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Nordin-Remberger C, Wells MB, Woodford J, Lindelöf KS, Johansson M. Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study. BMC Pregnancy Childbirth 2024; 24:388. [PMID: 38796427 PMCID: PMC11127315 DOI: 10.1186/s12884-024-06580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 05/13/2024] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity. METHODS Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately. RESULTS In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home. CONCLUSIONS Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.
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Affiliation(s)
- Carita Nordin-Remberger
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden.
- Women's Mental Health during the Reproductive Lifespan - WOMHER, Uppsala University, Uppsala, Sweden.
| | - Michael B Wells
- Women's and Children's Health, Karolinska Institute, Solna, Sweden
| | - Joanne Woodford
- Healthcare Sciences and e-Health, Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden
| | | | - Margareta Johansson
- Obstetric and Reproductive Health Research, Department of Women´s and Children´s Health, Uppsala University, Uppsala, 752 37, Sweden
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Hildingsson I, Nordin-Remberger C, Wells MB, Johansson M. Cluster Analysis of Fear of Childbirth, Anxiety, Depression, and Childbirth Self-Efficacy. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00071-6. [PMID: 38782047 DOI: 10.1016/j.jogn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Vaajala M, Liukkonen R, Ponkilainen V, Mattila VM, Kekki M, Kuitunen I. Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland. Ann Epidemiol 2023; 79:44-48. [PMID: 36690228 DOI: 10.1016/j.annepidem.2023.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy. METHODS Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). RESULTS In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63). CONCLUSIONS FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.
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Affiliation(s)
- Matias Vaajala
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
| | - Rasmus Liukkonen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Central Hospital Nova, Jyväskylä, Finland
| | - Ville M Mattila
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland; Department of Orthopaedics and Traumatology, Tampere University Hospital Tampere, Finland
| | - Maiju Kekki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland; Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ilari Kuitunen
- Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland; Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland
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Souto SPAD, Silva RCGD, Prata AP, Guerra MJ, Couto C, Albuquerque RSD. Midwives' interventions for reducing fear of childbirth in pregnant women: a scoping review. JBI Evid Synth 2022; 20:2867-2935. [PMID: 35976033 DOI: 10.11124/jbies-21-00382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review was to map and analyze midwives' interventions for reducing fear of childbirth in pregnant women. INTRODUCTION Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy. Over the past few decades, there has been growing research interest in interventions for reducing fear of childbirth in pregnant women. One of the challenges in midwifery care is to provide an appropriate model of care for pregnant women with fear of childbirth. Further research efforts are needed to identify midwives' interventions for reducing fear of childbirth in pregnant women and to examine their characteristics. INCLUSION CRITERIA This scoping review considered studies that included midwives' interventions for reducing fear of childbirth in pregnant women. Specifically, interventions were led and/or implemented by midwives during the antenatal period, and integrating all possible midwifery practice settings. Quantitative, qualitative, and mixed methods studies were included. This review also considered systematic reviews, text and opinion papers, and conference abstracts. METHODS The JBI methodology for conducting scoping reviews was used. Published and unpublished literature in English, Portuguese, and Spanish from January 1981 to October 2020 was included. MEDLINE (PubMed), CINAHL Complete, APA PsycINFO, Scopus, Embase, Web of Science, SciELO, MedicLatina, Academic Search Complete, ERIC, Psychology and Behavioral Sciences Collection, and the Cochrane Library databases were searched. Searches for gray literature were also undertaken on the Repositório Científico de Acesso Aberto de Portugal, ProQuest Dissertations and Theses, British Library EThOS, OvidSP Resource Center, Banco de Teses da CAPES, and OpenGrey. A three-step search strategy was followed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews checklist was used. Two independent reviewers extracted the data using a data extraction tool developed specifically for this scoping review. RESULTS A total of 3704 articles were identified and screened, of which 34 articles were included. The majority of studies had been published in the past 10 years (88%) in Scandinavian countries or Australia (79%). Several midwives' antenatal interventions were found, such as midwife-led team models of care. Midwives played a facilitator role that varied across the included studies. In 20 studies (59%), midwives led and implemented the interventions alone ( n = 13; 38%) or with the participation of other health professionals ( n = 7; 21%). In the remaining 14 studies (41%), midwives were part of a multidisciplinary team that included different health professionals (mainly obstetricians and psychologists) who had been involved in delivering interventions alongside midwives or with minor participation from midwives. Counseling ( n = 12; 35%) and psychoeducation ( n = 8; 24%) were the most common midwife interventions for reducing fear of childbirth in pregnant women. CONCLUSIONS Midwives working across their full scope of practice play a pivotal role in reducing fear of childbirth, which may explain the variety of midwives' antenatal interventions. Reducing fear of childbirth in pregnant women and promoting normal childbirth as a positive experience are key features of midwives' interventions, which should include women's empowerment measures. Evidence-based midwife-led intervention programs for pregnant women with fear of childbirth should be designed and tested to improve clinical practice as well as women's reproductive outcomes and perinatal experiences.
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Affiliation(s)
- Sandra Patrícia Arantes do Souto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Póvoa de Varzim/Vila do Conde, Póvoa de Varzim, Portugal
| | - Rosa Carla Gomes da Silva
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC).,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence, Nursing School of Coimbra, Coimbra, Portugal
| | - Ana Paula Prata
- CINTESIS - Center for Health Technology and Services Research, Nursing School of Porto (ESEP), Porto, Portugal
| | - Maria João Guerra
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal
| | - Cristina Couto
- Centre for Interdisciplinary Research in Health: Institute of Health Sciences, Universidade Católica Portuguesa, Porto, Portugal.,Maternity unit, Hospital Center Tâmega e Sousa, Penafiel, Portugal
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Hildingsson I, Rubertsson C. The role of women's emotional profiles in birth outcome and birth experience. J Psychosom Obstet Gynaecol 2022; 43:298-306. [PMID: 33586598 DOI: 10.1080/0167482x.2021.1885026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The aim was to investigate birth outcome and birth experience in relation to women's emotional health. An additional aim was to explore the relationship between emotional health, continuity with a known midwife, and the birth experience. METHODS A prospective longitudinal cohort study of 243 women enrolled in a continuity of care project in a rural area in Sweden. Profiles were constructed from instruments measuring depressive symptoms, worries, fear of birth, and sense of coherence. Antenatal and birth records and questionnaires were used to collect data. RESULT Women were categorized into two cluster profiles: "emotionally healthy" vs. "emotionally unhealthy". Women in the "emotionally unhealthy" cluster had a less positive birth experience (p = 0.006). The total score of the Childbirth Experience Questionnaire was highest in women who had had a known midwife assisting at birth. Babies born to women in the "emotionally unhealthy" cluster were more likely to have a severe neonatal diagnosis. CONCLUSION There were few differences in birth outcome between the clusters, while there were explicit differences in the childbirth experience. Having a known midwife is important to warrant women a more positive childbirth experience. Screening with validated instruments during antenatal care could be a first step to further investigate women's emotional well-being and provide targeted psychosocial support.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
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Larsson B, Elfving M, Vesterlund E, Karlström A, Hildingsson I. Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 33:100748. [PMID: 35728347 DOI: 10.1016/j.srhc.2022.100748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The fulfilment of birth expectations is important to women and strongly related to birth satisfaction. OBJECTIVE The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled. METHODS A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences. RESULTS The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled. CONCLUSIONS Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.
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Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Elin Vesterlund
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | | | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
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González-de la Torre H, Domínguez-Gil A, Padrón-Brito C, Rosillo-Otero C, Berenguer-Pérez M, Verdú-Soriano J. Validation and Psychometric Properties of the Spanish Version of the Fear of Childbirth Questionnaire (CFQ-e). J Clin Med 2022; 11:jcm11071843. [PMID: 35407450 PMCID: PMC8999905 DOI: 10.3390/jcm11071843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/20/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Héctor González-de la Torre
- Research Unit, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain
- Department of Nursing, Nursing School La Palma, University of La Laguna, 38200 San Cristóbal de La Laguna, Spain
- Correspondence: (H.G.-d.l.T.); (J.V.-S.)
| | - Adela Domínguez-Gil
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Cintia Padrón-Brito
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Carla Rosillo-Otero
- Obstetrics and Gynaecology Department, Insular Maternal and Child University Hospital Complex of Gran Canaria, Canary Health Service, 35016 Las Palmas de Gran Canaria, Spain; (A.D.-G.); (C.P.-B.); (C.R.-O.)
| | - Miriam Berenguer-Pérez
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
| | - José Verdú-Soriano
- Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, 03690 Alicante, Spain;
- Correspondence: (H.G.-d.l.T.); (J.V.-S.)
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Dual-Session Tokophobia Intervention, a Novel Ultrashort Cognitive Behavioral Therapy Protocol for Women Suffering From Tokophobia in the Third Term of Pregnancy. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hildingsson I, Rubertsson C. Postpartum bonding and association with depressive symptoms and prenatal attachment in women with fear of birth. BMC Pregnancy Childbirth 2022; 22:66. [PMID: 35078403 PMCID: PMC8788067 DOI: 10.1186/s12884-021-04367-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 12/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background Co-morbidity is prevalent in women with fear of birth. Depressive symptoms and lack of prenatal attachment might influence the postpartum bonding between the mother and the new-born. Aim To examine the underlying dimensions of the Postpartum Bonding Questionnaire and to investigate associations between depressive symptoms, prenatal attachment and postpartum bonding in women with fear of birth. Methods A longitudinal study comprising 172 women with fear of birth. Data were collected by questionnaires in mid- and late pregnancy and two months after birth. The Edinburgh Postnatal Depressive Scale, Prenatal Attachment Inventory and Postpartum Bonding Questionnaire were investigated. Results Two factors of the Postpartum Bonding Questionnaire were identified: Factor 1 mirrored caring activities and the women’s perceptions of motherhood, whereas Factor 2 reflected negative feelings towards the baby. The Postpartum Bonding Questionnaire was negatively correlated with the Prenatal Attachment Inventory and positively with The Edinburgh Postnatal Depressive Scale. Women with fear of birth and depressive symptoms both during pregnancy and postpartum showed the highest risk of impaired bonding after birth. Primiparity and being single were also associated with impaired bonding. Conclusion A focus on women’s mental health during pregnancy is necessary in order to avoid the negative effects of impaired bonding on the infant. Depressive symptoms could be concurrent with fear of birth and, therefore, it is important to determine both fear of birth and depressive symptoms in screening procedures during pregnancy. Caregivers who meet women during pregnancy need to acknowledge prenatal attachment and thereby influence adaptation to motherhood.
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Depressive symptoms during pregnancy and after birth in women living in Sweden who received treatments for fear of birth. Arch Womens Ment Health 2022; 25:473-484. [PMID: 35190877 PMCID: PMC8921011 DOI: 10.1007/s00737-022-01213-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/09/2022] [Indexed: 01/19/2023]
Abstract
The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.
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O'Connell MA, Khashan AS, Leahy-Warren P, Stewart F, O'Neill SM. Interventions for fear of childbirth including tocophobia. Cochrane Database Syst Rev 2021; 7:CD013321. [PMID: 34231203 PMCID: PMC8261458 DOI: 10.1002/14651858.cd013321.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Many women experience fear of childbirth (FOC). While fears about childbirth may be normal during pregnancy, some women experience high to severe FOC. At the extreme end of the fear spectrum is tocophobia, which is considered a specific condition that may cause distress, affect well-being during pregnancy and impede the transition to parenthood. Various interventions have been trialled, which support women to reduce and manage high to severe FOC, including tocophobia. OBJECTIVES To investigate the effectiveness of non-pharmacological interventions for reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with high to severe FOC, including tocophobia. SEARCH METHODS In July 2020, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and reference lists of retrieved studies. We contacted researchers of trials which were registered and appeared to be ongoing. SELECTION CRITERIA We included randomised clinical trials which recruited pregnant women with high or severe FOC (as defined by the individual trial), for treatment intended to reduce FOC. Two review authors independently screened and selected titles and abstracts for inclusion. We excluded quasi-randomised and cross-over trials. DATA COLLECTION AND ANALYSIS We used standard methodological approaches as recommended by Cochrane. Two review authors independently extracted data and assessed the studies for risk of bias. A third review author checked the data analysis for accuracy. We used GRADE to assess the certainty of the evidence. The primary outcome was a reduction in FOC. Secondary outcomes were caesarean section, depression, birth preference for caesarean section or spontaneous vaginal delivery, and epidural use. MAIN RESULTS We included seven trials with a total of 1357 participants. The interventions included psychoeducation, cognitive behavioural therapy, group discussion, peer education and art therapy. We judged four studies as high or unclear risk of bias in terms of allocation concealment; we judged three studies as high risk in terms of incomplete outcome data; and in all studies, there was a high risk of bias due to lack of blinding. We downgraded the certainty of the evidence due to concerns about risk of bias, imprecision and inconsistency. None of the studies reported data about women's anxiety. Participating in non-pharmacological interventions may reduce levels of fear of childbirth, as measured by the Wijma Delivery Expectancy Questionnaire (W-DEQ), but the reduction may not be clinically meaningful (mean difference (MD) -7.08, 95% confidence interval (CI) -12.19 to -1.97; 7 studies, 828 women; low-certainty evidence). The W-DEQ tool is scored from 0 to 165 (higher score = greater fear). Non-pharmacological interventions probably reduce the number of women having a caesarean section (RR 0.70, 95% CI 0.55 to 0.89; 5 studies, 557 women; moderate-certainty evidence). There may be little to no difference between non-pharmacological interventions and usual care in depression scores measured with the Edinburgh Postnatal Depression Scale (EPDS) (MD 0.09, 95% CI -1.23 to 1.40; 2 studies, 399 women; low-certainty evidence). The EPDS tool is scored from 0 to 30 (higher score = greater depression). Non-pharmacological interventions probably lead to fewer women preferring a caesarean section (RR 0.37, 95% CI 0.15 to 0.89; 3 studies, 276 women; moderate-certainty evidence). Non-pharmacological interventions may increase epidural use compared with usual care, but the 95% CI includes the possibility of a slight reduction in epidural use (RR 1.21, 95% CI 0.98 to 1.48; 2 studies, 380 women; low-certainty evidence). AUTHORS' CONCLUSIONS The effect of non-pharmacological interventions for women with high to severe fear of childbirth in terms of reducing fear is uncertain. Fear of childbirth, as measured by W-DEQ, may be reduced but it is not certain if this represents a meaningful clinical reduction of fear. There may be little or no difference in depression, but there may be a reduction in caesarean section delivery. Future trials should recruit adequate numbers of women and measure birth satisfaction and anxiety.
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Affiliation(s)
- Maeve Anne O'Connell
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Ali S Khashan
- School of Public Health, University College Cork, Cork, Ireland
| | | | - Fiona Stewart
- Cochrane Children and Families Network, c/o Cochrane Pregnancy and Childbirth, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Sinéad M O'Neill
- School of Epidemiology and Public Health Alumna, University College Cork, Cork, Ireland
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Hildingsson I, Rubertsson C. Testing the birth attitude profile scale in a Swedish sample of women with fear of birth. J Psychosom Obstet Gynaecol 2021; 42:132-139. [PMID: 32081051 DOI: 10.1080/0167482x.2020.1729118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore the "Birth Attitude Profile Scale (BAPS)" in a selected sample of women with fear of birth. Another aim was to develop profiles of women according to their birth attitudes and levels of childbirth fear in relation to background characteristics. METHODS A secondary analysis of data collected in two different samples of women with fear of birth. Data were collected by a questionnaire in gestational week 36 and background data from mid-pregnancy. A principal component analysis and a cluster analysis were performed of the combined sample of 195 women. RESULTS The principal component analysis revealed four domains of the BAPS: "personal impact, birth as a natural event, freedom of choice and safety concerns". When adding the fear of birth scale, two clusters were identified: one with strong attitudes and lower fear, labeled "self-determiners"; and one with no strong attitudes but high levels of fear, labeled "fearful." Women in the "Fearful" cluster more often reported previous and current mental health problems, which were the main difference between the clusters. CONCLUSION The BAPS instrument seems to be useful in identifying birth attitudes in women with fear of birth and could be a basis for discussions and birth planning during pregnancy. Mental health problems were the main difference in cluster membership; therefore, it is important to ask women with fear of childbirth about physical, mental and social aspects of health. In addition, a qualitative approach using techniques such as focus groups or interviews is needed to explore how women come to form their attitudes and beliefs about birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Lund University, Lund, Sweden
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Nguyen LD, Nguyen LH, Ninh LT, Nguyen HTT, Nguyen AD, Vu LG, Nguyen CT, Vu GT, Doan LP, Latkin CA, Ho CSH, Ho RCM. Fear of Childbirth and Preferences for Prevention Services among Urban Pregnant Women in a Developing Country: A Multicenter, Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5382. [PMID: 34070085 PMCID: PMC8158107 DOI: 10.3390/ijerph18105382] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/11/2021] [Accepted: 05/15/2021] [Indexed: 12/28/2022]
Abstract
This study aimed to examine fear of childbirth and willingness to pay for fear-prevention services in pregnant women. A multicenter, cross-sectional study was conducted on pregnant women in two obstetric hospitals in Vietnam. The Fear of Birth Scale was utilized to evaluate fear of childbirth. Multivariable, generalized linear regression and logistic regression models were performed to identify associated factors with fear of childbirth, demand, and willingness to pay for prevention services. Of 900 pregnant women, fear of childbirth was moderately high with a mean score of 18.1 (SD = 2.3). Age of partner; ever having complications of pregnancy; attitudes toward different aspects of childbirth delivery; satisfactions with friends, parents, and siblings' care; and information support were associated with fear of childbirth. Only 33.8% participants had a demand for the prevention service, and 43.7% were willing to pay for this service with an average amount of $US 10.0 per month (SD = 72.0). Our study suggested that individualized psychological counseling and information-seeking guidance should be provided appropriately and differently for multiparous and nulliparous women for reducing fear and improving the acceptability of the prevention services.
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Affiliation(s)
- Lam Duc Nguyen
- Department of Anaesthesiology, Hanoi Medical University, Hanoi 100000, Vietnam;
| | - Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
| | - Ly Thi Ninh
- Social Affair Department, Ca Mau Obstetrics & Pediatrics Hospital, Ca Mau 98000, Vietnam;
| | - Ha Thu Thi Nguyen
- Hanoi Obstetrics and Gynecology Hospital, Hanoi 100000, Vietnam; (H.T.T.N.); (A.D.N.)
| | - Anh Duy Nguyen
- Hanoi Obstetrics and Gynecology Hospital, Hanoi 100000, Vietnam; (H.T.T.N.); (A.D.N.)
| | - Linh Gia Vu
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (C.T.N.); (L.P.D.)
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (C.T.N.); (L.P.D.)
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-Based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 70000, Vietnam;
| | - Linh Phuong Doan
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam; (C.T.N.); (L.P.D.)
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (C.S.H.H.); (R.C.M.H.)
- Department of Psychological Medicine, National University Health System, Singapore 119228, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; (C.S.H.H.); (R.C.M.H.)
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Institute of Health Economics and Technology, Hanoi 100000, Vietnam
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14
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Souto SPAD, de Albuquerque RS, Silva RCGD, Guerra MJ, Prata AP. Midwifery interventions to reduce fear of childbirth in pregnant women: a scoping review protocol. JBI Evid Synth 2021; 18:2045-2057. [PMID: 32813435 DOI: 10.11124/jbisrir-d-19-00198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The objective of the review is to map and analyze midwifery interventions to reduce fear of childbirth in pregnant women. INTRODUCTION Fear of childbirth is a phenomenon negatively affecting women's health and well-being before and during pregnancy, as well as after childbirth. During the previous few decades, there has been a growing interest in research into interventions to reduce the fear of childbirth in childbearing women. Currently, providing an appropriate model of care for pregnant women with fear of childbirth is a challenge in midwifery care. Therefore, further efforts are needed to identify and examine the characteristics of different midwifery interventions to reduce fear of childbirth in pregnant women. INCLUSION CRITERIA This scoping review will consider studies that include interventions to reduce fear of childbirth in pregnant women, led and implemented by midwives, during the antenatal period, in all possible birth scenarios. Quantitative, qualitative, and mixed methods studies will be included. METHODS The JBI methodology for conducting scoping reviews will be employed. Published and unpublished literature in English, Portuguese, and Spanish, from 1981 to the present, will be included. MEDLINE, CINAHL Complete, Scopus, Web of Science, Embase, and Cochrane Library databases will be searched. Searches for gray literature will be performed. Data will be extracted using a tool developed specifically for the scoping review objectives.
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Affiliation(s)
- Sandra Patrícia Arantes do Souto
- Universidade Católica Portuguesa - Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Porto, Portugal
| | | | - Rosa Carla Gomes da Silva
- Universidade Católica Portuguesa - Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Porto, Portugal.,Portugal Centre for Evidence Based Practice: A JBI Centre of Excellence
| | - Maria João Guerra
- Universidade Católica Portuguesa - Centre for Interdisciplinary Research in Health, Institute of Health Sciences, Porto, Portugal
| | - Ana Paula Prata
- Nursing School of Porto, Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
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15
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Veringa-Skiba IK, de Bruin EI, Mooren B, van Steensel FJA, Bögels SM. Can a simple assessment of fear of childbirth in pregnant women predict requests and use of non-urgent obstetric interventions during labour? Midwifery 2021; 97:102969. [PMID: 33691226 DOI: 10.1016/j.midw.2021.102969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 02/13/2021] [Accepted: 02/23/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether the Wijma Delivery Expectation Questionnaire (W-DEQ-A) and the one-item Fear of Childbirth-Postpartum-Visual Analogue Scale (FOCP-VAS) - measuring high FOC - are useful tools in predicting requested and received non-urgent obstetric interventions in pregnant women. DESIGN A prospective cohort study. POPULATION AND SETTING Self-selected pregnant women from midwifery care settings (n=401). METHODS W-DEQ-A and FOCP-VAS were assessed at two timepoints in pregnancy. Measures of non-urgent obstetric interventions which were derived from medical files were: induction of labour, epidural analgesia, augmentation with oxytocin due to failure to progress and self-requested caesarean section. Hierarchical logistics regression models were used. MAIN OUTCOME MEASURES The change in the Nagelkerke R2 was examined for three models predicting two outcome measures: (1) explicitly requested non-urgent obstetric interventions during pregnancy and (2) received non-urgent obstetric interventions during labour. The first model only included participants' characteristics, the second model also included FOCP-VAS ≥5, and in the third model the W-DEQ-A ≥66 was added. RESULTS High FOC measured with FOCP-VAS≥5 predicted requested (pseudo-R2=0.33, X2=59.82, P<0.001) and received non-urgent obstetric interventions (pseudo-R2=0.19, X2=32.81, P<0.001) better than high FOC measured with W-DEQ-A≥66. CONCLUSION This study is the first evaluating self-reported FOC and postpartum based on VAS (subjective outcome) in relation to actual pregnancy and childbirth outcomes derived from medical files (objective outcome). Non-urgent obstetric interventions could already be predicted in the first half of pregnancy by means of a simple FOC assessment with the one-item FOCP-VAS. Implementing this easy to use one-item screening tool in midwifery care is suggested.
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Affiliation(s)
- Irena K Veringa-Skiba
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Research Priority Area Yield, Nieuwe Achtergracht 127, Amsterdam, WS 1018, the Netherlands.
| | - Esther I de Bruin
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Research Priority Area Yield, Nieuwe Achtergracht 127, Amsterdam, WS 1018, the Netherlands; UvA-minds, Academic Center of the University of Amsterdam, Banstraat 29, Amsterdam, JW 1071, the Netherlands
| | - Bennie Mooren
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Research Priority Area Yield, Nieuwe Achtergracht 127, Amsterdam, WS 1018, the Netherlands; Arkin Institute for Mental Health, Wisselwerking 46, 1112XR Diemen, the Netherlands
| | - Francisca J A van Steensel
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Research Priority Area Yield, Nieuwe Achtergracht 127, Amsterdam, WS 1018, the Netherlands
| | - Susan M Bögels
- University of Amsterdam, Research Institute of Child Development and Education (RICDE), Research Priority Area Yield, Nieuwe Achtergracht 127, Amsterdam, WS 1018, the Netherlands
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16
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Hildingsson I, Rubertsson C. Childbirth experiences among women with fear of birth randomized to internet-based cognitive therapy or midwife counseling. J Psychosom Obstet Gynaecol 2020; 41:205-214. [PMID: 31244352 DOI: 10.1080/0167482x.2019.1634047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Although women with fear of birth often report negative birth experiences, few studies have focused on their experiences in the long term. The aim of this study was to compare birth experiences a year after childbirth in two groups of women receiving treatment for experiencing fear of birth during pregnancy.Methods: As part of the U-CARE: Pregnancy Trial, a prospective multicenter randomized controlled trial comparing the effects of internet-based cognitive behavioral therapy (iCBT) and standard care among pregnant women with fear of birth. Women were recruited at three Swedish hospitals following a screening procedure that assessed their fear of birth. Data were collected online with the Childbirth Experience Questionnaire (CEQ), one question about the overall birth experience, and questions about personal background, collected before randomization.Results: A total of 181 women responded to the follow-up questionnaire a year after childbirth. Approximately half of participants reported a less positive birth experience. Preferred mode of birth, actual mode of birth, marital status and psychiatric history were associated with the domains of the CEQ. However, no statistically significant differences emerged between the treatment groups.Conclusions: Being randomized to receive iCBT or counseling with midwives for fear of birth was not associated with perceptions of the birth experience assessed a year after birth. Most participants reported less-than-positive birth experiences and scored low on the domain of the CEQ reflecting Own capacity. In response, additional research remains necessary to identify the best model of care that might facilitate positive experiences with giving birth among women with fear of birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Lund University, Lund, Sweden
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17
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Dai L, Zhang N, Rong L, Ouyang YQ. Worldwide research on fear of childbirth: A bibliometric analysis. PLoS One 2020; 15:e0236567. [PMID: 32726336 PMCID: PMC7390386 DOI: 10.1371/journal.pone.0236567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/09/2020] [Indexed: 12/14/2022] Open
Abstract
Objective To review the research on fear of childbirth, analyze and evaluate the publications by means of bibliometric analysis, and provide suggestions and scopes for future study. Data sources Web of Science, PubMed, Embase and the Cochrane Library databases. Study selection All published articles focusing on the fear of childbirth from inception to February 10, 2020. Data extraction A total of 743 articles were included for final analysis. Bibliographic data were exported from databases and then cleaned manually before using Microsoft Excel and VOSviewer to analyze and visualize the findings. Data synthesis It was found that 743 articles have been cited 31515 times (h-index: 98). The volume of publications increased by 29.3 times in the past two decades. Across the globe, Sweden was the most prolific country having 129 articles (17.4%) with six of its institutions in the top ten most prolific institutions in the world. Fifty-two (7.8%) documents were published in Midwifery journal. The most prolific author was Hildingsson, who published 35 articles (4.7%). “Cesarean section,” “experience,” and “factor” were the words that appeared most frequently in titles and abstracts of studies. “Point prevalence of psychiatric disorders during the second trimester of pregnancy: A population-based study” was the most cited article and received 525 citations. Conclusion There is an increasing interest in the research in fear of childbirth during the past two decades. This study has demonstrated that the Swedish authors have a leading role on this topic. Researchers especially in countries with high birth rates, need to promote research projects in this field as it is an important public health issue.
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Affiliation(s)
- Lijing Dai
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Na Zhang
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Liu Rong
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Yan-Qiong Ouyang
- School of Health Sciences, Wuhan University, Wuhan, China
- * E-mail:
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18
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Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33:323-333. [DOI: 10.1016/j.wombi.2019.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
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O'Connell MA, Khashan AS, Leahy-Warren P. Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence. Women Birth 2020; 34:e309-e321. [PMID: 32522443 DOI: 10.1016/j.wombi.2020.05.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Abstract
ISSUE Fear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions. AIM To conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them. METHODS A meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis. FINDINGS One overarching theme "Ownership of Childbirth" and three analytical themes "Facing the fear", "Feeling empowered", "Managing the fear with a sense of security" were generated through the synthesis. There were no studies outside of Scandinavia located. DISCUSSION This meta-synthesis provides a new way to describe the process of moving from fear to "Ownership of childbirth". The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff. CONCLUSION These findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.
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Affiliation(s)
- Maeve A O'Connell
- School of Nursing and Midwifery, Royal College of Surgeons Ireland in Bahrain, Adliya, Bahrain; Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Wilton, Cork, Ireland; Dept of Obstetrics & Gynaecology, College of Medicine & Health, University College Cork, Cork, Ireland.
| | - Ali S Khashan
- School of Public Health, University College Cork, Western Rd., Cork, Ireland; Irish Centre for Fetal and Neonatal Translational Research, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Patricia Leahy-Warren
- School of Nursing and Midwifery, University College Cork, College Rd., Cork, Ireland
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Wahlbeck H, Kvist LJ, Landgren K. Art Therapy and Counseling for Fear of Childbirth: A Randomized Controlled Trial. ART THERAPY 2020. [DOI: 10.1080/07421656.2020.1721399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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21
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Henriksen L, Borgen A, Risløkken J, Lukasse M. Fear of birth: Prevalence, counselling and method of birth at five obstetrical units in Norway. Women Birth 2020; 33:97-104. [DOI: 10.1016/j.wombi.2018.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/13/2018] [Accepted: 11/19/2018] [Indexed: 11/24/2022]
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Fıratlıgil FB, Fidan U. Az riskli term gebede prenatal takibe etki eden faktörler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.557138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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A known midwife can make a difference for women with fear of childbirth- birth outcome and women’s experiences of intrapartum care. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:33-38. [DOI: 10.1016/j.srhc.2019.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/08/2019] [Accepted: 06/14/2019] [Indexed: 11/20/2022]
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24
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Coates D, Foureur M. The role and competence of midwives in supporting women with mental health concerns during the perinatal period: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e389-e405. [PMID: 30900371 DOI: 10.1111/hsc.12740] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Perinatal mental health problems are linked to poor outcomes for mothers, babies and families. Despite a recognition of the significance of this issue, women often do not receive the care they need and fall between the gap of maternity and mental health services. To address this, there is a call for reform in the way in which perinatal mental healthcare is delivered. This paper responds to this by exploring the role and competence of midwives in delivering mental healthcare. Using a scoping review methodology, quantitative and qualitative evidence were considered to answer the research question 'what is the nature of the evidence relevant to the provision of mental health interventions by midwives?' To identify studies, the databases PubMed, Maternity and Infant Care, Science Citation Index, Social Sciences Citation Index, Medline, Science Direct and CINAHL were searched from 2011 to 2018, and reference lists of included studies were examined. Studies relevant to the role of midwives in the management and treatment of perinatal mental health issues were included; studies focussed on screening and referral were excluded. Thirty papers met inclusion criteria, including studies about the knowledge, skills, and attitudes of midwives and student midwives; the effectiveness of educational interventions in improving knowledge and skills; the delivery of counselling or psychosocial interventions by midwives; and barriers and enablers to embedding midwife-led mental healthcare in practice. Synthesis of the included studies indicates that midwives are interested in providing mental health support, but lack the confidence, knowledge and training to do so. This deficit can be addressed with appropriate training and organisational support, and there is some evidence that midwife-led counselling interventions are effective. Further research is needed to test midwife-led interventions for women with perinatal mental health problems , and to develop and evaluate models of integrated perinatal mental healthcare.
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Affiliation(s)
- Dominiek Coates
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Faculty of Health, Centre for Midwifery and Child and Family Health, University of Technology, Sydney, New South Wales, Australia
- Hunter New England Nursing and Midwifery Research Centre, Newcastle, Australia
- University of Newcastle, Faculty of Health and Medicine, Newcastle, Australia
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Tobiasson M, Lyberg A. Fear of childbirth from the perspective of midwives working in hospitals in Norway: A qualitative study. Nurs Open 2019; 6:1180-1188. [PMID: 31367444 PMCID: PMC6650651 DOI: 10.1002/nop2.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/10/2019] [Accepted: 05/10/2019] [Indexed: 11/11/2022] Open
Abstract
AIM To illuminate the perceptions of hospital-based midwives who support women suffering from moderate to severe fear of childbirth during an expected vaginal birth. DESIGN A qualitative descriptive and explorative study. METHODS Focus group interviews were conducted with 18 midwives representing four different hospitals in Norway. RESULTS Encountering fear of childbirth evoked the desire to protect and help, although the ability to provide optimal support was dependent on several circumstances, several of which were beyond the midwives̕ control. The main theme "Midwives finding their own strength when encountering the vulnerability of women with fear of childbirth" consisted of two themes: "Being present" and "Being alone." The midwives described being present as a prerequisite for continuity of care and affirmation. The emphasis on continuity of care could give rise to a sense of loneliness and guilt during and after demanding situations in the birthing room.
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Affiliation(s)
- Marthe Tobiasson
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Anne Lyberg
- Centre for Women̕ s, Family and Child Health, Department of Nursing and Health Sciences, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
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26
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Coates D, Homer C, Wilson A, Deady L, Mason E, Foureur M, Henry A. Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines. Women Birth 2019; 33:22-34. [PMID: 31253513 DOI: 10.1016/j.wombi.2019.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making. METHOD A systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers. FINDINGS In total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines. CONCLUSION The majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, NSW, Australia; Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Australia.
| | - Caroline Homer
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, NSW, Australia; Burnet Institute, Victoria, Australia
| | - Alyssa Wilson
- Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia
| | - Louise Deady
- South Eastern Sydney Local Health District, District Offices, Sutherland Hospital Locked Bag 21, Taren Point, NSW 2229, Australia.
| | - Elizabeth Mason
- South Eastern Sydney Local Health District, District Offices, Sutherland Hospital Locked Bag 21, Taren Point, NSW 2229, Australia.
| | - Maralyn Foureur
- Hunter New England Nursing and Midwifery Research Centre, Australia; University of Newcastle, Faculty of Health and Medicine, Australia.
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St. George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth. Women Birth 2019; 33:e227-e233. [PMID: 31160244 DOI: 10.1016/j.wombi.2019.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fear of Birth is common in pregnant women and associated with negative physical and mental health. There is a clear comorbidity with anxiety and depression. Internet-delivered Cognitive Behaviour Therapy has been suggested as a treatment option for Fear of Birth and a randomized controlled trial comparing internet-delivered Cognitive Behaviour Therapy with midwifery led counselling as standard care has been conducted. OBJECTIVE The aim of this study was to describe women's experiences of guided internet-delivered Cognitive Behaviour Therapy for Fear of Birth and to describe the content of their fear. METHODS The present study is a qualitative, follow-up interview study following the randomized controlled trial, the U-CARE Pregnancy Trial. In total 19 women allocated to internet-delivered Cognitive Behaviour Therapy for Fear of Birth were interviewed by telephone. A semi-structured interview guide was used and the transcripts were analyzed with thematic analysis. RESULTS The women's descriptions of Fear of Birth differed, however their fear was most often associated with fear of losing control, fear for the baby's life or health or own life threatening events. The experiences of internet-delivered Cognitive Behaviour Therapy for Fear of Birth varied, some women were positive to its flexibility although most women preferred a face-to face meeting. The treatment did not pin-point their fears, it was challenging to maintain motivation and to work with the treatment in solitude. CONCLUSIONS Women's descriptions of Fear of Birth varied. Most women undergoing internet-delivered Cognitive Behaviour Therapy would have preferred a face-to-face meeting which they imagined would have soothed their fear. Internet-delivered Cognitive Behaviour Therapy for Fear of Birth may be an alternative for some women.
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O'Connell MA, O'Neill SM, Dempsey E, Khashan AS, Leahy-Warren P, Smyth RMD, Kenny LC. Interventions for fear of childbirth (tocophobia). THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2019. [DOI: 10.1002/14651858.cd013321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maeve Anne O'Connell
- P.O. Box 15503; RCSI Bahrain; Adliya Bahrain
- University College Cork; Irish Centre for Fetal and Neonatal Translational Research; Cork Ireland
| | - Sinéad M O'Neill
- Health Information and Quality Authority; Health Technology Assessment Directorate; Unit 1301, City Gate Mahon Cork Munster Ireland T12 Y2XT
| | - Eugene Dempsey
- Cork University Maternity Hospital; Neonatology; Wilton Cork Ireland
| | - Ali S Khashan
- University College Cork; School of Public Health; Cork Ireland
| | - Patricia Leahy-Warren
- University College Cork; School of Nursing and Midwifery; Brookfield Health Sciences Complex Cork Ireland
| | - Rebecca MD Smyth
- The University of Manchester; Division of Nursing Midwifery and Social Work; Jean McFarlane Building Oxford Road Manchester UK M13 9PL
| | - Louise C Kenny
- University of Liverpool; Faculty of Health and Life Sciences; Foundation Building, 765 Brownlow Hill Liverpool Merseyside UK
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Rondung E, Ekdahl J, Sundin Ö. Potential mechanisms in fear of birth: The role of pain catastrophizing and intolerance of uncertainty. Birth 2019; 46:61-68. [PMID: 29954044 DOI: 10.1111/birt.12368] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/04/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Although many pregnant women experience fear, worry, or anxiety relating to the upcoming birth, little is known regarding the psychological mechanisms contributing to these experiences. In this study, we wanted to take a first step in trying to identify mechanisms of potential interest. The objective of this cross-sectional study was thus to investigate pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance as potential mechanisms predicting fear of birth among pregnant women. METHODS A sample of 499 pregnant women, recruited in antenatal health care settings in 2 Swedish regions, completed the Fear of Birth Scale, along with measurements of the mechanisms of interest. Linear and logistic hierarchical regression analyses were used to investigate the extent to which pain catastrophizing, intolerance of uncertainty, positive worry beliefs, and cognitive avoidance predicted fear of birth, both as a continuous and a dichotomous measure. RESULTS Logistic regression analysis showed high levels of pain catastrophizing and intolerance of uncertainty to be the best predictors of fear of birth, OR 3.49 (95% CI 2.17-5.61) and OR 3.25 (95% CI 2.00-5.27), respectively. Positive beliefs about worry and cognitive avoidance were both correlated with fear of birth as a continuous measure, but did not contribute to the logistic regression model. CONCLUSIONS Pain catastrophizing and intolerance of uncertainty were the most evident predictors of fear of birth. Although preliminary, the findings suggest that interventions targeting catastrophic cognitions and intolerance of uncertainty might be relevant to psychological treatment for fear, worry, or anxiety relating to giving birth.
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Affiliation(s)
- Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden
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Midwives’ counselling of women at specialised fear of childbirth clinics: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 19:24-30. [DOI: 10.1016/j.srhc.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/26/2018] [Accepted: 12/02/2018] [Indexed: 01/16/2023]
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Hildingsson I, Karlström A, Rubertsson C, Haines H. Women with fear of childbirth might benefit from having a known midwife during labour. Women Birth 2018; 32:58-63. [PMID: 29773474 DOI: 10.1016/j.wombi.2018.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/28/2018] [Accepted: 04/17/2018] [Indexed: 01/20/2023]
Abstract
AIM Having a known midwife at birth is valued by women across the world, however it is unusual for women with fear of childbirth to have access to this model of care. The aim of this study was to describe the prevalence and factors related to having access to a known midwife for women referred to counseling due to childbirth fear. We also wanted to explore if women's levels of childbirth fear changed over time. METHODS A pilot study of 70 women referred to counseling due to fear of birth in 3 Swedish hospitals, and where the counseling midwife, when possible, also assisted during labour and birth. RESULTS 34% of the women actually had a known midwife during labour and birth. Women who had a known midwife had significantly more counseling visits, they viewed the continuity of care as more important, were more satisfied with the counseling and 29% reported that their fear disappeared. Fear of birth decreased significantly over time for all women irrespective of whether they were cared for in labour by a known midwife or not. CONCLUSIONS Although the women in the present study had limited access to a known midwife, the results indicate that having a known midwife whom the women met on several occasions made them more satisfied with the counseling and had a positive effect on their fear. Building a trustful midwife-woman relationship rather than counseling per se could be the key issue when it comes to fear of birth.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | | | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Science, Faculty of Medicine, Lund University, Sweden
| | - Helen Haines
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Rural Health, University of Melbourne, Wangaratta, Victoria, Australia
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Hildingsson I, Rubertsson C, Karlström A, Haines H. Exploring the Fear of Birth Scale in a mixed population of women of childbearing age—A Swedish pilot study. Women Birth 2018; 31:407-413. [DOI: 10.1016/j.wombi.2017.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 01/24/2023]
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Rondung E, Ternström E, Hildingsson I, Haines HM, Sundin Ö, Ekdahl J, Karlström A, Larsson B, Segeblad B, Baylis R, Rubertsson C. Comparing Internet-Based Cognitive Behavioral Therapy With Standard Care for Women With Fear of Birth: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10420. [PMID: 30097422 PMCID: PMC6109226 DOI: 10.2196/10420] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although many pregnant women report fear related to the approaching birth, no consensus exists on how fear of birth should be handled in clinical care. OBJECTIVE This randomized controlled trial aimed to compare the efficacy of a guided internet-based self-help program based on cognitive behavioral therapy (guided ICBT) with standard care on the levels of fear of birth in a sample of pregnant women reporting fear of birth. METHODS This nonblinded, multicenter randomized controlled trial with a parallel design was conducted at three study centers (hospitals) in Sweden. Recruitment commenced at the ultrasound screening examination during gestational weeks 17-20. The therapist-guided ICBT intervention was inspired by the Unified protocol for transdiagnostic treatment of emotional disorders and consisted of 8 treatment modules and 1 module for postpartum follow-up. The aim was to help participants observe and understand their fear of birth and find new ways of coping with difficult thoughts and emotions. Standard care was offered in the three different study regions. The primary outcome was self-assessed levels of fear of birth, measured using the Fear of Birth Scale. RESULTS We included 258 pregnant women reporting clinically significant levels of fear of birth (guided ICBT group, 127; standard care group, 131). Of the 127 women randomized to the guided ICBT group, 103 (81%) commenced treatment, 60 (47%) moved on to the second module, and only 13 (10%) finished ≥4 modules. The levels of fear of birth did not differ between the intervention groups postintervention. At 1-year postpartum follow-up, participants in the guided ICBT group exhibited significantly lower levels of fear of birth (U=3674.00, z=-1.97, P=.049, Cohen d=0.28, 95% CI -0.01 to 0.57). Using the linear mixed models analysis, an overall decrease in the levels of fear of birth over time was found (P≤ .001), along with a significant interaction between time and intervention, showing a larger reduction in fear of birth in the guided ICBT group over time (F1,192.538=4.96, P=.03). CONCLUSIONS Fear of birth decreased over time in both intervention groups; while the decrease was slightly larger in the guided ICBT group, the main effect of time alone, regardless of treatment allocation, was most evident. Poor treatment adherence to guided ICBT implies low feasibility and acceptance of this treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02306434; https://clinicaltrials.gov/ct2/show/NCT02306434 (Archived by WebCite at http://www.webcitation.org/70sj83qat).
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Affiliation(s)
- Elisabet Rondung
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Helen M Haines
- Department of Rural Health, The University of Melbourne, Victoria, Australia
| | - Örjan Sundin
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | - Johanna Ekdahl
- Department of Psycholgy, Mid Sweden University, Östersund, Sweden
| | | | | | - Birgitta Segeblad
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Rebecca Baylis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Health Science, Faculty of Medicine, Lund university, Lund, Sweden
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Larsson B, Hildingsson I, Ternström E, Rubertsson C, Karlström A. Women's experience of midwife-led counselling and its influence on childbirth fear: A qualitative study. Women Birth 2018; 32:e88-e94. [PMID: 29709431 DOI: 10.1016/j.wombi.2018.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 03/28/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women's views about counselling for childbirth fear. AIM To explore women's experiences of midwife-led counselling for childbirth fear. METHOD A qualitative interview study using thematic analysis. Twenty-seven women assessed for childbirth fear who had received counselling during pregnancy at three different hospitals in Sweden were interviewed by telephone one to two years after birth. FINDINGS The overarching theme 'Midwife-led counselling brought positive feelings and improved confidence in birth' was identified. This consisted of four themes describing 'the importance of the midwife' and 'a mutual and strengthening dialogue' during pregnancy. 'Coping strategies and support enabled a positive birth' represent women's experiences during birth and 'being prepared for a future birth' were the women's thoughts of a future birth. CONCLUSIONS In this qualitative study, women reported that midwife-led counselling improved their confidence for birth through information and knowledge. The women experienced a greater sense of calm and preparedness, which increased the tolerance for the uncertainty related to the birthing process. This, in turn, positively affected the birth experience. Combined with a feeling of safety, which was linked to the professional support during birth, the women felt empowered. The positive birth experience strengthened the self-confidence for a future birth and the childbirth fear was described as reduced or manageable.
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Affiliation(s)
- Birgitta Larsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, 846 53 Sundsvall, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Department of Nursing Sciences, Mid-Sweden University, 851 70 Sundsvall, Sweden
| | - Elin Ternström
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden
| | - Christine Rubertsson
- Department of Women's and Children's Health, Obstetrics and Gynecology, Uppsala University, 751 85 Uppsala, Sweden; Department of Health Sciences, Faculty of Medicine, Lund University, 221 00 Lund, Sweden
| | - Annika Karlström
- Department of Nursing Sciences, Mid-Sweden University, 851 70 Sundsvall, Sweden
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Caseload midwifery for women with fear of birth is a feasible option. SEXUAL & REPRODUCTIVE HEALTHCARE 2018; 16:50-55. [PMID: 29804775 DOI: 10.1016/j.srhc.2018.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Continuity with a known midwife might benefit women with fear of birth, but is rare in Sweden. The aim was to test a modified caseload midwifery model of care to provide continuity of caregiver to women with fear of birth. METHODS A feasibility study where women received antenatal and intrapartum care from a known midwife who focused on women's fear during all antenatal visits. The study was performed in one antenatal clinic in central Sweden and one university hospital labor ward. Data was collected with questionnaires in mid and late pregnancy and two months after birth. The main outcome was fear of childbirth. RESULT Eight out of ten women received all antenatal and intrapartum care from a known midwife. The majority had a normal vaginal birth with non-pharmacological pain relief. Satisfaction was high and most women reported that their fear of birth alleviated or disappeared. CONCLUSION Offering a modified caseload midwifery model of care seems to be a feasible option for women with elevated levels of childbirth fear as well as for midwives working in antenatal clinics as it reduces fear of childbirth for most women. Women were satisfied with the model of care and with the care provided.
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Larsson B, Karlström A, Rubertsson C, Ternström E, Ekdahl J, Segebladh B, Hildingsson I. Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial. Women Birth 2017; 30:460-467. [DOI: 10.1016/j.wombi.2017.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/14/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Hildingsson I, Haines H, Karlström A, Nystedt A. Presence and process of fear of birth during pregnancy—Findings from a longitudinal cohort study. Women Birth 2017; 30:e242-e247. [DOI: 10.1016/j.wombi.2017.02.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 01/31/2017] [Accepted: 02/03/2017] [Indexed: 01/10/2023]
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Nystedt A, Hildingsson I. Women's and men's negative experience of child birth-A cross-sectional survey. Women Birth 2017; 31:103-109. [PMID: 28789827 DOI: 10.1016/j.wombi.2017.07.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/01/2017] [Accepted: 07/06/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND A negative birth experience may influence both women and men and can limit their process of becoming a parent. AIMS This study aimed to analyze and describe women's and men's perceptions and experiences of childbirth. DESIGN A cross-sectional study of women and their partners living in one Swedish county were recruited in mid pregnancy and followed up two months after birth. Women (n=928) and men (n=818) completed the same questionnaire that investigated new parents' birth experiences in relation to socio-demographic background and birth related variables. RESULTS Women (6%) and men (3%) with a negative birth experiences, experienced longer labours and more often emergency caesarean section compared to women (94%) and men (97%) with a positive birth experience. The obstetric factors that contributed most strongly to a negative birth experience were emergency caesarean and was found in women (OR 4.7, 95% CI 2.0-10.8) and men (OR 4.5, Cl 95% 1.4-17.3). In addition, pain intensity and elective caesarean section were also associated with a negative birth experiences in women. Feelings during birth such as agreeing with the statement; 'It was a pain to give birth' were a strong contributing factor for both women and men. CONCLUSIONS A negative birth experience is associated with obstetric factors such as emergency caesarean section and negative feelings. The content of negative feelings differed between women and men. It is important to take into account that their feelings differ in order to facilitate the processing of the negative birth experience for both partners.
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Affiliation(s)
- Astrid Nystedt
- Department of Nursing, Umeå Universitet, 90187 Umeå, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, 751 85 Uppsala, Sweden; Department of Nursing, Mid Sweden University, 85170 Sundsvall, Sweden
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Ternström E, Hildingsson I, Haines H, Karlström A, Sundin Ö, Ekdahl J, Segeblad B, Larsson B, Rondung E, Rubertsson C. A randomized controlled study comparing internet-based cognitive behavioral therapy and counselling by standard care for fear of birth - A study protocol. SEXUAL & REPRODUCTIVE HEALTHCARE 2017; 13:75-82. [PMID: 28844361 DOI: 10.1016/j.srhc.2017.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 06/04/2017] [Accepted: 06/13/2017] [Indexed: 11/25/2022]
Abstract
Fear of birth is a concern that requires evidence based treatment. The aim of this study is to present the protocol of a randomized controlled multi-center trial to compare internet-based cognitive therapy with counseling as standard care for pregnant women reporting fear of birth. Participants will be recruited in mid-pregnancy. Women who score 60 or above on the Fear of Birth Scale will be offered to participate in this study. Data will be collected by questionnaires including validated instruments at baseline and follow-ups at gestational weeks 30 and 36, two months and one year after birth. The primary outcome will be level of fear of birth measured with the Fear of Birth Scale at 36 weeks of gestation. Secondary outcome measures are level of fear of birth at two months and one year after giving birth, preferences for mode of birth, requests for elective cesarean section, compliance and satisfaction with treatment and birth outcomes. A power calculation based on a 20% reduction of fear implies that approximately 200 will be included in the trial. The study outlined in this protocol will be the first randomized controlled trial comparing internet-based cognitive therapy with counseling for women reporting fear of birth. An effective treatment may result in better overall health for women with fear of birth and a reduction in cesarean sections for non-medical reasons. Evidence regarding treatment options of fear of birth will also provide a greater choice for women.
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Affiliation(s)
- Elin Ternström
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | - Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Health Science, Mid Sweden University, Sundsvall, Sweden.
| | - Helen Haines
- Rural Health Academic Centre, University of Melbourne, Victoria, Australia.
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | - Örjan Sundin
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Johanna Ekdahl
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | | | - Birgitta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Research and Development Centre, Sundsvall Hospital, Sundsvall, Sweden.
| | - Elisabet Rondung
- Department of Psychology, Mid Sweden University, Östersund, Sweden.
| | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
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Nilsson C, Lalor J, Begley C, Carroll M, Gross MM, Grylka-Baeschlin S, Lundgren I, Matterne A, Morano S, Nicoletti J, Healy P. Vaginal birth after caesarean: Views of women from countries with low VBAC rates. Women Birth 2017; 30:481-490. [PMID: 28545775 DOI: 10.1016/j.wombi.2017.04.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 04/01/2017] [Accepted: 04/25/2017] [Indexed: 11/27/2022]
Abstract
PROBLEM AND BACKGROUND Vaginal birth after caesarean section is a safe option for the majority of women. Seeking women's views can be of help in understanding factors of importance for achieving vaginal birth in countries where the vaginal birth rates after caesarean is low. AIM To investigate women's views on important factors to improve the rate of vaginal birth after caesareanin countries where vaginal birth rates after previous caesarean are low. METHODS A qualitative study using content analysis. Data were gathered through focus groups and individual interviews with 51 women, in their native languages, in Germany, Ireland and Italy. The women were asked five questions about vaginal birth after caesarean. Data were translated to English, analysed together and finally validated in each country. FINDINGS Important factors for the women were that all involved in caring for them were of the same opinion about vaginal birth after caesarean, that they experience shared decision-making with clinicians supportive of vaginal birth, receive correct information, are sufficiently prepared for a vaginal birth, and experience a culture that supports vaginal birth after caesarean. DISCUSSION AND CONCLUSION Women's decision-making about vaginal birth after caesarean in these countries involves a complex, multidimensional interplay of medical, psychosocial, cultural, personal and practical considerations. Further research is needed to explore if the information deficit women report negatively affects their ability to make informed choices, and to understand what matters most to women when making decisions about vaginal birth after a previous caesarean as a mode of birth.
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Affiliation(s)
- Christina Nilsson
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Margaret Carroll
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | | | - Ingela Lundgren
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Andrea Matterne
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Sandra Morano
- Department of Neurologic, Oculistic, Gynaecologic, Maternal and Infant Sciences, University of Genoa, Italy
| | - Jane Nicoletti
- Department of Neurologic, Oculistic, Gynaecologic, Maternal and Infant Sciences, University of Genoa, Italy
| | - Patricia Healy
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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