Self-efficacy beliefs and fear of childbirth in nulliparous women

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

Background

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

Objective

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

Methods

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

Results

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

Conclusion

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

Systematic Review Registration

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

Factors influencing midwives' intentions to facilitate normal physiological birth: A qualitative study

BACKGROUND

Whilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals' intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth.

QUESTION/AIM

To explore factors influencing midwives' intentions to facilitate normal physiological birth.

METHODS

A qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control.

FINDINGS

Fourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives' intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery.

DISCUSSION

Factors influencing the midwives' intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives' intentions and the way in which they facilitate normal physiological birth.

CONCLUSIONS

Midwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.

Spiritual Health, Anxiety and Fear of Childbirth in Iran: Is there Any Relationship?

The most common reason for mothers' request for a cesarean section is fear of childbirth. The present study was conducted to determine the relationship between spiritual health and anxiety and fear of childbirth in pregnant women. This correlational cross-sectional study was performed on 426 pregnant women who were referred to Yahyanejad Hospital in Babol, Iran, during 2018-2021. These pregnant women were hospitalized in the maternity ward for vaginal delivery. Convenience sampling bases on inclusion criteria were done to select the subjects. The questionnaires used in this study included Demographic and Obstetric Questionnaire, Anxiety and Fear of Childbirth Questionnaire by Pirdel et al., and Palutzian & Ellison Spiritual Well-being Scale. Data were analyzed using SPSS version 16 using descriptive and analytical indicators and linear and multiple correlation tests. The results of the study showed that all pregnant women experienced moderate (23.1) or severe (76.9) fear and anxiety, and none of the women had low fear and anxiety. Moreover, all women in this study had moderate (50.5) or high (49.5) spiritual health. The results of linear regression test showed that there is a significant and inverse relationship between spiritual health and anxiety and fear of childbirth (R: - 0.12, CI - 0.14, - 0.019, P = 0.011). Furthermore, the results of multivariate linear regression test after adjustments for intervening demographic and midwifery variables showed a significant relationship between spiritual health (R: - 0.12, CI - 0.14, - 0.02, P = 0.009), education level and number of pregnancies, and anxiety and fear of childbirth. The results of the study showed that with the increase in spiritual health, anxiety and fear of childbirth decreases. Therefore, it can be inferred that women need spiritual care in addition to medical care to deal with fear and anxiety during pregnancy and childbirth.

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.

Cluster Analysis of Fear of Childbirth, Anxiety, Depression, and Childbirth Self-Efficacy

OBJECTIVE

To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters.

DESIGN

Cross-sectional survey.

SETTING

Online in Sweden.

PARTICIPANTS

Pregnant women (N = 1,419).

METHODS

We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables.

RESULTS

We identified 4 clusters based on severity: Resourceful-Robust, Resourceful-Fearful, Vulnerable-Fearful, and Fragile-Fearful. Participants in the Resourceful-Fearful and Vulnerable-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Vulnerable-Fearful and Fragile-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Fragile-Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful-Robust cluster.

CONCLUSIONS

Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.

The effect of interventions in vaginal birth on fear of childbirth: A multicentre study

AIM

This cross-sectional multicentre study aimed to determine the effect of interventions during vaginal birth for fear of childbirth.

METHODS

In this cross-sectional and analytical study, 852 women who had a vaginal birth between 2019 and 2020 were enrolled. Data were collected using the Descriptive Questionnaire and Wijma Birth Expectation/Experience Scale Version B.

RESULTS

The mean total Wijma Birth Expectation/Experience Scale Version B score of the women was 97.00 ± 24.24, indicating severe and clinical levels of fear of childbirth. Moreover, 69.4% of the women had clinical, 18.6% had severe and 12% had moderate levels of fear of childbirth. During birth, women who had close supporters, who were allowed to move and who did not undergo amniotomy, enema, perineal shaving and electronic foetal monitoring had a low level of fear of childbirth. As the number of pregnant women in the labour room, frequency of vaginal examinations, duration of delivery/hour, severity of labour pain and negative perception of the approach of health professionals increased, the women's fear of childbirth increased. Fear of childbirth decreased as the frequency of antenatal follow-ups, number of births and satisfaction levels of the women increased (p < 0.05). Low income perception, irregular prenatal follow-up, severe labour pain and a long duration of labour were strong predictors of increased fear of childbirth. Increasing number of births, high birth satisfaction level and positive perception of the approach of health professionals were strong predictors of reduced fear of childbirth.

CONCLUSIONS

The reduction of interventions in vaginal delivery and support from health care providers during delivery can be effective in reducing fear of childbirth.

Childbirth Self-Efficacy and Its Associated Factors among Pregnant Women in Arba Minch Town, Southern Ethiopia, 2023: A Cross-Sectional Study

Background

Childbirth self-efficacy is a pregnant women's perception of their ability to cope with labor stress. Low childbirth self-efficacy is linked to pain intolerance and poor labor progression, which increase the possibility of operative delivery. However, Ethiopia has limited data. So, the aim of this study was to assess childbirth self-efficacy and its factors among pregnant women attending antenatal care in public health facilities in Arba Minch town, Southern Ethiopia, in 2023.

Objective

To assess childbirth self-efficacy and associated factors among pregnant women attending antenatal care in public health facilities in Arba Minch town, Southern Ethiopia, in 2023.

Methods

An institution-based cross-sectional study was carried out among 416 women from January 1 to January 30, 2023. A systematic random sampling technique was employed. Data were collected by KoboToolbox through face-to-face interviews using a structured and pretested questionnaire. Modified short-form childbirth self-efficacy inventory was used to score self-efficacy. The Statistical Package for Social Sciences, version 27, was used for data management and analysis. Descriptive statistics were calculated for each variable, and a logistic model was used. Statistical significance was determined at a p value of less than 0.05 and 95% confidence level.

Results

A total of 416 pregnant women participated in the study. Two hundred twenty-eight (54.8%) of the pregnant women had low childbirth self-efficacy. Age group in ≤24 years (AOR = 3.80, 95% CI: 1.82-8), primigravida (AOR = 1.51, 95% CI: 1.10-2.86), unplanned pregnancy (AOR = 1.67, 95% CI: 1.02-2.70), poor social support (AOR = 2.17, 95% CI: 1.09-4.30), having anxiety (AOR = 1.30, 95% CI: 1.10-3.64), having poor knowledge of childbirth (AOR = 2.21, 95% CI: 2.09-5.39), and severe fear of childbirth (AOR = 6.40, 95% CI: 2.60-9.80) were statistically significant with low childbirth self-efficacy.

Conclusions

The magnitude of low childbirth self-efficacy was high in the study area. Being primigravida, unplanned pregnancy, age ≤ 24 years, severe fear of childbirth, anxiety, poor social support, and poor knowledge were significantly associated with low childbirth self-efficacy. Therefore, giving special attention to these factors during antenatal care would be important.

The mediating role of social support and resilience between self-efficacy and prenatal stress: a mediational analysis

BACKGROUND

Prenatal stress is a highly prevalent mental disorder experienced by pregnant women. This study assessed the prevalence and influencing factors of prenatal stress and investigated the mediating role of social support and resilience between self-efficacy and prenatal stress among pregnant women in China.

METHODS

A convenience sample comprising 1071 pregnant women from three hospitals in Nantong, Jiangsu Province, China, was recruited between February and June 2023. These participants completed a set of general survey questionnaires and were assessed using the Pregnancy Pressure Scale, Perceived Social Support Scale, the 10-item Connor-Davidson Resilience Scale, and the Chinese version of the General Self-Efficacy Scale. Furthermore, a hierarchical multiple regression model was employed to investigate the relevant factors and mediators of prenatal stress symptoms. A structural equation model was used to examine the mediating role of social support and resilience in the relationship between self-efficacy and prenatal stress.

RESULTS

The results of the multivariate regression analysis indicated significant associations between prenatal stress and parity, self-efficacy, social support, and resilience (P < 0.001). Self-efficacy accounted for 35.33% of the total effect, with a direct effect of -2.5306 (95% confidence interval [CI]: -4.0309 to -1,0303). Further examination through mediation analysis revealed the mediating roles of social support and resilience in the relationship between self-efficacy and prenatal stress. The mediating effect of social support was - 1.5933 (95% CI: -2.2907 to -0.9496), accounting for 22.24% of the total effect. Similarly, resilience exhibited a mediating effect of -3.0388 (95% CI: -4.3844 to -1.7135), accounting for 42.43% of the total effect.

CONCLUSION

The mediation analysis revealed that among pregnant women in China, the influence of self-efficacy on prenatal stress is channelled through social support and resilience. Therefore, enhancing social support, resilience, and self-efficacy might alleviate prenatal stress.

Discrepancy in parental fear of childbirth: A scoping review

BACKGROUND

Fear of childbirth is a prevalent clinical psychological issue for both mother and father; however, there is a lack of research comparing and summarizing discrepancies in parental fear of childbirth.

AIM

This study aimed to explore differences in parental fear of childbirth, identify gaps in related research area, and provide directions for future studies.

METHODS

Original references were searched from six databases by using subject terms associated with fear of childbirth. The guideline of the scoping review framework proposed by Arksey and O' Malley were applied.

RESULTS

The review covered 203 publications in all. Of them, 181 were maternal studies and 22 were paternal studies. 105 articles examined prevalence and influencing factors ranging from 0.7 % to 89.3 % in mothers and 5 % to 54.3 % in fathers. The current study included 84 influencing factors, 9 of which were common to parents and 75 of which were different, containing fathers' specific influences on fear of childbirth are perceived pregnancy difficulties, perceived birth difficulties, feelings about the upcoming birth, more frequent thoughts of birth in the middle of pregnancy and not attending parent education classes. 12 articles dealt with the experience of fear of childbirth, and the parents' fear of childbirth had 5 common themes, including fear of the birthing process, fear related to the baby, fear of lack of support, fear of postnatal health and life, and adverse psychological problems. But they have different sub-themes. 61 articles on fear of childbirth interventions, including 8 mother-specific approaches and 4 identical approaches for parents, and all of these methods were effective in reducing the prevalence of parental fear of childbirth.

CONCLUSION

Factors such as marital status, personality, etc., that are specific to mothers can also be applied to paternal fear of childbirth. Cognitive-behavioral therapy and group discussion, which are unique to maternal fear of childbirth, may be attempted for paternal fear of childbirth. In addition, future research should be devoted to developing a specific measurement tool for fathers, studying paternal fear of childbirth in depth from various aspects.

Effects of motivational interviews on childbirth perceptions and childbirthself-efficacy in nulliparous pregnant women: a randomised-controlled trial

BACKGROUND

Motivational interviews (MI) may change the perspective of birth in pregnant women by changing their negative thoughts and increasing their self-efficacy.

OBJECTIVE

This study was conducted to identify the effects of MI on childbirth perceptions and childbirth self-efficacy in nulliparous pregnant women who had traumatic childbirth perceptions.

METHODOLOGY

The research was carried out as a randomised-controlled trial wıth 166 pregnant women, including 83 experimental group and 83 control group. In the collection of data, the Traumatic Childbirth Perception Scale (TCPS) and the Childbirth Self-Efficacy Inventory (CSEI-C32) were utilised. Four sessions of MI were held with the pregnant women in the experimental group at weekly intervals whereas no initiative was applied to the pregnant women in the control group.

RESULTS

As per the measurements performed after the MI held with the experimental group, it was found that the experimental group had a significantly lower mean TCPS score than the control group (p < 0.001). The experimental group also had a significantly higher mean CSEI-C32 score than the control group (p < 0.001).

CONCLUSION

MI can be effective in reducing the traumatic childbirth perceptions and increasing childbirth self-efficacy. However, further research is required to assess the effectiveness MI on traumatic birth perception and self-efficacy.

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.

Childbirth self-efficacy and fear of childbirth and their predictors in adolescent and adult pregnant women referring to health centres of Urmia-Iran: a cross-sectional study

OBJECTIVE

Adolescent pregnancy as a growing phenomenon in the world has been investigated from different aspects. However, the examination of childbirth fear and self-efficacy has received less attention. Therefore, this study was conducted to compare the self-efficacy and fear of childbirth and to determine their predictors in adolescent and adult pregnant women.

DESIGN

In this comparative cross-sectional study, participants were selected through two-stage cluster sampling method. Data were collected using the Childbirth Self-Efficacy Inventory and Wijma Delivery Expectancy/Experience Questionnaire. The Pearson correlation test, independent t-test, and general linear model were used for data analysis.

SETTING

Urmia health centres, Iran in 2020.

PARTICIPANTS

Three hundred and sixty adults and adolescent pregnant women.

RESULTS

The mean (SD) of fear of childbirth was 114.7 (14.1) and 108.1 (23.1) in adolescent and adult pregnant women, respectively. The mean (SD) of childbirth self-efficacy in the active phase and the second stage of labour respectively were also obtained 208.8 (28.6) and 203.5 (32.1) for adolescent pregnant women and 213.8 (25.7) and 212.0 (26.5) for adult ones. There was a significant difference between adolescent and adult pregnant women in fear of childbirth (p=0.001), self-efficacy expectancy (p=0.003) and total childbirth self-efficacy (p=0.008) in the second stage of labour. After adjusting the sociodemographic characteristics, the mean score of fear of childbirth was significantly higher in adolescent pregnant women than in adult ones whereas the mean total self-efficacy score in the second stage of labour was significantly lower in adolescent pregnant women than in adult ones.

CONCLUSION

This study showed that adolescent pregnant women had more fear of childbirth and low self-efficacy than adult mothers, and there was also a relationship between fear of childbirth and self-efficacy. Paying more attention to fear and self-efficacy in childbirth and their predictors by health providers can improve pregnancy and childbirth outcomes.

Perceived Childbirth Self-Efficacy and Its Associated Factors Among Pregnant Women in South-Central Ethiopia

Background

Childbirth self-efficacy has been identified as a significant indicator of a positive childbirth experience. It is, however, the most neglected aspect of maternal care, and evidence in this regard was lacking in Ethiopia. Therefore, this study aimed to assess perceived childbirth self-efficacy and its associated factors among pregnant women in the Gurage zone, southern Ethiopia.

Methods

The current study was conducted from April to May 2022 using a facility-based cross-sectional study design. We used a systematic sampling technique and selected a total of 423 women. To collect the data, we utilized an interviewer-administered questionnaire containing a childbirth self-efficacy inventory scale. Multiple linear regression analysis was employed to discover the factors influencing a woman's self-efficacy during childbirth.

Results

The current study included 423 pregnant women in total. This study revealed that the overall mean score for perceived childbirth self-efficacy was 489.06 (SD = 65.77). Social support (β = 0.214, P< 0.001), psychological well-being (β = 0.254, P< 0.001), education status at the secondary level (β = 0.151, P< 0.001), no fundal pressure (β = 0.11, P = 0.010), and planned pregnancy (β = 0.10, P =0.013) were positively associated with childbirth self-efficacy. Fear of childbirth (β = 0.19, P< 0.001), Primipara women (β = 0.14, P< 0.001), women who had experienced discomfort during vaginal examination (β = 0.10, P = 0.009), and women who experienced the inability to push (β = 0.10, P = 0.013) were negatively associated with childbirth self-efficacy.

Conclusion

The overall mean score for the perceived childbirth self-efficacy was high when compared to the previous studies conducted in Australia. Healthcare professionals should create multifaceted strategies to support childbirth self-efficacy, such as relaxation techniques, prenatal psycho-education to reduce childbirth fear, enhance psychological well-being and encourage social support, particularly partner support during pregnancy and childbirth.

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.

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.

The Effect of Structured Antenatal Education on Childbirth Self-Efficacy

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

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.

The role of personality traits on mode of delivery

PURPOSE

The aim of this study is to understand the motives behind CS requests in nulliparous women in their late pregnancy better and to investigate if specific personality traits affect the maternal decision on mode of delivery.

MATERIAL AND METHOD

This prospective study was conducted with 70 healthy, nulliparous parturient with singleton pregnancies. Women at their 28-32. weeks of gestation were asked to fill a socio-demographic data form and the questionnaires; Personality Belief Questionnaire - Short Form (PBQ-SF) and The Childbirth Attitudes Questionnaire (CAQ). After delivery, all the results of pre-filled questionnaires and women's mode of delivery were analyzed and compared.

RESULTS

There were significant differences in personality types; dependent (p = 0.033), passive-aggressive (p = 0.031), obsessive-compulsive (p = 0.001), antisocial (p = 0.014), narcissistic (p = 0.014) and borderline (p = 0.014) between vaginal delivery and CS groups. The CAQ scores of the mothers who requested CS were significantly higher (p:0.007). Weak but significant positive relation was found between total CAQ scores and avoidant (p = 0.022), dependent (p = 0.034), passive-aggressive (p = 0.040), narcissistic (p = 0,006), schizoid (p = 0.007), paranoid (p = 0.007) and borderline (p = 0.007) personality types.

CONCLUSION

This is the first study that investigates the relationship between mode of delivery and personality traits according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and cognitive behavioral perspective in the literature. These personality traits can be carried at a level that is not clinically significant to create an obvious pathology, yet they might play a role as the motives behind the apparent reasons for women who request CS. Understanding women's motives and attitudes for childbirth during their pregnancy may help healthcare providers to tailor women's approach to childbirth to avoid unnecessary CS.

Fear of Childbirth in Nulliparous Women

Purpose

The relation between fear of childbirth (FoC) and gestational age is inconclusive, and self-reported need for help regarding this fear has never been investigated. This study aimed to determine the prevalence and course of FoC according to gestational age, to identify risk factors for the development of FoC, the influence of this fear on preferred mode of delivery, and self-reported need for help.

Methods

Nulliparous pregnant women of all gestational ages completed an online survey. The study consisted of a cross-sectional and a longitudinal analysis. Women who completed the survey in the first or second trimester (T₀) were approached again in their third trimester (T₁). The Wijma Delivery Expectancy Questionnaire Version A (W-DEQ A) was used with a cut-off score ≥ 85 to define presence of fear of childbirth. Questionnaires indexing social support, anxiety, symptoms of depression, preferred mode of delivery, and self-reported need for help were included.

Results

In total, 364 women were enrolled at T₀, and 118 out of 184 eligible women were included in the longitudinal analysis. Point prevalence of FoC at T₀ was 18.4% with no significant difference between trimesters. In the longitudinal sample, the prevalence of FoC decreased from 18.6% (T₀) to 11.0% (T₁), p = 0.004. Although mean scores for FoC decreased significantly, p < 0.001, scores increased in 41 (34.7%) women. The presence of FoC was associated with elevated anxiety, less family support, prenatal care of the obstetrician by choice, preference for a cesarean section, and for pain relief. Women with FoC were more likely to actively seek for help compared to women without FoC.

Conclusion

While FoC is common in each trimester, prevalence decreases over the course of pregnancy. Women with FoC are often actively seeking for help, suggesting that this fear should be addressed better, and help should be offered accordingly.

Associations of Musical Activities and Positive Affect With Fear of Childbirth: A Structural Equation Modeling Approach

Background

Fear of childbirth is a prevalent issue among women, with a wide range of interventions to dispel it. Here we explored a novel and beneficial intervention and one possible influence mechanism of it.

Methods

The cross-sectional study recruited 1,053 pregnant women from one tertiary-grade A class hospital between March to August 2021. The questionnaire included demographic characteristics, a self-made musical activities questionnaire, the Positive affect subscale, and the Childbirth Attitudes Questionnaire. We parceled the eight musical activities into three items by item parceling methodology. The associations of musical activities and positive affect with fear of childbirth were evaluated by a structural equation modeling approach.

Results

Our analyses demonstrated the effectiveness of musical activities, which was notably correlated with the increase in positive affect (β = 0.309, P < 0.01). On the contrary, positive affect predicted a decrease in fear of childbirth (β = −0.085, P = 0.019). Additionally, positive affect mediated the effect of musical activities on fear of childbirth (β = −0.026, P = 0.030). However, the direct effect of musical activities on fear of childbirth was not found (β = 0.029, P = 0.514).

Conclusions

Relying on musical activities alone may not be adequate to alleviate the fear of childbirth, and positive affect played a pivotal role between musical activities and fear of childbirth. The results showed that musical activities would be an effective non-pharmaceutical way to alleviate the fear of childbirth and positive affect can not be ignorant in future childbirth fear reduction programs.

Fear of childbirth and its predictors in re-pregnant women after cesarean section: a cross-sectional multicenter study in China

Background

Since the implementation of China’s two-child policy in 2016, the number of re-pregnant women after cesarean section has increased significantly. These women are more prone to fear of childbirth compared with primiparas due to their history of scarred uterus leading to a more complicated delivery process, which poses a great threat to their physical and mental health. However, there is currently limited research on the problem in China. The aim of this study was to assess fear of childbirth and its predictors in re-pregnant women after cesarean section in China.

Methods

A cross-sectional multicenter study was conducted in three hospitals from June 7 to December 7, 2020, in Changsha, China. Study hospitals were selected using a random sampling technique. Participants were selected using a convenience sampling technique. Three hundred fifty-eight women during the third trimester of pregnancy who were older than 18 years, having a history of CS(s), and not having major physical or mental health problems were included. Fear of childbirth and its predictors were evaluated using the Childbirth Attitude Questionnaire, the short form of the 32-item Chinese Childbirth Self-Efficacy Inventory, the Social Support Rating Scale, and the demographic-obstetric data sheet. After checking for completeness, data were exported to statistical software for analysis. Both univariate analysis and multiple linear regression analysis were computed to assess fear of childbirth and its predictors. Statistical significance was declared at a P-value of < 0.05.

Results

The average score of fear of childbirth was 43.76 (standard deviation = 5.27, range 17–58). Number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were significantly associated with fear of childbirth (P < 0.05).

Conclusions

In this study, re-pregnant women after cesarean section in China had moderate fear of childbirth, and the number of cesarean sections, experience with previous cesarean section, childbirth self-efficacy and social support were predictors of fear of childbirth. It is important for healthcare professionals to find re-pregnant women after cesarean section at high risk of fear of childbirth and provide appropriate services during pregnancy.

Factors associated with low childbirth self-efficacy for normal birth among women attending an urban prenatal clinic in Eastern Uganda

OBJECTIVE

While childbirth self-efficacy is a very important feature for normal birth, this concept has received limited scholarly attention, particularly in developing countries. This study explored childbirth self-efficacy and the associated factors amongst pregnant women.

DESIGN

A descriptive cross-sectional study. We used the Childbirth Self-Efficacy Inventory to assess childbirth self-efficacy for normal birth. and determined the associated factors.

SETTING

Jinja regional referral hospital, Uganda.

PARTICIPANTS

425 pregnant women at ≥ 28 weeks of gestation were included.

MEASUREMENTS

Participants with summated self-efficacy scores ≥ median were considered to have high childbirth self-efficacy, and those with less than the median summated score were considered to have low childbirth self-efficacy. Bivariate and multivariate binary logistic regressions were used to determine the factors associated with low childbirth self-efficacy.

FINDINGS

The Childbirth Self-Efficacy Inventory items consistently measured childbirth self-efficacy with a Cronbach's α 0.934. Childbirth self-efficacy scores ranged from 84 to 303 with a median score of 233 and a mean score of 228.7 (SD: 40.9). Dissatisfaction with prenatal care (aOR = 2.687; 95% CI: 1.124-6.427; P = 0.026), perception of community social support for women during childbirth as lacking (aOR = 2.274; 95% CI: 1.159-4.458; P = 0.017) and use and/or intention to use herbal medicines in the current pregnancy (aOR = 2.850; 95% CI: 1.553-5.232; P = 0.001) were associated with low childbirth self-efficacy for normal birth.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Low childbirth self-efficacy for normal birth was associated with dissatisfaction with prenatal care, lack of community social support for women during childbirth and use or intention to use herbal medicines in the current pregnancy. Identifying the associated characteristics and developing interventions for low childbirth self-efficacy is of clinical importance to promote normal birth.

The Childbirth Fear Questionnaire and the Wijma Delivery Expectancy Questionnaire as Screening Tools for Specific Phobia, Fear of Childbirth

Background: Perinatal anxiety and related disorders are common (20%), distressing and impairing. Fear of childbirth (FoB) is a common type of perinatal anxiety associated with negative mental health, obstetrical, childbirth and child outcomes. Screening can facilitate treatment access for those most in need. Objectives: The purpose of this research was to evaluate the accuracy of the Childbirth Fear Questionnaire (CFQ) and the Wijma Delivery Expectations Questionnaire (W-DEQ) of FoB as screening tools for a specific phobia, FoB. Methods: A total of 659 English-speaking pregnant women living in Canada and over the age of 18 were recruited for the study. Participants completed an online survey of demographic, current pregnancy and reproductive history information, as well as the CFQ and the W-DEQ, and a telephone interview to assess specific phobia FoB. Results: Symptoms meeting full and subclinical diagnostic criteria for a specific phobia, FoB, were reported by 3.3% and 7.1% of participants, respectively. The W-DEQ met or exceeded the criteria for a “good enough” screening tool across several analyses, whereas the CFQ only met these criteria in one analysis and came close in three others. Conclusions: The W-DEQ demonstrated high performance as a screening tool for a specific phobia, FoB, with accuracy superior to that of the CFQ. Additional research to ensure the stability of these findings is needed.

Factors Affecting Primiparous Pregnant Women's Prenatal Attachment Levels, Childbirth Self-Efficacy Beliefs, and Labor Worry Levels

This study aimed to identify the factors affecting primiparous pregnant women's prenatal attachment levels, childbirth self-efficacy beliefs, and labor worry levels. This cross-sectional study was conducted with 351 pregnant women. The data were collected by using a Personal Information Form, the Prenatal Attachment Inventory, the Oxford Worries about Labour Scale, and the Childbirth Self-Efficacy Inventory. The mean Prenatal Attachment Inventory, Oxford Worries About Labour Scale and Childbirth Self-Efficacy Inventory scores of the participants were 40.53 ± 10.32, 21.82 ± 6.8, and 201.35 ± 23.21, respectively. The data obtained in the study showed that the care offered in the preconception period affected the participating pregnant women's prenatal attachment, labor worry, and childbirth self-efficacy levels. With individualized preconception care provided by health personnel, not only will awareness be increased but also women will be able to have a more positive pregnancy and labor experience.

The development and the psychometric evaluation of the Adolescents Intentions towards the Birth Options Scale in Greek

INTRODUCTION

Worldwide, the rising of caesarean section rates is a major public health issue. Little is known regarding birth attitudes held by students who are the next generation of parents. The aim of this study was to develop and assess the psychometric properties of the Adolescents Intentions towards Birth Options Scale (AIBOS), a self-report and short instrument assessing intentions towards birth options in young adolescents.

METHODS

The AIBOS was framed by Ajzen's theory of planned behavior and developed in a three-phase process using an integrated mixed-methods approach that included literature reviews, professional focus groups, and a psychometric survey evaluation. The psychometric evaluation was conducted by recruiting a sample of 480 high school students. Content validity, exploratory factor analysis, discriminant and construct validity, test-retest reliability and internal consistency were explored.

RESULTS

The expert panel determined that the content validity was satisfactory. The final 17-item scale consisted of five factors explaining 48.9% of the total variance in the data. Discriminant validity was satisfactory. Cronbach's α coefficient was over 0.7 for each factor, indicating acceptable internal consistency of the questionnaire. There was significant agreement in all subscales as emerged from test-retest.

CONCLUSIONS

The AIBOS demonstrated good content validity, an easily interpretable five-factor structure, acceptable internal consistency, high test-retest reliability, and satisfactory discriminant and construct validity with sample characteristics. It is an easily comprehensible, easily completed tool, which matches the culture of young adolescents.

Screening for Perinatal Anxiety Using the Childbirth Fear Questionnaire: A New Measure of Fear of Childbirth

Fear of childbirth affects as many as 20% of pregnant people, and has been associated with pregnancy termination, prolonged labour, increased risk of emergency and elective caesarean delivery, poor maternal mental health, and poor maternal-infant bonding. Currently available measures of fear of childbirth fail to fully capture pregnant people’s childbirth-related fears. The purpose of this research was to develop a new measure of fear of childbirth (the Childbirth Fear Questionnaire; CFQ) that would address the limitations of existing measures. The CFQ’s psychometric properties were evaluated through two studies. Participants for Study 1 were 643 pregnant people residing in Canada, the United States, and the United Kingdom, with a mean age of 29.0 (SD = 5.1) years, and 881 pregnant people residing in Canada, with a mean age of 32.9 (SD = 4.3) years for Study 2. In both studies, participants completed a set of questionnaires, including the CFQ, via an online survey. Exploratory factor analysis in Study 1 resulted in a 40-item, 9-factor scale, which was well supported in Study 2. Both studies provided evidence of high internal consistency and convergent and discriminant validity. Study 1 also provided evidence that the CFQ detects group differences between pregnant people across mode of delivery preference and parity. Study 2 added to findings from Study 1 by providing evidence for the dimensional structure of the construct of fear of childbirth, and measurement invariance across parity groups (i.e., the measurement model of the CFQ was generalizable across parity groups). Estimates of the psychometric properties of the CFQ across the two studies provided evidence that the CFQ is psychometrically sound, and currently the most comprehensive measure of fear of childbirth available. The CFQ covers a broad range of domains of fear of childbirth and can serve to identify specific fear domains to be targeted in treatment.

Screening for Perinatal OCD: A Comparison of the DOCS and the EPDS

Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ (N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).

Personality traits, childbirth expectations, and childbirth experiences: a prospective study

OBJECTIVES

The current study investigated the role of multiple psychological factors in predicting women's subjective birthing experiences.

METHODS

An online prospective survey methodology was conducted with women in the US who had never before given birth. Participants (N = 101) completed surveys regarding their personality traits, childbirth fear, and childbirth self-efficacy in their third trimester of pregnancy (range 28-40 weeks gestation). After giving birth (range 5-50 days post birth), participants (N = 58) completed a measure of subjective childbirth experience.

RESULTS

Significant correlations were found between personality traits, childbirth fear, childbirth self-efficacy, and subjective childbirth experience. Neuroticism, fear, and self-efficacy were all correlated with childbirth experiences. However, regression analysis indicated that only childbirth fear significantly predicted subjective childbirth experiences.

CONCLUSIONS

While previous research has looked at the relationships between personality and expectations or personality and experiences separately, the current findings underscore the importance of including all variables in order to get the most effective picture of the relationships among these variables. The results from the current study can inform methods of identifying women at-risk for negative birth expectations and inform interventions aimed at reducing negative childbirth experiences.

The prevalence and predictors of fear of childbirth among pregnant Chinese women: a hierarchical regression analysis

Background

Fear of childbirth (FOC) occurs before, during and after pregnancy and is harmful to both the pregnant woman and the fetus. Identifying the prevalence and predictors of FOC can help us generate strategies for alleviating women’s FOC.

Methods

A cross-sectional study was conducted among a convenience sample of 646 pregnant women receiving antenatal care at a subordinate hospital of a university in China. Data were collected using a basic information form, the Childbirth Attitude Questionnaire, the Childbirth Self-Efficacy Inventory, and the 10-item Connor-Davidson Resilience Scale. The minimum and maximum total scores of the Childbirth Attitude Questionnaire are 16 and 64, respectively, with higher scores reflecting a greater degree of FOC. We conducted hierarchical regression analysis to explore the predictors of FOC and used a structural equation model to further examine the direct and indirect associations between FOC, resilience and childbirth self-efficacy.

Results

The total prevalence of FOC was 67.1%. The percentages of women with mild (score of 28–39), moderate (40–51), and severe FOC (52–64) were 45.4, 19.5, and 2.2%, respectively. The average score on the Childbirth Attitude Questionnaire was 32.49, indicating mild FOC. The final regression analysis revealed six variables predicting FOC that explained 64.5% of the variance in FOC: age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy. Furthermore, childbirth self-efficacy mediated the relationship between resilience and FOC, and the mediation effect rate was 53.5%.

Conclusions

A high prevalence of FOC among pregnant Chinese women was found in this study. Age, gestational age, parity, spousal support, resilience, and childbirth self-efficacy were predictors of FOC. It is suggested that healthcare professionals should pay close attention to FOC and implement targeted interventions in accordance with these predictors, especially resilience and childbirth self-efficacy.

Comparison of fear, anxiety and self-efficacy of childbirth among primiparous and multiparous women

Background

The aim of this study was to compare fear of childbirth, state and trait anxiety, and childbirth self-efficacy among primiparous and multiparous women in Ahvaz, southwest of Iran.

Methods

This cross-sectional study was conducted with 200 pregnant women (100 primiparous and 100 multiparous women) who had been admitted to the maternity ward of hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. The instruments used for data collection in this study included a demographic questionnaire, Delivery Fear Scale (DFS), Spielberger's State-Trait Anxiety Inventory (STAI), and Childbirth Self-Efficacy Inventory (CBSEI). The data were analyzed by chi-square test and independent t-test. Also, the univariate general linear model was used by adjusting for the socio-demographic and obstetric characteristics that were considered as possible confounding variables.

Results

The mean score of DFS in primiparous women was significantly higher than that of multiparous women. The mean of the overall score of childbirth self-efficacy of primiparous women was significantly lower than that of multiparous women. The mean score of the outcome expectancies and self-efficacy expectancies was significantly lower in primiparous women compared with multiparous women. There was no statistically significant difference between the two groups in terms of the mean score of STAI. After adjusting for possible confounding variables, the differences between the two groups in terms of fear of childbirth scores, overall childbirth self-efficacy score and self-efficacy expectancies remained significant.

Conclusion

Given the high fear of childbirth and low childbirth self-efficacy in primiparous women compared to the multiparous women, appropriate interventions should be adopted by health care providers in order to reduce fear and improve childbirth self-efficacy in primiparous women.

Preferred ways of giving birth in non-pregnant and pregnant nulliparous women: the role of control beliefs

PURPOSE

To explore the association between delivery-specific, health-related control beliefs and preferred ways of delivery in nulliparous Hungarian women. Moreover, since data about the delivery-specific control beliefs and delivery-related preferences of non-pregnant nulliparous women are lacking, the present study also seeks to provide descriptive information in this regard.

METHODS

A total of 984 Hungarian nulliparous women (26.45 ± 5.42 years; 660/77.2% non-pregnant and 224/22.8% pregnant) were included in the present study. The online assessment included measures of delivery-specific (internal-, healthcare professional-, and chance-related) health control beliefs, fears of childbirth, self-esteem, as well as preferences regarding delivery setting (i.e. spontaneous vaginal birth in hospital, planned cesarean birth and home birth).

RESULTS

Healthcare professional-related control beliefs were associated with a stronger preference for spontaneous vaginal birth in hospital (OR = 1.87, 95% CI: 1.56-2.23) and planned cesarean birth (OR = 1.96, 95% CI: 1.60-2.40), alongside a weaker preference for home birth (OR = 0.31, 95% CI: 0.25-0.39). In contrast, internal delivery-specific control beliefs predicted a weaker preference for planned cesarean (OR = 0.66, 95% CI: 0.55-0.78) and a stronger preference for home birth (OR = 1.63, 95% CI: 1.33-2.00). A general preference index for medicalized ways of delivery was negatively associated with internal - and positively with healthcare professional - and chance-related control beliefs (βs = -.173, .074 and .445, respectively).

CONCLUSIONS

Delivery-related control beliefs are important psychological characteristics in the prediction of preferences for ways of delivery. Understanding delivery-specific control beliefs may be an important component of supporting women to give birth in a mentally and physically healthy way.

Role of social capital and self-efficacy as determinants of stress in pregnancy

OBJECTIVES

The study investigated the role of social capital, self-efficacy, and depression as determinants of stress during pregnancy.

MATERIALS AND METHODS

In a cross-sectional study, 200 low-risk pregnant women with at least 5 years of education and ages 18 or more were enrolled in public obstetric clinics of Babol University of Medical Sciences. The participants completed four questionnaires including Social Capital, Revised Prenatal Distress Questionnaire (NuPDQ), Perceived Stress, and General Self-efficacy.

RESULTS

Women at late phase of pregnancy had lower mean scores of total social capital (61.5 ± 17.1 vs. 47.1 ± 18.1) and self-efficacy (60.1 ± 9.7 vs. 55.1 ± 15.2) compared to those at early pregnancy. Social capital was the negative independent variable associated with pregnancy-specific stress in the adjusted model (β = -0.418, P = 0.020). Both social capital (β = -0.563, P ≤ 0.001) and self-efficacy (β = -0.330, P ≤ 0.001) were negative independent variables associated with general stress.

CONCLUSIONS

Our findings suggest that health professionals should note the benefits of social capital in stress management and encourage women in establishing stronger relations and neighborhood environments during pregnancy.

Fear of Childbirth and Associated Risk Factors in Healthy Pregnant Women in Northwest of China: A Cross-Sectional Study

AIM

Fear of childbirth (FOC) is an extreme state of anxiety, distress and worry about childbirth. Despite its common occurrence, the prevalence and risk factors for FOC are inadequately understood in the northwestern region of China.

PURPOSE

This study aimed to examine the prevalence and risk factors for fear of childbirth (FOC) in a cohort of pregnant women in northwest of China.

PATIENTS AND METHODS

A total of 922 healthy pregnant women were included in this cross-sectional study. Participants filled out a questionnaire on socio-demographic characteristics, as well as the Childbirth Attitudes Questionnaire (CAQ), the Multidimensional Scale of Perceived Social Support (MSPSS), the Edinburgh Postnatal Depression Scale (EPDS), and the Pregnancy Pressure Scale (PPS). Psychosocial factors were analyzed to determine their association with fear of childbirth. Optimal scale regression analysis was used to determine the risk factors associated with FOC.

RESULTS

The mean score on the CAQ was 33.92 ± 10.17. A total of 72% of participants reported low to mild FOC. Six percent (n=51/922) and 22% (n=199/922) of pregnant women reported severe and moderate FOC, respectively. Based on optimal scaling regression analysis, the factors most strongly associated with FOC were residence, marital status, parity, gestational age, relationship with partner, pregnancy stress, social support and depressive symptoms.

CONCLUSION

This study indicates the high prevalence of FOC (70.3%, ranging from mild to severe) in healthy pregnant women in northwest of China. FOC showed a positive correlation with pregnancy-related stress and depressive symptoms and a negative correlation with social support. Screening for FOC and helping pregnant women identify a support system early in pregnancy could reduce a woman's stress level and severity of depression.

Psychosocial predictors of the fear of childbirth in Turkish pregnant women

INTRODUCTION

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Reliability and validity study of the Spanish adaptation of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-A)

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A) is an instrument that evaluates fear of childbirth through the expectations of women in relation to childbirth and their experience during the birth. The objective of this study was to translate the W-DEQ-A into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) adapting the questionnaire to Spanish and (2) a transversal study in a sample of 273 pregnant women in the Sexual and Reproductive Health centres in the Metropolitan Northern Barcelona in Catalonia (Spain). The psychometric properties were analysed in terms of reliability and construct validity. The confirmatory factorial analysis did not confirm the unidimensionality of the original structure of the WDEQ-A, as happened with the other studies in which it has previously been validated. The result of the exploratory factorial analysis suggests four factors, or dimensions, very similar but not identical to those obtained in other analysis studies of the W-DEQ-A. The Cronbach alpha and the omega scale were also adequate for all the scales and for each of the dimensions. The results of this study confirm the findings of other studies that suggest that the W-DEQ-A is multi-dimensional. In the Spanish version of the W-DEQ-A four dimensions have been identified to explore fear of childbirth in pregnant women. The Spanish version of the WDEQ-A (WDEQ-A-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Students' Attitudes Towards Birth Decisions

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

An psychoeducation programme based on self-efficacy theory to improve experience of natural birth for primigravid women: Study protocol for a randomised controlled trial

AIM AND OBJECTIVES

To present a study protocol for estimating the feasibility, effectiveness and safety of an individual (five sessions), group (one session) and face-to-face psychoeducation programme based on self-efficacy theory to improve childbirth experience of primigravid women.

BACKGROUND

In present China, fertility rates are falling and ageing is accelerating. How to improve the fertility level of childbearing women is of great significance. However, about 10%-20% of women have negative childbirth experience after birth, which seriously affects maternal and child health and family functions, and even fertility desires and intentions in the future. Nevertheless, due to the lack of a series of well-designed randomised controlled trials(RCTs), there is no specific methodology to guide the most effective intervention for primigravid women. In this regard, based on Bandura's self-efficacy theory, an intervention programme to promote a positive childbirth experience for primigravid women has been designed and will be evaluated to determine its impact on primigravid women.

DESIGN

A non-blinded randomised controlled trial.

METHODS

We report the study protocol for this randomised controlled trial based on the SPIRIT2013 statement. A total of 238 eligible primigravid women will be randomly divided into the control group (n = 119) or the intervention group (n = 119). The control group will receive care as usual, that is, six routine prenatal examinations. In addition to the routine examinations, the intervention group will also receive six face-to-face interventions. Baseline assessment will occur at about 24th week of gestation and follow up at 37th weeks of gestation, intrapartum, 1-3 days postpartum and 42 days postpartum. The primary outcomes are childbirth experience, childbirth self-efficacy; others are fear of childbirth, labour control, labour pain and labour satisfaction.

IMPACT

From the perspective of clinical work, this protocol provides practical guidance for cultivating the positive childbirth experience of the primigravid women. From the perspective of sociology, the positive experience and emotion of primigravid women can improve the fertility intention of women of childbearing age, which is relatively conducive to optimising Chinese demographic structure and reducing the pressure of ageing population in the long term.

[Do childbirth confidence, prenatal depression, childbirth knowledge, and spousal support influence childbirth fear in pregnant women?]

PURPOSE

This study investigated levels of childbirth fear and related prenatal factors (self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support) among pregnant women in South Korea.

METHODS

A correlational study design was used to explore levels of childbirth fear and related prenatal factors in 200 pregnant women over 28 weeks of gestation. A self-administered questionnaire was used to measure fear of childbirth and related factors, such as self-confidence for childbirth, prenatal depression, knowledge about childbirth, and spousal support.

RESULTS

One-third of the pregnant women were aged 35 years and older. Sixty-one percent of women were nulliparae, but only 26.0% had experienced prenatal education. The mean score for fear of childbirth was 66.99 out of 165. The prevalence of fear of childbirth was 72.0%, and childbirth fear was severe in 26.5% of the participants and moderate in 45.5%. Fear of childbirth was negatively related to self-confidence (r=-.45, p<.001), but positively related to prenatal depression (r=.21, p=.002). Two significant predictors were found to explain the fear of childbirth. Higher self-confidence for childbirth was associated with less severe fear of childbirth (β=-.44, p<.001), while higher prenatal depression was associated with more severe fear of childbirth (β=.13, p=.038).

CONCLUSION

The level of fear of childbirth was higher among pregnant women with lower self-confidence and higher prenatal depression. Reasonable evidence should be provided for implementing prenatal and childbirth classes to reduce pregnant women's depression and to increase their confidence.

Psychological, educational, and alternative interventions for reducing fear of childbirth in pregnant women: A systematic review

OBJECTIVE

This review aims to identify non-medical interventions that may reduce the fear of childbirth, directly or indirectly (through its factors).

METHODS

This review followed the PRISMA guidance and a rigorous protocol that was registered in PROSPERO. Searches were done in ProQuest, the International Clinical Trials Registry Platform, and Google Scholar. All RCTs published in the last 5 years, in English or Spanish, regarding women with a low-risk pregnancy and without mental disorders were included.

RESULTS

From 5147 articles found, only 69 were full-text assessed. Finally, 18 studies were included suggesting that prenatal education, psychoeducation, and counseling might be effective, whereas cognitive-behavioral therapy and some alternative therapies require more research. The results of relaxation techniques were contradictory. Results also suggest that social support and exposure (through education) might have an important role in the efficacy of interventions.

CONCLUSIONS

More appropriately randomized and blinded trials are necessary that use a prespecified definition of fear of childbirth and comprehensive measurement tools specific for pregnant women.

Effect of Psychotherapy on Reduction of Fear of Childbirth and Pregnancy Stress: A Randomized Controlled Trial

Introduction

The fear of childbirth (FOC) has an adverse effect on the physical and mental health of pregnant women and increases adverse maternal and fetal outcomes. Previous research reported the effect of psychological interventions such as cognitive behavioral therapy, relaxation therapies, and short-term psycho-educational intervention on FOC. We examined whether adding motivational interviewing (MI) psychotherapy to prenatal usual care (PUC) is superior to PUC alone to reduce the scores of FOC, pregnancy stress, and self-efficacy.

Materials and Methods

An RCT with two-arm parallel groups and 1:1 allocation ratio assigned 70 pregnant women (aged 18–50) attending public health centers in an education hospital in Iran to receive five sessions of group MI psychotherapy plus PUC (N = 35) or to receive PUC alone (N = 35). The primary outcomes were the FOC scores (Wijma Delivery Expectancy/Experience Questionnaire, W-DEQ), pregnancy-specific stress (Prenatal Distress Questionnaire, NuPDQ), anxiety (Spielberger state anxiety), and Childbirth Self-Efficacy Index (CBSI) at 5 weeks post-randomization. Additional measures included subscales of the W-DEQ and the NuPDQ, patients’ compliance, and satisfaction with psychotherapy intervention at 5 weeks post-randomization as secondary outcomes.

Main Results

The post-trial results indicated that the outcome scores diminished more considerably in psychotherapy than in PUC for total FOC scale with a large effect size (B = −23.54, p = < 0.001, η²η² = 0.27), for total pregnancy stress with a large effect size (B = −4.51, p = < 0.001, η² = 19), and for state anxiety with a large effect size (B = −12.42, p = < 0.001, η² = 0.22). However, the score of self-efficacy and concern about physical symptoms did not differ between the psychotherapy and PUC groups (P < 0.05).

Discussion

Adding 5 weeks of group psychotherapy to PUC could be considered as an adjunctive care option for reducing FOC, pregnancy stress, and general anxiety in pregnant women in the third trimester. Future research may focus on sustaining the effects and evaluating the economic impacts of adding psychotherapy to PUC.

The association between depressive symptoms during pregnancy and post-delivery fear of childbirth; a prospective study

BACKGROUND

Fear of childbirth is an important reason for a caesarean section on request.

OBJECTIVE

To assess the association between depressive symptoms during pregnancy and post-delivery fear of childbirth (PFOC).

METHODS

We prospectively studied pregnant women from two hospitals in the Netherlands. Women completed the Edinburgh Depression Scale (EPDS), the Wijma Delivery Experience Questionnaire (W-DEQ B) and questions concerning risk factors. Depressive symptoms were assessed at baseline and six weeks post-delivery. PFOC was assessed six weeks post-delivery. Baseline characteristics and pregnancy outcomes were compared between women with and without a depression at baseline. The association between depression and PFOC was assessed with multivariable logistic regression analysis.

RESULTS

245 women participated in this study. At baseline 11% suffered from depressive symptoms. There were no differences in pregnancy outcomes. Women with depressive symptoms more often suffered from depressive symptoms six weeks post-delivery (adjusted OR 4.9, 95% CI 1.4-17). PFOC six weeks post-delivery was present in 11%. Women with depression were at increased risk of PFOC six weeks post-delivery (adjusted OR 9.2, 95% CI 2.6-32).

CONCLUSION

This study shows that women with depression at baseline are at increased risk for depression and PFOC six weeks post-delivery.

Is fear of childbirth related to the woman's preferred location for giving birth? A Dutch low-risk cohort study

BACKGROUND

In The Netherlands, women with low-risk pregnancy are routinely given the option of home birth, providing a unique opportunity to study the relationship between fear of childbirth (FOC) and preference for childbirth location, and whether women experience higher FOC when the actual location differs from their preference.

METHODS

In this prospective cohort study, 331 nulliparous and parous women completed a questionnaire at gestational week 30 (T1) and two months postpartum (T2). FOC was assessed using versions A (T1) and B (T2) of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).

RESULTS

At T1, women who preferred home birth had significantly lower FOC compared with women who preferred a hospital birth (mean ± SD W-DEQ scores: 55 ± 19.8 and 64 ± 18.3, respectively, P < .01). About 28% of women who responded at T2 gave birth at home. Congruence between the preferred and actual childbirth location was not predictive of FOC assessed at T2 when adjusted for obstetric and psychological variables. In an extended analysis, we found that except for prepartum FOC, the following variables also correlated with postpartum FOC: being referred because of complications and poor neonatal condition.

CONCLUSIONS

Compared to women who prefer hospital birth, women who prefer home birth have lower prepartum and postpartum FOC. Giving birth at a location other than the preferred location does not appear to affect postpartum FOC. Whether giving birth at home or in the hospital, caregivers should pay extra attention to women with high FOC because they are vulnerable to postpartum FOC, especially after a complicated birth and referral.