Prenatal expectations and fears in pregnant women

The effect of exercise and childbirth classes on fear of childbirth and locus of labor pain control

This study sought to track changes in intensity of fear of childbirth and locus of labor pain control in women attending an exercise program for pregnant women or traditional childbirth classes and to identify the predictors of these changes. The study was longitudinal/non-experimental in nature and run on 109 healthy primigravidae aged from 22 to 37, including 62 women participating in an exercise program for pregnant women and 47 women attending traditional childbirth classes. The following assessment tools were used: two scales developed by the present authors - the Fear of Childbirth Scale and the Control of Birth Pain Scale, three standardized psychological inventories for the big five personality traits (NEO Five Factors Inventory), trait anxiety (State-Trait Anxiety Inventory) and dispositional optimism (Life Oriented Test-Revised) and a questionnaire concerning socioeconomic status, health status, activities during pregnancy, relations with partners and expectations about childbirth. Fear of childbirth significantly decreased in women participating in the exercise program for pregnant women but not in women attending traditional childbirth classes. Several significant predictors of post-intervention fear of childbirth emerged: dispositional optimism and self-rated health (negative) and strength of the belief that childbirth pain depends on chance (positive).

High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation

BACKGROUND

Perinatal mood disorders affect up to 20% of women in the United States. Little is known about how disorders in maternal mood may affect rates of breastfeeding.

OBJECTIVE

To determine the impact of prenatal depressive symptoms and high pregnancy-related anxiety on (1) prenatal intention to breastfeed and (2) breastfeeding initiation.

METHODS

We prospectively followed 1436 pregnant women enrolled in the cohort study Project Viva. The main outcome measures were (1) mother's second trimester self-report of intention to use all or mostly formula in the first week of life and (2) failure to initiate breastfeeding. We defined prenatal depressive symptoms as a second trimester Edinburgh Postpartum Depression Scale (EPDS) score of > or =13 and high pregnancy-related anxiety as a "very much" response to three or more questions on a first trimester pregnancy anxiety scale.

RESULTS

Of the 1436 participants, 9% (n = 125) had prenatal depressive symptoms indicative of depression, and 10% (n = 141) reported high pregnancy-related anxiety; 11% (n = 159) intended to give mostly or only formula in the first week of life, and 86% (n = 1242) initiated breastfeeding. In multivariate analyses, women with prenatal depressive symptoms (OR 1.92, 95% CI 1.11, 3.33) and high pregnancy-related anxiety (OR 1.99, 95% CI 1.12, 3.54) were roughly two times more likely than women without these mood disorders to plan to formula feed. However, neither prenatal depressive symptoms (OR 1.06, 95% CI 0.61, 1.84) nor high pregnancy-related anxiety (OR 1.28, 95% CI 0.74, 2.20) was associated with failure to initiate breastfeeding.

CONCLUSIONS

In a healthcare setting highly supportive of breastfeeding, women with prenatal depressive symptoms and possibly those with high pregnancy-related anxiety were less likely to plan prenatally to breastfeed, although this tendency did not translate into lower breastfeeding initiation rates.

Fears associated with childbirth among nulliparous women in Turkey

OBJECTIVE

to describe fears associated with childbirth and reasons for the fears.

DESIGN

a qualitative study. Data were gathered through semi-structured interviews and analysed using content-analysis method.

SETTING

outpatient maternity clinic of a university hospital in Turkey.

PARTICIPANTS

19 nulliparous pregnant women who stated that they had fear related to childbirth.

FINDINGS

women's fears were related to labour pain, birth-related problems and procedures, attitudes of health-care personnel and sexuality. The reasons for their fears included type and quality of childbirth information, personal characteristics and experiences, maternity ward environment and lack of confidence in health-care personnel. Seven of the women were considering an elective caesarean section. The role of husbands in the childbirth experience was not mentioned by any participants. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTISE: women experience considerable fear related to impending childbirth. Considering the potential for negative findings caused by fear, and the likelihood of requesting a caesarean section, it is important for health professionals who provide antenatal care to explore fears related to childbirth. The development and evaluation of formal childbirth education is also recommended.

A longitudinal study of women's memory of labour pain--from 2 months to 5 years after the birth

OBJECTIVE

To investigate the memory of labour pain at 2 months, 1 year and 5 years after childbirth and its association with the use of epidural analgesia and overall evaluation of childbirth.

DESIGN

Longitudinal observational.

SETTING

All hospitals in Sweden.

POPULATION

One thousand three hundred eighty-three women, who were recruited at their first antenatal visit and who provided complete data up to 5 years after the birth.

METHODS

Postal questionnaires in the second trimester and 2 months, 1 year and 5 years after the birth.

MAIN OUTCOME MEASURES

Memory of labour pain measured by a seven-point rating scale (1 = no pain at all, 7 = worst imaginable pain).

RESULTS

Memory of labour pain declined during the observation period but not in women with a negative overall experience of childbirth. Women who had epidural analgesia reported higher pain scores at all time points, suggesting that these women remember 'peak pain'.

CONCLUSIONS

There was significant individual variation in recollection of labour pain. In the small group of women who are dissatisfied with childbirth overall, memory of pain seems to play an important role many years after the event. These findings challenge the view that labour pain has little influence on subsequent satisfaction with childbirth. In-labour pain and long-term memory of pain are discussed as two separate outcomes involving different memory systems.

Anxiety, obsessions and morbid preoccupations in pregnancy and the puerperium

129 mothers referred to specialist psychiatric services in Birmingham and Christchurch were interviewed with the Birmingham Interview. Anxiety disorders were more frequent than depression during pregnancy, and equally frequent after delivery. The focus of pre- and post-partum anxiety may be important for psychological treatment. At a severe level, the most common prepartum theme was fear of foetal death; this was associated with a history of reproductive losses or infertility. After delivery the commonest themes were the pathological fear of cot death and fear of the criticism of mothering skills (which was a clue to a disordered mother-infant relationship). Clinicians should be vigilant for obsessional disorders, querulant (complaining) disorders, post-traumatic stress disorder, conjugal jealousy and dysmorphophobic states, which are all quite common. Patients with "postpartum depression" usually had at least one other (co-morbid) disorder, and 27% had two or more. These findings emphasize the diversity of postpartum psychiatric illness.

Fears and coping strategies associated with pregnancy and childbirth in Finland

The purpose of this study was to describe the causes of fear associated with pregnancy and childbirth and to describe coping strategies of pregnant women who have fears. Data were collected by using semistructured interviews on the maternity units of two university hospitals in Finland. A convenience sample of 20 women served as participants, and data were analyzed by using content analysis techniques. In most cases, the source of fear was either previous experience and knowledge or uncertainty. In some cases, the source of fear was beliefs about childbirth with no clear origin of the belief. Knowledge was described as a means of dealing with fear, as were talking, writing, and reasoning. When seeking help, many participants relied on their social network and on health care professionals, but some sought information independently from books, magazines, etc. Methods for dispelling or alleviating fear included talking about feelings, increasing knowledge, accessing health care services, referring to positive experiences, receiving reassurance from medical screening, and/or feeling the baby move. Knowledge can be a cause of fear, but its ability to decrease fear is of greater consequence. What seemed to matter most was the way in which information is given.

Wishes and expectations of pregnant women and their partners concerning delivery

AIMS

The study investigated factors related to the expectations and wishes concerning delivery of expectant parents.

METHODS

A self-administered questionnaire on the relevant aspects of delivery was developed, pre-tested, and administered to 545 expectant mothers (n = 336) and fathers (n = 209) attending open house informational events at 3 hospitals around Giessen, Germany.

RESULTS

Response rate was 96.3%. Three major areas of interest were identified and converted into scales: "management and obstetrical equipment" (ME; alpha = 0.81), "medical standards" (MS; alpha = 0.82), and "hospital conveniences" (HC; alpha = 0.78). Preferences of participants were influenced by age, gender and parity, as well as by different levels of state- and trait-anxiety. Expectant fathers focused more on HC of the hospital whereas ME, as well as MS, were more important to pregnant women, especially older women from rural areas with high state and/or trait anxiety (p < or = 0.05). However, MS were also found to be important for younger, nulliparous women with at risk pregnancy. Parents of high-risk pregnancies did not emphasize their wishes for ME (p < or = 0.05).

CONCLUSION

Fashionable obstetrical equipment of delivery rooms, high medical standards, the reputation of the hospital, and certain conveniences are important issues for expectant parents. However, their importance varies with the above mentioned factors.

Self-efficacy for labor and childbirth fears in nulliparous pregnant women

In this secondary analysis, the relationship between self-efficacy for labor and childbirth fears in healthy nulliparous women was investigated during the third trimester of pregnancy. The sample consisted of 280 predominantly white, well-educated, middle-class nulliparae enrolled in childbirth classes. Consistent with Bandura's self-efficacy theory, outcome expectancies for childbirth were unrelated to childbirth fears while self-efficacy expectancies were significantly correlated with childbirth fears. When the sample was divided into a low-fear and a high-fear group, significant differences were found between groups on a number of psychological variables. The women in the high-fear group were characterized by significantly higher learned helplessness, chance health locus of control and powerful others health locus of control, and significantly lower self-esteem and generalized self-efficacy. The most common fears of the high-fear women were of losing control during delivery, of the birth itself, of something being wrong with the baby and of painful contractions.

Fears associated with pregnancy and childbirth--experiences of women who have recently given birth

OBJECTIVE

To describe fears associated with pregnancy and childbirth and to see whether women who have recently given birth feel that their fears were justified.

DESIGN

A qualitative study. Data were collected by semi-structured interviews. Data interpretation was based on the method of content analysis.

SETTING

The maternity units of two university hospitals in Finland.

PARTICIPANTS

A convenience sample of 20 women, 10 primiparae and 10 multiparae. The interviews were held 2 or 3 days after childbirth.

FINDINGS

The most common fears associated with pregnancy and childbirth were concerned with the baby's well-being, the course of pregnancy, and childbirth. The fears found expression in different kinds of behaviours, emotions and physical sensations. Many of the participants felt that their fears had not been justified, but some maintained that their fears had been justifiable.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

There was much inter-individual variation in the fears associated with pregnancy and childbirth. It is important that diagnosis during pregnancy is undertaken sensitively and that midwifery staff remember that pregnant women may have very serious fears associated with pregnancy and childbirth. The participants in this study felt that fears associated with pregnancy and childbirth also had positive meanings. It may not be essential to try to protect women against these fears or to remove them altogether, but to give every pregnant women the opportunity to deal with her own fears and to obtain the help she needs in her situation.

Contents of childbirth-related fear among couples wishing the partner's presence at delivery

In order to explore the contents of childbirth-related fears, a survey was carried out among 216 pairs of prospective parents who opted for the presence of the partner at delivery. Each couple took part in a three-class parentcraft course during the third trimester. During the first antenatal class, couples were asked to fill in a questionnaire with inquiries about specific contents of fear they might have in relation to pregnancy, childbirth and relationship with their partner after childbirth. Each item of the questionnaire called for an answer from a five-grade scale of fear such as 'absolutely not', 'slightly', 'quite', 'quite strongly' and 'very much'. Their worries were ranked according to the weighted average of the frequency of positive answers. More than 80% of both men and women had some fears relating to childbirth. Women were most worried about, in order of significance, having a malformed or injured baby, assisted or operative delivery, being lonely in a strange environment, doing something wrong, and facing the uncertainties of how the delivery was going to happen. The wife having severe pain and suffering, operative delivery, fetal birth injuries, helplessness, powerlessness and the wife's death in childbirth were the most significant subjects of men's fears. Eighty per cent of women and 76% of men felt that the presence of the partner at delivery would have no adverse effect on their future personal relationship.

Reasons for anxiety about childbirth in 100 pregnant women

The aims were to document conscious reasons for anxiety about childbirth. Pregnant women (n = 100), consecutively referred from antenatal centers to a psychosomatic outpatient clinic because of extreme fear of childbirth, were interviewed. Three subgroups are described: primiparae (n = 36), women with a normal previous delivery (n = 18) and women with a previous complicated delivery (n = 46). Anxiety over the deliver was related to lack of trust in the obstetrical staff (73%), fear of own incompetence (65%), fear of death of mother, infant or both (55%), intolerable pain (44%) or loss of control (43%). In the description of the anxiety, more than one focus could be described. A previous complicated delivery predisposed for fear of death (p < 0.001). In other aspects, the subgroups were similar. Fear of death in a previous labor was associated with this fear regarding the impending delivery (100%, 21%, p < 0.001) and with fear of loss of control (61%, 18% p < 0.01). Many women (37%) had partners who admitted anxiety over the delivery. Anxiety over childbirth is related to fundamental human feelings: lack of trust, fear of female incompetence and fear of death. Fear of pain is important but not predominant. The results are discussed with regard to stress, theoretical and psychodynamic points of view.