The effect of midwifery led counseling based on Gamble's approach on childbirth fear and self-efficacy in nulligravida women

The effect of non-pharmacological prenatal interventions on fear of childbirth: an overview of systematic reviews and meta-analysis

BACKGROUND

During pregnancy and childbirth, alongside positive feelings, women undergo feelings such as fear of childbirth (FoC) and worry about its consequences, which could leave negative effects on the mother and her child during pregnancy, delivery, and postpartum. The study was carried out to determine the effectiveness of prenatal non-pharmacological interventions on reducing the FoC.

METHODS

The protocol of the study was registered in PROSPERO (ID: CRD42023468547). PubMed, Web of Science, Cochrane, Scopus, SID (Scientific Information Database) and Google Scholar search engine databases were systematically searched until July 27, 2023 with no limitation of time and limited to Persian and English studies in order to perform this overview. Certainty of evidence was assessed using GRADE, methodological quality using AMSTAR 2 and reporting quality using PRISMA score. Meta-analysis was performed on the data extracted from the original trials to evaluate the effect of different interventions on reducing the FoC. Sub-group analysis and meta-regression models were used to examine high heterogeneity, and sensitivity analysis was used to eliminate the effect of high risk of bias studies on the study findings.

RESULTS

Overall, 15 systematic reviews (SRs) were included in the overview, among which meta-analysis was performed in 9 studies. Considering methodological quality, these SRs were in low to critically low status and had relatively complete reports regarding reporting quality. Meta-analysis findings indicated that psychological interventions (SMD -2.02, 95% CI -2.69 to -1.36, 16 trials, 1057 participants, I2 = 95%) and prenatal educations (SMD -0.88, 95% CI -1.16 to -0.61, 4 trials, 432 participants, I2 = 72.8%) cause a significant reduction in FoC relative to prenatal usual cares with low certainty of evidence. Distraction techniques lead to a significant reduction in FoC relative to prenatal usual care with high certainty of evidence (SMD -0.75, 95% CI -1.18 to -0.33, 4 trials, 329 participants, I2 = 69%), but enhanced cares do not result in a significant decrease FoC relative to prenatal usual care with very low certainty of evidence (SMD -1.14, 95% CI -2.85 to 0.58, 3 trials, 232 participants, I2 = 97%).

CONCLUSIONS

Distraction techniques are effective in reducing FoC. Regarding the effect of psychological interventions and prenatal educations on the reduction of FoC, the findings indicated that the interventions may result in the reduction of FoC. Very uncertain evidence showed that enhanced cares are not effective in reducing the FoC.

Pre- and postpartum fear of childbirth and its predictors among rural women in China

BACKGROUND

Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women.

METHODS

This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed.

RESULTS

The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001).

CONCLUSION

The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women's FOC level and improve their overall pregnancy and childbirth experience.

Midwife-led psycho-education intervention to reduce childbirth fear: a quasi-experimental study

This quasi-experimental study aimed to assess the impact of a midwife-led psycho-education intervention on reducing fear of childbirth (FOC) and perceived stress (PS) in pregnant women. The present study involved 96 pregnant women. The intervention group received three 30-45 min telephone sessions using 'BELIEF' (Birth Emotion-Looking to Improve Expectant Fear) psycho-education approach. The outcomes were assessed using questionnaires on childbirth attitudes and PS. Data analysis was performed using Stata version 17. In the intervention group, the mean score for FOC decreased from 39.41 ± 7.02 to 29.91 ± 5.60 (9.5; 24.1%). The mean difference (MD) of 28.22% was statistically significant (adjusted MD: -10.51, 95% CI: -11.60, -9.41, P < 0.001). In the intervention group, mean scores for PS decreased from 22.77 ± 6.94 to 18.23 ± 5.69 (4.54; 19.93%). In the control group, scores increased from 22.68 ± 6.76 to 24.82 ± 6.58 (2.14; 9.43%). The 29.36% MD was statistically significant (aMD: -6.95, 95% CI: -8.73, -5.18, P < 0.001). The findings of this study indicate that the midwife-led psycho-education intervention, utilizing the 'BELIEF' protocol over the telephone, has a significant effect on reducing FOC and PS, as well as increasing the preference for vaginal birth.

The significance of positional care combined with doula delivery during childbirth in the correction of abnormal fetal position

OBJECTIVE

To explore the effects of positional care combined with doula delivery during childbirth in the correction of abnormal fetal position.

METHODS

In this retrospective study, a total 108 pregnant women with abnormal fetal orientation were included from February 2018 to February 2021 in the Jinan City People's Hospital. Among them, 54 patients who received positional care combined with doula delivery were included in the intervention group (IG), while the other 54 patients who received routine nursing were included in the control group (CG). The data of the fetal orientation correction, delivery method and the pain score of puerpera of two groups were collected. The length of delivery, delivery fear score, the degree of neonatal asphyxia and nursing satisfaction were observed as the secondary outcomes.

RESULTS

Compared with the CG, puerpera in the IG had more occipital anterior position, less occipital transverse and posterior position, higher eutocia rate, lower pain and fear scores and shorter length of delivery; the Apgar score and nursing satisfaction were higher in the IG (all P<0.05).

CONCLUSION

Positional care combined with doula delivery can effectively correct abnormal fetal orientation, improve the rate of eutocia, reduce puerpera's pain and fear, shorten the length of delivery, and improve the quality of neonatal outcome and patients' satisfaction.

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.

Evaluation of childbirth self-efficacy and associated factors among pregnant women

BACKGROUND

Increasing the rate of Normal Vaginal Delivery (NVD) and reducing elective cesarean section is one of the important concerns, especially in Iran. Childbirth self-efficacy can play an important role in managing the fear of childbirth and increasing the rate of NVD. The aim of this study was to determine demographic, fertility, and social factors related to childbirth self-efficacy.

MATERIALS AND METHODS

The present study was a single-group, single-stage, multivariate, cross-sectional study that assessed childbirth self-efficacy and associated factors in 358 eligible pregnant women with gestational age of 37 weeks and over in Guilan (North Iranian province) from November 2018 to July 2019. Data collection was performed based on consecutive sampling method from the pregnant women referring to the prenatal clinic. Data collection tools included a demographic and reproductive characteristics questionnaire; Lowe's childbirth self-efficacy Inventory and Zimet's perceived social support multidimensional questionnaire.

RESULTS

There was a significant relationship between the educational level of pregnant women and Outcome Expectancy (OE) and Self-efficacy Expectancy (EE) and also between the spousal level of education and OE (P < 0.05). Parity, previous experience of birth, participation in pregnancy preparation classes, access to information sources about childbirth, and birth preference were significantly related to OE and EE (P < 0.05). There was a significant relationship between the two domains of perceived social support, spouse and friends, and the OE and EE (P < 0.05). The multivariate logistic regression model revealed that birth preference was a predictor for OE and EE, while a pregnant woman's education level and perceived social support in the domain of significant others were predictors for OE. Spousal age, mean family income, and participation in the prenatal preparation classes were predictors for EE.

CONCLUSIONS

Regarding the importance of self-efficacy in childbirth in encouraging pregnant women to perform NVD, pregnancy and childbirth preparation classes with an emphasis on concepts including self-efficacy of childbirth should be focused by midwives and other health-care workers in order to improve pregnant women's knowledge regarding the benefits of NVD and to strengthen their belief in the benefits of pain-compatible actions.

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.

Factors relating to childbirth self efficacy among pregnant women: a CHAID analysis

Childbirth self-efficacy is a useful measure for determining a woman's confidence in managing childbirth and for determining any preconceptions that require reinforcement. Childbirth self-efficacy is also particularly helpful in advising not only how to cope with birth, but also maternal well-being and fostering the improvement of a wide variety of perinatal outcomes. The present study aims to determine the factors affecting childbirth self-efficacy in pregnant women. The sample size consisted of 380 pregnant women between the ages of 18 and 45. Data were collected via face to face interviews using the Childbirth Self Efficacy Scale Short Form (CBSEI-32) in the Akdeniz University Hospital between November 2019 and February 2020 and used Chi-squared Automatic Interaction Detector analyses, resulting in a mean CBSEI-32 score of 244.279 ± 45.121. As a result of the analysis, it was seen that income status affects self-efficacy, and personal experiences such as foetal loss affect a woman's childbirth self-efficacy. In addition, it was also found that the level of prenatal education affected childbirth self-efficacy. Health professionals should assess pregnant women during the antenatal period in terms of their childbirth self efficacy and prepare personalised training programs and plan initiatives to increase perceptions of self-efficacy.IMPACT STATEMENTWhat is already known on this subject? Childbirth self-efficacy is one of the important psychological parameters to determine a woman's belief in her confidence in managing childbirth and to measure women's perceptions of her need for reinforcement.What do the results of this study add? Sociodemographic and obstetric characteristics of women affect their childbirth self-efficacy perception positively and negatively. Women's birth self-efficacy can be improved positively with prenatal education. In addition, it is one of the interesting findings of the study that the self-efficacy level of women who had a previous low experience was high.What are the implications of these findings for clinical practice and/or further research? Women's childbirth self efficacy can be improved with trainings and appropriate nursing interventions. For this reason, it is important to determine the factors affecting the self-efficacy perception of women. In future studies, the childbirth self-efficacy perceptions of women in different samples (risky pregnancy, disabled pregnant, etc.) should be measured.

Factors of the childbirth fear among nulliparous women in Iran

BACKGROUND

Fear of childbirth is an anxiety associated with childbirth, which manifests itself in physical and concentration problems. It is often associated with requesting a cesarean section, and it is prevalent in nulliparous women. This is a study aimed to summarize the published research on the factors for fear of childbirth in nulliparous women in Iran.

METHODS

This study was conducted based on the PRISMA statement. A literature search was performed on nine electronic databases (Web of Sciences, Since Direct, Scopus, PubMed, Cochrane Library, ProQuest, and Persian databases including Scientific Information Database, Irandoc, and Magiran) using keywords related to fear of childbirth, factors, nulliparous, and Iran from 2000 to 2020. This study included cross-sectional studies with full-text in English or Persian in Iran. The quality of the selected studies was evaluated independently by two authors and via the STROBE checklist.

RESULTS

In this study, 93 articles were identified,13 duplicate articles were excluded, 80 articles were screened by title and abstract, 62 were excluded, and the full-text of 18 articles was assessed for analysis. Of these, 12 were excluded, and six articles were reviewed. Six studies were conducted in different provinces of Iran. Based on the study results, factors of the fear of childbirth in nulliparous women were: biological (the process of labor and childbirth and labor pain, concern for the baby (harm to the baby and baby infirmity), psychological (painful injections during labor and suturing in childbirth), and individual (loss of control during labor).

CONCLUSIONS

This study identified four main factors that affect fear of childbirth status in nulliparous women, and concern for the baby was a more common factor in this study. In conclusion, these factors can be reduced by increasing their assurance about child health, training during pregnancy, talking about positive experiences, and holding workshops.

The effect of midwifery-led counseling on expectant fathers' fear of childbirth: a smartphone- based randomized controlled trial

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.

Prevalence and associated factors of fear for childbirth among pregnant women in eastern Sudan

BACKGROUND

Prenatal fear of childbirth (FOC) is a major health problem. In spite of its importance, there are few studies on FOC in Africa and no published studies on FOC in Sudan.

OBJECTIVES

This research aims to assess the prevalence of FOC amongst pregnant Sudanese women and to determine its associated factors.

METHOD

A cross-sectional study was conducted in Gadarif , eastern Sudan. The sociodemographic and obstetric data were gathered through a questionnaire. Fear of childbirth was assessed with the Wijma Delivery Expectancy Questionnaire (W-DEQ. The three-item Oslo social support scale was used to measure the psychosocial condition of the participants. A logistic regression analysis was performed with severe FOC as dependent variable and sociodemographic, obstetric factors and social support as independent factors.

RESULTS

A total of 475 women were enrolled in the research. Their median age (interquartile range) was 26.0 (8.0) years. Of these 475 women, 110 (23.2%) were primigravidae, 270 (56.8%) were parous and 95 (20%) were grandmultiparae. Fitty -three (11.1%) women experienced severe FOC (scored ≥66 on the W-DEQ). In a multivariable logistic regression analysis, primiparity (adjusted odds ratio = 23.26) was associated with severe FOC. There was no significant association between age, education or social support and severe FOC.

CONCLUSIONS

This study demonstrates that 11.1% of pregnant Sudanese women exhibited FOC. Primigravidae were more likely to have severe FOC. The implementation of birth education programmes for this risk group is recommended in Sudan.

Interventions for fear of childbirth including tocophobia

BACKGROUND

Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia.

OBJECTIVES

To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia.

SEARCH METHODS

In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing.

SELECTION CRITERIA

We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials.

DATA COLLECTION AND ANALYSIS

We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use.

MAIN RESULTS

We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence).  Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence).

AUTHORS' CONCLUSIONS

The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.