Interventions for fear of childbirth including tocophobia

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.

Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study

BACKGROUND

There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity.

METHODS

Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately.

RESULTS

In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home.

CONCLUSIONS

Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.

The association between fear of childbirth and social support through the Internet and Social Networking Services in pregnant women: A cross-sectional study

Social support is an important factor in reducing fear of childbirth (FOC). Recently, the Internet and Social Networking Services (SNS) have become new forms of social support. However, it is unclear whether such support can reduce pregnant women's fear. This study aimed to investigate the association between FOC and social support through the Internet and SNS in pregnant women. A cross-sectional study using a web-based questionnaire including questions about FOC, social support, the Internet and SNS usage, psychological variables, and sociodemographic variables was conducted. Data from 111 participants were analyzed. A greater number of social support from people who are often seen during pregnancy, and becoming relieved by interaction with others through the Internet and SNS were negatively associated with FOC. This study showed that face-to-face social support was associated with lower FOC, while social support through the Internet and SNS was not. Further research is needed on how to use Internet and SNS to reduce FOC in pregnant women.

Effect of cognitive behavior therapy training and psychological nursing on the midwifery process in the delivery room

BACKGROUND

The severe physical and psychological impact of pain on the physical and mental health of women during labor leads to increased risks and complications during childbirth, presenting a major public health concern. Some studies have shown that cognitive behavioral therapy (CBT) has a positive effect on maternal psychology during delivery, reducing stress and shortening labor time. Thus, CBT training for mothers and delivery room staff may be beneficial in minimizing complications and adverse effects during natural birth.

AIM

To investigate the clinical effects of CBT training and psychological care during delivery, and their therapeutic effects on women in labor.

METHODS

This study used a retrospective analysis and included 140 mothers admitted to the maternity ward between January 2021 and January 2023. The study subjects were randomized into two groups: control (n = 70) and observation (n = 70). Routine care, CBT training, and psychological care were provided to mothers in both groups. Psychological status scores, delivery time, and satisfaction with care pre- and post-delivery were compared, and the incidence of complications after receiving care was analyzed between the two groups.

RESULTS

Although the psychological state of both groups improved significantly in the late stages of labor, the psychological state scores of the mothers in the observation group were significantly lower than those of the mothers in the control group (P < 0.05). The duration of labor and incidence of complications in the observation group were significantly lower than those in the control group (P < 0.05). The mothers in the observation group were significantly more satisfied with nursing care during the course of labor than those in the control group (P < 0.05).

CONCLUSION

CBT training and psychological care for mothers in the midwifery process can effectively improve anxiety and depression, shorten labor duration, reduce postnatal complications, and improve nursing satisfaction and nurse-patient relationships. Its clinical application is effective and has popularization value, providing a new way to protect maternal mental health.

Fear of childbirth and sleep quality among pregnant women: a generalized additive model and moderated mediation analysis

OBJECTIVES

This study aims to examine the associations among fear of childbirth, psychological distress, resilience, and sleep quality among Chinese pregnant women.

METHODS

A cross-sectional survey was carried out between January 2022 to March 2022 among pregnant women who met the inclusion criteria and sought healthcare services at The First Affiliated Hospital of Guangzhou University of Chinese Medicine in Guangdong Province, Southern China. Data was collected using a structured questionnaire that included sociodemographic characteristics, childbirth attitudes questionnaires (CAQ), hospital anxiety and depression scale (HADS), Connor-Davidson resilience scale (CD-RISC), and Pittsburgh sleep quality index (PSQI). A generalized additive model and moderated mediation analysis were employed for data analysis.

RESULTS

A non-linear and negative association between fear of childbirth and sleep quality was found in the second trimester and antenatal period. Psychological distress significantly mediated the relationship between fear of childbirth and sleep quality (first trimester: β = 0.044, 95%CI:0.022-0.071; second trimester: β = 0.029, 95%CI:0.009-0.056; third trimester: β = 0.064, 95%CI:0.046-0.088; antenatal period: β = 0.050, 95%CI:0.037-0.063). The moderating role of resilience between fear of childbirth and sleep quality was significant (second trimester: β=-0.006, 95%CI:-0.012-0.001, P = 0.025; antenatal period: β=-0.004, 95%CI:-0.007--0.001, P = 0.014), as well as between fear of childbirth and psychological distress (first trimester: β=-0.016, 95%CI:-0.026--0.005, P = 0.004; antenatal period: β=-0.005, 95%CI:-0.009--0.001, P = 0.014).

CONCLUSIONS

Fear of childbirth, psychological distress, and resilience are three important factors affecting sleep quality in Chinese pregnant women.

A Systematic Review of Tocophobia Rate Before and During the COVID-19 Pandemic

Introduction: Childbirth is a phenomenon that causes stress to future mothers. The fear of childbirth is complemented by the fear that prevails all over the world due to the COVID-19 pandemic. Childbirth alone entails many risks; adding to them the COVID-19 outbreaks lead to a considerable amount of uncertainty that affects the psychology of pregnant women. Aim:The present study aims at comparing the rate of tocophobia before and during the COVID-19 pandemic through a systematic review of studies published before and during the COVID-19 pandemic. Methods:The methodology used in this study comprised an advanced search in several scientific databases and the recovery of relevant quantitative studies. Results:The review included a total of 18 research papers published in English from January 2009 to April 2023, which examined the phenomenon of tocophobia before and during the COVID-19 pandemic. Conclusion:This systematic review shows that tocophobia was more prevalent after the outbreak of the COVID-19 pandemic (ranging from 4.8%-20.8% before the COVID-19 pandemic and 10.6%-62% during the COVID-19 pandemic). It seems that the increase in tocophobia rate after the onset of the COVID-19 pandemic ranged from 6.4% to 54.3%. According to our review, tocophobia constitutes a major source of anxiety, especially during the COVID-19 pandemic. Therefore, governments should take appropriate action, especially in times of the COVID-19 pandemic, to ensure a more secure and friendly hospital setting for pregnant women.

Prenatal wellbeing of mothers, their partners, and couples: a cross-sectional descriptive study

BACKGROUND

Prenatal posttraumatic stress symptoms (PTSS), fear of childbirth (FOC), and depressive symptoms have been related to various negative effects during pregnancy, childbirth, and in the postnatal period. This study evaluates the prevalence of PTSS, FOC, depressive symptoms, and health-related quality of life (HRQoL) among pregnant women, their partners, and as couples.

METHODS

In a cohort of 3853 volunteered, unselected women at the mean of 17th weeks of pregnancy with 3020 partners, PTSS was evaluated by Impact of Event Scale (IES), FOC by Wijma Delivery Expectancy Questionnaire (W-DEQ-A), depressive symptoms by Edinburgh Postnatal Depression Scale (EPDS), and HRQoL by 15D instrument.

RESULTS

PTSS (IES score ≥ 33) was identified among 20.2% of the women, 13.4% of the partners, and 3.4% of the couples. Altogether, 5.9% of the women, but only 0.3% of the partners, and 0.04% of the couples experienced symptoms suggestive of phobic FOC (W-DEQ A ≥ 100). Respectively, 7.6% of the women, 1.8% of the partners, and 0.4% of the couples reported depressive symptoms (EPDS ≥ 13). Nulliparous women and partners without previous children experienced FOC more often than those with previous children, but there was no difference in PTSS, depressive symptoms, or HRQoL. Women's mean 15D score was lower than partners' and that of age- and gender-standardized general population, while partners' mean 15D score was higher than that of age- and gender-standardized general population. Women whose partners reported PTSS, phobic FOC, or depressive symptoms, often had the same symptoms (22.3%, 14.3%, and 20.4%, respectively).

CONCLUSIONS

PTSS were common in both women and partners, as well as in couples. FOC and depressive symptoms were common in women but uncommon in partners, thus they rarely occurred simultaneously in couples. However, special attention should be paid to a pregnant woman whose partner experiences any of these symptoms.

The Prevalence of Fear of Childbirth and Its Association With Intolerance of Uncertainty and Coping Styles Among Pregnant Chinese Women During the COVID-19 Pandemic

Background

Fear of childbirth (FOC) is one of the most common psychological symptoms among pregnant women and significantly relates to cesarean section, anxiety, and depression. However, it is not clear the prevalence and risk factors of FOC among Chinese pregnant women since the outbreak of the COVID-19 pandemic.

Aims

The objective of this study was to examine the associations between coping styles, intolerance of uncertainty, and FOC.

Method

From December 2021 to April 2022, a cross-sectional survey was conducted in two hospitals in China through convenient sampling. The cross-sectional survey was conducted among 969 pregnant women, which included the Childbirth Attitude Questionnaire (CAQ), Intolerance of Uncertainty Scale-12 (IUS-12), and Simplified Coping Style Questionnaire (SCSQ).

Results

The total prevalence of FOC was 67.8%. The percentages of women with mild (a score of 28-39), moderate (40-51), and severe FOC (52-64) were 43.6, 20.2, and 4.0%, respectively. The regression results indicated that primiparas, unplanned pregnancy, few spousal support, intolerance of uncertainty, and negative coping styles were significant risk factors of FOC. Women who adopt positive coping strategies experienced a lower level of childbirth fear.

Conclusion

These findings suggest that cultivating positive coping styles and obtaining sufficient childbirth information may be helpful for mothers' mental health. Regular screening assessment of perinatal psychological symptoms, such as the high level of intolerance of uncertainty and negative coping styles, should be adopted to reduce the risk of fear of childbirth.

Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e)

The fear of childbirth is a topical concern, yet the issue has barely been studied in Spain, and only one fear of childbirth measurement instrument has been validated in the country. The aim of this study was to translate, adapt and validate the Fear of Childbirth Questionnaire (CFQ) for use in Spain, as well as to describe and evaluate the psychometric properties of the Spanish version of this instrument. In a first phase, a methodological study was carried out (translation–backtranslation and cross-cultural adaptation), and pilot study was carried out in the target population. In addition, content validation of the instrument was obtained (CFQ-e) from 10 experts. In the second phase, a cross-sectional study was carried out at several centres in Gran Canaria Island to obtain a validation sample. The evaluation of the psychometric properties of the CFQ-e, including construct validity through exploratory factor analysis and confirmatory factor analysis, the calculation of reliability via factor consistency using the ORION coefficients as well as alpha and omega coefficients were carried out. The CFQ-e showed evidence of content validity, adequate construct validity and reliability. The CFQ-e is composed of 37 items distributed in four subscales or dimensions: “fear of medical interventions”; “fear of harm and dying”; “fear of pain” and “fears relating to sexual aspects and embarrassment”. The CFQ-e constitutes a valid and reliable tool to measure the fear of childbirth in the Spanish pregnant population.

Tocophobia and Women's Desire for a Caesarean Section: a Systematic Review

Introduction:The rate of cesarean sections has been continuously increasing in most industrialized countries in recent years. It has been observed that the rate of cesarean sections has increased in the last thirty years and is now between 0.4 and 65%. A significant percentage of women, ranging from 1-20%, request a caesarean section without a medical indication. Aim:The aim of this study is to systematically review the available international literature concerning the phenomenon of tocophobia leading to woman`s desire for a caesarean section. Methods: The methodology followed, included an advanced search in various scientific databases and retrieval of the relevant quantitative studies. Results:We found a total of seven papers, all in English, which examined the correlation between tocophobia and women's desire for a caesarean section. Conclusions:One of the primary reasons behind women's desire to give birth through a caesarean delivery is the pathological fear associated with the labor process, known under the scientific term "tocophobia". According to the findings of this review, the prevalence of tocophobia ranged between 7-25% among primiparous women and 7.7-16.25% among multiparous ones. Approximately 7-18.6% of women with tocophobia asked for an elective cesarean section without any medical indication. Clinical treatment of tocophobia is required when the condition has a negative impact on the pregnant woman's quality of life and her bond with the embryo, as well as when it affects her decision regarding the method of childbirth.