Effectiveness of a Mindfulness-Based Childbirth Education pilot study on maternal self-efficacy and fear of childbirth

Childbirth self-efficacy and birth related PTSD symptoms: an online childbirth education randomised controlled trial for mothers

BACKGROUND

This study evaluated an online childbirth education course on childbirth self-efficacy and, subsequent birth related posttraumatic stress disorder (PTSD) symptoms and mother-infant relationship quality.

METHOD

Three group (intervention, passive control, active control) parallel randomised controlled trial. Groups were assigned using computer generated random allocation. For the passive control group participants were instructed to carry on with whatever they were currently undertaking with their pregnancy, while the active control group were asked to read a booklet comprised of twelve birth stories. The purpose of the active control was to check if the act of having an activity to complete would influence outcomes. For the online course group (intervention) participants were asked to complete the online version of a birthing course designed by She Births®. One hundred and twenty-five women residing in Australia between 12 and 24 weeks pregnant were recruited online. Participants were asked to complete their required activity between 24 and 36 weeks pregnant. Childbirth self-efficacy scores were tested pre and post intervention (time one and time 2), PTSD symptoms and mother-infant relationship quality were tested at six weeks and six months postnatal.

RESULTS

There was no significant interaction by group for childbirth self-efficacy scores. Mean difference scores at time one (pre-intervention) and time two (post-intervention) for each group indicated a trend in the online group towards higher childbirth self-efficacy compared with the two control groups. The main effect of group on birth related PTSD scores was not statically significant at six weeks postnatal or at six months postnatal. The main effect of group on mother-infant relationship scores was not statically significant at six weeks postnatal or six months postnatal.

CONCLUSIONS

Trends showed childbirth self-efficacy scores to be higher in the intervention group compared with the two control groups, demonstrating effectiveness for the intervention. Paradoxically, PTSD scores were higher in the intervention group compared with the two control groups and therefore also reported poorer mother-infant relationship quality. External factors may be more important than childbirth self-efficacy highlighting the need for a holistic approach that addresses systemic and socio-political influences to improve communication, autonomy, and respectful maternity care.

TRIAL REGISTRATION

This trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry number: ACTRN12624000241538 on March 11, 2024.

Psychometric evaluation of the wijma delivery expectancy/experience questionnaire for pregnant women in Taiwan

BACKGROUND

Fear of childbirth profoundly affects women's ability to cope during pregnancy and influences birth outcomes. In Taiwan, there's a lack of validated tools for assessing childbirth fear.

OBJECTIVE

To evaluate the psychometric properties of the Taiwanese version of the Wijma delivery expectancy/experience questionnaire version A (WDEQ-A) in pregnant women.

METHODS

We conducted a cross-sectional study with pregnant women, using the WDEQ-A and a Visual Analogue Scale to assess childbirth fear. We employed the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory, and Mindful Attention Awareness Scale to measure depressive symptoms, anxiety, and mindfulness, respectively. We evaluated internal consistency reliability and construct validity using exploratory factor analysis and Rasch analysis. Pearson correlations measured the association between childbirth fear and psychological variables. The receiver operating characteristic curve was used for determining the sensitivity and specificity indices.

RESULTS

The WDEQ-A demonstrated excellent reliability (Cronbach's alpha = 0.93) and revealed a three-factor structure, including fear, lack of positive anticipation, and isolation. Rasch analysis supported the dimensionality of each of the three revised factors. The total score significantly correlated with depression (r = 0.56), anxiety (r = 0.19), and mindfulness (r = -0.40) (Ps < 0.001). The optimal cut-off for WDEQ-A was established at 55.5, with a sensitivity of 83 % and a specificity of 65 %.

CONCLUSIONS

The Taiwanese version of WDEQ-A proved to be a reliable and valid tool for assessing fear of childbirth in pregnant women, demonstrating excellent psychometric properties.

IMPLICATION FOR PRACTICE

These findings can assist midwives in Taiwan in identifying and promptly providing effective strategies for women experiencing a high fear of childbirth.

Study protocol of a breathing and relaxation intervention included in antenatal education: A randomised controlled trial (BreLax study)

BACKGROUND

Antenatal education is part of antenatal care in many countries. Physical and mental preparation for childbirth and information on pain management are considered key elements of antenatal education classes. Evidence suggests that women who participate in antenatal education classes appear to benefit in terms of self-efficacy and childbirth experience. In particular, women with increased fear of childbirth benefit from trained breathing and relaxation techniques in antenatal education. However, little is known about the effect of breathing and relaxation techniques on the outcomes of healthy pregnant women without fear of childbirth or who do not have medical or obstetric risks, or on neonatal outcomes.

OBJECTIVE

The aim of this study is to test whether including a breathing and relaxation technique in an antenatal education class will improve self-efficacy towards birth compared to a standard antenatal education class.

METHODS

The study will be a two-armed randomised controlled trial (RCT). Healthy pregnant women between the 12th and 30th week of gestation with singleton low-risk pregnancies and who are receiving routine antenatal care will be recruited in a hospital in Switzerland. All women included will attend an 8-hour antenatal education class. The intervention group will additionally practise a breathing and relaxation technique, receive a handbook to guide their exercise practice at home, and be provided with access to an online brochure with video and audio recordings for guidance. Data on maternal and neonatal outcomes will be collected after recruitment, in the 37th week of pregnancy, and two to four weeks postpartum.

DISCUSSION

The effectiveness of including a breathing and relaxation technique in antenatal education classes on women's self-efficacy is discussed as a means to improving women's pregnancy and childbirth outcomes.

TRIAL REGISTRATION NUMBER

NCT06003946, SNCTP000005672.

The effect of mindfulness-based childbirth education intervention on fear of childbirth: systematic review and meta-analysis

OBJECTIVE

The aim of this study was to describe the effect size of mindfulness-based childbirth education on the fear of childbirth.

METHODS

In this study, the meta-analysis method, one of the methods of synthesising quantitative research, was used. EBSCO, PubMed, Google Scholar, WOS, and CINAHL databases were used to determine the studies to be included in the meta-analysis. The keywords such as "mindfulness", "fear of childbirth", "mindfulness-based childbirth", "mindfulness education" and "childbirth" were searched in the international literature. Four experimental studies published between 2013 and 2022 that aimed to determine the effect of mindfulness-based childbirth education on the fear of childbirth, had a full text available and met the inclusion criteria, were included in the study.

RESULTS

On the analysis of the data, mindfulness-based childbirth education was found to be effective in reducing the fear of childbirth (standard mean difference [SMD]=0.117, 95%CI: -1.049: -0.419, p<0.001, I2=36.98%). The results of this meta-analysis indicated that mindfulness-based education provided to pregnant women was found to be effective in reducing the fear of childbirth.

CONCLUSION

Mindfulness-based childbirth education is considered to be used as an effective non-pharmacological midwifery and nursing intervention in reducing the fear of childbirth in pregnant women. This review was preregistered on PROSPERO (Ref No: CRD42022316472).

Health economic evaluation of an electronic mindfulness-based intervention (eMBI) to improve maternal mental health during pregnancy - a randomized controlled trial (RCT)

BACKGROUND

Anxiety and depression are the most prevalent psychiatric diseases in the peripartum period. They can lead to relevant health consequences for mother and child as well as increased health care resource utilization (HCRU) and related costs. Due to the promising results of mindfulness-based interventions (MBI) and digital health applications in mental health, an electronic MBI on maternal mental health during pregnancy was implemented and assessed in terms of transferability to standard care in Germany. The present study focused the health economic outcomes of the randomized controlled trial (RCT).

METHODS

The analysis, adopting a payer's and a societal perspective, included women of increased emotional distress at < 29 weeks of gestation. We applied inferential statistics (α = 0.05 significance level) to compare the intervention group (IG) and control group (CG) in terms of HCRU and costs. The analysis was primarily based on statutory health insurance claims data which covered the individual observational period of 40 weeks.

RESULTS

Overall, 258 women (IG: 117, CG: 141) were included in the health economic analysis. The results on total health care costs from a payer's perspective indicated higher costs for the IGi compared to the CG (Exp(ß) = 1.096, 95% CI: 1.006-1.194, p = 0.037). However, the estimation was not significant after Bonferroni correction (p < 0.006). Even the analysis from a societal perspective as well as sensitivity analyses did not show significant results.

CONCLUSIONS

In the present study, the eMBI did neither reduced nor significantly increased health care costs. Further research is needed to generate robust evidence on eMBIs for women suffering from peripartum depression and anxiety.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00017210. Registered on 13 January 2020. Retrospectively registered.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The effect of cognitive-behavioral therapy and haptonomy on fear of childbirth in primigravida women: a randomized clinical trial

BACKGROUND

Considering the role of fear of childbirth (FOC) in the enhancement of unnecessary cesarean sections (CS), the present study aimed at evaluating the effect of Cognitive-Behavioral Therapy (CBT) and haptonomy on the FOC (as primary outcome) and intended birth method and final birth method (as secondary outcomes) among primigravida women.

METHODS

This randomized clinical trial was conducted on 99 primigravida women in Tabriz, Iran 2022. Participants were assigned to three groups with a ratio of 1:1:1 using stratified block randomization based on the fear intensity. One of the intervention groups (n = 33) received eight group sessions of CBT from 24 to 28 weeks of gestation and the other intervention group (n = 33) received haptonomy during seven sessions once a week. The control group (n = 33) received routine prenatal care. The Wijma questionnaire was completed by the participants before the intervention, after the intervention at 35-37 weeks of gestation, and after birth. The intended birth method was investigated before and after the intervention at 35-37 weeks of gestation. The final birth method and the reasons for CS were recorded based on the mother's medical profile. The one-way ANOVA was used before the intervention and RMANOVA after the intervention to compare the mean scores of FOC among the three groups. Further, chi-square test was applied to compare the intended and final birth method.

RESULTS

The mean (standard deviation: SD) of FOC in the CBT group changed from 74.09 (11.35) at 24-28 weeks of gestation to 46.50 (18.28) at 35-37 weeks and 48.78 (20.64) after birth (P < 0.001). The means (SDs) of FOC in the haptonomy group were 76.81 (13.09), 46.59 (15.81), and 45.09 (20.11), respectively (P < 0.001). The mean (SD) of FOC in the control group decreased from 70.31 (6.71) to 66.56 (18.92) and then, increased to 71.00 (21.14) after birth (P = 0.878). After the intervention, there was no statistically significant difference among the three groups in terms of the intended birth method (P = 0.278), and final birth method (P = 0.107).

CONCLUSION

The findings of the present study revealed that both CBT and haptonomy interventions reduce FOC. Although the desire for vaginal birth and final vaginal birth in the haptonomy group was more than that in the other two groups, there was no statistically significant difference among the three groups.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials: IRCT20170506033834N9. Date of registration: 02.01.2022. URL: http://en.irct.ir .

Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial

Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy. A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ). Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG. The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.

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

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.

The effect of an mHealth application based on continuous support and education on fear of childbirth, self-efficacy, and birth mode in primiparous women: A randomized controlled trial

BACKGROUND

The Fear of Childbirth (FOC) is associated with several adverse health outcomes for children and women. This study aimed to evaluate the effectiveness of an interactive mobile health application named Tele-midwifery with an emphasis on continuous care and education, on FOC, self-efficacy, and childbirth mode in primiparous women.

METHODS

Seventy primiparous women attending the prenatal clinic of Baharlou Hospital in Tehran, Iran, were randomly assigned to two parallel intervention and control groups with 35 participants each. Women in the intervention group received Tele-midwifery for eight weeks, whereas women in the control group only received routine care. The Wijma delivery expectancy/experience questionnaire and the Childbirth Self-Efficacy Inventory were used to measure the FOC and self-efficacy at baseline and eight weeks after the intervention. The FOC and birth mode were also measured after birth.

RESULTS

There was a significant decrease in FOC among women in the intervention group compared to control groups after eight weeks of intervention (- 20.9 [95% Confidence Interval,-24.01 to-17.83], p < 0.001), and after birth (- 30.8, [95% CI-33.8 to-27.97], p < 0.001). After eight weeks, the mean self-efficacy score in the intervention group was significantly higher than the control group (p < 0.001). Compared to the control group, the intervention group had a lower C-Section (CS) rate (p = 0.03).

CONCLUSIONS

Tele-midwifery intervention reduced FOC, increased women's self-efficacy in childbirth, and decreased the number of CS in a group of first-time mothers. Healthcare providers can use the mHealth approach to support pregnant women with FOC.

TRIAL REGISTRATION

Registration number: IRCT20200122046227N1, Registered on 27 January 2020.

The effect of an adapted Mindfulness-Based Stress Reduction program on mental health, maternal bonding and birth outcomes in psychosocially vulnerable pregnant women: a study protocol for a randomized controlled trial in a Danish hospital-based outpatient setting

BACKGROUND

Stress and mental disorders in pregnancy can adversely affect the developing fetus. Women with a preconception history of mental disorders or of psychosocial vulnerabilities are at increased risk of experiencing perinatal stress or mental health problems. Mindfulness-Based-Stress-Reduction (MBSR) is an acceptable intervention for pregnant women and has a growing evidence-base with meta-analyses consistently pointing to reductions in symptoms of stress, anxiety and depression. This study protocol aim to address the need for a wider array of evidence-based and non-pharmacological options during pregnancy to reduce stress and improve mental health in a psychosocially highly vulnerable group of women.

METHODS

Pregnant women with a preconception history of mental disorders or psychosocial vulnerabilities (n = 240) will be recruited from an obstetric ambulatory clinic at Copenhagen University Hospital, Hvidovre, Denmark. Recruitment for the study began in March 2022 and will continue until the desired number of participants is reached. Consenting pregnant women will be randomized to one of two study arms, an adapted MBSR program as add on to usual care or usual care alone. The primary outcome is mental wellbeing at nine months post-randomization. Secondary and exploratory outcomes include stress, anxiety, depression, and maternal antenatal attachment, experience of childbirth, delivery and mode of delivery. Mindfulness and self-compassion are examined as possible mediators of the effect on outcomes.

DISCUSSION

Teaching the skills of mindfulness meditation to a psychosocially vulnerable group of pregnant women could prove a viable and non-pharmacological approach to improve mental health and wellbeing during pregnancy, reduce stress and support the transition to parenthood. Mindfulness-Based Stress Reduction does not target a particular group, and results from the study is thus of potential relevance for pregnant women in general as a means of reducing stress and improving perinatal mental health and wellbeing.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05300646 . Registered March 29, 2022.

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

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

The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis

BACKGROUND

Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health.

METHODS

We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes.

CONCLUSIONS

Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions.

PROSPERO ID

CRD42022376895.

Pregnant women's perception of midwifery-led continuity care model in Ethiopia: a qualitative study

BACKGROUND

A Midwifery-led continuity care (MLCC) model is the provision of care by a known midwife (caseload model) or a team of midwives (team midwifery model) for women throughout the antenatal, intrapartum, and postnatal period. Evidence shows that a MLCC model becomes the first choice for women and improves maternal and neonatal health outcomes. Despite this, little is known about pregnant women's perception of the MLCC model in Ethiopia. Therefore, this study aimed to explore pregnant women's perception and experience of a MLCC model in Ethiopia.

METHODS

A qualitative study was conducted in Gurage zone public hospital, Southwest Ethiopia, from May 1^st to 15^th, 2022. Three focused group discussions and eight in-depth interviews were conducted among pregnant women who were selected using a purposive sampling method. Data were first transcribed and then translated from Amharic (local language) to English. Finally, the thematic analysis technique using open code software was used for analysis.

RESULTS

Thematic analysis revealed that women want a continuity of care model. Four themes emerged. Three were specific to women's improved care. That is, (1) improved continuum of care, (2) improved woman-centred care, and (3) improved satisfaction of care. Theme four (4), barrier to implementation, was concerned with possible barriers to implementation of the model.

CONCLUSION

The finding of this study shows that pregnant women had positive experiences and showed a willingness to receive midwifery-led continuity care. Woman-centred care, improved satisfaction of care, and continuum of care were identified as the main themes. Therefore, it is reasonable to adopt and implement midwifery-led continuity care for low-risk pregnant women in Ethiopia.

The effectiveness of mindfulness-based interventions on self-efficacy and fear of childbirth in pregnant women: A systematic review and meta-analyses

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.

Measuring women's empowerment during the perinatal period in high income countries: A scoping review of instruments used

Empowerment is acknowledged as a process facilitating those who are less powerful to be engaged in their problem identification, decision making and actions to gain control over their life. This is an important goal for women during the perinatal period in their transition to motherhood. A concept analysis of women's empowerment during the perinatal period found that psychological and social dimensions play a role in women's perinatal empowerment and identified several defining attributes. The aim of this study was to identify robust validated instruments that measure all the attributes of women's empowerment during the perinatal period. We did a scoping review of scientific literature following the methodology of the JBI Reviewer's Manual. We searched the database MEDLINE, CINAHL, PsycINFO, PsycARTICLES and SocINDEX and selected papers meeting the inclusion criteria. Instruments measuring empowerment or related concepts were identified in the selected papers. Two authors independently cross referenced the items of each instrument against the defining attributes for empowerment. Our search resulted in 9771 unique hits of which 36 papers were finally included. Studies were from various countries with a wide variety of aims, demographics of cohorts and timepoints across the perinatal period. Twenty-one different instruments were used to measure empowerment, of which 11 were validated among women during the perinatal period. However, no identified instrument was developed specifically for women during the perinatal period or included all the dimensions of empowerment and the defining attributes. There is a need for a theoretically sound valid and reliable instrument measuring all the dimensions of empowerment of women during the perinatal period. Once developed this instrument needs testing with a broad range of women. Results from such a study will inform the development of appropriate interventions that have a coherent theoretical basis and are empirically informed to enhance women's empowerment during the perinatal period.

Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study

OBJECTIVE

To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth.

DESIGN

Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014.

SETTING

Primary care, in the Netherlands.

POPULATION

Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history.

METHODS

Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth.

MAIN OUTCOME MEASURES

Trajectories of CAD symptoms and physiological birth.

RESULTS

Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders.

CONCLUSIONS

This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.

The Effect of Antenatal Education on Expectant Fathers' Attitudes toward Breastfeeding and Attachment to the Fetus

BACKGROUND

This study explores the effect of antenatal education on fathers' attitudes toward: (i) breastfeeding and (ii) attachment to the fetus. A secondary aim is to explore the relationship of fathers' demographic and the psycho-emotional characteristics that come with breastfeeding and attachment.

METHODS

This is a longitudinal study involving a group of 216 Greek expectant fathers who participated with their partners in an antenatal educational program performed by midwives in Athens, Greece (September 2020-November 2021). The Iowa Infant Feeding Attitudes Scale (IIFAS) and Paternal Antenatal Attachment Scale (PAAS) were administered at two time points: (a) 24th-28th gestation week and (b) 34th-38th gestation week. The T-test and Univariate Analyses of Variance (ANOVA) were performed.

RESULTS

The expectant fathers' scores show that breastfeeding intention/exclusivity and prenatal attachment to the fetus were higher after their participation in the antenatal education program, but the difference was not statistically insignificant. Expectant fathers with a cohabitation agreement (p = 0.026), who felt very much supported by their partners (p = 0.001) and had no relationship difficulties with their partners (p < 0.001), as well as those who reported being very happy during pregnancy (p < 0.001), showed greater paternal antenatal attachment to the fetus.

CONCLUSIONS

Although the difference was statistically insignificant, antenatal education appears to have an impact on paternal breastfeeding attitudes and antenatal attachment to the fetus. Additionally, several paternal characteristics were associated with greater antenatal attachment. Future research should be directed toward the investigation of additional factors that impact antenatal-paternal attachment and breastfeeding attitudes so that effective education programs can be designed.

The Chichewa Wijma delivery expectancy/experience questionnaire: a factor analytic study for postpartum women in Malawi

OBJECTIVE

To test the validity and reliability of the Chichewa Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) in Malawian postpartum women.

METHODS

A cross-sectional study of postnatal women (N= 415) at 1 day after vaginal birth was conducted at a district hospital in Malawi. The W-DEQ, Edinburgh Postnatal Depression Scale and the World Health Organization Quality of Life Scale were used to measure fear of birth (FOB), depressive symptoms and quality of life (QoL). Principal component analysis (PCA) and confirmatory factor analysis (CFA), Cronbach's alpha, the average variance extracted (AVE) and the composite reliability (CR) and Pearson correlation were used to test the construct validity, reliability, convergent and divergent validity of the Chichewa W-DEQ (CW-DEQ).

RESULTS

The participants had a mean age of 28.3 ± 6.7 years. A multidimensional structure containing three factors - a lack of positive feelings, fear and concerns about childbirth - with an appropriate model fit was reported for the CW-DEQ version. The Cronbach's α of the CW-DEQ was 0.87. The AVE and CR values were highly acceptable in lack of positive feelings - 0.17 (0.68), and concerns about childbirth - 0.79 (0.88) factors which proved the convergent validity of each; however, was marginally acceptable in the fear factor - 0.14 (0.53). Low range of correlations between the CW-DEQ constructs (r = 0.27 ∼ 0.42, p < .001), confirmed the divergent validity.

CONCLUSIONS

In this study, we found the CW-DEQ to be a reliable and valid tool for assessing FOB in postpartum women.

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

OBJECTIVE

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

INTRODUCTION

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

INCLUSION CRITERIA

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review

BACKGROUND

Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined.

AIM

Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes.

METHODS

The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I.

RESULTS

Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies.

CONCLUSIONS

Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.

Prenatal Symptom Cluster of Psychopathology and Associations With Mindfulness and Rumination: A Network Analysis

ABSTRACT

The present study aimed to examine the interrelationships of prenatal psychopathology (specifically symptom cluster), dispositional mindfulness, and rumination using network analysis. Network analysis estimates the links between symptoms and can evaluate the presence and strength of the links. A total of 1122 pregnant women were recruited from a tertiary hospital in China. Psychopathology symptoms (including anxiety, depression, stress, fatigue, sleep, fear of childbirth [FOC], and memory problems) were assessed and used along with mindfulness and rumination to construct networks of association using R. Results illustrated five communities within the network. Anxiety resulted in the highest strength of centrality followed by two symptoms: FOC and retrospective memory. Paths showed that mindfulness was directly connected to depression, prospective memory, retrospective memory, and lack of positive anticipation in FOC, whereas mindfulness was connected indirectly through rumination to anxiety, fatigue, stress, and sleep problems. The findings reinforce that anxiety is a key symptom of prenatal psychopathology and requires priority consideration. The direct associations between mindfulness and prenatal psychopathology symptoms provide potential targets for future mindfulness-based interventions, and mindfulness reducing rumination thus in turn decrease anxiety, suggesting potential mediating mechanism of mindfulness.

A Psychoeducational Intervention in Prenatal Classes: Positive Effects on Anxiety, Self-Efficacy, and Temporal Focus in Birth Attendants

Background: Previous studies have reported associations between high maternal anxiety, temporal perceptions during pregnancy, and a poor sense of self-efficacy. One type of anxiety expecting mothers experience is associated with childbirth, which previous studies have shown can be reduced by antenatal training. Recent contributions have pointed out that current prenatal courses, while providing important and useful knowledge, do not devote sufficient content to the mental health of the parturient and to the psychological issues that can arise before and after the birth. Methods: In total, 80 pregnant women were provided with a special prepartum course in which ample space was devoted to topics such as maternal mental health, parenting skills and couple relationship, relaxation techniques, and assertiveness. Perception of threat, state anxiety, temporal focus, needs and expectations, and self-efficacy were assessed by comparing this psychoeducational intervention group with a traditional antenatal course group (n = 80), and a control group (n = 80). Two-way mixed ANOVAS (3 × 2) were performed for each dependent variable considered, including the time variable (pre-course–post-course) as a factor within the participants and the group variable as a factor between the subjects. Results: The psychoeducational intervention actually induced significant and positive changes primarily on four dimensions: state anxiety, perceived self-efficacy, the need for information, and reassurance of the pregnant women who participated in this trial. Conclusions: The study suggests improving the quality of prenatal classes by paying particular attention to the content and communication used within the group, in order to gratify at the highest level, the need for information, reassurance, and sharing that characterize the parturient’s request for support. The evidence collected recommends further replicating the intervention protocol described in order to improve the psychophysical well-being of women in a delicate moment such as pregnancy and preparation for childbirth, but especially in terms of the prevention and containment of the risks of psychological distress that currently affect a significant number of women after childbirth.

Emphasizing mindfulness training in acceptance relieves anxiety and depression during pregnancy

Mindfulness intervention, which trains participants to monitor momentary experiences with an accepting attitude, is effective for reducing maternal anxiety and depression. Monitoring and acceptance are two central components of mindfulness training. The aim of the study is to clarify whether adding acceptance component to monitoring training can help improve the mental health of pregnant people by comparing the effects between mindfulness training on monitoring with an emphasis on acceptance training and training on monitoring alone. Pregnant people with depressive or anxious symptoms (N = 149) were randomized to either a 4-week online intervention of (1) monitoring training (MT), (2) monitoring with an emphasis on acceptance training (MAT), or (3) emotional regulation course conditions as an active control group. All mindfulness training was based on the WeChat platform. We used the Generalized Anxiety Disorder Scale (GAD-7), Patient Health Questionnaire (PHQ-9), Five Facets of Mindfulness Questionnaire (FFMQ), and Regulatory Emotional Self-Efficacy Scale (RESE) to evaluate symptoms of anxiety and depression, mindfulness monitoring and acceptance skills, and the self-efficacy of emotional regulation pre-and postintervention. Of the 149 people enrolled in this study, 10 in the MT training group, 9 in the MAT group, and 15 in the control group did not complete the intervention. Monitoring with an emphasis on acceptance training significantly reduced symptoms of anxiety and depression and improved perceived self-efficacy in managing depression/distress compared with the monitoring training alone and the control group. In addition, participants in the monitoring group showed a downward trend in GAD-7 scores and an upward trend in scores of perceived self-efficacy in managing anger/irritation. This study not only shows that the 4-week online mindfulness training could be a promising technique to help people improve mental health; moreover, it provides evidence that emphasizing acceptance skills on mindfulness training may play a critical role because of its positive effects. We suggest that the online mindfulness intervention should be added as part of psychological care and recommend emphasizing acceptance training during pregnancy.

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development

Background

Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being.

Methods

A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.

Results

A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation.

Conclusions

The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.

Assessment of the Postpartum Emotional Wellbeing among Women Participating and Not Participating in Antenatal Classes

The perinatal period is associated with an increased risk of emotional disorders. Exposure to stress impacts the functioning of the maternal brain, also shaping the developmental processes of the child's brain. To assess the emotional wellbeing of women participating and not participating in antenatal classes. The study involved a group of 200 women divided into two groups: the study group, participants of the antenatal classes (N = 100), and the control group, not participating in the antenatal classes (N = 100). The Edinburgh Postnatal Depression Scale (EPDS) and Mini-COPE inventory were used. EPDS was administered at two time points: on the 2nd day of puerperium and 6 weeks after the delivery, while Mini-COPE inventory was applied once during pregnancy. Severe symptoms of depression on the 2nd day after childbirth concerned 16.0% of the women (N = 15) participating in the antenatal classes and 11.0% of the controls (N = 11). Intensification of depressive symptoms 6 weeks after the delivery occurred in 19.5% of the females attending antenatal classes (N = 17) and 18.8% of the controls (N = 18). Severe symptoms of depression 6 weeks after the delivery in the group of women participating in antenatal classes were significantly related to adopting helplessness to cope with stress and a sense of being accepted by the husband/partner, family, and society. In the case of women not participating in antenatal classes, the severity of symptoms of depression 6 weeks after the delivery was slightly related to the sense of acceptance by the husband/partner, family, and society. Apart from identifying risk factors for emotional disorders in pregnancy, it is worth taking into account whether a woman participated in antenatal classes when planning the care in the perinatal period. This factor can be a potential protective factor in preventing emotional problems after childbirth.

A feasibility study of a psychoeducation intervention based on Human Caring Theory in nulliparous women with fear of childbirth

OBJECTIVE

To evaluate the effects of psychoeducation program based on the Human Caring Theory on the level of fear of childbirth (FOC) by comparing the antenatal education classes.

METHODS

This feasibility study was conducted in a single-blinded, randomized controlled trial on 24 nulliparous women with FOC between July and October 2018. The women received five sessions of psychoeducation and four sessions of antenatal education. The primary outcome was the level of FOC in prenatal period, and the secondary outcomes were the rate of preference for vaginal birth (VB) in prenatal period, the rate of VB, and the level of FOC in postnatal period. The level of the FOC was assessed using Wijma Delivery Expectancy/Experience Questionnaire A and B.

RESULTS

Although the levels of FOC of the women decreased in both groups for post-treatment, the decrease in the psychoeducation group was significantly higher compared to the antenatal education group (p = 0.022). In the postnatal period, the level of FOC of psychoeducation group was statistically lower than that of the antenatal education group (p = 0.000). Furthermore, all the women in the psychoeducation group and 58.33% of the women in the antenatal education group wanted to have a VB at the end of the program (p = 0.012). However, there was statistically no difference between the groups in terms of the birth type (p = 0.342).

CONCLUSIONS

There seems to be an indication that the psychoeducation program based on Human Caring Theory might have a benefit to reduce the level of FOC of women compared to the antenatal education classes.

Burned or engaged teachers? The role of mindfulness, self-efficacy, teacher and students’ relationships, and the mediating role of intrapersonal and interpersonal mindfulness

This study had the goal to examine factors that are associated with burnout and engagement among teachers from diverse educational stages. Among these factors, we analyzed socio-demographic aspects, such as gender, age and years of experience, and other psychological teacher-related variables like teacher’s self-efficacy and teacher-student relationships. We also considered the potential mediating role of mindfulness in these relationships. The sample was made up by 425 Spanish teachers who answered an online survey. We administered the following measures: Revised version of the Teacher’s Burnout Questionnaire, Utrecht Work Engagement Scale, Mindfulness in Teaching Scale –which distinguished between intrapersonal and interpersonal mindfulness-, Teacher’s Sense of Self-efficacy Scale, and some questions related to the relationships between students and teachers in the classroom. We conducted a mediational analysis through structural equation modeling (SEM). Our findings indicated that both intrapersonal and interpersonal mindfulness mediated the relation between self-efficacy, which played a direct and an indirect role, the teacher-student relationship, and burnout and engagement. The socio-demographic variables of gender and years of experience played a significant role in mindfulness. The teachers with more self-efficacy were more likely to pay attention to their daily activity and to show more receptivity with their students, which resulted in lower burnout and more engagement. In addition, better relationships with students led to higher intrapersonal mindfulness levels, which mediated the relation with burnout and engagement. These relations varied depending on specific burnout and engagement dimensions. We discuss the implications of these findings for improving teachers´ implication in the education field.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

PRACTICE IMPLICATIONS

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

Non-pharmacological interventions to reduce anxiety in pregnancy, labour and postpartum: A systematic review

BACKGROUND

The anxiety mothers experience during pregnancy is well known and may have negative consequences for the emotional, psychological, and social development of newborns. Anxiety must therefore be reduced using different strategies.

OBJECTIVE

To determine published non-pharmacological interventions to reduce anxiety during pregnancy, childbirth and postpartum.

METHODS

A systematic peer-review of experimental and quasi-experimental studies was conducted using the PubMed, Scopus, Web of Science (WOS), and CINAHL databases. The quality of the studies was assessed using the Spanish version of the PEDro scale. Two researchers participated independently in the data selection and extraction process.

FINDINGS

587 articles were identified, of which 21 met the eligibility criteria. In eleven studies the intervention was performed during pregnancy, in three of them during labour, in four of them during the postpartum period, and in three of them during pregnancy and postpartum. During pregnancy, the most effective interventions were behavioural activation, cognitive behavioural therapy, yoga, music therapy, and relaxation; during childbirth: aromatherapy; during pregnancy and postpartum: antenatal training, massage by partners, and self-guided book reading with professional telephone assistance.

CONCLUSION AND IMPLICATIONS

The most effective interventions to reduce anxiety were performed either during pregnancy or during the postpartum period, not during labour. Most of the interventions were performed on the women, with few of them being performed on both partners. Non-pharmacological interventions may be applied by nurses and midwives to reduce anxiety during pregnancy, labour and postpartum.

A Shift Toward Childbearing in One-Child Families Through a Mindfulness-Based Stress Reduction Program: A Randomized Controlled Trial

Objective: Fertility patterns are a key to the estimation of future population size, but they are restricted by serious indecision. One-child families are one of these patterns that is caused by a set of factors and one of these factors is the fear of re-pregnancy. In this regard, this study aimed to use a mindfulness-based stress reduction (MBSR) program to reduce the fear of women who have been experiencing anxiety after their first pregnancy and delivery.

Materials and methods: This interventional study was conducted on 67 one-child women, who at least 6 years have been passed since the birth of their child and according to the short form of the Pregnancy Related Anxiety Questionnaire (PRAQ-17), have been experienced anxiety. These women were randomly divided into control and intervention groups. For the intervention group, the MBSR program was conducted in 8 sessions, once every week, each session lasting 2.5 hours. At the end of the program, a second PRAQ-17 was completed by both groups.

Results: The findings showed that the MBSR approach in the intervention group significantly decreased the anxiety score in total (p=0.001) and individually in all subcategories.

Conclusion: The MBSR approach can reduce the anxiety of one-child women who have experienced anxiety after their pregnancy and childbirth. Thus, using this method in helping women with pregnancy-related anxiety is recommended to increase the birth rate.

Development and application of a couple-centered antenatal education program in Korea

Purpose

This study was conducted to develop a couple-centered antenatal education program and to test the program's feasibility.

Methods

With a preliminary-experimental study design, 33 pregnant couples who were expecting their first child participated in this study. The program consisted of four sessions (1 hour/session/week) of education and counseling. Data were collected before and after the intervention from September 2018 to April 2019 at a women's hospital in Daejeon, Korea, with demographic data forms, the Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Maternal-Fetal Attachment Scale, Korean Newborn Care Confidence Scale, Wijma Delivery Expectancy/Experience Questionnaire, and Dyadic Adjustment Scale-10.

Results

The pregnant women and their husbands were on average 32.30±3.10 and 33.21±6.25 years old, respectively. The mean marriage duration was 2.34±1.63 years, the gestational age was 31.30±2.66 weeks, and 78.8% of the couples had a planned pregnancy. After the program, both the pregnant women and their husbands showed significant improvements in attachment to the fetus and confidence in providing infant care. Prenatal depression, prenatal stress, and fear of childbirth in pregnant women significantly decreased after completing the program. However, the dyadic adjustment score did not change significantly either in the pregnant women or their husbands.

Conclusion

A couple-centered antenatal education program seems to be effective for couples adjusting to parenthood, but further studies should explore ways to have a positive impact on couples' relationships.

The Role of Emotion Regulation in Pain Management Among Women From Labor to Three Months Postpartum: An Integrative Review

BACKGROUND

Emotion regulation is a regulatory process to modify emotional activation in a wide range of situations and shows potential effects to reduce pain and emotional distress. The purpose of this review was to enhance an understanding of the role of emotion regulation strategies and their outcomes in reducing women's pain from labor to 3 months postpartum.

DESIGN

Integrative review.

METHODS

The literature was reviewed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted using electronic databases CINAHL, PsycINFO, PubMed, Scopus, and ProQuest dissertation from 1990-2019.

RESULTS

Nine publications were included. Two emotion regulation strategies, mindfulness and distraction, were used. The findings revealed that prolonged training in mindfulness-based interventions produced significant improvements in decreasing pain intensity during labor and increasing maternal comfort 2 hours postpartum. The distraction strategy showed a significant decrease in pain intensity during labor for women who were trained and self-practiced during the prenatal period.

CONCLUSIONS

Both mindfulness and distraction would be offered to pregnant women as part of alternative self-pain management strategies to prepare them for dealing with pain and other discomforts. Future research needs to test the effects of the intervention beyond childbirth.

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

Background

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

Methods

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

Results

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

Conclusions

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

Fear of childbirth in Iran: A systematic review of psychological intervention research

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.

The relationship between women's perception of support and control during childbirth on fear of birth and mother's satisfaction

The study was conducted in order to determine the relationship between women's perception of support and control during childbirth on fear of birth and mother's satisfaction. This descriptive study was carried out at the postpartum clinics of a state hospital. Seven hundred and twenty-five puerperal women were included in the sample. T test in independent groups and Pearson's correlation test were used in the evaluation of the data. Seventy-six percent of the puerperal women had vaginal birth, 24% had caesarean section. The mother's perception of control and support at birth was moderate (99.04 ± 17.30), the fear of birth was at clinical level in most of them (92.8%), and the satisfaction at vaginal and caesarean births was low. Puerperal women who had a planned pregnancy, non-invasive birth, birth without perineal tear had higher support and control perception at birth and lower fear of birth than who had unplanned pregnancy, invasive birth, or birth with a perineal tear (p<.05). Puerperal women who did not have any health problems during pregnancy and postpartum period had higher satisfaction levels compared to those who did (p<.05). The high level of perception of support and control at birth decreases the fear of childbirth and increases the satisfaction levels of puerperal women in vaginal and caesarean births. All health professionals, especially perinatal nurses and midwives, should strive to implement care initiatives that are appropriate to the needs of women.Impact StatementWhat is already known on this subject? The mode of delivery, insufficient supportive care during delivery, or perception of supportive care received are among the causes of trauma among women. Birth trauma may cause women to experience stress, anxiety, fear and loss of control, and maternal and foetal/neonatal health is adversely influenced during the delivery and postpartum period. A literature review revealed no study examining the effect of maternal perception of support and control during delivery on fear of childbirth and maternal satisfaction.What the results of this study add? Stronger perception of support and control during delivery reduces fear of childbirth, and also increases puerperal women's levels of satisfaction from care during vaginal and caesarean deliveries.What the implications are of these findings for clinical practice and/or further research? Facilitating women's achievement of personal control and expectations during childbirth should be the focus of care interventions. In line with these results, it may be recommended that all healthcare professionals, especially perinatal nurses and midwives, strive to implement care initiatives that comply with the needs of women.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis

Background

Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran.

Methods

This research is a qualitative study conducted in Iran to explore women’s perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis.

Results

From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.

Conclusion

Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03666-z.

How mindfulness impacts the positive forms of leadership and enhances performance at workplace

BACKGROUND: Mindfulness is a multi-millenary concept that is fundamental to meditative traditions. Nowadays it is a well-documented psychological construct and a proven therapeutic technique, particularly in stress reduction and depressive relapse prevention. However, mindfulness and its effects on management practices are still relatively unexplored in the literature. OBJECTIVES: This paper aims to address this shortage and demonstrate the claims that mindfulness is a psychological construct that is doubly beneficial to business executives by supporting a more balanced relationship to work while promoting the adoption of more positive and effective leadership behaviors (transformational leadership and authentic). METHOD: A model using positive forms of leadership as mediators of mindfulness / performance relationship is proposed for this assessment. A quantitate analysis is performed on a sample of 319 African managers, 95% of which are South Africans. RESULTS: The data supports the idea that mindfulness is a resource that can be mobilized for inducing transformational and authentic leadership development and positive organizational behaviors. CONCLUSION: Mindfulness seems to be a very interesting predictor of transformational and authentic leadership styles, which prove to be the most powerful generators of performance

Trait mindfulness during pregnancy and perception of childbirth

Women's subjective childbirth experience is a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms. Subjective childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics. A maternal characteristic that may be associated with a more positive childbirth experience is trait mindfulness. The current study aimed to assess this association and to assess whether trait mindfulness during pregnancy had a moderating role in the possible association between non-spontaneous delivery and perception of childbirth. A subsample of 486 women, participating in a longitudinal prospective cohort study (Holistic Approach to Pregnancy and the first Postpartum Year study), completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Women completed the Childbirth Perception Scale and the Edinburgh Postnatal Depression Scale between 7 and 21 days postpartum. The mindfulness facets acting with awareness and non-reacting were significantly associated with a more positive perception of childbirth, after adjusting for covariates. Moderation analyses showed a significant interaction between acting with awareness and non-spontaneous delivery and non-judging and non-spontaneous delivery. Non-spontaneous delivery was associated with a more negative perception of childbirth for low/medium scores of acting with awareness and non-judging, but not for high scores on these mindfulness facets. Trait mindfulness during pregnancy may enhance a positive perception of childbirth. Because this is among the first studies examining the association between maternal dispositional mindfulness and perception of childbirth, future research is needed to confirm the results of the current study.

Development of the Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p)

BACKGROUND

Receiving epidural analgesia during labor can possibly have negative consequences for mother and child. Yet, the use of epidural analgesia rapidly increased in the Netherlands over the last decade. Since antenatal plans for labor pain relief have been related to epidural analgesia use during labor, the aim of the current study was to develop a Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p).

METHODS

Three focus group interviews were conducted with pregnant women, new mothers and caregivers and 13 candidate items were derived. Psychometric properties were tested with explorative factor analysis in sample I (N = 429) and a subsequent confirmatory factor analysis in a different sample II (N = 432).

RESULTS

The explorative factor analysis suggested a two-factor seven-item solution: a 'women's perception' and 'social environment' subscale. The confirmatory factor analysis confirmed an excellent six-item model fit with appropriate internal consistency. Higher scores on the six-item LPRAQ-p indicate greater willingness for request of pain relief medication during labor. Two-tailed t-tests showed that women with elevated levels of depression and pregnancy-specific distress symptoms, nulliparous women and multiparous women with complications during a previous delivery had greater willingness for request of pain relief medication during labor. Linear regression showed that the most important association with higher scores on the LPRAQ-p were high pregnancy-specific distress symptoms.

CONCLUSIONS

This study showed the LPRAQ-p to be a valid instrument to evaluate attitude towards labor pain relief in pregnant women. High scores on this questionnaire are associated with high levels of pregnancy-specific distress symptoms.

Self-compassion predicts less fear of childbirth in childless women: the mediating role of birth beliefs

OBJECTIVE

Women can have fear of childbirth (FOC) in advance of their first pregnancy and such fear can have implications for reproductive and eventual childbirth choices. This study aims to further our understanding of the role of self-compassion in FOC in young childless women, including possible pathways through which self-compassion might relate to less FOC: through natural and medical birth beliefs.

DESIGN AND MAIN OUTCOME MEASURES

In this correlational study, 316 young childless Australian women completed measures of self-compassion, natural and medical birth beliefs, and FOC.

RESULTS

Self-compassion predicted less FOC, and although self-compassion as a total score did not relate to natural birth beliefs, it did relate to lower scores on medical birth beliefs. The indirect effect through medical birth beliefs was supported; greater self-compassion predicted lower scores on medical birth beliefs, which in turn predicted less FOC.

CONCLUSIONS

The findings, although cross-sectional, support the study of self-compassion in FOC, which is in part because self-compassion predicts less medical birth beliefs. With further research, self-compassion training might be incorporated into public health initiatives targeting FOC in young childless women.

A peer support intervention for first-time mothers: Feasibility and preliminary efficacy of the mummy buddy program

BACKGROUND

The transition to motherhood, although joyous, can be highly stressful, and the availability of professional postpartum support for mothers is often limited. Peer volunteer support programs may offer a viable and cost-effective method to provide community-based support for new mothers.

AIM

To determine the feasibility of a peer volunteer support program-The Mummy Buddy Program-in which experienced volunteer mothers are paired with, and trained to offer social support to, first-time mothers.

METHODS

Using a single-group non-randomised feasibility trial, a total of 56 experienced mothers participated in the Mummy Buddy training program, which was focused on education and practical exercises relating to the provision of various forms of social support. Experienced mothers ('Mummy Buddies') were subsequently paired with expectant first-time mothers (n=47 pairs), and were encouraged to provide support until 24-weeks postpartum.

FINDINGS

In terms of key feasibility considerations, 95.1% of Mummy Buddies felt that they were trained sufficiently to perform their role, and 85.8% of New Mothers were satisfied with the support provided by their Buddy. Analyses of preliminary efficacy (i.e., program outcomes) revealed that the first-time mothers maintained normal levels of stress and depressive symptomology, and possessed relatively strong maternal functioning, across the program duration.

CONCLUSION

The Mummy Buddy Program appears to be a feasible and potentially valuable peer volunteer support program for first-time mothers. This study provides a foundation for program expansion and for work designed to examine program outcomes-for first-time mothers, Mummy Buddies, and entire family units-within a sufficiently-powered randomised controlled trial.