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Sutton E, Detering K, East C, Whittaker A. Women's expectations about birth, requests for pain relief in labor and the subsequent development of birth dissonance and trauma. BMC Pregnancy Childbirth 2023; 23:777. [PMID: 37946106 PMCID: PMC10633977 DOI: 10.1186/s12884-023-06066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/13/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Birth is a significant event in women's lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. METHODS A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a 'natural birth' (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed - at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. RESULTS The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance - which we have termed 'birth dissonance' leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. CONCLUSIONS Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women's requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it.
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Affiliation(s)
- Elizabeth Sutton
- Monash Bioethics Centre - Monash University, Melbourne, Australia.
| | - Karen Detering
- Monash Bioethics Centre - Monash University, Melbourne, Australia
- Department of Health and Aged Care, Melbourne, Australia
| | - Christine East
- Nursing and Midwifery - La Trobe University, Melbourne, Australia
| | - Andrea Whittaker
- Sociology and Anthropology - Monash University, Melbourne, Australia
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Avignon V, Gaucher L, Baud D, Legardeur H, Dupont C, Horsch A. What do mothers think about their antenatal classes? A mixed-method study in Switzerland. BMC Pregnancy Childbirth 2023; 23:741. [PMID: 37858110 PMCID: PMC10585766 DOI: 10.1186/s12884-023-06049-8] [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: 05/05/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023] Open
Abstract
PROBLEM Research so far has evaluated the effect of antenatal classes, but few studies have investigated its usefulness from the perspective of mothers after birth. BACKGROUND Antenatal classes evolved from pain management to a mother-centred approach, including birth plans and parenting education. Evaluating the perception of the usefulness of these classes is important to meet mother's needs. However, so far, research on the mothers' perception of the usefulness of these classes is sparse, particularly when measured after childbirth. Given that antenatal classes are considered as adult education, it is necessary to carry out this evaluation after mothers have had an opportunity to apply some of the competences they acquired during the antenatal classes during their childbirth. AIM This study investigated mothers' satisfaction and perceived usefulness of antenatal classes provided within a university hospital in Switzerland, as assessed in the postpartum period. METHODS Primiparous mothers who gave birth at a Swiss university hospital from January 2018 to September 2020 were contacted. Those who had attended the hospital's antenatal classes were invited to complete a questionnaire consisting of a quantitative and qualitative part about usefulness and satisfaction about antenatal classes. Quantitative data were analysed using both descriptive and inferential statistics. Qualitative data were analysed using thematic analysis. FINDINGS Among the 259 mothers who answered, 61% (n = 158) were globally satisfied with the antenatal classes and 56.2% (n = 145) found the sessions useful in general. However, looking at the utility score of each theme, none of them achieved a score of usefulness above 44%. The timing of some of these sessions was questioned. Some mothers regretted the lack of accurate information, especially on labour complications and postnatal care. DISCUSSION Antenatal classes were valued for their peer support. However, in their salutogenic vision of empowerment, they did not address the complications of childbirth, even though this was what some mothers needed. Furthermore, these classes could also be more oriented towards the postpartum period, as requested by some mothers. CONCLUSION Revising antenatal classes to fit mothers' needs could lead to greater satisfaction and thus a better impact on the well-being of mothers and their families.
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Affiliation(s)
- Valérie Avignon
- Department Woman-Mother-Child, Obstetric Service, Lausanne University Hospital (CHUV) and University of Lausanne, Avenue Pierre-Decker 2, Lausanne, 1011, Switzerland
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, 69008, France
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Route de La Corniche 10 - Bâtiment Proline, Lausanne, CH-1010, Switzerland
| | - Laurent Gaucher
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, 69008, France
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts, Geneva, Western Switzerland, 1206, Switzerland
| | - David Baud
- Department Woman-Mother-Child, Obstetric Service, Lausanne University Hospital (CHUV) and University of Lausanne, Avenue Pierre-Decker 2, Lausanne, 1011, Switzerland
| | - Hélène Legardeur
- Department Woman-Mother-Child, Obstetric Service, Lausanne University Hospital (CHUV) and University of Lausanne, Avenue Pierre-Decker 2, Lausanne, 1011, Switzerland
| | - Corinne Dupont
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, 69008, France
| | - Antje Horsch
- Department Woman-Mother-Child, Obstetric Service, Lausanne University Hospital (CHUV) and University of Lausanne, Avenue Pierre-Decker 2, Lausanne, 1011, Switzerland.
- Institute of Higher Education and Research in Healthcare-IUFRS, University of Lausanne, Lausanne University Hospital, Route de La Corniche 10 - Bâtiment Proline, Lausanne, CH-1010, Switzerland.
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Cross H, Krahé C, Spiby H, Slade P. Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health? BMC Pregnancy Childbirth 2023; 23:543. [PMID: 37501081 PMCID: PMC10375777 DOI: 10.1186/s12884-023-05846-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/11/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards 'normal birth', whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has not been explored. We examined the relationship between the content of antenatal preparation received and birth experience, taking into account obstetric complications and procedures. As birth experience can have a profound impact on a mother's postnatal well-being, we also investigated associations with mothers' postnatal mood and anxiety. METHODS N = 253 first-time mothers completed a cross-sectional survey measuring demographic and clinical factors, antenatal preparation content (categorised as normality-focused or broader-focused), obstetric complications and procedures experienced, birth experience (measured using three separate indices; the Childbirth Experience Questionnaire, emotional experiences, and presence/absence of birth trauma), postnatal depression and anxiety, and qualitative information on how the COVID-19 pandemic had affected birth experience. RESULTS Regarding birth experience, receiving more broader-focused preparation was associated with a more positive birth experience irrespective of complications/procedures experienced, while receiving only normality-focused preparation was beneficial in the context of fewer complications/procedures. Regarding birth trauma, receiving more broader-focused preparation was associated with lower likelihood of reporting birth as traumatic only in the context of more complications/procedures. Degree of normality-focused preparation was unrelated to experience of birth trauma. Lastly, while more complications/procedures were associated with greater anxiety and low mood, only greater normality-focused preparation was linked with better postnatal mental health. CONCLUSIONS Antenatal preparation including both normality- and broader-focused information is positively related to women's birth experience. While normality-focused preparation seems most beneficial if fewer complications/procedures are experienced, broader-focused preparation may be most beneficial in the context of a greater number of complications/procedures. As complications/procedures are often unpredictable, offering broader-focused preparation routinely is likely to benefit women's birth experience. This antenatal preparation should be freely available and easily accessible.
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Affiliation(s)
- Hannah Cross
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- Lancashire and South Cumbria NHS Foundation Trust, Blackpool, UK
| | - Charlotte Krahé
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Pauline Slade
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, UK.
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Alizadeh-Dibazari Z, Abdolalipour S, Mirghafourvand M. The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis. BMC Pregnancy Childbirth 2023; 23:541. [PMID: 37501120 PMCID: PMC10373291 DOI: 10.1186/s12884-023-05867-0] [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: 03/08/2023] [Accepted: 07/22/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health. METHODS We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. RESULTS Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes. CONCLUSIONS Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions. PROSPERO ID CRD42022376895.
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Affiliation(s)
- Zohreh Alizadeh-Dibazari
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Somayeh Abdolalipour
- Midwifery Department, Faculty of Nursing and Midwifery, Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Leng LL, Yin XC, Chan CLW, Ng SM. Antenatal mobile-delivered mindfulness-based intervention to reduce perinatal depression risk and improve obstetric and neonatal outcomes: A randomized controlled trial. J Affect Disord 2023; 335:216-227. [PMID: 37156275 DOI: 10.1016/j.jad.2023.04.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/03/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES One in five mothers will experience perinatal depression (PND) during pregnancy and within their first year following childbirth. Current evidence suggests the short-term efficacy of Mindfulness-based interventions (MBI) for perinatal women, but the extent to which this positive impact remains the early postpartum period is unclear. This study investigated the short- and maintenance efficacy of a mobile-delivered four-immeasurable MBI on PND, and obstetric and neonatal outcomes. METHODS Seventy-five adult pregnant women suffering from heightened distress were randomized to receive a mobile-delivered four-immeasurable MBI (n = 38) or a web-based perinatal education program (n = 37). PND was measured by Edinburgh Postnatal Depression Scale at baseline, post-intervention, 37th-week gestation, and 4-6 weeks postpartum. Outcomes also included obstetric and neonatal outcomes, trait mindfulness, self-compassion, and positive affect. RESULTS Participants reported an average age of 30.6 (SD = 3.1) years with a mean gestational age of 18.8 (SD = 4.6) weeks. In intention-to-treat analyses, women in the mindfulness group showed a significantly greater reduction in depression from baseline to post-intervention (adjusted mean change difference [β] = -3.9; 95%CI = [-6.05, -1.81]; d = -0.6), and the reduction sustained until 4-6 weeks postpartum (β = -6.3; 95%CI = [-8.43, -4.12]; d = -1.0), compared with control. They had a significantly reduced risk of emergent cesarean section (relative risk = 0.5) and gave birth to infants with higher Apgar scores (β = 0.6;p = .03; d = 0.7). Depression reduction before giving birth significantly mediated the intervention effect on lowering the emergency cesarean risk. CONCLUSIONS With a reasonably low dropout rate (13.2 %), the mobile-delivered MBI can be an acceptable and effective intervention for reducing depression throughout pregnancy and postpartum. Our study also suggests the potential benefits of early prevention for mitigating emergent cesarean section risk and enhancing neonatal health.
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Affiliation(s)
- Ling Li Leng
- The Department of Sociology, Zhejiang University, Hangzhou, China.
| | - Xi Can Yin
- School of Humanities, Southeast University, Nanjing, China
| | | | - Siu Man Ng
- Social Work and Social Administration Department, Hong Kong.
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Kiani Z, Moghasemi M, Elyasi F, Shirvani MA, Hamzehgardeshi Z, Tayebi T, Tabari NSM, Azarfar H, Moosazadeh M, Khani S. Design, implementation, and validation of an application for childbirth preparation classes to improve the performance of midwifery students: Study protocol. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:137. [PMID: 37397094 PMCID: PMC10312412 DOI: 10.4103/jehp.jehp_611_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/30/2022] [Indexed: 07/04/2023]
Abstract
BACKGROUND Childbirth preparation classes are incredibly useful for midwifery students as future medical personnel. Nowadays, given the outbreak of Covid-19 pandemic and as mobile applications are extensively welcomed, virtual space can be used for education in the area of childbirth preparation classes. Given the lack of an application for childbirth preparation classes, this study will be conducted to design, implement and validate such an application to improve the performance of midwifery students in the areas of pregnancy and safe delivery. MATERIALS AND METHODS The present study will be conducted in three phases. In the first phase, content will be provided to Information Technology experts based on the content of the national guidelines for physiological delivery in Iran, and the application will be designed and validated for the use of midwifery students, then develop app for other medical students, midwives and physicians. In the second phase, the assessment will be based on Kirkpatrick's model. In the third stage, develop app for other medical students, midwives and physicians based on the results of the first and second phase. SPSS version 17 will be used in this phase for analysis of data through descriptive and analytical tests. CONCLUSION Owing to the expansion of virtual space and the outbreak of Covid-19 pandemic, design, validation, and evaluation of an application for childbirth preparation classes is an exceptionally significant necessity which contributes to the process of educating midwifery students.
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Affiliation(s)
- Zahra Kiani
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mobina Moghasemi
- Student Research Committee, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Marjan Ahmadi Shirvani
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Tahereh Tayebi
- Department of Midwifery, School of Nursing and Midwifery, Mazandaran University of Medical Science, Sari, Iran
| | | | - Hamidreza Azarfar
- Information Technology Department, Vice- Chancellor in Research Affairs, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Soghra Khani
- Sexual and Reproductive Health Research Center, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Natsiou K, Karaoulanis SE, Dafopoulos K, Garas A, Bonotis K. The Effect of Socioeconomic Factors on Maternal Perinatal Depressive Symptoms and the Contribution of Group Prenatal Support as a Preventive Measure. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:31-38. [PMID: 36727096 PMCID: PMC9883668 DOI: 10.1089/whr.2022.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/26/2023]
Abstract
Background The European and Greek financial turmoil that began in 2007 has had adverse health consequences. Stillbirth, low birth weight, infant mortality, and maternal suicide have all increased. The purpose of this study was to evaluate whether socioeconomic factors contribute to postpartum blues, and whether psychoprophylaxis with group prenatal education and support may have a beneficial effect. Materials and Methods The sample study comprised 414 pregnant women equally divided into psychoprophylaxis or standard care. There were six psychoprophylaxis sessions, with two each week lasting 2 hours each in groups of five people at the urban health center of Larissa, Greece. A questionnaire was used for data collection, including (1) closed-type questions about sociodemographic characteristics, and medical and obstetric history; (2) the Hamilton Depression Scale; (3) a Blues Questionnaire; (4) the Holmes and Rahe stressful life events scale; and (5) a scale of effects of the economic crisis. Differences between the two groups and within the groups at different time points were assessed by two-way repeated measures ANOVA tests. Results Maternity blues scores, depression scores at all time points, life stress event score, and financial difficulty score were all significantly related to each other in both groups at all time points (p < 0.01). The correlation between financial difficulties and depression/maternity blues disappeared after delivery in the intervention group. Financial difficulties, depression, and psychoprophylaxis sessions emerged as independent prognostic factors of maternity blues score, the group variable being most significantly associated with maternal blues. Conclusion Although financial status as well as depression continued to play a role, the deterrent contribution of psychoprophylaxis was the most important parameter in the final maternity blues prognostic model. The results of our study show a potential for prevention and suggest interesting hypotheses for future interventions.
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Affiliation(s)
- Konstantina Natsiou
- Midwife, Psychoprophylaxis Department, Health Center of Larissa, Larissa, Greece.,Address correspondence to: Konstantina Natsiou, MSc, Midwife, Psychoprophylaxis Department, Health Center of Larissa, Larissa, Greece, Platykampos Larissa, PC 40009, Larissa, Greece,
| | - Sokratis E. Karaoulanis
- Department of Psychiatry, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Konstantinos Dafopoulos
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Health Science, University of Thessaly, Larissa, Greece
| | - Antonis Garas
- Department of Obstetrics & Gynecology, Faculty of Medicine, School of Health Science, University of Thessaly, Larissa, Greece
| | - Konstantinos Bonotis
- Department of Psychiatry, University Hospital of Larissa, University of Thessaly, Larissa, Greece
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Ghaffari SF, Elyasi F, Nikbakht R, Shahhosseini Z. A structural equation model analysis of the relationship between maternal fear of childbirth and expectant fathers' fear of childbirth: The mediating role of fathers' depression, anxiety, and stress. Brain Behav 2022; 12:e2802. [PMID: 36288399 PMCID: PMC9759126 DOI: 10.1002/brb3.2802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/21/2022] [Accepted: 10/08/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Some fathers experience traumatic and unpleasant feelings such as fear of childbirth during pregnancy and childbirth. This study aimed to determine the mediating role of the expectant fathers' depression, anxiety, and stress in the relationship between maternal fear of childbirth and paternal fear of childbirth. METHODS In this cross-sectional study, using a two-stage sampling method, 502 expectant Iranian fathers and their wives in the second half of pregnancy were recruited. The participants completed self-administered questionnaires, including the fathers' fear of childbirth scale, the Wijma delivery expectancy/experience questionnaire, and the depression, anxiety, and stress scale-21. To analyze the data, structural equation modeling was employed in the Amos software version 24. RESULTS Results indicated an acceptable fit of the model to the data. Maternal fear of childbirth was associated with paternal fear of childbirth, directly (β = 0.23, p = .046) and indirectly through the mediator of paternal depression, anxiety, and stress (β = .17, p = .007). The expectant fathers' stress had a greater impact on their fear of childbirth. CONCLUSIONS By considering the role of maternal fear of childbirth as well as expectant fathers' depression, anxiety, and stress on paternal fear of childbirth, it seems this study has some practical implications for improving the fathers' psychological well-being.
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Affiliation(s)
| | - Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Nikbakht
- Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran
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Leutenegger V, Grylka-Baeschlin S, Wieber F, Daly D, Pehlke-Milde J. The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review. BMC Pregnancy Childbirth 2022; 22:856. [PMID: 36402944 PMCID: PMC9675115 DOI: 10.1186/s12884-022-05178-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 11/03/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined. AIM Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes. METHODS The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I. RESULTS Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies. CONCLUSIONS Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.
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Affiliation(s)
- Vanessa Leutenegger
- School of Health Sciences, Institute of Midwifery, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
- Faculty of Medicine, University of Zurich, Zurich, Switzerland.
| | - Susanne Grylka-Baeschlin
- ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Midwifery, Winterthur, Switzerland
| | - Frank Wieber
- ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Public Health, Winterthur, Switzerland
- Department of Psychology, University of Konstanz, Constance, Germany
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Jessica Pehlke-Milde
- ZHAW Zurich University of Applied Sciences, School of Health Sciences, Research Institute of Midwifery, Winterthur, Switzerland
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10
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Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol 2022; 36:37-51. [PMID: 35659959 DOI: 10.1016/j.bpa.2022.04.005] [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: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. Providing safe choices for labor analgesia and support is central to creating a tailored, safe, and effective analgesic treatment plan with high maternal satisfaction. Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.
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Affiliation(s)
- Emily E Sharpe
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Mark D Rollins
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Ghaffari SF, Elyasi F, Mousavinasab SN, Shahhosseini Z. The effect of midwifery-led counseling on expectant fathers' fear of childbirth: a smartphone- based randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:285. [PMID: 35382772 PMCID: PMC8985284 DOI: 10.1186/s12884-022-04638-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expectant fathers experience a range of different emotions during their wife's pregnancy; one of these feelings is fear. It has adverse consequences on both the father and his family. The aim of this study was to investigate the effect of midwifery-led counseling on the fear of childbirth among expectant fathers. METHODS A two-armed parallel design randomized controlled trial was conducted from July to August 2020. Fifty expectant fathers with severe fear of childbirth at the 24th-27th weeks of gestation, in the Iranian setting, were assigned to intervention and control groups (allocation ratio1:1) using permuted block randomization. Participants assigned to the intervention group were engaged in six 60-90-min midwifery-led counseling sessions (twice a week) in the Skyroom platform. Measures were administered at recruitment, post-intervention, and one-month follow-up. The primary outcome was the change in fear of childbirth score between groups over time. Secondary outcomes were changes in the General Self-Efficacy score as well as changes in the frequency of the preferred type of delivery between groups over time. RESULTS The mean age of the participants was 31.64 (3.33) years. In the intention-to-treat analysis, the fear of childbirth score in the intervention group significantly decreased (β = - 11.84; 95% Confidence Interval: - 21.90 to - 1.78; P = 0.021) compared to that of the control group. In terms of secondary outcomes, the intervention group showed a significant increase in General Self-Efficacy compared to the intervention group at one-month follow-up measurement (β = 1.43; 95% Confidence Interval: 0.28 to 2.58; P = 0.014). However, the frequency of preferred delivery type was not significantly different between the intervention and control groups (P = 0.139). CONCLUSIONS Midwifery-led counseling can be an effective approach in reducing expectant fathers' childbirth fear with potential clinical significance. Although the inconclusive results imply more research on this issue. TRIAL REGISTRATION Registration number: IRCT20150608022609N6 . Registered 12/04/2019.
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Affiliation(s)
| | - Forouzan Elyasi
- Sexual and Reproductive Health Research Center, Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Hassanzadeh R, Abbas-Alizadeh F, Meedya S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. Perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience: A qualitative study. Midwifery 2021; 103:103154. [PMID: 34627102 DOI: 10.1016/j.midw.2021.103154] [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: 02/01/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE to evaluate the perceptions of primiparous women about the effect of childbirth preparation classes on their childbirth experience. DESIGN descriptive qualitative study. PARTICIPANTS AND SETTING 13 Iranian women who participated in childbirth preparation classes and had a vaginal delivery were interviewed. MEASUREMENTS semi-structured interviews were used to collect data. FINDINGS six main themes were extracted from the data analysis: incentive and learning about pregnancy and childbirth; active participation in labour; sense of self-control; use of non- medical pain relief methods during labour; preferring vaginal birth to caesarean section; and positive childbirth experience. KEY CONCLUSIONS women reported that participation in childbirth preparation classes prepared them well for a vaginal birth, and these classes were perceived to be associated with a positive childbirth experience. IMPLICATIONS FOR PRACTICE attendance at childbirth preparation classes is perceived to have a positive effect on vaginal birth. Therefore, encouraging and supporting women to attend the full course of classes has the potential to increase women's preference towards vaginal birth, resulting in a reduction in the caesarean section rate.
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Affiliation(s)
- Robab Hassanzadeh
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Fatemeh Abbas-Alizadeh
- Reproductive Health Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network, School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | - Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
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Dai L, Shen Q, Redding SR, Ouyang YQ. Simulation-based childbirth education for Chinese primiparas: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2021; 104:2266-2274. [PMID: 33663905 DOI: 10.1016/j.pec.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and feasibility of simulation-based childbirth education (SBCE) on reducing fear of childbirth (FOC) of Chinese primiparas. METHODS A total of 56 primiparas completed the trial including 26 in the intervention group and 30 in the control group. The intervention group received four sessions of SBCE while the control group received routine prenatal care. Chinese versions of the Wijma Delivery Expectancy/Experience Questionnaire (WDEQ-A) and Childbirth Self-Efficacy Inventory (CBSEI) were used to evaluate FOC and childbirth self-efficacy. Birth outcomes including delivery method, labor duration and Apgar scores were collected. RESULTS Scores on the WDEQ-A of the intervention group were statistically lower than those of the control group (P < 0.05). The CBSEI scores of the intervention group were significantly higher than those of the control group (P < 0.05). The cesarean birth rate of the intervention group was lower than that of the control group (34.61% vs 46.67%, P > 0.05). CONCLUSION Simulation-based childbirth education alleviates FOC, increases childbirth self-efficacy and improves birth outcomes, providing a new perspective to alleviate FOC of primiparas in the future. PRACTICE IMPLICATIONS Simulation-based childbirth education is an effective and feasible method to educate women about childbirth. Its integration into routine prenatal care of Chinese primiparas should be encouraged to reduce FOC.
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Affiliation(s)
- Lijing Dai
- School of Health Sciences, Wuhan University, Wuhan, China.
| | - Quan Shen
- School of Health Sciences, Wuhan University, Wuhan, China.
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14
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Jansson S, Farahshoor S, Linden K, Bogren M. The implementation process of the Confident Birth method in Swedish antenatal education: opportunities, obstacles and recommendations. Health Promot Int 2021; 36:649-659. [PMID: 32944762 PMCID: PMC8384378 DOI: 10.1093/heapro/daaa096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Antenatal clinics in western Sweden have recently invested in a birth method called Confident Birth. In this study, we investigate midwives' and first line managers' perceptions regarding the method, and identify opportunities and obstacles in its implementation. Semi-structured individual interviews were conducted with ten midwives and five first line managers working in 19 antenatal clinics in western Sweden. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. Intervention Characteristics-such as perceptions about the Confident Birth method-were found to have equipped the midwives with coping strategies that were useful for expecting parents during birth. Outer Setting-the method was implemented to harmonize the antenatal education, and provided a mean for a birth companionship of choice. Inner setting-included time-consuming preparations and insufficient information at all levels, which affected the implementation. Characteristics of individuals-, such as knowledge and believes in the method, where trust in the method was seen as an opportunity, while long experience of teaching other birth preparatory methods, affected how the Confident Birth method was perceived. Process-such as no strategy for ensuring that the core of the method remained intact or plans for guiding its implementation were major obstacles to successful implementation. The findings speak to the importance of adequate planning, time, information and communication throughout the process to have a successful implementation. Based on lessons learned from this study, we have developed recommendations for successful implementation of interventions, such as the Confident Birth, in antenatal care settings.
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Affiliation(s)
- Sofia Jansson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sepideh Farahshoor
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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15
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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: 11] [Impact Index Per Article: 3.7] [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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Ghaffari SF, Elyasi F, Mousavinasab SN, Shahhosseini Z. A systematic review of clinical trials affecting anxiety, stress and fear of childbirth in expectant fathers. Nurs Open 2021; 8:1527-1537. [PMID: 34102022 PMCID: PMC8186672 DOI: 10.1002/nop2.681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/25/2020] [Accepted: 10/27/2020] [Indexed: 01/24/2023] Open
Abstract
AIM To investigate clinical trials affecting anxiety, stress and fear of childbirth in fathers. DESIGN A systematic literature search was conducted based on Cochrane Collaboration statement recommendation and Preferred Reporting Items for Systematic reviews and Meta-Analyses checklist. METHODS With assistance of Medical Subject Headings, keywords were employed to search for relevant trials. Articles published between November 2000-November 2019 were searched in five electronic databases including PubMed, Web of Science, Google Scholar, Scopus and Cochrane as well as Iranian databases. The risk of bias was assessed by Cochrane Risk of Bias Scale. RESULTS A total of eight studies met the inclusion criteria. Interventions were classified into four categories including pre-natal education, music therapy, massage therapy and relaxation training. The results showed that there is no evidence of a best intervention, but it showed that non-pharmacological interventions can decrease anxiety, stress and fear of childbirth and increase the positive experience of childbirth in the expectant fathers.
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Affiliation(s)
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research CenterSexual and Reproductive Health Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
| | | | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research CenterMazandaran University of Medical SciencesSariIran
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17
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Hambidge S, Cowell A, Arden-Close E, Mayers A. "What kind of man gets depressed after having a baby?" Fathers' experiences of mental health during the perinatal period. BMC Pregnancy Childbirth 2021; 21:463. [PMID: 34187395 PMCID: PMC8244226 DOI: 10.1186/s12884-021-03947-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 06/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To date, information and support has been focused on mothers, with evidence that healthcare professionals overlook fathers' mental health, and that fathers receive little or no support for themselves during the perinatal period. However, recently, fathers' mental health has become an area of interest. METHODS This study explored the support fathers receive for their own mental health during the perinatal period. A qualitative questionnaire was distributed on social media networks and completed by twenty-nine fathers. RESULTS Thematic analysis produced three main themes: Factors Influencing Fathers' Mental Health, Consequences of Poor Mental Health in Fathers and Solutions to Improve Fathers' Mental Health. CONCLUSIONS The findings from this study highlighted important implications about fathers' mental health and the need to support them more effectively. Fathers' reluctance to seek support and the limited support available need to be addressed. Fathers in this study perceived that perinatal health professionals view 'mothers as the priority'. It is clear that health professionals need more training on how to recognise that fathers are also important and need support for their mental health.
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Affiliation(s)
- Sarah Hambidge
- Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK
| | - Amy Cowell
- Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK
| | - Emily Arden-Close
- Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK
| | - Andrew Mayers
- Department of Psychology, Bournemouth University, Poole, BH12 5BB, UK.
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18
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Azizi M, Kamali M, Elyasi F, Shirzad M. Fear of childbirth in Iran: A systematic review of psychological intervention research. Int J Reprod Biomed 2021; 19:401-420. [PMID: 34278194 PMCID: PMC8261095 DOI: 10.18502/ijrm.v19i5.9250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/18/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
Background Due to the fear of childbirth (FOC) and failure to provide painless delivery in Iran, the prevalence rate of elective cesarean section (C-section) performed on request by pregnant women is on the rise. However, no systematic review assessing the results of studies in this respect has been thus far developed. Objective To systematically review published psychological intervention research reflecting on FOC in Iran. Materials and Methods In this systematic review, the databases of PubMed, MEDLINE, PsycINFO, Wiley, ISI Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, and Scientific Information Database were searched to retrieve the relevant studies. Manual searches were performed to find the relevant articles and finally 21 intervention studies were reviewed. Results Based on the modified Jadad Scale, a methodological quality (risk of bias) assessment tool, 14 and 7 studies had acceptable or good and low quality, respectively. The included articles covered fear, fear of childbirth, pregnancy, and psychological intervention in Iran. Cognitive behavioral therapy, relaxation techniques, psychological counseling, childbirth preparation classes (CPCs), mindfulness programs, and psychoeducation had been also practiced as the main types of psychological interventions for reducing FOC in pregnant women. Conclusion There was no clear evidence to establish the most effective method for minimizing levels of FOC in pregnant women. Based on the assessment tool and since most of the studies had moderate or low quality, conducting standard and high-quality randomized controlled trials focusing on FOC in pregnant women is of most importance in Iranian population.
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Affiliation(s)
- Marzieh Azizi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Kamali
- Boali-Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahboobeh Shirzad
- Department of lnternal Medicine, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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19
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Doaltabadi Z, Amiri-Farahani L, Hasanpoor-Azghady SB, Haghani S. The effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women: A controlled quasi-experimental study. J Telemed Telecare 2021; 29:1357633X211024101. [PMID: 34160307 DOI: 10.1177/1357633x211024101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The spouse has a special role in promoting the health of mothers and infants during pregnancy, childbirth, and postpartum. Women's health during pregnancy requires the participation and cooperation of their spouses. Therefore, this study was conducted to determine the effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women. METHODS This is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by available method and pregnant women were divided into three groups of face-to-face training (n = 35), virtual training (n = 35), and control (n = 33). The content of training program in the virtual and face-to-face groups was similar and included; nutrition during pregnancy, emotional support, fetal growth and development, advantages and disadvantages of vaginal delivery, planning for delivery, infant care, and danger signs for infants, which were presented in four sessions. The samples in the control group did not receive any training. In the 18th and 20th weeks of pregnancy, the demographic information form, pregnancy experience scale, and version A of the Wijma delivery expectancy/experience questionnaires were completed, and once again in the 37th and 38th weeks of pregnancy, the pregnancy experience scale and version A of the Wijma delivery expectancy/experience questionnaires were completed. RESULTS There was a statistically significant difference in the mean score of pregnancy experience after the intervention between the face-to-face training and control groups (p = 0.001). There was a statistically significant difference in the mean score of uplifts between the two groups of face-to-face training and control (p = 0.01), and also between virtual training and control groups (p = 0.02). There was a statistically significant difference between the two groups of face-to-face training and control in terms of and hassles score after the intervention (p = 0.04). There was a statistically significant difference between the two groups of face-to-face training and control (p = 0.02) and also between virtual training and control (p = 0.04) in terms of the mean score of fear of childbirth after the intervention. CONCLUSION The results of this study showed that teaching prenatal care to spouses of primiparous women by face-to-face and virtual methods can be a useful intervention in improving the pregnancy experience and reducing the fear of childbirth among primiparous women.
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Affiliation(s)
- Zari Doaltabadi
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Reproductive Health and Midwifery, Nursing Care Research Center, School of Nursing and Midwifery, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Shima Haghani
- Department of Biostatistics, Nursing Care Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
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Biana CB, Cecagno D, Porto AR, Cecagno S, Marques VDA, Soares MC. Non-pharmacological therapies applied in pregnancy and labor: an integrative review. Rev Esc Enferm USP 2021; 55:e03681. [PMID: 33886910 DOI: 10.1590/s1980-220x2019019703681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/22/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To identify non-pharmacological therapies applied during pregnancy and labor. METHOD Integrative review conducted in the databases: PubMed, ScieLO and PEDro, searching for articles from 2008 in English, Spanish and Portuguese. The descriptors used were: pregnancy, childbirth, physiotherapy, alternative and complementary medicine, alternative therapy, non-pharmacological therapy, biomechanical therapy. RESULTS Forty-one articles were analyzed and subdivided into ten categories of nonpharmacological therapies: massage, perineal massage, hot bath, supportive care, childbirth preparation group, breathing techniques, pelvic floor exercises, transcutaneous electrostimulation, Swiss ball and spontaneous pushing. Six articles (60%) showed a positive outcome for reduction of pain in labor and all of them had a positive outcome for different variables of labor, such as reduction of time, anxiety and pelvic floor laceration rates. CONCLUSION The use of non-pharmacological therapies was efficient to reduce the effects of labor and childbirth, such as pain, duration of labor, anxiety, laceration and episiotomy.
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Affiliation(s)
- Camilla Benigno Biana
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
| | - Diana Cecagno
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
| | - Adrize Rutz Porto
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
| | - Susana Cecagno
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
| | - Vanessa de Araujo Marques
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
| | - Marilu Correa Soares
- Universidade Federal de Pelotas, Faculdade de Enfermagem, Departamento de Enfermagem, Pelotas, RS, Brazil
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21
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Ghaffari SF, Sharif Nia H, Elyasi F, Shahhosseini Z, Mohammadpoorsaravimozafar Z. Design and psychometric evaluation of the fathers' fear of childbirth scale: a mixed method study. BMC Pregnancy Childbirth 2021; 21:222. [PMID: 33743619 PMCID: PMC7981919 DOI: 10.1186/s12884-021-03696-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/04/2021] [Indexed: 01/18/2023] Open
Abstract
Background Fear of childbirth is reported in 13% of fathers, and it may have adverse consequences for the fathers’ health as well as their families. To reduce the fear of childbirth in the expectant fathers, an appropriate screening tool is needed. Due to the lack of a valid and reliable questionnaire to measure fathers’ fear of childbirth, this study was conducted to develop the Fathers’ Fear of Childbirth Scale and evaluate its psychometric properties. Methods This mixed method study was conducted in two phases. In the qualitative phase (or item generation), semi-structured interviews were conducted with 20 expectant fathers, and a literature review was performed to generate the Fathers’ Fear of Childbirth Scale items pool. In the quantitative phase (or psychometric evaluation), reliability as well as face, content, and construct validity of this scale were evaluated. To establish construct validity, exploratory and confirmatory factor analyses were performed. Reliability was evaluated through internal consistency and composite reliability measures. Results The primary version of Fathers’ Fear of Childbirth Scale contained 32 items, which were reduced to 17 items while establishing construct validity. Exploratory factor analysis extracted two factors, namely fear of childbirth process (12 items) and fear of hospital (5 items). These factors explained 50.82% of the total variance. Goodness of fit indices within the confirmatory factor analysis was acceptable. Internal consistency and composite reliability indices of all the factors were greater than 0.70. Conclusion The Fathers’ Fear of Childbirth Scale has a suitable validity and reliability for assessing fear of childbirth in fathers. It is a simple report instrument that can be easily implemented by health care professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03696-7.
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Affiliation(s)
| | - Hamid Sharif Nia
- Amol Faculty of Nursing, Mazandaran University of Medical Sciences, Sari, Iran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research Center, Sexual and Reproductive Health Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Shahhosseini
- Sexual and Reproductive Health Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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Moran E, Bradshaw C, Tuohy T, Noonan M. The Paternal Experience of Fear of Childbirth: An Integrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1231. [PMID: 33573071 PMCID: PMC7908162 DOI: 10.3390/ijerph18031231] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/17/2020] [Accepted: 01/23/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is estimated that approximately 13% of expectant fathers experience a pathological and debilitating fear of childbirth. OBJECTIVE The aim of this integrative review was to examine and synthesise the current body of research relating to paternal experience of fear of childbirth. METHODS A systematic literature search of five databases-CINAHL, Cochrane Library, MEDLINE, PsycArticles and PsycInfo-identified seventeen papers. Methodological quality of studies was assessed using the Crowe Critical Appraisal Tool. RESULTS Thematic data analysis identified three themes: the focus of fathers' childbirth-related fears, the impact of fear of childbirth on health and wellbeing, and fear of childbirth as a private burden. DISCUSSION Fear of childbirth is a significant and distressing experience for expectant fathers who may benefit from an opportunity to express their childbirth-related fears in an environment where they feel validated and supported. Antenatal education is recommended to enhance fathers' childbirth-related self-efficacy to reduce fear of childbirth. CONCLUSIONS Fear of childbirth may negatively impact the lives of men and consequently their families. Further investigation into methods and models for identifying and supporting men at risk of or experiencing fear of childbirth is required to improve outcomes for this population of men.
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Affiliation(s)
- Emma Moran
- St. Patrick’s Mental Health Services, D08K7YW Dublin, Ireland
| | - Carmel Bradshaw
- Department of Nursing and Midwifery, University of Limerick, V94X5K6 Limerick, Ireland; (C.B.); (T.T.); (M.N.)
| | - Teresa Tuohy
- Department of Nursing and Midwifery, University of Limerick, V94X5K6 Limerick, Ireland; (C.B.); (T.T.); (M.N.)
| | - Maria Noonan
- Department of Nursing and Midwifery, University of Limerick, V94X5K6 Limerick, Ireland; (C.B.); (T.T.); (M.N.)
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Hassanzadeh R, Abbas-Alizadeh F, Meedya S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. Comparison of childbirth experiences and postpartum depression among primiparous women based on their attendance in childbirth preparation classes. J Matern Fetal Neonatal Med 2020; 35:3612-3619. [PMID: 33076724 DOI: 10.1080/14767058.2020.1834531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Assessment of women's childbirth experience is an important indicator in maternity services. Positive childbirth experiences improve mothers' health, whereas negative childbirth experiences can cause psychological stresses and, in extreme cases, may lead to postpartum depression. METHODS In this cohort study, 204 women at 35-37 weeks of gestation were selected using cluster sampling from the health centers of Tabriz, Iran. Women were divided into three groups (68 women in each group) based on their attendance in childbirth preparation classes: (a) non-attenders (did not attend any sessions), (b) irregular attenders (attended 1-3 sessions), and (c) regular attendants (attended 4-8 sessions). Interviews were conducted at one month postpartum to complete the Childbirth Experience Questionnaire (CEQ) and Edinburgh Postnatal Depression Scale (EPDS). The general linear model (GLM) was used to identify associations between women's attendance to the classes and either their childbirth experience or postpartum depression scores. RESULTS Based on the GLM, the mean score of childbirth experience among the regular attenders was significantly higher than women who were irregular attenders (p = .032) or non-attenders (p < .001). In addition, the mean score of postpartum depression scale was significantly lower among regular attenders compared with non-attenders (p < .001). However, there was no significant difference in postpartum depression score among regular and irregular attenders (p = .257). CONCLUSIONS Attending prenatal classes was associated with positive childbirth experience and low postpartum depression score.
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Affiliation(s)
- Robab Hassanzadeh
- Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Abbas-Alizadeh
- Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Berghella V, Di Mascio D. Evidence-based labor management: before labor (Part 1). Am J Obstet Gynecol MFM 2019; 2:100080. [PMID: 33345992 DOI: 10.1016/j.ajogmf.2019.100080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 11/16/2022]
Abstract
In preparation for labor and delivery, there is high-quality evidence for providers to recommend perineal massage with oil for 5-10 minutes daily starting at 34 weeks until labor; ≥1 daily sets of repeated voluntary contractions of the pelvic floor muscles, performed at least several days of the week starting at approximately 30-32 weeks gestation; no x-ray pelvimetry; sweeping of membranes weekly starting at 37-38 weeks gestation; for women with a risk factor for abnormal outcome plans should be made to deliver in a hospital setting; for low-risk women, alongside birth center birth is associated with maternal benefits and higher satisfaction, compared with hospital birth; midwife-led care for low-risk women; continuous support by a professional such as doula, midwife, or nurse during labor; and training of birth attendants in low- and middle-income countries.
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Affiliation(s)
- Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
| | - Daniele Di Mascio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Italy
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Davis D, Ferguson S, Nissen J, Fowler C, Mosslar S. A salutary childbirth education program: Health promoting by design. A discussion paper. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 22:100456. [DOI: 10.1016/j.srhc.2019.100456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/26/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
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Hassanzadeh R, Abbas-Alizadeh F, Meedya S, Mohammad-Alizadeh-Charandabi S, Mirghafourvand M. Assessment of childbirth preparation classes: a parallel convergent mixed study. Reprod Health 2019; 16:160. [PMID: 31699110 PMCID: PMC6836369 DOI: 10.1186/s12978-019-0826-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 10/11/2019] [Indexed: 01/14/2023] Open
Abstract
Background Women’s fear from childbirth has been associated with increased medical interventions and traumatized birth experience. Although antenatal education is a crucial factor to empower and prepare women for their birth journey, it is not clear how Iranian childbirth classes can influence women’s fear and prepare them positively towards childbirth. This research is designed to evaluate childbirth preparation classes and their impact on women’s perception on their childbirth experiences. Methods/design This mixed method study with the parallel convergent design has two phases. The first phase will be a quantitative cohort study with 204 primiparous pregnant women at the gestational age of 35–37 weeks. The participants will be divided into three groups based on the number of their attendance into the childbirth preparation classes: a) regular participation (4 to 8 sessions), b) irregular participation (1 to 3 sessions), and c) no-participation. Participant will be followed-up to 1 month after birth. Antenatal data will be collected by using a demographic survey questionnaire, the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ, version A), the Van den Bergh Pregnancy-Related Anxiety Questionnaire, the Satisfaction with Childbirth Preparation Classes Questionnaire, the Edinburgh Postpartum Depression Scale (EPDS) and Knowledge regarding pregnancy and childbirth Questionnaire. Postnatal data will be collected by using an Obstetric and Labor Characteristics Questionnaire, EPDS, and Childbirth experience questionnaire (CEQ). The quantitative data will be analyzed using one-way ANOVA and the multivariate linear regression. The second phase of the study will be a qualitative study that will explore the women’s perceptions on the impact of participation in childbirth preparation classes on their childbirth experience. The sampling in this phase will be purposeful and the participants will be studied individually by using in-depth, semi-structured interviews. The qualitative data will be analyzed through content analysis with conventional approach. Discussion Assessing the impact of childbirth preparation classes on women’s childbirth experience in Iran will lead to developing recommendations about the content and quality of the childbirth classes that can improve women’s’ preparation towards positive childbirth.
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Affiliation(s)
- Robab Hassanzadeh
- Students' Research Committee, Tabriz University of Medical sciences, Tabriz, Iran
| | - Fatemeh Abbas-Alizadeh
- Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Midwifery Department, Tabriz University of Medical sciences, Tabriz, Iran.
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Citak Bilgin N, Ak B, Ayhan F, Kocyigit F, Yorgun S, Topcuoglu MA. Effect of childbirth education on the perceptions of childbirth and breastfeeding self-efficacy and the obstetric outcomes of nulliparous women*,**,***. Health Care Women Int 2019; 41:188-204. [DOI: 10.1080/07399332.2019.1672171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Nevin Citak Bilgin
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Bedriye Ak
- Department of Pediatric Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Fatma Ayhan
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | | | | | - Mehmet Ata Topcuoglu
- Department of Obstetrics and Gynecology, Faculty of Medicine, Bolu Abant Izzet Baysal University, Bolu, Turkey
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Park S, Kim J, Oh J, Ahn S. Effects of psychoeducation on the mental health and relationships of pregnant couples: A systemic review and meta-analysis. Int J Nurs Stud 2019; 104:103439. [PMID: 32058139 DOI: 10.1016/j.ijnurstu.2019.103439] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 09/19/2019] [Accepted: 09/21/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous studies suggest that psychoeducational interventions for pregnant and postpartum couples can improve perinatal mental health outcomes and promote couples' relationships. However, most studies conducted to date have focused only on maternal depression, with few studies addressing the needs of fathers, or the effects of paternal participation on the mental health/relationship of both partners. OBJECTIVES This study aimed to systematically examine the effects of perinatal couples' psychoeducation on parental mental health and their relationship. DESIGN A systematic review and meta-analysis were conducted. DATA SOURCES Six electronic databases were searched, including Embase, MEDLINE, Web of Science, the Cochrane Library, CINAHL, and PubMed. REVIEW METHODS The authors independently extracted data from journals written in English or Korean, published between January 2000 and August 2017. Randomized controlled trials (RCTs) that reported psycho-emotional symptoms and couples' relationship outcomes were screened. Of the 11 studies that systematically reviewed couples' mental health and relationship problems, seven RCTs, with data available to pool for quantitative analysis, were reviewed. The total number of participants from all studies was 7119, and the number of participant couples ranged from 15 to 869. RESULTS Psychoeducational interventions had a small effect size in promoting maternal mental health (SMD = -0.307; 95% CI: -0.47 to -0.14). However, there was evidence of heterogeneity for the overall outcome, with I2 of 16% and p = .27. Paternal mental health also improved, but with a small effect size (SMD = -0.296; 95% CI: -0.53 to -0.05). The pooled results of four studies showed that interventions had very small effect sizes for improving maternal perception of the couple's relationship (SMD = 0.125; 95% CI: -0.05 to 0.30). There was evidence of heterogeneity for the overall outcome, with I2 of 7% and p = .36. Psychoeducational interventions with fathers showed a medium effect size for improving paternal perception of the couple's relationship (SMD = 0.348; 95% CI: 0.16 to 0.52); heterogeneity was I2 of 0% and p = .68. CONCLUSION This study was meaningful as it revealed evidence from published trials regarding the effectiveness of psychoeducational programs that target both pregnant women and their partners. Results indicate that psychoeducational interventions can reduce maternal postpartum depression and ameliorate paternal negative affect, as well as provide overall improvement in the couples' relationship satisfaction. However, further studies on physiological indicators and/or clinical symptoms of postpartum depression are needed to better understand the practical significance of psychoeducational intervention.
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Affiliation(s)
- Seyeon Park
- College of Nursing, Chungnam National University, Daejeon 35015 South Korea
| | - Jisoon Kim
- College of Nursing, Chungnam National University, Daejeon 35015 South Korea
| | - Jiwon Oh
- Seoul Women's Hospital, 7, Munjeong-ro, Seo-gu, Daejeon 35235 South Korea
| | - Sukhee Ahn
- College of Nursing, Chungnam National University, Daejeon 35015 South Korea.
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Ghanbari-Homayi S, Hasani S, Meedya S, Asghari Jafarabadi M, Mirghafourvand M. Nonpharmacological approaches to improve women's childbirth experiences: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2019; 34:479-491. [PMID: 30983443 DOI: 10.1080/14767058.2019.1608434] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I2 index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.
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Affiliation(s)
- Solmaz Ghanbari-Homayi
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sonia Hasani
- Students' Research Committee, Midwifery Department, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Mohammad Asghari Jafarabadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
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Campbell V, Nolan M. 'It definitely made a difference': A grounded theory study of yoga for pregnancy and women's self-efficacy for labour. Midwifery 2018; 68:74-83. [PMID: 30396001 DOI: 10.1016/j.midw.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/07/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth. DESIGN A longitudinal grounded theory study. METHODS Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework. SETTING Three yoga for pregnancy teachers' classes in England. PARTICIPANTS Twenty two women attending yoga for pregnancy classes. FINDINGS Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.
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Affiliation(s)
- Virginia Campbell
- University of Worcester, St John's Campus, Henwick Grove, Worcester WR2 6AJ, United Kingdom.
| | - Mary Nolan
- University of Worcester, St John's Campus, Henwick Grove, Worcester WR2 6AJ, United Kingdom.
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Chen I, Opiyo N, Tavender E, Mortazhejri S, Rader T, Petkovic J, Yogasingam S, Taljaard M, Agarwal S, Laopaiboon M, Wasiak J, Khunpradit S, Lumbiganon P, Gruen RL, Betran AP. Non-clinical interventions for reducing unnecessary caesarean section. Cochrane Database Syst Rev 2018; 9:CD005528. [PMID: 30264405 PMCID: PMC6513634 DOI: 10.1002/14651858.cd005528.pub3] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Caesarean section rates are increasing globally. The factors contributing to this increase are complex, and identifying interventions to address them is challenging. Non-clinical interventions are applied independently of a clinical encounter between a health provider and a patient. Such interventions may target women, health professionals or organisations. They address the determinants of caesarean births and could have a role in reducing unnecessary caesarean sections. This review was first published in 2011. This review update will inform a new WHO guideline, and the scope of the update was informed by WHO's Guideline Development Group for this guideline. OBJECTIVES To evaluate the effectiveness and safety of non-clinical interventions intended to reduce unnecessary caesarean section. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers in March 2018. We also searched websites of relevant organisations and reference lists of related reviews. SELECTION CRITERIA Randomised trials, non-randomised trials, controlled before-after studies, interrupted time series studies and repeated measures studies were eligible for inclusion. The primary outcome measures were: caesarean section, spontaneous vaginal birth and instrumental birth. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures recommended by Cochrane. We narratively described results of individual studies (drawing summarised evidence from single studies assessing distinct interventions). MAIN RESULTS We included 29 studies in this review (19 randomised trials, 1 controlled before-after study and 9 interrupted time series studies). Most of the studies (20 studies) were conducted in high-income countries and none took place in low-income countries. The studies enrolled a mixed population of pregnant women, including nulliparous women, multiparous women, women with a fear of childbirth, women with high levels of anxiety and women having undergone a previous caesarean section.Overall, we found low-, moderate- or high-certainty evidence that the following interventions have a beneficial effect on at least one primary outcome measure and no moderate- or high-certainty evidence of adverse effects.Interventions targeted at women or familiesChildbirth training workshops for mothers alone may reduce caesarean section (risk ratio (RR) 0.55, 95% confidence interval (CI) 0.33 to 0.89) and may increase spontaneous vaginal birth (RR 2.25, 95% CI 1.16 to 4.36). Childbirth training workshops for couples may reduce caesarean section (RR 0.59, 95% CI 0.37 to 0.94) and may increase spontaneous vaginal birth (RR 2.13, 95% CI 1.09 to 4.16). We judged this one study with 60 participants to have low-certainty evidence for the outcomes above.Nurse-led applied relaxation training programmes (RR 0.22, 95% CI 0.11 to 0.43; 104 participants, low-certainty evidence) and psychosocial couple-based prevention programmes (RR 0.53, 95% CI 0.32 to 0.90; 147 participants, low-certainty evidence) may reduce caesarean section. Psychoeducation may increase spontaneous vaginal birth (RR 1.33, 95% CI 1.11 to 1.61; 371 participants, low-certainty evidence). The control group received routine maternity care in all studies.There were insufficient data on the effect of the four interventions on maternal and neonatal mortality or morbidity.Interventions targeted at healthcare professionalsImplementation of clinical practice guidelines combined with mandatory second opinion for caesarean section indication slightly reduces the risk of overall caesarean section (mean difference in rate change -1.9%, 95% CI -3.8 to -0.1; 149,223 participants). Implementation of clinical practice guidelines combined with audit and feedback also slightly reduces the risk of caesarean section (risk difference (RD) -1.8%, 95% CI -3.8 to -0.2; 105,351 participants). Physician education by local opinion leader (obstetrician-gynaecologist) reduced the risk of elective caesarean section to 53.7% from 66.8% (opinion leader education: 53.7%, 95% CI 46.5 to 61.0%; control: 66.8%, 95% CI 61.7 to 72.0%; 2496 participants). Healthcare professionals in the control groups received routine care in the studies. There was little or no difference in maternal and neonatal mortality or morbidity between study groups. We judged the certainty of evidence to be high.Interventions targeted at healthcare organisations or facilitiesCollaborative midwifery-labourist care (in which the obstetrician provides in-house labour and delivery coverage, 24 hours a day, without competing clinical duties), versus a private practice model of care, may reduce the primary caesarean section rate. In one interrupted time series study, the caesarean section rate decreased by 7% in the year after the intervention, and by 1.7% per year thereafter (1722 participants); the vaginal birth rate after caesarean section increased from 13.3% before to 22.4% after the intervention (684 participants). Maternal and neonatal mortality were not reported. We judged the certainty of evidence to be low.We studied the following interventions, and they either made little or no difference to caesarean section rates or had uncertain effects.Moderate-certainty evidence suggests little or no difference in caesarean section rates between usual care and: antenatal education programmes for physiologic childbirth; antenatal education on natural childbirth preparation with training in breathing and relaxation techniques; computer-based decision aids; individualised prenatal education and support programmes (versus written information in pamphlet).Low-certainty evidence suggests little or no difference in caesarean section rates between usual care and: psychoeducation; pelvic floor muscle training exercises with telephone follow-up (versus pelvic floor muscle training without telephone follow-up); intensive group therapy (cognitive behavioural therapy and childbirth psychotherapy); education of public health nurses on childbirth classes; role play (versus standard education using lectures); interactive decision aids (versus educational brochures); labourist model of obstetric care (versus traditional model of obstetric care).We are very uncertain as to the effect of other interventions identified on caesarean section rates as the certainty of the evidence is very low. AUTHORS' CONCLUSIONS We evaluated a wide range of non-clinical interventions to reduce unnecessary caesarean section, mostly in high-income settings. Few interventions with moderate- or high-certainty evidence, mainly targeting healthcare professionals (implementation of guidelines combined with mandatory second opinion, implementation of guidelines combined with audit and feedback, physician education by local opinion leader) have been shown to safely reduce caesarean section rates. There are uncertainties in existing evidence related to very-low or low-certainty evidence, applicability of interventions and lack of studies, particularly around interventions targeted at women or families and healthcare organisations or facilities.
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Affiliation(s)
- Innie Chen
- University of OttawaDepartment of Obstetrics & GynecologyOttawaONCanada
| | - Newton Opiyo
- CochraneCochrane Editorial UnitSt Albans House, 57‐59 HaymarketLondonUKSW1Y 4QX
| | - Emma Tavender
- Monash UniversityAustralian Satellite of the Cochrane EPOC Group, School of Public Health and Preventative MedicineMelbourneVictoriaAustraliaVIC 3004
| | | | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH)600‐865 Carling AvenueOttawaONCanada
| | - Jennifer Petkovic
- University of OttawaBruyère Research Institute43 Bruyère StAnnex E, room 312OttawaONCanadaK1N 5C8
| | | | - Monica Taljaard
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramThe Ottawa Hospital ‐ Civic Campus1053 Carling Ave, Box 693OttawaONCanadaK1Y 4E9
| | | | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Jason Wasiak
- Austin Health; The University of MelbourneOlivia Newton John Cancer Research Institute; Department of PaediatricsMelbourneVictoriaAustralia
- University of MelbourneDepartment of PediatricsMelbourneVictoriaAustralia
| | - Suthit Khunpradit
- Lamphun HospitalDepartment of Obstetrics and Gynaecology177 Jamthevee RoadLamphunLamphunThailand51000
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Russell L Gruen
- Nanyang Technological UniversityLee Kong Chian School of Medicine11 Mandalay RoadSingaporeSingapore308232
| | - Ana Pilar Betran
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and ResearchGenevaSwitzerland
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Rajabi Naeeni M, Simbar M. Effect of Child Birth Preparation Classes on Empowering Iranian Pregnant Women: A Systematic Review. JOURNAL OF EDUCATION AND COMMUNITY HEALTH 2018. [DOI: 10.21859/jech.5.1.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Smith CA, Levett KM, Collins CT, Armour M, Dahlen HG, Suganuma M. Relaxation techniques for pain management in labour. Cochrane Database Syst Rev 2018; 3:CD009514. [PMID: 29589650 PMCID: PMC6494625 DOI: 10.1002/14651858.cd009514.pub2] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute to the popularity of complementary methods of pain management. This review examined currently available evidence on the use of relaxation therapies for pain management in labour. This is an update of a review first published in 2011. OBJECTIVES To examine the effects of mind-body relaxation techniques for pain management in labour on maternal and neonatal well-being during and after labour. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (9 May 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 5 2017), MEDLINE (1966 to 24 May 2017), CINAHL (1980 to 24 May 2017), the Australian New Zealand Clinical Trials Registry (18 May 2017), ClinicalTrials.gov (18 May 2017), the ISRCTN Register (18 May 2017), the WHO International Clinical Trials Registry Platform (ICTRP) (18 May 2017), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (including quasi randomised and cluster trials) comparing relaxation methods with standard care, no treatment, other non-pharmacological forms of pain management in labour or placebo. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We attempted to contact study authors for additional information. We assessed evidence quality with GRADE methodology. MAIN RESULTS This review update includes 19 studies (2519 women), 15 of which (1731 women) contribute data. Interventions examined included relaxation, yoga, music and mindfulness. Approximately half of the studies had a low risk of bias for random sequence generation and attrition bias. The majority of studies had a high risk of bias for performance and detection bias, and unclear risk of bias for, allocation concealment, reporting bias and other bias. We assessed the evidence from these studies as ranging from low to very low quality, and therefore the effects below should be interpreted with caution.RelaxationWe found that relaxation compared to usual care provided lowered the intensity of pain (measured on a scale of 0 to 10 with low scores indicating less pain) during the latent phase of labour (mean difference (MD) -1.25, 95% confidence interval (CI) -1.97 to -0.53, one trial, 40 women). Four trials reported pain intensity in the active phase; there was high heterogeneity between trials and very low-quality evidence suggested that there was no strong evidence that the effects were any different between groups for this outcome (MD -1.08, 95% CI -2.57 to 0.41, four trials, 271 women, random-effects analysis). Very low-quality evidence showed that women receiving relaxation reported greater satisfaction with pain relief during labour (risk ratio (RR) 8.00, 95% CI 1.10 to 58.19, one trial, 40 women), and showed no clear benefit for satisfaction with childbirth experience (assessed using different scales) (standard mean difference (SMD) -0.03, 95% CI -0.37 to 0.31, three trials, 1176 women). For safety outcomes there was very low-quality evidence of no clear reduction in assisted vaginal birth (average RR 0.61, 95% CI 0.20 to 1.84, four trials, 1122 women) or in caesarean section rates (average RR 0.73, 95% CI 0.26 to 2.01, four trials, 1122 women). Sense of control in labour, and breastfeeding were not reported under this comparison.YogaWhen comparing yoga to control interventions there was low-quality evidence that yoga lowered pain intensity (measured on a scale of 0 to 10) with low scores indicating less pain) (MD -6.12, 95% CI -11.77 to -0.47, one trial, 66 women), greater satisfaction with pain relief (MD 7.88, 95% CI 1.51 to 14.25, one trial, 66 women) and greater satisfaction with childbirth experience (MD 6.34, 95% CI 0.26 to 12.42 one trial, 66 women (assessed using the Maternal Comfort Scale with higher score indicating greater comfort). Sense of control in labour, breastfeeding, assisted vaginal birth, and caesarean section were not reported under this comparison.MusicWhen comparing music to control interventions there was evidence of lower pain intensity in the latent phase for women receiving music (measured on a scale of 0 to 10 with low scores indicating less pain) (MD -0.73, 95% CI -1.01 to -0.45, random-effects analysis, two trials, 192 women) and very low-quality evidence of no clear benefit in the active phase (MD -0.51, 95% CI -1.10 to 0.07, three trials, 217 women). Very low-quality evidence suggested no clear benefit in terms of reducing assisted vaginal birth (RR 0.41, 95% CI 0.08 to 2.05, one trial, 156 women) or caesarean section rate (RR 0.78, 95% CI 0.36 to 1.70, two trials, 216 women). Satisfaction with pain relief, sense of control in labour, satisfaction with childbirth experience, and breastfeeding were not reported under this comparison.Audio analgesiaOne trial evaluating audio analgesia versus control only reported one outcome and showed no evidence of benefit in satisfaction with pain relief.MindfulnessOne trial evaluating mindfulness versus usual care found an increase in sense of control for the mindfulness group (using the Childbirth Self-Efficacy Inventory) (MD 31.30, 95% CI 1.61 to 60.99, 26 women). There is no strong evidence that the effects were any different between groups for satisfaction in childbirth, or for caesarean section rate, need for assisted vaginal delivery or need for pharmacological pain relief. No other outcomes were reported in this trial. AUTHORS' CONCLUSIONS Relaxation, yoga and music may have a role with reducing pain, and increasing satisfaction with pain relief, although the quality of evidence varies between very low to low. There was insufficient evidence for the role of mindfulness and audio-analgesia. The majority of trials did not report on the safety of the interventions. Further randomised controlled trials of relaxation modalities for pain management in labour are needed. Trials should be adequately powered and include clinically relevant outcomes such as those described in this review.
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Affiliation(s)
- Caroline A Smith
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Kate M Levett
- The University of Notre DameSchool of MedicineSydneyAustralia
| | - Carmel T Collins
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
| | - Mike Armour
- Western Sydney UniversityNational Institute of Complementary Medicine (NICM)Locked Bag 1797PenrithNew South WalesAustralia2751
| | - Hannah G Dahlen
- Western Sydney UniversitySchool of Nursing and MidwiferyLocked Bag 1797PenrithNSWAustralia2751
| | - Machiko Suganuma
- South Australian Health and Medical Research InstituteHealthy Mothers, Babies and Children72 King William RoadNorth AdelaideSouth AustraliaAustralia5006
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Matvienko-Sikar K, Murphy G, Murphy M. The role of prenatal, obstetric, and post-partum factors in the parenting stress of mothers and fathers of 9-month old infants. J Psychosom Obstet Gynaecol 2018. [PMID: 28635525 DOI: 10.1080/0167482x.2017.1286641] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The aim of this paper was to examine the role of perinatal, obstetric and post partum factors on maternal and paternal stress. It will present the first examination of the role of prenatal, obstetric, post-partum, and demographic variables in parenting stress for mothers and fathers at 9 months. METHODS Data from 6821 parental dyads of 9-month-old infants were extracted from the Growing Up in Ireland National Longitudinal Study of Children. Participants completed the Parental Stress Scale, the Dyadic Adjustment Scale, the Quality of Attachment Sub-scale from the Maternal and Paternal Postnatal Attachment Scales, and a single item health status question from the Short Form 12 Health Survey. Information on prenatal care, pregnancy complications, obstetric outcomes, infant health, and participant demographics were also collected. Separate hierarchical linear regressions were conducted for mothers and fathers Results: Mothers reported higher levels of parenting stress than fathers (p < 0.001). Maternal parenting stress was predicted by attachment, own health status, average sleep, occupation, household income, and having a very rapid labor. Paternal parenting stress was predicted by attachment and own health status. DISCUSSION A range of perinatal factors was associated with an increased risk of higher parenting stress at 9 months post-partum and the roles of these factors differ between mothers and fathers. These findings are important for predicting and reducing risk of parenting stress in both genders.
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Affiliation(s)
| | - Gillian Murphy
- b School of Applied Psychology, University College Cork , Ireland
| | - Mike Murphy
- b School of Applied Psychology, University College Cork , Ireland
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Sarpkaya Güder D, Yalvaç M, Vural G. The effect of pregnancy Pilates-assisted childbirth preparation training on childbirth fear and neonatal outcomes: a quasi-experimental/quantitative research. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s11135-018-0682-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Sanders RA, Crozier K. How do informal information sources influence women's decision-making for birth? A meta-synthesis of qualitative studies. BMC Pregnancy Childbirth 2018; 18:21. [PMID: 29316887 PMCID: PMC5761120 DOI: 10.1186/s12884-017-1648-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 12/28/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Women approach birth using various methods of preparation drawing from conventional healthcare providers alongside informal information sources (IIS) outside the professional healthcare context. An investigation of the forms in which these informal information sources are accessed and negotiated by women, and how these disconnected and often conflicting elements influence women's decision-making process for birth have yet to be evaluated. The level of antenatal preparedness women feel can have significant and long lasting implications on their birth experience and transition into motherhood and beyond. The aim of this study was to provide a deeper understanding of how informal information sources influence women's preparation for birth. METHODS Seven electronic databases were searched with predetermined search terms. No limitations were imposed for year of publication. English language studies using qualitative methods exploring women's experiences of informal information sources and their impact upon women's birth preparation were included, subject to a quality appraisal framework. Searches were initiated in February 2016 and completed by March 2016. Studies were synthesised using an interpretive meta-ethnographic approach. RESULTS Fourteen studies were included for the final synthesis from Great Britain, Australia, Canada and the United States. Four main themes were identified: Menu Birth; Information Heaven/Hell; Spheres of Support; and Trust. It is evident that women do not enter pregnancy as empty vessels devoid of a conceptual framework, but rather have a pre-constructed embodied knowledge base upon which other information is superimposed. Allied to this, it is clear that informal information was sought to mitigate against the widespread experience of discordant information provided by maternity professionals. CONCLUSION Women's access to the deluge of informal information sources in mainstream media during pregnancy have significant impact on decision making for birth. These informal sources redefine the power dynamic between women and maternal healthcare providers, simultaneously increasing levels of anxiety and challenging women's pre-existing ideations and aspirations of personal birth processes. A lack of awareness by some professionals of women's information seeking behaviours generates barriers to women-centred support, leaving an experience expectation mismatch unchecked. TRIAL REGISTRATION CRD42016041491 17/06/16.
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Affiliation(s)
- Ruth A. Sanders
- Norfolk & Norwich, University Hospitals NHS Foundation Trust, Colney Lane, Norwich, Norfolk NR4 7UY UK
- Norwich Norfolk, UK
| | - Kenda Crozier
- University of East Anglia, Norwich Research Park, Norwich, Norfolk NR4 7TJ UK
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Labor Pain Management. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Philpott LF, Leahy-Warren P, FitzGerald S, Savage E. Stress in fathers in the perinatal period: A systematic review. Midwifery 2017; 55:113-127. [DOI: 10.1016/j.midw.2017.09.016] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/15/2017] [Accepted: 09/17/2017] [Indexed: 01/23/2023]
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Moghaddam Hosseini V, Nazarzadeh M, Jahanfar S. Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials. Women Birth 2017; 31:254-262. [PMID: 29126794 DOI: 10.1016/j.wombi.2017.10.007] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/22/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Fear of childbirth is a problematic mental health issue during pregnancy. But, effective interventions to reduce this problem are not well understood. OBJECTIVES To examine effective interventions for reducing fear of childbirth. MATERIAL AND METHODS The Cochrane Central Register of Controlled Trials, PubMed, Embase and PsycINFO were searched since inception till September 2017 without any restriction. Randomised controlled trials and quasi-randomised controlled trials comparing interventions for treatment of fear of childbirth were included. The standardized mean differences were pooled using random and fixed effect models. The heterogeneity was determined using the Cochran's test and I2 index and was further explored in meta-regression model and subgroup analyses. RESULTS Ten studies inclusive of 3984 participants were included in the meta-analysis (2 quasi-randomized and 8 randomized clinical trials). Eight studies investigated education and two studies investigated hypnosis-based intervention. The pooled standardized mean differences of fear for the education intervention and hypnosis group in comparison with control group were -0.46 (95% CI -0.73 to -0.19) and -0.22 (95% CI -0.34 to -0.10), respectively. CONCLUSIONS Both types of interventions were effective in reducing fear of childbirth; however our pooled results revealed that educational interventions may reduce fear with double the effect of hypnosis. Further large scale randomized clinical trials and individual patient data meta-analysis are warranted for assessing the association.
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Affiliation(s)
| | - Milad Nazarzadeh
- The Collaboration Center of Meta-Analysis Research, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran.
| | - Shayesteh Jahanfar
- School of Health Sciences, Health Professions Building, Central Michigan University, Mount Pleasant, MI 48859, USA.
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Childbirth and parenting preparation in antenatal classes. Midwifery 2017; 57:1-7. [PMID: 29128739 DOI: 10.1016/j.midw.2017.10.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 10/22/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVES to describe topics (1) presented by midwives' during antenatal classes and the amount of time spent on these topics and (2) raised and discussed by first-time parents and the amount of time spent on these topics. DESIGN qualitative; data were gathered using video or tape recordings and analysed using a three-pronged content analysis approach, i.e., conventional, summative, and directed analyses. SETTING AND PARTICIPANTS 3 antenatal courses in 2 antenatal units in a large Swedish city; 3 midwives; and 34 course participants. FINDINGS class content focused on childbirth preparation (67% of the entire antenatal course) and on parenting preparation (33%). Childbirth preparation facilitated parents' understanding of the childbirth process, birthing milieu, the partner's role, what could go wrong during delivery, and pain relief advantages and disadvantages. Parenting preparation enabled parents to (i) plan for those first moments with the newborn; (ii) care for/physically handle the infant; (iii) manage breastfeeding; (iv) manage the period at home immediately after childbirth; and (v) maintain their relationship. During the classes, parents expressed concerns about what could happened to newborns. Parents' questions to midwives and discussion topics among parents were evenly distributed between childbirth preparation (52%) and parenting preparation (48%). KEY CONCLUSIONS childbirth preparation and pain relief consumed 67% of course time. Parents particularly reflected on child issues, relationship, sex, and anxiety. Female and male participants actively listened to the midwives, appeared receptive to complex issues, and needed more time to ask questions. Parents appreciated the classes yet needed to more information for managing various post-childbirth situations. IMPLICATIONS FOR PRACTICE while midwifery services vary among hospitals, regions, and countries, midwives might equalise content focus, offer classes in the second trimester, provide more time for parents to talk to each other, allow time in the course plan for parents to bring up new topics, and investigate: (i) ways in which antenatal course development and planning can improve; (ii) measures for evaluating courses; (iii) facilitator training; and (iv) parent satisfaction surveys.
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Suto M, Takehara K, Yamane Y, Ota E. Effects of prenatal childbirth education for partners of pregnant women on paternal postnatal mental health and couple relationship: A systematic review. J Affect Disord 2017; 210:115-121. [PMID: 28024222 DOI: 10.1016/j.jad.2016.12.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/17/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Partner education during pregnancy may be able to prevent postnatal mental health problems, and support expectant fathers in their transition to parenthood. The aim of this systematic review is to investigate the effects of prenatal childbirth education among partners of pregnant women, particularly regarding paternal postnatal mental health and couple relationship. METHODS We searched Medline, CINAHL, EMBASE, PsycINFO, ERIC, and CENTRAL using terms such as "partners of pregnant women," "education," and "prenatal support." Searches were limited to randomized trials. RESULTS We included 11 trials out of 13 reports that addressed the following topics: childbirth preparation, couple relationship, infants and parenting, postpartum psychosocial issues, and housework sharing. Overall risk of bias was low or unclear. Study outcomes, including parents' mental health (e.g., anxiety, depression, distress), couple relationship, parents' transition adjustment and parenting stress, and parents' satisfaction with their experience of childbirth and prenatal childbirth education programs were reported. LIMITATIONS The studies included in this review were very diverse regarding intervention intensity and content, outcome types, measurement tools, and outcome timing. This impeded evaluation of the interventions' effectiveness. CONCLUSION No sufficient evidence was identified that prenatal childbirth education for partners of pregnant women protects against paternal postnatal depression and couple relationship; however, paternal postnatal mental health is important to maternal and perinatal healthcare. The results of this review suggest that further research and intervention are required to provide partners of pregnant women with evidence-based information and support whole families during the perinatal period.
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Affiliation(s)
- Maiko Suto
- Graduate School of International and Cultural Studies, Tsuda College, Tokyo, Japan
| | - Kenji Takehara
- National Center for Child Health and Development, Tokyo, Japan
| | - Yumina Yamane
- College, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Erika Ota
- Graduate School of Nursing Science, St.Luke's International University, Tokyo, Japan.
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Zeyneloğlu S, Kısa S, Özberk H, Badem A. Predictors and measurement of satisfaction with postpartum care in a government hospital. Nurs Health Sci 2017; 19:198-203. [DOI: 10.1111/nhs.12327] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 11/09/2016] [Accepted: 11/15/2016] [Indexed: 01/20/2023]
Affiliation(s)
| | - Sezer Kısa
- Department of Nursing and Health Promotion; Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences; Kjeller Norway
| | - Hülya Özberk
- Department of Women's Health and Gynecological Disorders; Dokuz Eylül University; İzmir Turkey
| | - Aysun Badem
- Department of Obstetrics and Gyneocology; Erciyes University Medical School Research and Practice Hospital; Kayseri Turkey
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Symon A, Pringle J, Downe S, Hundley V, Lee E, Lynn F, McFadden A, McNeill J, Renfrew MJ, Ross-Davie M, van Teijlingen E, Whitford H, Alderdice F. Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models. BMC Pregnancy Childbirth 2017; 17:8. [PMID: 28056877 PMCID: PMC5216531 DOI: 10.1186/s12884-016-1186-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antenatal care models vary widely around the world, reflecting local contexts, drivers and resources. Randomised controlled trials (RCTs) have tested the impact of multi-component antenatal care interventions on service delivery and outcomes in many countries since the 1980s. Some have applied entirely new schemes, while others have modified existing care delivery approaches. Systematic reviews (SRs) indicate that some specific antenatal interventions are more effective than others; however the causal mechanisms leading to better outcomes are poorly understood, limiting implementation and future research. As a first step in identifying what might be making the difference we conducted a scoping review of interventions tested in RCTs in order to establish a taxonomy of antenatal care models. METHODS A protocol-driven systematic search was undertaken of databases for RCTs and SRs reporting antenatal care interventions. Results were unrestricted by time or locality, but limited to English language. Key characteristics of both experimental and control interventions in the included trials were mapped using SPIO (Study design; Population; Intervention; Outcomes) criteria and the intervention and principal outcome measures were described. Commonalities and differences between the components that were being tested in each study were identified by consensus, resulting in a comprehensive description of emergent models for antenatal care interventions. RESULTS Of 13,050 articles retrieved, we identified 153 eligible articles including 130 RCTs in 34 countries. The interventions tested in these trials varied from the number of visits to the location of care provision, and from the content of care to the professional/lay group providing that care. In most studies neither intervention nor control arm was well described. Our analysis of the identified trials of antenatal care interventions produced the following taxonomy: Universal provision model (for all women irrespective of health state or complications); Restricted 'lower-risk'-based provision model (midwifery-led or reduced/flexible visit approach for healthy women); Augmented provision model (antenatal care as in Universal provision above but augmented by clinical, educational or behavioural intervention); Targeted 'higher-risk'-based provision model (for woman with defined clinical or socio-demographic risk factors). The first category was most commonly tested in low-income countries (i.e. resource-poor settings), particularly in Asia. The other categories were tested around the world. The trials included a range of care providers, including midwives, nurses, doctors, and lay workers. CONCLUSIONS Interventions can be defined and described in many ways. The intended antenatal care population group proved the simplest and most clinically relevant way of distinguishing trials which might otherwise be categorised together. Since our review excluded non-trial interventions, the taxonomy does not represent antenatal care provision worldwide. It offers a stable and reproducible approach to describing the purpose and content of models of antenatal care which have been tested in a trial. It highlights a lack of reported detail of trial interventions and usual care processes. It provides a baseline for future work to examine and test the salient characteristics of the most effective models, and could also help decision-makers and service planners in planning implementation.
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Affiliation(s)
- Andrew Symon
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ Dundee, UK
| | - Jan Pringle
- School of Nursing & Health Sciences, University of Dundee, DD1 4HJ Dundee, UK
| | - Soo Downe
- School of Health, Brook Building, University of Central Lancashire, Preston, PR1 2HE UK
| | - Vanora Hundley
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, BU1 3LH Poole, UK
| | - Elaine Lee
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ Dundee, UK
| | - Fiona Lynn
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL UK
| | - Alison McFadden
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ Dundee, UK
| | - Jenny McNeill
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL UK
| | - Mary J Renfrew
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ Dundee, UK
| | - Mary Ross-Davie
- Maternal & Child Health, NHS Education for Scotland, Edinburgh, EH3 9DN UK
| | - Edwin van Teijlingen
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, BU1 3LH Poole, UK
| | - Heather Whitford
- Mother & Infant Research Unit, University of Dundee, DD1 4HJ Dundee, UK
| | - Fiona Alderdice
- School of Nursing & Midwifery, Queens University, Belfast, BT9 7BL UK
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Toosi M, Akbarzadeh M, Ghaemi Z. The Effect of Relaxation on Mother's Anxiety and Maternal–Fetal Attachment in Primiparous IVF Mothers. J Natl Med Assoc 2017; 109:164-171. [DOI: 10.1016/j.jnma.2017.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/04/2017] [Accepted: 03/11/2017] [Indexed: 11/28/2022]
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Veringa IK, de Bruin EI, Bardacke N, Duncan LG, van Steensel FJA, Dirksen CD, Bögels SM. 'I've Changed My Mind', Mindfulness-Based Childbirth and Parenting (MBCP) for pregnant women with a high level of fear of childbirth and their partners: study protocol of the quasi-experimental controlled trial. BMC Psychiatry 2016; 16:377. [PMID: 27821151 PMCID: PMC5100329 DOI: 10.1186/s12888-016-1070-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Approximately 25 % of pregnant women suffer from a high level of Fear of Childbirth (FoC), as assessed by the Wijma Delivery Expectancy Questionnaire (W-DEQ-A, score ≥66). FoC negatively affects pregnant women's mental health and adaptation to the perinatal period. Mindfulness-Based Childbirth and Parenting (MBCP) seems to be potentially effective in decreasing pregnancy-related anxiety and stress. We propose a theoretical model of Avoidance and Participation in Pregnancy, Birth and the Postpartum Period in order to explore FoC and to evaluate the underlying mechanisms of change of MBCP. METHODS/DESIGN The 'I've Changed My Mind' study is a quasi-experimental controlled trial among 128 pregnant women (week 16-26) with a high level of FoC, and their partners. Women will be allocated to MBCP (intervention group) or to Fear of Childbirth Consultation (FoCC; comparison group). Primary outcomes are FoC, labour pain, and willingness to accept obstetrical interventions. Secondary outcomes are anxiety, depression, general stress, parental stress, quality of life, sleep quality, fatigue, satisfaction with childbirth, birth outcome, breastfeeding self-efficacy and cost-effectiveness. The total study duration for women is six months with four assessment waves: pre- and post-intervention, following the birth and closing the maternity leave period. DISCUSSION Given the high prevalence and severe negative impact of FoC this study can be of major importance if statistically and clinically meaningful benefits are found. Among the strengths of this study are the clinical-based experimental design, the extensive cognitive-emotional and behavioural measurements in pregnant women and their partners during the entire perinatal period, and the representativeness of study sample as well as generalizability of the study's results. The complex and innovative measurements of FoC in this study are an important strength in clinical research on FoC not only in pregnant women but also in their partners. TRIAL REGISTRATION Dutch Trial Register (NTR): NTR4302 , registration date the 3rd of December 2013.
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Affiliation(s)
- Irena K. Veringa
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
| | - Esther I. de Bruin
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
| | - Nancy Bardacke
- Osher Center for Integrative Medicine and Department of Nurse-Midwifery, University of California-San Francisco (UCSF), UCSF box 1726, San Francisco, CA 94143-1726 USA
| | - Larissa G. Duncan
- Department of Human Development and Family Studies and Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI 53706 USA
| | - Francisca J. A. van Steensel
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
| | - Carmen D. Dirksen
- Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
| | - Susan M. Bögels
- Research Institute Child Development and Education (RICDE), Faculty of Social and Behavioral Sciences, Research Priority Area Yield, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS Amsterdam, The Netherlands
- UvA minds, academic outpatient child and adolescent treatment center of the University of Amsterdam, Plantage Muidergracht 14, 1018 TV Amsterdam, The Netherlands
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Takehara K, Okamura M, Sugiura N, Suto M, Sasaki H, Mori R. Study protocol for a randomised controlled trial to test the effectiveness of providing information on childbirth and postnatal period to partners of pregnant women. BMJ Open 2016; 6:e011919. [PMID: 27466241 PMCID: PMC4964202 DOI: 10.1136/bmjopen-2016-011919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The objective of this study is to investigate the effect of the distribution of a booklet providing information to fathers during their partners' pregnancies on fathers' and mothers' postpartum mental health and quality of life (QOL), as well as on fathers' childcare participation and living situations. METHODS AND ANALYSIS This randomised controlled trial will comprise 554 couples consisting of pregnant women due to give birth at an obstetric institution in Aichi Prefecture, Japan and their partners. Participants will be recruited during prenatal check-ups in the third trimester, and those who provide written consent will be allocated randomly to an intervention and a control group. The pregnant women's partners allocated to the intervention group will be given a booklet written for men containing information on childbirth and postnatal period. Its content will include matters such as what preparations the partner should make before birth and tips for housework and childcare as well as how to prevent unintentional injury to the baby. The control group will not receive any intervention. A baseline survey in the third trimester and follow-up surveys at 1 and 3 months post partum will be carried out using self-administered questionnaires. The primary outcome is the proportion of new mothers' partners at risk for paternal depression (Edinburgh Postnatal Depression Scale score ≥8). Secondary outcomes include the risk of postnatal depression in new mothers, QOL of new mothers and their partners, partners' knowledge of and engagement in housework and childcare, marital relations and parenting stress on the part of new mothers. ETHICS AND DISSEMINATION This study has been approved by the Ethical Committee at the National Center for Child Health and Development, Tokyo, Japan. The results of the study will be widely disseminated as peer-reviewed papers and at international conferences, with the aim of improving public health services in Japan. TRIAL REGISTRATION NUMBER UMIN000021475; Pre-results.
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Affiliation(s)
- Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naomi Sugiura
- Okamura Obstetrics and Gynecology Clinic, Aichi, Japan
| | - Maiko Suto
- Graduate School of International and Cultural Studies, Tsuda College, Tokyo, Japan
| | - Hatoko Sasaki
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Abstract
This study investigated parents' experiences of parental education groups at antenatal and child health care centers, including content, presentation of content, the leader's role, and the importance of other participating parents. Twenty-one interviews with 26 parents from 6 cities across Sweden were analyzed with 3 content analysis approaches. Parents expressed both satisfaction and dissatisfaction with the content, presentation of content, and the leader's role. They reported that social contact with other parents was important, that parenthood topics were covered less frequently than child and childbirth-related topics, and that group activities were less frequent than lectures. When designing future parental education groups, it is important to consider expanding parenthood topics and group activities because this structure is considered to provide support to parents.
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 2016; 6:e010691. [PMID: 27406639 PMCID: PMC4947718 DOI: 10.1136/bmjopen-2015-010691] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. DESIGN Open-label, assessor blind, randomised controlled trial. SETTING 2 public hospitals in Sydney, Australia. POPULATION 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. METHODS AND INTERVENTION The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24-36 weeks' gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. MAIN OUTCOME MEASURES Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. RESULTS There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25). CONCLUSIONS The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - C A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - A Bensoussan
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Streibert LA, Reinhard J, Yuan J, Schiermeier S, Louwen F. Clinical Study: Change in Outlook Towards Birth After a Midwife Led Antenatal Education Programme Versus Hypnoreflexogenous Self-Hypnosis Training for Childbirth. Geburtshilfe Frauenheilkd 2015; 75:1161-1166. [PMID: 26719600 DOI: 10.1055/s-0035-1558250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Aim: To compare the change of maternal outlook towards birth due to a midwife led antenatal education programme versus hypnoreflexogenous self-hypnosis training for childbirth. Method: Before beginning of the classes and after the last class maternal perception on birth was evaluated using Osgood semantic differential questionnaire. The Gießen personality score was evaluated once. Results: 213 patients were enrolled in this study. 155 were in the midwife led education programme and 58 in the self-hypnosis training programme. There was no statistically significant difference between the two groups in regard of participants' characteristics, Gießen personality score and initial Osgood semantic differential scores. After the midwife led course childbirth was emotionally more negatively scored (displeasure, tarnishing, dimension evaluation [p < 0.05]), whereas after the hypnosis course childbirth was emotionally more positively evaluated (pleasure, harmony, dimension evaluation [p < 0.01] and brightness [p < 0.05]). Summary: In this study hypnoreflexogenous self-hypnosis training resulted in a positive maternal outlook towards childbirth, in comparison to the midwife led course. Further prospective randomised studies are required to test these initial results.
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Affiliation(s)
- L A Streibert
- Johann Wolfgang Goethe-University Frankfurt am Main, Faculty of Medicine, Department of Obstetrics and Gynaecology, Frankfurt am Main
| | - J Reinhard
- St. Marienkrankenhaus, Frauenklinik, Frankfurt
| | - J Yuan
- Johann Wolfgang Goethe-University Frankfurt am Main, Faculty of Medicine, Department of Obstetrics and Gynaecology, Frankfurt am Main
| | - S Schiermeier
- University Witten/Herdecke, Marien-Hospital Witten, Witten
| | - F Louwen
- Johann Wolfgang Goethe-University Frankfurt am Main, Faculty of Medicine, Department of Obstetrics and Gynaecology, Frankfurt am Main
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Firouzbakht M, Nikpour M, Khefri S, Jamali B, Kazeminavaee F, Didehdar M. The Effectiveness of Prenatal Intervention on Pain and Anxiety during the Process of Childbirth-Northern Iran: Clinical Trial Study. Ann Med Health Sci Res 2015; 5:348-52. [PMID: 26500792 PMCID: PMC4594348 DOI: 10.4103/2141-9248.165260] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Due to the painful nature of childbirth and its maternal and neonatal complications, the woman needs support in this phase of their life. Increased knowledge and skills during pregnancy prepares pregnant mothers for labor and leads to promoted health. AIM This study was designed to evaluate the effectiveness of "prenatal education" on the process of childbirth. SUBJECTS AND METHODS This clinical trial was conducted on 195 pregnant women, that is, control group (N = 132) and case group (N = 63) attending health centers in Amol-Iran from 20 weeks of gestation age during 2012. Case group members attended in "prenatal education" class and the control group only received routine care. Data were collected through demographic questionnaire, standard hospital anxiety questionnaire, and a checklist related to childbirth information, and intensity of pain based on visual analogue scale and McGill scales. The data were analyzed by Statistical Package for the Social Sciences software using t-test and Chi-square test. RESULTS The result of this study showed that the parent with a high level of education was more interested to participant in prenatal classes. The anxiety level in case group (who received education) was 14.47 (4.69) and in control group it was 16 (4.86), (P < 0.001) the pain intensity in case group was 85.68 (1.85) and in control group was 90.99 (14.72) (P = 0.03), intervention on labor such episiotomy was 39 %66.1 (39/63) in case group and 80 %72.8 (80/132) in control group (P = 0.01) and cesarean section was 13 %17.1 (13/63) in case group and 58 %32.2 (58/132) in control group (P = 0.01). CONCLUSIONS According to findings of this study, the prenatal education and psychological support are beneficial for mothers during pregnancy and labor. Therefore, it is recommended for educating all the pregnant women.
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Affiliation(s)
- M Firouzbakht
- Department of Midwifery, Islamic Azad university, Babol Branch, Babol, Tehran, Iran ; Department of Social Determinant of Health, Babol University Medical Science, Tehran, Iran
| | - M Nikpour
- Department of Social Determinant of Health, Babol University Medical Science, Tehran, Iran ; Department of Midwifery, Babol University Medical Science, Tehran, Iran
| | - S Khefri
- Department of Science, Babol University Medical Science, Tehran, Iran
| | - B Jamali
- Department of Midwifery, Islamic Azad university, Babol Branch, Babol, Tehran, Iran
| | - F Kazeminavaee
- Department of Midwifery, Islamic Azad university, Babol Branch, Babol, Tehran, Iran
| | - M Didehdar
- Department of Psychology, Elicit and Researchers Club, Tehran, Iran
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