.3% exhibiting severe FOC. Key determinants associated with greater FOC were younger age, nulliparity, unplanned pregnancy, negative previous birth experiences, and preference for cesarean delivery. An inverse relationship was found between FOC and childbirth self-efficacy. CONCLUSIONS This study reveals a high FOC prevalence among Egyptian pregnant women, necessitating the need for systematic screening and tailored interventions to mitigate this concern, especially among high-risk groups like young, nulliparous mothers. Fostering childbirth self-efficacy may aid in reducing FOC. These findings can inform the enhancement of holistic maternal health practices in Egypt.
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Affiliation(s)
- Nadia Bassuoni Elsharkawy
- Department of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia; Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt
| | - Majed Mowanes Alruwaili
- Department of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia
| | - Osama Mohamed Elsayed Ramadan
- Department of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia.
| | - Abeer Nuwayfi Alruwaili
- Department of Nursing Administration and Education, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia
| | - Marwa Mohamed Ahmed Ouda
- Department of Maternal and Child Health Nursing, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia; Department of Pediatric Nursing, Faculty of Nursing, Damanhur University, Damanhur 22516, Egypt
| | - Fatma Ali Oraby
- Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Misr University for Science and Technology, 6th of October city, Giza 12566, Egypt
| | - Azza Medhat Aziz Mansy
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Damanhur University, Damanhur 22516, Egypt
| | - Enas Mahrous Abdelaziz
- Department of Psychiatric Mental Health Nursing, Faculty of Nursing, Cairo University, Cairo 11562, Egypt; Department of Psychiatric Mental Health Nursing, College of Nursing, Jouf University, Sakaka, AL-Jouf 72388, Saudi Arabia
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Nordin-Remberger C, Wells MB, Woodford J, Lindelöf KS, Johansson M. Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study. BMC Pregnancy Childbirth 2024; 24:388. [PMID: 38796427 PMCID: PMC11127315 DOI: 10.1186/s12884-024-06580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/13/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity. METHODS Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately. RESULTS In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home. CONCLUSIONS Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.
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Affiliation(s)
- Carita Nordin-Remberger
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Michael B Wells
- Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden
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Bakhteh A, Jaberghaderi N, Rezaei M, Naghibzadeh ZAS, Kolivand M, Motaghi Z. The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review. J Reprod Infant Psychol 2024; 42:5-21. [PMID: 35435061 DOI: 10.1080/02646838.2022.2059458] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Azam Bakhteh
- Student Research Center, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Nasrin Jaberghaderi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mansour Rezaei
- Department of Biostatistics, School of Health & Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Mitra Kolivand
- Department of Reproductive Health, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Motaghi
- Reproductive Health Department, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
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Howard S, Houghton CMG, White R, Fallon V, Slade P. The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. Psychol Health 2023; 38:1460-1481. [PMID: 35060404 DOI: 10.1080/08870446.2021.2024190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the feasibility and acceptability of a single-session Acceptance and Commitment Therapy intervention to help women manage fear of childbirth during a first pregnancy. DESIGN A mixed-methods approach including qualitative feedback and pre/post-intervention self-report measures. Pregnant women (14-37 weeks gestation) were recruited via the UK National Health Service and attended a single-session (<3 hours) Acceptance and Commitment Therapy intervention alongside routine antenatal care. Data were analysed using content and statistical analyses. MAIN OUTCOME MEASURES Fear of childbirth, anxiety and wellbeing were the main outcome measures. Secondary to these, intolerance of uncertainty and valued life domains (e.g. relationships, recreation) as hypothesised mechanisms of change, were also assessed. RESULTS 33 expressions of interest were received, 21 women signed up, 15 participated, and 11 completed follow-up measures (participation rate: 33%). Findings demonstrated clinical and statistical reductions in fear of childbirth and anxiety alongside positive feedback on the intervention. Intolerance of uncertainty and wellbeing were low at baseline and remained unchanged. CONCLUSION A single-session Acceptance and Commitment Therapy intervention to manage fear of childbirth is potentially feasible and acceptable. A pilot randomised controlled trial is warranted. Further research should explore efficacy and how Acceptance and Commitment Therapy may reduce perinatal distress.
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Affiliation(s)
- Sarah Howard
- Clinical Psychology, University of Liverpool, Liverpool, UK
| | | | - Ross White
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Vicky Fallon
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
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Sandström L, Kaunonen M, Klemetti R, Raussi-Lehto E, Aho AL. Factors helping pregnant multiparas cope with fear of birth: A qualitative study. Midwifery 2023; 125:103803. [PMID: 37659151 DOI: 10.1016/j.midw.2023.103803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE This study describes factors helping pregnant multiparas cope with their fear of birth and aims to contribute insight into measures that could be taken to support and develop care for multiparas with fear of birth. METHODS Purposive sampling was used for collecting data from closed discussion forums. An electronic questionnaire included structured background questions and qualitative open-ended questions related to the factors multiparas had found helped them cope with their fear of birth. After excluding respondents in early pregnancy (n = 20), the data consisted of answers from 78 pregnant multiparas from Finland. The data were analysed using inductive content analysis. RESULTS The factors helping pregnant multiparas to cope with their fear of birth included obtaining information, planning ahead, receiving empathic support, dealing with emotions in different ways, and focusing on the positive. CONCLUSIONS The support multiparas receive for their fear of birth from healthcare providers is insufficient and the quality and content of care varies widely. As a result, multiparas have been left to personally take responsibility for coping with their fear. IMPLICATIONS FOR PRACTICE The care for treating fear of birth in multiparas needs to be improved. This requires a critical evaluation of the maternity system, policies, and competence of healthcare professionals who work with pregnant people.
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Affiliation(s)
- Laura Sandström
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland.
| | - Marja Kaunonen
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland; Pirkanmaa Hospital District, PO BOX 2000 FI-33521 Tampere, Finland
| | - Reija Klemetti
- Department of Knowledge Management and Co-Creation, Finnish Institute for Health and Welfare, Po Box 30, FI-00271 Helsinki, Finland
| | - Eija Raussi-Lehto
- Customer oriented Wellbeing and Health Hub, Metropolia University of Applied Sciences, PO BOX 4000, FI-00079 Metropolia, Helsinki, Finland
| | - Anna Liisa Aho
- Faculty of Social Sciences, Health Sciences, Nursing Science, Tampere University, Arvo Ylpön katu 34, 33520, Tampere, Finland
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Bjørseth H, Vinnes Kvarme C, Lundgren I. Norwegian midwiveś experiences of encounter and support women with fear of childbirth during birth. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100881. [PMID: 37399760 DOI: 10.1016/j.srhc.2023.100881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To describe midwiveś experiences of encountering and supporting women with fear of childbirth (FOC) during the birth. METHOD Qualitative study with a phenomenological approach, using 10 individual semi-structured interviews with midwives who had cared for women with FOC during the birth. All midwives worked in birth clinics or maternity wards. The data was analysed using Malterud́s systematic text condensation (STC). RESULTS The findings present in three main themes: taking on a professional role as a midwife to take care of women; time matters for safety and trust; and to encounter and see women without prejudices. Themes to describe a 'professional midwife' included self-confidence, control, competence/experience, independence, promoting normal birth, and motivation. Time played a crucial role in enabling a calm approach and a relationship built on trust, as well as in creating a sense of continuity and being present. Individual care and equality among the women was of importance to prevent prejudices, as was having control of the term FOC. Self-awareness was also important for evaluating the quality of the relationship, and the midwives' wanted clear guidelines for handling women with FOC. CONCLUSION Aspects related to professional midwifery skills, organisational factors such as time to establish safety and trust, and use of the concept of FOC, are all important for midwives when encountering and supporting women with FOC at birth. All these aspects need to be improved in the care of women with FOC, and clearly defined guidelines for handling such cases need to be developed.
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Affiliation(s)
- Henrikke Bjørseth
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Norway
| | - Cathrine Vinnes Kvarme
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Norway
| | - Ingela Lundgren
- Institute of Health Care and Sciences, University in Tromsø (UiT) - Norway's Arctic University, Norway
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Abdolalipour S, Charandabi SMA, Mashayekh-Amiri S, Mirghafourvand M. The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: A systematic review and meta-analyses. J Affect Disord 2023; 333:257-270. [PMID: 37084975 DOI: 10.1016/j.jad.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/19/2023] [Accepted: 04/14/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Mindfulness-based interventions are a relatively new and potentially useful psychological approach in prenatal care. This study aimed to determine the effect of mindfulness-based programs on pregnant women's fear of childbirth FOC and self-efficacy. METHODS The systematic search of PubMed, Scopus, Web of Science, Cochrane Library, Google Scholar, SID, and Magiran databases began on 11 November 2021 and ended on 17 December 2021 to obtain studies published in English and Persian without date constraints. Another search was conducted in March 2023. The Cochrane handbook tool was used to evaluate selected studies and their risk of bias. RESULTS From a total of 316 records obtained, after removing duplicate items, 16 full texts were evaluated for eligibility; and finally, 10 studies were included in the study and meta-analysis. Based on the results of meta-analyses, mindfulness-based exercises may improve childbirth self-efficacy (SMD = 1.34, 95 % CI: 0.39 to 2.30; P < 0.00001; 5 studies, 304 women; low-certainty evidence) and probably reduce the level of FOC (SMD = -0.71, 95 % CI: -1.14 to -0.27; P = 0.001; 5 studies, 424 women; moderate-certainty evidence) in the intervention group compared to the control group. LIMITATIONS Different duration of interventions across studies, different gestational ages at the time of enrollment, and large heterogeneity in the meta-analysis of results were the limitations of this study. CONCLUSION Mindfulness-based interventions probably reduce FOC and may promote self-efficacy. More randomized controlled trials with stronger designs and adequate power samples are required to verify the effectiveness of mindfulness-based interventions, especially on self-efficacy in pregnant women. PROSPERO ID CRD42021294056.
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Affiliation(s)
- Somayeh Abdolalipour
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | | | - Sepideh Mashayekh-Amiri
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, IR, Iran.
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Souto SPAD, Silva RCGD, Prata AP, Guerra MJ, Couto C, Albuquerque RSD. Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth 2022; 20:2867-2935. [PMID: 35976033 DOI: 10.11124/jbies-21-00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
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.
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Affiliation(s)
- Sandra Patrícia Arantes do Souto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal
| | - Rosa Carla Gomes da Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC).,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Ana Paula Prata
- CINTESIS - Center for Health Technology and Services Research, Nursing School of Porto (ESEP), Porto, Portugal
| | - Maria João Guerra
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | - Cristina Couto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Tâmega e Sousa, Penafiel, Portugal
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Rondung E, Magnusson S, Ternström E. Preconception fear of childbirth: experiences and needs of women fearing childbirth before first pregnancy. Reprod Health 2022; 19:202. [PMID: 36307851 PMCID: PMC9617446 DOI: 10.1186/s12978-022-01512-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although early case studies have indicated that fear of childbirth can predate a woman’s first pregnancy, the concept of preconception fear of childbirth is largely unexplored. The few studies reporting on the prevalence of preconception fear of childbirth found higher levels than most prevalence estimates in pregnant populations. However, little is known about women’s fear of childbirth before becoming pregnant. The aim of this qualitative study was to give voice to the experiences of this often-neglected group of women. Methods To address the experiences and needs of women who do not dare become pregnant due to fear of childbirth, we conducted nine qualitative interviews and analyzed these using reflexive thematic analysis. Results The women perceived childbirth as an extremely risky event and doubted their abilities to cope with it. With increasing age, the fear became more real. It was associated with thoughts of becoming too old to be able to conceive. The women did their best to cope with fear on their own by seeking information, trying not to think about it, and using multiple strategies to avoid becoming pregnant. Despite expressing a strong wish for professional support, they all described very limited opportunities to receive support from maternal care services. They felt abandoned, left on their own in a stressful and constantly ongoing negotiation with themselves, feeling the pressure to decide whether to dare become pregnant or not. Conclusion In this study, women expressed having experienced fear of childbirth long before a first pregnancy. They felt abandoned as they had to deal with their fear by themselves, without support from maternal care services. The results point to the necessity of an increased awareness of preconception fear of childbirth. We encourage maternal care services to consider their opportunities to support these women. Many researchers have studied the experiences of pregnant women who are afraid of giving birth. Although it is known that women can fear childbirth long before becoming pregnant, little research has investigated this issue. In this study, we interviewed nine women who wanted to have children but did not dare become pregnant because they were afraid of giving birth. The women perceived childbirth as an extremely risky event and doubted their abilities to cope with it. They tried to cope with their fear by seeking information about pregnancy and childbirth. They also tried not to think about these issues and did what they could to avoid becoming pregnant. The women felt abandoned as they had to deal with their fear on their own. They wanted support from maternal care services, but this was seldom the case. Instead, they felt pressured to decide whether to dare become pregnant or not without support. Here, we want to give voice to the experiences of this often-neglected group of women and make researchers, policy makers, and health care personnel aware of the needs of women who are afraid of giving birth before becoming pregnant. We encourage maternal care services to consider how they can support these women.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology and Social Work, Mid Sweden University, 831 25, Östersund, Sweden.
| | - Susanna Magnusson
- Department of Psychology and Social Work, Mid Sweden University, 831 25, Östersund, Sweden
| | - Elin Ternström
- Institution for Health and Welfare, Dalarna University, Falun, Sweden.,Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden
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Hildingsson I, Rubertsson C. The role of women's emotional profiles in birth outcome and birth experience. J Psychosom Obstet Gynaecol 2022; 43:298-306. [PMID: 33586598 DOI: 10.1080/0167482x.2021.1885026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim was to investigate birth outcome and birth experience in relation to women's emotional health. An additional aim was to explore the relationship between emotional health, continuity with a known midwife, and the birth experience. METHODS A prospective longitudinal cohort study of 243 women enrolled in a continuity of care project in a rural area in Sweden. Profiles were constructed from instruments measuring depressive symptoms, worries, fear of birth, and sense of coherence. Antenatal and birth records and questionnaires were used to collect data. RESULT Women were categorized into two cluster profiles: "emotionally healthy" vs. "emotionally unhealthy". Women in the "emotionally unhealthy" cluster had a less positive birth experience (p = 0.006). The total score of the Childbirth Experience Questionnaire was highest in women who had had a known midwife assisting at birth. Babies born to women in the "emotionally unhealthy" cluster were more likely to have a severe neonatal diagnosis. CONCLUSION There were few differences in birth outcome between the clusters, while there were explicit differences in the childbirth experience. Having a known midwife is important to warrant women a more positive childbirth experience. Screening with validated instruments during antenatal care could be a first step to further investigate women's emotional well-being and provide targeted psychosocial support.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Calpbinici P, Özçirpan ÇY. The effect of the training program provided to primiparous pregnant women through the motivational interview method on their fear of childbirth, childbirth self-efficacy, and delivery mode: a randomized controlled trial. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ghaffari SF, Elyasi F, Mousavinasab SN, Shahhosseini Z. The effect of midwifery-led counseling on expectant fathers' fear of childbirth: a smartphone- based randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:285. [PMID: 35382772 PMCID: PMC8985284 DOI: 10.1186/s12884-022-04638-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expectant fathers experience a range of different emotions during their wife's pregnancy; one of these feelings is fear. It has adverse consequences on both the father and his family. The aim of this study was to investigate the effect of midwifery-led counseling on the fear of childbirth among expectant fathers. METHODS A two-armed parallel design randomized controlled trial was conducted from July to August 2020. Fifty expectant fathers with severe fear of childbirth at the 24th-27th weeks of gestation, in the Iranian setting, were assigned to intervention and control groups (allocation ratio1:1) using permuted block randomization. Participants assigned to the intervention group were engaged in six 60-90-min midwifery-led counseling sessions (twice a week) in the Skyroom platform. Measures were administered at recruitment, post-intervention, and one-month follow-up. The primary outcome was the change in fear of childbirth score between groups over time. Secondary outcomes were changes in the General Self-Efficacy score as well as changes in the frequency of the preferred type of delivery between groups over time. RESULTS The mean age of the participants was 31.64 (3.33) years. In the intention-to-treat analysis, the fear of childbirth score in the intervention group significantly decreased (β = - 11.84; 95% Confidence Interval: - 21.90 to - 1.78; P = 0.021) compared to that of the control group. In terms of secondary outcomes, the intervention group showed a significant increase in General Self-Efficacy compared to the intervention group at one-month follow-up measurement (β = 1.43; 95% Confidence Interval: 0.28 to 2.58; P = 0.014). However, the frequency of preferred delivery type was not significantly different between the intervention and control groups (P = 0.139). CONCLUSIONS Midwifery-led counseling can be an effective approach in reducing expectant fathers' childbirth fear with potential clinical significance. Although the inconclusive results imply more research on this issue. TRIAL REGISTRATION Registration number: IRCT20150608022609N6 . Registered 12/04/2019.
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Affiliation(s)
| | - Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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13
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Grundström H, Malmquist A, Ivarsson A, Torbjörnsson E, Walz M, Nieminen K. Fear of childbirth postpartum and its correlation with post-traumatic stress symptoms and quality of life among women with birth complications - a cross-sectional study. Arch Womens Ment Health 2022; 25:485-491. [PMID: 35230529 PMCID: PMC8921122 DOI: 10.1007/s00737-022-01219-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 02/22/2022] [Indexed: 12/03/2022]
Abstract
The primary aim of the study was to analyze differences in post-traumatic stress symptoms (PTSS) and quality of life (QoL) between women with and without severe fear of childbirth postpartum (PP FOC). The secondary aims were to analyze the correlation between PP FOC and PTSS, and PP FOC and QoL, in women undergoing complicated childbirth. This cross-sectional study was conducted in South-East Sweden. Women aged ≥ 18 years who had undergone complicated childbirth (i.e., acute or emergency cesarean section, vacuum extraction, child in need of neonatal care, manual placenta removal, sphincter rupture, shoulder dystocia, or hemorrhage ≥ 1000 ml) were invited. Seventy-six women answered demographic questions and three validated instruments measuring PP FOC, PTSS, and QoL. The study population was divided into two sub groups: severe PP FOC or no severe PP FOC. Statistical analyses were conducted using Mann-Whitney U-test, chi-square test or Fisher's exact test, and Spearman's rank-order correlation. Severe PP FOC was reported by 29% of the women, and 18% reported PTSS indicating post-traumatic stress disorder. Women with severe PP FOC reported significantly higher levels of PTSS, and significantly lower QoL in five dimensions: physical role functioning, emotional role functioning, energy/fatigue, emotional well-being, and social functioning. There was a positive significant correlation between level of PP FOC and PTSS. There were also significant negative correlations between level of PP FOC and most of the QoL dimensions. In conclusion, almost one-third of the women with complicated childbirth reported severe PP FOC, and almost one-fifth reported PTSS indicating post-traumatic stress disorder. PP FOC correlated with PTSS and deteriorated QoL.
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Affiliation(s)
- Hanna Grundström
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Anna Malmquist
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Alice Ivarsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elin Torbjörnsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Malin Walz
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Katri Nieminen
- Department of Obstetrics and Gynecology in Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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14
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Dadkhahtehrani T, Khalili M, Torabi F, Heidari Z. The effect of expressive writing on fear of childbirth among nulliparous pregnant women: A randomized controlled trial. Nurs Midwifery Stud 2022. [DOI: 10.4103/nms.nms_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Abstract
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.
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16
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Azizi M, Kamali M, Elyasi F, Shirzad M. Fear of childbirth in Iran: A systematic review of psychological intervention research. Int J Reprod Biomed 2021; 19:401-420. [PMID: 34278194 PMCID: PMC8261095 DOI: 10.18502/ijrm.v19i5.9250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/18/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Due to the fear of childbirth (FOC) and failure to provide painless delivery in Iran, the prevalence rate of elective cesarean section (C-section) performed on request by pregnant women is on the rise. However, no systematic review assessing the results of studies in this respect has been thus far developed. Objective To systematically review published psychological intervention research reflecting on FOC in Iran. Materials and Methods In this systematic review, the databases of PubMed, MEDLINE, PsycINFO, Wiley, ISI Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, and Scientific Information Database were searched to retrieve the relevant studies. Manual searches were performed to find the relevant articles and finally 21 intervention studies were reviewed. Results Based on the modified Jadad Scale, a methodological quality (risk of bias) assessment tool, 14 and 7 studies had acceptable or good and low quality, respectively. The included articles covered fear, fear of childbirth, pregnancy, and psychological intervention in Iran. Cognitive behavioral therapy, relaxation techniques, psychological counseling, childbirth preparation classes (CPCs), mindfulness programs, and psychoeducation had been also practiced as the main types of psychological interventions for reducing FOC in pregnant women. Conclusion There was no clear evidence to establish the most effective method for minimizing levels of FOC in pregnant women. Based on the assessment tool and since most of the studies had moderate or low quality, conducting standard and high-quality randomized controlled trials focusing on FOC in pregnant women is of most importance in Iranian population.
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Affiliation(s)
- Marzieh Azizi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Kamali
- Boali-Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahboobeh Shirzad
- Department of lnternal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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17
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Baas MAM, van Pampus MG, Stramrood CAI, Dijksman LM, Vanhommerig JW, de Jongh A. Treatment of Pregnant Women With Fear of Childbirth Using EMDR Therapy: Results of a Multi-Center Randomized Controlled Trial. Front Psychiatry 2021; 12:798249. [PMID: 35222106 PMCID: PMC8866441 DOI: 10.3389/fpsyt.2021.798249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/13/2021] [Indexed: 11/24/2022] Open
Abstract
Fear of childbirth (FoC) occurs in 7. 5% of pregnant women and has been associated with adverse feto-maternal outcomes. Eye Movement Desensitization and Reprocessing (EMDR) therapy has proven to be effective in the treatment of posttraumatic stress disorder (PTSD) and anxiety; however, its effectiveness regarding FoC has not yet been established. The aim was to determine the safety and effectiveness of EMDR therapy for pregnant women with FoC. This single-blind RCT (the OptiMUM-study, www.trialregister.nl, NTR5122) was conducted in the Netherlands. FoC was defined as a score ≥85 on the Wijma Delivery Expectations Questionnaire (WDEQ-A). Pregnant women with FoC and a gestational age between 8 and 20 weeks were randomly assigned to EMDR therapy or care-as-usual (CAU). The severity of FoC was assessed using the WDEQ-A. Safety was indexed as worsening of FoC symptoms, dropout, serious adverse events, or increased suicide risk. We used linear mixed model analyses to compare groups. A total of 141 women were randomized (EMDR n = 70; CAU n = 71). No differences between groups were found regarding safety. Both groups showed a very large (EMDR d = 1.36) or large (CAU d = 0.89) reduction of FoC symptoms with a mean decrease of 25.6 (EMDR) and 17.4 (CAU) points in WDEQ-A sum score. No significant difference between both groups was found (p = 0.83). At posttreatment, 72.4% (EMDR) vs. 59.6% (CAU) no longer met the criteria for FoC. In conclusion, the results are supportive of EMDR therapy as a safe and effective treatment of FoC during pregnancy, albeit without significant beneficial effects of EMDR therapy over and above those of CAU. Therefore, the current study results do not justify implementation of EMDR therapy as an additional treatment in this particular setting.
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Affiliation(s)
- M A M Baas
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - M G van Pampus
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - C A I Stramrood
- Department of Obstetrics and Gynecology, OLVG, Amsterdam, Netherlands
| | - L M Dijksman
- Department of Quality and Safety, St. Antonius Hospital, Nieuwegein, Netherlands
| | - J W Vanhommerig
- Department of Research and Epidemiology, OLVG, Amsterdam, Netherlands
| | - A de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Vrije Universiteit University Amsterdam, Amsterdam, Netherlands.,PSYTREC, Bilthoven, Netherlands.,School of Health Sciences, Salford University, Manchester, United Kingdom.,Institute of Health and Society, University of Worcester, Worcester, United Kingdom.,School of Psychology, Queen's University, Belfast, United Kingdom
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18
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Wigert H, Nilsson C, Dencker A, Begley C, Jangsten E, Sparud-Lundin C, Mollberg M, Patel H. Women's experiences of fear of childbirth: a metasynthesis of qualitative studies. Int J Qual Stud Health Well-being 2020; 15:1704484. [PMID: 31858891 PMCID: PMC6968519 DOI: 10.1080/17482631.2019.1704484] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose: Women’s experiences of pregnancy, labour and birth are for some pregnant women negative and they develop a fear of childbirth, which can have consequences for their wellbeing and health. The aim was to synthesize qualitative literature to deepen the understanding of women’s experiences of fear of childbirth. Methods: A systematic literature search and a meta-synthesis that included 14 qualitative papers. Results: The main results demonstrate a deepened understanding of women’s experiences of fear of childbirth interpreted through the metaphor “being at a point of no return”. Being at this point meant that the women thought there was no turning back from their situation, further described in the three themes: To suffer consequences from traumatic births, To lack warranty and understanding, and To face the fear. Conclusions: Women with fear of childbirth are need of support that can meet their existential issues about being at this point of no return, allowing them to express and integrate their feelings, experiences and expectations during pregnancy, childbirth and after birth. Women with fear after birth, i.e., after an earlier negative birth experience, need support that enables them to regain trust in maternity care professionals and their willingness to provide them with good care that offers the support that individual women require. Women pregnant for the first time require similar support to reassure them that other’s experiences will not happen to them.
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Affiliation(s)
- Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Division of Neonatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cecily Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elisabeth Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Carina Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Margareta Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Harshida Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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19
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Bülez A, Soğukpınar N, Sayıner FD. A Quasi-Experimental Study to Assess Hypnobirthing Educational Intervention on Labor Pain and Fear of Childbirth—The Case of Eskisehir/Turkey. INTERNATIONAL JOURNAL OF CHILDBIRTH 2020. [DOI: 10.1891/ijcbirth-d-19-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSETo determine the effectiveness of antenatal period hypnobirthing education for childbirth fear and labor pain management during labor.STUDY DESIGNA quasi-experimental methodological study to assess the education of hypnobirthing. Women were recruited from Eskişehir State Hospital Obstetrics and Gynecology Clinic in Turkey between 24 and 26 pregnancy weeks and July 1–September 1, 2016 and the hypnobirthing education was given 5 weeks in the antenatal period. Participants; 30 Turkish-speaking pregnant women. Following labor, questionnaires were completed in hospital by women in order to assess the mother and infant after birth and determine the effect of education first 24 hours after birth.FINDINGSIt was determined that hypnobirthing knowledge scores after education of the participating pregnancies decreased significantly, Wijma Delivery Expectancy/Experience Questionnaire-Version B (WDEQ-B) scale score decreased significantly (p = 0.002). Participating laborers; (p = 0.448), but there was also no significant relationship between birth satisfaction scores (p = 0.540) and posttraining hypnobirthing information status scores and Visual Analogue Scale (VAS) scores.MAIN CONCLUSIONHypnobirthing training has an effect on fear of childbirth but has no effect on birth satisfaction and labor pain.
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20
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Han Q, Guo M, Ren F, Duan D, Xu X. Role of midwife-supported psychotherapy on antenatal depression, anxiety and maternal health: A meta-analysis and literature review. Exp Ther Med 2020; 20:2599-2610. [PMID: 32765754 PMCID: PMC7401497 DOI: 10.3892/etm.2020.9011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
The onset of depression and anxiety during the antenatal stage of pregnancy is common. Despite the conception of numerous interventions in the past decades, studies show no signs of decline in the prevalence of antenatal depression and anxiety. Recently, the use of midwife-supported psychotherapy to treat these psychosomatic disorders has garnered a lot of attention. However, no attempt to date has been made to synthesize the evidence evaluating the influence of midwife-supported psychotherapy on antenatal depression, anxiety, and overall maternal health-status. The aim of the present meta-analysis was to demonstrate the effectiveness of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome during the antenatal stage of pregnancy. A systematic identification of literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis evaluated the influence of midwife-supported psychotherapy on depression, anxiety, and maternal health-status outcome as compared to conventional obstetric care. Of the 1,011 records, 17 articles, including 6,193 pregnant women (mean age: 28.9±2.2 years) were included in this meta-analysis. Eleven studies compared the effects of midwife-supported therapy on depression, 14 compared its effects on anxiety and 2 compared its effects on maternal health-status outcome. The meta-analysis reveals the beneficial effects of midwife-supported psychotherapy for reducing depression (Hedge's g: -0.9), anxiety (-0.8) and enhancing maternal health-status outcome (0.1), as compared to conventional obstetric care. The current systematic review and meta-analysis recommend the use of midwife-supported psychotherapy for the reduction of depression, anxiety and enhancing maternal health-status during the antenatal stage of pregnancy.
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Affiliation(s)
- Qing Han
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Min Guo
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Fenfen Ren
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Dongyun Duan
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
| | - Xiufeng Xu
- Department of Obstetrics, Zaozhuang Hospital of Maternal and Child Health, Zaozhuang, Shandong 277100, P.R. China
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21
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Hildingsson I, Rubertsson C. Childbirth experiences among women with fear of birth randomized to internet-based cognitive therapy or midwife counseling. J Psychosom Obstet Gynaecol 2020; 41:205-214. [PMID: 31244352 DOI: 10.1080/0167482x.2019.1634047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Although women with fear of birth often report negative birth experiences, few studies have focused on their experiences in the long term. The aim of this study was to compare birth experiences a year after childbirth in two groups of women receiving treatment for experiencing fear of birth during pregnancy.Methods: As part of the U-CARE: Pregnancy Trial, a prospective multicenter randomized controlled trial comparing the effects of internet-based cognitive behavioral therapy (iCBT) and standard care among pregnant women with fear of birth. Women were recruited at three Swedish hospitals following a screening procedure that assessed their fear of birth. Data were collected online with the Childbirth Experience Questionnaire (CEQ), one question about the overall birth experience, and questions about personal background, collected before randomization.Results: A total of 181 women responded to the follow-up questionnaire a year after childbirth. Approximately half of participants reported a less positive birth experience. Preferred mode of birth, actual mode of birth, marital status and psychiatric history were associated with the domains of the CEQ. However, no statistically significant differences emerged between the treatment groups.Conclusions: Being randomized to receive iCBT or counseling with midwives for fear of birth was not associated with perceptions of the birth experience assessed a year after birth. Most participants reported less-than-positive birth experiences and scored low on the domain of the CEQ reflecting Own capacity. In response, additional research remains necessary to identify the best model of care that might facilitate positive experiences with giving birth among women with fear of birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Lund University, Lund, Sweden
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22
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Malmquist A, Nieminen K. Negotiating who gives birth and the influence of fear of childbirth: Lesbians, bisexual women and transgender people in parenting relationships. Women Birth 2020; 34:e271-e278. [PMID: 32418651 DOI: 10.1016/j.wombi.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 04/23/2020] [Accepted: 04/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied. AIM The aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC. METHODS Seventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis. RESULTS FOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care. CONCLUSIONS It is important that healthcare staff address both partners' prenatal expectancies and postnatal experiences.
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Affiliation(s)
- Anna Malmquist
- Department of Behavioural Sciences and Learning, Linköping University, SE-581 83 Linköping, Sweden.
| | - Katri Nieminen
- Department of Clinical and Experimental Medicine, Linköping University, Sweden
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23
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Wahlbeck H, Kvist LJ, Landgren K. Art Therapy and Counseling for Fear of Childbirth: A Randomized Controlled Trial. ART THERAPY 2020. [DOI: 10.1080/07421656.2020.1721399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Lyckestam Thelin I, Lundgren I, Nilsson C. To challenge oneself as a childbearing woman-the lived experience of vaginal birth after caesarean section in Sweden. Int J Qual Stud Health Well-being 2019; 14:1605784. [PMID: 31046655 PMCID: PMC6507961 DOI: 10.1080/17482631.2019.1605784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2019] [Indexed: 01/05/2023] Open
Abstract
PURPOSE There is a need to gain deeper knowledge about women's experience of vaginal birth after caesarean section (VBAC). Considerable research has been conducted on VBAC; however, only a few qualitative studies focus on women's experiences. Therefore, the aim of this study was to describe the lived experiences of VBAC among women resident in Sweden, a country with a high VBAC rate. METHOD This studywas performed in accordance with a phenomenological reflective lifeworld approach. Interviews were conducted with nine women in an urban region of Sweden one year after their VBAC birth. RESULTS The essential meaning of the studied phenomenon is "to challenge oneself as a childbearing woman", which is further described by its four constituents: "striving for support from professionals", "desiring the experience", "contrasting and comparing memories of two different births" and "being part of the birthing culture". CONCLUSIONS The experience of VBAC meant regained trust in the ability to give birth vaginally. The women lacked follow-up and support after the caesarean section (CS), during the subsequent pregnancy and the forthcoming VBAC. Enhanced support could be a key factor in helping women meeting the challenge and feel confident about giving birth vaginally despite their previous experiences of CS. ABBREVIATIONS VBAC: vaginal birth after caesarean section; CS: caesarean section.
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Affiliation(s)
- Ida Lyckestam Thelin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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25
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A known midwife can make a difference for women with fear of childbirth- birth outcome and women’s experiences of intrapartum care. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:33-38. [DOI: 10.1016/j.srhc.2019.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/08/2019] [Accepted: 06/14/2019] [Indexed: 11/20/2022]
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26
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Tobiasson M, Lyberg A. Fear of childbirth from the perspective of midwives working in hospitals in Norway: A qualitative study. Nurs Open 2019; 6:1180-1188. [PMID: 31367444 PMCID: PMC6650651 DOI: 10.1002/nop2.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/11/2022] Open
Abstract
AIM To illuminate the perceptions of hospital-based midwives who support women suffering from moderate to severe fear of childbirth during an expected vaginal birth. DESIGN A qualitative descriptive and explorative study. METHODS Focus group interviews were conducted with 18 midwives representing four different hospitals in Norway. RESULTS Encountering fear of childbirth evoked the desire to protect and help, although the ability to provide optimal support was dependent on several circumstances, several of which were beyond the midwives̕ control. The main theme "Midwives finding their own strength when encountering the vulnerability of women with fear of childbirth" consisted of two themes: "Being present" and "Being alone." The midwives described being present as a prerequisite for continuity of care and affirmation. The emphasis on continuity of care could give rise to a sense of loneliness and guilt during and after demanding situations in the birthing room.
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Affiliation(s)
- Marthe Tobiasson
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Anne Lyberg
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
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Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth. Women Birth 2019; 33:e227-e233. [PMID: 31160244 DOI: 10.1016/j.wombi.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fear of Birth is common in pregnant women and associated with negative physical and mental health. There is a clear comorbidity with anxiety and depression. Internet-delivered Cognitive Behaviour Therapy has been suggested as a treatment option for Fear of Birth and a randomized controlled trial comparing internet-delivered Cognitive Behaviour Therapy with midwifery led counselling as standard care has been conducted. OBJECTIVE The aim of this study was to describe women's experiences of guided internet-delivered Cognitive Behaviour Therapy for Fear of Birth and to describe the content of their fear. METHODS The present study is a qualitative, follow-up interview study following the randomized controlled trial, the U-CARE Pregnancy Trial. In total 19 women allocated to internet-delivered Cognitive Behaviour Therapy for Fear of Birth were interviewed by telephone. A semi-structured interview guide was used and the transcripts were analyzed with thematic analysis. RESULTS The women's descriptions of Fear of Birth differed, however their fear was most often associated with fear of losing control, fear for the baby's life or health or own life threatening events. The experiences of internet-delivered Cognitive Behaviour Therapy for Fear of Birth varied, some women were positive to its flexibility although most women preferred a face-to face meeting. The treatment did not pin-point their fears, it was challenging to maintain motivation and to work with the treatment in solitude. CONCLUSIONS Women's descriptions of Fear of Birth varied. Most women undergoing internet-delivered Cognitive Behaviour Therapy would have preferred a face-to-face meeting which they imagined would have soothed their fear. Internet-delivered Cognitive Behaviour Therapy for Fear of Birth may be an alternative for some women.
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Badaoui A, Kassm SA, Naja W. Fear and Anxiety Disorders Related to Childbirth: Epidemiological and Therapeutic Issues. Curr Psychiatry Rep 2019; 21:27. [PMID: 30868272 DOI: 10.1007/s11920-019-1010-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Alexandra Badaoui
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon.
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
| | - Wadih Naja
- Faculty of Medical Sciences, Department of Psychiatry, Lebanese University, Beirut, Lebanon
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Rondung E, Ekdahl J, Sundin Ö. Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty. Birth 2019; 46:61-68. [PMID: 29954044 DOI: 10.1111/birt.12368] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women. METHODS A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure. RESULTS Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model. CONCLUSIONS Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:24-30. [DOI: 10.1016/j.srhc.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 01/16/2023]
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Calderani E, Giardinelli L, Scannerini S, Arcabasso S, Compagno E, Petraglia F, Ricca V. Tocophobia in the DSM-5 era: Outcomes of a new cut-off analysis of the Wijma delivery expectancy/experience questionnaire based on clinical presentation. J Psychosom Res 2019; 116:37-43. [PMID: 30654992 DOI: 10.1016/j.jpsychores.2018.11.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/15/2018] [Accepted: 11/15/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND AIMS Diagnosis of tocophobia using existing instruments is an area of active investigation. Although a range of Wijma Delivery Experience Questionnaire (W-DEQ) cut-off scores has been suggested for detecting tocophobia, there is no consensus among researchers about an optimal cut-off score. The primary goal of the present study was to identify a cut-off value while referring to the DSM-5 Specific Phobia criteria as a gold standard, and to accordingly evaluate how the fearful component of the childbirth experience and psychopathology in the post-natal period are affected by tocophobia. METHODS We conducted an observational, longitudinal study on nulliparous women (n = 106). Routine pregnancy data and data from psychometric questionnaires investigating depression, anxiety, and fear of childbirth were collected. A psychiatric Structured Clinical Interview for DSM-5 (SCID-5) was also conducted. The same parameters were re-evaluated one month after parturition. RESULTS A W-DEQ score of 85 was found to be the optimal cut-off score for detecting tocophobia, with sound sensitivity (100%) and specificity (93.8%). We found substantial agreement between the W-DEQ A and SCID-5 Specific Phobia Criteria (Cohen's Kappa coefficient, κ = 0.720). CONCLUSIONS A W-DEQ cut-off value of 85 is a reliable tool for detecting clinically relevant fear of childbirth according to the DSM-5 diagnosis of Specific Phobia. Therefore, accurate psychopathological investigation must be administered to women with W-DEQ scores greater than this cut-off score.
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Affiliation(s)
- Enrico Calderani
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.
| | - Lisa Giardinelli
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Silvia Scannerini
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Susanna Arcabasso
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Elisa Compagno
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy
| | - Felice Petraglia
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Viale Morgagni 50, Florence, Italy
| | - Valdo Ricca
- Department of Health Sciences, University of Florence, Psychiatry Unit, Largo Brambilla 3, Florence, Italy.
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Möller L, Josefsson A, Lilliecreutz C, Gunnervik C, Bladh M, Sydsjö G. Reproduction, fear of childbirth and obstetric outcomes in women treated for fear of childbirth in their first pregnancy: A historical cohort. Acta Obstet Gynecol Scand 2018; 98:374-381. [PMID: 30431149 DOI: 10.1111/aogs.13503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/07/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION About 8% of the pregnant women in Sweden receive counseling for fear of childbirth (FOC) during pregnancy. Little is known about the long-term reproductive and obstetric outcomes after counseling for FOC: Therefore, the objective of this historical cohort study was to compare the long-term reproductive and obstetric outcomes in women treated for FOC in their first pregnancy to women without FOC. MATERIAL AND METHODS All nulliparas consecutively referred for treatment of severe FOC between 2001 and 2007 (n = 608) were compared with all other nulliparas giving birth on the same day (n = 431). Women who were not fluent in Swedish, missing a postal address, had moved out of the area, given birth at another hospital or had a late spontaneous abortion were excluded (n = 555). A total of 235 women agreed to participate in the study, 63 (39%) women in the index group and 172 (53%) in the reference group. The women were contacted by letter in 2015, ie 7-14 years after first childbirth, and asked to permit access to their medical charts from pregnancies and childbirths and to fill out a study specific questionnaire. Based on data from the medical charts and questionnaire, the mode of delivery, birth experience, obstetric complications, FOC, counseling for FOC and number of childbirths were compared in the two groups. RESULTS Women in the index group less often gave birth more than twice compared with the reference group (8.2% vs 22.0%, P = 0.012). We found no significant differences in complications during subsequent pregnancies and deliveries. Women in the index group more often gave birth by CS in their first (P = 0.002) and second childbirth (P = 0.001), more often had a less positive birth experience (index group NRS: median 6.0, interquartile range 6 vs reference group NRS: 7.0, interquartile range 5, P = 0.004) in their first delivery and more often received counseling for FOC (58.7% vs 12.5%, P < 0.001) in subsequent pregnancies. Women in the index group more often experienced FOC (18% vs 5.3%, P = 0.001) 7-14 years after first childbirth. CONCLUSIONS FOC is not easily treated. Despite treatment and exposure to childbirth many women received treatment in their next pregnancy and still suffered from FOC 7-14 years after the first childbirth.
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Affiliation(s)
- Louise Möller
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ann Josefsson
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Caroline Lilliecreutz
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Christina Gunnervik
- Department of Obstetrics and Gynecology, Värnamo County Hospital, Värnamo, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gunilla Sydsjö
- Department of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Hildingsson I, Karlström A, Rubertsson C, Haines H. Women with fear of childbirth might benefit from having a known midwife during labour. Women Birth 2018; 32:58-63. [PMID: 29773474 DOI: 10.1016/j.wombi.2018.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
Abstract
AIM Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time. METHODS A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth. RESULTS 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not. CONCLUSIONS Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife-woman relationship rather than counseling per se could be the key issue when it comes to fear of birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | | | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Science, Faculty of Medicine, Lund University, Sweden
| | - Helen Haines
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Rural Health, University of Melbourne, Wangaratta, Victoria, Australia
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Hildingsson I, Rubertsson C, Karlström A, Haines H. Exploring the Fear of Birth Scale in a mixed population of women of childbearing age—A Swedish pilot study. Women Birth 2018; 31:407-413. [DOI: 10.1016/j.wombi.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 01/24/2023]
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Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, Hildingsson I. Factors influencing decision-making for caesarean section in Sweden - a qualitative study. BMC Pregnancy Childbirth 2018; 18:377. [PMID: 30223780 PMCID: PMC6142337 DOI: 10.1186/s12884-018-2007-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. METHODS A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin. RESULTS The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. CONCLUSION Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, 2 Clare Street, D02 CK80 Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
- Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden
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Rondung E, Ekdahl J, Hildingsson I, Rubertsson C, Sundin Ö. Heterogeneity in childbirth related fear or anxiety. Scand J Psychol 2018; 59:634-643. [DOI: 10.1111/sjop.12481] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 07/05/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Ingegerd Hildingsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Nursing; Mid Sweden University; Sweden
| | - Christine Rubertsson
- Department of Women′s and Children′s Health, Obstetrics and Gynecology; Uppsala University; Sweden
- Department of Health Sciences; Faculty of Medicine; Lund University; Sweden
| | - Örjan Sundin
- Department of Psychology; Mid Sweden University; Sweden
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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. OBJECTIVE This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. METHODS This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. RESULTS We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). CONCLUSIONS Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Gaining hope and self-confidence—An interview study of women’s experience of treatment by art therapy for severe fear of childbirth. Women Birth 2018; 31:299-306. [DOI: 10.1016/j.wombi.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 11/23/2022]
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Larsson B, Hildingsson I, Ternström E, Rubertsson C, Karlström A. Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study. Women Birth 2018; 32:e88-e94. [PMID: 29709431 DOI: 10.1016/j.wombi.2018.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women's views about counselling for childbirth fear. AIM To explore women's experiences of midwife-led counselling for childbirth fear. METHOD A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth. FINDINGS The overarching theme 'Midwife-led counselling brought positive feelings and improved confidence in birth' was identified. This consisted of four themes describing 'the importance of the midwife' and 'a mutual and strengthening dialogue' during pregnancy. 'Coping strategies and support enabled a positive birth' represent women's experiences during birth and 'being prepared for a future birth' were the women's thoughts of a future birth. CONCLUSIONS In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.
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Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, 846 53 Sundsvall, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Department of Nursing Sciences, Mid-Sweden University, 851 70 Sundsvall, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
| | - Annika Karlström
- Department of Nursing Sciences, Mid-Sweden University, 851 70 Sundsvall, Sweden
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Striebich S, Mattern E, Ayerle GM. Support for pregnant women identified with fear of childbirth (FOC)/tokophobia - A systematic review of approaches and interventions. Midwifery 2018; 61:97-115. [PMID: 29579696 DOI: 10.1016/j.midw.2018.02.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/20/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND providing appropriate care for pregnant women with high or severe fear of childbirth (FOC) is a challenge in midwifery care today. FOC is associated with predisposing anamnestic factors, various sociodemographic and psychosocial characteristics, and may result in serious healthrelated consequences. It is therefore important to establish which interventions may increase a woman's faith in her own ability to cope with labour and birth. AIM to systematically identify and review studies examining interventions for relief of severe fear of childbirth in pregnancy and their underlying conceptual foundation. METHODS a systematic literature search was performed following Cochrane Collaboration and PRISMA Statement recommendations. Inclusion criteria were: studies including pregnant women diagnosed with high or severe FOC or who requested a caesarean section due to severe FOC, studies (regardless of design) observing the effect of an intervention addressing FOC, and studies published in English. Publications addressing anxiety or stress were excluded. 377 references were screened by title and abstract. The risk of bias was assessed. FINDINGS 19 articles referring to 15 research projects were included in the analysis. The studies show heterogeneity regarding assessment methods, type, conceptualisation and application of interventions. There is evidence that both cognitive therapy sessions and a theory-based group psychoeducation with relaxation are effective interventions. KEY CONCLUSIONS despite methodological limitations, single or group psychoeducation sessions for nulliparous women or therapeutic conversation during pregnancy (in group or individual sessions) have the potential to strengthen women's self-efficacy and decrease the number of caesarean sections due to FOC. The theoretical validation of an intervention deepens the understanding of psychological processes in women coping with severe FOC. IMPLICATIONS FOR PRACTICE theory-based concepts of care for both antenatal and intrapartum support of pregnant women with high or severe FOC should be developed, piloted, tested, evaluated and implemented within the given healthcare system. Midwives need to be competent to address pregnant women's fears regarding labour and birth in antenatal care. The use of a valid assessment tool to identify the level of FOC in women, even if they do not raise the issue, is recommended in routine antenatal care so that appropriate expert support can be offered. A one-on-one conversation may be feasible for those women unwilling to fill in a questionnaire. Cooperative local networks between midwives, psychologists and obstetricians qualified in psychotherapy should be established to ensure timely and effective care for women with high or severe FOC.
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Affiliation(s)
- Sabine Striebich
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
| | - Elke Mattern
- Department of Applied Health Sciences, University of Applied Sciences, Gesundheitscampus 6-8, 44801 Bochum Germany.
| | - Gertrud M Ayerle
- Institute for Health and Nursing Sciences, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Magdeburger Str. 8, 06112 Halle (Saale), Germany.
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Stoll K, Swift EM, Fairbrother N, Nethery E, Janssen P. A systematic review of nonpharmacological prenatal interventions for pregnancy-specific anxiety and fear of childbirth. Birth 2018; 45:7-18. [PMID: 29057487 DOI: 10.1111/birt.12316] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 12/19/2022]
Abstract
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.
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Affiliation(s)
- Kathrin Stoll
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Emma Marie Swift
- Department of Nursing, University of Iceland, Reykjavík, Iceland
| | - Nichole Fairbrother
- Department of Psychiatry, University of British Columbia, Island Medical Program, Victoria, Canada
| | - Elizabeth Nethery
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
| | - Patricia Janssen
- School of Population & Public Health, University of British Columbia, Vancouver, Canada
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Bagherian-Afrakoti N, Alipour A, Pourasghar M, Ahmad Shirvani M. Assessment of the efficacy of group counselling using cognitive approach on knowledge, attitude, and decision making of pregnant women about modes of delivery. Health Care Women Int 2018; 39:684-696. [PMID: 29388880 DOI: 10.1080/07399332.2018.1428804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The choice of casarean deliveries by mothers is highly influenced by inadequate knowldge and negative attitudes towards vaginal birth. In this semi-experimental study, we compared knowledge, attitude, and decision making about modes of delivery between nulliparous pregnant women who received eight sessions of group consultation and those who took routine prenatal education. Contrary to the control group, the improvement of knowledge and attitudes were significant in the consultation group (p < 0.001), as well as mothers' decisions for vaginal birth (p = 0.03). Group consultation is an appropriate approach to improving knowledge, attitudes, and tendencies of mothers toward natural birth.
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Affiliation(s)
| | - Abbas Alipour
- b Department of Community Medicine , School of Medicine, Mazandaran University of Medical Sciences , Sari , Iran
| | - Mehdi Pourasghar
- c Department of Psychiatry , Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences , Sari , Iran
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Caseload midwifery for women with fear of birth is a feasible option. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:50-55. [PMID: 29804775 DOI: 10.1016/j.srhc.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. METHODS A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. RESULT Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. CONCLUSION Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.
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Stoll K, Fairbrother N, Thordarson DS. Childbirth Fear: Relation to Birth and Care Provider Preferences. J Midwifery Womens Health 2018; 63:58-67. [PMID: 29364575 DOI: 10.1111/jmwh.12675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/27/2017] [Accepted: 07/02/2017] [Indexed: 11/29/2022]
Abstract
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.
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Nilsson C, Hessman E, Sjöblom H, Dencker A, Jangsten E, Mollberg M, Patel H, Sparud-Lundin C, Wigert H, Begley C. Definitions, measurements and prevalence of fear of childbirth: a systematic review. BMC Pregnancy Childbirth 2018; 18:28. [PMID: 29329526 PMCID: PMC5766978 DOI: 10.1186/s12884-018-1659-7] [Citation(s) in RCA: 183] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/07/2018] [Indexed: 11/22/2022] Open
Abstract
Background Fear of Childbirth (FOC) is a common problem affecting women’s health and wellbeing, and a common reason for requesting caesarean section. The aims of this review were to summarise published research on prevalence of FOC in childbearing women and how it is defined and measured during pregnancy and postpartum, and to search for useful measures of FOC, for research as well as for clinical settings. Methods Five bibliographic databases in March 2015 were searched for published research on FOC, using a protocol agreed a priori. The quality of selected studies was assessed independently by pairs of authors. Prevalence data, definitions and methods of measurement were extracted independently from each included study by pairs of authors. Finally, some of the country rates were combined and compared. Results In total, 12,188 citations were identified and screened by title and abstract; 11,698 were excluded and full-text of 490 assessed for analysis. Of these, 466 were excluded leaving 24 papers included in the review, presenting prevalence of FOC from nine countries in Europe, Australia, Canada and the United States. Various definitions and measurements of FOC were used. The most frequently-used scale was the W-DEQ with various cut-off points describing moderate, severe/intense and extreme/phobic fear. Different 3-, 4-, and 5/6 point scales and visual analogue scales were also used. Country rates (as measured by seven studies using W-DEQ with ≥85 cut-off point) varied from 6.3 to 14.8%, a significant difference (chi-square = 104.44, d.f. = 6, p < 0.0001). Conclusions Rates of severe FOC, measured in the same way, varied in different countries. Reasons why FOC might differ are unknown, and further research is necessary. Future studies on FOC should use the W-DEQ tool with a cut-off point of ≥85, or a more thoroughly tested version of the FOBS scale, or a three-point scale measurement of FOC using a single question as ‘Are you afraid about the birth?’ In this way, valid comparisons in research can be made. Moreover, validation of a clinical tool that is more focussed on FOC alone, and easier than the longer W-DEQ, for women to fill in and clinicians to administer, is required. Electronic supplementary material The online version of this article (10.1186/s12884-018-1659-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Nilsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, S-501 90, Borås, Sweden. .,Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.
| | - E Hessman
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - H Sjöblom
- Biomedical Library, Gothenburg University Library at University of Gothenburg, Box 416, -405 30, Gothenburg, SE, Sweden
| | - A Dencker
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - E Jangsten
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - M Mollberg
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Patel
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Sparud-Lundin
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - H Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden
| | - C Begley
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Box 457, -405 30, Gothenburg, SE, Sweden.,Chair of Nursing and Midwifery, School of Nursing and Midwifery,Trinity College Dublin, 24, D'Olier St. Dublin 2, Dublin, Ireland
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Larsson B, Karlström A, Rubertsson C, Ternström E, Ekdahl J, Segebladh B, Hildingsson I. Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial. Women Birth 2017; 30:460-467. [DOI: 10.1016/j.wombi.2017.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Hildingsson I, Haines H, Karlström A, Nystedt A. Presence and process of fear of birth during pregnancy—Findings from a longitudinal cohort study. Women Birth 2017; 30:e242-e247. [DOI: 10.1016/j.wombi.2017.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 01/10/2023]
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Development of a questionnaire for assessing the childbirth experience (QACE). BMC Pregnancy Childbirth 2017; 17:279. [PMID: 28854894 PMCID: PMC5577741 DOI: 10.1186/s12884-017-1462-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Due to its potential impact on women’s psychological health, assessing perceptions of their childbirth experience is important. The aim of this study was to develop a multidimensional self-reporting questionnaire to evaluate the childbirth experience. Methods Factors influencing the childbirth experience were identified from a literature review and the results of a previous qualitative study. A total of 25 items were combined from existing instruments or were created de novo. A draft version was pilot tested for face validity with 30 women and submitted for evaluation of its construct validity to 477 primiparous women at one-month post-partum. The recruitment took place in two obstetric clinics from Swiss and French university hospitals. To evaluate the content validity, we compared item responses to general childbirth experience assessments on a numeric, 0 to 10 rating scale. We dichotomized two group assessment scores: “0 to 7” and “8 to 10”. We performed an exploratory factor analysis to identify underlying dimensions. Results In total, 291 women completed the questionnaire (response rate = 61%). The responses to 22 items were statistically significant between the 0 to 7 and 8 to 10 groups for the general childbirth experience assessments. An exploratory factor analysis yielded four sub-scales, which were labelled “relationship with staff” (4 items), “emotional status” (3 items), “first moments with the new born,” (3 items) and “feelings at one month postpartum” (3 items). All 4 scales had satisfactory internal consistency levels (alpha coefficients from 0.70 to 0.85). The full 25-item version can be used to analyse each item by itself, and the short 4-dimension version can be scored to summarize the general assessment of the childbirth experience. Conclusions The Questionnaire for Assessing the Childbirth Experience (QACE) could be useful as a screening instrument to identify women with negative childbirth experiences. It can be used as both a research instrument in its short version and a questionnaire for use in clinical practice in its full version. Electronic supplementary material The online version of this article (10.1186/s12884-017-1462-x) contains supplementary material, which is available to authorized users.
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Nystedt A, Hildingsson I. Women's and men's negative experience of child birth-A cross-sectional survey. Women Birth 2017; 31:103-109. [PMID: 28789827 DOI: 10.1016/j.wombi.2017.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/01/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND A negative birth experience may influence both women and men and can limit their process of becoming a parent. AIMS This study aimed to analyze and describe women's and men's perceptions and experiences of childbirth. DESIGN A cross-sectional study of women and their partners living in one Swedish county were recruited in mid pregnancy and followed up two months after birth. Women (n=928) and men (n=818) completed the same questionnaire that investigated new parents' birth experiences in relation to socio-demographic background and birth related variables. RESULTS Women (6%) and men (3%) with a negative birth experiences, experienced longer labours and more often emergency caesarean section compared to women (94%) and men (97%) with a positive birth experience. The obstetric factors that contributed most strongly to a negative birth experience were emergency caesarean and was found in women (OR 4.7, 95% CI 2.0-10.8) and men (OR 4.5, Cl 95% 1.4-17.3). In addition, pain intensity and elective caesarean section were also associated with a negative birth experiences in women. Feelings during birth such as agreeing with the statement; 'It was a pain to give birth' were a strong contributing factor for both women and men. CONCLUSIONS A negative birth experience is associated with obstetric factors such as emergency caesarean section and negative feelings. The content of negative feelings differed between women and men. It is important to take into account that their feelings differ in order to facilitate the processing of the negative birth experience for both partners.
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Affiliation(s)
- Astrid Nystedt
- Department of Nursing, Umeå Universitet, 90187 Umeå, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden; Department of Nursing, Mid Sweden University, 85170 Sundsvall, Sweden
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Rondung E, Thomtén J, Sundin Ö. Psychological perspectives on fear of childbirth. J Anxiety Disord 2016; 44:80-91. [PMID: 27788373 DOI: 10.1016/j.janxdis.2016.10.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 08/22/2016] [Accepted: 10/13/2016] [Indexed: 11/27/2022]
Abstract
The objective of this narrative review was to examine the literature on fear of childbirth from a psychological perspective, addressing the specificity of childbirth fear, the pathways of fear acquisition, and the physiological, cognitive and behavioral aspects of fear. Systematic procedures for literature search, inclusion and exclusion left 86 original research papers for analysis. Findings summarize the body of knowledge for each area of interest, as well as the number of studies addressing each theme. Overall, few studies adopt a clear-cut psychological perspective, leaving the psychological mechanisms of childbirth fear largely unexplored. Although methodological limitations make conclusions difficult, results give a hint of etiological diversity and possible psychological mechanisms commonly described as transdiagnostic features in anxiety. Systematic investigations of psychological mechanisms, longitudinal studies exploring possible vicious circles of fear, and studies comparing psychological characteristics within the group of women fearing childbirth are identified as research areas of high priority.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Johanna Thomtén
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, 831 40 Östersund, Sweden.
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