Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study

BACKGROUND

Childbirth is a long-lasting physiological stress. As one of the main stressors, labor pain exists throughout the whole process. Childbirth self-efficacy is the confidence, or belief that they can manage pain during childbirth. This sense of self-efficacy determines how pregnant women deal with labor pain and enables them to regulate their behavior and actively deal with childbirth. However, the difference in pain sensitivity between single births (primiparas) and multiple births (multiparas) has rarely been investigated.

OBJECTIVES

This study is aimed at investigating self-efficacy, fear of childbirth, labor pain of primiparas and multiparas and exploring factors related to the perceived labor pain intensity of pregnant women.

DESIGN

Prospective cross-sectional study.

SETTING(S)

Labour and delivery in a large academic specialized hospital in Guangzhou, China.

PARTICIPANTS

A total of 347 women, (182 primiparas and 165 multiparas) were enrolled in the data analysis. Pain was assessed before cervical dilatation (cervical dilatation ≤ 3 cm for the first delivery and ≤ 2 cm for the second delivery).

METHOD

The general information of participants was obtained by questionnaire and obstetrical records of the subjects were obtained from the electronic medical records extracted from the electronic medical record system (EMRS). Childbirth self-efficacy, fear of childbirth (FOC) and labor pain were compared between primiparas and multiparas. Paired t-test, chi-square test, Mann-Whitney test, univariate and multivariate regression analysis were used to analyze labor pain between the two groups and investigate factors related perceived labor pain intensity.

RESULTS

The total scores related to fear of childbirth, fetal health, self-control, and labor pain injury of multiparas were notably reduced compared with primiparas (all P < 0.05). The perceived labor pain intensity and duration of the first stage of labor was reduced in the multipara group compared with the primipara group. The childbirth control sense of the multipara was better than that of the primipara. The perceived labor pain intensity was negatively correlated with advanced age (age ≥ 35 years), self-efficacy score, family support, and education (all P < 0.05). In contrast, the perceived labor pain intensity was positively correlated with tension, severe fear of childbirth, and anxiety (P < 0.05). Self-efficacy, gravidity, delivery cognition, and fear of childbirth were independent risk factors for the perceived labor pain intensity in the latent period (all P < 0.05).

CONCLUSIONS

Fear of childbirth is a predictor of perceived labor pain intensity. The extent of labor pain (minimum and maximum) can be predicted by the level of fear the expectant mother has. During the latent phase of labor, self-efficacy, fear of childbirth and labor pain are different between primiparas and multiparas.

Validity and reliability of the Greek version of Wijma delivery expectancy/experience questionnaire (Version A) among low-risk pregnant women

BACKGROUND

Fear of childbirth is a frequent health issue for pregnant women. The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) is a widely used instrument to measure the fear of childbirth during the antenatal period. The aim of the study was to assess the psychometric properties of the W-DEQ (version A) in a sample of Greek pregnant women.

METHODS

Low-risk pregnant women in the second or third trimester of pregnancy (N = 201) were invited to participate in the study and to complete a booklet of questionnaires including the Greek versions of W-DEQ-A, State-Trait Anxiety Inventory (STAI), Coping Orientations to Problems Experienced (Brief COPE), Perceived Stress Scale (PSS-10) and Edinburgh Postnatal Depression Scale (EPDS). Exploratory (EFA) and confirmatory factor analysis (CFA) was performed.

RESULTS

The mean age of participants was 34.2 years (SD = 4.3 years). EFA yielded six factors ("Lack of self-efficacy", "Lack of positive anticipation", "Lack of feeling lonely", "Concerns about delivery and losing control", "Calmness", and "Concern for the child") of 33 items of W-DEQ-A. CFA confirmed the multidimensionality of the instrument. All Cronbach's alpha were over 0.7, indicating acceptable reliability of the factors. All factors were significantly correlated with each other, and convergent validity was demonstrated by a significant association with stress, anxiety, and depression among low-risk pregnant women.

CONCLUSION

The Greek version of W-DEQ-A proved to be a valid and reliable instrument of fear of childbirth among Greek low-risk pregnant women.

The prevalence and associated factors of fear of childbirth among Turkish pregnant women

OBJECTIVE

This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey.

MATERIALS AND METHODS

This was a cross-sectional study and included a total of 2025.    Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection.

FINDINGS

In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001).

CONCLUSIONS

The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.

Investigation of the relationship between fear of birth and prenatal attachment in pregnancy

OBJECTIVE

This study was conducted to examine the relationship between the fear of birth and level of prenatal attachment experienced by the pregnant women.

METHODS

In our descriptive and relationship-seeking study conducted between January and March 2020 in Konya, 485 pregnant women who met the inclusion criteria were included in the study. Inclusion criteria for the study were women who were pregnant at the age of 18 years and above, having Turkish literacy, had spontaneous conception were over the 28th gestational week, having a healthy fetus, and not having any existing health problems (based on self-report). The data were collected with an information form, "Prenatal Attachment Inventory" and "Wijma Birth Expectation/Experience (Version A) Scale."

RESULTS

The mean score of the pregnant women from the "Prenatal Attachment Inventory" was 62.44 (21-84), and the mean score of the "Wijma Birth Expectation/Experience Scale/Version A" was found to be 59.45 (0-165). It was concluded that 47.2% of the pregnant women had low, 38.7% had moderate, and 14.1% had high levels of fear of birth. It was determined that there was a negative and weakly significant relationship between "Prenatal Attachment Inventory" and "Wijma Birth Expectation/Experience Scale/Version A" scores of pregnant women (r=-0.11 and p=0.23).

CONCLUSION

In our study, it was determined that as the fear of birth increased, prenatal attachment levels decreased. Initiating and maintaining a healthy mother-infant bond is important for reducing fear of birth.

The relationship of perceived social support, personality traits and self-esteem of the pregnant women with the fear of childbirth

This research was conducted to examine the relationship of perceived social support, personality traits, and self-esteem of pregnant women with fear of childbirth. The study was performed between April 15, 2016 and May 15, 2016 using face-to-face interviews with 128 pregnant women who were at 28-40 weeks of pregnancy. A negative correlation between the fear of childbirth and the levels of social support perceived by pregnant women and a positive correlation between the fear of childbirth and self-esteem were observed. Furthermore, a negative correlation between the fear of childbirth and extraversion, self-discipline, and openness to development and a positive correlation between the fear of childbirth and neurotic personality traits were noted. Hence, we propose that social support status, personality traits, and self-esteem of pregnant women should be viewed as risk factors for the fear of childbirth.

Traumatic childbirth experiences, effects and coping: A qualitative study

OBJECTIVE

Childbirth experience and perception of birth are personal. It is important to understand how the traumatic childbirth experiences affected women and for the nursing care that would be given to them. The aim of the research was to determine the childbirth experiences perceived by women as traumatic, how they were affected by these experiences, and how they coped.

METHODS

The study was a descriptive phenomenological approach study. The data were obtained through semi-structured, in-depth individual interviews. Content analysis was used in the analysis of the data. The mothers were contacted by using the social media platforms. Sixteen women were included in the research who expressed that they had traumatic childbirth experiences.

RESULTS

It was determined that women experienced severe fear and pain during childbirth, that they were in unsuitable maternity hospital environments, and that care was not taken for their privacy. At the same time, it was determined that they experienced disorders in the postpartum period connected to their traumatic birth experiences, that they postponed their pregnancy plans due to their fear of childbirth that developed connected to traumatic childbirth or that they did not want to become pregnant, and that they did not receive sufficient support from health personnel.

CONCLUSION

It is necessary to provide privacy during childbirth, to take into consideration the decisions of women, and to provide for their continuous support by midwives.

Factors associated with the intention of pregnant women to give birth with epidural analgesia: a cross-sectional study

BACKGROUND

In Belgium most women receive epidural analgesia during labour. Although, it offers satisfactory pain relief during labour, the risk on a series of adverse advents has been reported. The objective of this study was to determine factors associated with the intention of pregnant women, anticipating a vaginal birth, of requesting epidural analgesia during labour.

METHODS

A cross-sectional study, using an online self-report questionnaire was performed, including socio-demographic and personal details. Associated factors were examined with the HEXACO-60 questionnaire, the Mental Health Inventory-5, the Tilburg Pregnancy Distress Scale and the Labour Pain Relief Attitude Questionnaire for pregnant women. The level of intention to request epidural analgesia was based on two questions: Do you intend to ask for epidural analgesia (1) at the start of your labour; (2) at some point during labour? Data were collected predominantly during the second and third trimester of pregnancy. Descriptive analysis and a multiple linear regression analysis were performed.

RESULTS

949 nulliparous (45.9%) and multiparous (54.1%) pregnant women, living in Flanders (Dutch-speaking part of Belgium) anticipating a vaginal birth completed the questionnaires. Birth-related anxiety (ß 0.096, p < 0.001), the attitude that because of the impact of pregnancy on the body, asking for pain relief is normal (ß 0.397, p < 0.001) and feeling more self-confident during labour when having pain relief (ß 0.034, p < 0.001) show a significant positive relationship with the intention for intrapartum epidural analgesia. The length of the gestational period (ß - 0.056, p 0.015), having a midwife as the primary care giver during pregnancy (ß - 0.048, p 0.044), and considering the partner in decision-making about pain relief (ß - 0.112, p < 0.001) show a significant negative relationship with the intention level of epidural analgesia. The explained variability by the multiple regression model is 54%.

CONCLUSIONS

A discussion during pregnancy about the underlying reason for epidural analgesia allows maternity care providers and partners to support women with pain management that is in line with women's preferences. Because women's intentions vary during the gestational period, pain relief should be an issue of conversation throughout pregnancy.

The effect of prenatal education on fear of childbirth, pain intensity during labour and childbirth experience: a scoping review using systematic approach and meta-analysis

BACKGROUND

Antenatal education provides parents with strategies for pregnancy, childbirth, and parenthood. There is not enough evidence of the positive effect of prenatal education on childbirth and maternal outcomes. The present scoping review using a systematic approach, evaluates the effectiveness of prenatal education on fear of childbirth, pain intensity during labour, childbirth experience, and postpartum psychological health.

METHODS

We used Google Scholar and systematically reviewed databases such as PubMed, Web of Science, Cochrane, Scopus, and SID (Scientific Information Database). Randomized controlled and quasi-experimental trials examining the effect of structured antenatal education and routine prenatal care compared to routine prenatal care were reviewed. The participants included pregnant women preferring a normal vaginal delivery and had no history of maternal or foetal problems. The outcomes considered in this study included fear of childbirth, pain intensity during labour, childbirth experience (as primary outcomes) and postpartum psychological health (as secondary outcomes). The grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence.

RESULTS

Overall, 3242 studies were examined, of which 18 were qualified for the final analysis. The meta-analysis showed that providing prenatal education and routine care compared to only routine care may decrease the fear of childbirth, postpartum depression, and pain intensity during labour. However, we found no study examining the outcome of the childbirth experience. In addition, the inconsistency of included studies prevented conducting a meta-analysis on the rest of the outcomes.

CONCLUSIONS

Our investigations showed that there are very few or no studies on the effect of prenatal education on outcomes such as childbirth experience, postpartum anxiety, and maternal attachment, and the existing studies on the effect of prenatal education on outcomes such as the fear of childbirth, postpartum depression, and pain intensity during labour lack sufficient quality to make definitive conclusions. Therefore, high-quality, randomized trials with a more extensive sample size are suggested to provide clear reports to make definitive decisions.

PROSPERO ID

CRD42022376895.

The Assessment of Natural Vaginal Delivery in Relation to Pregnancy-Related Anxiety-A Single-Center Pilot Study

BACKGROUND

Pregnancy-related anxiety (PrA) is a specific type of anxiety experienced during the perinatal period. It may concern a person's health and physical appearance, fetal development, hospital and health care experiences, impending childbirth, and early parenthood. PrA is considered to be a stronger predictor of adverse pregnancy outcomes than general anxiety and depression. The purpose of this research was to conduct a pilot study and evaluate the course of vaginal birth (VB) in relation to PrA levels in a population of pregnant women with low obstetrical risk.

METHODS

This cross-sectional exploratory study included 84 pregnant women (with a mean age of 28.61 ± 4.99) (without cesarean section (CS) indications and with a low risk of complications during VB). Research questionnaires were distributed and filled in in person during the course of hospitalization. Groups that varied at the level of PrA were compared using the Wilcoxon rank-sum test, Fisher's exact test, or chi-square test of independence, as appropriate.

RESULTS

More than two-thirds of the respondents (72.6%) were medicated in labor. Women with high PrA, selected based on a cut-off point with a total PRAQ-R2 score of 60, experienced significantly longer first (start of established labor to fully dilated cervix) and second (lasts from when cervix is fully dilated until the birth) periods of labor, instrumental delivery, or emergency CS. In the group with high PrA levels, a episiotMmentation of evidence-based recommendations for the affected population to identify and further treat women with elevated levels of PrA.

Association of antenatal anxiety disorders with antenatal comorbidities and adverse pregnancy outcomes among clinic attendees at a tertiary-care hospital in Sri Lanka

Purpose

Evidence on the association between antenatal anxiety disorders (AADs) and adverse pregnancy outcomes with detection of AADs using the gold-standard is scarce despite being vital to make decisions on interventions. We aimed to determine this association in women attending tertiary-care antenatal clinics in Sri Lanka.

Material and methods

Presence/absence of AADs in a systematic random sample of 221 antenatal women attending routine antenatal clinics of a teaching hospital who participated in a questionnaire-validation study were confirmed by a psychiatrist. These women were followed up until the end of pregnancy. Information on antenatal comorbidities, adverse pregnancy outcomes was extracted from health records. The association between AADs with antenatal comorbidities and adverse pregnancy outcomes were reported using adjusted odds ratios (ORs) and 95%confidence intervals (CIs) generated from logistic regression models.

Results

Mean (±SD) age of the women was 30 (±5.8) years. AADs were diagnosed in 81 (37%) women. Compared to women without AADs, those who had AADs were more at risk of pregnancy-induced hypertension (OR 6.1; 95% CI 1.2-31.9), gestational diabetes mellitus (OR 12.6; 95% CI 1.5-107.2), preterm labour (OR 4.3; 95% CI 1.4-13.0), prolonged labour (OR 19.0; 95% CI 7.1-51.1), lower segment caesarean section (OR 4.7; 95% CI 2.5-8.7) and low birthweight (OR 11.2; 95% CI 4.8-26.3). All miscarriages, stillbirths and assisted labour occurred exclusively in those with AADs.

Conclusions

AADs are strongly associated with several adverse pregnancy outcomes. Causal pathways and effect of interventions for AADs must be explored in future research.

The Pathophysiology of Labor Dystocia: Theme with Variations

Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.

Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland

PURPOSE

The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy.

METHODS

Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI).

RESULTS

In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63).

CONCLUSIONS

FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.

Preparation for Childbirth: Coping with the Fear of Childbirth

Pregnancy is a vital event in a woman's life that involves not only important physical changes, but also psychological changes [...].

The Effect of Intimate Partner Violence on Fear of Childbirth Among Pregnant Women

This study was conducted to determine the effect of intimate partner violence on childbirth fear of pregnant women. This descriptive and cross-sectional study included 335 pregnant women who applied to pregnant outpatient clinics. The data of the study were collected with Questionnaire Form and Wijma Birth Expectation/Experience Scale A Version (W-DEQ-A). Descriptive statistical methods, t-test, one-way ANOVA, Mann-Whitney U-test, and Kruskal-Wallis test were used in the analysis of the data. W-DEQ-A scale score of pregnant women was found to be 69.34 ± 29.37. It was found that 15.2% of pregnant women experienced "mild level" childbirth fear, 28.4% had "moderate level" childbirth fear, 26.6% had "severe level" childbirth fear, and 29.9% had "clinical level" childbirth fear. It was determined that 49.3% of pregnant women were exposed to any type of violence by their partners. It was found that pregnant women were exposed to 46% verbal violence, 23.9% emotional violence, 13.7% economic violence, 8.7% physical violence, and 2.1% sexual violence. When pregnant women experiencing any type of violence (p = .000), verbal violence (p = .000), emotional violence (p = .000), and economic violence (p = .000) were compared with pregnant women who did not experience violence, W-DEQ-A scores were higher and differences were statistically significant. It was determined to be statistically significant differences of W-DEQ-A scores according to the age of the pregnant women (p = .044), family type (p = .004), place of residence (p = .026), and psychological problems before pregnancy (p = .026). As a result, the rate of violence exerted by their intimate partners against pregnant women was high. In addition, intimate partner violence during pregnancy had negative effects on the fear of childbirth of pregnant women.

Validating the use of the Wijma Delivery Expectancy/Experience Questionnaire in Mainland China: a descriptive, cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a common psychological problem in Chinese pregnant women. FOC can influence both maternal health and infants' wellness. Special assessment tools for FOC in Mandarin Chinese are currently lacking. The aim of this study was to evaluate the psychometric properties of the Mandarin Chinese of the Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ-A).

METHODS

We recruited 364 Chinese pregnant women from April 2021 to July 2021. Translation and cultural adaptation, as well as reliability and validity testing were conducted. Analyses included the content validity, structural validity, criterion-related validity, convergent validity and reliability. The content validity indices were used to assess the content validity of the tool. The structural validity was tested through exploratory factor analysis and confirmatory factor analysis. The Cronbach's alpha coefficient was used to evaluate the reliability of the W-DEQ-A Chinese version.

RESULTS

The Chinese translation showed excellent similarities and equivalence to the original version, with the satisfactory content validity. Factor analysis indicated 5 factors, accounting for 57% of the total variance. Both criterion-related validity and convergent validity proved to be acceptable. The reliability was tested with a Cronbach's alpha coefficient of 0.911 for the total scale.

CONCLUSION

The W-DEQ-A Chinese version is a reliable and valid tool to identify FOC in Mandarin Chinese-speaking populations.

Identifying women with fear of childbirth with the Dutch Fear of Birth Scale and its added value for consultations

OBJECTIVES

Determine whether the Fear of Birth Scale (FOBS) is a useful screening instrument for Fear of Childbirth (FoC) and examine the potential added value of screening by analyzing how often pregnant women discuss their FoC during consultation.

METHODS

This cross-sectional survey study included nulliparous pregnant women of all gestational ages, recruited via the internet, hospital and midwifery practices. The online questionnaires included the FOBS and Wijma Delivery Expectations Questionnaire version A (W-DEQ A). The latter was used as golden standard for assessing FoC (cutoff: ≥85).

RESULTS

Of the 364 included women, 67 (18.4%) had FoC according to the W-DEQ A. Using the FOBS with a cutoff score of ≥49, the sensitivity was 82.1% and the specificity 81.1%, with 111 (30.5%) women identified as having FoC. Positive predictive value was 49.5% and negative predictive value 95.3%. Of the women with FoC (FOBS ≥49), 68 (61.3%) did not discuss FoC with their caregiver.

CONCLUSION

The FOBS is a useful screening instrument for FoC. A positive score must be followed by further assessment, either by discussing it during consultation or additional evaluation with the W-DEQ A. The majority of pregnant women with FoC do not discuss their fears, underscoring the need for screening.

The Tilburg Pregnancy Distress Scale revised (TPDS-R): Psychometric aspects in a longitudinal cohort study

Pregnant women may be specifically prone to experience pregnancy-specific distress, which has been associated with adverse maternal, pregnancy and child outcomes. Accurately identifying pregnancy-specific distress is thus crucial. The Tilburg Pregnancy Distress Scale (TPDS) - translated into many different languages - was previously developed to measure pregnancy-specific distress, resulting in a 16-item screening scale with a partner involvement dimension (PI) and a negative affect dimension (NA). A critical evaluation of the psychometric properties of the TPDS-NA items and feedback from pregnant women over the last decade has led to the need to revise the TPDS. Therefore, in the current study, we describe the procedure for revision and evaluate the psychometric properties of the revised TPDS (TPDS-R). More specifically, we describe the revision of the TPDS-R-PI (4 items) and the TPDS-R-NA (10 items: five-item pregnancy and five-item childbirth subcomponent). A sample of 1081 pregnant women participating in the Brabant Study completed the TPDS-R at 12, 20 and 28 weeks of pregnancy. An exploratory factor analysis and confirmatory factor analysis, descriptive statistics and repeated measures ANOVA demonstrated good test-retest reliability, concurrent validity, internal consistency, and construct validity of the TPDS-R. The TPDS-R provides a robust screening tool to accurately identify pregnant women at risk of pregnancy-specific distress.

Determinants of delayed onset of lactogenesis II among women who delivered via Cesarean section at a tertiary hospital in China: a prospective cohort study

BACKGROUND

Cesarean birth is associated with a higher prevalence of delayed onset of lactogenesis II (DOLII) than vaginal birth. DOLII refers to the delayed initiation of copious milk production beyond 72 h after birth. This study aimed to determine the prevalence of, and factors associated with, DOLII among women who delivered via Cesarean section in China.

METHODS

This prospective longitudinal cohort study recruited 468 women who delivered via Cesarean section at a tertiary hospital in China from 9 October 2021 to 17 May 2022. Face-to-face interviews were conducted during their delivery hospital stay to obtain information about demographic, medical, and breastfeeding factors. We assessed the onset of lactogenesis on postpartum day four, based on the maternal perception of changes in breast fullness. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postpartum depression. Women with DOLII were interviewed via telephone or WeChat daily for one week postpartum to determine the timing of the onset of lactogenesis II. Univariate and multivariable logistic regression analyses were used to identify the determinants of DOLII.

RESULTS

DOLII was experienced by 156 of 468 participants (33.3%). After adjusting for potential confounders, the odds of DOLII were 95% higher in primiparous women than multiparous women (adjusted odds ratio [aOR] 1.95; 95% confidence interval [CI] 1.29, 2.98), 75% higher in women with a serum albumin concentration < 35 g / L than women with normal serum albumin concentrations (aOR 1.78; 95% CI 1.09, 2.99), increased by 2.03-fold in women with an EPDS score ≥ 10 than women with an EPDS score < 10 (aOR 2.03; 95% CI 1.35, 3.07), and decreased in women with a higher number of breastfeeding sessions in the first 48 h postpartum (aOR 0.88; 95% CI 0.83, 0.93).

CONCLUSIONS

One-third of women with Cesarean section delivery experienced DOLII. DOLII was more likely in women who were primiparous, had a serum albumin concentration < 35 g / L, had a lower frequency of breastfeeding sessions, and had an EPDS score ≥ 10. Women with these risk factors who deliver via Cesarean section may need early breastfeeding support to ensure successful lactation.

Patterns and predictors of fear of childbirth and depressive symptoms over time in a cohort of women in the Pwani region, Tanzania

BACKGROUND

Fear of childbirth (FoB) and depressive symptoms (DS) are experienced by many women and can negatively affect women during and after pregnancy. This study assessed patterns of FoB and DS over time and associations of postpartum FoB and DS with sociodemographic and obstetric characteristics.

METHODS

We conducted a longitudinal study at six health facilities in Tanzania in 2018-2019. Pregnant women were consecutively assessed for FoB and DS before and after childbirth using the Wijma Delivery Expectancy/Experience Questionnaire versions A & B and the Edinburgh antenatal and postnatal depressive scale. This paper is based on 625 women who completed participation.

RESULTS

The prevalence rates of FoB and DS during pregnancy were 16% and 18.2%, respectively, and after childbirth, 13.9% and 8.5%. Some had FoB (6.4%) and DS (4.3%) at both timepoints. FoB was strongly associated with DS at both timepoints (p < 0.001). Both FoB (p = 0.246) and DS (p < 0.001) decreased after childbirth. Never having experienced obstetric complications decreased the odds of postpartum and persisting FoB (adjusted odds ratio (aOR) 0.44, 95% confidence interval (CI) 0.23-0.83). Giving birth by caesarean section (aOR 2.01, 95% CI 1.11-3.65) and having more than 12 hours pass between admission and childbirth increased the odds of postpartum FoB (aOR 2.07, 95% CI 1.03-4.16). Postpartum DS was more common in women with an ill child/stillbirth/early neonatal death (aOR 4.78, 95% CI 2.29-9.95). Persisting DS was more common in single (aOR 2.59, 95% CI 1.02-6.59) and women without social support from parents (aOR 0.28, 95% 0.11-0.69).

CONCLUSIONS

FoB and DS coexist and decrease over time. Identifying predictors of both conditions will aid in recognising women at risk and planning for prevention and treatment. Screening for FoB and DS before and after childbirth and offering psychological support should be considered part of routine antenatal and postnatal care. Furthermore, supporting women with previous obstetric complications is crucial. Using interviews instead of a self-administered approach might have contributed to social desirability. Also, excluding women with previous caesarean sections could underestimate FoB and DS prevalence rates.

Preference of homebirth and associated factors among pregnant women in Arba Minch health and demographic surveillance site, Southern Ethiopia

BACKGROUND

Home birth preference is the need of pregnant women to give birth at their home with the help of traditional (unskilled) birth attendants. Homebirth with unskilled birth attendants during childbirth is the main leading indicator for maternal and newborn death. In Ethiopia, numbers of women prefer homebirth which is assisted by unskilled personal. However, there is no information regarding the problem in the Arba Minch zuria woreda. Therefore, it is important to identify prevalence of preference of homebirth and associated factors.

OBJECTIVES

This study aimed to assess the preference of home birth and associated factors among pregnant women in Arba Minch health and demographic surveillance site.

METHOD AND MATERIALS

A community-based cross-sectional study was conducted among pregnant women in Arba Minch health and demographic surveillance site, from May 1 to June 1, 2021. Using simple random sampling technique, 416 study samples were selected. Data were collected by interviewer-administered questionnaire. Data were coded and entered into Epi-Data version 4.4.2.1 computer software and exported to Statistical Package for Social Sciences software version 25 for analysis. Bi-variable binary logistic regression for the selection of potential candidate variables at p-value < 0.25 for multivariable analysis and multivariable binary logistic regression to identify the association between homebirth preference and independent variables were carried out. The level of statistical significance was declared at a p-value < 0.05.

RESULT

In this study, in Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24% [95%CI: (19.9%-28.2%)] The factors significantly associated with the preference of home birth were husband involvement in decision making [AOR: 0.14 (0.05-0.38)], no access of road for transportation [AOR: 2.4 (1.2-5.18)], not heard about the benefit of institutional birth [AOR: 5.3 (2.3-12.2)], poor knowledge about danger signs [AOR: 3 (1.16-7.6)], negative attitude toward services [AOR: 3.1 (1.19-8.02)], and high fear to give birth at institution [AOR: 5.12 (2.4-10.91)].

CONCLUSIONS

In Arba Minch demographic health surveillance site, the prevalence of preference of pregnant women to give birth at their home was 24%. Husband involvement in decision making, no access of road for transportation, not heard about the benefit of institutional birth, poor knowledge about danger signs, negative attitude toward services, and high fear to give birth at health institutions were factors significantly associated with the preference of home birth.

Perinatal mental health: how nordic data sources have contributed to existing evidence and future avenues to explore

PURPOSE

Perinatal mental health disorders affect a significant number of women with debilitating and potentially life-threatening consequences. Researchers in Nordic countries have access to high quality, population-based data sources and the possibility to link data, and are thus uniquely positioned to fill current evidence gaps. We aimed to review how Nordic studies have contributed to existing evidence on perinatal mental health.

METHODS

We summarized examples of published evidence on perinatal mental health derived from large population-based longitudinal and register-based data from Denmark, Finland, Iceland, Norway and Sweden.

RESULTS

Nordic datasets, such as the Danish National Birth Cohort, the FinnBrain Birth Cohort Study, the Icelandic SAGA cohort, the Norwegian MoBa and ABC studies, as well as the Swedish BASIC and Mom2B studies facilitate the study of prevalence of perinatal mental disorders, and further provide opportunity to prospectively test etiological hypotheses, yielding comprehensive suggestions about the underlying causal mechanisms. The large sample size, extensive follow-up, multiple measurement points, large geographic coverage, biological sampling and the possibility to link data to national registries renders them unique. The use of novel approaches, such as the digital phenotyping data in the novel application-based Mom2B cohort recording even voice qualities and digital phenotyping, or the Danish study design paralleling a natural experiment are considered strengths of such research.

CONCLUSIONS

Nordic data sources have contributed substantially to the existing evidence, and can guide future work focused on the study of background, genetic and environmental factors to ultimately define vulnerable groups at risk for psychiatric disorders following childbirth.

The effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment: randomized controlled experimental study

This study was conducted to determine the effect of haptonomy applied to pregnant women on perceived stress, fear of childbirth, and prenatal attachment. The population of the randomized controlled experimental study consisted of 72 primiparous pregnant women within the gestational weeks 22-28 who presented to the Obstetrics and Gynecology Polyclinic of a state hospital in Turkey for check-up (36 experimental subjects, 36 control subjects). A home visit was made to the experimental group, and haptonomy was applied for at least 30 min, once a week, for 7 weeks (with the researcher for 3 weeks, with the husband by providing the training brochure and video that will help the practice for the next 4 weeks). The control group did not receive any treatment. After the haptonomy application, the stress levels and fears of childbirth of the pregnant women in the experimental group decreased, and their attachment levels with their babies increased.

Fear of Childbirth in Nulliparous Women

Purpose

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

Methods

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

Results

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

Conclusion

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

Is it Necessary to Evaluate Fear of Childbirth in Pregnant Women? A Scoping Review

OBJECTIVE

 To review concepts, definitions, and findings about fear of childbirth (FOC).

METHODS

 A bibliographic review was carried out through the main scientific databases in 2020.

RESULTS

 All 32 articles considered potentially relevant were analyzed. A recent study suggests that the global prevalence of FOC can reach up to 14%. Factors such as parity, gestational age, previous birth experience, age and nationality of the woman seem to influence FOC.

CONCLUSION

 Fear of childbirth could be related to an increased risk of adverse obstetric outcomes such as maternal request for cesarean delivery, preterm birth, prolonged labor, postpartum depression, and post-traumatic stress. These evidence highlight the importance of the discussion regarding this topic.

Fear of childbirth in pregnancy was not increased during the COVID ‐19 pandemic in the Netherlands: a cross‐sectional study

Introduction

Fear of childbirth is a well‐known problem during pregnancy and can have implications for childbirth, including prolonged labor, use of epidural analgesia, obstetric complications, presence of traumatic stress symptoms, or request for an elective cesarean section. The coronavirus disease 2019 (COVID‐19) pandemic has affected mental health and therefore could have increased fear of childbirth during the pandemic. The aim of this study was to investigate fear of childbirth during the pandemic in the Netherlands compared with a reference group from before the pandemic.

Material and methods

We conducted a cross‐sectional study to evaluate pregnant women during the first and second waves of COVID‐19 compared with both each other and with pregnant women from before the pandemic. Participants were recruited through social media platforms, hospitals, and midwifery practices. Pregnant women aged ≥18 years who had mastered the Dutch language were eligible to participate. Fear of childbirth was measured with the Wijma Delivery Expectancy Questionnaire online using a cut‐off score of ≥85 to indicate clinically relevant fear of childbirth. The primary outcome was the prevalence of fear of childbirth. We undertook additional analyses to specifically look at possible effect modification.

Results

In total, 1102 pregnant women completed the questionnaire during the first wave of the pandemic, 731 during the second wave, and 364 before the pandemic. Fear of childbirth was present in 10.6%, 11.4%, and 18.4%, respectively. We considered possible effect modification, which indicated that age and parity had a significant influence. In participants during the first wave of COVID‐19, nulliparous women had significantly lower odds (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.34–0.73; p < 0.01) of having a fear of childbirth than did the reference group. Both younger participants in the first wave (OR 0.59; 95% CI 0.37–0.93; p < 0.05) and older participants in the first wave (OR 0.44; 95% CI 0.28–0.71; p < 0.01) and the second wave (OR 0.36; 95% CI 0.21–0.62; p < 0.01) of COVID‐19 had lower odds of fear of childbirth than the reference group.

Conclusions

Pregnant women during the first and second waves of COVID‐19 had lower fear of childbirth scores than pregnant women before the pandemic, indicating less fear of childbirth during the pandemic. This could be explained by an increased level of information, more time to consume information, and better work–life balance with more people working at home during the pandemic.

The Effect of Holistic Birth Support Strategies on Coping With Labor Pain, Birth Satisfaction, and Fear of Childbirth: A Randomized, Triple-Blind, Controlled Trial

The current study was aimed to evaluate the effects of interventions conducted in line with the coping with labor pain algorithm (holistic birth support strategies) on women's coping with labor pain, birth satisfaction, and fear of childbirth. The study is a single-center, parallel-group randomized, three-blind, controlled trial. The study was completed with 33 women in the experimental group and 31 in the control group. The mean score of the women in the experimental group from the Birth Satisfaction Scale (128.57 ± 5.83) was statistically significantly higher than that of the women in the control group (81.80 ± 7.73). The mean score of the women in the experimental group (61.96 ± 9.78) from the Wijma Birth Expectation/Experience Scale, Version B scale was statistically significantly lower than that of the women in the control group (148.64 ± 14.62). It was found that the women in the experimental group were able to better cope with labor pain, had higher birth satisfaction, and had less fear of childbirth.

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

Background

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

Methods

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

Results

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

Conclusions

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

The association between epidural analgesia during labor and mother-infant bonding

STUDY OBJECTIVE

This study was aimed to assess the association between the use of epidural analgesia during labor and mother-infant bonding.

DESIGN

A cross-sectional study.

SETTING

Maternity ward at Soroka University Medical Center during 2020.

PATIENTS

Women who delivered a singleton live-born infant vaginally in their immediate post-partum period.

INTERVENTIONS

Women completed questionnaires. 25 items post-partum bonding questionnaire (PBQ) to assess mother-infant bonding (A high score on the PBQ indicates impaired mother-infant bonding) and the Edinburgh postnatal depression scale (EPDS) questionnaire to assess risk for post-partum depression.

MEASUREMENTS

The study used PBQ questionnaire and four sub-scales to assess mother-infant bonding and the EPDS questionnaire to assess risk for post- partum depression. Generalized linear regression models (gamma) were constructed to examine the association between epidural analgesia and mother-infant bonding total score and impaired bonding sub- scale, while adjusting for confounders Additional information such as pregnancy complications and sociodemographic data was drawn from women's medical records.

MAIN RESULTS

A total of 234 women were included in the final analysis, of them 126 (53.8%) delivered with epidural analgesia. The total PBQ score was significantly lower among women who received epidural analgesia compared to women without epidural analgesia (7.6 vs. 10.2, p = 0.024), demonstrating a better mother -infant bonding. Using two multivariable linear regression models, controlling for confounders such as maternal age and educational status, epidural analgesia during labor was independently associated with a better mother -infant bonding total score and better impaired bonding sub-scale score (Beta coefficient-0.252, 95% CI -0.5; -0.006, p = 0.045 and Beta coefficient - 0.34, 95% CI -0.52; -0.08, p = 0.01 for mother-infant bonding total score and sub-scale score, respectively). No differences in post-partum depression risks were found between the groups (EDPS≥13, 5.7% vs. 13%, p = 0.058).

CONCLUSION

Our study demonstrated better mother -infant bonding among women delivering with epidural analgesia.

Women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor: A cross-sectional survey

INTRODUCTION

The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor.

METHODS

A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test.

RESULTS

Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants’ experiences of fear and pain were significantly associated with the implementation of pain assessment.

CONCLUSIONS

Women’s pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives’ own personal contributions were rarely offered to the women.

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

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

Maternal childhood maltreatment and perinatal outcomes: A systematic review

BACKGROUND

Maternal childhood maltreatment (MCM) is linked to poor perinatal outcomes but the evidence base lacks cohesion. We explore the impact of MCM on four perinatal outcome domains: pregnancy and obstetric; maternal mental health; infant; and the quality of the care-giving environment. Mechanisms identified in the included studies are discussed in relation to the maternal programming hypothesis and directions for future research.

METHOD

We completed a comprehensive literature search of eight electronic databases. Independent quality assessments were conducted and PRISMA protocols applied to data extraction.

RESULTS

Inclusion criteria was met by N = 49 studies. MCM was consistently associated with difficulties in maternal and infant emotional regulation and with disturbances in the mother-infant relationship. Directly observed and maternal-reported difficulties in the mother-infant relationship were often mediated by mothers' current symptoms of psychopathology. Direct and mediated associations between MCM and adverse pregnancy and obstetric outcomes were suggested by a limited number of studies. Emotional and sexual abuse were the most consistent MCM subtype significantly associated with adverse perinatal outcomes.

LIMITATIONS

A meta-analysis was not possible due to inconsistent reporting and the generally small number of studies for most perinatal outcomes.

CONCLUSIONS

MCM is associated with adverse perinatal outcomes for mothers' and infants. Evidence suggests these associations are mediated by disruptions to maternal emotional functioning. Future research should explore biological and psychosocial mechanisms underpinning observed associations between specific subtypes of MCM and adverse perinatal outcomes. Services have a unique opportunity to screen for MCM and detect women and infants at risk of adverse outcomes during the perinatal period.

The magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in Ethiopia: a cross-sectional study

Background

Childbirth fear affects 5–40% of all mothers around the world, and there is mounting evidence that it has harmful impacts on women’s health. It could potentially lead pregnant women to feel isolated and unsupported if not identified. But studies addressing this issue are limited in Ethiopia. Therefore, this study was aimed at assessing the magnitude and associated factors of childbirth fear among pregnant women attending antenatal care at public hospitals in West Wollega Zone.

Methods

Facility-based cross-sectional study was conducted among 304 pregnant women selected by systematic random sampling from 20 March to 20 April 2020. A structured interviewer-administered questionnaire was adapted and used to collect data. Data were entered into EpiData version 3.1 and exported to IBM SPSS statistics version 26 for analysis. Descriptive statistics were done to calculate frequencies, mean scores, and standard deviation. Bivariate and multivariable logistic regression was used to identify factors associated with childbirth fear. Variables with p < 0.25 in bivariate analyses were selected for multivariable analysis. Finally, statistical significance was declared at p < 0.05.

Results

Out of the total of 304 participants, 298 completed the interview making the response rate 98%. The overall prevalence of childbirth fear was 28.9% with 95% CI (23.5, 34.2). Mean age of the respondents was 27.60 (SD ± 4.56) years. Having previous pregnancy complications [AOR (95% CI)], [6.949 (2.060 – 23.445), presence of long time during childbirth [AOR (95% CI)], [4.765 (1.161 – 19.564)], presence of episiotomy [AOR (95% CI)], [4.197 (1.107 – 15.917)], low social support [AOR (95% CI)], [.011 (.003 – .050)] were significantly associated with childbirth fear.

Conclusion

Pregnant women in the study area have a significant level of childbirth fear. Previous pregnancy complications, prolonged labor, labor pain, previous perineal tear, and social support were all found to be significantly linked with childbirth fear. This calls for the need to identify and develop interventions for women to reduce childbirth fear during pregnancy.

Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial

BACKGROUND

Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth.

METHODS

One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section).

RESULTS

It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome.

CONCLUSIONS

An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC.

TRIAL REGISTRATION

The Netherlands Trial Register (NTR; 4302 ).

The Role of Personality Traits and Delivery Experience in Fear of Childbirth: A Prospective Study

This study aimed to examine fear of childbirth (FOC) before and after delivery in relation to personality (anxiety and anxiety sensitivity) and birth experience (type of delivery, pain, and staff support). One-hundred and five women completed questionnaires during pregnancy and one month after childbirth. Participants completed the Wijma Delivery Expectancy/Experience Questionnaire; the State and Trait Anxiety Inventory and Anxiety Sensitivity Index, and the McGill Pain Questionnaire and a Support from staff questionnaire. FOC levels decreased after childbirth, but only in the high-level fear group. Path analysis showed that physical concerns, one aspect of anxiety sensitivity, shape FOC during pregnancy. Together with interventions at delivery (instrumental vaginal delivery and emergency caesarean section), pain and low staff support, this in turn modifies FOC after delivery. In conclusion, FOC decreases after childbirth. However, combined with adverse birth experience and certain personality traits, FOC during pregnancy affects FOC after delivery.

The influence of maternal psychological distress on the mode of birth and duration of labor: findings from the FinnBrain Birth Cohort Study

Antepartum depression, general anxiety symptoms, and pregnancy-related anxiety have been recognized to affect pregnancy outcomes. Systematic reviews on these associations lack consistent findings, which is why further research is required. We examined the associations between psychological distress, mode of birth, epidural analgesia, and duration of labor. Data from 3619 women with singleton pregnancies, from the population-based FinnBrain Birth Cohort Study were analyzed. Maternal psychological distress was measured during pregnancy at 24 and 34 weeks, using the Pregnancy-Related Anxiety Questionnaire-Revised 2 (PRAQ-R2) and its subscale "Fear of Giving Birth" (FOC), the anxiety subscale of the Symptom Checklist-90 (SCL-90) and the Edinburgh Postnatal Depression Scale (EPDS). Mode of birth, epidural analgesia, and labor duration were obtained from the Finnish Medical Birth Register. Maternal psychological distress, when captured with PRAQ-R2, FOC, and SCL-90, increased the likelihood of women having an elective cesarean section (OR: 1.04, 95% CI 1.01-1.06, p = .003; OR: 1.13, 95% CI 1.07-1.20, p < .001; OR: 1.06, 95% CI 1.03-1.10, p = .001), but no association was detected for instrumental delivery or emergency cesarean section. A rise in both the PRAQ-R2, and FOC measurements increased the likelihood of an epidural analgesia (OR: 1.02, 95% CI 1.01-1.03, p = .003; OR: 1.09, 95% CI 1.05-1.12, p < .001) and predicted longer second stage of labor (OR: 1.01, 95% CI 1.00-1.01, p = .023; OR: 1.03, 95% CI 1.02-1.05, p < .001). EPDS did not predict any of the analyzed outcomes. The results indicate that maternal anxiety symptoms (measured using PRAQ-R2, FOC, and SCL-90) are associated with elective cesarean section. Psychological distress increases the use of epidural analgesia, but is not associated with complicated vaginal birth.

The effect of Zhang's guideline versus the WHO partograph on childbirth experience measured by the Childbirth Experience Questionnaire in the Labor Progression Study (LaPS): A cluster randomized trial

INTRODUCTION

Childbirth experience is an increasingly recognized and important measure of quality of obstetric care. Previous research has shown that it can be affected by intrapartum care and how labor is followed. A partograph is recommended to follow labor progression by recording cervical dilation over time. There are currently different guidelines in use worldwide to follow labor progression. The two main ones are the partograph recommended by the World Health Organization (WHO) based on the work of Friedman and Philpott and a guideline based on Zhang's research. In our study we assessed the effect of adhering to Zhang's guideline or the WHO partograph on childbirth experience. Zhang's guideline describes expected normal labor progression based on data from contemporary obstetric populations, resulting in an exponential progression curve, compared with the linear WHO partograph. The choice of labor curve affects the intrapartum follow-up of women and this could potentially affect childbirth experience.

MATERIAL AND METHODS

The Labor Progression Study (LaPS) study was a prospective, cluster randomized controlled trial conducted at 14 birth centers in Norway. Birth centers were randomized to either follow Zhang's guideline or the WHO partograph. Nulliparous women in active labor, with one fetus in cephalic presentation at term and spontaneous labor onset were included. At 4 weeks postpartum, included women received an online login to complete the Childbirth Experience Questionnaire (CEQ). Total score on the CEQ, the four domain scores on the CEQ, and scores on the individual items on the CEQ were compared between the two groups.

RESULTS

There were 1855 women in the Zhang group and 1749 women in the WHO partograph group. There was no difference in the total or domain CEQ scores between the two groups. We found statistically significant differences for two individual items; women in the Zhang group scored lower on positive memories and feeling of control.

CONCLUSIONS

Based on our findings on childbirth experience there is no reason to prefer Zhang's guideline over the WHO partograph.

The effect of continuous supportive care on birth pain, birth fear, midwifery care perception, oxytocin use, and delivery time during the intrapartum period: An experimental study

Background

Intrapartum professional midwifery support can improve the coping skills with the fear of childbirth and birth pain, increase the perception of the woman, and prevent negative experiences. However, there are relatively few studies supporting this postulation.

Aims

To investigate the effects of supportive care given during labor on birth pain, birth fear, perception of midwifery care, oxytocin use, and delivery time.

Patients and Methods

This is a quasi-experimental study. We collected the data between January and June 2019 in a province in Central Anatolia, Turkey. Primiparous 102 pregnant women were included in the study. However, we excluded five pregnant women from the intervention group and four pregnant women from the control group as emergency cesarean section developed. In total, 93 pregnant women, 46 in the continuous supportive care intervention group, and 47 in the usual intrapartum care control group were evaluated. The following tools were used to collect data: The Delivery Fear Scale, a Visual Analog Scale for perceived pain, the Scale of Women's Perception for Supportive Care Given During Labor, and labor outcomes information form.

Results

The participants in the intervention group receiving continuous intrapartum supportive care had less fear of birth and lower birth pain in the active and transitional stages of labor, their midwifery care perception increased, and the duration of labor was shorter (P < 0.05). However, there was no significant difference in oxytocin use between the two groups at 95% confidence interval (-0.265-0.091) (p > 0.05, Cohen's d = 0.2).

Conclusion

Pregnant women who received continuous intrapartum supportive care had less fear of birth and reduced labor pain in active and transitional stages of labor. In addition, with the continuous supportive care provided, the perception of midwifery care of the pregnant women increased and the duration of labor decreased. Therefore, midwifery care support should be provided to women throughout their labor and delivery process.

Tocophobia experience and its impact on birth choices among Nigerian women: a qualitative exploratory study

Introduction

while pregnancy is a very beautiful and memorable experience for most women, some women may experience apathy towards childbirth and have feelings of fear and anxiety (tocophobia). Tocophobia can be far reaching with adverse physiologic and emotional consequences for mothers, infants and families. This study therefore explored tocophobia experiences among primigravid women and explored its influence on birth choices among antenatal women.

Methods

the study employed a qualitative exploratory research design. Participants who were primigravida (women who had never experienced childbirth), were selected using purposive sampling technique on antenatal clinic days. Data was obtained using semi-structured interview questions. Data was analyzed using content analysis approach and thematic categorization.

Results

results showed that few of the women experienced tocophobia and these fears were not strong enough to make them opt for caesarian section. Reasons attributed to tocophobia experience among the participants included "horror stories" told in the neighborhood, "past experiences" of close acquaintance and "entertainment videos" broadcast. Furthermore, all the participants preferred to have vaginal delivery.

Conclusion

few of the primigravid women in Ekiti State, Nigeria, experience tocophobia and this experience does not influence their choice of delivery option, as all participant´s preferred vaginal delivery to caesarian section. It is important for midwives to be aware of their role in counselling and identifying women with tocophobia in order to promote good and safe transition from pregnancy to motherhood.

Assessment of the level of anxiety and pain in women who do and do not attend childbirth classes during the SARS-CoV-2 pandemic

INTRODUCTION

Participation in childbirth classes is aimed at learning to cope with the anxiety that accompanies a woman during her pregnancy and childbirth. The aim of the study was to answer the question whether the lack of access to childbirth classes affected anxiety and perinatal pain in pregnant women who gave birth during the pandemic period.

MATERIALS AND METHODS

This cross-sectional survey-based study involved women who were pregnant during the lockdown period. The respondents were asked to fill in the following questionnaires: a personal questionnaire, the Polish version of the Delivery Fear Scale and the Numeric Rating Scale for the assessment of average and maximum pain experienced during the labour. The survey was completed within 24-72 hours after the birth of the child. The obtained questionnaires were divided into 2 groups based on the information concerning attending or not attending childbirth classes (divided into subgroups): group A - patients participated in childbirth classes, and group B - patients did not participate in childbirth classes.

RESULTS

Groups were homogeneous in terms of age, weight, height, body mass index and week of gestation. Perception of anxiety did not differ between groups. There was a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there were no significant differences between groups in terms of mean and maximum pain during labour.

CONCLUSION

The level of anxiety and pain associated with childbirth is not modulated by childbirth classes during the pandemic period. There is s a correlation between particular formulation of the Delivery Fear Scale and "week of gestation" variable. In the group of women who gave birth naturally without anesthesia, there are no significant differences between groups in terms of mean and maximum pain during labour.

Fear of childbirth: Validation study of the Chinese version of Wijma delivery expectancy/experience questionnaire version A

INTRODUCTION

Fear of childbirth causes significant distress and impact on women's wellbeing. It contributed to the rising trend of non-medically indicated Caesarean births worldwide. The objective of this study was to translate and validate the Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) (W-DEQ-A), which is a comprehensive instrument for the assessment of fear of childbirth among antenatal women.

METHODS

The translated questionnaire was finalised after back-translation and review by an expert panel. Hong Kong Chinese women at an antenatal clinic completed the translated questionnaire, Edinburgh Postpartum Depression Scale (EPDS), and State-trait Anxiety Inventory (STAI). The reliability of the translated questionnaire was analysed using Cronbach's alpha coefficient and intraclass correlation coefficient. Convergent validity was measured by Pearson's correlation between the W-DEQ-A and STAI or EPDS scores. The subscales of the questionnaire were determined using exploratory factor analysis.

RESULTS

One hundred and fifty women completed the study. The Cronbach's alpha coefficient and test-retest reliability of the Chinese version were 0.907 and 0.867, respectively. Convergent validity was demonstrated by the moderate correlation between the translated W-DEQ-A and STAI or EPDS. Exploratory factor analysis of the W-DEQ-A revealed a multi-dimensional structure with four factors: sense of isolation, moment of birth, negative emotion, and lack of positive self-evaluation. Using a standard cut-off of 85, 11.3% of women were found to suffer from fear of childbirth.

CONCLUSION

The Chinese version of the Wijma Delivery Expectancy/Experience Questionnaire (Version A) is a reliable and valid instrument to measure antenatal fear of childbirth among Chinese women.

Predictors of fear of childbirth and depressive symptoms among pregnant women: a cross-sectional survey in Pwani region, Tanzania

BACKGROUND

Many women experience fear of childbirth (FoB) and depressive symptoms (DS) during pregnancy, but little is known about FoB among Tanzanian women. The current study aimed to assess the prevalence of FoB and DS among pregnant women and determine predictors of each and both, focusing on sociodemographic and obstetric predictors.

METHODS

A cross-sectional study was conducted at six health facilities in two districts in Tanzania between 2018 and 2019. In total, 694 pregnant women with gestational age between 32 and 40 weeks and expecting vaginal delivery were consecutively recruited and assessed for FoB and DS. We collected data through interviews using 6 and 4-points Likert Scale of the Wijma Delivery Expectancy Questionnaire Version A and Edinburgh Postnatal Depression Scale, respectively. Women who scored ≥66 and ≥ 10 were categorised as having FoB and DS, respectively. We performed multivariable logistic regression to investigate the predictors of FoB and DS.

RESULTS

The prevalence rates of FoB and DS among pregnant women were 15.1 and 17.7%, respectively. FoB and DS were more likely in women aged above 30 years [Adjusted Odds Ratio (AOR) 6.29, 95%CI 1.43-27.84] and in single mothers (AOR 2.57, 95%CI 1.14-5.78). Women with secondary education and above (AOR 0.22, 95%CI 0.05-0.99) and those who had given birth previously (AOR 0.27, 95% CI 0.09-0.87) were less likely to have FoB in combination with DS Women who had previous obstetric complications, and those who did not receive any social support from male partners in previous childbirth were more likely to have FoB and DS. FoB was strongly associated with DS (AOR 3.42, 95%CI 2.12-5.53). DS only was more common in women who had inadequate income (AOR 2.35, 95%CI 1.38-3.99) or had previously experienced a perineal tear (AOR 2.32, 95%CI 1.31-4.08).

CONCLUSIONS

Not having a formal education, having only primary education, being aged above 30 years, being single, being nulliparous, having experienced obstetric complications, and having a lack of social support from a male partner during previous pregnancy and childbirth were predictors of FoB and DS during pregnancy. FoB and DS were strongly associated with each other. It is vital to identify at-risk women early, to offer support during pregnancy and childbirth.

A comparison of maternal fear of childbirth, labor pain intensity and intrapartum analgesic consumption between primiparas and multiparas: A cross-sectional study

Objectives

To describe and compare fear of childbirth and in-labor pain intensity between primiparas and multiparas and explore the association between the amount of actual pain relief and fear of childbirth.

Methods

A convenience sampling method was used. A total of 260 women undergoing spontaneous or induced labor, including 97 primiparas and 163 multiparas, were recruited in a large academic specialized hospital in Guangzhou, China, from February 2018 to August 2019. The clinical data of maternal and neonatal were extracted from a structured electronic medical record system. Other demographic information, such as employment and family monthly income, was collected by a questionnaire. The Numeric Rating Scale (NRS) and the Chinese version of the Childbirth Attitude Questionnaire (C-CAQ) were applied to assess maternal in-labor pain intensity and fear of childbirth. The analgesic consumption and the frequency of manual boluses as rescue analgesia were stored and collected from the analgesia pump.

Results

Eighty-two (84.5%) primiparas and ninety-nine (60.7%) multiparas received epidural analgesia (P < 0.001). In the epidural subgroup, the primiparous average fear of childbirth (36.46 ± 10.93) was higher than that of the multiparas (32.06 ± 10.23) (P = 0.007). However, multiparas reported more intense in-labor pain [8.0 (8.0, 9.0) vs. 8.0 (7.0, 8.0)], had more successful manual boluses per hour [2.68 (1.65, 3.85) vs. 1.77 (0.90, 2.47)], more hourly analgesic consumption [23.00 (16.00, 28.25) vs. 17.24 (11.52, 21.36) mL] and more average analgesic consumption [0.35 (0.24, 0.45) vs. 0.26 (0.19, 0.35) mL/(h·kg)] than the primiparas (P < 0.05). Spearman's correlation analysis showed that the maximum in-labor pain was weakly positively correlated with fear of childbirth (r = 0.09) (P < 0.05), hourly analgesic consumption (r = 0.16) (P < 0.01) and average analgesic consumption (r = 0.17) (P < 0.05). No statistically significant association was uncovered between analgesic consumption and maternal fear of childbirth.

Conclusions

Fear of childbirth is a potential predictor of labor pain intensity. Further study is needed to explore its role and value in pain management during delivery. Parity is not a determinant of pain relief use and should not be a preconceived preference of obstetric care team members to determine the distribution of epidural analgesia, especially when analgesia resources are insufficient.

Does institutional maternity services contribute to the fear of childbirth? A focus group interview study

BACKGROUND

The quality of institutional maternity services offered significantly determine the health outcomes of pregnant women and their infants.

OBJECTIVES

The study aimed at understanding perceptions and experiences of new mothers diagnosed with the fear of childbirth in Kenya; regarding the institutional maternity services offered and if they contribute to the fear of childbirth (FOC).

METHODS

This was a qualitative descriptive study. A total of 29 women who had given birth recently in a maternity institution, and had been screened with the fear of childbirth at 32 weeks' gestation period participated in focus group interviews. The Framework for Assessing the Quality of Care of institutional maternity services (FAQC) developed by the University of Southampton was adopted in this study. Thematic analyses were used.

RESULTS

It was reported that institutional maternity services contributed directly and indirectly to FOC. The direct contribution included the performance of unintended caesarian sections, severe and prolonged labour pains and negative attitude of healthcare providers. The indirect contribution was in form of challenges in the provision of care and the experience of care in the maternity institutions. In the provision of care; human and physical resources, inadequate referral systems, and inadequate management of emergencies were reported. In the experience of care; lack of cognition, respect, dignity, equity and inadequacies in emotional support were reported.

CONCLUSION

The study identified systemic challenges related to both the provision and the experience of care. Therefore, there is need to astutely analyze all critical steps identified in the FAQC, as this will greatly improve the uptake of institutional maternity services.